James C. Eisenach, MD, Editor

By David A. E. Shephard. York Point Publishing, Cornwall, Prince Edward Island, 1995. Pages: 373. Price:$18.00 (soft cover).

Dr. David Shephard has expended a magnificent effort to describe undoubtedly the most significant early figure in the field of anesthesiology. This work fills a void pointed out by Shephard himself in the preface to the book, notably the previous lack of a formal biography on John Snow. All enthusiasts of medical history, with emphasis on either the history of anesthesia or the epidemiology of 19th-century plagues, will enjoy this contribution.

Like most other physicians of his day, Snow managed a busy private medical practice. He used his spare time to conduct research, publish his results, and speak at local medical societies. For the most part a teetotaler and a confirmed bachelor, he was unencumbered by the demands of family life, thereby devoting himself to the practice and study of medicine. He saw no conflicts between his interests in general medicine and anesthesia; rather, he used his growing knowledge of each to abate pain and remove suffering experienced by his patients. By examining and displaying the records of Snow's research, collection of patient cases, and notes in tracking the cholera epidemics, Shephard aptly presents a picture of a man dedicated to both his work and the betterment of mankind. The book goes to great lengths to portray the human side of this man, his persistence and patience, natural curiosity, and intelligence, tempered by a strong sense of reason and order. These were the qualities he needed to succeed in the face of inate shyness, a gruff and far from pleasing voice, and an underdeveloped social life.

The strength of the book lies in its presentation. There are three parts to the story of Snow's life as presented by Shephard, each intertwined but presented separately for clarity and emphasis. The reader is able to understand the complexity of this man through an appreciation of the enormous volume of work he accomplished. Shephard has done an enviable job of organizing Snow's credits in this way, giving greater emphasis to the discoveries and contributions within both fields, anesthesia and epidemiology.

Snow's life from birth through childhood, training, and professional life is portrayed in association with historical events of the time and their influence on him. As intimately as possible, Snow's life is described, including his early family life, the neighborhoods in which he lived, and the people who helped to shape him.

The second part of the story deals with his interest in anesthesia, thoroughly describing the development of his clinical expertise and his research efforts. There are numerous references to the number and types of cases he was involved with, as well as his evaluation of various agents through animal research, development of equipment and apparatus, and patient case notes.

The final portion of the text details his interest in the then new field of epidemiology and his subsequent contribution to medicine as a whole by the utilization of these fact-finding and organizational skills to elucidate the spread (and thereby the future prevention) of cholera. An accurate description of Snow's part in the closing of London's Broad Street pump as a source of infection corrects some of the myths that have arisen over the years concerning his contribution there and emphasizes the lengths to which he frequently went to overcome the problems confronting him.

Compared with the volume of information presented, the weaknesses of the text are minor. There are many grammatical and typographical errors, perhaps in part due to Shephard's tendency to slip into the vernacular of the 19th century. The book is studded with a great number of quotations, which give proper emphasis and empathy to the story being told. The tendency for the author to continue his own words in the form and manner of those quoted from more than 100 yr ago is understandable. Although these passages could have been more simply stated, it is a minor detraction and easily forgivable. In no way do these small infractions detract from the overall strength and intent of the book.

This is a worthwhile text for inclusion in any personal medical library. Today, as anesthesiologists seek more and more to be considered perioperative physicians, the story of Snow as depicted by Shephard paints an ideal example for all of us in the field to emulate.

Terrence D. Bogard, MD, Associate Professor of Anesthesia, Wake Forest University Medical Center, Winston-Salem, North Carolina 27157–1009