John Snow - Wikipedia

John Snow - Wikipedia
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English epidemiologist and physician (1813–1858)
This article is about the physician. For other uses, see
John Snow (disambiguation)
John Snow
Snow in 1856
Born
1813-03-15
15 March 1813
York
England
Died
16 June 1858
(1858-06-16)
(aged 45)
London
England
Education
University of London
MD
Known for
Anaesthesia
Locating source of a
cholera
outbreak (thus establishing the disease as water-borne)
Scientific career
Fields
Anaesthesia
Epidemiology
Signature
John Snow
(15 March 1813 – 16 June 1858
) was an English physician and a leader in the development of
anaesthesia
and
medical hygiene
. He is considered one of the founders of modern
epidemiology
and early
germ theory
, in part because of his work in tracing the source of a
cholera outbreak in London's Soho
, which he identified as a particular public water pump. Snow's findings inspired fundamental changes in the water and
waste systems of London
, which led to similar changes in other cities, and a significant improvement in general
public health
around the world.
Early life and education
Snow was born on 15 March 1813 in
York
, England, the first of nine children born to William and Frances Snow in their
North Street
home, and was baptised at
All Saints' Church, North Street, York
. His father was a labourer
who worked at a local coal yard, by the Ouse, constantly replenished from the Yorkshire coalfield by barges, but later was a farmer in a small village to the north of York.
The neighbourhood was one of the poorest in the city, and was frequently in danger of flooding because of its proximity to the
River Ouse
. Growing up, Snow experienced unsanitary conditions and contamination in his hometown. Most of the streets were unsanitary and the river was contaminated by runoff water from market squares, cemeteries and sewage.
All Saints' Church, North Street, York
, where Snow was baptised
From a young age, Snow demonstrated an aptitude for mathematics. In 1827, when he was 14, he obtained a medical apprenticeship with William Hardcastle in the area of
Newcastle-upon-Tyne
. In 1832, during his time as a surgeon-apothecary apprentice, he encountered
a cholera epidemic
for the first time in
Killingworth
, a coal-mining village.
Snow treated many victims of the disease and thus gained experience. Eventually he adjusted to
teetotalism
and led a life characterized by abstinence, signing an
abstinence pledge
in 1835. Snow was also a vegetarian and tried to only drink distilled water that was "pure".
Between 1832 and 1835 Snow worked as an assistant to a
colliery
surgeon, first in
Burnopfield
, County Durham, and then in
Pateley Bridge
West Riding of Yorkshire
. In October 1836 he enrolled at the
Hunterian school of medicine
on
Great Windmill Street
, London.
Career
In the 1830s, Snow's colleague at the
Newcastle Infirmary
was surgeon
Thomas Michael Greenhow
. The surgeons worked together conducting research on England's
cholera
epidemics, both continuing to do so for many years.
10
11
In 1837, Snow began working at the
Westminster Hospital
. Admitted as a member of the
Royal College of Surgeons of England
on 2 May 1838, he graduated from the
University of London
in December 1844 and was admitted to the
Royal College of Physicians
in 1850. Snow was a founding member of the
Epidemiological Society of London
which was formed in May 1850 in response to the cholera outbreak of 1849. By 1856, Snow and Greenhow's nephew,
Dr. E.H. Greenhow
were some of a handful of esteemed medical men of the society who held discussions on this "dreadful scourge, the
cholera
".
12
13
14
After finishing his medical studies in the
University of London
, he earned his MD in 1844. Snow set up his practice at 54 Frith Street in Soho as a surgeon and general practitioner. John Snow contributed to a wide range of medical concerns including
anaesthesiology
. He was a member of the
Westminster Medical Society
, an organisation dedicated to clinical and scientific demonstrations. Snow gained prestige and recognition all the while being able to experiment and pursue many of his scientific ideas. He was a speaker multiple times at the society's meetings and he also wrote and published articles. He was especially interested in patients with respiratory diseases and tested his hypothesis through animal studies. In 1841, he wrote,
On Asphyxiation, and on the Resuscitation of Still-Born Children
, which is an article that discusses his discoveries on the physiology of neonatal respiration, oxygen consumption and the effects of body temperature change.
15
In 1857, Snow made an early and often overlooked
16
contribution to epidemiology in a pamphlet,
On the adulteration of bread as a cause of
rickets
17
Anaesthesia
Portrait of John Snow by
Thomas Jones Barker
(detail), 1847, private collection
Snow's interest in
anaesthesia
and breathing was evident from 1841 and beginning in 1843, he experimented with
ether
to see its effects on respiration.
Only a year after ether was introduced to Britain, in 1847, he published a short work titled,
On the Inhalation of the Vapor of Ether,
which served as a guide for its use. At the same time, he worked on various papers that reported his clinical experience with anaesthesia, noting reactions, procedures and experiments. Within two years of ether being introduced, Snow was the most accomplished anaesthetist in Britain. London's principal surgeons suddenly wanted his assistance.
As well as ether, John Snow studied
chloroform
, which was introduced in 1847 by
James Young Simpson
, a Scottish obstetrician. He realised that chloroform was much more potent and required more attention and precision when administering it. Snow first realised this with Hannah Greener, a 15-year-old patient who died on 28 January 1848 after a surgical procedure that required the cutting of her toenail. She was administered chloroform by covering her face with a cloth dipped in the substance. However, she quickly lost pulse and died. After investigating her death and a couple of deaths that followed, he realized that chloroform had to be administered carefully and published his findings in a letter to
The Lancet
John Snow was one of the first physicians to study and calculate dosages for the use of ether and chloroform as surgical
anaesthetics
, allowing patients to undergo surgical and
obstetric
procedures without the distress and pain they would otherwise experience. He designed the apparatus to safely administer ether to the patients and also designed a mask to administer chloroform.
18
Snow published an article on ether in 1847 entitled
On the Inhalation of the Vapor of Ether
19
A longer version entitled
On Chloroform and Other Anaesthetics and Their Action and Administration
was published posthumously in 1858.
20
Although he thoroughly worked with ether as an anaesthetic, he never attempted to patent it; instead, he continued to work and publish written works on his observations and research.
Obstetric anaesthesia
Snow's work and findings were related to both anaesthesia and the practice of childbirth. His experience with obstetric patients was extensive and used different substances including ether,
amylene
and chloroform to treat his patients. However, chloroform was the easiest drug to administer. He treated 77 obstetric patients with chloroform. He would apply the chloroform at the second stage of labour and controlled the amount without completely putting the patients to sleep. Once the patient was delivering the baby, they would only feel the first half of the contraction and be on the border of unconsciousness, but not fully there. Regarding administration of the anaesthetic, Snow believed that it would be safer if another person that was not the surgeon applied it.
15
The use of chloroform as an anaesthetic for childbirth was seen as unethical by many physicians and even the
Church of England
. However, on 7 April 1853,
Queen Victoria
asked John Snow to administer chloroform during the delivery of her eighth child,
Leopold
. He then repeated the procedure for the delivery of her daughter
Beatrice
in 1857.
21
This led to wider acceptance of obstetrical anaesthesia.
Cholera
Main article:
1854 Broad Street cholera outbreak
Map of a later cholera outbreak in London, in 1866
Legend for the map above
Snow was a skeptic of the then-dominant
miasma theory
that stated that diseases such as cholera and
bubonic plague
were caused by pollution or a noxious form of "bad air". The
germ theory of disease
had not yet been developed, so Snow did not understand the mechanism by which the disease was transmitted. His observation of the evidence led him to discount the theory of foul air. He first published his theory in an 1849 essay,
On the Mode of Communication of Cholera
22
followed by a more detailed treatise in 1855 incorporating the results of his investigation of the role of the water supply in the
Soho
epidemic of 1854.
23
24
By talking to local residents (with the help of
Henry Whitehead
), he identified the source of the outbreak as the public water pump on Broad Street (now
Broadwick Street
). Although Snow's chemical and microscope examination of a water sample from the
Broad Street pump
did not conclusively prove its danger, his studies of the pattern of the disease were convincing enough to persuade the local council to disable the well pump by removing its handle (
force rod
). This action has been commonly credited as ending the outbreak, but Snow observed that the epidemic may have already been in rapid decline:
There is no doubt that the mortality was much diminished, as I said before, by the flight of the population, which commenced soon after the outbreak; but the attacks had so far diminished before the use of the water was stopped, that it is impossible to decide whether the well still contained the cholera poison in an active state, or whether, from some cause, the water had become free from it.
23
: 51–52
Original map by John Snow showing the
clusters
of cholera cases in the London epidemic of 1854, drawn and lithographed by
Charles Cheffins
Snow later used a
dot map
to illustrate the cluster of cholera cases around the pump. He also used statistics to illustrate the connection between the quality of the water source and cholera cases. He showed that homes supplied by the
Southwark and Vauxhall Waterworks Company
, which was taking water from sewage-polluted sections of the
Thames
, had a cholera rate fourteen times that of those supplied by
Lambeth Waterworks Company
, which obtained water from the upriver, cleaner
Seething Wells
25
26
Snow's study was a major event in the history of public health and geography. It is regarded as the founding event of the science of
epidemiology
citation needed
Snow wrote:
On proceeding to the spot, I found that nearly all the deaths had taken place within a short distance of the [Broad Street] pump. There were only ten deaths in houses situated decidedly nearer to another street-pump. In five of these cases the families of the deceased persons informed me that they always sent to the pump in Broad Street, as they preferred the water to that of the pumps which were nearer. In three other cases, the deceased were children who went to school near the pump in Broad Street...
With regard to the deaths occurring in the locality belonging to the pump, there were 61 instances in which I was informed that the deceased persons used to drink the pump water from Broad Street, either constantly or occasionally...
The result of the inquiry, then, is, that there has been no particular outbreak or prevalence of cholera in this part of London except among the persons who were in the habit of drinking the water of the above-mentioned pump well.
I had an interview with the Board of Guardians of St James's parish, on the evening of the 7th inst [7 September], and represented the above circumstances to them. In consequence of what I said, the handle of the pump was removed on the following day.
— John Snow, letter to the editor of the
Medical Times and Gazette
27
John Snow memorial and public house on
Broadwick Street
Soho
Researchers later discovered that this public well had been dug only 3 feet (0.9 m) from an old
cesspit
, which had begun to leak faecal bacteria. The cloth nappy of a baby, who had contracted cholera from another source, had been washed into this cesspit. Its opening was originally under a nearby house, which had been rebuilt farther away after a fire. The city had widened the street and the cesspit was lost. It was common at the time to have a cesspit under most homes. Most families tried to have their raw sewage collected and dumped in the Thames to prevent their cesspit from filling faster than the sewage could decompose into the soil.
28
Thomas Shapter
had conducted similar studies and used a point-based map for the study of cholera in
Exeter
, seven years before John Snow, although this did not identify the water supply problem that was later held responsible.
29
Political controversy
After the cholera epidemic had subsided, government officials replaced the Broad Street pump handle. They had responded only to the urgent threat posed to the population, and afterward they rejected Snow's theory. To accept his proposal would have meant indirectly accepting the fecal-oral route of disease transmission, which was too unpleasant for most of the public to contemplate.
30
It was not until 1866 that
William Farr
, one of Snow's chief opponents, realised the validity of his diagnosis when investigating another outbreak of cholera at
Bromley by Bow
and issued immediate orders that unboiled water was not to be drunk.
31
Farr denied Snow's explanation of how exactly the contaminated water spread cholera, although he did accept that water had a role in the spread of the illness. In fact, some of the statistical data that Farr collected helped promote John Snow's views.
32
Public health officials recognise the political struggles in which reformers have often become entangled.
33
During the annual
Pumphandle Lecture
in England, members of the
John Snow Society
remove and replace a pump handle to symbolise the continuing challenges for advances in public health.
34
Personal life
Snow was known to swim as a hobby for exercise.
35
He became a
vegetarian
at the age of 17 and was a
teetotaller
35
He embraced a
lacto-ovo vegetarian
diet by supplementing his vegetables with dairy products and eggs for eight years. Whilst in his thirties he became a
vegan
35
His health deteriorated and he suffered a
renal disorder
which he attributed to his vegan diet so he took up meat-eating and drinking wine.
35
He continued drinking pure water (via boiling) throughout his adult life. He never married.
36
In 1830, Snow became a member of the
temperance movement
. In 1845, he became a member of York Temperance Society.
35
After his health declined it was only about 1845 that he consumed a little wine to aid digestion.
35
Snow lived at 18
Sackville Street
, London, from 1852 to his death in 1858.
37
Snow suffered a stroke while working in his London office on 10 June 1858. He was 45 years old at the time.
38
He never recovered, dying six days later on 16 June 1858. He was buried in
Brompton Cemetery
39
It has been speculated that his premature death may have been related to his frequent exposure and experimentation with anesthetic gases, which is now known to have numerous adverse health effects. Snow administered and experimented with ether, chloroform, ethyl nitrate, carbon disulfide, benzene, bromoform, ethyl bromide and dichloroethane during his lifetime.
40
Legacy and honours
Funerary monument,
Brompton Cemetery
, London
Blue plaque
erected by the
Royal Society of Chemistry
A plaque commemorates Snow and his 1854 study in the place of the water pump on Broad Street (now Broadwick Street). It shows a water pump with its handle removed. The spot where the pump stood is covered with red granite.
A public house nearby was named the "
John Snow
" in his honour.
41
The John Snow Society is named in his honour, and the society regularly meets at The John Snow pub. An annual Pumphandle Lecture is delivered each September by a leading authority in contemporary public health.
His grave in
Brompton Cemetery
, London, is marked by a funerary monument.
42
In York a
blue plaque
on the west end of the Park Inn, a hotel in North Street, commemorates John Snow.
Together with fellow pioneer of anaesthesia
Joseph Thomas Clover
, Snow is one of the
heraldic supporters
of the
Royal College of Anaesthetists
43
The
Association of Anaesthetists of Great Britain and Ireland
awards The John Snow Award, a bursary for undergraduate
medical students
undertaking research in the field of anaesthesia.
Despite reports that Snow was awarded a prize by the
Institut de France
for his 1849 essay on cholera,
44
a 1950 letter from the Institut indicates that he received only a nomination for it.
45
In 1978 a public health research and consulting firm,
John Snow, Inc
, was founded.
citation needed
In 2001 the
John Snow College
was founded on the
University of Durham
's Queen's Campus in
Stockton-on-Tees
46
In 2003 John Snow was voted by readers in the United Kingdom of 'Hospital Doctor' magazine as 'the greatest doctor of all time'.
47
In 2009, the John Snow lecture theatre was opened by
Anne, Princess Royal
, at the
London School of Hygiene & Tropical Medicine
citation needed
In 2013
The Lancet
printed a correction of its brief obituary of Snow, originally published in 1858: "The journal accepts that some readers may wrongly have inferred that
The Lancet
failed to recognise Dr Snow's remarkable achievements in the field of epidemiology and, in particular, his visionary work in deducing the mode of transmission of epidemic cholera."
48
In 2016, Katherine Tansley published a fictionalised account based on Snow's activities, in her historical novel
The Doctor of Broad Street
(Troubadour Books).
In 2017 York Civic Trust erected a memorial to John Snow in the form of a pump with its handle removed, a blue plaque and an interpretation board, in North Street Gardens, York, close to his birthplace.
49
See also
History of public health in the United Kingdom
William Budd
, recognised that cholera was contagious
The Ghost Map
, book on cholera epidemiology
Florence Nightingale
, founder of modern nursing
Filippo Pacini
, isolated cholera
Joseph Bazalgette
, sewer engineer for London
References
"John Snow"
Encyclopædia Britannica
. 8 March 2018
. Retrieved
12 March
2018
Vinten-Johansen et al. (2003)
Wedding Record of William Snow and Frances Empson, Huntington All Saints, 24 May 1812
Census 1841
Ramsay, Michael A. E. (6 January 2009).
"John Snow, MD: anaesthetist to the Queen of England and pioneer epidemiologist"
Proceedings (Baylor University. Medical Center)
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The History Teacher
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Tominey, Camilla (28 May 2020).
"The Duchess of Cambridge's Ancestor Would Have Led The Fight Against Covid 19"
Daily Telegraph
. UK. PressReader. p. 25
. Retrieved
28 June
2020
Based in Tynemouth, near Newcastle, Dr Greenhow, his nephew Dr EH Greenhow and Dr John Snow were founding members of the Royal Society of Medicine's Epidemiological Society in the 1850s.... Dr Snow was Dr Greenhow's former surgery apprentice and Queen Victoria's personal anaesthetist...
Smith, D. (2017).
Water-Supply and Public Health Engineering
. Routledge.
ISBN
9781351873550
....Dr T.M. Greenhow, a Newcastle colleague of Dr John Snow, had published: Cholera: its non–contagious nature, and the best means of arresting its progress shortly ...
Greenhow, Thomas M. (1852).
"Cholera from the east. A letter addressed to Mayor of Newcastle-upon-Tyne James Hodgson, Esq"
. E. Charnley.
Vinten-Johansen et al. (2003)
, pp. 30 & 198: "The senior surgeon was Thomas Michael Greenhow (1792–1881)" and "Consider also T. M. Greenhow: 'When patients rally from collapse, it is often most difficult to ascertain on what causes...'" respectively.
"London Epidemiology Society"
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"The Lancet London: A Journal of British and Foreign Medicine ..., Volume 1... Epidemiological Society"
. Elsevier. 1856. p. 167.
The following members of the Epidemiological Society (10 gentleman) took part in the discussion....Drs. Snow, Greenhow...
Frerichs, R.
"London Epidemiological Society"
. Department of Epidemiological (UCLA)
. Retrieved
18 March
2019
...dreadful scourge, the cholera ....Snow as a founding member of .....(Tucker's) stimulating words led to a meeting on March 6, 1850 in Hanover Square, within walking distance of the Broad Street pump in the Soho region of London. It was here that the London Epidemiological Society was born.
Caton, Donald (January 2000).
"John Snow's Practice of Obstetric Anesthesia"
Anesthesiology: The Journal of the American Society of Anesthesiologists
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Dunnigan, M. (2003).
"Commentary: John Snow and alum-induced rickets from adulterated London bread: an overlooked contribution to metabolic bone disease"
International Journal of Epidemiology
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Snow, J. (1857).
"On the Adulteration of Bread As a Cause of Rickets"
The Lancet
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5.
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Reedited in
Snow, J. (2003).
"On the adulteration of bread as a cause of rickets"
(PDF)
International Journal of Epidemiology
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7.
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John Snow (1813–58)
Archived
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Wayback Machine
. sciencemuseum.org.uk
Snow, John (1847)
On the Inhalation of the Vapor of Ether
. ph.ucla.edu
Snow, John (1858)
On Chloroform and Other Anaesthetics and Their Action and Administration
. London: John Churchill
"Anesthesia and Queen Victoria"
John Snow
. Department of Epidemiology
UCLA School of Public Health
. Retrieved
21 August
2007
Snow, John
(1849).
On the Mode of Communication of Cholera
(PDF)
. London: John Churchill. Archived from
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(PDF)
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Snow, John
(1855).
On the Mode of Communication of Cholera
(2nd ed.). London: John Churchill.
Gunn, S. William A.; Masellis, Michele (2007).
Concepts and Practice of Humanitarian Medicine
. Springer. pp. 87–.
ISBN
978-0-387-72264-1
"Location of water companies"
www.ph.ucla.edu
"Proof from Seething Wells"
seethingwellswater.org
Snow, John (1854).
"The cholera near Golden-Square, and at Deptford"
The Medical Times and Gazette
. 2nd series.
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322.
; see p. 322.
Klein, Gary (2014).
Seeing What Others Don't
. p. 73.
ISBN
978-1480592803
Shapter, Thomas (1849).
The History of the Cholera in Exeter in 1832
. London: John Churchill.
Chapelle, Frank (2005)
Wellsprings
. New Brunswick, New Jersey: Rutgers University Press. p. 82.
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Cadbury, Deborah (2003).
Seven Wonders of the Industrial World
. London and New York: Fourth Estate. pp.
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Essential Public Health
. Radcliffe Publishing.
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1-900603-87-X
. p. 105
"Pumphandle Lecture 2017"
johnsnowsociety.org
. The John Snow Society. 12 September 2017
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Mather, J. D. (2004).
200 Years of British Hydrogeology
. London: The Geological Society. p. 48.
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Snow, Stephanie J. (2004)
"Snow, John (1813–1858)"
in
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JOHN SNOW'S HOMES
UCLA Department of Epidemiology, 2014. Retrieved 6 June 2014.
Johnson, Steven (2006).
The Ghost Map
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. p.
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Brompton Cemetery
. Archived from
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"John Snow's final rest - information on his death"
www.ph.ucla.edu
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Punt, Steve
(12 May 2014).
"Birmingham"
The 3rd Degree
. Season 3. Episode 6. Event occurs at 7:05.
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"The College Crest"
. The Royal College of Anaesthetists. 2014. Archived from
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S. William Gunn; M. Masellis (2008).
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. Springer Science & Business Media. p.
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institut de france and john snow.
Google Books
Couvrier R, Edwards G (July 1959).
"John Snow and the Institute of France"
Med Hist
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Remembering Dr. John Snow on the sesquicentennial of his death
Hempel, S. (2013).
"John Snow"
The Lancet
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Sources
Hempel, Sandra (2006).
The Medical Detective: John Snow, Cholera, and the Mystery of the Broad Street Pump.
Granta Books.
ISBN
1862078424
Johnson, Steven
(2006).
The Ghost Map
: The Story of London's Most Terrifying Epidemic – and How it Changed Science, Cities and the Modern World
Riverhead Books
ISBN
1-59448-925-4
Körner, T. W.
(1996).
The Pleasures of Counting
, chapter 1.
Cambridge University Press
ISBN
0-521-56823-4
Morris, Robert D. (2007).
The Blue Death
HarperCollins
ISBN
0-06-073089-7
Shapin, Steven
(6 November 2006) [Electronic version]. "
[1]
".
The New Yorker
. Retrieved 10 November 2006
Tufte, Edward
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Visual Explanations
, chapter 2.
Graphics Press
ISBN
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Further reading
Vinten-Johansen, Peter; Brody, Howard; Paneth, Nigel; Rachman, Stephen; Rip, Michael (2003).
Cholera, Chloroform, and the Science of Medicine: A Life of John Snow
Oxford University Press
ISBN
9780199747887
External links
Wikimedia Commons has media related to
John Snow (physician)
Wikisource
has the text of the 1885–1900
Dictionary of National Biography's
article about
Snow, John
"On the Mode of Communication of Cholera" by John Snow, M.D. (1st ed., 1849)
"On the Mode of Communication of Cholera" by John Snow, M.D. ("2nd edition, much enlarged", includes cholera map opposite p. 45)
Short narrative film about John Snow
UCLA site devoted to the life of John Snow
Myth and reality regarding the Broad Street pump
John Snow Society
Source for Snow's letter to the Editor of the Medical Times and Gazette
Interactive versions of the John Snow's Map of Board Street Cholera Outbreak
umapper
arcgis
John Snow’s cholera analysis data in modern GIS formats
PredictionX: John Snow and the Cholera Epidemic of 1854 (a Harvard/edX MOOC)
The John Snow Archive and Research Companion
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