John Snow
John Snow | |
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Anaesthesia Locating source of a cholera outbreak (thus establishing the disease as water-borne) | |
Scientific career | |
Fields | Anaesthesia Epidemiology |
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John Snow (15 March 1813 – 16 June 1858
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[3] 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.[4]
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.[5]
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
Career
In the 1830s, Snow's colleague at the
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
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
Snow's interest in
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.[5]
John Snow was one of the first physicians to study and calculate dosages for the use of ether and chloroform as surgical
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,
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.[5]
Cholera
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
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
Snow later used a
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]
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
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.
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
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
- 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.
- 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 heraldic supporters of the Royal College of Anaesthetists.[42]
- The medical studentsundertaking 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,[43] a 1950 letter from the Institut indicates that he received only a nomination for it.[44]
- In 1978 a public health research and consulting firm, John Snow, Inc, was founded.[citation needed]
- In 2001 the University of Durham's Queen's Campus in Stockton-on-Tees.[45]
- In 2003 John Snow was voted by readers in the United Kingdom of 'Hospital Doctor' magazine as 'the greatest doctor of all time'.[46]
- In 2009, the John Snow lecture theatre was opened by 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."[47]
- 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.[48]
- The 2019 TV series Victoria in the third-season episode "Foreign Bodies", John Snow meets Queen Victoria (no date mentioned but this happened in 1854) and, with the Queen's help, has the local authorities remove the Broad Street pump handle. (They did not mention his 1853 use of chloroform on the Queen for childbirth.)[citation needed]
See also
- 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
- ^ PMID 16424928.
- JSTOR 40543358.
- ^ Thomas, KB. (1973) "John Snow" in Dictionary of Scientific Biography. Vol 12. New York, NY: Charles Scribner's Sons; pp. 502–503.
- ^ 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...
- 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". UCLA. Retrieved 22 October 2012.
- ^ "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.
- ^ S2CID 8117674.
- PMID 12777415.
- PMID 12777413.
- ^ John Snow (1813–58) Archived 6 January 2016 at the 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
- UCLA School of Public Health. Retrieved 21 August 2007.
- ^ Snow, John (1849). On the Mode of Communication of Cholera (PDF). London: John Churchill.
- ^ a b Snow, John (1855). On the Mode of Communication of Cholera (2nd ed.). London: John Churchill.
- 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. 9: 321–322.; see p. 322.
- ISBN 978-1480592803.
- ^ Shapter, Thomas (1849). The History of the Cholera in Exeter in 1832. London: John Churchill.
- ISBN 0-8135-3614-6
- ^ Cadbury, Deborah (2003). Seven Wonders of the Industrial World. London and New York: Fourth Estate. pp. 189–192.
- PMID 4572629.
- ISBN 1-900603-87-X. p. 105
- ^ "Pumphandle Lecture 2017". johnsnowsociety.org. The John Snow Society. 12 September 2017. Retrieved 15 October 2020.
- ^ ISBN 1-86239-155-6
- ^ Snow, Stephanie J. (2004) "Snow, John (1813–1858)" in Oxford Dictionary of Biography.
- ^ JOHN SNOW'S HOMES. UCLA Department of Epidemiology, 2014. Retrieved 6 June 2014.
- ISBN 1-59448-925-4.
- ^ "List of notable occupants". Brompton Cemetery. Archived from the original (HTTP) on 23 August 2006. Retrieved 21 August 2007.
- ^ "John Snow's final rest - information on his death". www.ph.ucla.edu. Retrieved 7 January 2023.
- ^ Punt, Steve (12 May 2014). "Birmingham". The 3rd Degree. Season 3. Episode 6. Event occurs at 7:05. BBC Radio 4. Retrieved 1 December 2016.
- ^ "The College Crest". The Royal College of Anaesthetists. 2014. Archived from the original on 12 September 2014. Retrieved 12 September 2014.
- PMC 1034490.
- ^ John Snow College
- ^ Remembering Dr. John Snow on the sesquicentennial of his death
- S2CID 5591843.
- ^ "John Snow Memorial, North Street Gardens – York Civic Trust". yorkcivictrust.co.uk. Retrieved 5 May 2022.
Sources
- Hempel, Sandra (2006). The Medical Detective: John Snow, Cholera, and the Mystery of the Broad Street Pump. Granta Books. ISBN 1862078424
- ISBN 1-59448-925-4
- ISBN 0-521-56823-4
- Morris, Robert D. (2007). The Blue Death. ISBN 0-06-073089-7
- Shapin, Steven (6 November 2006) [Electronic version]. "[1]". The New Yorker. Retrieved 10 November 2006
- ISBN 0-9613921-2-6
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. ISBN 9780199747887.
External links
- "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
- 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