John Snow (physician)

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John Snow

Dr John Snow

Born 15 March 1813

York, England

Died 16 June 1858 (aged 45)

Citizenship United Kingdom

Nationality English

Fields epidemiology

Known for Anaesthesia, locating source of a choleraoutbreak, thus establishing the

link between this infection and water as its vector.

John Snow (15 March 1813 – 16 June 1858) was an English physician and a leader in the adoption
of anaesthesia and medical hygiene. He is considered to be one of the fathers of epidemiology, because of
his work in tracing the source of a cholera outbreak in Soho, England, in 1854.

Contents
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 1 Early life and education

 2 Career

 3 Anaesthesia

 4 Cholera

 5 Political controversy

 6 Later life

 7 Memorials

 8 See also

 9 Sources

 10 References

 11 External links

[edit]Early life and education

Snow was born 15 March 1813 in York, England. He was the first of nine children born to William and
Frances Snow in their North Street home. His neighbourhood was one of the poorest in the city and was
always in danger of flooding because of its low proximity to the River Ouse. His father worked in the local
coal yards, which were constantly replenished from the Yorkshire coalfields through the barges on the
Ouse. Snow was baptised at the Anglican church of All Saints, North Street.

All Saints, North Street.

Snow studied in York until the age of 14, when he was apprenticed to William Hardcastle, a surgeon
in Newcastle-upon-Tyne and physician toGeorge Stephenson and family. William Hardcastle was a friend
of Snow's uncle, Charles Empson, who was both a witness to Hardcastle's marriage and executor of his
will. Charles Empson also went to school with Robert Stephenson and it was probably through these
connections that Snow acquired his apprenticeship so far from his home town of York. Snow later worked
as a colliery surgeon. Between 1833 and 1836 he was an assistant in practice, first in Burnopfield, County
Durham, and then in Pateley Bridge, North Yorkshire. In October 1836 he enrolled as a student at
the Hunterian school of medicine in Great Windmill Street, London.

[edit]Career

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.

In 1857, he made an early and overlooked[1] contribution to epidemiology in a little-known pamphlet : On

the adulteration of bread as a cause of rickets.[2]

[edit]Anaesthesia

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 procedures without
the distress and pain they would otherwise experience. He personally administered chloroform to Queen
Victoriawhen she gave birth to the last two of her nine children, Leopold in 1853 and Beatrice in
1857,[3] leading to wider public acceptance of obstetricanaesthesia. Snow published an article on ether in
1847 entitled On the Inhalation of the Vapor of Ether. A bigger, longer work was published posthumously in
1858 entitled On Chloroform and Other Anaesthetics, and Their Action and Administration.

[edit]Cholera

Main article: 1854 Broad Street cholera outbreak

Original map by Dr. John Snow showing the clusters of cholera cases in the London epidemic of 1854

Snow was a skeptic of the then dominant miasma theory that stated that diseases such as cholera or the
Black Death were caused by pollution or a noxious form of "bad air". The germ theory of disease was not to
be created until 1861, so he was unaware of the mechanism by which the disease was transmitted, but
evidence led him to believe that it was not due to breathing foul air. He first publicized his theory in an
essay On the Mode of Communication of Cholera in 1849. Contrary to what is often still written,[4] he was
not awarded 30000 French francs for this work by the Institut de France.[5] In 1855 a second edition was
published, with a much more elaborate investigation of the effect of the water-supply in the Soho, London
epidemic of 1854.

By talking to local residents (with the help of Reverend 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 sample of the Broad Street pump water was not able to 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. Although this action has been commonly reported as ending
the outbreak, the epidemic may have already been in rapid decline, as explained by Snow himself:

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.
John Snow memorial and public house onBroadwick Street, Soho

Snow later used a spot map to illustrate how cases of cholera clustered around the pump. He also made a
solid use of statistics to illustrate the connection between the quality of the source of water and cholera
cases. He showed that the Southwark and Vauxhall Waterworks Companywas taking water from sewage-
polluted sections of the Thames and delivering the water to homes with an increased incidence of cholera.
Snow's study was a major event in the history of public health, and geography, and can be regarded as the
founding event of the science ofepidemiology.

In Snow's own words:

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 [Sept 7],
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
It was discovered later that this public well had been dug only three feet from an old cesspit that had begun
to leak fecal bacteria. A baby who had contracted cholera from another source had its nappies washed into
this cesspit, the opening of which was under a nearby house that had been rebuilt farther away after a fire
had destroyed the previous structure, and the street was widened by the city. 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.

Map of cholera outbreak in London

Legend for the map above

[edit]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 be indirectly accepting the oral-fecal method transmission of disease,
which was too unpleasant for most of the public. [6]

Public health officials today recognize the political struggles in which reformers often become
entangled. [7]During the Annual Pumphandle Lecture in England, members of the John Snow Society
remove and then replace a pump handle to symbolize the continuing challenges that face public health
advancements.

[edit]Later life

In 1830 Snow became a member of the Temperance Movement, and lived for a decade or so as a
vegetarian and teetotaler. In the mid-1840s his health deteriorated, and he returned to meat-eating and
drinking wine. He continued drinking pure water (via boiling) throughout his adult life. He never married. [8]
At the age of 45, Snow suffered a stroke while working in his London office on 10 June 1858.[9] He never
recovered, dying on 16 June 1858 and is buried in Brompton Cemetery.[10]

[edit]Memorials

Funerary monument, Brompton Cemetery, London

There is a plaque commemorating Snow and his 1854 study in the place of the water pump on Broad
Street (now Broadwick Street) with a water pump with its handle removed, near what is now "The John
Snow" public house, which is rather ironic, given that Snow was teetotal for the majority of his life. In York,
there is a blue plaque to Snow on the west end of the Park Inn, a hotel in North Street. The spot where the
pump stood is covered with red granite. Snow is one of the heraldic supporters of the Royal College of
Anaesthetists and was voted in a poll of British doctors in 2003 as the greatest physician of all time. Snow
gives his name to John Snow College, founded in 2001 on the University of Durham's Queen's Campus
in Stockton-on-Tees.