|Died||16 June 1858 45) (aged|
London, United Kingdom
|Alma mater||University of London|
|Known for|| Anaesthesia |
Locating source of a cholera outbreak (thus establishing the disease as water-borne)
|Fields|| Anaesthesia |
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, in part because of his work in tracing the source of a cholera outbreak in Soho, London, in 1854, which he curtailed by removing the handle of a water pump. Snow's findings inspired the adoption of anaesthesia as well as 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.
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 labourerwho 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.
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.
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.
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".
In 1857, Snow made an early and often overlookedcontribution to epidemiology in a pamphlet, On the adulteration of bread as a cause of rickets .
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.He personally administered chloroform to Queen Victoria when she gave birth to the last two of her nine children, Leopold in 1853 and Beatrice in 1857 and was still not yet knighted, leading to wider public acceptance of obstetric anaesthesia. Snow published an article on ether in 1847 entitled On the Inhalation of the Vapor of Ether. A longer version entitled On Chloroform and Other Anaesthetics and Their Action and Administration was published posthumously in 1858.
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.Therefore, his interest in anaesthesia and breathing was evident since 1841 and beginning in 1843, Snow 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.
Though 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. Within two years after ether was introduced, Snow was the most accomplished anaesthetist in Britain. London's principal surgeons suddenly wanted his assistance.
John Snow studied chloroform as much as he studied ether, 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.
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.
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. He then repeated the procedure for the delivery of her daughter three years later. Medical and religious acceptance of obstetrical anaesthesia came after in the 19th century.
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,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.
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 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. 51–52:
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. [ citation needed ]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.
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.
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.
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.
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.
It wasn't 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.
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.
Public health officials recognise the political struggles in which reformers have often become entangled.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.
Snow became a vegetarian at the age of 17 and was a teetotaller.He embraced an ovo-lacto vegetarian diet by supplementing his vegetables with dairy products and eggs. On this diet he excelled at swimming. He later became a vegan. In the mid-1840s, 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. He continued drinking pure water (via boiling) throughout his adult life. He never married.
In 1830, Snow became a member of the temperance movement. In 1845, he became a member of York Temperance Society.After his health declined it was only about 1845 that he consumed a little wine to aid digestion.
Snow lived at 18 Sackville Street, London, from 1852 to his death in 1858.
Snow suffered a stroke while working in his London office on 10 June 1858. He was 45 years old at the time.He never recovered, dying on 16 June 1858. He was buried in Brompton Cemetery.
Anesthesia or anaesthesia is a state of controlled, temporary loss of sensation or awareness that is induced for medical purposes. It may include some or all of analgesia, paralysis, amnesia, and unconsciousness. A patient under the effects of anesthetic drugs is referred to as being anesthetized.
Anesthesiology, anaesthesiology, anaesthesia or anaesthetics is the medical speciality concerned with the total perioperative care of patients before, during and after surgery. It encompasses anesthesia, intensive care medicine, critical emergency medicine, and pain medicine. A physician specialised in this field of medicine is called an anesthesiologist, anaesthesiologist or anaesthetist, depending on the country.
Sir James Young Simpson, 1st Baronet, FRCPE was a Scottish obstetrician and a significant figure in the history of medicine. He was the first physician to demonstrate the anaesthetic properties of chloroform on humans and helped to popularise its use in medicine.
Sir Ivan Whiteside Magill was an Irish-born anaesthetist who is famous for his involvement in much of the innovation and development in modern anaesthesia. He helped to establish the Association of Anaesthetists of Great Britain and Ireland. Several medical devices are named after him.
Edward Headlam Greenhow FRS, FRCP was an English physician, epidemiologist, sanitarian, statistician, clinician and lecturer.
Sir Benjamin Ward Richardson was a British physician, anaesthetist, physiologist, sanitarian, and a prolific writer on medical history. He was the recipient of the Fothergill gold medal, awarded by the Medical Society of London in 1854 and of the Astley Cooper triennial prize for an essay in physiology.
Medical geography is a sub-discipline of geography, focused on understanding spatial patterns of health and disease as related to the natural and social environment. Conventionally, there are two primary areas of research within medical geography: the first deals with the spatial distribution and determinants of morbidity and mortality, while the second deals with health planning, help-seeking behavior, and the provision of health services.
Edwin Lankester FRS, FRMS, MRCS was an English surgeon and naturalist who made a major contribution to the control of cholera in London: he was the first public analyst in England.
Thomas Michael Greenhow MD MRCS FRCS was an English surgeon and epidemiologist.
The Ghost Map: The Story of London's Most Terrifying Epidemic – and How it Changed Science, Cities and the Modern World is a book by Steven Berlin Johnson in which he describes the most intense outbreak of cholera in Victorian London and centers on John Snow and Henry Whitehead.
The third cholera pandemic (1846–60) was the third major outbreak of cholera originating in India in the nineteenth century that reached far beyond its borders, which researchers at UCLA believe may have started as early as 1837 and lasted until 1863. In Russia, more than one million people died of cholera. In 1853–54, the epidemic in London claimed over 10,000 lives, and there were 23,000 deaths for all of Great Britain. This pandemic was considered to have the highest fatalities of the 19th-century epidemics.
The Broad Street cholera outbreak was a severe outbreak of cholera that occurred in 1854 near Broad Street in the Soho district of the City of Westminster, London, England, and occurred during the 1846–1860 cholera pandemic happening worldwide. This outbreak, which killed 616 people, is best known for the physician John Snow's study of its causes and his hypothesis that germ-contaminated water was the source of cholera, rather than particles in the air. This discovery came to influence public health and the construction of improved sanitation facilities beginning in the mid-19th century. Later, the term "focus of infection" started to be used to describe sites, such as the Broad Street pump, in which conditions are good for transmission of an infection. Snow's endeavour to find the cause of the transmission of cholera caused him to unknowingly create a double-blind experiment.
Joseph Thomas Clover was an English doctor and pioneer of anaesthesia. He invented a variety of pieces of apparatus to deliver anaesthetics including ether and chloroform safely and controllably. By 1871 he had administered anaesthetics 13,000 times without a fatality.
ACE mixture is an historical anaesthetic agent for general anaesthesia. It was first suggested by George Harley and first used in England around 1860. In 1864 it was recommended for use by the Royal Medical and Surgical Society's Chloroform Committee. It was rarely used after the 19th century, except in Germany, where it was used for slightly longer.
The Epidemiological Society of London, also known as the Royal Society of Medicine's Epidemiological Society, was founded in London in 1850 with the objective of investigating the causes and conditions which influence the origin, propagation, mitigation, and prevention of epidemic disease. The society became a part of the Royal Society of Medicine in 1907.
Dr Robert Mortimer Glover FRSE (1815-1859) was an English physician. In 1838 he co-founded the Paris Medical Society and served as its first Vice President. He won the Medical Society of London’s Fothergill Gold Medal in 1846 for his lecture "On the Pathology and Treatment of Scrofula". Some 5 years prior to James Young Simpson’s use of chloroform on human patients in 1842 Glover discovered its anaesthetic qualities on laboratory animals. He is sometimes called "the true discoverer of chloroform". In an ironic twist of fate he died from a chloroform overdose.
George Warwick Bampfylde Daniell was medical practitioner and anaesthesiologist who practised in South Africa in the 19th and 20th centuries.
Obstetric anesthesia or obstetric anesthesiology, also known as ob-gyn anesthesia or ob-gyn anesthesiology is a sub-specialty of anesthesiology that provides peripartum pain relief (analgesia) for labor and anesthesia for cesarean deliveries ('C-sections').
The Edinburgh Obstetrical Society is a medical society in Edinburgh devoted to obstetrics. It was founded in 1840 by Robert Bowes Malcolm and boasts James Young Simpson as their most eminent past member.
John Gillies, was a Scottish anaesthetist, who worked at the Royal Infirmary of Edinburgh (RIE). For gallantry as a serving soldier in WWI he was awarded the Military Cross. He founded the department of anaesthetics in the RIE and became its first director. The Gillies anaesthetic machine which he devised was the first British closed circuit anaesthetic device and was in use until the 1960s. With his colleague HWC ('Griff') Griffiths he pioneered the technique of high spinal anaesthesia to produce hypotension and 'bloodless' operating fields. Gillies anaesthetised King George VI in Buckingham Palace and was made Commander of the Royal Victorian Order (CVO) for this service. He was president of the Association of Anaesthetists of Great Britain and Ireland from 1947 to 1950.
A Life of John Snow Peter Vinten-Johansen, Howard Brody, Nigel Paneth, Stephen ... The senior surgeon was Thomas Michael Greenhow (1792–1881)....Consider also T. M. Greenhow: “When patients rally from collapse, it is often most difficult to ascertain on what causes....
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...
....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 ...
The following members of the Epidemiological Society (10 gentleman) took part in the discussion....Drs. Snow, Greenhow...
...dreadful scourge, the cholera ....Snow was q founding member of .....(Tucker's) stimulating words lead 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.
institut de france and john snow.Google Books
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