John Snow

Overview

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 one of the fathers of modern epidemiology, in part because of his work in tracing the source
of a cholera outbreak in Soho, London, in 1854. His 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.

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 publicised 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. 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

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 the Southwark and Vauxhall Waterworks Company was taking water from sewage-polluted sections of the Thames and delivering the water to homes, leading to an increased incidence of cholera. 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.

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 fecal bacteria. The nappies 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, Devon years before John Snow, although this did not identify the water supply problem that was later held responsible.

Legacy and honors

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.

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 Joseph Thomas Clover, Snow is one of the heraldic supporters of the Royal College of Anaesthetists.

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.

In 2001 the John Snow College was founded on the University of Durham's Queen's Campus in Stockton-on-Tees.

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."