John Snow (15 March 1813 – 16 June 1858)

If you only ever heard of John Snow, commonly known as the father of epidemiology in regards to the SARS-CoV-2 pandemic, you’d be forgiven for thinking this to be his only, and greatest, claim to fame.

But we don’t celebrate the well known in this series as much as we discover new and exciting things that make trailblazers into heroes and heroines. John Snow, for all that he did against Cholera and for epidemiology, was one of those heroes.

Born in 1813, Snow shared something with many of the heroes on this list: he was a reluctant physician. Pluridisciplinary thinking seems to be one of the great factors in what makes the good great and the great greater. Unlike many of his colleagues on this list, though, he was a thoroughly nice person, a visionary and teacher, unaffected by the antics that seem to be defining features of others.

In that regard, he is more like Åke Senning (14 September 1915 – 21 July 2000), a reluctant physician as well, who wanted to be nothing more than an engineer and found his calling in the combination of engineering and medicine in the development of the first pacemaker. Like John Snow, he also was one of the genuinely nice people in this series.

John Snow wanted to be a mathematician. But at 14 a spot as a medical apprentice opened up and, lacking funds and connections to continue into university, Snow accepted.

Into Medicine

He performed impressively and was often left to himself to tend to patients from as early as sixteen years old. When he was 19, working as an apothecary-surgeon apprentice, he managed a local Cholera breakout largely by himself. His experience led to him adopting a teetotal life, becoming a vegetarian, and beginning to distill his drinking water. He also published a first book on Cholera management.

It also gave him valuable insights into the workings of Cholera that would become important later. His mathematical mindset led to his painstaking documenting of infection vectors and contacts, helping him to prevent hundreds of infections and resolve the outbreak quickly.

His efforts did not go unnoticed. He was invited to work as an assistant surgeon in a coal mining operation and, in 1836, at 23 years old, received an invitation to study medicine in London.

He graduated two years later. During his time in school, he had developed an interest in the first moves into anesthesia. Working as a surgeon, he graduated with an MD in 1844. In the mean time he wrote a book about asphyxiation and resuscitation in still born children, the first of its kind to like body temperature and resuscitation success.

First Anesthetist

By 1846, ether ended the barbaric days of wake surgery. However, physicians administered the ether themselves and gave as much as they could to extend their time of concentrated working on the patient. This wasn’t always a good idea.

Using his math skills, Snow first recorded and charted the optimal dose per kilogram for men and women, taking into account age and occupation. He experimented on consenting volunteers and even developed a scale to chart the “hangover” after sedation.

He published his findings in papers and never attempted to keep any of the formulae he used a secret. No patent was filed, as was the habit of those times, to ensure his dominance in the market, yet despite his openness, he quickly became the go-to person to perform anesthetic procedures for other surgeons. And just like that, John Snow became the first Anesthetist.

While working with ether, he also experimented with chloroform. While the first experiments didn’t go so well, one of his patients died after a relatively minor surgery from chloroform inhalation, he quickly developed algorithms to ensure patient survival. Unlike ether, chloroform had to be titrated, that is given slowly, and patients often cleared a little before being put back “under.” This ended the days of surgeons doing the sedation themselves and the profession of Anesthetist was truly born.

He designed masks to administer ether and chloroform and gave them away.

His greatest claim to fame, however, was his painstaking work in calculating dosages which allowed him to partially sedate patients. This was useful in obstetrics, where mothers were slightly sedated but not put to sleep. So well was this received, that he was called to perform this procedure for two of Queen Victoria’s child births. At the time, most people saw the easing of labor pains as wrong, believing that the pain of labor was God’s punishment for Eva’s sins and not to be reversed. Queen Victoria’s births, however, changed this perception and, two years later, chloroform was used routinely, using the “Snow Table” to determine doses in deliveries.

First Epidemiologist

A year after Queen Victoria’s first chloroform-assisted delivery, Cholera came to London (again).

It was not the first, and it would not be the last. Unlike some common claims, John Snow did not independently do his research, however, but was asked by the Crown and by many prominent physicians to lend his expertise.

He’d previously been a co-founder and driving force behind the Epidemiological Society of London, which surveilled and recorded Cholera and other outbreaks since 1850, four years before the Broad Street Pump outbreak.

Additionally, he’d published works as early as ten years before the Broad Street Cholera outbreak, questioning the truth behind common belief that the illness was caused by inhaling “unholy air.” Instead, he analyzed his work earlier in his career and, despite this not being common belief and germs being unknown to science, believed it must have something to do with contamination of food or water.

He set off to prove or disprove his ideas in the 1854 Cholera outbreak that made him famous. By simply talking to residents and mapping water and food sources he quickly identified the Broad Street pump as the possible culprit but could not isolate any contaminants in the water. Nevertheless, thanks to his already stellar reputation as a physician and his thorough recording and analysis of the interviews done with residents, he convinced the council to disable the pump.

While this is rightfully hailed as the first step into the field of Epidemiology, Snow himself wasn’t so sure that he was the savior he was called. Due to the lack of pathogens in the water and already declining numbers, he often stated, that he was unsure if he had not drawn the right conclusions but only after the water had already cleared. Declining numbers prior to the disabling of the well seem to agree.

A year later, Snow rewrote the book he had written at age 19 to include the Broad Street outbreak. In it, he popularized the use of dot maps to map outbreaks and strongly favored a primitive germ theory that heavily influenced Louis Pasteur’s work in sterilization and food safety. He was the first to recommend boiling water before use.

Sadly, unlike scientists, the council of London did not agree with Snow, replacing the pump after the outbreak. While no further cases of Cholera caused by it are known, it had been built next to a cesspit, a fecal dump, and was implicated in other illnesses and many other deaths.

It took until 1866, after Snow’s death, that one of the greatest opponents of Snow on the matter of water contamination, William Farr, observed the same issue at another pump and issued orders that all water had to be boiled before use.

Farr is also known for another scientific win. In 1867 he stated that, “although I disagree, I have calculated it myself and numbers do not lie. I do not know how, but I will advise to boil water.”

Snow had always lived a dietary life that emphasized purity. In 1840, however, he suffered kidney damage, which he attributed to his vegan lifestyle and he allowed himself a little wine for digestion and returned to eating meat a few times a month. Sadly, he never fully recovered and his hectic life as a medical celebrity and the stress of being the odd man out in germ theory, took its toll.

He died, aged 45, from a stroke.

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