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John Snow – An Obituary
If we had to list some characteristics of people, who throughout history have been the most important medical knowledge, certainly would mention John Snow’s observation skills, logical reasoning and a significant share of perseverance. During his lifetime, John Snow faithfully embodied these virtues. He is remembered around the world for being a more prominent anaesthesiologist, especially for being a brilliant epidemiologist, to the point of being considered the father of modern epidemiology.
John Snow (1813-1858) was born in the city of York, England, in the late winter of 1813. William Snow and Francis were his parents, who mainly belonged to the lower-middle class. John Snow got earlier education privately at a nearby school. At the age of 14 years, with the firm intention of becoming a doctor, he became apprenticed to William Hardcastle, a surgeon in Newcastle-resident pharmacist, initiating a strict training period of five years (Ramsay, 2006). Snow turned into an abstainer and vegetarian during his apprenticeship. At 17, the young Snow had contact with the first of a series of outbreaks of a deadly dis-V disease, cholera, during which he attended many sick mining villages Killings-worth, experiences to score for always his work as a physician and investigator.
He completed his apprenticeship in 1836, moved to London, and enrolled at the Hunterian School of Medicine. In 1844, he obtained his degree of Doctor of Medicine from the University of London, establishing his consulting surgeon and general practitioner in central London's Soho. For a very brief period, he served as an unqualified assistant and colliery surgeon. This was 1836 took admission in the Hunterian school of medicine.
The school was located at London’s Great Windmill Street. In 1838, John Snow joined the Society of Apothecaries. In May 1838, he became a formal member of the Royal College of Surgeons, and in 1844 Snow graduated from the University of London. In 1850, he also became a licentiate of the Royal College of Physicians, England. In 1852, the Medical Society of London chose him as the orator. In 1855, he became Society’s President. For a short period, he taught in the Aldersgate Street School of medicine. Always attracted to research intensively studied breathing and choking, as well as the physical and chemical behaviour of gases, with special emphasis on anaesthetic gases and its application to women during childbirth (Ramsay, 2006). By then, the administration of anaesthesia was quite uncertain due to the limited knowledge about the pharmacological properties of gases and erratic administration.
During the autumn of 1848, there was a second epidemic of cholera in England, causing many deaths. Based on the record of deaths from cholera occurred between 1848-49, Snow noted that the districts of the south London area concentrated most number of cases in absolute terms and accounted for the highest mortality rate, much higher than the rest of the city (8.0 and 2.4 deaths per 1,000 population, respectively). Similarly, he noted that the inhabitants of the southern part of London obtained drinking water downstream of the Thames, where the waters were highly contaminated, unlike people in other areas of London, who was obtained from areas less polluted upstream thereof or its tributaries (Bingham et al., 2004). With this background in mind, Snow ran in 1849 an innovative hypothesis, arguing that cholera was transmitted by ingestion of "morbid matter" invisible to the human eye, which should act at the level of the intestines, producing an acute dehydrated diarrheal syndrome. This "morbid matter" had to reproduce and eliminated through the stool, which finally ended in the Thames. People, when drinking contaminated water extracted from the river, ate the "morbid matter," thus closing the circle of contagion. Snow published his hypothesis in an article entitled "On the Mode of Communication of Cholera" (1849); however, his theory was not accepted among his colleagues, however, was heavily criticized several occasions. His first essay on the cholera’s mode of communication was published in 1849, after six years a second revised and more detailed edition of the same work was published in 1855.
Snow designed an ether delivery device and wrote a practical guide to its use, soon becoming one of the most prestigious UK anaesthesiologists. The anaesthesiology discipline gave him a place in the history of medicine, a very different area, the epidemiology.
Bingham, P., Verlander, N.Q. & Cheal, M. J. (2004). John Snow, William Farr and the 1849 outbreak of cholera that affected London: a reworking of the data highlights the importance of the water supply. Public Health,118: 387-94.
Newsom, S W B. (2006). Pioneers in infection control: John Snow, Henry Whitehead, the Broad Street pump and the beginnings of geographical epidemiology. J Hosp Infect, 64: 210-6.
Ramsay, M. (2006). John Snow, MD: anesthetist to the Queen of England and pioneer epidemiologist. Proc, 19: 24-8.