30 Days of #DrJohnSnow

This is not the original Broad Street pump, but is located near the site of the killer of hundreds

By Michael J. McGuire

Beginning February 14 and continuing over the next 30 days, daily messages about #DrJohnSnow and the #BroadStPump will be posted on Twitter. The following posting is about the life of Dr. Snow and how he influenced our understanding of disease propagation. His work ultimately led to others taking up the struggle and fighting for improvements in drinking water safety and public health. We owe him a lot. The countdown to March 15 will culminate in a virtual gathering around the #BroadStPump in Twitter-land.

Below are the tweets commemorating #DrJohnSnow and quotes from notable sources about his life:

30 days of #DrJohnSnow. DYK that Snow was born in York, England on March 15, 1813? He was the 1st of 9 children born into a family of limited means.

“William and Fanny Snow began their married life as a laboring family with the advantages of literacy and connections to extended families with modest resources. On March 13, 1813 Mr. G. Brown, the minister at All Saints North Street since 1798, baptized ‘John son of William & Francis Snow,’ born the same day. John’s birth occurred ten months after his parents’ marriage; they had eight more children, three daughters and five sons, over the course of fifteen years…and maintained attachments to their home parish throughout. They had ambitions for all their children and would provide each child with basic schooling.” (Vinten-Johansen et al., Cholera, Chloroform,21.)

29 days of #DrJohnSnow. Read The Strange Case of the Broad Street Pump by Sandra Hempel; see the book review http://bit.ly/WSf2DK

“It was a huge and daunting undertaking. He was, after all, only nineteen and he was being asked to shoulder quite alone the responsibility for the lives of scores of men, women and children. But he was also a steady young man, conscientious and clever, with a maturity far beyond his years. This slightly built, painfully shy youth was not everyone’s first choice of dinner-party guest, but when life took a serious turn, when wisdom was needed more than wit, and strength of character more than charisma, then John Snow would always be in the front rank of candidates. Now as he packed his belongings in the Newcastle house that had been his home for four long, sometimes difficult years, he could only pray that when he returned it would be with no sense of having failed those desperate families he was being sent to help.” (Hempel, Strange Case, 67.)

28 days of #DrJohnSnow. DYK Snow died of a stroke at age of 45 on 6/16/1858?—4 years after #BroadStPump episode ‪http://bit.ly/12Id4sc

“Somehow the most notorious cloud of miasmatic air in the history of London [the Great Stink of 1858] had failed to produce even the slightest uptick in disease mortality. If all smell was disease, as Edwin Chadwick had so boldly pronounced more than a decade before, then the Great Stink should have conjured up an outbreak on the scale of 1848 or 1854. Yet nothing out of the ordinary had happened.

It’s easy to imagine John Snow taking great delight in the puzzling data from the Weekly Returns, perhaps writing up a brief survey for The Lancet or the London Medical Gazette. But he never got the opportunity. He had suffered a stroke in his office on June 10, while revising his monograph on chloroform, and died six days later, just as the Great Stink was -reaching its peak above the foul waters of the Thames. He was forty-five years old. More than a few friends wondered if his many experiments inhaling experimental anesethetics in his home lab had brought on his sudden demise.

Ten days later, The Lancet ran this brief, understated item in its obituary section:

‘DR. JOHN SNOW-This well-known physician died at noon on the 16th instant, at his house in Sackville-street, from an attack of apoplexy. His researches on chloroform and other anesethetics were appreciated by the profession.’” (Johnson, Ghost Map, 206.)

27 days of #DrJohnSnow. DYK Snow was most famous during his lifetime as an innovator using ether & chloroform-anesthesia in surgeries?

“Nonetheless, he [Snow] remained a relatively obscure general practitioner, little known outside two London medical societies and a small private medical school whose best years were behind it. He still had a flat in Frith Street, and he still worked long hours serving working-class patients for the most part. The time and energy available for medical research were limited. No change for the better was on his horizon. Then came news about ether anesthesia.” (Vinten-Johansen et al., Cholera, Chloroform, 102.)

26 days of #DrJohnSnow. DYK that Snow delivered Queen Victoria’s baby Prince Leopold on 4/7/1853 using chloroform as an anesthesia?

Prince Leopold

“I received a note from Sir James Clark [physician in ordinary to Her Majesty] a little after 10, asking me to go to the Palace. I remained in an apartment near that of the Queen, along with Sir James Clark, Dr Ferguson and, for the most part of the time, Dr Lacock, till a little after 12. At 12.20 p.m., I commenced to give a little chloroform with each pain by pouring about 15 minims [0.9 millilitres] by measure on a folded handkerchief. The first stage of labour was nearly over when the chloroform commenced.

Her Majesty expressed great relief from the application, the pains being very trifling during the uterine contractions, whilst between the periods of contraction there was complete ease. The effect of the chloroform was not at any time carried to the extent of quite removing consciousness. Dr Lacock thought that the chloroform prolonged the intervals between the pains and retarded the labour somewhat. The infant [Prince Leopold] was born at 1.13 p.m., [so] the chloroform [had been] inhaled for 53 minutes. The placenta was expelled in a few minutes, and the Queen appeared very cheerful and well, expressing herself much gratified with the effect of the chloroform.” (Hempel, Strange Case, 103.)

25 days of #DrJohnSnow. DYK that Snow was a vegetarian and that he abstained from alcohol?

“At the age of seventeen he read John Frank Newton’s influential 1811 manifesto The Return to Nature: A Defence of the Vegetable Regimen and promptly converted to vegetarianism. Shortly thereafter, he became a strict teetotaler. He would largely avoid meat and alcohol for the rest of his adult life.” (Johnson, Ghost Map, 58-9.)

24 days of #DrJohnSnow. DYK that Snow only drank distilled water and recommended that others boil their water?

“Snow who distilled his own drinking water, agreed that London water should be improved, but he considered the abolition of cesspools and the increasing preference for water closets a sanitary disaster…water closets connected to sewer lines that emptied into rivers also used for metropolitan drinking water were, in his mind, primarily an efficient means of recycling the cholera agent through the intestines of victims as rapidly as possible. Sanitary reforms were needed, but flushing the waste of a town into the same river by which one quenched ones’ thirst seemed sheer stupidity.” (Vinten-Johansen et al., Cholera, Chloroform, 256.)

23 days of #DrJohnSnow. DYK that Snow was admitted to membership in the Royal College of Surgeons of England on 5/2/1838 and Royal College of Physicians in 1850?

Royal College of Surgeons, London

“Snow passed the Royal College of Surgeons’ exams in May 1838 and those of the Society of Apothecaries in October. He asked permission to sit the latter exam in July because he wanted to apply for a vacancy as an apothecary at the Westminster Hospital. But despite excellent references from William Hardcastle, two Yorkshire doctors and several London lecturers, including Mr Anthony White and Sir Anthony Carlisle, the Apothecaries stood firm and refused to take into account his hospital experience in Newcastle. They made him wait until October, losing him the chance of a post that would have given him an excellent footing on the ladder to private practice and a good living.” (Hempel, Strange Case, 90-1.)

22 days of #DrJohnSnow. 16 October 1841 John Snow gave his 1st paper: Asphyxia and the resuscitation of still-borns. http://bit.ly/XTLclJ

“The number of children that die of asphyxia at the time of birth is very considerable. Writers on midwifery have stated that one-twentieth of the children brought forth are still born, and of these a large proportion are asphyxiated, from various causes, often at the very moment of birth. The first measures that are generally and very properly adopted, when a child is born in a state of suspended animation, are to admit the cool air to its skin, to dash a few drops of cold water on it, and use similar means to arouse sensibility, more especially that of the nerves of respiration. From the great vascularity and sensibility of the skin, and the thinness of the cuticle of newborn children, great benefit may be expected from the access of air to the surface of the body. Immersion in [224/225] warm water is sometimes had recourse to, and I have seen it completely successful in two or three instances, after the means just enumerated had failed; but this is a dangerous measure, one which, if it do not succeed, will quickly extinguish any possibility of recovery which may exist, as we have already seen. The great object in this, as in every case of asphyxia, is to establish respiration; and if the patient cannot be roused to perform natural breathing, artificial respiration must be had recourse to as quickly as possible.” Snow, John. 1841. “On asphyxia, and on the resuscitation of still-born children.” London Medical Gazette. (November 5, 1841): 222-27. PDF from photocopy; Taubman Medical Library, University of Michigan.

21 days of #DrJohnSnow. DYK that there is a website devoted to the bicentenary of #DrJohnSnow? List of celebrations http://bit.ly/W3Su2N

“A pair of meetings hosted by the London School of Hygiene and Tropical Medicine and the Wellcome Trust, in collaboration with the International Epidemiological Association, the John Snow Society and the Centre for History in Public Health.

• 15 – 16 March 2013: Mapping disease: John Snow and Cholera
• 11 – 12 April 2013: Snow’s legacy: Epidemiology today and tomorrow

There will also be a public Exhibition: Cartographies of Life & Death: John Snow and Disease Mapping, combining historical material and new artworks at the London School of Hygiene & Tropical Medicine and related sites, 13 March – 17 April 2013, Monday – Saturday, 10am – 5pm”

20 days of #DrJohnSnow. DYK that in 1849, John Snow published On the Mode of Communication of Cholera.

“It cost him £200 to produce but his income was only £3.12s. Journals dismissed Snow’s book. “There is, in our view, an entire failure of proof that the occurrence of any one case could be clearly and unambiguously assigned to water”. The reviewer later concludes, “Notwithstanding our opinion that Dr Snow has failed in proving that cholera is communicated in the mode in which he supposes it to be, he deserves the thanks of the profession for endeavouring to solve the mystery. It is only by close analysis of facts and the publication of new views, that we can hope to arrive at the truth”. (London Medical Gazette, 1849) http://bit.ly/dPl0hW

19 days of #DrJohnSnow. Go to exhibition: Cartographies of Life & Death: John Snow & Disease Mapping http://bit.ly/12WI8sV

“13 March – 17 April 2013 London School of Hygiene & Tropical Medicine, Keppel Street, London, WC1E 7HT and off-site locations (to be announced).

Inspired by the pioneering work of medical detective John Snow, who traced the source of a deadly cholera outbreak in 1850s London to a water pump in Soho, we are opening our doors to the public with an exhibition celebrating Snow’s work and legacy.

Historical treasures and newly commissioned artworks inspired by science will be found both in and around the London School of Hygiene & Tropical Medicine. Presented in the style of a disease mapping ‘detective’ trail, exhibition highlights will include a pop-up water-based cocktail bar, weekly street performances, and disease maps from the School’s archives showing how scientists have tracked disease outbreaks around the world from the early 1900s to the present day.” http://bit.ly/12WI8sV

18 days of #DrJohnSnow. Travel to York, England on Mar 15 and attend the one-day symposium on his life http://bit.ly/W1obfD

17 days of #DrJohnSnow. DYK Snow published a paper on rickets in children which he related to alum added to bread? http://bit.ly/XCq2Xt

“On commencing, in the year 1839, to see a considerable amount of practice amongst the poor of London, chiefly the out-patients of a public hospital, I was very much struck with the great number of cases of rickets. The complaint was shown more particularly in the bones of the leg, causing an outward curvature of the tibia and fibula; in children in their second and third year, it seemed almost the rule, and might be observed in the streets and the parks, as well as amongst children brought for advice. The complaint, moreover, was not by any means confined to the poor, but affected the children of the middle classes to a considerable extent….

Now, the bakers, so far as I have examined, all put alum in their bread, whilst this is never done in domestic practice, and the flour dealers rarely adulterate the flour with this substance. They are liable to a heavy penalty for adulterating flour, but the law is never enforced against the bakers. I have never examined a specimen of flour which contained alum, or a specimen of baker’s bread which did not contain it.”

16 days of #DrJohnSnow. Read the Victorian novel The Drummer was the First to Die which includes Snow-its free http://bit.ly/12v3PA1

“The younger drummer, standing in front of the elephant, eased himself out of the rhythm to stop for another drink of arak. Only his brother was left hitting the steady sixteen beats against the shanai and the singers. He increased his volume, pummeling at the drum he’d fashioned himself out of hide and rosewood. The complex refrain had persisted so long that the whole village had altered their movements, their speech patterns, even their breathing, to synchronize with the plangent beat.

Suddenly, the pulse stopped. All heads, even the elephant’s, looked up. The rest of the musicians went on for a few beats before colliding into silence. Every eye fixed on the drummer.

He bent himself double, clutching at his stomach and the drum, and sank to the ground in a grotesque embrace with his instrument. He convulsed in a sudden spasm of vomiting. A puddle, viscous in the firelight, spread from his mouth and widened around him. His face faded to the color of ashes.

For seconds, nobody moved. Then the victim’s youngest son peeked out from behind the elephant’s leg and toddled over to the writhing man, shouting, “Baba! Baba!” But before he’d gone three steps, he fell, grabbing his belly like his father.

The village scattered in chaos. Three by the fire collapsed like the drummer. The drummer’s wife tried to help her husband and their boy, but within minutes she too fell. The drummer was the first to die.”

Commentary: And thus cholera struck with a ferocity and speed that seemed demonic.

15 days of #DrJohnSnow. DYK-on 9/7/1854, Snow persuaded the St James Bd of Commissioners of Paving to remove handle from #BroadStPump

“The General Register Office had not yet received the death returns for the week after 2 September, but local observers knew that the cholera around Golden Square, though now declining, had exacted a very high toll. The numbers meant little until one realized how very few city blocks made up the affected area. A walk of less than three minutes sufficed to take one from the epicenter of the outbreak to a region mostly free of cholera. Whitehead could stand at the front door of St. Luke’s and point to four houses, at an average distance of fifteen yards, that had collectively lost thirty-four inhabitants in four days.

The official body most directly responsible for local health matters in St. James’s parish in 1854 was the Board of Governors and Directors of the Poor, rather than a Board of Guardians. The parish had been exempted from implementation of the New Poor Law. Instead of in-door relief provided in a union workhouse, St. James offered its poor a combination of out-door relief or admission to a small local workhouse. The Board of Governors handled day-to-day affairs and reported to the parish vestry. The governors and directors were concerned about the threat of cholera and on 14 August 1854 had voted to abandon their usual meeting protocol and form themselves into a special emergency response committee to deal with the it. It seemed during the past week as if their worst fears had been realized. As they considered at their weekly meeting what course of action to pursue next, they were notified that Dr. John Snow had respectfully requested an interview with them. He was admitted and presented an account of his investigation so far. As a result the committee issued an order that the handle be removed from the Broad Street pump.” (Vinten-Johansen et al., Cholera, Chloroform, 292, 294.)

14 days of #DrJohnSnow. Watch 3 great videos re: Snow and #BroadStPump http://bit.ly/WZjfta http://bit.ly/12StJ16 http://bit.ly/ZuCzRB

“A video looking at reasons for improvements in public health provision during the 19th century. These reasons include Dr John Snow, Louis Pasteur, cholera outbreaks and the Great Stink.”

“A video looking at the reasons why public health in Britain was improved in the latter half of the 19th Century.”

13 days of #DrJohnSnow. DYK that the Broad Street pump handle was actually removed on 9/8/1854? http://bit.ly/12Id4sc

1854 Cholera statistics in the vicinity of the Broad Street pump

“The order was carried out, and the pump handle was removed. The event passed totally unnoticed by the newspapers and journals of the day, but it was certainly noticed by the local populace, who were not pleased. The butts and cisterns in which piped drinking water was stored (because the water companies typically provided running water only a few hours each day) were coated with dirt, uncovered, and often located in ‘close, unwholesome, and disgusting propinquity [proximity]’ to the water closets and garbage cans. Small wonder that many supplied with piped water still preferred the Broad Street pump.” (Vinten-Johansen et al., Cholera, Chloroform, 294.)

12 days of #DrJohnSnow. Travel to London School of Hygiene and Tropical Medicine for lecture & scientific mtg http://bit.ly/150cDN4

Mapping Disease: John Snow and Cholera–Friday 15 – Saturday 16 March 2013

London School of Hygiene & Tropical Medicine—Celebrate John Snow’s 200th birthday and discover the history of John Snow at a public lecture and drinks reception with historian and journalist, Sandra Hempel on 15 March, followed by an all-day scientific symposium looking at historical aspects of his work on 16 March.

11 days of #DrJohnSnow. Watch movie trailer for Snow the Movie. It was made into a student film of 22 mins http://bit.ly/YFgewH

“It is the summer of 1854 and a violent cholera outbreak has decimated the unseemly district of Soho, London. While the source of the outbreak remains unclear, the leading medical authorities blame the miasma, or poisonous air, which emanates from the nearby bone boiling establishments. When an unlikely physician, Dr. John Snow, uncovers an entirely different theory, he must piece together a scientific puzzle that will culminate in one historic moment, anointing Dr. John Snow as the ‘Father of Modern Epidemiology.’”

10 days of #DrJohnSnow. DYK that due to public protests Broad Street pump handle was reinstalled on 9/26/1855? Not removed for good til 1866

“The commissioners of paving of St. James’s again received a petition from the inhabitants of Broad Street and environs. There was much complaint in the neighborhood that the Broad Street pump remained without its handle. Back in June the parish medical officer, John G. French (a friend of Snow’s since 1849 and a member of the Cholera Inquiry Committee), had warned of the increased threat of cholera with the warm weather and had advised strongly that all the street pumps be closed down. The pumps remained popular, however, compared to the filthy cisterns that normally held the piped water. Besides, it was now autumn, and the cholera seemed to be gone from London. On a 10-2 vote the commission decided to reopen the Broad Street Pump….The Broad Street pump was not permanently closed until the cholera epidemic of 1866…” (Vinten-Johansen et al., Cholera, Chloroform, 310, 317.)

9 days of #DrJohnSnow. Watch the TED talk by Steven Johnson author of The Ghost Map. http://bit.ly/G1jxb

“Author Steven Johnson takes us on a 10-minute tour of The Ghost Map, his book about a cholera outbreak in 1854 London and the impact it had on science, cities and modern society. Steven Berlin Johnson is the best-selling author of six books on the intersection of science, technology and personal experience.”

8 days of #DrJohnSnow. Read Cholera, Chloroform, and the Science of Medicine by Stephen Vinten-Johansen et al. IMHO the best book about Snow

“The product of six years of collaborative research, this new biography interprets a pioneering figure in anesthesiology, epidemiology, medical cartography, and public health. It modifies the conventional rags-to-riches portrait of John Snow by synthesizing fresh information about his early life from archival research and recent studies. It explores the intellectual roots of his commitments to vegetarianism, temperance, and pure drinking water, first developed when he was a medical apprentice and assistant in the north of England. The authors argue that many of Snow’s later contributions are traceable to the medical perspective he imbibed as a medical student in London and put into practice early in his career as a clinician: that medicine as a science required the incorporation of recent developments in its collateral sciences-chiefly anatomy, chemistry, and physiology-in order to understand the causes of disease. Snow’s theoretical breakthroughs in anesthesia were extensions of his experimental research in respiratory physiology and the properties of inhaled gases. Shortly thereafter, his understanding of gas laws led him to reject miasmatic explanations for the spread of cholera, and to develop an alternative theory that explained all facets of cholera epidemiology from transmission in households to the course of epidemics in cities and nations.” (Vinten-Johansen et al., Cholera, Chloroform, dustcover.)

Queen Victoria holding Princess Beatrice

7 days of #DrJohnSnow. DYK that Snow delivered Queen Victoria’s baby, Princess Beatrice, on 4/14/1857 using chloroform as an anesthesia?

“For Snow personally, the trip to the palace [for the birth of Prince Leopold] had clearly been a success, and it was not surprising that three years later, when the queen was about to give birth to her ninth child, Princess Beatrice, he again received the call. This time, however, the royal labour proved more of an ordeal, and Her Majesty began demanding more pain relief than Snow felt it safe or expedient to provide. In managing this particular birth, the doctors had a difficult balancing act. They were clearly worried about the slow progress of the labour, and Lacock gave the Queen ergot in order to strengthen her contractions….Increasing the queen’s contractions also meant increasing her pain, of course; yet at the same time, once in the second stage of labour, Her Majesty must not be too drugged to push.

‘The labour occurred about a fortnight later than was expected,’ Snow wrote. It commenced about 2 a.m., when the medical men were sent for. The labour was lingering and, a little after 10, Dr Lacock administered half a drachm [half a teaspoonful] of powdered ergot, which produced some effect in increasing the pains. At 11 o’clock, I began to administer chloroform. Prince Albert had previously administered a very little chloroform on a handkerchief… for each pain. Her Majesty expressed great relief from the vapour.” (Hempel, Strange Case, 104-5.)

6 days of #DrJohnSnow. Read The Ghost Map by Steven Johnson-the most popularized account of Snow’s discoveries http://bit.ly/ZqmEy9

“It’s the summer of 1854, and London is seized by a violent outbreak of cholera that no one knows how to stop. As the epidemic spreads, a maverick physician and a local curate are spurred to action, working to solve the most pressing medical riddle of their time. In a triumph of multidisciplinary thinking, Johnson illuminates the intertwined histories of the spread of disease, the rise of cities, and the nature of scientific inquiry, offering both a thrilling account of the most intense cholera outbreak to strike Victorian London and a powerful explanation of how it has shaped the world we live in.” (Johnson, Ghost Map, back cover)

References:

Frerichs, Ralph R. “John Snow.” http://www.ph.ucla.edu/epi/snow.html (accessed October 4, 2012).

Hempel, Sandra. 2007. The Strange Case of the Broad Street Pump: John Snow and the Mystery of Cholera. Los Angeles, Ca.: University of California.

Johnson, Steven. 2006. The Ghost Map: The Story of London’s Most Terrifying Epidemic and How It Changed Science, Cities and the Modern World, New York City, N.Y.: Riverhead Books.

Vinten-Johansen, Peter, Howard Brody, Nigel Paneth, Stephen Rachman and Michael Rip. 2003. Cholera, Chloroform, and the Science of Medicine. New York City, N.Y.: Oxford University Press.