英国麻醉学家、流行病专家约翰•斯诺（1813—1858）

华西小卒 · 发表于 2009-12-11 13:27:22

John Snow 约翰•斯诺（1813—1858），英国麻醉学家、流行病专家。他首次提出了预防霍乱的措施。

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(Original map by John Snow showing the clusters of cholera cases in the London epidemic of 1854)

Dr. John Snow
Born 15 March 1813
York, England
Died 16 June 1858 (45 years)
Citizenship British
Fields epidemiology
Known for anaesthesia, locating source of a cholera outbreak, thus establishing the link between this infection and water as its vector.

　　1844年或伦敦大学博士学位。1846年后，积极推进了麻醉剂乙醚和氯仿的临床使用。1854年，伦敦霍乱流行，斯诺通过研究霍乱病死者的日常生活情况，寻找到他们的共同行为模式，发现了霍乱与饮用不洁水的关系。由于及时切断了二者的联系，有效制止了霍乱的流行。他推荐几种实用的预防措施，如清洗肮脏的衣被，洗手和将水烧开饮用等，效果良好。虽然约翰•斯诺没有发现导致霍乱的病原体，但他创造性地使用空间统计学查找到传染源，并以此证明了这种方法的价值。今天，绘制地图已成为医学地理学及传染病学中一项基本的研究方法。“斯诺的霍乱地图”成为一个经典案例。

约翰斯诺是伦敦的一位很有名的医生。他是个中专家，以至于成为了伊丽莎白女王的私人医护。但是当他想到帮助患上霍乱的平常人时他受到了启发。霍乱是那个年代致命的疾病。治病的原因和治疗的方法都为为人所知。每一次爆发成千上万可怜的人都死去了。约翰斯诺想要面对这一个挑战以及解决这一个问题。他明白无法找到治病的根源就无法控制霍乱。他开始对两种可能解释霍乱如何杀死人的理论感到兴趣。第一种理论认为霍乱在空气中量化，变成一团危险的气体浮在空气中直到有人受感染。第二种理论认为人们吃饭的时候将这种疾病吸入体内。在胃里疾病迅速攻击身体，很快被感染的人就死了。
约翰斯诺怀疑第二种理论是正确的但是他需要证据。所以当1854年伦敦再次爆发霍乱的时候，他准备开始他的调查。由于疾病迅速的在贫穷区散开，他开始在两条街上收集咨询。霍乱爆发是如此的严重以至于10天内500人死亡。他下定决定要找到原因。
最初他在地图上将所有死亡的人所居住的地方的确切位置标志了出来。这给了他宝贵的线索去寻找疾病的原因。大部分的死亡都发生在’宽阔大街’的自来水管附近（特别是16，37，38 和40号）。他也注意到有些房子（例如是宽阔大街20 和21号，剑桥大街8和9号）并没有发生死亡。他没有预料到这一点，所以他做了进一步的调查。他发现住在剑桥大街7号的人们在酒吧里工作。他们可以有免费的啤酒所以并没有从自来水管里喝水。似乎自来水是疾病的源头。
接下来，约翰斯诺寻找了这两条大街的水源。他发现自来水来自一条被伦敦的脏水所污染的河流。他立即让宽阔大街上吃惊的人们将开关从水管上移走。很快疾病的传播慢了下来。他显示了霍乱是透过细菌而不是空气传播的。
在伦敦的另一部分，他从另外两宗和宽阔大街爆发有关的死亡中发现了支持证据。一个从宽阔大街搬走的女人因为喜欢宽阔大街的水所以每天从宽阔大街的自来水管中取水。她和她的女儿在饮用自来水之后死于霍乱。有了这一个额外的证据约翰斯诺可以肯定的宣布受污染的水带有病毒。
为了防止疾病再次爆发，约翰斯诺建议应当检查所有自来水的来源。自来水公司不可以让人们饮用来自守污染的河里的水。最后’霍乱王’被打败了。

John Snow (15 March 1813 – 16 June 1858) was a British physician and a leader in the adoption of anaesthesia and medical hygiene. He is considered to be one of the fathers of epidemiology, because of his work in tracing the source of a cholera outbreak in Soho, England, in 1854.
Early life and education
Snow was born 15 March 1813 in York, England. He was the first of nine children born to William and Frances Snow in their North Street home. His neighbourhood was one of the poorest in the city and was always in danger of flooding because of its proximity to the River Ouse. His father worked in the local coal yards, which were constantly replenished from the Yorkshire coalfields via barges on the Ouse. Snow was baptised Anglican at the church of All Saints, North Street.

All Saints, North Street.Snow studied in York until the age of 14, when he was apprenticed to William Hardcastle, a surgeon in Newcastle-upon-Tyne and physician to George Stephenson and family. William Hardcastle was a friend of Snow's uncle, Charles Empson, who was both a witness to Hardcastle's marriage and executor of his will. Charles Empsom also went to school with Robert Stephenson and it was probably through these connections that Snow acquired his apprenticeship so far from his home town of York. Snow later worked as a colliery surgeon. Between 1833 and 1836 he was an assistant in practice, first in Burnopfield, Durham, and then in Pateley Bridge, North Yorkshire. In October 1836 he enrolled as a student at the Hunterian school of medicine in Great Windmill Street, London. A year later, he began working at the Westminster Hospital and was admitted 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.
Anaesthesia
Snow was one of the first physicians to study and calculate dosages for the use of ether and also chloroform as surgical anaesthesia. 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.[1] This led 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 work was published posthumously in 1858 entitled On Chloroform and Other Anaesthetics, and Their Action and Administration. o
Cholera
Main article: 1854 Broad Street cholera outbreak

Original map by Dr. John Snow showing the clusters of cholera cases in the London epidemic of 1854Snow was a sceptic of the then-dominant miasma theory that stated that diseases such as cholera or the Black Death were caused by pollution or a noxious form of "bad air". The germ theory was not widely accepted by this time, so he was unaware of the mechanism by which the disease was transmitted, but evidence led him to believe that it was not due to breathing foul air. He first publicized his theory in an essay On the Mode of Communication of Cholera in 1849. In 1855 a second edition was published, with a much more elaborate investigation of the effect of the water-supply in the Soho, London 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 sample of the Broad Street pump water was not able to 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. Although this action has been commonally reported as ending the outbreak, the epidemic may have already been in rapid decline, as explained by Snow himself:
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.
Snow later used a spot map to illustrate how cases of cholera were centred around the pump. He also made a solid use of statistics to illustrate the connection between the quality of the source of water 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 with an increased incidence of cholera. Snow's study was a major event in the history of public health, and can be regarded as the founding event of the science of epidemiology.
In Snow's own words:
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 prence 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 [Sept 7], and represented the above circumstances to them. In consequence of what I said, the handle of the pump was removed on the following day.
—John Snow, letter to the editor of the Medical Times and Gazette
It was discovered later that this public well had been dug only three feet from an old cesspit that had begun to leak fecal bacteria. A baby who had contracted cholera from another source had its nappies washed into this cesspit, the opening of which was under a nearby house that had been rebuilt farther away after a fire had destroyed the previous structure, and the street was widened by the city. 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.

Map of cholera outbreak in London
Legend for the map abovePolitical controversy
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 be indirectly accepting the oral-fecal method transmission of disease, which was too unpleasant for most of the public.[citation needed]
Public health officials today recognize the political struggles that reformers often get entangled in. During the Annual Pumphandle Lecture in England, members of the John Snow Society remove and then replace a pump handle to symbolize the continuing challenges that face public health advancements.
Later life
Snow was a vegetarian and an ardent teetotaler and believed in drinking pure water (via boiling) throughout his adult life. He never married.[citation needed]
At the age of 45, Snow suffered a stroke while working in his London office on 10 June 1858.[2] He never recovered, dying on 16 June 1858 and is buried in Brompton Cemetery.[3]
Memorials

Funerary monument, Brompton Cemetery, London
John Snow memorial and public houseThere is a plaque commemorating Snow and his 1854 study in the place of the water pump on Broad Street (now Broadwick Street) with a water pump with its handle removed, near what is now "The John Snow" public house, which is rather ironic, given that Snow was a teetotaler for the majority of his life. The spot where the pump stood is covered with red granite.
In York, there is a blue plaque to Snow on the west end of the Park Inn, a hotel in North Street.
John Snow was voted in a poll of British doctors in 2003 as the greatest physician of all time.
Snow gives his name to John Snow College, founded in 2001 on the University of Durham's Queen's Campus in Stockton-on-Tees.
Snow is one of the heraldic supporters of the Royal College of Anaesthetists.
The public health consulting firm John Snow, Inc is named after him.

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