The Snow series is an educational course. We hope you will recognise our efforts by donating to TTE or becoming a paying subscriber, as writing the series took a lot of time and effort.

The publication On the Mode of Communication of Cholera, 2nd edition, 1855 (MCC 2), which Snow funded out of his own pocket, was not a runaway success. It sold less than 60 copies. The Lancet’s review of the book was as follows:

Dr Snow claims to have discovered that the law of propagation of cholera is the drinking of sewage water. His theory, of course, displaces all other theories. (…) In riding his hobby very hard, he has fallen down through a gully-hole and has never since been able to get out again. And to Dr. Snow, an impossible one: so there we leave him.

The fact is that the well whence Dr. Snow draws all sanitary truth is the main sewer. His specus, or den, is a drain. 

The Lancet June 23, 1855,

Snow’s work was set aside and forgotten after his death and possibly plagiarised. Some people, chiefly his friend Sir Benjamin Richardson, tried until the very end of his life to keep Snow’s memory alive. He is buried in Brompton cemetery. His funeral monument was erected via a public subscription led by his friend Richardson many years after his death. This was partly in belated recognition of Snow’s extraordinary contributions to science and public health. 

His 1858 obituary downplays his anaesthetic work and makes no mention of his study of cholera:

It is difficult to categorise Snow as a contagionist or a contingent contagionist, given that he recognises the play of external variables such as temperature, humidity, overcrowding or poor diet as contributory factors to the spread of epidemic cholera. He also recognised the importance of susceptibility and the complexity of microbial transmission. Notably, the significance of V.cholerae was recognised by a faraway Tuscan anatomist whose name generations of medical students will recognise: Filippo Pacini.

Contrary to popular perception, Pacini was not the first to visualise the agent (Hassal, among others, had done that), but he was the first to recognise its significance. Koch’s re-discovery came many years later. Pacini recognised that vibrios (so-called because they seemed to vibrate in the slides) were only present in slides taken from rice water faeces. Here is the original slide from Pacini’s archive, with a sample taken from the small gut lining of a cholera case:

The date (29 August 1854) is remarkable. It was the beginning of the acute phase of the Golden Square outbreak when the presumed index case started having symptoms of the disease (see Lecture 18). Pacini’s contribution was also belatedly recognised in 1965: the bug was named after him.

The Dutch epidemiologist Jan Vandenbroucke and colleagues credited Wade Hampton Frost for bringing Snow’s work back to centre stage in the 1930s. Vandenbroucke commented that Snow’s work fitted well with the bacteriological paradigm of the interwar years, and Frost was trying to lift epidemiology into its own space rather than being a handmaiden of bacteriology. However, Snow’s biographers Peter Vintnen-Johansen and colleagues chart the trajectory of Snow’s acceptance and subsequent transformation into a hero as far back as 1866, the date of the last cholera pandemic in the UK. One by one, Farr, Simon and subsequent epidemiologists such as Sedgwick accepted Snow’s theory and, as Frost did, pointed out his work as iconic and seminal.

Whatever the sequence, Snow’s work is as fresh and applicable today as it was 150 years ago, as we hope to have shown. 

Frost assembled most of Snow’s work in “Snow on Cholera,” published in 1936 (it is known as “the Hafner” after its publisher).

The material for these articles and bibliography is taken from our own copy of: 

Snow J. Snow on Cholera -- A Reprint of Two Papers by John Snow, M.D. together with A Biographical Memoir by B.W. Richardson, M.D., and an Introduction by Wade Hampton Frost, M.D., Hafner Publishing Company, London, 1965 and The John Snow website at UCLA.

Snow’s work has spawned numerous re-evaluations, discussions and developments in epidemiology, geography cartography, topography, microbiology, history and many other disciplines. We hope you enjoyed the story and the lessons.

Readings

The John Snow website at UCLA

Vandenbroucke JP et al. Who made John Snow a hero? Am J Epidemiol. 1991 May 15;133(10):967-73. doi: 10.1093/oxfordjournals.aje.a115816. PMID: 2035507.

Tom holding his copy of Wade Hampton Frost’s Snow on Cholera (HAFNER edition, 1936), from which the pictures for the lecture series were taken.

"Snow on Cholera . . . together with a biographical memoir by B. W. Richardson and an Introduction by Wade Hampton Frost." View this document as a PDF

On the mode of communication of cholera. London, J. Churchill, 1849, 31 pp. Available as drill through here.

Reading list of Snow’s production on Cholera:

• The cholera at Albion Terrace. LondonMed. Gazette, vol. 44, Sep. 15, 1849, 504-05. [letter to the editor.] (Link)

• On the pathology and mode of communication of cholera. London Med. Gazette, vol. 44, Nov. 2, 1849, pp. 745-752, Nov. 30, 1849, pp. 923-929. (Link)

• On the mode of propagation of cholera. Medical. Times, n. s. vol. 3, Nov. 29, 1851, pp. 559-562, Dec. 13, 1851, pp. 610-612. (Link)

• On the comparative mortality of large towns and rural districts, and the causes by which it is influenced." Transactions of the Epidemiological Society. In Journal of Public Health & Sanitary Review 1 (1855): 16-24. Paper delivered May 2, 1853. (Link)

• On the prevention of cholera. Med. Times and Gazette, n.s. vol. 7, Oct. 8, 1853, pp. 367-369 (Link)

• The water supply at Newcastle. Times, 11 November 1853. [letter to the editor]. (Link)

• The principles on which the treatment of cholera should be based. Med. Times and Gazette, n. s. vol. 8, Feb. 25, 1854, pp. 180-182. (Link)

• Cholera in the Baltic Fleet." Medical Times and Gazette 9 (12 August 1854): 170. [ltr. to ed., 5 August 1854] (Link)

• Communication of cholera by Thames water. (Letter.) Med. Times and Gazette, n. s. vol. 9, Sept. 2, 1854, pp. 247-248. (Link)

• The cholera near Golden Square and at Deptford. (Letter.) Med. Times and Gazette, n. s. vol. 9, Sept. 23, 1854, pp. 321-322. (Link)

• On the communication of cholera by impure Thames water. Med. Times and Gazette, n. s. vol. 9, Oct. 7, 1854, pp. 365-366. (Link)

• "On the chief cause of the recent sickness and mortality in the Crimea." Med. Times and Gazette, n. s. vol. 10, Apr. 28, 1855, pp. 457-458. [ltr. to ed., April 1855] (Link)

• Further remarks on the mode of communication of cholera; including some comments on the recent reports on cholera by the General Board of Health." Medical Times and Gazette 11 (1855): 31-35, 84-88. (Link)

•  "Dr. Snow's report" in Report on the cholera outbreak in the Parish of St. James, Westminster, during the autumn of 1854 presented to the Vestry by the Cholera Inquiry Committee. London, J. Churchill, 1855, pp. 97-120. (Link)

• On the mode of communication of cholera. Edinburgh Medical Journal 1 (1855-56): 668-70. [abbreviated ltr. to ed., 14 December 1855] (Link)

• The mode of propagation of cholera. Lancet, Feb. 16, 1856, p. 184.  (Link) 

• Drainage and water supply in connection with the public health. Med. Times and Gazette, n. s. vol. 16, Feb. 13, 1858, pp. 161-162, Feb. 20, 1858, pp. 188-191. (Link)

•  Cholera and the water supply. Times, June 26, 1856, p. 12, col. B. [ltr. to ed.] (Link)

• On the supposed influence of offensive trades on mortality. Lancet, July 26, 1856, pp. 95-97. (Link)

• Cholera and the water supply in the south districts of London, in 1854. Jour. Pub. Health and Sanitary Rev., vol. 2, Oct. 1856, pp. 239-257. (Link)

• Cholera, and the water supply in the south districts of London. British Med. Jour., Oct. 17, 1857, pp. 864-865. (Link)

• On the outbreak of cholera at Abbey-Row, West Ham. Med. Times and Gazette, n. s. vol. 15, Oct. 24, 1857, pp. 417-419. (Link) 

•  On the origin of the recent outbreak at West Ham." British Medical Journal(November 7, 1857), pp. 934-935. [ltr. to ed., 31 Oct 1857] (Link)

• Drainage and water supply in connexion with the public health. Med. Times and Gazette, n. s. vol. 16, Feb. 13, 1858, pp. 161-162, Feb. 20, 1858, pp. 188-191. (Link)

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