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Too unpleasant for most of the public to contemplate: The Political Stupidity of the 19th Century

snow and well

The medical series, House, M.D. makes excellent television for many interested in the health field. As the foundation of the diagnostics department, Dr Greg House uses his exceptional knowledge of medicine, infectious and chronic diseases, and even aspects of psychology to unravel the causes of his patient’s illness. Few hospitals actually have departments of diagnostic medicine however, and even the very largest hospitals in the United States employee few diagnosticians. While House, MD is fun viewing, a real-life diagnostician and one of the founders of epidemiology had fought public ignorance and even politics by insisting that diseases had direct, understandable causal agents.

Dr. John Snow was born March 15, 1813 and died on 16 June in 1858. John Snow was a major force in the adoption of the use of anesthesia and in medical hygiene. Snow was considered one of the founding fathers of epidemiology for his work in tracing the source of a cholera outbreak in Soho, London, in 1854.

After graduating from his medical studies, Snow began work at the Westminster Hospital in 1837. During Snow’s time, the dominant theory of disease was that miasma or gases in the air were the cause of plagues and illness. The germ theory had not yet been developed. Snow was not content in the miasma theory, instead seeking a direct cause of disease. During a major outbreak of cholera in Soho, Snow and his team of investigators begin talking to local residents about the onset of their sickness, their symptoms, and the course of their illness. By using a pinpoint chart, they were able to identify the source of the cholera outbreak as a public water pump on Broad Street. Although Snow’s chemical and microscope examination of a water sample from the Broad Street pump did not 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.

 

Snow used biostatistics to illustrate the connection between the quality of the water source and cholera cases. He showed that the Southwark and Vauxhall Waterworks Company had been taking water from sewage-polluted sections of the Thames and delivering the water to homes, leading to an increased incidence of cholera. Snow’s study was a major event in the history of public health and geography, and Snow was one of the founding members of the Epidemiological Society of London.

Snow wrote:

“On proceeding to the spot, I found that nearly all the deaths had taken place within a short distance of the 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 prevalence 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.” —John Snow, letter to the editor of the Medical Times and Gazette

Researchers later discovered that this public well had been dug only three feet from an old cesspool, which had begun to leak fecal bacteria. Ironically, politics intervened, after the cholera epidemic had subsided. Government officials replaced the Broad Street Pump Handle, and they had responded only to the urgent threat posed to the population, and afterward they rejected Snow’s theory. To accept his proposal would have meant indirectly accepting the oral-fecal method transmission of disease, which they believed was “too unpleasant for most of the public to contemplate.”

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