28-29 that lead to her death on September 2nd. Both contained physiological reasoning as to why the gastrointestinal tract was the likely port of entry and port of exit for the cholera agent, together with clinical observations and details of several outbreaks which could only plausibly be explained by the transmission of an infectious agent of disease. Shapter, himself, considered cholera ‘essentially an epidemic, originating in, and chiefly due to, aerial influences, but capable, under peculiar and rare conditions, of being transmitted from man to man’. An Dr. John Snow is credited with taking bold action when he Philadelphia: Open University Press, 1994. A stranger had asked in a modest speech for a brief Snow J. Body and City: Histories of Urban Public Health. That the new organisms are developed only in the human intestine. Thus cholera was highly dependent on social circumstances, but through determining patterns of exposure, rather than through lowering general health, reducing the strength of people and thus increasing their susceptibility.88 As Snow pointed out, genteel people contracted cholera if exposed to contaminated water.6 Wealthy people could generally avoid this, however, making their experience of cholera considerably more favourable to that of the poor. The duty itself we may evade, but we cannot evade the sure penalties of its neglect. Pelling M. Cholera, Fever and English Medicine 1825–1865. Williams AS. On the supposed influence of offensive trades on mortality. of the blue cholera of India. fecal matter through the decayed brickwork of the cesspool to the well which was After indicating that they were using contagion and infection synonymously (because some authorities used these terms to designate distinct transmission modes13), the Lancet also discussed evidence against the contagious nature of cholera, but they dismissed this and advocated quarantine and sanitary measures. By mapping the disease outbreak he identified a specific London water source, the Broad Street pump, as its proximate cause. London had suffered a series of debilitating cholera outbreaks before the 1853 outbreak, including serious outbreaks in 1832 and the worst outbreak which killed some 14,137 residents in 1849. hearing. Snow reported crude death rates from cholera by London district, and drew attention to the higher rates in South and East London, which he attributed to differences in water supply. With respect to cholera in the mid-19th century the distinction between unifactorial and multifactorial approaches has several dimensions. © 2020 Atlas Obscura. On the communication of cholera by impure Thames water. Hand bill from the New York Board of Health, 183229, if habit have rendered it indispensable, take much less. By the mid-19th century this was less of an issue. He Chave SPW. Vestry was incredulous but had the good sense to carry out the advice. The Broad Street Pump newsletter provides up-to-date information about important or interesting communicable disease outbreaks and measures taken to identify and control them; epidemiological trends; and new developments in diagnosis and typing of pathogens of public health importance. sensed that contaminated water from the public pump on Broad Street was the John Snow’s conviction about the source for the London outbreak and his concern for public health compelled him to oppose the popular beliefs of his time and convince the local council in London’s West End to disable the water pump on Broad Street. removal of the pump-handle had nothing to do with checking the outbreak which Philadelphia: WB Saunders Co., 1996. The fact that rates of mortality for many diseases began to decline well before there were effective medical interventions102 attests to this, with the particular contribution of motivated attempts to increase the salubrity of the environment, by non-medical and medical interests, making an important contribution.103 But this is not automatically the case—cigarette smoking was adopted initially by the better off, who also used to be more obese than the poor. II The London Bridge—It never fell. Therefore, in the current issue of the International Journal of Epidemiology we reprint a section of Dr John Sutherland’s report for the General Board of Health on the 1848–1849 British cholera epidemic (Figure 1), together with a series of commentaries.8–10 The extracts from Sutherland’s report include his investigation of the effect of water source on cholera risk in Salford, Manchester, which was briefly referred to by Snow6 and has occasionally been recognized as a seminal investigation.11,12 The discussion by Sutherland of the implications of his finding are clearly at variance with those of Snow, who more strongly emphasized the necessary transmissible element in generating cholera (and thus in triggering epidemics), but Sutherland’s utilization of quantitative data is striking. Others pointed out that cholera in India followed the pathsof rivers. did they respond as they did to Dr. Snow J. Cholera and the water supply in the South districts of London, in 1854. Winkelstein W. A new perspective on John Snow’s Communicable Disease Theory. This fact was pointed out by Reverend Henry Whitehead, a local priest and fellow member of the parish inquiry committee who had initially been a critic of Snow, but after his own investigation came to support Snow’s conclusions. He created a map depicting where cases of cholera occurred in London’s West End and found them to be clustered around a water pump on Broad Street. On the mode of propagation of cholera. A report from the General Board of Health (of which Edwin Chadwick and Southwood Smith were authors) published in 1850 quoted the evidence from Sutherland’s report, which we excerpt in this issue of the International Journal of Epidemiology, and other findings that implicated unwholesome water. Davey Smith G, Ebrahim S, Frankel S. How policy informs the evidence. As physicians, we can be watchful over the smaller communities that we serve; we can identify environmental factors that affect the health of our patients and their families; and, when we come across something that is causing harm to our patients, we can have the courage of John Snow to turn off the Broad Street pump. Aldershot: Ashgate Publishing, 2000. But, on re-perusing the passage and its context, we found that these deaths had taken place in all districts supplied by the two companies, separately or conjointly. Pascual M, Bouma MJ, Dobson AP. "I had an interview Cambridge Group for the History of Population and Social Structure Working Paper Series, No. From John Sutherland’s report on the 1854 cholera epidemic in London33. It has been suggested that his first-hand research into the subject may have lead to his early demise. Moreover, just as theories of disease contained nuances that a binary opposition ignores, political, economic and social beliefs were not simply polarized between two or three cores. Epidemiology in Medicine. ScienceDirect ® is a registered trademark of Elsevier B.V. ScienceDirect ® is a registered trademark of Elsevier B.V. John Snow, the Broad Street pump and the precautionary principle. Richardson BW. However, many people were furious that the pump had been shut down. Timmreck TC. cesspool and thence to the well. His friend and biographer, Benjamin Ward Richardson (a prominent member of The Epidemiological Society of London), wrote that the theory was referred to as ‘Dr Snow’s theory’.40 Snow was particularly concerned with priority, a typical example being a letter in the Lancet in 1856 complaining that a paper had attributed the water-borne theory to William Budd.41 Snow stated that Budd had adopted his views, but that he (Snow) had: not made the above remarks in the way of complaint; but as my researches respecting cholera were conducted with great labour, and very much to the detriment of my more immediate interests, I feel it a duty not to allow the credit of them to pass from me by a mere mistake.41, Others were chided by Snow for ignoring his crucial contribution.42. Budd G, Busk G. Report of twenty cases of malignant cholera that occurred in the Seamen’s Hospital, Dreadnought, between the 8th and 28th of October, 1837. In the 1830s epidemiological and public health approaches to cholera were being developed in the context of some understanding of the contagious nature of some diseases, in particular smallpox and syphilis, but with little agreed differentiation of the fevers.

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