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John Snow and the Cholera Epidemic
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Medicine Through Time – John Snow and Cholera, 1813-58
In this course, Professor Stephen Rachman (Michigan State University) looks at the outbreak of cholera in 19th century England, focusing in particular on the involvement of John Snow. In the first module, we take a look at Snow’s career, specifically focusing on his developing interest in cholera. In the second module, we look at the 19th century debate surrounding the nature of epidemic disease, before in the third module turning to look at Snow’s career in anaesthesia, in particular his experimentation with chloroform. In the fourth module, we trace the evolution of Snow’s theory about cholera, then in the fifth module, we focus in on the Broad Street Cholera Outbreak to assess its significance in shaping Snow’s theory. Finally, in the sixth module, we consider the myths that have developed around Snow, and why these need to be challenged.
John Snow and the Cholera Epidemic
In this module, we look at Snow’s career and contribution to cholera, focusing in particular on: (i) what cholera is, and how it affected England in the 19th century; (ii) Snow’s early theories about cholera and how they were developed in his On the Mode of Communication of Cholera (1849); (iii) Snow’s investigation of the 1854 cholera epidemic, and how this outbreak helped him to develop his theory of cholera; and (iv) the reception of Snow’s theory of cholera and the consequent removal of the Broad Street pump handle.
Hello. My name is Steven Rockman,
00:00:06and I'm a professor in the English department at Michigan State University.
00:00:09But I also have a specialty in the history of medicine,
00:00:13and it's part of that history that I'm going to speak to you about.
00:00:17In this series of lectures,
00:00:22these lectures concern
00:00:24the English physician John Snow, who was born in Yorkshire in 18 13
00:00:26and died in London in 18 58. He lived a short but eventful life
00:00:31in his 45 years,
00:00:38and he is best known to us as a foundational figure
00:00:40in
00:00:45the history and development of anaesthesia
00:00:46and also the history of epidemiology.
00:00:49It is extremely rare for any individual
00:00:52of any kind to make an achievement in such a way in in such important disciplines,
00:00:55but especially for someone coming from humble origins in a working class family in
00:01:00Yorkshire and rising up to become an
00:01:06extremely important figure in Victorian England,
00:01:10and
00:01:14this lecture is going to focus on his life and career to a certain extent.
00:01:16But our particular focal point is his most famous case, uh,
00:01:21the outbreak of cholera in 18, 53
00:01:2754
00:01:30in particular the outbreak that occurred in Broad Street, London,
00:01:31Golden Square and how Snow, uh, developed his own theories from that.
00:01:37Now this is probably the most celebrated incident in his career,
00:01:43but it's also probably the most mythologised that is.
00:01:48There's a lot of inaccurate information that surrounds that.
00:01:52And so the purpose of these lectures are to put your
00:01:55understanding of Snow's achievement and his
00:01:59investigations in a proper historical,
00:02:01uh, medical epidemiological and social context,
00:02:05so that we can evaluate the nature of that achievement without mythologising it.
00:02:09And on another level, we want to think about him as a flexible thinker,
00:02:15a person who was able to make intuitive and, um, uh,
00:02:22rational leaps of insight into problems that were terrifying to
00:02:28the population and baffling to the experts of his day.
00:02:34Given that we have recently gone through a pandemic,
00:02:38I think it should be clear to everyone how important
00:02:42these kinds of skills are for for all of us.
00:02:45And one of the great purposes of study is to be able
00:02:48to take whatever fields of expertise we cultivate and to promote them
00:02:52in a way that is both a benefit to our disciplines, but also to mankind in general.
00:02:59So what did Jon Snow do?
00:03:05Um, in this particular moment that we're thinking about in 18 54 in London that has,
00:03:08uh, led him to be so celebrated.
00:03:17And basically he investigated a cholera epidemic that was going on there,
00:03:20and we need to step back and think about what cholera was in the 19th century.
00:03:25Today, cholera exists everywhere.
00:03:30We usually hear about it when there are outbreaks in
00:03:33refugee camp or any place where there's unsanitary water conditions.
00:03:35We know now that cholera is spread by a bacterium,
00:03:40and that particular bacterium reproduces very quickly,
00:03:45and it dehydrates the body of the infected patient
00:03:49and that dehydration can be very severe and will lead to death if it is untreated.
00:03:52We generally treated by replacing fluids in a person,
00:03:59but all of this was unknown in the 19th century,
00:04:02and Jon Snow did not know for certain about the existence of what would call an, um,
00:04:05al Kyul.
00:04:10Those are germs.
00:04:11Um,
00:04:12that is tiny microscopic organisms that reproduce in bodies
00:04:13or hosts or ever favourable conditions that exist.
00:04:18He had to work through these kinds of health
00:04:22issues through the existing theories of the time,
00:04:26and we will be discussing those in the lectures as well
00:04:29to understand what medical thought was in the period and how his innovations in
00:04:34medical thinking were received and understood and
00:04:40argued about and debated and ultimately accepted.
00:04:44Now cholera came in waves. Its origins are endemic to India and Asia, and
00:04:48what started to happen in the 19th century
00:04:57was as the modern world started to take shape
00:04:59and global shipping routes were developed and there was
00:05:02much more transatlantic or transpacific or transoceanic travel.
00:05:05We started to see epidemic spreading across the world,
00:05:11and they would happen periodically.
00:05:16So far for Jon Snow.
00:05:19Growing up in England,
00:05:21England was visited by a pandemic in 18 32 where cholera struck coming into
00:05:23the ports both in the north and the south of England in particular,
00:05:30and it hit very hard.
00:05:34Then and then there were minor outbreaks that would happen in between.
00:05:36But then the next great outbreak was in 18, 48
00:05:3818 49 and that one hit London particularly hard.
00:05:42And that's the one that John Snow begins to investigate in a serious way.
00:05:47It turns out that in 18 32.
00:05:52He was a young apprentice doctor in Yorkshire and he actually visited, uh,
00:05:54the mines.
00:06:01He was apprenticing in Newcastle and outside of Newcastle,
00:06:02where there are a lot of coal mines.
00:06:05He spent time with coal miners and he, uh, saw the, uh,
00:06:06his first face to face encounters with, um, cholera victims.
00:06:12And and it gave him an understanding of the horror of the disease.
00:06:16But he didn't properly investigate it till he was already
00:06:20a practising physician in London in 18 48 and 18 49
00:06:24after the 18, 48
00:06:3049 epidemic,
00:06:31he came up with the theory that it was transmitted through drinking water
00:06:32or people inadvertently swallowing human waste
00:06:38that contained cholera bacterium and would reproduce
00:06:41in the guts of the individual and then be transmitted either back into
00:06:45the water supply or directly transmitted to
00:06:50another by inadvertent forms of transmission.
00:06:53Then he develops that theory in 18, 40 and 49
00:06:57publishes it
00:07:01in a very important first attempt to try and propound
00:07:03the theory called the mode of Communication of cholera. And
00:07:06this title is important.
00:07:11He would use it again when he refined his theory and mode of communication is
00:07:12such an interesting phrase to use that he wanted to create a neutral phrase,
00:07:17uh, to simply talk about how diseases were transmitted.
00:07:21And he created this general framework for thinking about it without
00:07:25using terms like contagion or my asthma or Hugh moral theories,
00:07:30any of the older models in the history of medicine.
00:07:36He created a study there in 18, 48
00:07:4049 where he propounded his theory.
00:07:43It was not generally accepted,
00:07:45and it certainly wasn't accepted by the Board of Health
00:07:47or any of the powerful medical authorities in London.
00:07:49But there were debates raging over how cholera was spread
00:07:53and people were working on it in many different quarters.
00:07:58He continued his work as a physician and an anesthesiologist, and then in 18, 53
00:08:0454 when cholera returned to London,
00:08:10he knew that he had an opportunity to really open up his study of it and to prove,
00:08:13in a deeper way, his case.
00:08:20And he did that in several ways, which I will talk about in subsequent lectures.
00:08:22But what happens in late summer?
00:08:28Basically August 31st of 18 54 in Broad Street, and the Golden Square area,
00:08:30which is a working class part of London at this time,
00:08:37is a terrible outbreak where up to 600 individuals
00:08:41die with in 10 days or so of cholera,
00:08:46and it seems to be a point source outbreak.
00:08:49And Jon Snow is contacted by the parish there
00:08:53to aid in the investigation of this outbreak,
00:08:58which is being led by a reverend who
00:09:00is also an epidemiologist named Henry Whitehead,
00:09:03and between basically August 31st, 18 54 and September 8th or ninth.
00:09:05A great number of individuals
00:09:14die
00:09:16of
00:09:17cholera very quickly, and they're sort of overwhelmed by it. And Jon Snow
00:09:18has already had his theory for a long time.
00:09:24In fact,
00:09:27he's he's doing a long sort of survey at
00:09:27the point when the outbreak occurs in south London to
00:09:30look at the water supplies of South London in
00:09:33order to prove that water is the main vector,
00:09:36as we call it for cholera.
00:09:39And so he diverts himself from that study and goes and does,
00:09:41based on the morbidity records that are coming in
00:09:46a study of the deaths that are going on
00:09:50in Broad Street and he already suspects that water might be the agent.
00:09:53And he knows that there is a pump in Broad Street there,
00:09:58and he begins to start to trace evidence that might connect a contamination
00:10:04in that pump in Broad Street to the outbreak that occurs there.
00:10:10He
00:10:15makes inquiries on his own.
00:10:17He, uh,
00:10:19combines those with information coming from the General
00:10:20Records office and the General Registrar's Office,
00:10:23That is.
00:10:26And he, um,
00:10:26uses those pieces of evidence to come before the board and then request that the
00:10:29handle on that pump be removed as a public safety measure in order to mitigate the
00:10:37effects of the outbreak there. And that is agreed to and the pump handle is removed.
00:10:48And Jon Snow
00:10:55becomes,
00:10:58uh, one of the people whose,
00:11:01whose most sort of celebrated for this public health gesture Now, at the time,
00:11:03the Board of Health and the larger London authorities did not
00:11:09necessarily accept his conclusion that the pump handle being removed was,
00:11:12uh was necessary, Uh, that this was a, in fact,
00:11:18proof that water was the sole mode of transmission.
00:11:23But it has come down to us, sort of as
00:11:26one of those very important cases in the history of epidemiology,
00:11:29where a public health understanding
00:11:34takes on symbolism and it takes on a kind of public symbolism.
00:11:38Now, in 18, 55 people were still complaining that the pump handle had been removed,
00:11:42and they wanted to put back on because they liked the drinking water in Broad Street.
00:11:47But on a larger level,
00:11:51Jon Snow's actions here came to symbolise a sense
00:11:54of how an informed medical opinion could not prevent
00:11:59an epidemic as it was happening, but rather when the next epidemic occurred in 18, 66
00:12:06people were now prepared.
00:12:12And they now understood in a more clear and settled way that if
00:12:14there were these kinds of outbreaks where there seemed to be a point source
00:12:18that you could
00:12:23clearly identify that might be a public health threat,
00:12:24it would be prudent to take public health measures and to save the population
00:12:29from that. And that's precisely what happened in 18 66.
00:12:33Now Jon Snow died in 18 58 and he did not live to see that recognition.
00:12:37But nonetheless,
00:12:44it stands as a kind of symbol for how human beings can face
00:12:46the terrifying prospect of epidemic disease and through
00:12:52the cogent power of shoe leather epidemiology,
00:12:57going house to house, making inquiries,
00:13:02find what the mysterious modes of transmission
00:13:05are and make prudent recommendations about them.
00:13:09
Cite this Lecture
APA style
Rachman, S. (2022, November 21). Medicine Through Time – John Snow and Cholera, 1813-58 - John Snow and the Cholera Epidemic [Video]. MASSOLIT. https://massolit.io/courses/medicine-through-time-john-snow-and-cholera-1813-58-rachman/snow-and-the-broad-street-cholera-outbreak
MLA style
Rachman, S. "Medicine Through Time – John Snow and Cholera, 1813-58 – John Snow and the Cholera Epidemic." MASSOLIT, uploaded by MASSOLIT, 21 Nov 2022, https://massolit.io/courses/medicine-through-time-john-snow-and-cholera-1813-58-rachman/snow-and-the-broad-street-cholera-outbreak