A well-written and well-researched look at London’s cholera epidemic in 1834. London at that time was a growing city with no effective infrastructure for municipal services such as safe water or effective waste management. People would just collect their … waste… and either throw it down into the cellar where it stayed until things got unmanageable and the inhabitants called for the Night Soil Man to come and clean it out (which must rank up there in the World’s Most Disgusting Jobs of the Victorian Era).
And this custom of throwing the human waste out of the window into the nearest drain was exactly how the particular epidemic started. Cholera kills many and it kills fast, especially when the vast majority of health officers believe in the Miasma theory (or that the epidemic was caused by noxious smells which, of course, were everywhere then).
A medical doctor, Dr. John Snow, decided to try to work out how the cholera epidemic was spreading and why. There didn’t seem to be a pattern to the Miasma theory – if this was true, wouldn’t the people who work with the smelliest jobs be getting sick? Well, they weren’t so Snow knew there was something else to look for. However, he was going against the widely held belief of Miasma, so he knew that when he found the answer, it would be hard going to convince the Powers that Be.
Snow recognized that the cholera was being spread through water – every city area had its own water pump where neighbors would go for their daily supplies, and it was common knowledge that some pump water tasted better than others. The Broad Street pump was the one in focus in regards to the cholera epidemic, and although Snow convinced the Board of Health to remove the pump handle (thereby making it unusable), it was not enough to sell the theory of water-borne contamination.
At the same time, a young curate Charles Whitehead was doing his own detective work although Snow didn’t know that at the time. Whitehead had an intimate knowledge of the surrounding community, and by asking questions and tracking down affected families, he worked out that it also came from the Broad Street pump.
So, between Snow and Whitehead, the waterborne contamination theory was proven, but not without a big fight to convince the powerful London Board of Health (who had the power to change things). By disease mapping in various ways (i.e. drawing a map which reflected which houses where were affected by the epidemic from a birds-eye view), the board cut off the water supply to that particular pump, but it was a couple of years before they were fully convinced by the waterborne theory.
What is particularly notable about this case is that this marked the very first time that a public institution (i.e. the Board of Health) had made an informed decision based on scientific theory. Before everything had been based on the Mediaeval miasma theory (which was never proven using the scientific method). So, in effect, this cholera epidemic changed the whole future for urban environments – it lead to the formation of a new effective and safe sewer system for the city, it lead to the formation of the study of epidemiology, it introduced the concept of public health…
Overall, I really enjoyed this book as it is in a field that I particularly love – public health. Unfortunately, public health funding in the US tends to move like a pendulum in that it either receives tons of public funding so disease goes down which leads people to believe that there is no need for public health which leads to disease going up which means the funding returns because there is a problem.
My city is having a public hearing this afternoon on whether to close its own City Health Department which seems to me to be a *very* short-sighted thing to do. When a problem (such as STDs, vaccination etc.) is everyone’s problem, it’s no one’s problem and so nothing usually gets done. Public health needs to have a leader, a headquarters, and the City Health department provides that. It’s unbiased, it covers most of the bases, and it’s just the right thing to do. Fingers crossed that they don’t close the department, but
I wouldn’t be surprised if they do, as that’s where the funding pendulum seems to be right now.
Update (edited 08/22/11): The City Council will be reviewing the decision to shut City Health over the next 90 days. However, most of the employees will be RIF’d at the end of the month, so not sure how this will change things. We will see.
Public health will be re-funded at some point in the future, but only when a big community health problem raises its head.
Back to the book (and off my Public Health Soapbox): this was a good read with a very nice bibliography at the end of it for further reading.
This was an Inter-Library Loan. Hooray for Texas libraries.