London, 1832. A cholera outbreak killed about 5,000 people, some dying within eight hours of reporting illness. John Snow was apprenticed to a colliery surgeon, providing unqualified help during the outbreak of cholera in Newcastle. After witnessing the spread and effect of the disease he went to medical school, and then the Royal College of Surgeons, finally qualifying as a physician in 1844.
Cholera is in the Air
In 1849 Snow published a paper that went against the thinking of the time, stating that cholera was waterborne. More experienced physicians refuted these claims, asserting that cholera was transmitted by bad air. With open sewers in the poorer parts of London this was not an unreasonable assumption.
Cholera is Back
Five years later cholera struck London again. In late August of 1854 people were falling sick in Golden Square and the streets around it, with some dying 12 hours after symptoms appeared. Medical treatment was scarce, and some hospitals would not accept patients with infectious diseases. As cholera was still believed to be transmitted through bad air, healthy people avoided the sick. Families were lying, and dying, helpless and crowded in their small airless rooms.
The Map
Convinced that he knew the route of contagion, Dr. Snow set out to prove his theory. He created a map and added a mark for the people who had died. The cholera cases were all centered around a water pump on Broad Street, which provided free water for locals from a well below ground. Snow also looked at water samples under a microscope, but did not know what he was looking for and didn’t find anything. He took his map to the Board of Governors.
The Authorities
Snow wanted the Board to order the pump handle to be removed. At first the Board refused to do this, because the belief that the infection was miasmal, or caused by evil vapors, was so prevalent. Snow insisted, using his map to demonstrate the spread of the disease, and the Board allowed him to remove the pump handle. The result was obvious in couple of days; there were no new cases.
While Snow was pressing his case with the Board of Governors and having to convince physicians too, other people were putting pieces of the jigsaw together. A curate, who knew the local people well, remembered a sick child whose diapers had been rinsed at the pump. This was the source of the infection in the Broad Street Pump.
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In the same year of 1854 Filippo Pacini, an Italian physician with a powerful microscope (for the time) was performing autopsies on patients who died of cholera. He found a comma shaped bacillus in the intestines of the bodies.
Vibrio Cholerae
Pacini called the bacillus a Vibrio and published a paper describing his findings and implications. The paper was unknown to Snow, who died in 1858, his theory unproved. Pacini died in 1883 and in 1884 Robert Koch, a German physician, celebrated his own discovery of the Vibrio. It is unlikely that he had seen Pacini’s paper. Koch had isolated the tuberculosis bacillus in 1882 and was a founder of the science of bacteriology, receiving the Nobel Prize in 1905.
Each of these men defied the prevailing opinions of the time, but it took improvements in microscopy for the question of cholera infection to finally be answered. John Snow is famous for being the first epidemiologist and the first medical geographer. It is through the efforts of men like him that we have greater longevity than our forebears of two centuries ago.
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