1238 6
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INTERNATIONAL JOURNAL OF EPIDEMIOLOGY
Report by Dr Sutherland. Extracts from Appendix (A) to the Report of the General Board of Health on the Epidemic Cholera of 1848 & 1849 (reprinted from HMSO 1850). Int J Epidemiol 2002;31:900–07. Ackerknecht EH. Anticontagionism between 1821 and 1867. Bull Hist Med 1948;22:562–93. Krieger N. Letter to Editor re: Who made John Snow a hero? Am J Epidemiol 1992;135:450–51. Vandenbroucke JP. The 1855 cholera epidemic in Ferrara: lessons from old data reanalysed with modern means. Eur J Epidemiol 2003;18:599–602.
10 11 12
13
Lilienfeld DE. John Snow—The first hired gun? Am J Epidemiol 2000;152:4–9. Vandenbroucke JP. Invited Commentary: The testimony of Dr Snow. Am J Epidemiol 2000;152:10–12. Vandenbroucke JP, Eelkman Rooda HM, Beukers H. Who made John Snow a hero? Am J Epidemiol 1991;133: 967–73. Winkelstein W. A new perspective on John Snow’s Communicable Disease Theory. Am J Epidemiol 1995; 142:S3–S9.
Published by Oxford University Press on behalf of the International Epidemiological Association ß The Author 2013; all rights reserved.
International Journal of Epidemiology 2013;42:1238–1239 doi:10.1093/ije/dyt140
Sandra Hempel www.sandrahempel.co.uk. E-mail: [email protected]
Accepted
2 February 2013
John Snow’s 1856 paper ‘On the Supposed Influence of Offensive Trades on Mortality’1 was published against a background of debate about the role of offensive smells, or miasma, in the morbidity and mortality of the population. Much of the argument focused upon the transmission of fevers and epidemic diseases and whether they were contagious: especially cholera, which during the previous 25 years had killed over 100 000 people in Britain in three nationwide epidemics. In 1856 the miasmatists were in the ascendant. Ten years earlier Edwin Chadwick, who was to become head of the Board of Health, had told MPs: ‘. . . . we may say that, by depressing the system and rendering it susceptible to the action of other causes, all smell is disease’.2 By 1856 though, John Snow had accumulated a sizeable body of evidence to support his theory that cholera was an intestinal disease spread via the oral-faecal route, mainly through polluted drinking water.3 In the mid-1850s many accepted that polluted water sometimes had a part to play, but only as one of several possible contributory factors rather than as the primary cause. The summer of 1854 saw the famous incident of the Broad Street pump when Snow persuaded the parish authorities in Soho to remove the pump handle in an attempt to stop a particularly virulent cholera
outbreak. More importantly that summer, however, Snow had carried out his Grand Experiment in South London, comparing the numbers of cholera deaths in those households that obtained their water from the Southwark and Vauxhall company with those in households supplied by the Lambeth company. Southwark and Vauxhall pumped their water unfiltered from the Thames close to where the sewage of the capital was discharged. Lambeth, however, had moved its works to rural Thames Ditton, beyond the reach of the filth. In the first 4 weeks of the epidemic, mortality was 14 times greater among the Southwark and Vauxhall customers than among Lambeth customers, Snow found.2 Also in the summer of 1854, the British Government recruited its own team of doctors, chemists, microscopists [microbiologists] and meteorologists to conduct a wide-ranging investigation of the causes, transmission and treatment of epidemic cholera. The experts finally concluded that ‘after careful inquiry’, they saw no reason to adopt Snow’s belief that cholera was largely waterborne. Cholera, they said, was not contagious but caused by ‘a wandering ferment’ in the atmosphere.4 Three months before this report was published in 1855, John Snow appeared before a parliamentary committee studying the proposed Nuisances
Downloaded from http://ije.oxfordjournals.org/ at UNIVERSIDAD DE SEVILLA on June 15, 2015
Commentary: on ‘On the Supposed Influence of Offensive Trades on Mortality’
‘ON THE SUPPOSED INFLUENCE OF OFFENSIVE TRADES ON MORTALITY’
The MPs seemed incredulous. Snow was asked: Do you not know that the effect of breathing such tainted air [i.e. the smell of rotting animal or vegetable matter] often is to produce violent sickness at the time? He replied: Yes, when the gases are in a very large quantity . . . Do you mean to tell the committee that when the effect is to produce violent sickness there is no injury produced to the constitution or health of the individual? Snow replied: No fever or special disease. The final legislation was far less draconian on the nuisance traders than originally proposed. The Lancet, under its founder editor, the surgeon and politician Thomas Wakley, was savage in its criticism of the manufacturers and of John Snow. The Bill had come up against ‘formidable opposition from a host of vested interests in the production of pestilent vapours, miasms, and loathsome abominations of every kind’, the Lancet claimed.6 The journal continued that although Snow said that the effluvia from bone-boiling were not in any way prejudicial to health and that ordinary decomposing matter would not produce disease in the human subject, he admitted that gases from the decay of animal matter might produce vomiting but said this would not be injurious unless frequently repeated. ‘Is this scientific evidence? Is it consistent with itself?’ Wakley asked.
The following year Snow submitted ‘On the Supposed Influence . . . .’ to the Lancet.1 This paper looked at deaths from all causes rather than only from acute fevers and epidemic disease, as Snow had done in his testimony to the MPs, and put forward evidence that workers in offensive trades did not suffer more ill health than other workers. As well as presenting the statistics that informed his reasoning, here Snow also repeats a point he had made to the MPs: that is, if offensive smells were injurious to health then individuals working close to the source would be at greater risk. Two years after publication of ‘On the Supposed Influence. . . .’, in June 1858, John Snow died of what was almost certainly a stroke, aged 45. As he lay on his deathbed that hot summer, Londoners were feeling the force of what became known as the Great Stink. The Thames, virtually an open sewer at the time, began giving off a particularly appalling stench, and MPs in the Houses of Parliament, right on the river, found themselves especially exposed. In breathing the foulness, however, the politicians were given a first-hand demonstration of the argument Snow had put before them: there was no outbreak of disease among their number or among Londoners generally. Conflict of interest: None declared.
References 1
2 3 4
5
6
Snow J. On the Supposed Influence of Offensive Trades on Mortality. Lancet 1856;ii:95–97. Reprinted Int J Epidemiol 2013;42:1233–35. Metropolitan Sewage Commission Proceedings. Parliamentary Papers 1846;10:651. Snow J. On the Mode of Communication of Cholera. 2nd ed. London: Churchill, 1855. General Board of Health. Report of the Committee for Scientific Inquiries in Relation to the Cholera Epidemic of 1854. London: HMSO, 1855. Irish University Press Series of British Parliamentary Papers. Medical relief and public health. In Health: General. Vol 8. Shannon, Ireland: Irish University Press, 1968. Vinten-Johansen P, Brody H, Paneth N et al. Editorial. Lancet 1855;i:634–35.
Downloaded from http://ije.oxfordjournals.org/ at UNIVERSIDAD DE SEVILLA on June 15, 2015
Removal and Diseases Prevention Act. This legislation aimed to control ‘nuisance trades’ such as tanning and soap-making that produced bad smells largely from rotting animal matter and therefore, according to the miasmatists, were by definition deleterious to health. Snow appeared on behalf of the manufacturers. ‘I have arrived at the conclusion with regard to what are called offensive trades, that many of them really do not assist in the propagation of epidemic diseases, and that in fact they are not injurious to the public health’, he told the MPs. ‘I consider that if they were injurious to the public health they would be extremely so to the workmen engaged in those trades, and as far as I have been able to learn, that is not the case’.5
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INTERNATIONAL JOURNAL OF EPIDEMIOLOGY
Report by Dr Sutherland. Extracts from Appendix (A) to the Report of the General Board of Health on the Epidemic Cholera of 1848 & 1849 (reprinted from HMSO 1850). Int J Epidemiol 2002;31:900–07. Ackerknecht EH. Anticontagionism between 1821 and 1867. Bull Hist Med 1948;22:562–93. Krieger N. Letter to Editor re: Who made John Snow a hero? Am J Epidemiol 1992;135:450–51. Vandenbroucke JP. The 1855 cholera epidemic in Ferrara: lessons from old data reanalysed with modern means. Eur J Epidemiol 2003;18:599–602.
10 11 12
13
Lilienfeld DE. John Snow—The first hired gun? Am J Epidemiol 2000;152:4–9. Vandenbroucke JP. Invited Commentary: The testimony of Dr Snow. Am J Epidemiol 2000;152:10–12. Vandenbroucke JP, Eelkman Rooda HM, Beukers H. Who made John Snow a hero? Am J Epidemiol 1991;133: 967–73. Winkelstein W. A new perspective on John Snow’s Communicable Disease Theory. Am J Epidemiol 1995; 142:S3–S9.
Published by Oxford University Press on behalf of the International Epidemiological Association ß The Author 2013; all rights reserved.
International Journal of Epidemiology 2013;42:1238–1239 doi:10.1093/ije/dyt140
Sandra Hempel www.sandrahempel.co.uk. E-mail: [email protected]
Accepted
2 February 2013
John Snow’s 1856 paper ‘On the Supposed Influence of Offensive Trades on Mortality’1 was published against a background of debate about the role of offensive smells, or miasma, in the morbidity and mortality of the population. Much of the argument focused upon the transmission of fevers and epidemic diseases and whether they were contagious: especially cholera, which during the previous 25 years had killed over 100 000 people in Britain in three nationwide epidemics. In 1856 the miasmatists were in the ascendant. Ten years earlier Edwin Chadwick, who was to become head of the Board of Health, had told MPs: ‘. . . . we may say that, by depressing the system and rendering it susceptible to the action of other causes, all smell is disease’.2 By 1856 though, John Snow had accumulated a sizeable body of evidence to support his theory that cholera was an intestinal disease spread via the oral-faecal route, mainly through polluted drinking water.3 In the mid-1850s many accepted that polluted water sometimes had a part to play, but only as one of several possible contributory factors rather than as the primary cause. The summer of 1854 saw the famous incident of the Broad Street pump when Snow persuaded the parish authorities in Soho to remove the pump handle in an attempt to stop a particularly virulent cholera
outbreak. More importantly that summer, however, Snow had carried out his Grand Experiment in South London, comparing the numbers of cholera deaths in those households that obtained their water from the Southwark and Vauxhall company with those in households supplied by the Lambeth company. Southwark and Vauxhall pumped their water unfiltered from the Thames close to where the sewage of the capital was discharged. Lambeth, however, had moved its works to rural Thames Ditton, beyond the reach of the filth. In the first 4 weeks of the epidemic, mortality was 14 times greater among the Southwark and Vauxhall customers than among Lambeth customers, Snow found.2 Also in the summer of 1854, the British Government recruited its own team of doctors, chemists, microscopists [microbiologists] and meteorologists to conduct a wide-ranging investigation of the causes, transmission and treatment of epidemic cholera. The experts finally concluded that ‘after careful inquiry’, they saw no reason to adopt Snow’s belief that cholera was largely waterborne. Cholera, they said, was not contagious but caused by ‘a wandering ferment’ in the atmosphere.4 Three months before this report was published in 1855, John Snow appeared before a parliamentary committee studying the proposed Nuisances
Downloaded from http://ije.oxfordjournals.org/ at UNIVERSIDAD DE SEVILLA on June 15, 2015
Commentary: on ‘On the Supposed Influence of Offensive Trades on Mortality’
‘ON THE SUPPOSED INFLUENCE OF OFFENSIVE TRADES ON MORTALITY’
The MPs seemed incredulous. Snow was asked: Do you not know that the effect of breathing such tainted air [i.e. the smell of rotting animal or vegetable matter] often is to produce violent sickness at the time? He replied: Yes, when the gases are in a very large quantity . . . Do you mean to tell the committee that when the effect is to produce violent sickness there is no injury produced to the constitution or health of the individual? Snow replied: No fever or special disease. The final legislation was far less draconian on the nuisance traders than originally proposed. The Lancet, under its founder editor, the surgeon and politician Thomas Wakley, was savage in its criticism of the manufacturers and of John Snow. The Bill had come up against ‘formidable opposition from a host of vested interests in the production of pestilent vapours, miasms, and loathsome abominations of every kind’, the Lancet claimed.6 The journal continued that although Snow said that the effluvia from bone-boiling were not in any way prejudicial to health and that ordinary decomposing matter would not produce disease in the human subject, he admitted that gases from the decay of animal matter might produce vomiting but said this would not be injurious unless frequently repeated. ‘Is this scientific evidence? Is it consistent with itself?’ Wakley asked.
The following year Snow submitted ‘On the Supposed Influence . . . .’ to the Lancet.1 This paper looked at deaths from all causes rather than only from acute fevers and epidemic disease, as Snow had done in his testimony to the MPs, and put forward evidence that workers in offensive trades did not suffer more ill health than other workers. As well as presenting the statistics that informed his reasoning, here Snow also repeats a point he had made to the MPs: that is, if offensive smells were injurious to health then individuals working close to the source would be at greater risk. Two years after publication of ‘On the Supposed Influence. . . .’, in June 1858, John Snow died of what was almost certainly a stroke, aged 45. As he lay on his deathbed that hot summer, Londoners were feeling the force of what became known as the Great Stink. The Thames, virtually an open sewer at the time, began giving off a particularly appalling stench, and MPs in the Houses of Parliament, right on the river, found themselves especially exposed. In breathing the foulness, however, the politicians were given a first-hand demonstration of the argument Snow had put before them: there was no outbreak of disease among their number or among Londoners generally. Conflict of interest: None declared.
References 1
2 3 4
5
6
Snow J. On the Supposed Influence of Offensive Trades on Mortality. Lancet 1856;ii:95–97. Reprinted Int J Epidemiol 2013;42:1233–35. Metropolitan Sewage Commission Proceedings. Parliamentary Papers 1846;10:651. Snow J. On the Mode of Communication of Cholera. 2nd ed. London: Churchill, 1855. General Board of Health. Report of the Committee for Scientific Inquiries in Relation to the Cholera Epidemic of 1854. London: HMSO, 1855. Irish University Press Series of British Parliamentary Papers. Medical relief and public health. In Health: General. Vol 8. Shannon, Ireland: Irish University Press, 1968. Vinten-Johansen P, Brody H, Paneth N et al. Editorial. Lancet 1855;i:634–35.
Downloaded from http://ije.oxfordjournals.org/ at UNIVERSIDAD DE SEVILLA on June 15, 2015
Removal and Diseases Prevention Act. This legislation aimed to control ‘nuisance trades’ such as tanning and soap-making that produced bad smells largely from rotting animal matter and therefore, according to the miasmatists, were by definition deleterious to health. Snow appeared on behalf of the manufacturers. ‘I have arrived at the conclusion with regard to what are called offensive trades, that many of them really do not assist in the propagation of epidemic diseases, and that in fact they are not injurious to the public health’, he told the MPs. ‘I consider that if they were injurious to the public health they would be extremely so to the workmen engaged in those trades, and as far as I have been able to learn, that is not the case’.5
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