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See this guy? He is afraid for his life. This drawing is an 1832 joke - it's a riff
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on how nobody knew how to prevent cholera. You might suspend acorus over your masked
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mouth, or wear a copper breastplate, and tie pitchers of water behind your calves.
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Anything to keep the disease away. Starting in the 1830s, cholera pandemics swept
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the United Kingdom. Nobody knew how the disease was transmitted.
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Germs weren't an established idea. One London doctor — John Snow — tried
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to find out how the diseases spread, and today, one of his investigations is iconic in the
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field of epidemiology. And it all centered on a pump.
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This is a map John Snow made to prove his solution to the cholera mystery in London.
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It also shows the confusion and the problems he was up against.
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Each of these bars represents a death from cholera.
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The disease often killed half the people who got it — it caused vomiting and diarrhea.
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The rapid loss of fluids was fatal. At the time, a lot of people believed cholera
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was transmitted in a “miasma” — imagine an evil cholera cloud.
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This typical map from the 1840s shows a cholera “mist” that was blamed for transmission.
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Snow suspected a different source. At the time, people usually didn't get water
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directly in their homes. It came from a neighborhood pump connected
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to one of the few water companies in the city. John Snow mapped different water company's
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service areas in London. You can see how they are occasionally separate,
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and occasionally overlap. If a common pump was contaminated at any point
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— at the source or near the pump — Snow believed the water could kill.
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In 1849, he wrote that his study of symptoms and specific cases had led him to suspect
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'the emptying of sewers into the drinking water of the community," caused outbreaks
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— not a miasma. Five years later, he had a chance to prove
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it — and stop a fresh outbreak in the process. In August 1854, 20 people lived here at 40
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Broad Street, including an infant who died of cholera. After her death, Snow started
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to investigate the outbreak. He didn't think the original water source
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was the problem, but he thought something might be wrong down the line, at the pump.
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He took samples of the water. They seemed clean.
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But he wasn't satisfied, because more people were getting sick.
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He asked questions up and down the street, where one man had noticed a bad smell from
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his water. Snow asked the registrar for a list of people
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who'd died. He started going house by house to interview
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the survivors - and many of the dead had taken water from the pump.
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He became convinced the Broad Street Pump was the common link among the dead.
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He wrote, “I had an interview with the Board of Guardians of St. James's Parish on the
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evening of Thursday, 7th September, and represented the above circumstances to them. In consequence
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of what I said, the handle of the pump was removed on the following day.”
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People stopped using the water. But Snow had not won yet. Newspapers reported
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the streets were covered in lime — the city was using it as “a powerful disinfectant”
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on the streets. That showed they weren't fully convinced
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the pump was the problem. They still suspected miasma.
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So Snow bolstered his case through investigation and recording.
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He learned the 18 workers who died at this factory had drunk from big barrels of water
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drawn from the pump. At the same time, unlikely survivors could
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serve as proof of Snow's theory. According to the miasma theory, this place
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would've been covered in cholera clouds, affecting all workers.
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But Snow learned the workhouse had its own well — no bad water got in.
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The same went for this brewery. That's because Snow learned the workers
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there drank from the brewery's water supply or, more likely, only drank the free malt
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liquor they got on the job. That's right, drinking on the job saved
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their lives. Snow strengthened his argument and his map.
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He adjusted the location of the pump to show how close it was to 40 Broad Street and drew
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a dotted line - he showed a zone where it would be closest to walk to the Broad Street
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pump, rather than another one. That zone is where most people died.
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He tabulated every death, by date, to do it. This was paired with a local Reverend's
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similar data-driven investigations. A local surveyor looked at the plumbing at
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40 Broad Street, where the infant had died. He learned that the cesspool, where sewage
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collected, was poorly designed and lined with decaying bricks.
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When the infant's diapers had been washed, the cholera-carrying water had leaked into
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the Broad Street pump's supply. John Snow died in 1858. His obituary read,
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“Dr John Snow: This well-known physician died at noon, on the 16th instant, at his
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house in Sackville Street, from an attack of apoplexy. His researches on chloroform
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and other anaesthetics were appreciated by the profession.”
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At the time, Snow was more famous for stuff like a chloroform inhaler than a map.
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It took years for the “investigation of John Snow” to become an example for subsequent
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outbreaks and epidemiology textbooks, and it slowly, eventually, helped end the miasma
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myth. That's because Snow didn't just make a
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map of a city. It's a map of his process and the field
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it shaped. It gave direction to a world where disease
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didn't have to be hidden in a cloud. Instead, it could start at a pump.
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OK, so the
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best book about John Snow is Cholera, Chloroform, and the Science of Medicine. It features an
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amazing story, which is that John Snow gave chloroform to Queen Victoria while she was
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giving birth.