July 30 – Broad Street Blues

Today’s factismal: A cholera epidemic was once stopped by removing a pump handle.

Cholera is one of those disgusting diseases that nobody likes. Princesses never die of it in fairy tales and heroes never conquer it – except in real life. And that’s a story far more interesting than any fairy tale!

The story starts, as all good stories must, long ago and far away in the hidden depths of India more than 2000 years ago. A bacterium decided that it wanted to give up its free-wheeling days and live in the human gut, just as millions of other bacteria do. Unfortunately for the people, the bacterium was Vibrio cholerae (“creator of cholera”). This unloveable little bug causes muscle cramps, restlessness, irritability, a rapid heart rate, vomiting and diarrhea. Without that last complication, it would be just another unpleasant form of food poisoning. But with it, the victim can lose so much water that they die. To make a bad thing worse, the diarrhea acts to spread the bug to yet more victims by contaminating the water supply.

Public (health) Enemy #1: Cholera (Image courtesy Dartmouth College)

Public (health) Enemy #1: Cholera
(Image courtesy Dartmouth College)

That last happens because it wasn’t until the turn of the last century that people started to realize that the best place for an outhouse was far away from the place they got their water; before then, the outhouse and the well were frequently side-by-side. As a result, any contamination from the outhouse could easily slip back into the well water and keep the cycle going. This was bad in the countryside. In a city, it was disaster.

Most cities were designed to get their water either from cisterns that were fed by aqueducts or from wells drilled under the city. And, until very recently, few cities had sewers capable of removing all of the “output” from their citizens; sewage often backed up and overflowed into the cisterns. And if some of that sewage happened to come from someone with cholera, an epidemic was born.

Our hero, John Snow (Image courtesy Wikipedia)

Our hero, John Snow
(Image courtesy Wikipedia)

That’s what happened in London in 1854. Large numbers of people were dying of cholera; more that 127 in the first three days of the epidemic and more than 600 before it was done. Those that could fled the city for safer climes. But the poorest people, who were also those most likely to get cholera, couldn’t flee. Luckily for them, a hero by the name of John Snow was able to track down the common factor in all of the cases: everyone was getting their water from the same pump. Though nobody at the time knew how cholera was transmitted (Snow suspected bacteria but couldn’t prove it), Snow had enough evidence to convince the town council to remove the pump handle at the center of the outbreak. With the handle gone, people stopped getting contaminated water and the outbreak was over and John Snow had helped invent the science of epidemiology.

If you’d like to help the epidemiologists of today, then why not work with them on chronic diseases at the Chronic Collaborative Care Network (C3N):
http://c3nproject.org/

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