1854 Broad Street cholera outbreak
The Broad Street cholera outbreak was a severe outbreak of cholera that occurred near Broad Street (now renamed Broadwick Street) in Soho district of London, England in 1854. This outbreak is best known for the physician John Snow's study of the outbreak and his discovery that cholera is spread by contaminated water. This discovery came to influence public health and the construction of improved sanitation facilities beginning in the 19th century.
In the mid-19th century, the Soho district of London had a serious problem with filth due to the large influx of people and a lack of proper sanitary services: the London sewer system had not reached Soho. Many cellars (basements) had cesspools of night soil underneath their floorboards. Since the cesspools were overrunning, the London government decided to dump the waste into the River Thames. This action contaminated the water supply, leading to the cholera outbreak.
On 31 August 1854, after several other outbreaks had occurred elsewhere in the city, a major outbreak of cholera struck Soho. John Snow, the physician who eventually linked the outbreak to contaminated water, later called it "the most terrible outbreak of cholera which ever occurred in this kingdom."
Over the next three days, 127 people on or near Broad Street died. In the next week, three quarters of the residents had fled the area. By 10 September, 500 people had died and the mortality rate was 12.8 percent in some parts of the city. By the end of the outbreak, 616 people had died.
John Snow investigation
Snow was a skeptic of the then-dominant Miasma theory that stated that diseases such as cholera or the Black Death were caused by pollution or a noxious form of "bad air". The germ theory was not created at this point (as Louis Pasteur would not create it until 1861), so Snow was unaware of the mechanism by which the disease was transmitted, but evidence led him to believe that it was not due to breathing foul air. He first publicized his theory in an essay On the Mode of Communication of Cholera in 1849. In 1855 a second edition was published, with a much more elaborate investigation of the effect of the water-supply in the Soho, London epidemic of 1854.
By talking to local residents (with the help of Reverend Henry Whitehead), he identified the source of the outbreak as the public water pump on Broad Street (now Broadwick Street). Although Snow's chemical and microscope examination of a sample of the Broad Street pump water was not able to conclusively prove its danger, his studies of the pattern of the disease were convincing enough to persuade the local council to disable the well pump by removing its handle. Although this action has been popularly reported as ending the outbreak, the epidemic may have already been in rapid decline, as explained by Snow himself:
Snow later used a spot map to illustrate how cases of cholera were centered on the pump. He also made a solid use of statistics to illustrate the connection between the quality of the source of water and cholera cases. Snow's efforts to connect the incidence of cholera with potential geographic sources centered on creating what is now known as a Voronoi diagram. He mapped out the locations of individual water pumps and generated cells which represented all the points on his map which were closest to each pump. The section of Snow's map representing areas in the city where the closest available source of water was the Broad Street pump circumscribed most cases of cholera.
There was one significant anomaly - none of the monks in the adjacent monastery contracted cholera. Investigation showed that this was not an anomaly, but further evidence, for they drank only beer, which they brewed themselves. Residents near or in the brewery on Broad Street were also not affected as a result of the fermentation of the contaminated water. The beer was safer to drink than the dirty water from the Broad Street Pump.
Snow also showed that the Southwark and Vauxhall Waterworks Company was taking water from sewage-polluted sections of the Thames and delivering the water to homes with an increased incidence of cholera. Snow's study was in the history of public health and health geography, and can be regarded as the founding event of the science of epidemiology.
In Snow's own words:
It was discovered later that this public well had been dug only three feet from an old cesspit that had begun to leak fecal bacteria. A baby who had contracted cholera from another source had its nappies (diapers) washed into this cesspit, the opening of which was under a nearby house that had been rebuilt farther away after a fire had destroyed the previous structure, and the street was widened by the city. It was common at the time to have a cesspit under most homes. Most families tried to have their raw sewage collected and dumped in the Thames to prevent their cesspit from filling faster than the sewage could decompose into the soil.
After the cholera epidemic had subsided, government officials replaced the Broad Street Pump Handle. They had responded only to the urgent threat posed to the population, and afterward they rejected Snow's theory. To accept his proposal would have meant indirectly accepting the oral-fecal method transmission of disease, which was too unpleasant for most of the public to contemplate.
Henry Whitehead involvement
The Reverend Henry Whitehead was an assistant curate at St. Luke's church in Soho, London, during the 1854 cholera outbreak.
A former believer in the miasma theory of disease, Whitehead worked to disprove false theories, eventually focusing on John Snow's idea that cholera spreads through water contaminated by human waste. Snow's work, particularly his maps of the Soho area cholera victims, convinced Whitehead that the Broad Street pump was the source of the local infections. Whitehead then joined with Snow in tracking the contamination to a faulty cesspool and the outbreak's index case.
Whitehead's work with Snow combined demographic study with scientific observation, setting important precedent for the burgeoning science of epidemiology. <ref>Template:Cite web</ref>
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