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Cuyamaca College Snow on Cholera Worksheet

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COPYRIGHTED MATERIAL — DO NOT DUPLICATE, DISTRIBUTE, OR POST 42 | Introduction to Scientific Thought It is interesting that the belief that disease was a consequence of evil behavior coexisted with the rec- ognition of contagion for hundreds of years. Attempts to develop treatments for syphilis were opposed on the grounds that syphilis was a punishment for sexual immorality. Cholera was most prevalent among the poor for reasons that will become apparent and there were many who regarded it also as a just punishment for the undeserving and vicious classes of society. A governor of New York State once stated during a chol- era epidemic, “… an infinitely wise and just God has seen fit to employ pestilence as one means of scourg- ing the human race for their sins, and it seems to be an appropriate one for the sins of uncleanliness and intemperance. … .” The President of New York’s Special Medical Council stated at the onset of an epidemic in 1832, “The disease had been confined to the intem- perate and the dissolute with but few exceptions.” A newspaper report noted, “Every day’s experience gives us increased assurance of the safety of the temperate and prudent, who are in circumstances of comfort. The disease is now, more than before, rioting in the haunts of infamy and pollution. A prostitute at 62 Mott Street, who was decking herself before the glass at 1 o’clock yesterday, was carried away in a hearse at half past three o’clock. The broken down constitutions of these miserable creatures perish almost instantly on the attack.. But the business part of our population, in general, appear to be in perfect health and security.” A Sunday School newspaper for children explained, “Drunkards and filthy wicked people of all descriptions are swept away in heaps, as if the Holy God could no longer bear their wickedness, just as we sweep away a mass of filth when it has become so corrupt that we cannot bear it. … The Cholera is not caused by intemperance and filth in themselves, but is a scourge, a rod in the hand of God.”(2) By the middle of the nineteenth century some of the major communicable diseases had been identified and well differentiated from each other. This was no easy task in itself. For example, a large number of OSW WO children’s diseases have as symptoms fever and a sore throat; these diseases are still not easy to distinguish today. There are many conditions associated with severe diarrhea, for example, cholera, typhoid, dysen- tery, bacterial food poisoning, noninfectious diseases of the lower intestine such as colitis, and poisoning with certain drugs. In the nineteenth century it had also been demonstrated that some of the contagious diseases could be artificially transmitted by inoculation of small amounts of “morbid matter” taken from the sick. The modes of transmission of particular diseases such as syphilis, intestinal worms, and skin diseases were known. Further, certain types of living organ- isms had been shown to cause disease directly: the itch mite in scabies as well as certain types of fungus in a disease of silkworms, in ringworm, and in other conditions. Bacteria and protozoa were discovered with the invention and further development of the microscope. These were often observed in the bodies of victims of certain diseases, and various scientists were beginning to speculate that they might be the cause of communicable diseases. The idea in various forms was in the air by the time of Snow, and he made use of it. Solid proof of the germ theory of disease came only in the 1860s and 1870s, after Snow’s study, in the work of Pasteur and Koch. The Disease Cholera is a bacterial disease characterized by severe diarrhea, vomiting, and muscular cramps. The diar- rhea can produce extreme dehydration and collapse; death is frequent, and often occurs within hours after the onset of sickness. The disease had been known to exist in India since the eighteenth century, and occurs there and in other parts of the world today. In the nineteenth century, as travel between Asia and the West became more com- mon and as the crowding of people in urban centers increased as a result of the industrial revolution, major COPYRIGHTED MATERIAL — DO NOT DUPLICATE, DISTRIBUTE, OR POST COPYRIGHTED MATERIAL — DO NOT DUPLICATE, DISTRIBUTE, OR POST How We Know | 43 time places where Snow’s explanations of discordant facts are shaky. Introduction to the Study We have chosen to tell the story as much as possible in Snow’s own words, partly because it conveys more of the direct personal experience of making a major scientific discovery, and partly because Snow tells it so well. Page references are to Snow on Cholera, a reprint of two of Snow’s major monographs, published by the Commonwealth Fund, New York, 1936. All quota- tions are from “On the Mode of Communication of Cholera,” originally published in 1854. All italics are ours. In the selections from the monograph we have mostly followed Snow’s order of presentation except in a few cases where logical clarity is achieved by deviating from it. Snow begins with a brief historical review, follow- ing which he cites evidence to show that cholera can be transmitted by close personal contact with the sick: epidemics occurred in Europe and America. England had epidemics in 1831–32, 1848–49, and 1853–54. The question of how cholera is transmitted was especially difficult. On the one hand there was good evidence that it could be transmitted by close personal contact. Yet there was equally good evidence that some who had close personal contact with the sick, such as physicians, rarely got it, and that outbreaks could occur at places located at great distances from already existing cases of the disease. A number of theories were proposed, some of which were too vague to be rationally examined but some of which had solid experimental support. A number of people, including both physicians and uneducated laymen, had blamed the water supply. Snow adopted this theory, but refined it by specifically implicating the excretions of the cholera victims. Snow’s genius lay not so much in hitting on the correct mechanism for the spread of the disease as in providing a beautiful and convincing experimental proof of it; he recognized the importance of the circumstance that, by chance, in a single district of London where an outbreak had occurred, some houses got their drinking water from one source and some from another
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