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""Who made John Snow a Hero?""

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(May 1991)American Journal of Epidemiology 133 (May 1991): 967-73

PDF from photocopy, Michigan State University Libraries, via Nigel Paneth.

The synopsis states that "the work of John Snow was first studied in depth in the Dutch medical literature, and thereafter traced more superficially in the bacteriologic, hygienic, and epidemiologic literature of Germany, the United Kingdom, and the United States. From the oral tradition of teaching, as well as from the written sources, it is concluded that US epidemiologist W. H. Frost was responsible for the revival of the work of John Snow in the 1930s . . . since his convictions came very close to the bacteriologic paradigm of the day" (967).

The article begins, "The tale of John Snow, the 1853 and 1854 London cholera epidemics and the Broad Street pump, is known today by every epidemiologist as 'the epidemiologic classic'" (967). Later in the opening paragraph, the authors assert that "Snow was a staunch believer in some little animalcule that would transmit cholera by contagion; more particularly, he held this theory many years before he made his renowned epidemiologic observations [in MCC2 1855]. . . . This book was preceded by his 1849 writings in which he had already expressed the same opinions" [both editions are mentioned in the endnotes] (968).

However, as I [PVJ] have already noted in the Study Detail to Frost's Introduction, Snow did not hold such a belief. In the 1849 edition, he remarked: "The writer, however, does not wish to be misunderstood as making this comparison so closely as to imply that cholera depends on veritable animals, or even animalcules, but rather to appeal to that general tendency to the continuity of molecular changes, by which combustion, putrefaction, fermentation, and the various processes in organized beings, are kept up" (9). In the 1855 edition, he wrote that he had taken samples from water yielded by the pump in Broad Street: "The water at the time of the cholera contained impurities of an organic nature, in the form of minute whitish flocculi visible on close inspection to the naked eve, as I before stated. Dr. Hassall, who was good enough to examine some of this water with the microscope, informed me that these particles had no organised structure, and that he thought they probably resulted from decomposition of other matter. He found a great number of very minute oval animalcules in the water, which are of no importance, except as an additional proof that the water contained organic matter on which they lived" (52).

The article by Vandenbroucke, et al. lives up to the billing in the synopsis by stressing findings from Dutch sources. In arriving at their conclusion about a parallel situation in the United Kingdom, the authors did not take into account what Henry Whitehead said before the London Epidemiological Society in 1867:

"It is commonly supposed, and sometimes asserted even at meetings of Medical Societies, that the Broad Street outbreak of cholera in 1854 was arrested in mid-career by the closing of the pump in that street. That this is a mistake is sufficiently shown by the following table, which, though incomplete, proves that the outbreak had already reached its climax, and had been steadily on the decline for several days before the pump-handle was removed."

For a different explanation than the Dutch authors give of how Snow came to receive heroic status in the United Kingdom, see Sidney Chave's 1958 article on Whitehead, pp. 103-04.

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