John Snow and Cholera

By
Mohammed Saad Abdullah
Supervised by:
Dr. Namir Ghanm
"If you want to learn about the health of a
population, look at the air they breath, the water
they drink, and the places where they live."
– Hippocrates, the Father of Medicine, in the Fifth
Century B.C.
 John Snow(1813–1858)

o An England physician.

o Anesthesiologist

o administered chloroform to Queen Victoria

during childbirth.

o Interested in the cause and spread of cholera.

o Published On Pathology And Mode Of

Communication Of Cholera(1949)

o Father of modern epidemiology

 London in mid 1800 and Thames river
• The 18th–19th centuries
• Industrialization.
• migration.
• demographic shift:
• overcrowding in poor housing.
• inadequate or public water supplies.
• waste-disposal systems.
• “The Great Stink” .
• the Lambeth Company, for technical, non–health-related
reasons, shifted its water intake upstream in the Thames
to a less polluted part of the river.
• Southwark and Vauxhall company did not move the
locations of their water intakes.
• Most residents did not even know which company
Miasma theory vs. Germ theory

• Miasma Theory (bad air) : cholera was caused

by airborne transmission of poisonous vapors
from foul smells due to poor sanitation.
• Germ theory held microorganisms known as
pathogens or "germs" can cause disease
• the Registrar General was William Farr Vs,
John snow.
• At the time, the germ theory was not
accepted.
• Louis Pasteur 1861.
• Robert Koch in 1883.
• Filipo Pucini 1984
William Farr findings
Critique William Farr findings
• Individuals living at lower altitudes much more likely to be drinking water
containing the sewage of those at higher elevations.
• Inhalation of bad air would make more sense if the cholera patient developed a
respiratory disease, but he saw that clinically the disease begins as a
gastrointestinal affliction.
Snow’s work and hypothesis ( The Grand Experiment 1853-1854)
• Epidemic: Broad Street, Golden Square, in Soho, a poor district of central London
with unhygienic industries and housing.
• In the first week of September 1854, approximately 600 people living within a
few blocks of the Broad Street pump in London died of cholera.
• “shoe-leather epidemiology”
• Observation:
• that the cases either lived close to or were using the Broad Street pump for
drinking water.
• brewery workers and poorhouse residents.

• Hypothesis: the mortality rate from cholera would be lower in people getting
their water from the Lambeth Company than in those obtaining their water from
Snow’s findings
Original map by John Snow showing the clusters of cholera cases in the
London epidemic of 1854
The Broad Street Pump

• It all starts with a pump.

• surveyed deaths reported in
the homes mostly near the
pump and used it for their
drinking water.
• removal of the handle, and the
already declining epidemic.
Lessons learned
• It is not always necessary to know every detail of the possible
pathogenic mechanisms to prevent disease.
• Dr. Snow recognized that part of treating disease requires viewing
patients not as individual, isolated cases, but within the larger
environment in which they live.
References
• Gordis, L. (2013). Epidemiology e-book. Elsevier Health Sciences.
• Tulchinsky, T. H. (2018). John Snow, cholera, the broad street pump;
waterborne diseases then and now. Case Studies in Public Health, 77.