Nelson1

Microbe Investigators

E. Lockett Nelson

College of Charleston

History 291 - Dr. Steere-Williams

October 26, 2015

In the face of dire need for health reform and regulation, the government ofnineteenth-century London instituted Medical Officers of Healthin 1848 for every willing parish throughout London. These men utilized early epidemiological methods to analyze disease outbreaks and prevent future mortality. John Snow, a well-known anesthesiologist in London during the mid-1800s, and Henry Whitehead, a parish priest during the same time, shared the same goal as these men. While not Medical Officers of Health themselves, these two incorporated methods of statistical analysis to discover the source of the cholera epidemic of 1854. In The Ghost Map, a work of historical fiction narratingthis epidemic, Steven Johnson romanticizes the “shoe leather epidemiology” practiced by these two truth-seekers. Johnson asserts in the conclusion of his book that Snow’s discovery of cholera as a water-borne illness was revolutionary, even if it did not exclusively lead to the acceptance of contagion theory as a sole cause for disease. He insinuates that Snow’s approach was a novel invention and more advanced thancontemporarypublic health methodology. In actuality,Johnson’s account of Snow and Whitehead’s investigations illustrate the survey and statistical methods utilized in most of London during this era of public health. J. S. Bristow, Medical Officer of Health of Camberwell in the parish of St. Giles, also studied and wrote extensively in 1856 on the occurrence of cholera in the Southern districts. His analysis is extremely similar, and in some ways more thorough, to that of Snow and Whitehead.

According to Johnson, proving to a community of miasmatiststhat cholera was a water-borne illness was difficult, because the noxious air surrounding the epidemic’s place of origin. He states that even with the presentation of Snow’s convincing evidence, the Board of Health closed the Broad Street pump more out of desperation than belief.1Two years following the epidemic, however, Dr. J.S. Bristow was entirely convinced of the legitimacy of Snow’s research. Regarding an 1855 study performed by Snow comparing the water companies Lambeth and Southwark & Vauxhall with deaths by cholera, Bristow states “the investigation… [left] no room for deception” and clearly the source of water determined the fate of whomever drank it.2 This same study was examined in Johnson’s book. The study somewhat proved that drinkers of S&V-sourced water were more likely to fall ill from cholera in 1854 than people who drank water from the Lambeth company. This is contrary to the same analysis conducted in 1848, in which drinkers of either company were equally likely to die from cholera.3The results were compelling due to the fact that the Lambeth company began resourcing its water from above the tideline of the Thames in 1852.4 An 1850 examination of London’s water by Arthur Hassall states that S&W and Lambeth water were “demonstratively contaminated with more or less of the organic and decomposing matters…derived from sewer water.”5To the modern germ theorist, this information seems obviously causative. However, Bristow and Snow were not analyzing the microscopic world; and statistical analysis of any epidemic at the time could lead to several theories about origin, even if water was seen as a proven carrier.6Because Johnson proclaims Snow’s findings as radical for the time, he implies that Snow discovered the final evidence needed to prove contagion theory. In reality, men like Bristow could accept Snow and Whitehead’s conclusions wholeheartedly without believing in pathogenic microbes.

Bristow’s confidence in the theories of water-borne cholera, however strong, did not force him to ignore preconceived notions regarding miasmatic theory. In one year, he warns against the use of cesspools and water storage in any urban environment since stagnant water is allowed “to absorb every poisonous gas.”7Bristow could confidently give such advice because his statistical analysis of instances of illness did not rule out miasmatic theory. Instead, correlations like thatof low-lying marshy areas with high death rate from zymotic disease could easily lead to a conclusions outside of germ theory.8 Mistaking correlation for causation was a widespread error for epidemiologists of the day. Bristow refers to a “cloud of unhealthy moisture” lingering above low areas of Camberwell and states that “what it is that impresses on the emanations from such a soil” are not known but are surely detrimental.9Here, Bristow came close to seeing the true reason behind the dangers of moist areas but did not fully understand because he, like others, did not consider the properties of germs. In a sense, this observation about harmful moisture is just as “revolutionary” as Snow’s, since both were correct but neither fully acknowledged the presence of bacteria in water. Bristow did understand that there was still much to learn about the exact causes of disease, and this he would“ere long endeavor to explain.”10Interestingly, Bristow acknowledged bad air as a source of disease based on the fact that feces (known to cause illness when contaminating drinking water) produces a noxious smell.11He could then correlate these facts and come to the conclusion that bad smell meant apathogen was present.

Bristow examines several aspects of sanitation reform that, while helpful for public well-being, did not directly address the true cause of disease.The nineteenth-century Medical Officer of Health used statistics to form correlative theories, but definitive answers to the question of contagion remained out of reach. However, most reforms he and others called for would in fact prevent disease, even if not for the reasons they suspected. For example, Bristow states that there is clearly a correlation between poor drainage and the instance of disease. He observed that Camberwell’s higher elevated areas like Dulwich, suffered least from zymotic diseases and infant mortality.12 He attributes these statistics to Dulwich’s “better drainage and purer air.”13While it is now understood that these factors could not directly lead to a healthier environment, it is true that if districts sought to remove fecal deposits with better efficiency, the chances of bacterial growth and proliferation would decrease, leading to fewer instances of illness.

Bristow was extremely thorough in his statistical reports, dividing instances of mortality into every conceivable category of cause, location, age, and time of year. In this sense, Bristow was more informative than Snow (as depicted by Johnson) because he compared the statistics of his parish to those of greater London in order the find answers. He even accounts for rates change in population densityand the presence of hospitals in certain areas that may skew death statistics.14He and Snow shared the understanding that statistical analysis could lead to accurate conclusions about factors of disease.In fact, Snow and Whitehead’s use of survey methods and statistical results were the same as any epidemiologist of the time. However, it can be argued that Snow simply lucked upon a correlation between cholera sufferers and the Broad Street pump, while other epidemiologists during the epidemic simply failed to consider polluted water as a factor. In the absence of extensive knowledge of contagious diseases, men like Bristow and Snow relied on numbers to paint a picture of what factors could influence the probability of an average citizen contracting a deadly illness.

Efforts by individuals like J.S. Bristow and John Snow certainly led to improvements in public health. However, while the institution of Medical Officers of Health throughout London was overall beneficial in detecting causes of disease, at times the statistics collected by these men were seen as proof to false theories. It was not until germ theory was widely accepted later in the nineteenth century that the information gathered by these early epidemiologists could be fully utilized. But in the meantime, individuals like Snow, Whitehead, and Bristow laid the foundation for effective collection of data that could be used for the health of communities. As most historians with the privilege of hindsight would say, “necessity is the mother of invention;” and we have the accuracy of this statement to thank for countless modern innovations. In the face of numerous uncontrollable outbreaks of disease in nineteenth-century London, epidemiological methodology became one such innovation.

End Notes

  1. Steven Johnson, The Ghost Map: The Story of London’s Most Terrifying Epidemic—and How it Changed Science, Cities, and the Modern World (New York: Riverhead Books, 2006), 195.
  2. Metropolis Local Management, Vestry of the Parish of St. Giles, Camberwell, Annual Report by J.S. Bristow, M.D. (London: E. Billing Son, 1857), 18-19.
  3. Johnson, 105-106.
  4. Bristow, 18.
  5. Arthur Hill Hassall, M.B. A Microscopic Examination of the Water Supplied to the inhabitants of London and the Suburban Districts (London: Samuel Highly, 1850), 18.
  6. Jacob Steere-Williams, “The Perfect Food and Filth Disease: Milk-borne Typhoid and Epidemiological Practice in Late Victorian Britain,” Journal of the History of Medicine and Allied Sciences 65 (2010): 515.
  7. Bristow, 17.
  8. Bristow, 20.
  9. Bristow,20.
  10. Bristow,10.
  11. Bristow, 21.
  12. Bristow,15-16.
  13. Bristow, 15-16.
  14. Bristow, 7-13.