JOHN SNOW : CHALLENGING THE STATUS QUO

Dr. John Snow (1813-1858)

From time immemorial, being sick of cholera was considered as a result of miasma (foul/ haunted air) or because of being immoral or poor. It was even believed, to prevent cholera you just had to spray a sweet fragrance in the air around you. This preventive measure was supported by the most learned medical practitioners of the society at the time and it continued being the case until the 1850’s when this ideology was challenged by John Snow.

John Snow was born in 1813 in a poor family and his father was a coal miner. Given his family background, Snow was destined to be a coal miner like his father but his mother noted his curious, inquisitive and active mind and decided his son will not be a coal miner. Snow’s mother used her small inheritance and sent snow to school.

Snow studied and graduated. He was attached to a doctor to apprentice under. During his apprentice, there was cholera outbreak in 1831.  The cases were so many that the doctor was so overwhelmed that he sent Snow to the slums and mines to check the cholera cases that had been reported there. In his effort to treat the sick people in the slums he tried the various methods that were common for treating cholera  such as the use of strong herbs, opium and bleeding but none worked, his years of apprentice amounted to nothing.

Cholera was mysterious at the time, a person would wake up healthy and suddenly and swiftly he would vomit, complain of stomach ache and intestinal pain, and then they would die within hours. Medical advancement, has shown that, the cholera bacteria multiplies twice it’s self every 30 minutes leading to persistent vomiting and diarrhea, causing to great loose of water in the body leading to dehydration. The cholera victim loses so much water that a patient does not die out of the germs, but because of lack of water in the body that causes the blood to be sludgy and unable to circulate through the body, therefore critical organs such as kidney, liver, heart and brain would shut down one by one causing death. Years later, it was discovered that drinking glucose could act as remedy to increase absorption of water in the body slowing down the progress of cholera.

Days later, the cholera outbreak ended mysteriously just as it had started but the experience left a print on Snow’s mind. He had noted that most patience complained of stomach and intestinal pain and diarrhea and he theorized that the sickness must have been as a result of something egested other than inhaled. Since, if it was something inhaled then the patience would have complained of throat or lungs pain.

To actualize his theory, he took to the study of the water supply in the town. There were two water pump station on a street where people on opposite side would fetch water. On one side of the street, waste water running from toilets and households containing fecal matter flowed towards the water pump. The statistic indicated that people who consumed water from this pump had died of the cholera and further they were 998% likely to die compared with the people who consumed water from the other pump.  The other Pump had waste water containing fecal matter flowing away from it. In conclusion, Snow noted that fecal waste water had to do with the cholera outbreak; He proceeded to publish the research and distributed it all over London saying the cause was a “self-multiplying poison”. He in away intentionally avoided to use the term germs since at the time the medical community were repulsed by such a term. He was sure he had made a discovery, that cholera was a waterborne disease. 

In as much as his findings were backed with data and a clear scientific method approach, the medical community gave him a cold back and informed him that the miasma theory was the only true reason why people got sick of cholera. The medical community refused his idea. The Medical establishment believed in the one and only ancient theory - the Miasma Theory that had a powerful grip over the establishment and no one would part from this theory.

After the chaos of the cholera outbreak settled, people moved on with life as usual. John Snow progressed with his career as a doctor. He gained prominence in the field of euthanasia. He was able to come with proper procedure and dosage to be used during euthanasia. He even euthanized the queen. He became one of the founders of the Epistemology Society in order to find means to control contain and prevent outbreaks of epidemics.

In 1854, as snow was reading a newspaper he read a case; where in Broadway street many people had died of a cholera outbreak, that the hearse was do full of caskets carrying dead bodies that others had to be tied on top and on the sides. This time Cholera did not seem to have a specific pattern it cut through the classes indiscriminately, the rich and the poor, male and female, the professionals and the casuals, the educated and the uneducated, the moral and the immoral, all were victims of this terrifying disease. This experience was enough to remind him of the cholera of his youth and to push him to action. He rushed to the center of the epidemic. He knew he needed to act fast, as every second there was likely a case of a new contamination or death.

He walked the streets of broadways and beyond. He visited as much sick people as he could or their physician or care giver collecting information from every person. He was assisted with a curator, named Whitehead, who being a religious person was trusted by the people and was familiar with almost all death in the area.

The figure at left is the personification of cholera

With this data, he plotted a map to illustrate where death of people was more clustered. He noted the death was more clustered near a water pump on Broadway Street and radiated outwards, thinning as a person moved away from the water pump. Having earlier developed a case study that proposed that cholera was a waterborne disease, he was sure this was an affirmation of his findings. He went to meet the Local Health Committee and proposed that the handle of the water had to be removed to prevent further spreading of the disease. He showed them the data and he firmly persuaded them to do so and finally, though reluctantly they removed the handle. Days later, maybe because of the removal of the handle or because of nature cholera ended. All this work of visiting broadways street, visiting the sick and the victims of the sick, plotting the map, visiting the register office, organizing meeting with local health officer, removing the handle on the water pump happened within 72 hours (3 days). For all this activities to have succeeded within such a short time it required his total commitment and dedication.

Since many people and important members of the society had died a Commission was formed to investigate the disease. Snow and whitehead were invited to be members of the commission. On investigation they found that the water pump obtained water from a well. The well had been dug next to a cesspit. The cesspit was not properly built and the waste from the cesspit was leaking to the well. A woman, whose child had died of cholera, had thrown the nappies of the child in the cesspit. The waste leaked to the well. This all made a complete chain. The commission made a report that cholera had been caused by leakage from the cesspit. This was a small discovery by the commission but a great leap to the discovery of causes of cholera.

Snow, did not live to see triumph of his ideas. It would be years later when the report by the commission would be believed and implemented.

John Snow effort to stop cholera is remarkable. It may not all be attributed to him directly, but looking at it in hindsight we come to appreciate his determination and courage.  That during his lifetime microscopes were yet to be invented to identify germs in the water and in fact things like germs and bacteria were still unknown; That using his own logical mind to develop methods to meticulously collect data and join the dots and give them meaning;  that he took a whole traditional medical practice head on by challenging the well engrained belief that cholera was caused by foul air and being immoral; that he developed a new scientific reason based on data; That he was able to collect data and plot it on a map and to date the same method(coronoid diagraph)  he develop on top of his head is still being used, this demonstrates how effective and practical his innovation was; that  he courageously walked the streets of  London meeting and interviewing sick patients to collect data in as much as it was suspected cholera was cause by breathing foul air in that street; his pioneering to flow against the times. To date millions of lives have been saved due to his study. His study and method has improved health and healthcare around the world.  

In current times, we now know cholera is caused by egesting contaminated water or food and that basic hygiene can greatly prevent cholera.

The battle that Snow fought years ago is the same battle we fight today. Narrow and ancient views have prevented the discovery of new truth. In this present age we have perceptions and theories that exist side by side by scientific evidence that have been tested, confirmed and proved but due to the powerful grip tradition or custom has on us we hold on to them. Frank Fanon has to say this about this condition, “Sometimes people hold a core belief that is very strong. When they are presented with evidence that works against that belief, the new evidence cannot be accepted. It would create a feeling that is extremely uncomfortable, called cognitive dissonance. And because it is so important to protect the core belief, they will rationalize, ignore and even deny anything that doesn't fit in with the core belief.” Now or days to come, we shall find ourselves in a position to lead a new order or be the cause of change. To be the people to push humanity one step to change to a better world. Changing a core belief is a herculean responsibility we must all embrace.

It will take incredible courage for a person to challenge an entire infrastructure of tradition or ignorance, to speak truth to power but by the example set by many pioneers before us such as John Snow who want a better health care, Wangari Mathai who wants a better environment, Martin Luther who burns with the dream of all people to be treated equally, we know we are in good company. John Snow gives us an example that any ordinary person from unknown background, no wealth or no fame or title can use his own creativity and knowledge to challenge the imperfection of a system or bring people together and challenge the status quo.  And to strongly know that it is within their power to remake or to rethink an ideology and make it closely align with the ultimate truth or utopia that all humanity are working towards.

I end with the words of John Lewis who said “if you do not do everything you can to change things, then they will remain the same. You only pass this way once; you have to give it all you have.” John snow change the way the world thinks and in the process changed the world, the world awaits for you.