The Strange Case of the Broad Street Pump: John Snow and the Mystery of Cholera. Sandra Hempel.

1593 b o ok r e v ie w s T h e ne w e ngl a nd jou r na l o f m e dic i ne L ondon in 1854 was a virtual sea of human and animal waste, and it stank. Two and a half million people were crammed into a 30-mile circumference with no means of safe sewage disposal. Historically, cholera, which had been en-demic in India for millennia, was spread by people in caravans, military operations, pilgrimages, and sailing ships to cause seven great pandemics. The disease reached England for the first time during the second pandemic, in June 1831, and again during the third pandemic, in 1853 and 1854. The causative agent, Vibrio cholerae, was unknown until it was isolated in pure culture by Robert Koch in Egypt in 1883. Until John Snow, the subject of the two books under review, conducted his experiment, the miasma, or " bad air, " theory of the cause of cholera prevailed over the contagion theory, whose believers held that the disease was somehow transmitted from person to person, but not by water. Snow (1813–1858) was the founding father of boots-on-the-ground epidemiology. A vegetarian and teetotaler, Snow received his apothecary and surgeon's licenses at age 25 from the Hunterian School of Medicine and established a general practice in London. He was a witness to one of the first uses of ether in London — for a dental extraction in 1846 — and this started his highly successful career as a researcher and practitioner in anesthesiology. In 1853, he administered chloroform to Queen Victoria for the birth of her eighth child. Snow's interest in cholera began when he saw patients as a physician's apprentice during the epidemic of 1831 and 1832 in England, which killed 32,000, and was rekindled during the outbreak of 1848 and 1849, which killed 52,000. A series of cases and other observations led Snow to hypothesize that the disease was spread from person to person by the oral route and most likely through water, in contrast to the prevailing view that it was caused by the stench arising from open sewers, kitchen sinks, and rubbish piles. His 1849 publication describing his conclusions was ignored by the medical establishment. He needed an experimentum crucis, which would become known as " Snow's grand experiment, " to show that water, conveyed to a distant locality where …