Pioneers in infection control: John Snow, Henry Whitehead, the Broad Street pump, and the beginnings of geographical epidemiology

doi:10.1016/j.jhin.2006.05.020

Journal of Hospital Infection

Volume 64, Issue 3, November 2006, Pages 210-216

https://doi.org/10.1016/j.jhin.2006.05.020 Get rights and content

Summary

John Snow was one of the founders of epidemiology. Already convinced of the value of pure water, he analysed the distribution of cholera cases in the 1848 epidemic in relation to the purity of the water supply in London. His hypothesis that cholera was spread by contaminated water was tested by the ‘Broad Street’ epidemic of 1854. Snow quickly traced the water used in the houses affected by cholera to the pump in Broad Street, and persuaded the parish council to remove the handle. The epidemic subsided. The council did not really believe Snow, so the curate, Henry Whitehead, set out to repeat Snow's work, albeit at a more leisurely pace as the epidemic had subsided. He located 700 deaths within a 250-yard radius and showed that use of water from the Broad Street pump was strongly correlated with death from cholera. This surprised him as he had drunk water from the pump himself during the outbreak. Thus ‘geographical epidemiology’ began, although it was some years before Snow's observations were generally accepted.

Introduction

Two undervalued ‘pioneers in infection control’ are linked by their investigations into cholera, namely John Snow and Henry Whitehead. Snow (1815–1858) has an international reputation exceeding that of Semmelweis, partly because of the breadth of his work. He was a pioneer of anaesthesia and is the subject of a recent biography from Michigan State University, from which this review has drawn extensively.¹ The John Snow Society is devoted to him (www.johsnowsociety.org).² This review has also drawn from the anthology, ‘Snow on cholera’, which summarizes his work.² Henry Whitehead (1825–1896) was quite different; he was the curate of St Luke's Church in Berwick Street, adjacent to Broad Street, London at the time of the 1854 cholera epidemic. A memorial to him was written by Canon H.D. Rawnsley of Keswick, perhaps better known as one of the founders of the National Trust in England.³

Section snippets

John Snow: youth

John Snow was born in York, the eldest of seven children in a working-class family. Until he was 12 years old, he lived in Michaelgate, a particularly unsanitary area near the river that was often contaminated with excreta as well as providing household water. His father's job improved enough to move to a more salubrious area, and provide the best possible education for all seven children. At the age of 14 years, John was apprenticed to an apothecary called Hardcastle who was a family friend in

Cholera

The first epidemic of the ‘Asiatic cholera’ hit England in 1831. It was called ‘Asiatic’ to differentiate it from ‘cholera morbis’, which was thought to be due to excess bile (choler). The disease came by sea and the results were devastating. The village of Upwell near the port of Wisbech lost ‘60 persons of all ages and sexes’; they were buried in mass graves in the churchyard marked merely with the letter ‘C’. A memorial in the church ends: ‘Reader think on this – why hast thou been spared’.

John Snow: London life

Snow finished his apprenticeship in 1833 and became an assistant apothecary. However, he soon realized that he needed a London degree and so he became a student at the Royal College of Surgeons and then the Westminster Hospital. Once qualified, he embarked on a somewhat precarious life as a general practitioner in Soho, London. Life was enriched by membership of the Westminster Medical and Surgical Society, with weekly meetings for discussion of current research. In 1846, he watched one of the

Henry Whitehead

Henry Whitehead (Figure 1) had a middle-class background. His father was headmaster of Chatham House School, which still exists in Ramsgate. Henry therefore grew up in academic surroundings and became very good at collecting data and writing. His parents both imparted a sense of caring. ‘The religious atmosphere in which he grew up however….included Sunday observances (so strict)… that it was a wonder the boy ever entered the ministry’.³ After some years teaching at Chatham House, he entered

Broad Street and the cholera epidemic

Broad Street is no longer to be found on the London map as it became Broadwick Street in the 1930s. Large terraced houses (some of which remain) were originally built there for upper-middle-class families, but they were used as tenements by the 1850s, with up to 50 people in one house. Those on the upper floors were occasionally seen to haul a cow up to supply milk. Gullies in front of the houses communicated with an open sewer. Many houses had cesspits for sewage, although during the epidemic,

London's water supplies and cholera

Snow, meanwhile, continued to study death rates in relation to water supply using addresses of those who had died of cholera obtained from the Registrar-General's office. He concentrated on areas supplied by water from the River Thames, which was becoming steadily more polluted. Districts served by two companies (Lambeth Water Company and Southwark and Vauxhall Water Company) had had equal numbers of cholera deaths in 1849. Both supplied water to the populations south of the Thames, sometimes

Conclusion

Snow only lived for another three years; in June 1858, just as he had written the word ‘exit’ in a book on anaesthesia, he had a fatal stroke. Sadly, it was some time before his work was taken seriously – he had never been considered one of the ‘medical elite’. The Lancet noted his death on 28 June 1858, with just two lines on his role as an anaesthetist. William Farr, rightly considered as one of the founders of epidemiology, had analysed the same data on the 1849 cholera deaths in 1852 and

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Influence of elevation on the fatality of cholera
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There are more references available in the full text version of this article.

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ReviewPioneers in infection control: John Snow, Henry Whitehead, the Broad Street pump, and the beginnings of geographical epidemiology

Summary

Introduction

Section snippets

John Snow: youth

Cholera

John Snow: London life

Henry Whitehead

Broad Street and the cholera epidemic

London's water supplies and cholera

Conclusion

J Hosp Infect

Public Health

Cholera, chloroform and the science of medicine

Snow on cholera

Henry Whitehead 1825–1896

The return to nature, or, a defence of the vegetable regimen; with some account of an experiment made during the last three or four years in the author's family

Editorial

Lancet

Influence of elevation on the fatality of cholera

J Stat Soc Lond

Review
Pioneers in infection control: John Snow, Henry Whitehead, the Broad Street pump, and the beginnings of geographical epidemiology