It is difficult to overestimate John Snow’s merits in the struggle with cholera because he made a breakthrough in Victorian medicine. In the nineteenth century, pharmacy and medical doctrines significantly differed from the modern ones. The major difference between the work of present-day and Victorian physicians consists in the scope of activity. In overpopulated London of that time, most physicians were general practitioners who had to deal with general medical care, infectious diseases, surgery, and even dentistry because most of their patients were from low or low-middle classes. Diagnostic techniques and laboratory analysis were in their infancy, which is why John Snow had to develop his own methods to diagnose cholera. Poor living standards, deplorable sanitation, and frequent industrial injuries were main problems faced by physicians in Victorian London. The total number of family physicians was low as only rich families could afford their services. Many physicians studied apothecary and made medicines on their own. Diploma of the Royal College of Surgeons of England allowed them to cure everything “from minor colds to excising bunions to amputating limbs” (Johnson, 2006, p. 60). In turn, modern physicians rely on evidence-based medicine, yet they often have additional or narrow specializations, for instance, in cancer treatment or dentistry. Currently, professions of a physician and a pharmacist are differentiated. Physicians apply advanced diagnostic techniques and have access to innovative chemical laboratories. Besides, the total number of general practitioners and family physicians has been increasing.
Through his experiments with chloroform, Snow`s findings had become the cornerstone of modern anesthesiology. His investigations and findings in this field promoted the development of obstetric and surgical anesthesia. Such professions as epidemiologists and health officers emerged thanks to Snow’s study of the reasons of cholera epidemics in London. Health officers are responsible for the control of water supply and sewerage systems functioning, waste disposal, and recycling.
The main reason why John Snow and his contemporaries preferred living in the city is the fact that it was a favorable place to make a successful career. In spite of numerous social and sanitary problems, in London there were more opportunities for people with an entrepreneurial spirit, for example, a broader range of customers, advanced training, and more education opportunities.
Role of Henry Whitehead
Henry Whitehead, an assistant curate of St Luke’s Church in London, made his own contribution to the treatment of cholera. The priest proved to be an efficient researcher because he had been working in Soho for many years and was familiar with local people, their vital needs, social infrastructure, and architecture. Knowing the area of research from the inside is an important advantage. Besides, as a clergyman, Whitehead visited the sick and dying and talked to them and their relatives, thus collecting information for the evidence-based analysis. Whitehead’s analytical skills and critical thinking allowed processing broad-ranging information and gathering his own statistics of death and morbidity rates.
Henry Whitehead’s contribution to solving the mystery of cholera seems to be equal to that of John Snow. John Snow established the scientific foundation of the germ theory of cholera in London. At the same time, Whitehead who had initially supported the miasmatic theory tracked early ????????patterns of cholera in the district on his own. For example, it occurred to him that “contrary to the prevailing wisdom, the sanitary conditions of the homes seemed to have no predictive power where the disease was concerned” (Johnson, 2006, p. 112). Whitehead’s demographic research and cooperation with Snow emphasize the importance of his achievements.
Henry Whitehead was respected by both the local population and the authorities. After publication of Dr. Snow’s conclusion on the Broad Street’s pump as the main source of infection, he was appointed to the cholera investigation committee. This factor benefitted his investigation because people eagerly shared information with him and he succeeded in establishing contacts by mail with former residents of Soho who had recently moved out. The results of his investigation confirmed Snow’s germ theory of cholera and the pump was closed.
The Ghost Map
John Snow developed his map in order to illustrate his waterborne theory. The first versions of the map were based on miasmic and sanitary hypotheses and were later revised by the investigation committed. Sewer lines were indicated as a potential source of poisoning with miasmas and the discovered plague pit supported the sanitary hypothesis. Snow’s scientific approach was based upon methodological research of existing social patterns of cholera and its spreading throughout the city. Such factor as cholera index rate, living standards, and proximity to the Broad Street pump were taken into account. Further, Whitehead provided valuable evidence from people who survived the epidemics, family members of the deceased, and Soho former residents, which additionally strengthened the waterborne theory. Snow used the dot mapping method to display the cholera death rate in Soho and adjacent districts. At the same time, he made an alternative version of the map, using Voronoi diagrams in order “to represent graphically the foot-traffic activity around the pump that he had so painstakingly reconstructed” (Johnson, 2006, p. 140). Alongside with a detailed layout, the map incorporates elements of demographic statistics provided by Whitehead, as well as Snow’s epidemiological research. Thus, cholera transmission was shown in dynamics.
Nevertheless, the ghost map should not be regarded as the only possible way to explain the cholera outbreak of 1854. This myth was subseqeuently created when the map was reproduced and reprinted in textbooks. The first publication of Snow’s monograph accompanied by the map did not evoke interest of local scientists and experts. Johnson (2006) emphasizes that Snow also considered “the Broad Street map merely a piece of supporting evidence, a sideshow” (p. 171). On the one hand, the map allowed to determine the area where the source of the epidemics could be located. On the other hand, by lucky chance Henry Whitehead got interested in the Snow’s project and provided valuable statistics and evidence relating to the Broad Street pump as the source of the infection. Johnson describes another misconception that Snow’s map does not give an exact answer to: “what is the main reason of infectiousness of the Broad Street pump?” Maybe, cholera is caused by miasmas emitted from the pump. The scientist grounded his waterborne theory in the shape of death rate graph around the main source of infection, but this point is at odds with the additional factors described in the book. Consequently, the ghost map just allows identifying the outbreak source and dynamics of its transmission but does not provide reliable evidence of Snow’s waterborne theory.
Although Steven Johnson debunked the myths surrounding the cholera epidemics, importance of John Snow’s project cannot be ignored. His discovery did not go to waste and changed lives of millions of urban residents. London’s sanitary system was significantly improved and infections were controlled in overpopulated city districts. Water supply and sewerage systems were fully reconstructed.
Urbanization
I agree with Steven Johnson’s positive assessment of urbanization because it promotes development of city infrastructure, renewable energy sources, mass media, etc. Urbanization is unavoidable because population density on the Earth has been steadily rising and habitable space has been steadily reducing. The author of the book claims that a megalopolis cannot survive “without efficient forms of waste recycling, those dense concentrations of life can't survive for long” (Johnson, 2006, p. 24). In the book, an example of a temporary self-organized waste recycling system of Victorian London is described, which consisted of bone-pickers, pure-finders, night-soil men, dredgermen, etc. In such a way, the urban environment tries to cleanse itself and provide minimum permissible living standards for the majority of citizens.
The book “Ghost Map” makes me think about an important role of a waste management system in the process of urbanization. Actually, most urban residents hardly notice the system if it works efficiently. People have gotten used to the blessings of the civilization like water supply, central heating, and daily waste collection so much that it is now impossible to imagine daily lives without them. This book gives positive examples of urban residents’ contribution to the improvement of the living environment and public health. These examples are worth studying and following.
Overpopulated cities of developing countries face problems described in the book under discussion. Populations of highly developed countries should assist them with the improvement of the local medical infrastructure and city-owned utilities in order to avoid outbreaks of hazardous infections, control the negative environmental impact, and prevent ecological catastrophes. Qualified specialists and sanitary officers should be sent to supervise and analyze operation of sewerage and water supply systems; quality of tap water had to be constantly controlled; and detailed disease-related statistics has to be collected. Above all, qualified medical officers and practitioners should be invited as they can study advantages and disadvantages of the local public healthcare system and train their foreign colleagues on the use of analytical research methods and infection prevention techniques.
Reference
Johnson, S. (2006). The ghost map: The story of London's most terrifying epidemic — and how it changed science, cities, and the modern world. New York, NY: Riverhead Books.