Grosse Point Blank

While visiting Eccles with my brother, I found this plaque on a pub.


It’s a reminder of one of the outbreaks of cholera that occurred in the UK, many of which were epidemics killing hundreds or thousands of people. The pub isn’t lovely, but that’s the current-Eccles-factor rather than the past-cholera-factor.

The story of cholera in the UK is special, because it is also the story of the birth of epidemiology, and a part of the story of the development of our understanding of disease transmission.

In 1854 there was an outbreak of cholera in Soho, in London. As a skeptic of the miasma theory (that bad air caused disease), John Snow (a doctor from York, handy with anaesthetics) proposed an alternative theory; that it might be transmitted by polluted water. His skepticism and theory were shared by others working contemporaneously with him, and before him, although he was not aware of much of their work.

Not this Jon Snow.


Not this Jon Snow.


This John Snow.

John SNow


John Snow wrote an essay on this theory of cholera outbreaks in 1849, helped found the Epidemiological Society of London in 1850, and by observing and graphing the pattern of the outbreak in 1854 was able to prove the source of the outbreak. He used a new(ish) type of graph (used years before by Thomas Shapter) – a dot map – with a dot in the geographical location of each case of cholera. By observing the distribution of the dots (cases) and by interviewing residents he was able to find a pattern in the location and behaviour of people who had contracted cholera – they all used a public water pump on Broad Street.


The outbreak was subsiding by the time John Snow had enough evidence to act (people tend not to stick around if there’s a reasonably high chance of a horrible death). He had the handle of the pump removed, and the cases of cholera stopped. Later it was discovered that a cesspit was leaking into the public well. Drinking faeces was not a fashionable hobby then (unlike today), so rather than admit that was what had been happening, the pump handle was replaced so that everyone could quietly keep doing it.

And we’re still doing it! In the last two months there have been cholera outbreaks in Mozambique (Mocuba), Iraq (Baghdad), Muscat (Iran), Uvinza, Mwanza and Dar es Salaam (Tanzania), Kye-thi (Myanmar), Naivasha (Kenya) and South Kivu (Democratic Republic of the Congo). Those in Iraq and Tanzania have been particularly bad, killing many thousands of people.

Outbreaks of cholera can mostly be prevented by separating sewage (dirty) from the drinking water supply (ideally clean), but clean water and toilets are not exciting. Money invested in development projects and given to charities providing these facilities goes a long way. The problem is we’re not into evidence-based giving. And we like donkeys better than people anyway. And cholera is not glam. It’s been around for a very long time. It’s not exciting looking. It’s totally preventable. It’s totally treatable. BORING. And you basically vomit and poo yourself to death. GROSS.

Zika anyone? zika


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