Snow-Cholera

                                                         Snow-Cholera

Truth is slow to get traction, witness the well-established connection between citrus and scurvy before it was institutionalized. The famous Snow-Cholera epidemiological observation followed a "miasma" explanation that became the basis for an invested bureaucracy as they "followed the science." Like killing the cats during the Plague. Magness has an interesting article on the event.

In the 19th century, outbreaks of Cholera were common, and Britain deployed a “Board of Health” to manage and suppress the disease. England experienced a particularly severe wave of outbreaks in 1848 and 1849, with recurring instances over the next decade and a half. 

The Board of Health in London adopted the consensus belief that Cholera spread by miasmic properties, which is to say “bad air” that supposedly caused the disease to linger in the vicinity of sewage, garbage, and similar sanitary problems. Address these concerns and the disease would vanish, or so the logic followed. The Board of Health accordingly hired and deployed teams of sanitary inspectors around the city to oversee and regulate the improvement of sewage systems that would carry the perceived source of Cholera away.

Although the Board of Health was conceived of as a government body to lead the effort to improve and regulate sanitary conditions in accordance with scientific expertise, it quickly became an entrenched political interest devoted to the perpetuation of its own power and expansion of its own budget. 

The 19th century liberal philosopher Herbert Spencer included a devastating critique of the Board of Health in his 1851 book Social Statics, which argued that the bureaucratic properties of the agency had led it astray from its mission and even created an impediment to public health.  

Instead of taking immediate mitigation measures to prepare for an epidemic that had already stricken continental Europe, the Board devoted its energies to long-term engineering projects to improve the city’s sewer system. Some of these projects would eventually yield sanitary benefits. But they also provided lucrative money-making opportunities for politically connected contractors, and – due to the prevailing miasma theory – they largely misdiagnosed the causes of Cholera. Although the sewer improvements removed stagnant sources of waste and refuse, they also deposited them in the Thames – the major source of drinking water for the city. The “improvements,” premised on eliminating miasmas from the air, thereby further spread the water-carried disease.

Spencer’s indictment of the public health bureaucracy catalogued these and other successions of government missteps in fighting off Cholera. The public health agencies became a lucrative political interest, invested in holding up an erroneous “scientific consensus” about how the disease spread. Medical journals such as the Lancet became advocacy vehicles for expanding the public health bureaucracy’s “sanitary” oversight, along with accompanying budgetary appropriations.

Two years after Spencer wrote his chapter another Cholera outbreak hit London’s SoHo district, seemingly concentrated in the vicinity of a water pump. The outbreak is now regarded as one of the most famous events in the history of epidemiology . A physician named John Snow theorized that Cholera spread by contaminated water that carried an associated pathogen, rather than “bad air.” Facing intense skepticism from the miasma-oriented medical consensus viewpoint, Snow convinced the local council to remove the pump handle from the suspected source – the contaminated Broad Street well. Snow’s theory, as we now know, was correct and the natural experiment proved the water-born nature of the underlying pathogen.

Despite Snow’s discovery, the political interests behind the public health bureaucracy resisted its implications for the next decade as Cholera continued to ravage Britain’s cities. Just as Spencer predicted, the Board and its supportive medical establishment acted in the interest of their own perpetuation rather than true public health. 

The Lancet, whose owner Spencer identified in 1852 as an advocacy vehicle for expansive public health expenditures rather than scientific knowledge, published a harsh editorial denunciation of Snow in 1855. The General Board of Health commissioned a medical council investigation of Snow’s theory as well, attacking it as scientifically unsound. “After careful inquiry,” they wrote, “we see no reason to adopt this belief. We do not find it that the water was contaminated in the manner alleged.” Instead, the Board reverted back to the disproven but politically entrenched miasma theory: 

Thus, if the Broad Street pump did actually become a source of disease to persons dwelling at a distance, we believe that this may have depended on other organic impurities than those exclusively referred to, and may have arisen, not in its containing choleraic excrements, but simply in the fact of its impure waters having participated in the atmospheric infection of the district.

The Board’s position has since been thoroughly discredited. Indeed, it was a former rival of Snow and miasma theory adherent William Farr who statistically repeated and verified Snow’s theory during another outbreak in 1866. But the damage was already done. Although Snow’s work revealed the answer to the Cholera problem in 1854, the biggest obstacle to operationalizing this knowledge into fighting the disease was the public health bureaucracy itself and the entrenched political interests it had come to represent. Snow’s experience, in effect, proved the reality of Herbert Spencer’s assessment. Rather than improve public health, the government had only distorted and politicized the necessary scientific processes.