Springtime in New Jersey

Blooming ForsythiaBy Michael J. McGuire

Many of you, dear readers, have been following my seven-year journey to first write, find a publisher and then promote my book, The Chlorine Revolution:  Water Disinfection and the Fight to Save Lives. The book was released on April 1, and 30 days later, there is much to report. My publisher, the American Water Works Association (AWWA) has been doing a lot of traditional marketing using their usual methods, but I knew that I would have to do some marketing on my own if I wanted the book to become known beyond the water community. I have focused on a two-pronged strategy for bringing the book to the attention of the reading public. First, I have created a fairly significant web/social media presence, which I will talk about in another blog later this month. Secondly, I have made a big effort to book speaking engagements to spread the word.

As of today, I have given talks on the book or had book signings at five locations. As noted on the linked table, I have 13 more to go. It has taken a lot of work and a lot of help from friends and colleagues to put together the speaking schedule. So far, some of the events have been successful and others not so much. However, there was no real way of knowing ahead of time what would work.

How do I gauge success for one of these events? All of the events so far have been successful in one way or another. A couple have been terrific in all categories. What I have been striving to do is get the word out to the water community (my target audience) but also to reach a broader audience of people who are interested in water and the history of technology.

I just returned from a trip to Pennsylvania, which was a big success. I spoke twice at the spring conference of Pennsylvania Section of AWWA. The conference was held in Hershey, PA, which is always a lot of fun to visit. Spring was busting out all over Pennsylvania—the forsythia was blooming, I could see dogwood blooming in the forests and I swear that I could see the tulip flowers opening before my eyes. Perhaps I should have titled this article “Springtime in Pennsylvania.”

My two talks at the conference were well received and I met some old friends who I had not seen in many years. I sold a few books, but that is not the main reason I am doing all of this. Just being there created a lot of buzz among the Pennsylvania water community, and many more people heard about the circumstances surrounding the first use of chlorine in a drinking water supply in the U.S. In truth, that is what I am trying to do—spread the word. Except for authors who sell millions of books, people rarely make much money selling the books they write. As one wise person said, “I could have made more money babysitting.”

The book launch party that I had at my house last Sunday was spectacular. Over 70 friends showed up. There was fruit, cheese and wine for the attendees. I read an abridged version of the first chapter of the book (see the video on YouTube). I sold a bunch of books. But, mostly this was a party to celebrate the official launch of the book and talk to old friends. Most of these friends were not part of the water community. Several of them bought books, and I have already heard that they are really enjoying the read. What more could an author ask? My water friends were there in force. Folks that I worked with at the Metropolitan Water District of Southern California and at McGuire Environmental Consultants, Inc. were well represented. Good fun.

It is next weekend and beyond that I am really excited about—four days of springtime in New Jersey. On Friday I fly to Newark, NJ for four whirlwind days of talks, signings and ceremonies. The main events in The Chlorine Revolution take place in northern New Jersey and I have planned a number of events to spread the word in that area. Saturday, May 4, I am speaking to the Passaic County Historical Society at Lambert Castle. As you might expect from the organization name, the attendees will be interested in the history of the area. Sunday, we will be unveiling a grave monument to Dr. John L. Leal who had been buried in an unmarked grave for 98 years. Some of his descendants will attend the event. Monday, I speak at a half-day seminar sponsored by the New Jersey Section of AWWA that will explore the importance of disinfection. Finally, on Tuesday, I will speak at the Passaic County Community College to a bunch of students interested in science and technology—my favorite audience.

Once again, I do not know how these events will turn out. I have done all of the footwork planning these talks. Now, I will just show up and do my best and try not to focus on any specific results. If nothing else, I will see a lot of blooming forsythia.

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Chapter 1–The Chlorine Revolution: Water Disinfection and the Fight to Save Lives

By Michael J. McGuire

Book in hand smallThe Journey that Launched a Revolution

“revolution . . . a: sudden, radical, or complete change . . . e: a changeover in use or preference especially in technology” Merriam-Webster, “Revolution”

Dr. John L. Leal, a physician turned water expert, sat in the law offices of William H. Corbin on June 19, 1908, to discuss a matter of great importance. Leal worked for the Jersey City Water Supply Company (JCWSC), which had hired Corbin to protect its contract interests. Corbin had recently completed a months-long trial defending his client’s actions under a contract signed in 1899. The judge’s decision on May 1, 1908, had largely supported the company’s contractual right to be paid $7.6 million (more than $175 million in current dollars) for building one of the largest new water supplies on the East Coast. The judge agreed that the JCWSC should be compensated for constructing a large dam, creating Boonton Reservoir, and for laying a 23-mile pipeline to supply Jersey City.

But there was a problem. The judge found that the company was not at all times providing the city with water that was “pure and wholesome.” Because of sewage contamination, water from the Rockaway River that contained high concentrations of bacteria would short-circuit the natural purifying processes of the reservoir during rainstorms two or three times a year. In his May 1 opinion, the judge made it clear that sewers should capture sanitary wastes and divert the contaminated materials away from Jersey City’s water supply. The cost of the sewers, which was significant, would be deducted from the $7.6 million contract price. However, Dr. Leal was convinced that because of contaminated runoff from agricultural and urban lands, the sewers would not solve the problem identified by the judge. He also saw an opportunity to end waterborne disease in Jersey City, but he knew that would require a revolution in drinking water treatment.

Corbin and Leal realized they had only one chance to overturn the negative part of the judge’s decision. Vice Chancellor Frederic William Stevens issued his final decree on June 4, 1908. Between May 1 and June 4, Corbin and Leal had somehow convinced Stevens that they should be given a chance to install “other plans or devices” that would reduce bacterial concentrations in the delivered water, which was the intent of the judge’s requirement to build sewers. In his final decree, Stevens referred the assessment of sewer costs and the suitability of the “other plans or devices” to one of the special masters of the New Jersey Chancery Court. Leal was given only three months from June 4 to develop his alternative plan, and the urgent meeting in Corbin’s law offices on June 19 was to chart the next steps.

Dr. Leal was uniquely qualified to develop and implement his radical idea. He was a physician educated at Princeton and trained at Columbia College of Physicians and Surgeons. Fascinated by the new science of bacteriology, he had taken courses and performed experiments that had furthered his knowledge in this emerging field. He was also an expert in public health. For 10 years, he had been the health officer for Paterson, New Jersey, and he had dealt with all of the public health issues of the day—smallpox outbreaks, diphtheria, typhoid fever epidemics, high rates of infant mortality, collection and disposal of sewage, and protection of public water supplies.

Leal’s revolutionary idea was nothing less than introducing a “poison” into the Jersey City water supply to kill the bacteria that were present in high concentrations two or three times per year. However, he had specialized knowledge that this poison could be used safely and, in small concentrations, would be highly effective in controlling bacteria. Leal was aware of the historical uses of the poison—chloride of lime (a convenient form of chlorine)—as a disinfectant to purify contaminated households after an infectious disease had struck a family. He also knew about some limited uses of chlorine in European water supplies over the previous 10 years.

Leal’s biggest challenge was that no city in the United States was using chlorine as a disinfectant as of June 19, 1908. Leal was convinced that the only course open to JCWSC was to install a chlorine feed system, treat the entire Jersey City water supply, and present the improved bacteriological evidence to the special master. But his course of action involved a major problem: no one had designed and constructed a reliable chlorine feed system capable of treating 40 million gallons per day—a huge flow of water. He knew from his years as a municipal health officer that dependable sources of chloride of lime existed. He also knew that only one man could design a reliable feed system for chloride of lime in the insanely short time period available.

Leal presented Corbin with a two-pronged plan. First, he had to recruit world-class experts in the field of chemistry and bacteriology to test the efficacy of chloride of lime in their laboratories. Second, he had to build a full-scale operating plant and show how effective chloride of lime could be. The first part of his plan would have to wait until a conference in Winnipeg, Manitoba, but the second part of his plan needed to be started right away; the only thing in his way was the Hudson River.

Leal left the Collins & Corbin law offices and walked three blocks to the ferry terminal on the Jersey City waterfront. At the terminal, he boarded a ferry to take him across the Hudson to a rendezvous with his co-conspirator in this revolutionary plan.

The thoughts that went through Leal’s mind during that short ferry ride to the Manhattan ferry terminal must have been dramatic. After today, there was no turning back. He was about to set in motion a series of events that would brand him as a visionary or a criminal. He knew that jumping ahead of the entire sanitary engineering discipline and the water treatment practices of decades was fraught with risks. In the field of public health, in which human lives were at stake, there was no room for error on this scale.

From the ferry terminal on the New York City side, it was only a half-mile walk to Leal’s destination—170 Broadway, the office of the consulting engineering firm of Hering and Fuller. There he sat down with George Warren Fuller and a junior member of the firm to discuss the assignment and to map out the execution of his radical idea. At the time of the meeting, Fuller was only 39 years old, but he was at the height of his intellectual powers and the foremost sanitary engineer in the early twentieth century. He was also an expert chemist and bacteriologist. He certainly understood what Leal wanted to accomplish and was aware of investigations of the use of chlorine to disinfect water supplies.

Everyone at the meeting knew they had only one chance to get this right. The good news was that George Warren Fuller had designed and installed a successful feed system for aluminum sulfate six years earlier at the Little Falls, New Jersey, water treatment plant. Leal asked Fuller to repeat his successful design and adapt it to feed chloride of lime in very small doses (fractions of a part per million) to a flow of 40 million gallons per day.

There is no record that a contract was signed on that day; it is more likely that the work was agreed to on the basis of a handshake. We know, however, that successful chlorination of water from Boonton Reservoir began on September 26, 1908—an astonishing 99 days after that fateful meeting at 170 Broadway in Manhattan. Purification of water supplies has never been the same since. Though Leal’s journey from Jersey City to New York City was short in distance, it was long in its impact on public health. Millions of lives have been saved since Dr. John L. Leal made that journey to launch a revolution. The partnership between a physician and an engineer brought about a permanent change in drinking water treatment, and a court case brought the revolution to the attention of the world.

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In Fairness to John Snow

By Peter Vinten-Johansen

Peter Vinten Johansen smIf I were still teaching a history of medicine course at Michigan State University, I would have prepared a mini-lecture on John Snow for mid-March. The syllabus would have included a series of readings by and about Snow, selected to show why the opening paragraph on the home page of the John Snow Archive and Research Companion reads:

“John Snow’s contributions during the early years of inhalation anesthesia, and his investigations during two mid–century cholera epidemics in Victorian London, are landmarks in anesthesiology, epidemiology, medical cartography, and public health.”

On entering the classroom, the students would see two items projected onto screens at the front of the room: the epimonitor listing of special events commemorating the 200th anniversary of Snow’s birth (http://epimonitor.net/Snow_200th_Birthday_Events.htm); and a name, Frank Pembleton, followed by a short quotation, “It’s our job to speak for those who can no longer speak for themselves.”

In March 2013, I would have to explain that Pembleton was a fictional detective in the television series, Homicide: Life on the Street, that aired during the 1990s; that the quotation was Pembleton’s raison d’tre; and that while I had no desire to rain on any of the events planned to honor John Snow this year, I very much feared that this plain-spoken and forthright man, who certainly expected what he thought was his due but no more, would be embarrassed if any honorifics came by way of demeaning his contemporaries and over-, or misstating, his accomplishments.

For that’s happened all too often since Snow’s death in 1858. Benjamin Ward Richardson, his ostensible champion, was among the first to do so in his depiction of the Broad Street pump episode during the 1854 London cholera epidemic:

“He had fixed his attention on the Broad-street pump as the source and centre of the calamity. He advised the removal of the pump-handle as the grand prescription. The vestry was incredulous, but had the good sense to carry out the advice. The pump-handle was removed, and the plague was stayed. There arose hereupon much discussion amongst the learned, much sneering and jeering even; for the pump-handle removal was a fact too great for the abstruse science men who wanted to discover the cause of a great natural phenomenon in some overwhelming scientific problem. But it matters little. Men with great thoughts in their heads, think of little things which little men cover with their wide-spread feet. It matters little, for the plague was stayed . . .” (http://johnsnow.matrix.msu.edu/work.php?id=15-78-43, page xxi)

In 1866, when cholera again visited the London metropolis, Edwin Lankester, the driving force behind the creation of a parish committee to inquire into the horrific local outbreak of 1854, inserted a lightly redacted, Richardson-version of Snow’s doings for a popular pamphlet on the nature of the disease and its prevention:

“Of all the means by which this poison may be conveyed, that by water seems the most constant and the most dangerous. This mode [30/31] of conveyance was so novel, that when first suggested it was almost universally opposed. Medical men had really no experience of any contagious diseases that could be conveyed in this way, and were incredulous as to the fact. . . . The most gigantic case of this kind which has ever appeared in the history of epidemic cholera, is that which occurred in the [32/33] months of August and September, 1854, in the parish of St. James, Westminster. . . . On the 1st of September [sic; should be the 7th] the Board of Guardians met to consult as to what ought to be done. Of that meeting the late Dr. Snow demanded an audience. He was admitted, and gave it as his opinion that the pump in Broad-street, and the pump alone, was the cause of all the pestilence. He was not believed–not a member of his own profession, not an individual [34/35] in the parish believed that Dr. Snow was right. But the pump was closed, nevertheless, and the plague was stayed. . .” (http://johnsnow.matrix.msu.edu/work.php?id=15-78-FA)

These two chaps knew how to rewrite back-stories. Richardson never jeered at Snow’s theory, but he was among those who sneered at Snow’s insistence that cholera communication was limited to the oral-fecal route. In an 1855 review of MCC2, among other writings on cholera, Richardson concluded that:

“Dr. Snow and his objectors are both right in the main; and that while the specific poison of cholera (for we must presume the existence of such a poison, though we may not understand its nature), may, by accident, be carried into the intestinal canal by the medium of water, it may also be wafted into the lungs by the medium of the air. Many of Dr. Snow’s objectors would, we doubt not, join us in this view of the case; which is more than we could expect from him, since it is opposed to his essential idea . . .” (http://johnsnow.matrix.msu.edu/work.php?id=15-78-14B)

Lankester was either careless or opportunistic, perhaps both. Careless if he mis-wrote the date of the meeting whilst essentially plagiarizing the rest of Richardson’s passage; opportunistic if he intentionally wrote 1 September since as chair of the sub-committee that drafted the parish report, he knew that the outbreak had peaked on September 2; posing an earlier date for Snow’s meeting would exonerate Richardson and help Lankester make the case that shallow wells like that under the Broad Street pump should be permanently eliminated due to extensive contamination from sewage and surface run-off.  (http://johnsnow.matrix.msu.edu/work.php?id=15-78-AA , page 23)

It’s quite likely that Henry Whitehead had Lankester in mind, perhaps Richardson as well, when he began a talk at the Epidemiological Society of London on 6 May 1867 as follows:

“It is commonly supposed, and sometimes asserted even at meetings of Medical Societies, that the Broad Street outbreak of cholera in 1854 was arrested in mid-career by the closing of the pump in that street. That this is a mistake is sufficiently shown by the following table, which, though incomplete, proves that the outbreak had already reached its climax, and had been steadily on the decline for several days before the pump-handle was removed.” (http://johnsnow.matrix.msu.edu/work.php?id=15-78-82)

Whitehead’s table contained figures slightly different from those in Lankester and Co.’s parish report, but the pattern is identical. Whitehead, also a committee member from the get-go in November 1854, may have had his own criteria for establishing fatal attacks. As did John Snow, added to the committee several weeks later after presenting the results of his on-going investigation, which was later added to the general report under the title, “Dr. Snow’s Report.” After presenting his own table of fatal attacks and deaths in August and September 1854, Snow wrote: “It will be observed that the daily number of fatal attacks was already much diminished by September the 8th, the day when the handle of the pump in Broad Street was removed” (http://johnsnow.matrix.msu.edu/work.php?id=15-78-55, page 118).

He was even more explicit in MCC2: “On September the 8th–the day when the handle of the pump was removed–there were twelve attacks; on the 9th, eleven; on the 10th, five; on the 11th, five; on the 12th, only one; and after this time, there were never more than four attacks on one day” (http://johnsnow.matrix.msu.edu/work.php?id=15-78-52 , 51). And lest one wonders if Richardson and Lankester had found confirmatory evidence for their canard in Snow’s only other published discussion of the Broad Street pump episode, he wrote the following in a letter to the Editor of Medical Times and Gazette: “I had an interview with the Board of Guardians of St. James’s parish, on the evening of the 7th inst., and represented the above circumstances to them. In consequence of what I said, the handle of the pump was removed on the following day. The number of attacks of cholera had been diminished before this measure was adopted.” (http://johnsnow.matrix.msu.edu/work.php?id=15-78-45 , 23 September 1854) Disabling the Broad Street pump undoubtedly prevented a follow-up outbreak, but no one has ever presented evidence that it had an impact on the trajectory of the “plague” as claimed by Richardson and Lankester.

But  Whitehead’s corrective did not take. Ninety years later, Bradford Hill felt compelled to say that

“…it is necessary in this centenary year [since the original publication of MCC2] once more to point out that Snow’s claim to fame does not rest upon the removal of a pump handle and a post hoc propter hoc argument which he would, I believe, have despised. Yet that belief is still widespread. It may well have its origin in Sir Benjamin Ward Richardson’s fine memoir of Snow . . . . [Hill quotes part of the same passage I do above, concluding with “the plague was stayed.”] It is difficult to resist the final dramatic touch; it is almost sacrilege to attempt to de-bunk it. Yet perhaps it is fair in a centenary year to see what Snow himself wrote [and Hill then quotes from MCC2].”

The final sentence in the quotation above gives me away. I got the notion of Snow’s embarrassment at false honorifics from Hill, as well as using Snow’s own writings to try to debunk myths about him. I doubt, however, if I’ll be any more successful than Whitehead and Hill have been. We seem to have a need to create and cherish myths for a variety of reasons, personal and professional. Richardson’s pump-handle tale has remarkable staying power, perhaps due in part to the fact that for many decades Snow’s version was only popularly available in Wade Hampton Frost’s reprint of MCC2, which also included an abbreviated form of Richardson’s memoir containing the passage quoted above. So much easier to read a short biographical memoir than wade through Snow’s closely argued pages. Perhaps I’m just a belly-aching codger and should let this go, for I do understand that the myth advances constructive action in epidemiology and public health. I just wish we could come up with a story, fairer to all concerned, that expresses what is unquestionably heroic about Snow’s recommendation and the parish Sanitary Committee’s decision to disable the Broad Street pump: caution should be the decisive factor when the public’s health is at issue, even when causes are unknown and the evidence probabilistic.

Repeat a tale often enough over time and it may become the default explanation, trumping anything else at odds with it. For example, in October 2010 Joe Palca introduced a segment of National Public Radio’s “Science Friday” in the following manner:

“Over 600 people died of cholera in London during the outbreak of 1854, and it was a pretty mysterious disease back then. The prevailing medical theory of the day blamed it on contaminated vapors, but the English physician, John Snow, had his own theory. To prove it he mapped out the cholera deaths during the outbreak, and he noticed that many of the deaths were concentrated around one particular water pump on Broad Street. Snow recommended disabling the pump; and sure enough, the outbreak was contained, so they knew it had something to do with water.”

The Science Friday home page for that episode included three sources on which the segment was based, including Steven Johnson’s Ghost Map.

Johnson, however, says nothing of the kind. I should add that he sent me an advanced draft of the book for comments since he relied so heavily on the Snow biography I co-authored, Cholera, Chloroform, and the Science of Medicine (CC&SoM) We were in agreement from the outset that Snow never said that removing the pump handle had “contained” or “stayed” the Broad Street outbreak. On the contrary, Johnson states explicitly that cholera mortality began dropping dramatically several days before the handle was removed (155), in agreement with what Snow had written, Whitehead and Bradford Hill repeated, and we set forth in the Snow biography. Palca is a fine journalist. He does his homework. What happened? Was the dramatic flourish of the oft-told tale so much more appealing than the banal uncertainty described by Snow?

Palca’s comment contains a second myth about the Broad Street outbreak which isn’t attributable to Richardson or Lankester – that mapping was part of Snow’s initial investigation during the first week of September. John Noble Wilford had written much the same in 2008: “A turning point in prevention [of cholera] came in 1854, when a London physician, Dr. John Snow, established the connection between contaminated water and cholera. Dr. Snow tested the idea by plotting cholera cases on a map . . . This showed that most of the victims drew their water from a public pump on Broad (now Broadwick) Street.” A recent book, ‘Ghost Map,’ by Steven Johnson, recounts the discovery” (“Plague: How cholera helped shape New York,” New York Times (15 April 2008): D4).

Not exactly. Johnson said that “John Snow began working on his first map of the Broad Street outbreak sometime in the early fall of 1854. Its initial form . . . [was first shown] in December . . .” (193). In September 1854, Johnson only depicted Snow as “imagining the paths residents might take” (136), “drawing maps” in his mind (141), and “he drew maps in his head, looking for patterns, looking for clues” (149). Why such a significant disconnect between Wilford’s assertion and the source he gives? Wilford knows his stuff; I always learn something from anything in the NYT with his byline. The article on cholera is no exception. This is only the second time I have encountered the notion that Snow had mapped the results of his inquiries about drinking habits of the 83 victims on the list he compiled at the General Register Office (GRO) on 5 September.

The first was Sandra Hempel, whose account (2007) anticipates both Palca and Wilford. Her version is that after making the list at the GRO, Snow

“. . .marked the deaths, house by house, on a street plan, a line for each fatality. And as he did so, a distinct pattern began to emerge. . . both figuratively on the map and physically in Broad Street, right at the heart of the outbreak . . . . Five of the ten victims’ families told Snow that their relative had preferred the water from Broad Street and always used that pump. . . . Setting aside those victims who drank the Broad Street water even though the pump was not the nearest to their homes, the map clearly showed that the deaths had either plummeted or stopped altogether at every point where it was easier to go to another pump . . . . So on the evening of Thursday, 7 September, he made his way to the Vestry Hall in Piccadilly . . .” (The Strange Case of the Broad Street Pump, 212-18)

Hempel uses quotation marks in the text but does not provide footnotes. She does have a listing of sources used in each chapter, but specifics in the passage from chapter 13 excerpted above come from MCC2 [Snow, John. 1855. On the Mode of Communication of Cholera. 2nd ed. London:Churchill.], listed for a previous chapter. Hempel zeroes in, appropriately, on Snow’s discussion of the 83 addresses he received from the GRO (MCC2, 39-40). But then her text jumps over the two paragraphs on page 40 (of MCC2) containing Snow’s conclusion and his interview with parish officials, cherry-picks confirmatory evidence Snow had garnered during multiple re-investigations later in the fall (http://johnsnow.matrix.msu.edu/BrStP-MCC2-CIC.pdf), selectively quotes and paraphrases Snow’s discussion of streetscapes in relation to his spot map that begins on page 45, and quotes from an expanded conclusion on page 54, before concluding this chapter by doubling back to the interview paragraph on page 40.

If one accepts Hempel rendition of events, Snow accomplished a herculean feat in two days of inquiries and presented the following findings at his meeting with parish authorities on the evening of 7 September: an account of the drinking habits of 77 of 83 cholera victims; an explanation for why an army officer from St. John’s Wood had died after dining in Wardour Street; how the distinguished ornithologist, John Gould, had dodged the cholera because freshly drawn water from the Broad Street pump had a dodgy odor; why there was so little cholera in the parish workhouse and the Lion Brewery; and how the Hampstead widow had succumbed after drinking Broad Street water taken from the pump on 31 August. The latter is especially impressive since the death of the Hampstead widow on 2 September was not published until almost a week after Snow’s interview, when it was called to his attention by a colleague and its significance still had to be run to ground.

Snow’s account is quite different:

“I made inquiry in detail, respecting the eighty-three deaths registered as having taken place during the last three days of the week.

On proceeding to the spot, I found that nearly all the deaths had taken place within a short distance of the pump. There were only ten deaths in houses situated decidedly nearer to another street pump. In five of these cases the families of the deceased persons informed me [39/40] that they always sent to the pump in Broad Street, as they preferred the water to that of the pump which was nearer. In three other cases, the deceased were children who went to school near the pump in Broad Street. Two of them were known to drink the water; and the parents of the third think it probable that it did so. The other two deaths, beyond the district which this pump supplies, represent only the amount of mortality from cholera that was occurring before the irruption took place.

With regard to the deaths occurring in the locality belonging to the pump, there were sixty-one instances in which I was informed that the deceased persons used to drink the pump-water from Broad Street, either constantly or occasionally. In six instances I could get no information, owing to the death or departure of every one connected with the deceased individuals; and in six cases I was informed that the deceased persons did not drink the pump-water before their illness.

The result of the inquiry then was, that there had been no particular outbreak or increase of cholera, in this part of London, except among the persons who were in the habit of drinking the water of the above-mentioned pump-well.

I had an interview with the Board of Guardians of St. James’s parish, on the evening of Thursday, 7th September, and represented the above circumstances to them. In consequence of what I said, the handle of the pump was removed on the following day.” (MCC2, 39-40)

No mention of a map. He knew the area well since it was the catchment area of his general practice for ten years before specialization in anesthesia regularly took him to distant parts of the London metropolis. As I re-read Snow’s paragraphs, Steven Johnson’s evocative image comes to mind: When Snow came to the cholera field with GRO addresses in hand, “he drew maps in his head, look[ed] for patterns, look[ed]for clues,” “imagining the paths residents might take” to fetch their drinking water. Actually, that was all anyone could have done under the circumstances.

For the simple fact of the matter is that no publicly accessible frontage plan containing individual house numbers on each street existed for this part of Westminster in early September 1854. The most recent map available with such detail was the 1819 edition of Richard Horwood’s Plan of the Cities of London and Westminster, the Borough of Southwark, and Parts Adjoining (I consulted a microfilm of this edition at the City of Westminster Archives Centre; the 1792-99 edition is available on the Motco web site). At 26 inches to the mile, the full map included thirty-two sheets. Even if Snow possessed Sheet B2, which included streets west of Dean Street and Soho Square, street and building renovations in the decades after1819 would have rendered most of it useless for anyone searching for specific addresses in what constituted the Broad Street cholera field of 1854. George Thompson’s 1825 Plan of the Parish of St. James, Westminster (SC/GL/FLM/022/1825/K1290810, housed at the London Metropolitan Archives) is a huge, folded velum map, containing very few house numbers; it would have been of no use to a shoe-leather epidemiologist. Since the Metropolitan Commission of Sewers (MCS) had an updated frontage plan (MCS/PR/036; see http://johnsnow.matrix.msu.edu/work.php?id=15-78-7E ) produced to accompany the report into the outbreak by their engineer, Edmund Cooper, which appeared the third week of September 1854, I wondered if Snow could have popped into the MCS office on Greek Street earlier to obtain a blank copy for his personal use. But there is no record of such a plan in the MCS archives; Cooper’s map was a purpose-lithographed, one-off event. The General Board of Health and Parish Cholera Inquiry Committee maps produced the following year to accompany their respective reports were based on the MCS map made for Cooper, but produced by different lithographers. I have visited these two archives (or their predecessors in brick-and-mortar or title) dozens of times since the mid-1980s, most recently in November 2012, when I verified my findings (and lack thereof) with Alison Kenney, Archivist at the CWAC, and Amy Proctor, Senior Information Officer at the LMA.

Let’s imagine an alternative scenario for a moment. Snow did have an up-to-date frontage plan (something that’s disappeared without a trace since) tucked into a pocket when he leaves the GRO on Wednesday morning 5 September. He’s just copied the addresses of eighty-three persons reported by registrars as having died of cholera the previous week in the sub-districts of Golden-square, Berwick-street, and St. Ann’s, Soho. Snow has been taking water samples, episodically, from the Broad Street pump since Sunday evening since, according to his theory, it seemed the most likely suspect for such a sudden and massive point-source cholera outbreak. So far, evidence of organic sediment (suggestive of possible sewage contamination–the best anyone could test for at the time) has been absent or inconclusive. Nonetheless, he returns again to what he’s sure is point zero, this time with addresses and frontage plan in hand. He scans the list of addresses, looks west at the intersection of Broad and Marshall Streets; then eastward where Broad dead-ends in Berwick Street but continues as Edward Street toward St. Ann’s, Soho; takes a few steps and looks south down Cambridge Street/Little Windmill Street; and immediately begins walking westward on Broad Street toward Marshall.

Hold on, says an intrepid modern cartographer in this imaginary re-enactment. Why, Dr. Snow, didn’t you plot the deaths on your map?

Why would I waste time doing that, he replies. I must discover if the deceased drank from the Broad Street pump. If it turns out the preponderant number did so, then I have reliable circumstantial evidence that this pump was the original source of the mischief, even if the worst is hopefully behind us.

But wouldn’t it help to plot those findings?

Not in the least. Mortality spot maps are grist for the miasmatic mill. Look at the addresses I copied down. Most are within a couple hundred yards from the pump. If I plot them on a map, the miasmatists will say the spot map proves that a morbid effluvial cloud emanating from the pump-well caused the outbreak. Again, I’m interested in drinking habits of those who died from cholera in this vicinity. The geographical location of where they died is only important if it helps me understand which of five nearby water pumps they preferred. End of imaginary scenario.

In short, anyone who seriously thinks that Snow used disease mapping in his initial investigation of the Broad Street outbreak must explain away all three of Snow’s accounts and offer evidence that an accurate frontage plan existed for him to use.

I do understand how easily a modern reader could be misled about Snow’s investigative mode of proceeding. For Snow commissioned a spot map for insertion in MCC2 and situates the locations of some of his initial 83 house-to-house inquiries in terms of this map. However, his purpose was solely illustrative and the decision to include one at all came late in the course of his inquiries. The first mention of one I have located is a Monday evening in December 1854. After the main presentation at a meeting of the Epidemiological Society of London, Snow exhibited a copy of a spot map and statistical table he’d already sent to John Churchill, publisher of MCC2. “The map was handed round, and after some brief observations by the members present, the Society adjourned to February” (http://johnsnow.matrix.msu.edu/work.php?id=15-78-A8 ). It requires little imagination to construct what probably happened during the discussion at the Epidemiological Society. The miasmatists were surely gloating. The spot map hijacked Snow’s carefully constructed argument in the text of MCC2. My hunch is that Snow received a preliminary critique much like what E. A. Parkes would later write in a formal review:

“. . .it would clearly appear that the centre of the outburst was a spot in Broad-street, close to which is the accused pump; and that cases were scattered all round this nearly in a circle, becoming less numerous as the exterior of the circle is approached. This certainly looks more like the effect of an atmospheric cause than any other; if it were owing to the water, why should not the cholera have prevailed equally everywhere where the water was drunk?”  (http://johnsnow.matrix.msu.edu/work.php?id=15-78-C1 )

Eight days later he would exhibit an altered version when he read a paper containing results of an expanded investigation of the outbreak (including evidence beyond what he had already submitted for MCC2) before the parish Cholera Inquiry Committee (CIC). Text and map now emphasized drinking habits of cholera victims, not geographical mortality data (http://johnsnow.matrix.msu.edu/work.php?id=15-78-55 ). He was added to the committee shortly thereafter. The CIC’s report had a limited circulation, however, which meant that the map and discussion there that Snow probably wished he had employed in MCC2 remained relatively unknown for 150 years. It had no Wade Hampton Frost to give it new life as a reprint in the mid-twentieth century as occurred with MCC2. But the full parish report, including Snow’s, is now readily accessible; I’ve posted it on the John Snow Archive and Research Companion.

The past isn’t sacred territory. Our sense of what happened in the past changes, sometimes with each retelling. No neutral, “objective” video-tape exists of what transpired during the Broad Street outbreak. Snow’s own accounts aren’t sacred tablets. All were written after the fact, subject to distortion and misrepresentation as all memory is. I offer a nit-picking example. The group Snow addressed on the evening of 7 September 1854 was not the Board of Guardians but the Sanitary Committee, a committee of the whole set up by the Governors and Directors of the Poor for the Parish of St. James, Westminster. At the time, the parish was still exempt from reorganizing itself as a Union under the New Poor Law. Most of the London metropolis was set up with Unions in which Boards of Guardians handled sanitary matters. The Board of Health had recently published a circular in which it stated that it was simplifying matters by referring to any local group responsible for cholera-prevention policies as a Board of Guardians. It may have been a slip-up on Snow’s part, or he may simply have been following the Board’s usage.

At any rate, the least commentators who claim to speak on his behalf should do is explain why they think Snow’s version might be faulty and offer a smidgen of evidence when they present something to the contrary. Richardson chose to do otherwise, stealthily altering the narrative of the Broad Street outbreak Snow had written. My hunch is that Richardson felt the obituaries in 1858 ignored or undervalued Snow’s epidemiological contributions; the pump episode could be tweaked to advantage, the south London study could not. Lankester, as a medical officer of health, may have thought that popularizing Richardson’s version was in the public interest, but does a noble end justify messing with Snow’s legacy? Wade Hampton Frost had no personal motive in this matter; he quite simply and inadvertently propagated it by reprinting Richardson’s biographical sketch.

Early in the twentieth century, a new myth was grafted onto the Richardson/Lankester pump-handle tale when disease mapping appeared in the microbe hunter’s tool kit. Snow’s spot map fit the bill. I won’t repeat the provenance of this myth since there is a synopsis in CC&SoM, 396-99. The excerpts I selected from three journalists – Palca, Wilford, and Hempel – show that this two-part myth is now rooted in popular discourse. I’ll offer a final example, and fulfill a long-standing promise to my former colleague and co-author, Howard Brody, that one day I would publish the cartoon (circulated 24 August 1997) he gave me at a meeting when the Snowflakes were gathering to hash out the makings of a chapter in CC&SoM:

Prince Valiant med

OK. This historian is crying uncle. The dragon I’ve been trying to slay all these years was a Hydra all along. But I cannot give up the hope that we can be fair to Snow, even if I accept that some myths about him are nigh indelible and can serve constructive purpose. Our default response to the name, Isaac Newton, is not the image of a lad under an apple tree. George Washington is not typecast by the stump of a cherry tree. Why, then, should a pump-handle tale dominate our epidemiological sense of Snow?

On this 200th anniversary of his birth, I propose a chess metaphor to celebrate his achievements in epidemiology and public health. His experience at Killingworth in the 1832 epidemic had convinced him that Asiatic cholera was an infectious contagion. Men came out of the pits, retching and with the trots; it seemed more reasonable to assume they had inhaled morbid effluvia given off by fellow miners than miasmata carried by prevailing winds. Thereafter, during the winter of 1848/49 Snow made a knight’s move in his thinking the second time he encountered the disease, this time in metropolitan London. The opening pages of MCC [Snow, John. 1849. On the Mode of Communication of Cholera. London:Churchill.] show how Snow advanced the contagionist argument in 1849 with respect to cholera by rejecting infection and moving sideways to an alternative contagionist mode of communication. He hops over contact (the acclaimed smallpox model), makes a case for the alimentary canal as the medium, yet gives contact an indirect role if cholera victims or caregivers handle food without taking sanitary precautions. It was, by anyone’s measure, a brilliant inductive-hypothetico-deductive gambit.

However, substantiation of this hypothesis was fraught with difficulties and missteps. Being fair to Snow means that we, in the twenty-first century, should admit that he never presented enough evidence to convince most contemporaries to give up alternate explanations of the cause and dissemination of cholera. When I ribbed Richardson above for being an ostensible champion, I had in mind the disingenuous contrast between his tone in the biographical memoir and the reservation he expressed previously in a review of MCC2, not the reservation as such. Richardson was a contingent contagionist in 1855, and the evidence Snow had presented to date did not rule out atmospheric infection via the lungs.

Parkes thought the spot map in MCC2 was proof of this pudding, not Snow’s. The mortality pattern in the map was precisely what one expected from an effluvial cloud of morbid cholera matter, dispersing circularly from a contaminated pump in late-summer dog days; only predisposed individuals (some certainly weakened by drinking befouled Broad Street water) who inhaled this noxious atmosphere would come down with cholera, perhaps die from it. That was why the map had spots, not solid circular swathes of decreasing mortality, until the morbidity factor dissipated completely after a few hundred yards. It was still an absolutist era, medically speaking, so Parkes dismissed Snow’s probabilistic argument that the stomach, not the lungs, was the medium of contagion in cholera: “why should not the cholera have prevailed equally everywhere where the water was drunk?” Ah, we moderns would counter, why didn’t everyone who inhaled the effluvial cloud contract cholera? The reply would be predisposition, that “placeholder” of medical uncertainty (the term is Chris Hamlin’s, Cholera. The Biography [2009], 157). Not everyone is constitutionally or environmentally predisposed to cholera. Snow’s insistence that constitutional predisposition was a chimera had left him vulnerable to this kind of criticism since proposing an alternative explanation of the communication of cholera.

The natural experiment in South London during the 1854 epidemic was arguably Snow’s best chance to checkmate sceptics. His initial conception was a tight, limited study of sub-districts with intermixed watersheds. Snow intended to neutralize the effluvial objection by a happenstance in competitive capitalism between two private water companies. Based on information Farr’s team at the GRO published near the end of the 1853 wave of the third epidemic of Asiatic cholera to reach London, Snow envisioned a stunning study if cholera returned the following year. The grisly numerators would be the numbers of cholera victims who received pure versus vitiated Thames water piped to their homes, respectively. The denominators were intended to eliminate discrepancies in market share: the exact number of establishments served by each water company in each sub-district within the intermixed area.

The epidemic did resume in July 1854. Four weeks into it, when the GRO reported unimpeachable evidence of a mortality imbalance south of the Thames, Snow began inquiries. A week later he learned that neither Parliament nor the GRO had ever requested the information he needed—the projected denominators in his ratios of mortality by company that provided water to the address where victims had died. Imagine his regret that he had not sorted this matter previously. In late August 1854, however, he had no alternative but to scramble if he hoped to salvage something from this natural experiment. Denominators became population-based, control groups were set up for each water company, the majority of house-to-house inquiries about water usage were farmed out to a newly minted surgeon and Farr’s bevy of sub-district registrars, and estimates were made to cover a few shortfalls.

But the potential argumentative punch of the natural experiment in South London never materialized in MCC2. Dr. Parkes’ review shows why it failed to convince a contemporary; Hamlin assesses its persuasive limitations, quite fairly in my view, a century and a half later (Cholera, 179-95; see also CC&SoM, 267-82, 392-96). In 1856, some denominator data unavailable in 1854 appeared in John Simon’s Report (http://johnsnow.matrix.msu.edu/work.php?id=15-78-7F) on the 1848-49 and 1853-54 epidemics. Snow was able to rectify some deficiencies in the MCC2 analysis, but the clincher still eluded him: the exact number of houses supplied by both water companies in every intermixed sub-district (http://johnsnow.matrix.msu.edu/work.php?id=15-78-56, 246). Snow’s calculations are ingenious, but Simon’s Report had already stolen most of the thunder by pinching his idea of a natural experiment; Snow’s name, priority, and prior analysis are never mentioned. Snow did not live to see John Netten Radcliffe, Henry Whitehead, and William Farr set things to right and seal the deal for him during the 1866 cholera epidemic.

So let’s not poke fun at Snow’s contemporary critics. They weren’t medical dinosaurs or theoretical Luddites. They simply reasoned differently and, by their measure, Snow’s substantiation of his cholera theory came up short. It pains me to admit that Thomas Wakley, who often treated Snow shamefully in life, was fairer in death when the Lancet said his passing was a loss to anesthesia, period. For in this specialty his achievements were generously recognized in his time. Just because we value more than that now doesn’t mean contemporaries who saw things differently were wrong or deserve ridicule. It’s worth remembering that the root of epidemiology calls to mind miasmatic non-contagion, not the communication of cholera.

Peter Vinten-Johansen

Co-Author of Cholera, Chloroform, and the Science of Medicine:  A Life of John Snow

Content manager, the John Snow Archive and Research Companion

Some of the material in this essay is drawn from an historical narrative/historiographical primer, currently in process, on the Broad Street cholera outbreak.

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Dr. John Snow Online Seminar Recording

Title slide for Online SeminarThe online seminar, Dr. John Snow Speaks from Beyond the Grave, that was held on March 12, 2013, was a lot of fun and seemed to be well received by our audience. The entire two-hour seminar can be found at: http://bit.ly/14X5k6U

When you click on the link, you will be directed to Blackboard Collaborate, a Java applet will be downloaded to your computer and you will be asked it Blackboard Collaborate can have access to your computer. Click on “Allow” and you will be taken to the window that will show you the entire seminar. Be patient. It takes a few seconds to load. Click on the arrow on the bottom to start the talks. You can use the slider to jump ahead, and the vertical markers on the slider indicate when a new slide was shown. In order for the application to work, you MUST have the latest version of Java on your computer.

Later next week, the individual segments will be posted on the wastewatereducation.org YouTube Channel. Many thanks to Dendra Best for giving us access to all of these wonderful tools. Watch this space for a link and more information.

Here is the final agenda for the seminar:

Dr. John Snow Speaks from Beyond the Grave—An Online Seminar

1. Sandra Hempel, Author of The Strange Case of the Broad Street Pump. “John Snow–The Man.”

2. Michael J. McGuire, MJM, Inc. “Legacy of Dr. John Snow: Water Filtration & Chlorination in the U.S. during the Early 20th Century.”

3. Steve Via, American Water Works Association. “Dr. John Snow: Impact on U.S. Regulation of Drinking Water.”

4. Lindsay Olson, Artist In Residence, Stickney Water Reclamation Plant. “Raising Awareness About Wastewater Through Art:  Manufactured River.”

5. Deborah Falta, Senior Lecturer, Department of Public Health Sciences, Clemson University. “Miasma and Death by Cholera: Dr. John Snow and the Dawn of the Germ Theory of Disease.”

6. Christl Tate, Water Resources Project Coordinator and Shelly Wallingford, Credentialing Manager, National Environmental Health Association. “The History of Sanitarians:  How Far We Have Come.”

Enjoy the seminar!

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30 Days of #DrJohnSnow

This is not the original Broad Street pump, but is located near the site of the killer of hundreds

This is not the original Broad Street pump, but is located near the site of the killer of hundreds

By Michael J. McGuire

Beginning February 14 and continuing over the next 30 days, daily messages about #DrJohnSnow and the #BroadStPump will be posted on Twitter. The following posting is about the life of Dr. Snow and how he influenced our understanding of disease propagation. His work ultimately led to others taking up the struggle and fighting for improvements in drinking water safety and public health. We owe him a lot. The countdown to March 15 will culminate in a virtual gathering around the #BroadStPump in Twitter-land.

Below are the tweets commemorating #DrJohnSnow and quotes from notable sources about his life:

30 days of #DrJohnSnow. DYK that Snow was born in York, England on March 15, 1813? He was the 1st of 9 children born into a family of limited means.

“William and Fanny Snow began their married life as a laboring family with the advantages of literacy and connections to extended families with modest resources. On March 13, 1813 Mr. G. Brown, the minister at All Saints North Street since 1798, baptized ‘John son of William & Francis Snow,’ born the same day. John’s birth occurred ten months after his parents’ marriage; they had eight more children, three daughters and five sons, over the course of fifteen years…and maintained attachments to their home parish throughout. They had ambitions for all their children and would provide each child with basic schooling.” (Vinten-Johansen et al., Cholera, Chloroform,21.)

29 days of #DrJohnSnow. Read The Strange Case of the Broad Street Pump by Sandra Hempel; see the book review http://bit.ly/WSf2DK

Hempel book cover“It was a huge and daunting undertaking. He was, after all, only nineteen and he was being asked to shoulder quite alone the responsibility for the lives of scores of men, women and children. But he was also a steady young man, conscientious and clever, with a maturity far beyond his years. This slightly built, painfully shy youth was not everyone’s first choice of dinner-party guest, but when life took a serious turn, when wisdom was needed more than wit, and strength of character more than charisma, then John Snow would always be in the front rank of candidates. Now as he packed his belongings in the Newcastle house that had been his home for four long, sometimes difficult years, he could only pray that when he returned it would be with no sense of having failed those desperate families he was being sent to help.” (Hempel, Strange Case, 67.)

28 days of #DrJohnSnow. DYK Snow died of a stroke at age of 45 on 6/16/1858?—4 years after #BroadStPump episode ‪http://bit.ly/12Id4sc

“Somehow the most notorious cloud of miasmatic air in the history of London [the Great Stink of 1858] had failed to produce even the slightest uptick in disease mortality. If all smell was disease, as Edwin Chadwick had so boldly pronounced more than a decade before, then the Great Stink should have conjured up an outbreak on the scale of 1848 or 1854. Yet nothing out of the ordinary had happened.

It’s easy to imagine John Snow taking great delight in the puzzling data from the Weekly Returns, perhaps writing up a brief survey for The Lancet or the London Medical Gazette. But he never got the opportunity. He had suffered a stroke in his office on June 10, while revising his monograph on chloroform, and died six days later, just as the Great Stink was -reaching its peak above the foul waters of the Thames. He was forty-five years old. More than a few friends wondered if his many experiments inhaling experimental anesethetics in his home lab had brought on his sudden demise.

Ten days later, The Lancet ran this brief, understated item in its obituary section:

‘DR. JOHN SNOW-This well-known physician died at noon on the 16th instant, at his house in Sackville-street, from an attack of apoplexy. His researches on chloroform and other anesethetics were appreciated by the profession.’” (Johnson, Ghost Map, 206.)

27 days of #DrJohnSnow. DYK Snow was most famous during his lifetime as an innovator using ether & chloroform-anesthesia in surgeries?

ether and chloroform“Nonetheless, he [Snow] remained a relatively obscure general practitioner, little known outside two London medical societies and a small private medical school whose best years were behind it. He still had a flat in Frith Street, and he still worked long hours serving working-class patients for the most part. The time and energy available for medical research were limited. No change for the better was on his horizon. Then came news about ether anesthesia.” (Vinten-Johansen et al., Cholera, Chloroform, 102.)

26 days of #DrJohnSnow. DYK that Snow delivered Queen Victoria’s baby Prince Leopold on 4/7/1853 using chloroform as an anesthesia?

Prince Leopold

Prince Leopold

“I received a note from Sir James Clark [physician in ordinary to Her Majesty] a little after 10, asking me to go to the Palace. I remained in an apartment near that of the Queen, along with Sir James Clark, Dr Ferguson and, for the most part of the time, Dr Lacock, till a little after 12. At 12.20 p.m., I commenced to give a little chloroform with each pain by pouring about 15 minims [0.9 millilitres] by measure on a folded handkerchief. The first stage of labour was nearly over when the chloroform commenced.

Her Majesty expressed great relief from the application, the pains being very trifling during the uterine contractions, whilst between the periods of contraction there was complete ease. The effect of the chloroform was not at any time carried to the extent of quite removing consciousness. Dr Lacock thought that the chloroform prolonged the intervals between the pains and retarded the labour somewhat. The infant [Prince Leopold] was born at 1.13 p.m., [so] the chloroform [had been] inhaled for 53 minutes. The placenta was expelled in a few minutes, and the Queen appeared very cheerful and well, expressing herself much gratified with the effect of the chloroform.” (Hempel, Strange Case, 103.)

25 days of #DrJohnSnow. DYK that Snow was a vegetarian and that he abstained from alcohol?

“At the age of seventeen he read John Frank Newton’s influential 1811 manifesto The Return to Nature: A Defence of the Vegetable Regimen and promptly converted to vegetarianism. Shortly thereafter, he became a strict teetotaler. He would largely avoid meat and alcohol for the rest of his adult life.” (Johnson, Ghost Map, 58-9.)

24 days of #DrJohnSnow. DYK that Snow only drank distilled water and recommended that others boil their water?

distilled water“Snow who distilled his own drinking water, agreed that London water should be improved, but he considered the abolition of cesspools and the increasing preference for water closets a sanitary disaster…water closets connected to sewer lines that emptied into rivers also used for metropolitan drinking water were, in his mind, primarily an efficient means of recycling the cholera agent through the intestines of victims as rapidly as possible. Sanitary reforms were needed, but flushing the waste of a town into the same river by which one quenched ones’ thirst seemed sheer stupidity.” (Vinten-Johansen et al., Cholera, Chloroform, 256.)

23 days of #DrJohnSnow. DYK that Snow was admitted to membership in the Royal College of Surgeons of England on 5/2/1838 and Royal College of Physicians in 1850?

Royal College of Surgeons, London

Royal College of Surgeons, London

“Snow passed the Royal College of Surgeons’ exams in May 1838 and those of the Society of Apothecaries in October. He asked permission to sit the latter exam in July because he wanted to apply for a vacancy as an apothecary at the Westminster Hospital. But despite excellent references from William Hardcastle, two Yorkshire doctors and several London lecturers, including Mr Anthony White and Sir Anthony Carlisle, the Apothecaries stood firm and refused to take into account his hospital experience in Newcastle. They made him wait until October, losing him the chance of a post that would have given him an excellent footing on the ladder to private practice and a good living.” (Hempel, Strange Case, 90-1.)

22 days of #DrJohnSnow. 16 October 1841 John Snow gave his 1st paper: Asphyxia and the resuscitation of still-borns. http://bit.ly/XTLclJ

“The number of children that die of asphyxia at the time of birth is very considerable. Writers on midwifery have stated that one-twentieth of the children brought forth are still born, and of these a large proportion are asphyxiated, from various causes, often at the very moment of birth. The first measures that are generally and very properly adopted, when a child is born in a state of suspended animation, are to admit the cool air to its skin, to dash a few drops of cold water on it, and use similar means to arouse sensibility, more especially that of the nerves of respiration. From the great vascularity and sensibility of the skin, and the thinness of the cuticle of newborn children, great benefit may be expected from the access of air to the surface of the body. Immersion in [224/225] warm water is sometimes had recourse to, and I have seen it completely successful in two or three instances, after the means just enumerated had failed; but this is a dangerous measure, one which, if it do not succeed, will quickly extinguish any possibility of recovery which may exist, as we have already seen. The great object in this, as in every case of asphyxia, is to establish respiration; and if the patient cannot be roused to perform natural breathing, artificial respiration must be had recourse to as quickly as possible.” Snow, John. 1841. “On asphyxia, and on the resuscitation of still-born children.” London Medical Gazette. (November 5, 1841): 222-27. PDF from photocopy; Taubman Medical Library, University of Michigan.

21 days of #DrJohnSnow. DYK that there is a website devoted to the bicentenary of #DrJohnSnow? List of celebrations http://bit.ly/W3Su2N

“A pair of meetings hosted by the London School of Hygiene and Tropical Medicine and the Wellcome Trust, in collaboration with the International Epidemiological Association, the John Snow Society and the Centre for History in Public Health.

There will also be a public Exhibition: Cartographies of Life & Death: John Snow and Disease Mapping, combining historical material and new artworks at the London School of Hygiene & Tropical Medicine and related sites, 13 March – 17 April 2013, Monday – Saturday, 10am – 5pm”

20 days of #DrJohnSnow. DYK that in 1849, John Snow published On the Mode of Communication of Cholera.

Mode of communication of Chloera Snow“It cost him £200 to produce but his income was only £3.12s. Journals dismissed Snow’s book. “There is, in our view, an entire failure of proof that the occurrence of any one case could be clearly and unambiguously assigned to water”. The reviewer later concludes, “Notwithstanding our opinion that Dr Snow has failed in proving that cholera is communicated in the mode in which he supposes it to be, he deserves the thanks of the profession for endeavouring to solve the mystery. It is only by close analysis of facts and the publication of new views, that we can hope to arrive at the truth”. (London Medical Gazette, 1849) http://bit.ly/dPl0hW

19 days of #DrJohnSnow. Go to exhibition: Cartographies of Life & Death: John Snow & Disease Mapping http://bit.ly/12WI8sV

19 Cartographies of life and death“13 March – 17 April 2013 London School of Hygiene & Tropical Medicine, Keppel Street, London, WC1E 7HT and off-site locations (to be announced).

Inspired by the pioneering work of medical detective John Snow, who traced the source of a deadly cholera outbreak in 1850s London to a water pump in Soho, we are opening our doors to the public with an exhibition celebrating Snow’s work and legacy.

Historical treasures and newly commissioned artworks inspired by science will be found both in and around the London School of Hygiene & Tropical Medicine. Presented in the style of a disease mapping ‘detective’ trail, exhibition highlights will include a pop-up water-based cocktail bar, weekly street performances, and disease maps from the School’s archives showing how scientists have tracked disease outbreaks around the world from the early 1900s to the present day.” http://bit.ly/12WI8sV

18 days of #DrJohnSnow. Travel to York, England on Mar 15 and attend the one-day symposium on his life http://bit.ly/W1obfD

18 York johsnowprogramme

17 days of #DrJohnSnow. DYK Snow published a paper on rickets in children which he related to alum added to bread? http://bit.ly/XCq2Xt

“On commencing, in the year 1839, to see a considerable amount of practice amongst the poor of London, chiefly the out-patients of a public hospital, I was very much struck with the great number of cases of rickets. The complaint was shown more particularly in the bones of the leg, causing an outward curvature of the tibia and fibula; in children in their second and third year, it seemed almost the rule, and might be observed in the streets and the parks, as well as amongst children brought for advice. The complaint, moreover, was not by any means confined to the poor, but affected the children of the middle classes to a considerable extent….

Now, the bakers, so far as I have examined, all put alum in their bread, whilst this is never done in domestic practice, and the flour dealers rarely adulterate the flour with this substance. They are liable to a heavy penalty for adulterating flour, but the law is never enforced against the bakers. I have never examined a specimen of flour which contained alum, or a specimen of baker’s bread which did not contain it.”

16 days of #DrJohnSnow. Read the Victorian novel The Drummer was the First to Die which includes Snow-its free http://bit.ly/12v3PA1

16 Drummer first to die“The younger drummer, standing in front of the elephant, eased himself out of the rhythm to stop for another drink of arak. Only his brother was left hitting the steady sixteen beats against the shanai and the singers. He increased his volume, pummeling at the drum he’d fashioned himself out of hide and rosewood. The complex refrain had persisted so long that the whole village had altered their movements, their speech patterns, even their breathing, to synchronize with the plangent beat.

Suddenly, the pulse stopped. All heads, even the elephant’s, looked up. The rest of the musicians went on for a few beats before colliding into silence. Every eye fixed on the drummer.

He bent himself double, clutching at his stomach and the drum, and sank to the ground in a grotesque embrace with his instrument. He convulsed in a sudden spasm of vomiting. A puddle, viscous in the firelight, spread from his mouth and widened around him. His face faded to the color of ashes.

For seconds, nobody moved. Then the victim’s youngest son peeked out from behind the elephant’s leg and toddled over to the writhing man, shouting, “Baba! Baba!” But before he’d gone three steps, he fell, grabbing his belly like his father.

The village scattered in chaos. Three by the fire collapsed like the drummer. The drummer’s wife tried to help her husband and their boy, but within minutes she too fell. The drummer was the first to die.”

Commentary: And thus cholera struck with a ferocity and speed that seemed demonic.

15 days of #DrJohnSnow. DYK-on 9/7/1854, Snow persuaded the St James Bd of Commissioners of Paving to remove handle from #BroadStPump

15 Persuade Bd to remove handle“The General Register Office had not yet received the death returns for the week after 2 September, but local observers knew that the cholera around Golden Square, though now declining, had exacted a very high toll. The numbers meant little until one realized how very few city blocks made up the affected area. A walk of less than three minutes sufficed to take one from the epicenter of the outbreak to a region mostly free of cholera. Whitehead could stand at the front door of St. Luke’s and point to four houses, at an average distance of fifteen yards, that had collectively lost thirty-four inhabitants in four days.

The official body most directly responsible for local health matters in St. James’s parish in 1854 was the Board of Governors and Directors of the Poor, rather than a Board of Guardians. The parish had been exempted from implementation of the New Poor Law. Instead of in-door relief provided in a union workhouse, St. James offered its poor a combination of out-door relief or admission to a small local workhouse. The Board of Governors handled day-to-day affairs and reported to the parish vestry. The governors and directors were concerned about the threat of cholera and on 14 August 1854 had voted to abandon their usual meeting protocol and form themselves into a special emergency response committee to deal with the it. It seemed during the past week as if their worst fears had been realized. As they considered at their weekly meeting what course of action to pursue next, they were notified that Dr. John Snow had respectfully requested an interview with them. He was admitted and presented an account of his investigation so far. As a result the committee issued an order that the handle be removed from the Broad Street pump.” (Vinten-Johansen et al., Cholera, Chloroform, 292, 294.)

14 days of #DrJohnSnow. Watch 3 great videos re: Snow and #BroadStPump http://bit.ly/WZjfta http://bit.ly/12StJ16 http://bit.ly/ZuCzRB

14 Three videos of Dr“A video looking at reasons for improvements in public health provision during the 19th century. These reasons include Dr John Snow, Louis Pasteur, cholera outbreaks and the Great Stink.”

“A video looking at the reasons why public health in Britain was improved in the latter half of the 19th Century.”

13 days of #DrJohnSnow. DYK that the Broad Street pump handle was actually removed on 9/8/1854? http://bit.ly/12Id4sc

1854 Cholera statistics in the vicinity of the Broad Street pump

1854 Cholera statistics in the vicinity of the Broad Street pump

“The order was carried out, and the pump handle was removed. The event passed totally unnoticed by the newspapers and journals of the day, but it was certainly noticed by the local populace, who were not pleased. The butts and cisterns in which piped drinking water was stored (because the water companies typically provided running water only a few hours each day) were coated with dirt, uncovered, and often located in ‘close, unwholesome, and disgusting propinquity [proximity]’ to the water closets and garbage cans. Small wonder that many supplied with piped water still preferred the Broad Street pump.” (Vinten-Johansen et al., Cholera, Chloroform, 294.)

12 days of #DrJohnSnow. Travel to London School of Hygiene and Tropical Medicine for lecture & scientific mtg http://bit.ly/150cDN4

Mapping Disease: John Snow and Cholera–Friday 15 – Saturday 16 March 2013

London School of Hygiene & Tropical MedicineCelebrate John Snow’s 200th birthday and discover the history of John Snow at a public lecture and drinks reception with historian and journalist, Sandra Hempel on 15 March, followed by an all-day scientific symposium looking at historical aspects of his work on 16 March.

12 London School of Hygiene Snow mtg agenda sm

11 days of #DrJohnSnow. Watch movie trailer for Snow the Movie. It was made into a student film of 22 mins http://bit.ly/YFgewH

11 Snow movie trailer“It is the summer of 1854 and a violent cholera outbreak has decimated the unseemly district of Soho, London. While the source of the outbreak remains unclear, the leading medical authorities blame the miasma, or poisonous air, which emanates from the nearby bone boiling establishments. When an unlikely physician, Dr. John Snow, uncovers an entirely different theory, he must piece together a scientific puzzle that will culminate in one historic moment, anointing Dr. John Snow as the ‘Father of Modern Epidemiology.’”

10 days of #DrJohnSnow. DYK that due to public protests Broad Street pump handle was reinstalled on 9/26/1855? Not removed for good til 1866

10 Pump handle reinstalled 1855“The commissioners of paving of St. James’s again received a petition from the inhabitants of Broad Street and environs. There was much complaint in the neighborhood that the Broad Street pump remained without its handle. Back in June the parish medical officer, John G. French (a friend of Snow’s since 1849 and a member of the Cholera Inquiry Committee), had warned of the increased threat of cholera with the warm weather and had advised strongly that all the street pumps be closed down. The pumps remained popular, however, compared to the filthy cisterns that normally held the piped water. Besides, it was now autumn, and the cholera seemed to be gone from London. On a 10-2 vote the commission decided to reopen the Broad Street Pump….The Broad Street pump was not permanently closed until the cholera epidemic of 1866…” (Vinten-Johansen et al., Cholera, Chloroform, 310, 317.)

9 days of #DrJohnSnow. Watch the TED talk by Steven Johnson author of The Ghost Map. http://bit.ly/G1jxb

9 TED talk by Steven Johnson“Author Steven Johnson takes us on a 10-minute tour of The Ghost Map, his book about a cholera outbreak in 1854 London and the impact it had on science, cities and modern society. Steven Berlin Johnson is the best-selling author of six books on the intersection of science, technology and personal experience.”

8 days of #DrJohnSnow. Read Cholera, Chloroform, and the Science of Medicine by Stephen Vinten-Johansen et al. IMHO the best book about Snow

8 Cholera Chloroform“The product of six years of collaborative research, this new biography interprets a pioneering figure in anesthesiology, epidemiology, medical cartography, and public health. It modifies the conventional rags-to-riches portrait of John Snow by synthesizing fresh information about his early life from archival research and recent studies. It explores the intellectual roots of his commitments to vegetarianism, temperance, and pure drinking water, first developed when he was a medical apprentice and assistant in the north of England. The authors argue that many of Snow’s later contributions are traceable to the medical perspective he imbibed as a medical student in London and put into practice early in his career as a clinician: that medicine as a science required the incorporation of recent developments in its collateral sciences-chiefly anatomy, chemistry, and physiology-in order to understand the causes of disease. Snow’s theoretical breakthroughs in anesthesia were extensions of his experimental research in respiratory physiology and the properties of inhaled gases. Shortly thereafter, his understanding of gas laws led him to reject miasmatic explanations for the spread of cholera, and to develop an alternative theory that explained all facets of cholera epidemiology from transmission in households to the course of epidemics in cities and nations.” (Vinten-Johansen et al., Cholera, Chloroform, dustcover.)

Queen Victoria holding Princess Beatrice

Queen Victoria holding Princess Beatrice

7 days of #DrJohnSnow. DYK that Snow delivered Queen Victoria’s baby, Princess Beatrice, on 4/14/1857 using chloroform as an anesthesia?

“For Snow personally, the trip to the palace [for the birth of Prince Leopold] had clearly been a success, and it was not surprising that three years later, when the queen was about to give birth to her ninth child, Princess Beatrice, he again received the call. This time, however, the royal labour proved more of an ordeal, and Her Majesty began demanding more pain relief than Snow felt it safe or expedient to provide. In managing this particular birth, the doctors had a difficult balancing act. They were clearly worried about the slow progress of the labour, and Lacock gave the Queen ergot in order to strengthen her contractions….Increasing the queen’s contractions also meant increasing her pain, of course; yet at the same time, once in the second stage of labour, Her Majesty must not be too drugged to push.

‘The labour occurred about a fortnight later than was expected,’ Snow wrote. It commenced about 2 a.m., when the medical men were sent for. The labour was lingering and, a little after 10, Dr Lacock administered half a drachm [half a teaspoonful] of powdered ergot, which produced some effect in increasing the pains. At 11 o’clock, I began to administer chloroform. Prince Albert had previously administered a very little chloroform on a handkerchief… for each pain. Her Majesty expressed great relief from the vapour.” (Hempel, Strange Case, 104-5.)

6 days of #DrJohnSnow. Read The Ghost Map by Steven Johnson-the most popularized account of Snow’s discoveries http://bit.ly/ZqmEy9

6 Ghost map“It’s the summer of 1854, and London is seized by a violent outbreak of cholera that no one knows how to stop. As the epidemic spreads, a maverick physician and a local curate are spurred to action, working to solve the most pressing medical riddle of their time. In a triumph of multidisciplinary thinking, Johnson illuminates the intertwined histories of the spread of disease, the rise of cities, and the nature of scientific inquiry, offering both a thrilling account of the most intense cholera outbreak to strike Victorian London and a powerful explanation of how it has shaped the world we live in.” (Johnson, Ghost Map, back cover)

References:

Frerichs, Ralph R. “John Snow.” http://www.ph.ucla.edu/epi/snow.html (accessed October 4, 2012).

Hempel, Sandra. 2007. The Strange Case of the Broad Street Pump: John Snow and the Mystery of Cholera. Los Angeles, Ca.: University of California.

Johnson, Steven. 2006. The Ghost Map: The Story of London’s Most Terrifying Epidemic and How It Changed Science, Cities and the Modern World, New York City, N.Y.: Riverhead Books.

Vinten-Johansen, Peter, Howard Brody, Nigel Paneth, Stephen Rachman and Michael Rip. 2003. Cholera, Chloroform, and the Science of Medicine. New York City, N.Y.: Oxford University Press.

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Dr. John Snow and the Broad Street Pump

0907 John_SnowBy Michael J. McGuire

Dr. John Snow (March 15, 1813–June 16, 1858) was famous for the Broad Street Pump episode but he accomplished so much more than that. He was first and foremost a physician who trained in England in the early part of the 19th century. He made significant contributions to the development of anesthesia and he is considered by many to be the Father of Modern Epidemiology.

The story of Dr. John Snow and how he discovered the cause of a cholera epidemic in the Golden Square neighborhood of London in 1854 has reached almost mythical proportions in public health literature.  Three excellent books describe Snow’s life and the details of the Broad Street Pump incident. (Hempel 2007; Johnson 2006; Vinten-Johansen et al. 2003)

Snow was born on March 15, 1813 in the City of York.  He served his medical-apothecary apprenticeship in Newcastle-on-Tyne with later assistantships in the villages of Burnop Field and Pateley Bridge.  In 1836 at the age of 23, Snow moved to London to complete his medical education.  He qualified as a licensed apothecary in 1838 and a surgeon with a London practice in October 1838.  With an office in the parish of Saint Anne-Soho, Snow would have a medical career of only two-dozen years before he was struck down at the age of 45.

At the age of 17, Snow became a vegetarian and soon thereafter committed to only drinking boiled water or, preferably, distilled water as a result of the writings of John Frank Newton.  He embraced abstinence from alcohol around 1836.  Snow was known to be quiet, frugal and energetic, a man of integrity and a surgeon with an indifferent bedside manner.  He refused to dispense pills and other medicines just because his patients wanted them.  He was able to make a living and acquire some success as a physician when he perfected the administration of chloroform as an anesthetic used during surgeries and infant deliveries.  He even delivered two babies while attending Queen Victoria.

He never married.  His solitary existence and his abstinent personal habits allowed him more time than his colleagues to develop his medical practice and enabled him to pursue his intense interest in determining the cause of cholera epidemics.

Snow gave away all of the knowledge he developed.  He made it available for free to any doctor who wanted it.  No attempt was made by him to patent his many devices for dispensing chloroform and ether. As a result, physicians hired him to use his skill with their patients and he became famous for this.

One overriding personal characteristic of this ascetic doctor of the Victorian era was courage.  He worked hard to develop his ideas and used the scientific method and laboratory investigations to establish his case in whatever area he was working.  Once he became convinced of the rightness of his position, nothing could dislodge him.  It was only his tremendous courage that made it possible for him to go up against the establishment and argue that something other than foul air was causing the deadly cholera. (McGuire 2013)

Snow’s determination of the cause of the cholera epidemic near the Broad Street pump and his ability, albeit temporary, to have the pump handle removed is worthy of recounting here.  The 1854 cholera epidemic struck the Golden Square neighborhood of London with particular viciousness. It began on August 31 and started to wind down about September 7, however, many died over the next few days. Well over 500 people died during this epidemic in a small neighborhood. Snow tracked the numbers of deaths in the neighborhood, and it was clear to him from the pattern of death that the Broad Street pump was the center of the affliction and most likely the source of infection. On September 7, Snow convinced the Board of Governors and Directors of the Poor of St. James Parish that the epidemic was being caused by water from the pump. The next day the commissioners ordered that the pump handle be removed. Structural defects in the Broad Street well sump and the cross-connection to the nearby house sewer were not corrected until 1855.

Incredibly, the residents of Broad Street petitioned the Commissioners to reopen the well that had caused hundreds of deaths in their neighborhood.  This was partly due to the official linkage of the severe, isolated epidemic in the Broad Street area to miasma (foul air). In an amazing footnote to history, the commissioners voted 10 to 2 to reopen the well on September 26, 1855, one year and one week after the last deaths during the epidemic.  According to contemporary reports, there was much rejoicing in the street that the Broad Street well was reopened.  The polluted well was not permanently closed until the cholera epidemic of 1866.

With the emphasis on the Broad Street pump episode in most historical accounts, his pioneering work in epidemiology based on cholera occurrence in a district of London served by two water supplies usually gets lost.  Snow was able to demonstrate that homes in areas of London that were being served contaminated water from the tidal portion of the Thames Estuary were far more likely to have cholera deaths than the homes served water from an unpolluted upland source. He believed that dumping sewage into a water supply perpetuated the death spiral caused by cholera and other waterborne diseases. Snow had strong opinions on sewers and drinking water systems.

“Snow who distilled his own drinking water, agreed that London water should be improved, but he considered the abolition of cesspools and the increasing preference for water closets a sanitary disaster…water closets connected to sewer lines that emptied into rivers also used for metropolitan drinking water were, in his mind, primarily an efficient means of recycling the cholera agent through the intestines of victims as rapidly as possible.  Sanitary reforms were needed, but flushing the waste of a town into the same river by which one quenched ones’ thirst seemed sheer stupidity.” (Vinten-Johansen et al 2003)

Dr. John Snow died of a stroke on June 16, 1858, 42 days after the birth of John L. Leal who grew to be a physician who carried on Snow’s concern about the ability of contaminated water to spread disease.  If the discoveries of Dr. John Snow had been accepted and followed by engineers, sewer planners and drinking water providers beginning in 1854, millions of deaths would have been avoided.  Snow was only one person trying to overcome the juggernaut of the miasma theory.  He was far ahead of his time.

References:

Hempel, Sandra. 2007. The Strange Case of the Broad Street Pump: John Snow and the Mystery of Cholera. Los Angeles, Ca.: University of California.

Johnson, Steven. 2006. The Ghost Map: The Story of London’s Most Terrifying Epidemic and How It Changed Science, Cities and the Modern World, New York City, N.Y.: Riverhead Books.

McGuire, Michael J. (2013). The Chlorine Revolution:  Water Disinfection and the Fight to Save Lives. Denver, CO:American Water Works Association.

Vinten-Johansen, Peter, Howard Brody, Nigel Paneth, Stephen Rachman and Michael Rip. 2003. Cholera, Chloroform, and the Science of Medicine. New York City, N.Y.: Oxford University Press.

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The Best of “This Day in Water History”—2012

By Michael J. McGuire

I have been posting daily water historical happenings since September 1, 2012 on my other blog This Day in Water History. I thought it would be fun to choose my favorites and post short versions of them for your perusal and amusement.

0907 John_SnowSeptember 7, 1854:  The St. James Board of Governors and Directors of the Poor was convinced by Dr. John Snow that the Broad Street pump was the source of a cholera epidemic in a London neighborhood.  The Board ordered the removal of the pump handle preventing a continuation of the epidemic.  Incredibly, public protests resulted in the replacement of the pump handle on September 26, 1855.

0926 Chloride of lime treatment buildingSeptember 26, 1908:  First day of operation of the chlorination facility at Boonton Reservoir for Jersey City, NJ.  This was the first continuous use of chlorine in the U.S. for drinking water disinfection. Dr. John L. Leal was responsible for this breakthrough in public health. Details of the facility planning and operation are included in The Chlorine Revolution: Water Disinfection and the Fight to Save Lives.

0930 Roosevelt dedicates Hoover damSeptember 30, 1936:  Hoover Dam Dedication by U.S. Secretary of the Interior, Harold L. Ickes and President Franklin D. Roosevelt. Click HERE for an audio recording of the dedication.  New York Times headline–President…Speaks at Boulder Dam.  ”Standing on a platform perched high above the Colorado River at the eastern terminus of the great, towering Boulder Canyon Dam, President Roosevelt dedicated it today…

1014 Baby drinking milk from bottleOctober 14, 1862:  New York Times headline–Mixing of Water with Milk Not an Adulteration. “The People ex rel. Jacob Fauerbach vs. Court of Sessions. — The relator was convicted in the Court of Sessions of vending adulterated milk, and sentenced to pay a fine of $55. He appealed the case to the New York Supreme Court, contending that the act under which he was convicted was purely a sanitary measure, intending to prevent traffic in impure, diseased and unwholesome milk…

1021 Rupert Blue 4th Surg Gen of USOctober 21, 1914:  The first numerical drinking water regulations in the U.S. were adopted. “On October 21, 1914, pursuant to the recommendation of the Surgeon General of the Public Health Service [Dr. Rupert Blue], the Treasury Department adopted the first standards for drinking water supplied to the public by any common carrier engaged in interstate commerce. These standards specified the maximum permissible limits of bacteriological impurity…

1030 Common CupOctober 30, 1912. 100th Anniversary of the Regulation Banning the Common Cup. At the turn of the 20th century, public health professionals were still struggling to incorporate the precepts of the germ theory into all of their protocols. The general population was even further behind and, in many cases, resisted the momentum for change. One popular custom during this period was the use of a single cup or dipper for a pail of water or water cooler aboard trains—the common cup. Disease transmission as a result of using a common cup in public places was a serious problem…

1116 Privy in southern cityNovember 16, 1918:  Municipal Journal. A Sanitary Survey of an Unnamed City. The conditions about which you will read were by no means unusual in 1918 in the U.S. “A State Board of Health a few months ago, made a sanitary survey of a certain city (the name of which is unessential) which was of more than usual interest, because of its thoroughness and the sensible recommendations based upon it….The city in question has a population of about 30,000

1125 Margaret ThatcherNovember 25, 1988:  New York Times headline—Britain Planning to Sell Its Waterworks. “The British Government today began the latest and most contentious step in its sweeping privatization program by presenting its plans for selling off the nation’s state-owned water industry. ‘Privatizing water makes about as much sense as privatizing the air we breathe.’…

1126 Dr Ruth PatrickNovember 26, 1907: 105th Birthday of Dr. Ruth Patrick. “Dr. Ruth Myrtle Patrick (born November 26, 1907) is a botanist and limnologist specializing in diatoms and freshwater ecology, who developed ways to measure the health of freshwater ecosystems and established a number of research facilities. Dr. Patrick’s research in fossilized diatoms showed that the Great Dismal Swamp between Virginia and North Carolina was once a forest, which had been flooded by seawater. Similar research proved that the Great Salt Lake was not always a saline lake.

1203 Ellen Swallow RichardsDecember 3, 1842:  Ellen Swallow Richards was born. “Ellen Swallow Richards is perhaps best known as MIT’s first female graduate and instructor, but launching coeducation at the Institute is merely the first in a long list of her pioneering feats. The breadth and depth of her career are astounding; a 1910 tribute in La Follette’s Weekly Magazine professed that ‘when one attempts to tell of the enterprises, apart from her formal teaching, of which Mrs. Richards has been a part or the whole, he is lost in a bewildering maze.’ Authors and scholars have called her the founder of ecology, the first female environmental engineer, and the founder of home economics.

1216 Safe Drinking Water Act signed into lawDecember 16, 1974: Safe Drinking Water Act signed into law by President Ford.  “The Safe Drinking Water Act (SDWA) is the principal federal law in the United States intended to ensure safe drinking water for the public. Pursuant to the act, the Environmental Protection Agency (EPA) is required to set standards for drinking water quality and oversee all states, localities, and water suppliers who implement these standards.

1221 GW Fuller 1903  35 yrs oldDecember 21, 1868:  George Warren Fuller is born in Franklin, Massachusetts. George Warren Fuller was, quite simply, the greatest sanitary engineer of his time, and his time was long—lasting from 1895 to 1934.  In truth, we have not seen his like since.  How did he reach the pinnacle of his field?  What early influences led him on his path? There is a biography of Fuller on Wikipedia that I wrote which summarizes his life from a “neutral point of view.” The material below is taken in part from Chapter 7 of The Chlorine Revolution:  Water Disinfection and the Fight To Save Lives. By design, it gives more of a personal flavor to his life.

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2012 in review

By Michael J. McGuire

The WordPress.com stats helper monkeys prepared a 2012 annual report for this blog.

Here’s an excerpt:

In 2012, there were 42 new posts, not bad for the first year! There were 71 pictures uploaded, taking up a total of 10 MB. That’s about a picture per week.

The busiest day of the year was August 20th with 274 views. The most popular post that day was All Water Cycle Diagrams are Wrong.

Visitors came from 105 countries. The top countries were U.S., Canada, India and UK.

Click here to see the complete report.

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Nascent Oxygen?–What is Really Killing Bacteria in Water?

by Michael J. McGuire

Oxidation-Reduction Reactions

Oxidation-Reduction Reactions

Before we understood that oxidation-reduction reactions involved electron transfers, chemists theorized that oxygen existed in a “nascent state.” This state made it possible for oxidation reactions to take place. Such an outmoded chemistry concept is relevant to a discussion of the history of chlorination in the U.S.

Nascent Oxygen Theory

Nascent Oxygen Theory

The first continuous use of chlorine to disinfect a U.S. water supply occurred at Boonton Reservoir—the water supply for Jersey City, New Jersey. As recounted in a forthcoming book (The Chlorine Revolution), two trials defined the need for disinfection and documented how it happened. In the second Jersey City trial, Dr. John L. Leal claimed that chlorine was not responsible for killing bacteria. Instead, he put forth the long-standing theory that chlorine when added to water liberated something called nascent oxygen, and it was the nascent oxygen was responsible for disinfection. (McGuire 2013)

The concept of nascent oxygen originated with James Watt, who described the importance of liberated oxygen in the bleaching process. An equation suggested by Watt (Race 1918) showed chlorine producing oxygen when it was dissolved in water:

Cl2 + H2O = 2HCl + O

In which Cl2 = chlorine, H2O = water, HCl = hydrochloric acid, and O = nascent oxygen.

In a later, well-known publication, Albert D. Hooker stated the theory most clearly: “It should be well understood that chloride of lime, in its industrial application of bleaching, deodorizing, or disinfecting, does not act by its chlorine, but by its oxygen.” (Emphasis in original.) (Hooker 1913)

In 1918, Joseph Race described the controversy surrounding chlorine’s mode of action in water. Race stated that Fischer and Proskauer (1884) believed that chlorine was not directly toxic. Warouzoff, Winograoff, and Kolessnikoff (1886) found that chlorine gas killed airborne tetanus spores. Interestingly, Race quoted at length John L. Leal’s second-trial testimony supporting the theory of disinfection by nascent or potential oxygen. However, Race’s laboratory work in 1915–17 appeared to convince him that disinfection was caused by the direct toxic action of chlorine and not by nascent oxygen. (Race 1918)

Other publications reflected the confusion over chlorine’s mechanism of action. In his 1917 textbook, Ellms (who would testify in the second Jersey City trial) presented equations showing the formation of hypochlorous acid (HOCl) when chlorine was added to water. At this point in his discussion, he was correct. However, he then stated “The HOCL is decomposed into HCl and oxygen, which latter acts upon any oxidizable matter that may be present.” (Ellms 1917)

2HOCL à 2HCl + O2

In this case, HOCl = hypochlorous acid and O= oxygen.

“The energy liberated by the decomposition of the hypochlorous acid, as previously stated, explains the powerful oxidizing action of the evolved oxygen, and the destructive effect upon the microorganisms. Chlorine or the hypochlorites are therefore, merely agents for the production of oxygen under conditions which render it extremely active.” (Ellms 1917)

Abel Wolman and I.H. Enslow tried to put a stop to the nascent oxygen theory in 1919, but it persisted long after that. (Fair and Geyer 1954) We know now that HOCl exists in water in equilibrium with the dissociated hypochlorite ion and that the degree of dissociation is a function of the water’s pH.

HOCL ↔ OCl + H+

For this equation, OCl = hypochlorite ion and H+ = hydrogen ion.

In a textbook published in 1924, authors F.E. Turneaure and H.L. Russell tried to straddle the issue:

“The reaction of both hypochlorite and liquid chlorine in sterilization of water is substantially the same. The accepted theory is that the chlorine forms hypochlorous acid with the water setting free nascent oxygen which is considered the effective sterilization agent. Some authorities, however, contend that the chlorine itself has a toxic effect upon the bacteria.” (Turneaure and Russell 1924)

A 1935 rewrite of Sedgwick’s famous book on sanitary science favored the direct action of chlorine theory but did not totally discount the action by nascent oxygen.

“The mechanism by which chlorine brings about germicidal action is still undetermined. It is believed by some that the bacteria are destroyed because of the direct toxic effect of the chlorine. Others maintain that the introduction of chlorine into water results in the formation of hypochlorous acid—an unstable compound—which breaks up and liberates nascent oxygen and hydrochloric acid, the supposition being that the bacteria are destroyed by the nascent oxygen. . . . Since chlorine compounds can destroy bacteria even when oxygen is not liberated it would seem that those mechanisms that explain the germicidal action of chlorine without hypothesizing the formation of nascent oxygen have a more sound scientific basis.” (Prescott and Horwood 1935)

A 1944 publication by S.L. Chang appeared to put the controversy to rest: “The action of chlorine and chloramine compounds on cysts was attributed to the active chlorine which may oxidize or chlorinate the proteins in the protoplasm. The possibility of action by nascent oxygen liberated by HOCl was indirectly studied, and the evidence strongly indicated that this was unlikely to occur.” (Chang 1944) Since Chang’s publication, nascent oxygen has not been mentioned in professional publications except as a historical curiosity.

In their classic 1954 textbook on water and wastewater engineering, Gordon M. Fair and John C. Geyer addressed the historically curious concept and stated categorically that oxygen did not accomplish disinfection. It was chlorine in its various forms in water that was toxic to bacteria. (Fair and Geyer 1954) Like many a scientific theory that conveniently explained a troubling public relations problem, it took a lot of time to kill the nascent oxygen idea.

References:

  • Chang, S.L. 1944. “Destruction of Micro-Organisms.” Journal AWWA. 36:11 1192-1207.
  • Davies, Edward. 1878. “The Nascent State as Affecting Chemical Action.” The Pharmaceutical Journal and Transactions. 8: 485-6.
  • Ellms, Joseph W. 1917. Water Purification. New York City, N.Y.: McGraw-Hill.
  • Fair, Gordon M., and John C. Geyer. 1954. Water Supply and Waste-water Disposal. New York City, N.Y.: John Wiley & Sons, Inc.
  • Hooker, Albert D. 1913. Chloride of Lime in Sanitation. New York City, N.Y.: John Wiley & Sons.
  • McGuire, Michael J. The Chlorine Revolution:  Water Disinfection and the Fight to Save Lives. Denver:American Water Works Association, 2013.
  • Prescott, Samuel C. and Murray P. Horwood. 1935. Sedgwick’s Principles of Sanitary Science and the Public Health:  Rewritten and Enlarged. New York:McMillan.
  • Race, Joseph. 1918. Chlorination of Water. New York City, N.Y.: John Wiley & Sons.
  • Turneaure, F.E., and H.L. Russell. 1924. Public Water-Supplies: Requirements, Resources, and the Construction of Works. 3rd Edition. New York City, N.Y.: John Wiley & Sons, Inc.
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Drinking Water Regulatory Update—December 3, 2012

 Alan RobersonBy Michael J. McGuire

Alan Roberson is the Director of Federal Relations for the American Water Works Association. He has released the latest in a series of drinking water regulatory updates. The regulatory update covers these important topics:

  1. Consumer Confidence Report—electronic delivery options
  2. Status of the final Revised Total Coliform Rule (RTCR)
  3. New definition of “lead free” water service products (i.e., <0.25% lead)
  4. More delay in perchlorate regulation
  5. EPA third regulatory determination due sometime in 2013
  6. Proposed Long-Term Lead and Copper Rule (LT-LCR) Revisions due in 2013
  7. Schedule for the proposed carcinogenic Volatile Organic Compound (cVOC) Rule
  8. Third six-year review of existing drinking water regulations
  9. Hexavalent chromium

Alan’s update is required reading for anyone who has the huge responsibility for maintaining their water utility in compliance with the federal drinking water regulations.

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