August 28, 1854 Broad Street Well

If you’re ever in London, stop and hoist a glass to an unsung hero.  One of the Founding Fathers, of modern epidemiology.

The waterborne bacterium Vibrio cholerae (V. cholerae) lives in the warm waters of coastal estuaries and rivers, and the waters along coastal plains. Most of the time, those contracting the bacterium do so by consuming contaminated water, developing only mild symptoms or none at all.

Most times the infection resolves itself yet, at times, urban density has combined with poor sanitation, to produce some of the most hideous pandemics, in medical history.

The origins of Cholera, are unknown. The Portuguese explorer Gaspar Correa described a flare-up in the Ganges Delta city of Bangladesh in the spring of 1543, an outbreak so virulent that it killed most victims within eight hours, with a mortality rate so high that locals struggled to bury all the dead.

vibrio-cholerae-louisa-howard-and-charles-daghlian-and-photo-researchers

V. Cholerae populations undergo explosive growth in the intestines of the sufferer, releasing a toxin and causing cells to expel massive quantities of fluid. Severe cramps lead to “rice water” diarrhea and the rapid loss of electrolytes.  Dehydration is so severe that it leads to plummeting blood pressures and often, death.  It’s easy to see how the disease can “spike”.  One such episode can cause a million-fold increase in bacterial populations in the environment, according to the CDC.

The first pandemic emerged out of the Ganges Delta in 1817, spreading to Thailand, Indonesia and the Philippines. 100,000 were killed on the island of Java, alone. The severe winter of 1823-’24 appears to have killed off much of the bacteria living in water supplies, but not for long.

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H/T Cholera. Between Life and Death Fr. Scott Binet MD, MI CTF-SOS D RS Sao Paulo, Brazil – October 20, 2011

The second Cholera pandemic began in 1830-’31, spreading throughout Poland, Russia and Germany. The disease reached Great Britain in 1832, when authorities undertook quarantines and other measures, to contain the outbreak.

Four years earlier, William Burke and William Hare had carried out 16 murders over a ten-month period in Edinburgh, selling the corpses to Doctor Robert Knox for dissection during his anatomy lectures. Now, quarantines were met with pubic fear, and distrust of government and medical authorities. ‘Cholera riots’ broke out in Liverpool and London, with demands to ‘Bring out the Burkers”.

burke_and_hare-600x450The world would see four more cholera pandemics between 1852 and 1923, with the first being by far, the deadliest. This one devastated much of Asia, North America and Africa. in 1854, the worst year of the outbreak, 23,000 died in Great Britain, alone.

In 1760, the British capital of London was home to some 740,000 souls. One-hundred years later, population shifts had ballooned that number to nearly 3.2 million, in a city without running water.

A_Drop_of_Thames_Water,_by_Punch,_1850
A Drop of Thames Water, by Punch,,1850

At one time, the many farms surrounding the city of London used the, er…”stuff” provided by “Gong Farmers”, the ‘nightsoilmen’ whose execrable job it was to shovel out the growing numbers of cesspits throughout the city, for fertilizer.  Transportation costs grew as the city expanded, and the farms moved away.  In 1847, solidified bird droppings (guano) were brought in from South America at a cost far below that of the local stuff, leaving London’s poorer quarters increasingly, to their own filth.

The “Great Stink” of Victorian-era London is beyond the scope of this essay, save to point out that formal portraits may be found of Queen Victoria herself, with a clothespin on her nose.  Today the topic is mildly amusing and not a little disgusting however, in an era before public sewage, we’re talking about life and death.

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In 1854, police constable Thomas Lewis lived with his wife Mary and five-month-old Frances, at 40 Broad Street in the Soho neighborhood of London.  The baby developed severe diarrhea over August 28-29, as Mrs Lewis soaked the soiled ‘nappies’ in pails of water.  These she dumped into the pit in front of her house, as first her baby and then her husband, sickened and died.

The pit was three feet away from the Broad Street well, where much of the neighborhood came to pump drinking water.

homePageImageSeveral other outbreaks had occurred that year, but this one was particularly acute.  Within the next three days, 127 died within a short distance of the Broad Street address.  By September 10, there were five-hundred more.

In the third century AD, the Greek physician Galen of Pergamon first described the “miasma” theory of illness, holding that infectious disease such as Cholera were caused by noxious clouds of “bad air”. Today the theory is discredited but, such ideas die hard.

Most everyone blamed the fetid air for the cholera outbreak, but Dr. John Snow was different.  Snow suspected there was something in the water and, through door-to-door interviews and careful analysis of mortality rates, devised a ‘dot map’ identifying the Broad Street address.

“On proceeding to the spot, I found that nearly all the deaths had taken place within a short distance of the [Broad Street] 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 that they always sent to the pump in Broad Street, as they preferred the water to that of the pumps which were nearer. In three other cases, the deceased were children who went to school near the pump in Broad Street …”

Snow himself believed in the Miasma theory of disease as did Reverend Henry Whitehead, who helped him collect his data. Yet somehow, the pair became convinced that infectious agents were somehow concentrated in the water, and they had found the “Index Case”.

Despite near-universal skepticism regarding Dr. Snow’s theories, the pump handle at 40 Broad Street was removed.  It was later re-installed but, by that time, the danger had passed.  Untold numbers of lives were saved by Dr. Snow’s intervention.

Dr. Snow succumbed to a stroke in 1858 and died at the age of 45, never learning how right he had been.  Dr. Louis Pasteur opened his institute for the study of microbiology, thirty years later.

Today, the place is known as “Broadwick Street”.  There’s a replica of the old water pump out front of #40, across from the John Snow pub.  If you’re ever in London, stop and hoist a glass to an unsung hero.  One of the Founding Fathers, of modern epidemiology.

If you enjoyed this “Today in History”, please feel free to re-blog, “like” & share on social media, so that others may find and enjoy it as well. Please click the “follow” button on the right, to receive email updates on new articles.  Thank you for your interest, in the history we all share.

August 12, 1865 Wash your Hands

Today, the idea that microrganisms such as fungi, viruses and other pathogens cause infectious disease is common knowledge, but such ideas were held in disdain among scientists and doctors, well into the 19th century.

In the 12th century, French philosopher Bernard of Chartres expressed the concept of “discovering truth by building on previous discoveries”. The idea is familiar to the reader of English as expressed by the mathematician and astronomer Isaac Newton, who observed that “If I have seen further it is by standing on the shoulders of Giants.”

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Dr. Ignaz Semmelweis

Nowhere is there more truth to the old adage, than in the world of medicine. In 1841, the child who survived to celebrate a fifth birthday could look forward to a life of some 55 years. Today, a five-year-old can expect to live to eighty-two, fully half again that of the earlier date.

Yet, there are times when the giants who brought us here are unknown to us, as if they had never been. One such is Dr. Ignaz Semmelweis, one of the earliest pioneers in anti-septic medicine.

Semmelweis  studied law at the University of Vienna in the fall of 1837, but switched to medicine the following year. He received his MD in 1844 and, failing to gain a clinical appointment in internal medicine, decided to specialize in obstetrics.

In the third century AD, the Greek physician Galen of Pergamon first described the “miasma” theory of illness, holding that infectious diseases such as cholera, chlamydia and the Black Death were caused by noxious clouds of “bad air”.  The theory is discredited today, but such ideas die hard.

miasma-theory

The germ theory of disease was first proposed by Girolamo Fracastoro in 1546 and expanded by Marcus von Plenciz in 1762. Single-cell organisms – bacteria – were known to exist in human dental plaque as early as 1683, yet their functions were imperfectly understood. Today, the idea that microrganisms such as fungi, viruses and other pathogens cause infectious disease is common knowledge, but such ideas were held in disdain among scientists and doctors, well into the 19th century.

InfectiousDisease16_9In the mid-19th century, birthing centers were set up all over Europe, for the care of poor and underprivileged mothers and their illegitimate infants. Care was provided free of charge, in exchange for which young mothers agreed to become training subjects for doctors and midwives.

In 1846, Semmelweis was appointed assistant to Professor Johann Klein in the First Obstetrical Clinic of the Vienna General Hospital, a position similar to the “chief resident,” of today.

300px-AAKH-1784At the time, Vienna General Hospital ran two such clinics, the 1st a “teaching hospital” for undergraduate medical students, the 2nd for student midwives.

Semmelweis quickly noticed that one in ten women and sometimes one in five, were dying in the First Clinic of postpartum infection known as “childbed fever”, compared with less than 4% at the Second Clinic.

The difference was well known even outside of the hospital. Expectant mothers were admitted on alternate days into the First or Second Clinic. Desperate women begged on their knees not to be admitted into the First, some preferring even to give birth in the streets, over childbirth in that place. The disparity between the two clinics “made me so miserable”, Semmelweis said, “that life seemed worthless”. He had to know the reason why.

Puerperal Peritonitis 1912 MAChildbed or “puerperal” fever was rare among these “street births”, and far more prevalent in the First Clinic, than the Second. Semmelweis carefully eliminated every difference between the two, even including religious practices. In the end, the only difference was the people who worked there.

The breakthrough came in 1847, following the death of Semmelweis’ friend and colleague, Dr. Jakob Kolletschka. Kolletschka was accidentally cut by a student’s scalpel, during a post-mortem examination. The doctor’s own autopsy showed a pathology very similar to those women, dying of childbed fever. Medical students were going from post-mortem examinations of the dead to obstetrical examinations of the living, without washing their hands.

Midwife students had no such contact with the dead. This was it. Some unknown “cadaverous material” had to be responsible for the difference.

Semmelweis instituted a mandatory handwashing policy, using a chlorinated lime solution between autopsies and live patient examinations.

Ignaz Philipp SemmelweisMortality rates in the First Clinic dropped by 90%, to rates comparable with the Second. In April 1847, First Clinic mortality rates were 18.3% – nearly one in five. Hand washing was instituted in mid-May, and June rates dropped to 2.2%.  July was 1.2%. For two months, the rate was zero.

The European medical establishment celebrated the doctor’s findings, and Semmelweis was feted as a giant of modern medicine.  No, just kidding.  He wasn’t.

The imbecility of the response to Semmelweis’ findings is hard to get your head around, and the doctor didn’t help himself.  The medical establishment took offense to the idea that they themselves were the cause of the mortality problem, and that the answer lay in simple cleanliness.

Semmelweis himself was anything but tactful, publicly berating those who disagreed with his hypothesis and gaining powerful enemies.   For many, the doctor’s ideas were extreme and offensive, ignored or rejected and even ridiculed.  Are we not Gentlemen!?  Semmelweis was fired from his hospital position and harassed by the Vienna medical establishment, finally forced to move to Budapest.

Yearly_mortality_rates_1841-1846_two_clinicsDr. Semmelweis was outraged by the indifference of the medical community, and began to write open and increasingly angry letters to prominent European obstetricians.  He went so far as to denounce such people as “irresponsible murderers”, leading contemporaries and even his wife, to doubt his mental stability.

Dr. Ignaz Philipp Semmelweis was committed to an insane asylum on July 31, 1865, twenty-three years before Dr. Louis Pasteur opened his institute for the study of microbiology.

On August 12, 1865, British surgeon and scientist Dr. Joseph Lister performed the first anti-septic surgery, in medical history.  Dr. Semmelweis died the following day at the age of 47, the victim of a blood infection sustained following a severe beating by asylum guards.

If you enjoyed this “Today in History”, please feel free to re-blog, “like” & share on social media, so that others may find and enjoy it as well. Please click the “follow” button on the right, to receive email updates on new articles.  Thank you for your interest, in the history we all share.