Presented by Dr Paul Bingham, who used to be the NHS Director of Public Health on the Isle of Wight, on Monday 11th November.
'John Snow Bicentenary, Cholera Epidemiology, and the Isle of Wight'
John Snow discovered the source of cholera in the 19th century and Paul will also bring the subject up to date by looking at the ongoing problem of Cholera in Haiti.
John snow and cholera dr paul bingham - isle of wight cafe scientifique - nov 2013
1. Café Scientifique: 11 November 2013
‘John Snow Bicentenary,
Cholera Epidemiology,
the Isle of Wight and Haiti’.
2. My talk - not just a narrative
account of medical history!
Modest aim of presentation :
to give insight into how science advances
& to provoke discussion
7. Greatest Doctor ever:
1. John Snow (1813-1858)
2. Hippocrates (460-370 BC)
3. Dame Cicely Saunders (1918-2005)
8. John Snow –
London’s number 1 Anaesthetist
End 1846 ‘Ether’
arrives from Boston
1847 Book ‘On the
Inhalation of the
Vapour of Ether in
Surgical Operations’
9. Anaesthetist to royalty
1853 Provided anaesthetic for the birth
of Prince Leopold (no. 8)
‘Dr Snow gave that blessed chloroform
and the effect was soothing, quieting,
and delightful beyond measure’
1857 Birth of Princess Beatrice (no. 9)
(1858 Posthumous book
‘On Chloroform and Other Anaesthetics’
Snow is said to have given 11,000
anaesthetics without a death)
17. Waves of cholera/deaths
E & W IOW
1832
22k
2
1848/9 53k 188
1854
20k
35
1866
14k 125
(Snow)
Apprentice in Sunderland
Used IOW data
Broad Street
South London water supply
Dead
18. Snow
• Had a strong conviction
that cholera was
transmissible by water,
food and person-to-person
• Applied the science then
available
• But his findings not
endorsed by the medical or
political establishment
31. Historians point out:
• in the 1840s and 50s there was much
confusion over cholera
• Many ‘pet theories’ were published
• Snow’s work did not lead to a scientific
revolution
32. Snow was made famous
by Hampton Frost
• 1936 republished second edition
of ‘Snow on Cholera’
• Used Snow’s outbreak maps
as a John Hopkins class exercise
• Hampton’s pupils wrote the
textbooks of the second half
of the 20th century
33. Good story:
• Poor boy made good
• Solitary medical genius
• Public Health hero
34. Good scientist?
Tom Koch: John Snow –
• Rushed to print
• Misused data
(Snow did not endear himself
to Thomas Wakley)
But he was right!
35. First 1848/49 IOW death from cholera
20th Dec 1848: The surgeon of the Cowes
District reported to the Guardians of the Poor
that a case of malignant Cholera he had under
his care had terminated fatally.
The name of the Individual was
Charles Nutkins, a sailor, 27 years
of age who returned on the
evening of the 15th December
from Rotterdam via London and
Southampton and died in the
night of the 16th.
36. National enquiry conducted in 1849 of previous
year’s outbreak by Provincial Medical and
Surgical Association
Published a questionnaire in its Journal
Few responded but
Mr Bloxam of
Newport did
37. Read by Snow who contacted Mr Bloxam for more detail
38. Snow published the Carisbrooke cluster in the
second edition of his ‘On the Mode’ as an
example of the transmission of Cholera via food
39. 12 January 2010: Haitian Earthquake
Moment magnitude scale 7.0
Depth 8 to 10 Km
15 Km southwest of Port-au-Prince
220,000 killed
42. 2010 Haitian outbreak of Cholera
No evidence of cholera in Haiti before 2010
Since Oct 2010, has killed 8,361 (17 Oct 2013)
43. Haitian outbreak of Cholera:
Sudden, and initially localised
Artibonite
District
44. UN: ‘the main task is to control the outbreak
not look for the source’
45. Jan 2011
New England Journal of Medicine
‘Haitian outbreak
strain shares
ancestry with
recent South Asian
strains and not
those circulating
in Latin America
and East Africa’
46. UN independent panel report
‘The sanitation conditions at the (Nepalese)
camp were not sufficient to prevent faecal
contamination’
47. UN independent panel report
The outbreak could not have occurred ‘without
simultaneous water, sanitation and health
care system deficiencies’
‘Outbreak caused by the confluence of
circumstances - not the fault of or deliberate
action of a group or individual’
(Oct 2013: Haitian strain found in Mexico)
49. Tom Koch
‘When in the thick of another epidemic, raise a
glass of lemonade to John Snow,
but follow it with
a chaser for all the
other alcoholics
who laboured in
the field’
50. Questions/Conclusion
• John Snow is venerated by the specialty of public
health – but should he be? Should science have
heroes?
• As a scientist, is it enough just to be right?
• The Isle of Wight’s connection with cholera and
Snow’s bicentenary (Carisbrooke cluster/Hassall
at Ventnor/Queen Victoria) have been
commemorated - just in time.
• Organism genetics (bacteria ‘fingerprinting’)
is revolutionising outbreak investigation.
51. "You and I", he (Snow) would
say to me, "may not live to see
the day, and my name may be
forgotten when it comes, but
the time will arrive when great
outbreaks of cholera will be
things of the past; and it is the
knowledge of the way in which
the disease is propagated which
will cause them to disappear.“
Rev Henry Whitehead at his
farewell dinner