They were holding on hard. Some were still unmoved and furious. Medical journals like the Lancet were especially withering. The editor wrote of Snow:
Why is it, then, that Dr. Snow is so singular in his opinion? Has he any facts to show in proof? No!… But Dr. Snow claims to have discovered that the law of propagation of cholera is the drinking of the sewage-water. His theory, of course, displaces all other theories. Other theories [that] attribute great efficacy in the spread of cholera to bad drainage and vegetable decomposition are innocuous! If this logic does not satisfy reason, it satisfies a theory; and we all know that theory is often more despotic than reason. The fact is, that the well whence Dr. Snow draws all sanitary truth is the main sewer. His specus, or den, is a drain. In riding his hobby very hard, he has fallen down through a gully-hole and has never since been able to get out again.28
First of all, it’s surprising to see a medical journal declaring “He lives in a metaphorical sewer!” of a fellow doctor. I guess the medical profession was filled with more vim and vigor and public hatred then. Beyond that, Snow had many facts to show proof. He made a map! He did study after study! He spent his life doing absolutely nothing except accumulating facts to prove his theory on the cause of cholera, dosing people with chloroform, and eating uncooked vegetables. His life was defined by his relentless dedication to combatting cholera. Richardson wrote, “No one but those who knew him intimately can conceive how he labored, at what cost, and at what risk. Wherever cholera was visitant, there was he in the midst.”29
Saying Snow did not have his facts in order was groundless. Although I would never have dinner with the man, I will defend to the death the statement that Snow’s investigative research was impeccable.
But his opponents persisted. The public health activist Edwin Chadwick and the president of the Board of Health Benjamin Hall denounced Snow’s reasoning. Snow’s rebuttal in a letter to Hall declared: “Although there is sufficient direct evidence to prove that cholera is neither caused nor increased by offensive trades, that circumstance is very much confirmed by the facts which I have been able to collect in illustration of the mode of propagation of cholera; for it is not reasonable to seek for additional causes of any phenomenon, when a real and adequate cause is known.”30 He does not know why you keep trying to find other causes for a disease when he has told you the cause.
Another detractor skeptical of Snow’s theory was Reverend Henry Whitehead. The twenty-nine-year-old curate of St. Luke’s Church in the Soho neighborhood was convinced of the miasma theory. He claimed “an extensive inquiry would reveal the falsity of the Snow hypothesis regarding the Broad Street pump.”31
If you have ever read the comments under a medical article online (oh, God, do not, please do not; you will get so angry your head will explode, and you need your brain), you will know that many people think that in boldly making a claim—any claim—their point is proven, and that they can sit back smugly secure in the fact that it has been established that they are smarter than the author-doctor-scientist.
Cool group photo of those commenters
But Reverend Whitehead was not an Internet commenter. He was a man of God who had ethics as well as bold convictions. He meticulously interviewed everyone in the Soho neighborhood, sometimes reviewing their information four or five times. He completed an even more elaborate map than Snow’s, which took into account everyone who had left the neighborhood and been hospitalized elsewhere, and all the people who had visited the area and then became sick. “Slowly and I may add reluctantly,” he concluded, “that the use of water [from the Broad Street pump] was connected with the continuation of the outburst.”32 He became such a firm convert to Snow’s theory that until his death Whitehead kept over his desk a portrait of Snow, which, he noted, “ever serves to remind me that in any profession the highest order of work is achieved not by fussy demand for ‘something to be done,’ but by patient study of the eternal laws.”33 Whitehead published his findings in June 1855 in the article “Special Investigation of Broad Street.” Only then did the medical committee of the General Board of Health decide that the outbreak of cholera “lasting for the few early days in September was in some manner attributable to the use of the impure water of the well in Broad Street.”34 The committee members were nearly evenly split on that decision.
Skepticism persisted for years. As late as 1859 the Lancet claimed that there was absolutely no doubt that noxious smells were “a most efficient and malignant influence in the causation and aggravation of disease.”35 However, in 1866, during the next outbreak of cholera, officials told citizens that they should begin boiling their water. You know, just in case John Snow was right.
There was never another cholera outbreak in London.
Ever.
The local government board declared in 1866 that “the remarkable and shrewd observations of Dr. Snow, demonstrat[ed] incontrovertibly the connexion of cholera with a consumption of specifically polluted water.”36
John Snow, sadly, never witnessed the public validation of his theory. He died in 1858 of a reported stroke. Possibly! There is a rumor that the cause of death was not a stroke and instead an overdose as he was allegedly always dosing himself with anesthesia, which would be a genuinely surprising habit for such a fervent teetotaler.
In that same year a heat wave caused the river—and the city surrounding it—to reek so badly that the phenomenon was referred to as “the Great Stink.” That summer, it was also found that the rate of death from diseases like cholera had not spiked, even with the many terrible smells in the air. Snow would have been delighted; I am sincerely sad he did not live to see the miasma theory waft away.
Snow’s obituary in the Lancet did not mention his cholera findings. It only read: “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 anaesthetics were appreciated by the profession.”37 But by 1866 the journal declared: “The researches of Dr. Snow are among the most fruitful in modern medicine. He traced the history of cholera. We owe to him chiefly the severe induction by which the influence of the poisoning of water-supplies was proved. No greater service could be rendered to humanity than this; it has enabled us to meet and combat the disease, where alone it is to be vanquished, in its sources or channels of propagation … Dr. Snow was a great public benefactor, and the benefits which he conferred must be fresh in the minds of all.”38 That’s very nice. However, this praise ran beside an article regarding the 1866 outbreak in which some dude (okay, Mr. Orton, a medical officer) claimed he had “facts which induce him to believe that the local nuisances have had their part quite as well as the water in production of cholera.”39
There are always going to be some people who believe that the sun is revolving around a flat earth.
Today, John Snow is a medical legend. As for him being boring company, well, Dr. Richardson, Snow’s biographer, hammers home my shallowness in his preface to Snow’s On Chloroform and Other Anaesthetics: Their Action and Administration (1858). Richardson remarks that a biography of Snow would “be scanty in its details; it is of but little count that the life of him who is about to be shadowed forth is destitute of incident fitted for the taste of wonder-loving, passion-courting, romance-devouring readers. Biographies for these are common. Good men are scarce.”40
Okay, Dr. Richardson. I get it. Still, you may be delighted to know that in Snow’s memory, there is now an institution named after him by the site of the Broad Street pump in London. It is a pub. The owner must either have known nothing about Snow’s personal character or had a really keen, beautiful sense of humor.
If you genuinely want to celebrate John Snow and you are in London, go in and raise a glass to him. It should be a glass full of clean, cool, feces-free water. It’s what Snow would have wanted.
Cheers, guys.
Leprosy
The biggest disease today is not
leprosy or tuberculosis, but rather
the
feeling of being unwanted, uncared
for, and deserted by everybody.
—MOTHER TERESA
The best-case scenario when it comes to the outbreak of a disease is that the community will rally around the afflicted. It will tend to them gently; it will raise funds; it will do whatever is necessary to allow the people stricken with the disease to live with dignity while science searches for a cure. When the community as a whole swings into action, plagues can be overcome relatively swiftly.
That almost never happens.
But, fortunately, it doesn’t always take an entire community. Every so often there is an outsider who is willing to take on the caregiving of the diseased. Maybe you’re thinking, Well, I would do that, but I am not a doctor. But you don’t have to be a doctor! Groups of people doing walks to benefit disease research in brightly colored T-shirts come to mind, as do elegantly attired people hosting events to raise funds. And, though he wasn’t as impressively attired, so does that shining nineteenth-century example of compassion and humanity—Father Damien of Molokai.
Guided by his faith, Father Damien chose to live among the lepers on the island of Molokai as their priest, assisting them practically and spiritually and, while doing so, contracted leprosy himself. In 2009 he was canonized by Pope Benedict XVI, who claimed: “Father Damien made the choice to go on the island of Molokai in the service of lepers who were there, abandoned by all. So he exposed himself to the disease of which they suffered. With them he felt at home. The servant of the Word became a suffering servant, leper with the lepers, during the last four years of his life.”1 Damien’s sainthood prompted President Barack Obama to remark: “In our own time as millions around the world suffer from disease, especially the pandemic of HIV/AIDS, we should draw on the example of Father Damien’s resolve in answering the urgent call to heal and care for the sick.”2 That comment is especially applicable today as Damien is the unofficial patron saint of those suffering from HIV/AIDS; the sole Catholic memorial chapel to the victims of HIV and AIDS is dedicated to him.3
Leprosy, the disease Father Damien gave his life to fighting, is terrifying in an epic way. People have been very afraid of it from the beginning of recorded history. It is mentioned in the Bible, where it is often associated with sin. Leviticus 13:45–46 says: “And the leper in whom the plague [is], his clothes shall be rent, and his head bare, and he shall put a covering upon his upper lip, and shall cry, Unclean, unclean. All the days wherein the plague [shall be] in him he shall be defiled; he [is] unclean: he shall dwell alone; without the camp [shall] his habitation [be].”4
Sunday school teachings notwithstanding, this is not true. Leprosy has nothing to do with whether someone has a shiny, clean soul or body. No diseases have anything to do with anyone’s soul. Leprosy is a bacterial disease, caused by Mycobacterium leprae. The Norwegian doctor Gerhard Hansen identified the bacterial cause in 1873, and the disease today is often called Hansen’s disease. However, he is not going to be a hero in this story, and I refuse to refer to leprosy by that term because in the course of his research he infected a woman with full-blown leprosy without her knowledge.5 He claimed he didn’t tell her what he was going to do because he couldn’t “presuppose that the patient would regard the experiment from the same point of view as I myself did.”6
No, perhaps not, Gerhard.
The Mycobacterium leprae can pass into a body through an open cut or through mucous membranes in the nose. That seems like an easy way to become infected, but the good news is that most individuals aren’t especially susceptible to the disease. To contract it, people have to be in constant, close contact with lepers.
Leprosy manifests in two ways. The first is tuberculoid leprosy, where rough, scaly lesions develop over the skin. That’s because the disease sets off a cellular reaction in which immune cells rush to isolate the bacteria. The reaction spreads to the nerves in the affected areas and stops nerve signals from being transmitted, so sufferers lose sensation at that site. Sometimes this kind of leprosy resolves, though in other cases it progresses and turns into lepromatous leprosy. In those cases, the bacteria spread all over the body, causing open sores on the face and body. In some cases, the disease also leads to blindness.
The most notable feature of leprosy—and in many cases the first symptom of the disease—is the loss of the sense of touch. That doesn’t sound terrible until you realize that if you are accidentally walking over broken glass, it is good to know that. It’s also good to know if you burned yourself or chopped off your finger while cooking or otherwise injured yourself in a way that should be tended to. And the injuries don’t have to be that extreme to cause problems! With no feeling in your limbs, you could just not notice an everyday blister from too-tight shoes and continue walking around in those shoes until the sore becomes infected. It’s because of the resulting infections from these injuries that lepers came to be associated with missing fingers, hands, or feet—the bacterium itself doesn’t actually cause them to fall off. However, it does cause muscles to weaken in a way that results in deformities. For instance, lepers are often thought to have hands that look like claws. That’s because the muscles in their hands are no longer strong enough to extend their fingers.
Today, like many historical plagues, leprosy can be treated with antibiotics, which are provided for free by the World Health Organization. It is yet another disease that, if you have enough resources at your disposal to buy and read this book, you are never going to need to worry about. But it understandably terrified people of the past. Because the symptoms of the disease were so obvious, the people who had it were regarded as outcasts. In fact, some people thought the best way to fight the disease was to make sure no one had contact with any lepers at all.
In 1865 the Hawaiian government enacted “An Act to Prevent the Spread of Leprosy.” It claimed that a portion of land—which would end up being on the island of Molokai—would be set aside for leprous individuals. This is where it got scary:
The Board of Health or its agents are authorized and empowered to cause to be confined, in some place or places for that purpose provided, all leprous patients who shall be deemed capable of spreading the disease of leprosy … it shall be the duty of the Marshal of the Hawaiian Islands and his deputies, and of the police officers, to assist in securing the conveyance of any person so arrested to such place, as the Board of Health, or its agents may direct, in order that such person may be subjected to medical inspection, and thereafter to assist in removing such person to place of treatment or isolation, if so required, by the agents of the Board of Health.7
In short, if you were suspected of being a leper, the government was going to hunt you down and forcibly move you off to quarantine.
If this policy does not strike you as desirable or in any way okay, you are not alone. There is even a Jack London story, called “Koolau the Leper,” in which the protagonist is a leper who would rather fight and die than go to Molokai. The story begins with him saying: “Because we are sick they take away our liberty. We have obeyed the law. We have done no wrong. And yet they would put us in prison. Molokai is a prison.”8
I would have gone with hellhole rather than prison, but however you phrase it, conditions on Molokai were dire. The government hoped that the lepers would take care of themselves, farming the land and living off their own resources, seemingly forgetting how hard that is to do if people do not have all of their extremities intact. Moreover, the lepers were depressed about being suddenly cast out of society. If you isolate people from their families and friends when they have a serious disease, physical disabilities, and very little hope, they understandably may not behave really well.
I would probably have responded to that situation by becoming a severe alcoholic and having a lot of sex to try to distract myself from the daily misery of my condition and surroundings. Maybe you would have done better, but many seemed to share my feelings. In 1913 the missionary Joseph Dutton wrote in the Catholic Encyclopedia, volume 10
: “Matters went on pretty well at first, but after some time an ugly spirit developed at Molokai. Drunken and lewd conduct prevailed. The easy-going, good-natured people seemed wholly changed.”9
Arriving at the colony was like being plunged into some sort of heartbreaking dystopia. In Leper Priest of Molokai: The Father Damien Story, Richard Stewart writes of the medical facilities: “Conspicuously absent in the so-called hospital were doctors, nurses and a supply of medicines with which to treat the more common diseases that plagued the lepers and precipitated their demise … water for cleaning the open sores and bathing was in disturbingly short supply.”10 Some doctors would not touch their patients and lifted their bandages with a cane. Others just left medicine where the lepers could access it and refused to have any contact with them at all.11
If you treat people like monsters, they behave that way. Dutton wasn’t exaggerating. The island was filled with crime, drunkenness, and abuses of every kind. Damien later reported that “many an unfortunate woman had to become a prostitute in order to obtain friends who would take care of her.” This wasn’t just the fate of grown women; child prostitutes abounded on the island.12 And, as Damien went on to say, “once the disease prostrated them, such women and children were cast out.”13 So there were outcasts even among the lepers. If you visited Molokai, you would hear the phrase “A ’ole kanawai ma keia wahi” with some regularity. It means, “In this place there is no law.”14 There was—comically—a jail, but it stood empty because no one was able to enforce rules.15
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