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150th Anniversary of John Snow and the Pump Handle
John Snow, M.D. (1813--1858), a legendary figure in epidemiology, provided one of the earliest examples of using epidemiologic methods to identify risk for disease and recommend preventive action (1). Best known for his work in anesthesiology, Snow also had an interest in cholera and supported the unpopular theory that cholera was transmitted by water rather than through miasma (i.e., bad air).
On August 31, 1854, London experienced a recurrent epidemic of cholera; Snow suspected water from the Broad Street pump as the source of disease. To test his theory, Snow reviewed death records of area residents who died from cholera and interviewed household members, documenting that most deceased persons had lived near and had drunk water from the pump. Snow presented his findings to community leaders, and the pump handle was removed on September 8, 1854. Removal of the handle prevented additional cholera deaths, supporting Snow's theory that cholera was a waterborne, contagious disease. Despite the success of this investigation, the cause of cholera remained a matter of debate until Vibrio cholerae was isolated in 1883.
Snow's studies and the removal of the pump handle became a model for modern epidemiology. To recognize his pioneering work, this issue of MMWR highlights public health actions guided by epidemiologic data to control a modern epidemic of cholera, detect and prevent adverse reactions to vaccinations, stop an epidemic of aflatoxin poisoning, and correct environmental causes of waterborne outbreaks.
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