Tag Archives: cholera

May 7, 1848: Public Health Act, England

May 7, 1848:Public Health Act is passed by a reluctant Parliament fearful of spread of cholera. National Board of Health is formed and leads local boards to regulate water supply, sewerage, offensive trades.”

“The first local boards [of health] were created under the Public Health Act 1848 (11 & 12 Vict. c.63). The aim of the act was to improve the sanitary condition of towns and populous places in England and Wales by placing the supply of water, sewerage, drainage, cleansing and paving under a single local body. The act could be applied to any place in England and Wales except the City of London and some other areas in the Metropolis already under the control of sewer commissioners. The Act was passed by the incoming Liberal government, under Prime Minister Lord John Russell, in response to urgings by Edwin Chadwick.”

March 16, 1802: Corps of Engineers Established; 1804: Birth of Chester Averill

March 16, 1802: President Jefferson authorized to establish the Corps of Engineers. “The history of United States Army Corps of Engineers can be traced back to 16 June 1775, when the Continental Congress organized an army with a chief engineer and two assistants. Colonel Richard Gridley became General George Washington’s first chief engineer; however, it was not until 1779 that Congress created a separate Corps of Engineers. One of its first tasks was to build fortifications near Boston at Bunker Hill. The first Corps was mostly composed of French subjects, who had been hired by General Washington from the service of Louis XVI.

The Corps of Engineers as it is known today came into being on 16 March 1802, when President Thomas Jefferson was authorized to ‘organize and establish a Corps of Engineers … that the said Corps … shall be stationed at West Point in the State of New York and shall constitute a Military Academy.’ Until 1866, the superintendent of the United States Military Academy was always an engineer officer. During the first half of the 19th century, West Point was the major and, for a while, the only engineering school in the country. The Corps’s authority over river works in the United States began with its fortification of New Orleans after the War of 1812.”

Chester Averill

March 16, 1804: Birth of Chester Averill who became a Professor of Chemistry at Union College in Schenectady, New York. Averill is known for a letter that he wrote to the Mayor of Schenectady, New York during the 1832 cholera epidemic which praised the disinfecting properties of chloride of lime (chlorine). The treatise quoted many learned men of the time who demonstrated that chloride of lime eliminated the spread of contagious diseases by attacking the miasmas associated with them. The letter also made reference to the destruction of certain “viruses” that may have been responsible for transmission of the diseases.

Commentary: Averill’s letter is an extraordinary document that is worth reading. He was far ahead of his time. Indeed, he preceded Dr. John Snow’s conclusions about cholera transmission (1849) by 17 years.

March 15, 1813: Birth of Dr. John Snow

Dr. John Snow

March 15, 1813: Birth of John Snow. Dr. John Snow (March 15, 1813–June 16, 1858) is 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.

Commentary: In 2013, we had a great time celebrating the 200th anniversary of his birth.

TDIWH—January 9, 2014: MCHM Chemical Spill in West Virginia; 1985: Plane Crashes into Kansas Water Treatment Plant; 2012: First Haitian Cholera Victim; 1997: Water is Still Deadly Drink in Parts of the World

Middle Tank (#396) was the source of most of MCHM spill

Middle Tank (#396) was the source of most of MCHM spill

January 9, 2014: MCHM Chemical Spill in West Virginia. “Charleston, WV; January 9, 2014. 7:46AM. You’re trying to get your children up, fix breakfast and get them ready for school. You stick your head out the door to see how cold it is, and a wave of something smelling like black licorice hits you. The Elk River below you seems fine, but that odor is rolling off the surface. None of the radio news stations are saying anything. Wait. You know where your water comes from-the Elk River. Is the drinking water safe? You call the water department to find out what’s going on.

Sounding the Alarm: Do Not Use!

So began the day for 300,000 people in Charleston, West Virginia and in the surrounding nine counties. A tweet from Gov. Earl Ray Tomblin at 2:36 PM on January 9 previewed the 5:45 pm press conference where a Do Not Use order was issued by West Virginia American Water (WVAW) for all of the water in their service area. (A Do Not Use order is the most serious warning that can be given for drinking water. It means that tap water can only be used for flushing toilets and fighting fires.) At the press conference, the governor declared a state of emergency for the affected area.

It later became clear that a spill of about 10,000 gallons of something called Crude MCHM took place at a Freedom Industries facility 1.5 miles above the intake of the Kanawha Valley Water Treatment Plant (KVWTP), which is run by WVAW. When the spill actually occurred and when the material entered the water treatment plant has not been determined at this writing. The maximum MCHM concentration measured in the influent to the plant was about 3.4 mg/1. No one has adequately explained why the plant intake was not shut down early on January 9.

By 7 PM on January 9 a full-blown water-buying panic had gripped the area. Cases of bottled water were stripped from shelves within a 20-mile radius of Charleston. The morning of January 10, President Obama declared the nine counties a federal disaster area.”

Reference: McGuire, M.J., 2014. “The West Virginia Chemical Spill: A Massive Loss in Public Confidence.” Source. CA NV Section AWWA, 28:3:31 Summer.

0109 plane crashJanuary 9, 1985: Plane crashes into Kansas water treatment plant. “Last January the Board of Public Works (BPU) of Kansas City, Kansas was the victim of an airplane crash at their Quindaro water treatment plant complex. Although all members of the airplane’s crew were killed, the members of the BPU operations staff on duty that morning were unharmed, although shook up. The airplane managed to miss two nearby power plant structures, the east side of the treatment plant, and the chemical treatment plant building where the four employees were working, but landed in a primary basin less than 50 feet away from the building. An intensive manpower effort was launched to get the debris cleaned up and the plant back in operation as soon as possible. Three weeks to the day after the crash, the basin without a walkway bridge was returned to service. Kermit

Mangum, the water plant superintendent, is scheduled to talk about this story at the KSAWWA conference in Wichita.”

Commentary: Thanks to Paul Crocker of the Kansas City BPU for providing this information.

The most effective treatment for cholera is intravenous hydration.

The most effective treatment for cholera is intravenous hydration.

January 9, 2012: New York Times headline—Haiti: Cholera Epidemic’s First Victim Identified as River Bather Who Forsook Clean Water. “The first Haitian to get cholera at the onset of the 2010 epidemic was almost undoubtedly a 28-year-old mentally disturbed man from the town of Mirebalais, researchers reported Monday.

The man, whose name was not revealed in the report, in The American Journal of Tropical Medicine and Hygiene, was known as the village “moun fou” — Creole for “crazy person” — said the authors, who work for Partners in Health, a Boston group associated with Dr. Paul E. Farmer that has provided free health care in Haiti since 1987.

Although his family had clean drinking water, the man often walked naked through town to bathe and drink from the Latem River just downstream from the Meye River, into which raw sewage drained from an encampment of United Nations peacekeepers from Nepal.

Map: Distribution of cholera cases in Haiti

Map: Distribution of cholera cases in Haiti

Haiti’s outbreak was of a Nepali strain, and that encampment is considered the source.

The man developed severe diarrhea on Oct. 12, 2010, and died in less than 24 hours. Two people who washed his body for a wake fell ill 48 hours later. Haiti’s first hospitalized cholera case was in Mirebalais on Oct. 17.

The epidemic has since sickened nearly 500,000 people across Haiti and killed nearly 7,000.”

Commentary:  The death toll is now about 10,000 with no end in sight. The UN finally took some responsibility for starting the epidemic. It was caused by poor sanitation habits of Nepalese soldiers who were stationed in Haiti to aid in recovery from the devastating earthquake.

0109 India slum childrenJanuary 9, 1997: New York Times headline— For Third World, Water Is Still a Deadly Drink. By Nicholas Kristof “THANE, India— Children like the Bhagwani boys scamper about barefoot on the narrow muddy paths that wind through the labyrinth of a slum here, squatting and relieving themselves as the need arises, as casual about the filth as the bedraggled rats that nose about in the raw sewage trickling beside the paths.

Parents, like Usha Bhagwani, a rail-thin 28-year-old housemaid, point out their children and fret about how to spend their rupees. Should they buy good food so that the children will get stronger? Or should they buy shoes so that the children will not get hookworms? Or should they send their sons and daughters to school? Or should they buy kerosene to boil the water?

There is not enough money for all of those needs, so parents must choose. It was to save money, as well as to save time, that Mrs. Bhagwani was serving unboiled water the other day to her 5- and 7-year-old boys in her one-room hovel. Her bony face and sharp eyes softened as she watched them take the white plastic cup and gulp the deadly drink.

The water has already killed two of her children, a 15-month-old, Santosh, a boy who died two years ago, and Sheetal, a frail 7-month-old girl who died just a few months ago. But everyone in the slum drinks the water, usually without boiling, and water seems so natural and nurturing that Mrs. Bhagwani does not understand the menace it contains.”

December 6, 1866: Chicago: First Water Supply Tunnel

1206 Crib Structure in LakeDecember 6, 1866: “First water supply tunnel for U.S. city completed for Chicago, IL; Chicago Lake Tunnel extended 10,587 feet under Lake Michigan to an inlet crib; 5 feet in diameter, final cost of $380,784; March 17, 1864 – work started; March 25, 1867 – water allowed into the tunnel. Pumping station with the standpipe tower still stands at the intersection of Michigan Blvd and Chicago Ave., escaped destruction in the 1871 Chicago fire.”

1206 chicago lake tunnel detailThe two-mile tunnel under Lake Michigan proposed by Ellis Chesbrough in 1863 brought him international fame when it was completed and, with its remarkable Two-mile Crib intake structure, was heralded as the eighth wonder of the world. Tunnel construction began in May 1864 and then continued for 24 hours a day and six days a week. A lower semicircular arch was dug and built about six feet in advance of the upper arch. Two men could work side by side, with the miners in front and the masons laying brick about 10-20 feet behind.

1206 Digging TunnelTwo small mules were found to work in the tunnel, pulling railroad cars to move clay out and building materials in. Digging proceeded first from the shore end and later from the lake end of the tunnel. Chesbrough and a few other dignitaries descended into the tunnel to remove the final inches separating the two tunnels in November 1866. The mayor placed the final masonry stone, and fresh water from the lake entered the tunnel for the first time with great fanfare in March 1867, bringing pure unpolluted water into the city through the structure.”

1206 Bricking TunnelCommentary: The purity of the water from this tunnel was grossly overstated in this article and in the minds of Chicagoans in 1866. Cholera and typhoid fever continued to kill tens of thousands of people in Chicago because the city’s sewage was also discharged into the lake for many decades after 1866.

References:

“Business History.” Website http://www.businesshistory.com/index.php, Accessed November 14, 2012.

“The Lake Tunnel in Chicago.” Website http://www.lindahall.org/events_exhib/exhibit/exhibits/civil/lake_tunnel_2.shtml Accessed December 5, 2012.

November 6, 1893: Cholera Kills Tchaikovsky

Tchaikovsky's Tomb

Tchaikovsky’s Tomb

November 6, 1893: Death of Tchaikovsky. “On 6 November 1893, nine days after the premiere of his Sixth Symphony, the Pathétique, Pyotr Ilyich Tchaikovsky died in Saint Petersburg, at the age of 53. The official cause of death was reported to be cholera, most probably contracted through drinking contaminated water several days earlier. This explanation was accepted by many biographers of the composer. However, even at the time of Tchaikovsky’s death, there were many questions about this diagnosis.

The timeline between Tchaikovsky’s drinking unboiled water and the emergence of symptoms was brought into question. So was the possibility of the composer’s procuring unboiled water in the midst of a cholera epidemic with strict health regulations in effect. Also, while cholera actually attacked all levels of Russian society, it was considered a disease of the lower classes. The resulting stigma from such a demise for as famous a personage as Tchaikovsky was considerable, to the point where its possibility was inconceivable for many people. The accuracy of the medical reports from the two physicians who had treated Tchaikovsky was questioned. The handling of Tchaikovsky’s corpse was also scrutinized as it was reportedly not in accordance with official regulations for victims of cholera.”

October 27, 1850: Cholera in Sacramento, California

Memorial to Courageous Physicians who Died in the Epidemic

Memorial to Courageous Physicians who Died in the Epidemic

October 27, 1850Cholera in Sacramento, California. “Alas for Sacramento in 1850, cholera is a disease that thrives in conditions of urban filth. The bacterium can be transmitted from one host to another through unwashed hands or raw sewage. When raw sewage containing the bacteria finds its way into the public water supply, cholera spreads rapidly. Its symptoms include severe abdominal pain, vomiting, and diarrhea. The disease strikes without warning. In the course of a single day, cholera can be fatal to a previously healthy person. Perkins wrote on October 27, ‘Some have been taken who were to all appearances in good health and have died in a few hours.’ Likewise, on October 23, Lord noted in his journal, ‘A man walking down J Street last evening, dropped suddenly, and lived only long enough to be carried into the nearest door.’

The first death from cholera occurred on October 20. The number of cases rapidly multiplied over the next few weeks, radiating into the city from the commercial riverside district….Public health measures proved to be worse than ineffective. A city ordinance passed on October 21 ordered residents to burn their garbage or face a $500 fine. Lord wrote that the ‘filth is burned in the middle of the streets—old shoes and boots and clothes by the ton, and cart loads of bones, and raw hides, and putrid meat, and spoiled bacon—so that the end of the matter is worse than the beginning.’ By the end of the month, half of the population of the city had either succumbed to the disease or fled the city. By the end of the first week of November, it was 80 percent. ‘In this pestilential reign of terror and dismay the most dreadful abandonments of relatives and friends took place’….”

Reference:  Isenberg, Andrew C. Mining California:  An Ecological History. New York:Hill and Wang, 2005, p.66.

Commentary The Sacramento 1850 epidemic was one of the worst in U.S. history.