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History of Medicine

John Snow, a hero of Public Health and Epidemiology, and his time

There is more to know about his story – it is not just only about cholera and the water pump

of the Golden Square District in London. Without knowing the ultimate cause of the

disease, Snow could convincingly demonstrate that polluted water was instrumental in the

transmission of the deadly epidemic. His investigations into the spread of cholera within

London in the middle of the 19


century made him the ‘father of epidemiology’. He did not

succeed in bringing down the miasma theory, but his methods of investigation are still

exemplary ways of detecting the mode of transmission and source of outbreaks of epidemics

of infectious diseases.

Teaching public health to medical students can be frustrating. I don’t say this about

Thailand. I am referring to medical students in my country of

origin. Their interest in public health, or social medicine as it was

called, was less than enthusiastic. Sometime I could not resist

exposing them to a rush of adrenalin when it came to examining

them in the final ‘State Examination’. One of my introductory

questions was, ‘What could be taken as the symbol of public health

and especially epidemiology?’ In introducing my question I did

remind the candidate about the symbol of medicine being the Staff

of Aesculapius. In my introductory lecture about epidemiology I

mentioned that the drawing of some street pump might, like the

Staff of Aesculapius, be taken as the symbol of epidemiology, if

not of public health, because it refers to the story of the cholera in

London in the middle of the 19


century and the investigation of

Snow into the cause of the epidemic. This event could be

considered as a milestone in epidemiological investigations and the fight against a disease

which was exposing millions at risk to a cruel death. Since it was not compulsory for the

students to attend the lecture but only to attend a seminar where basic issues were no longer

discussed, none of the candidates could answer correctly. Finally, I

had to abandon the question, because the candidates distributed

protocols about the examination questions for the use of the next

batch of students being examined. I must add that of course I didn’t

let the student fail for not knowing an answer to this question.

My guess is that the story of the street water pump in

London’s Golden Square District of Soho is on the agenda of every

introductory lecture in epidemiology and public health all over the

world. What students usually remember is that John Snow

dismantled the handle of that pump because the water was

Replica of Broad Street

Pump -Photo: F.P. Schelp