Pioneers in infection control: John Snow, Henry Whitehead, the Broad Street pump, and the beginnings of geographical epidemiology

SummaryJohn Snow was one of the founders of epidemiology. Already convinced of the value of pure water, he analysed the distribution of cholera cases in the 1848 epidemic in relation to the purity of the water supply in London. His hypothesis that cholera was spread by contaminated water was tested by the ‘Broad Street’ epidemic of 1854. Snow quickly traced the water used in the houses affected by cholera to the pump in Broad Street, and persuaded the parish council to remove the handle. The epidemic subsided. The council did not really believe Snow, so the curate, Henry Whitehead, set out to repeat Snow's work, albeit at a more leisurely pace as the epidemic had subsided. He located 700 deaths within a 250-yard radius and showed that use of water from the Broad Street pump was strongly correlated with death from cholera. This surprised him as he had drunk water from the pump himself during the outbreak. Thus ‘geographical epidemiology’ began, although it was some years before Snow's observations were generally accepted.