While reading chapter entitled, “All Smell is Disease”, I found the miasmist’s recalcitrant behavior, to a certain extent, to be quite unusual. In the end, one of the causes of the rapid spread of Cholera was the development of a sewage system; the system’s development was highly promoted by the miasmists. Edwin Chadwick was a very influential miasmist who was a major force behind the development of London’s sewage system, at the same time, he caused the death of many people living in London.

What I found to be strange was that the miasmists were not willing to even give John Snow’s water borne theory a chance. They were so enveloped in London’s putrid smell that all the evidence John Snow had to prove otherwise, was simply brushed off. What’s even more ironic to point out was the John Snow was an esteemed physician. He had plenty of experience with ether vapor and chloroform. This would give him back ground knowledge of the effects of noxious fumes on bodies, and they all pointed away from the miasmist’s theory. Certain obvious factors like differing effects of “poisonous” airs amongst people were deemed to be the cause of moral depravity etc. It just seems like, as the author pointed out, that the miasmists could not admit that they were possibly wrong in their diagnosis of the cause of Cholera. They even elected another miasmist, Benjamin Hall, to replace Edwin Chadwick as president of the Board of Health. I just can’t but blame many deaths of Londoners because of the miasmist’s refusal to clearly see the evidence pointing in another direction from miasma.

What I wanted to ask is: How would the development of Cholera in London be different if John Snow was president of the Board of Health? Would the miasmist’s listen to him if he were in such an esteemed position?

David Zilberman

Victorian medicine was severely limited by the lack of basic empirical method or scientific knowledge. Germ theory, which we take for granted today, would have saved countless lives and allowed for progress in the field of bacteriology which would ultimately have revealed V. cholerae to be the perpetrator of cholera. Scientists and physicians of the era seemed to be largely concerned with promoting their own quack cures which superficially eliminated or obscured the symptoms of the disease. John Snow was able to overcome the conventional thinking of the era and laid the road for modern medicine and public health by examining the trends and analyzing what might be the underlying causes rather than acting entirely upon superficial observations.

Miasma theory had gained a strong foothold in the medical community, and supporters of the theory had remained steadfast even with John Snow’s discovery that V.cholerae was waterborne. Why was miasma theory so popular? Was it entirely because of ignorance and stubborn public opinion or could there have been an economic drive as well?

I found the beginning of the books with it’s description to how London was amazing. I could picture how disgusting it must have looked, how crowded the streets were, the sweat rolling off people’s face. It got me to me every time they talked about the waste and how it piled on the cesspool. Just by picturing it, I can see how disgusting everything must have been, how suffocating it must have been to live there, I can’t imagine how these people continued to live there with those conditions, especially after Cholera broke out. People were definitely not rich but was it not possible at all to evacuate the area because there was clearly something wrong with the area. If it was up to me, I would give up all my money to live somewhere else as long as it meant that my family and I wouldn’t die. I wouldn’t want to take the risk of catching the disease and the area was filthy anyway. It makes me cherish what I have now, when I see how we try to keep our streets clean to an extent and most definitely our homes. I cannot imagine facing waste everyday or even being within vicinity of that much waste. It also makes me glad how much we’ve advanced as a society especially when they had their doctors in London coming out with a different cure everyday without actual evidence. Now we actually go through experiments to make sure a cure works. I cannot imagine our daily newspapers covered with ads of doctors to try their cure for a disease.

As a pre-med student, I’ve taken Biology and am in the middle now of MicroBiology. In that class, we actually touched upon Snow’s remarkable accomplishment of figuring out cholera’s dastardly ways. We also talked about the symptoms and just how deadly it was. But none of the classes that I’ve taken so far come close to demonstrating just how gruesome and terrible it actually was. It is, and will always be, something imaginary, something that unless we actually contract, we can only sympathize, not empathize. But trying to put yourself in their collective perspective is, in my opinion, probably one of the few skills needed to effectively run public health initiatives. Understanding the disease is only one of the skills. Understanding the effect it has on the public is an entirely different and more powerful one, one that is absolutely necessary in order to effectively combat the panics of the public. As we see with Thomas Latta and his cure, which actually worked, his insights were buried under the public’s clamor for a cure, any cure at all, even ones that were most probably hoaxes.

My question then is: How do public health officials get this skill? Reading books is definitely not enough. How is it possible to obtain this very powerful skill of not just sympathizing, but empathizing?

– Joseph Kabariti