Lessons Learned: Looking Back to Go Forward
A series of articles exploring historical events that provide an important lesson for ensuring a more sustainable and healthy environment. Originally published as a bulletin feature for the newsletter of CHE-WA (Collaborative on Health and the Environment, Washington State chapter); produced by Steven G. Gilbert.
“May God be with me! May Heaven bless this New Year. May it be a year of fruitfulness, of peace and prosperity; may it be a year of peace and unity for all mankind; may the world be freed of cholera.” - Giacomo Meyerbeer (September 05, 1791 - May 02, 1864)
We are not free of cholera, as we learned from the outbreak of cholera infections in Haiti in 2010 that affected over 250,000 people and killed over 4,500. Worldwide that year, it affected 3-5 million people and caused 100,000-130,000 deaths, mostly in developing countries. Cholera is an ancient disease that originated in the Indian subcontinent and has been prevalent in the Ganges delta since ancient times. Throughout history it has killed millions of people; for example, eight million died in India between 1900 and 1920.
You need to ingest a dose of about one hundred million cholera bacteria to become infected as a normal, healthy adult. You are more susceptible to infection if your gut has lower acidity, if you have type O blood, or you are a child two to four years of age.
Imagine the 1850s before it was known that cholera is caused by the bacterium Vibrio cholerae. Imagine further you are in London, England in the 1850s and your neighbors seem to be randomly contracting cholera and dying. Some thought it was caused by pollution or a noxious form of "bad air," but John Snow, a London physician, publicized his theory that cholera was transmitted by water in an essay, “On the Mode of Communication of Cholera,” in 1849. Snow plotted the incidence of cholera on a map and noticed the increased incidence around a single source of water. As Snow stated, “On proceeding to the spot, I found that nearly all the deaths had taken place within a short distance of the [Broad Street] pump.” Though his theory was not well accepted, the Broad Street pump handle was removed and the epidemic stopped. John Snow made this enormous contribution to public health and started the discipline of epidemiology all before the exact cause and effect had been discovered. Just a few years later in 1885, German physician and microbiologist Robert Koch discovered that cholera was caused by Vibrio cholerae. Koch received the 1905 Nobel Prize for Physiology and Medicine for his discovery of the bacterial cause of tuberculosis.
The Broad Street Pump can still be found in London near the John Snow Tavern. From a public health perspective this is a pilgrimage worth making. In developed countries, cholera infections are rare and treatable; we are able to keep our water supply and food safe from this common bacterium. The tragedy is that many children in developing countries are still dying from cholera due to poor sanitation infrastructure and practices. We must support efforts to assure children access to safe food and clean water; like all children, they deserve an environment in which they can reach and maintain their full potential.