Epidemiology is crucial in public health care because it significantly affects health of people. Dr John Snow, whose work focused on protecting public health, contributed significantly to the modern epidemiological knowledge.
This paper argues that Snow contributed to epidemiology by applying techniques like mapping and use of data tables to describe disease outbreak, demonstrating the importance of written expression and observation, , participating in a natural experiment, recommending public measures to prevent disease and contributed to environmental epidemiology.
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Snow described the 1849 cholera outbreak graphically through mapping and data tables. He demonstrated the application of both analytic and descriptive epidemiology. For example, his initial activities during the outbreak involved plotting mortality from cholera in connection with a pump that he suggested was the source of the disease outbreak. A short line on the map represented each death while an arrow pointed to pump location (Snow & Richardson, 1965).
During Snow’s time, major urban centres in Europe used direct water from rivers for domestic purposes. The water was mostly contaminated with germs. Thus, he hypothesized that pumps dispensing river water were bases of fatal contamination. His suggestion led to the removal of pumps, which was a public measure to manage disease outbreak.
Snow also participated in a natural experimented by observing two water companies over a period. For example, the Lambeth and, the Southwark and Vauxhall Companies provided water to residents. In turn, this meant that adjacent homes could get their water from two different sources. Later in 1952, Lambeth relocated its water source to a less contaminated section of the river. In a cholera outbreak that emerged in 1854, Dr Snow observed that many people who were infected received their water from the Southwark and Vauxhall Company. His observation regarding the fluctuations in the water quality and fluctuations in the disease infection constituted a natural experiment. Through this observation, he concluded that cleaner water came from the Lambeth Company while contaminated water originated from the Southwark Company, which led him to argue that homes supplied by the second company had high mortality rates compared to those supplied by the first company ((Snow & Richardson, 1965).
Besides the natural experiment technique, Dr Snow contributed to environmental epidemiology by offering professional observer evidence on behalf of the industry in relation to environmental exposures to possible disease causes (Lilienfeld, 2000). He demonstrated this by attempting to deduce from the effects of exposures to high doses of environmental pollutants on health compared to exposure to low exposure doses. The Nuisance Elimination and Infections Prevention Amendments bill was introduced in 1855 in the British parliament to reform the earlier public health bill that followed the 1854 disease outbreak (Lilienfeld, 2000). The aim of the new bill was to manage the release of fumes from factories into the atmosphere.
According to Dr Snow, the fumes were not public health hazards (Sandler, 2000). He based his conclusion on the fact that harmful effects to health from low exposure levels that the public faced was unlikely because of the understanding about the high doses that workers in the factories received. He claimed that factory workers did not experience negative health effects due to the high doses and thus it was not possible that the low doses that the public was exposed to could lead to harmful health effects.
In conclusion, Dr John Snow contributed significantly to epidemiology because he keenly observed emerging out of the norm patterns. His ability to observe and be attentive to detail offered important insights regarding factors that affect health and what can be done to protect public health. He also demonstrated the importance of understanding and interpreting data.
References
Lilienfeld, D. E. (2000). John Snow: the first hired gun?. American Journal of Epidemiology , 152 (1), 4-9.
Sandler, D. P. (2000). John Snow and modern-day environmental epidemiology. American Journal of Epidemiology , 152 (1), 1-3.
Snow, J., & Richardson, B. W. (1965). Snow on Cholera: Being a Reprint of Two Papers by John Snow, MD, Together with a Biographical Memoir by BW Richardson, and an Introduction by Wade Hampton Frost, MD . Hafner.
