Latest / Daniel and Kelly’s Extraordinary Universe / To swill or to smell: How John Snow determined the cause of cholera

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To swill or to smell: How John Snow determined the cause of cholera · Daniel and Kelly’s Extraordinary Universe

• 0:00
  Speaker 1: How the extraordinaries. Just a quick heads up that in
• 0:02
  Speaker 1: today's episode, we're going to be talking about cholera, which
• 0:06
  Speaker 1: is a particularly unpleasant disease that still claims lives today
• 0:11
  Speaker 1: on with today's episode. Since eighteen seventeen, there have been
• 0:23
  Speaker 1: seven cholera pandemics. Many of us listening to this podcast
• 0:27
  Speaker 1: are probably lucky enough to be blissfully unaware that the
• 0:31
  Speaker 1: seventh pandemic is actually not over yet and continues to
• 0:36
  Speaker 1: claim lives in Sub Saharan Africa and Southeast Asia. The
• 0:41
  Speaker 1: World Health Organization or WHO, which the US officially withdrew
• 0:47
  Speaker 1: from recently, to my absolute dismay, reported that in twenty
• 0:52
  Speaker 1: twenty three, there were over half a million cases of
• 0:55
  Speaker 1: cholera and over four thousand deaths across forty five countries.
• 1:00
  Speaker 1: The WHO suspects that this is an underestimate, in part
• 1:04
  Speaker 1: because some regions are hesitant to report cholera because of
• 1:08
  Speaker 1: how that might impact trade in their region. The WHO
• 1:12
  Speaker 1: estimates that the numbers are probably closer to one point
• 1:16
  Speaker 1: three to four million cases of cholera, resulting in somewhere
• 1:20
  Speaker 1: between twenty one thousand and one hundred and forty three
• 1:23
  Speaker 1: thousand deaths annually. We're going to look at the state
• 1:27
  Speaker 1: of things today in the next episode. But today we're
• 1:31
  Speaker 1: going to go to the past, to a time when
• 1:33
  Speaker 1: people had no idea how cholera picked its victims, so
• 1:37
  Speaker 1: there was nothing you could do to protect yourself from
• 1:39
  Speaker 1: death visiting you and your family, and death's visits were
• 1:43
  Speaker 1: often short and to the point taking away entire families
• 1:48
  Speaker 1: in less than a week. Doubt put into perspective what
• 1:51
  Speaker 1: it was like living in a time before we knew
• 1:53
  Speaker 1: how cholera was transmitted and how to treat it. I'm
• 1:57
  Speaker 1: going to read to you a short passage from Stephen
• 1:59
  Speaker 1: john Since two thousand and six book The Ghost Map.
• 2:03
  Speaker 1: This book is also a major source that I drew
• 2:05
  Speaker 1: from while researching today's episode, and I definitely recommend it. Okay,
• 2:09
  Speaker 1: here's the passage. To live in such a world was
• 2:13
  Speaker 1: to live with the shadow of death hovering over your
• 2:16
  Speaker 1: shoulder at every moment. To live was to not be dead. Yet,
• 2:21
  Speaker 1: from our vantage point more than a century later, it's
• 2:24
  Speaker 1: hard to tell how heavily that fear weighed upon the
• 2:27
  Speaker 1: minds of individual victorians. As a matter of practical reality,
• 2:32
  Speaker 1: the threat of sudden devastation your entire extended family wiped
• 2:36
  Speaker 1: out in a matter of days was far more immediate
• 2:40
  Speaker 1: than the terror threats of today. At the height of
• 2:42
  Speaker 1: a nineteenth century cholera outbreak, one thousand Londoners would often
• 2:46
  Speaker 1: die of the disease in a matter of weeks, out
• 2:49
  Speaker 1: of a population that was a quarter of the size
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  Speaker 1: of modern New York. Imagine the terror and panic if
• 2:55
  Speaker 1: a biological attack killed four thousand otherwise healthy New Yorkers
• 2:59
  Speaker 1: over a tw twenty day period. Living amid cholera in
• 3:02
  Speaker 1: eighteen fifty four was like living in a world where
• 3:06
  Speaker 1: urban tragedies on that scale happened week after week, year
• 3:11
  Speaker 1: after year, a world where it was not at all
• 3:14
  Speaker 1: out of the ordinary for an entire family to die
• 3:17
  Speaker 1: in the space of forty eight hours, children suffering alone
• 3:21
  Speaker 1: in the arsenic lit dark, next to the corpses of
• 3:24
  Speaker 1: their parents. Today, we're going to take a stroll through
• 3:28
  Speaker 1: the history of medicine, and in particular, we're going to
• 3:31
  Speaker 1: chat about doctor John Snow's amazing work showing that cholera
• 3:35
  Speaker 1: is transmitted through drinking contaminated water. This work played a
• 3:39
  Speaker 1: role in finally overturning the idea that cholera and a
• 3:43
  Speaker 1: bunch of other diseases were something that you caught by
• 3:46
  Speaker 1: breathing foul smelling air. This helped usher in the germ
• 3:50
  Speaker 1: theory of disease. Welcome to Daniel and Kelly's germ filled universe.
• 4:09
  Speaker 2: Hi. I'm Daniel. I'm a particle physicist, and I know
• 4:12
  Speaker 2: so many biologists that I've become desensitized to poop talk.
• 4:16
  Speaker 1: Hello. I'm Kelly Wainer Smith. I study parasites and space
• 4:19
  Speaker 1: and I can't even remember a time when poop talk
• 4:21
  Speaker 1: used to bother me anymore. How far gone I am.
• 4:27
  Speaker 2: I realized this recently when we were at dinner at friends'
• 4:29
  Speaker 2: houses and I started bringing up some pooper related stories
• 4:33
  Speaker 2: and Katrina was like giving me funny looks like that's
• 4:36
  Speaker 2: not appropriate, And then I realized, Wow, she has context
• 4:40
  Speaker 2: sensitivity to this, and I've lost it.
• 4:41
  Speaker 1: Oh no, oh no. Do you think that being a
• 4:43
  Speaker 1: physicist played a role, like lack of social skills sort
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  Speaker 1: of thing?
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  Speaker 2: Ooh wow, oh make it personal?
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  Speaker 1: Sorry?
• 4:52
  Speaker 2: No. I think that she's just aware that she talks
• 4:55
  Speaker 2: about it at dinner, she talks about at work, but
• 4:57
  Speaker 2: she doesn't talk about it at friends dinners or out
• 5:00
  Speaker 2: in public and I've just totally lost that because I
• 5:03
  Speaker 2: hear about it all the time.
• 5:04
  Speaker 1: I got invited to give a talk at this like
• 5:06
  Speaker 1: Smithsonian magazine event, and they brought me out for like
• 5:09
  Speaker 1: a fancy dinner and a bunch of people were eating
• 5:11
  Speaker 1: lobster afterwards. And at the end of the dinner, I
• 5:14
  Speaker 1: looked around the table and a bunch of people still
• 5:17
  Speaker 1: had the lobster in front of them, and it took
• 5:19
  Speaker 1: me a second. I was like, oh, was the lobster
• 5:21
  Speaker 1: not delicious? And I asked one of the people was
• 5:23
  Speaker 1: my friend, And I was like, why didn't know I
• 5:25
  Speaker 1: eat the lobster? And they were They said, why did
• 5:29
  Speaker 1: you talk about parasites all dinner?
• 5:33
  Speaker 2: I'm so sorry.
• 5:34
  Speaker 1: I mean, you guys inviting me here to do that,
• 5:38
  Speaker 1: That's why I did. I'm sorry.
• 5:40
  Speaker 2: So you were like talking about parasites while stuffing your
• 5:42
  Speaker 2: face with shellfish? Nice?
• 5:44
  Speaker 1: I mean I don't eat shellfish. So I was eating
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  Speaker 1: something else and it wasn't bothering me. And so anyway,
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  Speaker 1: I do need to be reminded that not every conversation
• 5:53
  Speaker 1: is dinner conversation.
• 5:54
  Speaker 2: Well, today we're having a very context sensitive conversation.
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  Speaker 1: Take it away, Kelly, well, today, hey, we are talking
• 6:00
  Speaker 1: about cholera. And since Daniel usually asks what does that
• 6:05
  Speaker 1: word come from? And usually I just stare at him
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  Speaker 1: blankly and then have to jump onto Google.
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  Speaker 2: Look at that. You had developed a little internal Daniel
• 6:14
  Speaker 2: to help you in your life.
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  Speaker 1: That's right, what would Daniel do? Wwdd. So cholera comes
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  Speaker 1: from the Greek word for bile. Very long ago, Gallan
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  Speaker 1: was the one who popularized this idea that we had
• 6:28
  Speaker 1: to keep in balance the four humors in our bodies
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  Speaker 1: and bile, which again the Greek word for it sounded
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  Speaker 1: sort of like cholera. When you were having diarrhea or vomiting,
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  Speaker 1: that was interpreted as your body trying to get back
• 6:42
  Speaker 1: into balance the right amount of bile in your body.
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  Speaker 1: And so a long time ago, anytime you had a
• 6:48
  Speaker 1: diarrheal disease, people would say you had cholera. And over
• 6:53
  Speaker 1: time cholera became the quintessential diarrheal disease.
• 6:57
  Speaker 2: And now it's one specific one.
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  Speaker 1: Yes, it is specifically the disease caused by Vibrio cholerad.
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  Speaker 2: And is it like the champion diarrheal disease? Is it
• 7:07
  Speaker 2: like the most diuretic of all diar reeal diseases it is.
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  Speaker 1: Yeah, yeah, unfortunately it wins that race.
• 7:14
  Speaker 2: Yeah yeah, that's sad. So why are we talking about
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  Speaker 2: cholera today? What is it about cholera that you find extraordinary?
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  Speaker 1: Well, there are some stories about cholera that I was
• 7:25
  Speaker 1: particularly interested in for another project that I'm working on,
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  Speaker 1: and as I dug in, I was like, oh my gosh,
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  Speaker 1: there's so much about cholera that I didn't know. And
• 7:33
  Speaker 1: to be honest, I'm like kind of a huge John
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  Speaker 1: Snow fangirl, and this was my operation.
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  Speaker 2: John Snow from Game of Thrones.
• 7:41
  Speaker 1: Uh no, no, actually, fun fact, have not watched Game
• 7:44
  Speaker 1: of Thrones nor read the books. One day. I feel like,
• 7:48
  Speaker 1: if I'm between projects and I have like a month
• 7:50
  Speaker 1: and a half, I want to watch all of the
• 7:52
  Speaker 1: all of the episodes, but that day may never come.
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  Speaker 1: All right, but no, doctor John Snow, physician in London
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  Speaker 1: in eighteen forty that John's real person, real person. Yep,
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  Speaker 1: absolutely amazing, and I thought this was a great opportunity
• 8:05
  Speaker 1: to talk about his amazing experiments, which helped overturn this
• 8:08
  Speaker 1: idea that often we get sick because we're breathing in
• 8:12
  Speaker 1: stinky air, and there were multiple quote great stinks end
• 8:17
  Speaker 1: quote in Europe. There were two I think great stinks
• 8:20
  Speaker 1: in Paris and at least one great stink in London
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  Speaker 1: because we were not very good at containing our sewage
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  Speaker 1: for a long time there, and our cities were growing
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  Speaker 1: like exponentially and we were not keeping up. And at
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  Speaker 1: the same time, diseases were rampantly spreading because we were
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  Speaker 1: just not doing a good job at containing our sewage.
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  Speaker 1: There were lots of people, diseases were just bouncing between
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  Speaker 1: these people, and we thought there was this correlation between
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  Speaker 1: the stankiness in our cities and the fact that we
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  Speaker 1: were all getting sick.
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  Speaker 2: I see fascinating. Well, we've had some great stinks over here,
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  Speaker 2: usually after I eat too much garlic for dinner, but
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  Speaker 2: it doesn't usually get anybody like physically ill. Yes, But
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  Speaker 2: I love this story because it's the triumph of like
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  Speaker 2: data science and reason and rationality and solving problems. It's
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  Speaker 2: like a triumph of empiricism, you know, penetrating all these
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  Speaker 2: vague ideas and showing you like the data will tell
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  Speaker 2: you the answer, right, the universe speaks to you through data.
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  Speaker 2: It's wonderful. Yeah, So where does this start. How long
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  Speaker 2: have people been suffering from cholera?
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  Speaker 1: Yeah, so it's hard to know exactly. We have very
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  Speaker 1: ancient records of people having absolutely horrific diarrheal diseases which
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  Speaker 1: could be cholera, but we our best records on cholera
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  Speaker 1: start around eighteen seventeen and even for the first handful
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  Speaker 1: of pandemics, which is essentially when this disease goes global,
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  Speaker 1: that's what we mean by a pandemic. We can't be
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  Speaker 1: one hundred percent sure because nobody actually like looked, you know,
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  Speaker 1: at the diarrhea under a microscope to actually identify the bacteria,
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  Speaker 1: because this was before we knew that bacteria was the cause.
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  Speaker 1: But based on symptoms, we think that around eighteen seventeen
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  Speaker 1: this disease left India. So it was common in the
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  Speaker 1: Yes region of India and it was what we call endemic,
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  Speaker 1: which is like an area where you find this disease
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  Speaker 1: over and over again, you know, seasonally for example. And
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  Speaker 1: around eighteen seventeen it started spreading. And why it started spreading,
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  Speaker 1: we think is because you know the world was becoming
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  Speaker 1: a lot more connected. There were pilgrimages happening, there were
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  Speaker 1: importantly the East India Company was doing a lot of
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  Speaker 1: trade in the region. The British Navy was in there
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  Speaker 1: and they were you know, bring in their boats and
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  Speaker 1: then they were traveling all over the world. And what
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  Speaker 1: sources you read will impact who is getting blamed for
• 10:35
  Speaker 1: bringing cholera. But at the end of the day, it
• 10:37
  Speaker 1: is our connectedness that is spreading cholera. And there have
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  Speaker 1: been seven major pandemics where cholera started in India and
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  Speaker 1: started spreading way far out there. The seventh pandemic is
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  Speaker 1: actually still happening today.
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  Speaker 2: Oh, I know, right, We're in the middle of a
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  Speaker 2: cholera pandemic right now.
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  Speaker 1: Yes, yeah, Sub Saharan Africa and some parts of Asia
• 10:59
  Speaker 1: still have a lot of cholera issues going on right now.
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  Speaker 1: The World Health Organization is you know, working on trying
• 11:05
  Speaker 1: to tackle these problems. But yeah, we still have a
• 11:07
  Speaker 1: cholera pandemic going on right now.
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  Speaker 2: And in each case, is it leaving India or are
• 11:12
  Speaker 2: there now other pockets that can spark pandemics.
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  Speaker 1: It can start in other places, like the seventh pandemic
• 11:18
  Speaker 1: appears to have started in Indonesia, but now it is
• 11:21
  Speaker 1: you know, pretty common in some parts of Africa and
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  Speaker 1: it's just kind of sticking around.
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  Speaker 2: Fascinating. Wow. So probably people have been suffering from cholera
• 11:29
  Speaker 2: in India for thousands and thousands of years, and now
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  Speaker 2: in our new modern, interconnected world, you can get colera anywhere.
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  Speaker 1: Yeah. Yeah, at least hundreds, maybe even thousands of years,
• 11:39
  Speaker 1: it's been a problem in India. Yeah, and that's right.
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  Speaker 2: So this has become a common experience around the world.
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  Speaker 2: So let's share with our listeners what is it like
• 11:47
  Speaker 2: to have cholera? Kelly walk us through the experience.
• 11:50
  Speaker 1: It sounds absolutely horrible. A paper that I was reading
• 11:54
  Speaker 1: today says the cardinal manifestation of the disease is the
• 11:58
  Speaker 1: voluminous outpour of fluid. Oh and so yeah, essentially that
• 12:03
  Speaker 1: the deal here is you accidentally consume the bacteria, usually
• 12:08
  Speaker 1: in water. Sometimes it can be because like the fruits
• 12:10
  Speaker 1: are vegetables that you're eating, didn't like they got maybe
• 12:13
  Speaker 1: fertilized with water that had the color of bacteria, they
• 12:16
  Speaker 1: didn't get rinsed off, And then you eat it, and
• 12:18
  Speaker 1: you happen to eat a bunch of the bacteria, and
• 12:21
  Speaker 1: then maybe you'll start hearing borborygmy. Have you heard this
• 12:26
  Speaker 1: word before, Daniel.
• 12:28
  Speaker 2: I've never heard of bor burugny.
• 12:30
  Speaker 1: I hadn't either.
• 12:31
  Speaker 2: Apparently this is sounds like a Polish delicacy to me.
• 12:34
  Speaker 1: Apparently it's the gurgling sound that your tummy makes.
• 12:37
  Speaker 2: Oh no, just before it's like the warning noise just
• 12:41
  Speaker 2: before you explode.
• 12:42
  Speaker 1: No, it's just like generally the gurgling noise that your
• 12:45
  Speaker 1: tummy makes. But when you have chlora, you tend to
• 12:48
  Speaker 1: get a lot of those noises before the massive diarrhea onsets.
• 12:53
  Speaker 1: And like just think for a second. So like if
• 12:55
  Speaker 1: you lived in, for example, London in the eighteen fifties,
• 12:58
  Speaker 1: when like food sanityation standards were like nonexistent, you probably
• 13:04
  Speaker 1: got barberigby all the time, you know, And like, so
• 13:08
  Speaker 1: can you imagine every time your stomach or your child's
• 13:11
  Speaker 1: stomach went But I'm making a great face right now
• 13:15
  Speaker 1: for everybody wondering, can you imagine wondering like is this?
• 13:19
  Speaker 1: Am I about to get cholera? Like? Is this is
• 13:22
  Speaker 1: this the end? Like that must have been petrifying.
• 13:24
  Speaker 2: Do you think people in eighteen fifteen London were saying
• 13:27
  Speaker 2: the word borberger to each other?
• 13:31
  Speaker 3: I doubt it, you know, Like, you know.
• 13:32
  Speaker 2: Person one is like, like, are you having the bord
• 13:36
  Speaker 2: berrig me? I can't imagine that. It doesn't seem like
• 13:40
  Speaker 2: an English word.
• 13:41
  Speaker 1: Cheerio, chep, you got to touch at the bar brigby.
• 13:48
  Speaker 2: All right? So stage one or brig mey gone wild?
• 13:51
  Speaker 1: Yeah, okay, all right? So stage two is just massive
• 13:55
  Speaker 1: diarrhea that that can hit with essentially like no warning.
• 13:58
  Speaker 1: I was reading an eighteen ninety three description written by
• 14:01
  Speaker 1: a physician who worked in the United States, and he
• 14:03
  Speaker 1: worked two different cholera outbreaks, so he had quite a
• 14:05
  Speaker 1: bit of experience, and his description was it often happens
• 14:10
  Speaker 1: that without warning, a large water stool is evacuated and
• 14:14
  Speaker 1: the diarrhea sets in with sudden violence.
• 14:17
  Speaker 2: Violence is not a word do you ever want to
• 14:20
  Speaker 2: associate with stool?
• 14:21
  Speaker 1: No, no, absolutely not. He says. There's no pain or
• 14:26
  Speaker 1: anything like that. But it's fluid. Evacuation pours out noisily, and.
• 14:31
  Speaker 2: There's rather a relief there isn't there?
• 14:33
  Speaker 1: Yes, right from distension. I guess your tummy was, you know,
• 14:36
  Speaker 1: feeling like it really needed to let go of something.
• 14:39
  Speaker 1: And another characteristic is what they call rice water stools.
• 14:43
  Speaker 1: It's got these little white things in it and it
• 14:45
  Speaker 1: turns out those white things are the lining of your intestine,
• 14:48
  Speaker 1: which is being shed off in this massive quantity of stools.
• 14:53
  Speaker 1: And it comes on so suddenly that you often you
• 14:56
  Speaker 1: don't have a chance to get to the restroom wherever
• 14:58
  Speaker 1: you are when it happens, that's where you are, and
• 15:01
  Speaker 1: so clothing and bedding are stained, and you know it's
• 15:05
  Speaker 1: a very unpleasant thing.
• 15:06
  Speaker 2: Why did you skip over the juiciest detail?
• 15:09
  Speaker 1: What this is a look into Daniel's psychology? Well, I
• 15:14
  Speaker 1: thought that maybe the quote was too long, so I jumped.
• 15:16
  Speaker 1: What was the juiciest detail that I skipped? Daniel?
• 15:19
  Speaker 2: Well, this doctor describes it as thin lighting color, yeasty
• 15:23
  Speaker 2: in appearance, and with a mouse like odor.
• 15:26
  Speaker 1: Oh okay, yeah, mouse like odor is no good. I
• 15:29
  Speaker 1: don't like the smell of mice.
• 15:31
  Speaker 2: I don't know what that means. Like, Wow, your diarrhea
• 15:34
  Speaker 2: smells like mice. That's fascinating.
• 15:36
  Speaker 1: Oh see, I used to work with a lot of snakes,
• 15:38
  Speaker 1: and so I know exactly what a mouse like odor is.
• 15:41
  Speaker 1: Do you Is it hard for you to imagine a
• 15:42
  Speaker 1: mouse like odor?
• 15:43
  Speaker 2: We had rats, and so I know a little bit
• 15:45
  Speaker 2: about what rats smell like. Is it related?
• 15:48
  Speaker 1: Uh?
• 15:49
  Speaker 2: Is there a rodent aroma.
• 15:51
  Speaker 1: I think mice have a slightly different smell.
• 15:53
  Speaker 2: So there are no perfumes inspired by like the rodent aroma. No, no,
• 15:58
  Speaker 2: not a business idea.
• 15:59
  Speaker 1: No, I don't think so. I'm not going into business
• 16:02
  Speaker 1: with you.
• 16:03
  Speaker 2: All right. So basically, you have massive watery diarrhea. Right,
• 16:08
  Speaker 2: this isn't even stool. This is just like your body's
• 16:11
  Speaker 2: just dumping water. That's fascinating, right, Like what's happening inside
• 16:14
  Speaker 2: you chemically to make your body just like eject all
• 16:17
  Speaker 2: of its fluids.
• 16:18
  Speaker 1: Yeah, I'm going to make you wait because next week
• 16:20
  Speaker 1: you're going to talk about the science behind what the
• 16:22
  Speaker 1: bacteria is doing to make this happen.
• 16:25
  Speaker 2: It's just chemistry of cholera.
• 16:27
  Speaker 1: Yeah, that's right. But like very quickly you go from
• 16:29
  Speaker 1: having you know, like stools the color you would expect
• 16:32
  Speaker 1: to as you said, just it essentially being like clear
• 16:35
  Speaker 1: or white with these white like splotches of bits of
• 16:40
  Speaker 1: your intestine, like your epithelium, which is like you know,
• 16:42
  Speaker 1: the skin lining your intestine that have just sloughed off. Yeah,
• 16:45
  Speaker 1: and at the same time you also are vomiting. There's
• 16:47
  Speaker 1: just so much fluid that it's you know, starts coming
• 16:50
  Speaker 1: out of both ends. And the main problem that you
• 16:52
  Speaker 1: end up having here is that your blood starts to
• 16:55
  Speaker 1: get very thick because there's not enough water in it,
• 16:58
  Speaker 1: and it gets difficult for your heart to pump it
• 17:00
  Speaker 1: to all the places it needs to go, so you
• 17:02
  Speaker 1: stop getting oxygen to all the places that you need
• 17:04
  Speaker 1: to get the oxygen to. So organs starts shutting down.
• 17:07
  Speaker 1: You start like your skin starts sort of sinking in,
• 17:11
  Speaker 1: your pulse starts to slow, your heart needs to work
• 17:14
  Speaker 1: a lot harder, and essentially, in a lot of cases,
• 17:16
  Speaker 1: you go into a coma as your organs shut down,
• 17:18
  Speaker 1: and you die. And death can happen in some cases,
• 17:21
  Speaker 1: like in a day, like literally, you know, at midday
• 17:24
  Speaker 1: you can start having this like absolutely massive diarrhea. Adults
• 17:29
  Speaker 1: can lose something like twenty leaders.
• 17:31
  Speaker 2: Twenty leaders. That's twenty leaders, wow.
• 17:35
  Speaker 1: And that is why you die. Yeah, like in a day,
• 17:38
  Speaker 1: and you know they can be dead by the end
• 17:40
  Speaker 1: of the day. And you know, families can get this,
• 17:42
  Speaker 1: and you know you read stories about like the parents
• 17:45
  Speaker 1: dying and you know, like just they're hoping that they
• 17:48
  Speaker 1: can outlive their kids by a few hours and they don't,
• 17:51
  Speaker 1: and it's just absolutely tragic the way this disease very quickly,
• 17:55
  Speaker 1: you know, destroys families essentially just by dehydrating everybody very rapidly.
• 18:00
  Speaker 1: There was this quote in the book that I was
• 18:02
  Speaker 1: looking at that, like, you know, so he's describing just
• 18:05
  Speaker 1: how horrible it is to have this disease. And then
• 18:09
  Speaker 1: there's this moment of levity where he says, he describes
• 18:13
  Speaker 1: what some of his patients were doing in this state
• 18:15
  Speaker 1: of like near death. He's describing like the end stages.
• 18:19
  Speaker 1: So here's a quote he says, although lying thus in
• 18:23
  Speaker 1: the lowest state compatible with existence, sometimes his muscular strength
• 18:28
  Speaker 1: is preserved to a marvelous degree. Without pulse at the wrist,
• 18:32
  Speaker 1: patients have been known to get up unexpectedly and wander about,
• 18:36
  Speaker 1: and some in bed alongside each other have been heard
• 18:39
  Speaker 1: to make bets regarding the distance to which they could
• 18:42
  Speaker 1: eject the vomit and onto the dexterity with which they
• 18:45
  Speaker 1: could deposit it in a given receptacle. Just I love
• 18:49
  Speaker 1: the idea that our species is like, all right, this
• 18:53
  Speaker 1: is it, this is the end for me. But in
• 18:57
  Speaker 1: my last shot a vomit, I'm putting twenty I can
• 19:02
  Speaker 1: get it in that fucket. Yeah, I'm getting in that
• 19:04
  Speaker 1: pot over there, and like, you know, I love the
• 19:07
  Speaker 1: idea that, like I'm going out with the.
• 19:08
  Speaker 2: Last people can find joy even in suffering.
• 19:12
  Speaker 1: Yes, right, so anyway, go our species.
• 19:15
  Speaker 2: Well, it's amazing to me that people die so quickly,
• 19:18
  Speaker 2: because for a disease to spread, people have to like
• 19:21
  Speaker 2: live long enough to spread it. So it's fascinating to
• 19:24
  Speaker 2: me that it kills you so rapidly. Right, So let's
• 19:28
  Speaker 2: take a break, but when we come back, we're going
• 19:30
  Speaker 2: to hear more about cholera, specifically how it gets around.
• 19:53
  Speaker 2: All right, we're back and we're talking about the disease cholera,
• 19:56
  Speaker 2: which creates an extraordinary amount of diarrhea in it's suffering patients.
• 20:01
  Speaker 2: And next we're going to hear about how cholera goes
• 20:04
  Speaker 2: from person to person. How does it all work. When
• 20:07
  Speaker 2: we understood cholera was that pre germ theory or post
• 20:11
  Speaker 2: germ theory.
• 20:12
  Speaker 1: So this was pre wide acceptance of the germ theory.
• 20:16
  Speaker 1: And so at the time, we mostly thought that diseases
• 20:19
  Speaker 1: were caught by you know, like as we talked about
• 20:21
  Speaker 1: a little bit earlier, by stinky air. But we had
• 20:24
  Speaker 1: some sense that there could be contagious diseases. So for
• 20:28
  Speaker 1: a long time we knew that this disease called leprosy
• 20:32
  Speaker 1: was something that could pass from person to person. So
• 20:35
  Speaker 1: the idea of contagious stuff was something that we could handle. Also,
• 20:39
  Speaker 1: Van Lewin Hook, whose name I will never say correctly,
• 20:44
  Speaker 1: Let's have some Dutch listeners send in a correct pronunciation
• 20:47
  Speaker 1: for comparison. Okay, great, and we'll wait and we'll send
• 20:51
  Speaker 1: them to our audio engineer. And every time I have
• 20:53
  Speaker 1: to say it in the future, he could just pick
• 20:55
  Speaker 1: one of those and cover up my my voice. It's
• 20:59
  Speaker 1: in the future, okay. So in sixteen seventy three, so
• 21:04
  Speaker 1: like two hundred years earlier, he had looked under the
• 21:07
  Speaker 1: microscope and noted that there's a tiny microscopic world that
• 21:11
  Speaker 1: you know, none of us had seen before.
• 21:13
  Speaker 2: Amazing.
• 21:14
  Speaker 1: But this connection between that tiny microscopic world could make
• 21:19
  Speaker 1: us sick and kill us had not been made by
• 21:22
  Speaker 1: a lot of people. There were some people out there
• 21:24
  Speaker 1: who were maybe starting to think about it, but this
• 21:26
  Speaker 1: idea that stinky air could make people sick was just
• 21:30
  Speaker 1: really hard to shake and was much much, much, much
• 21:33
  Speaker 1: much more popular.
• 21:34
  Speaker 2: That's really fascinating. Do you think that revealing that microscopic
• 21:37
  Speaker 2: world also connected with like existing ideas about reductionism. You
• 21:43
  Speaker 2: know that like our world at this scale is controlled
• 21:47
  Speaker 2: by the behavior at a smaller scale. It's sort of
• 21:49
  Speaker 2: in the same century as like atomic theory, which you
• 21:52
  Speaker 2: know leads to reductionism in particle physics. But do you
• 21:54
  Speaker 2: think that sort of thinking was widespread, that we're like
• 21:58
  Speaker 2: looking at the internal mechanisms of the world by seeing
• 22:01
  Speaker 2: the microscopic view.
• 22:02
  Speaker 1: No, I don't think that that had really taken hold
• 22:05
  Speaker 1: with the biology folks yet. Unfortunately, like you know, because
• 22:08
  Speaker 1: the miasma theory was still so big, and it wouldn't
• 22:11
  Speaker 1: be until like I think eighteen ninety is when Cooke's
• 22:14
  Speaker 1: postulates came out, and Lister's antiseptic technique doesn't come out
• 22:18
  Speaker 1: until like something like a decade after John snow does
• 22:21
  Speaker 1: this experiment we're about to talk about, Like, I think
• 22:24
  Speaker 1: it took a while for those connections to be made.
• 22:27
  Speaker 2: It seems so obvious to us now, But I think
• 22:29
  Speaker 2: that's an example of how much modern philosophical assumptions we're
• 22:34
  Speaker 2: carrying with us all the time. And so when we
• 22:37
  Speaker 2: look back at what people were doing two hundred years ago,
• 22:39
  Speaker 2: like the connections and the conclusions seem obvious to us
• 22:42
  Speaker 2: in hindsight, but at the time like that's a big
• 22:45
  Speaker 2: ingredient in understanding how the world works. So anyway, it's fascinating.
• 22:50
  Speaker 2: So that means that in early days of cholera, we
• 22:52
  Speaker 2: didn't really understand the germ based mechanism for how this
• 22:56
  Speaker 2: disease spread.
• 22:57
  Speaker 1: I do think it's tempting to paint broad straight though
• 23:00
  Speaker 1: for an era, and you know, assume that everybody sort
• 23:03
  Speaker 1: of had the same ideas, and there were some people
• 23:06
  Speaker 1: in the era who were, you know, sort of thinking
• 23:08
  Speaker 1: along the lines that John Snow would be thinking. So
• 23:10
  Speaker 1: for example, I'm gonna I'm gonna jump ahead a little bit.
• 23:13
  Speaker 1: In the same year John Snow does his experiments, there's
• 23:15
  Speaker 1: an Italian guy named, uh, Filipo Puccini. My apologies to
• 23:22
  Speaker 1: every Italian out there because I.
• 23:23
  Speaker 2: Probably sounded correct.
• 23:24
  Speaker 1: Oh yeah, nice, okay, all right, At the University of
• 23:27
  Speaker 1: Florence in eighteen fifty four he publishes the paper microscople
• 23:32
  Speaker 1: and that's where I blow it. No, I'm not gonna
• 23:37
  Speaker 1: I'm not gonna go back. I'm moving forward. Observations and
• 23:39
  Speaker 1: pathological deductions on cholera. He actually identifies the cholera bacteria
• 23:45
  Speaker 1: and publishes on it, but the rest of the community
• 23:47
  Speaker 1: was not ready to move past the miasma theory, and
• 23:50
  Speaker 1: so for thirty years his paper is essentially just totally ignored.
• 23:55
  Speaker 1: So like, there are people out there, were other people
• 23:57
  Speaker 1: out there, like this idea was in the air that
• 23:59
  Speaker 1: like germs could be causing diseases, but like as a whole,
• 24:03
  Speaker 1: the community was just not really ready to embrace this idea.
• 24:06
  Speaker 1: But you know, John Snow's paper is part of what
• 24:08
  Speaker 1: helps turn the tide.
• 24:09
  Speaker 2: Yeah, that's a really important point that there's a huge
• 24:12
  Speaker 2: diversity of thinking and ideas, right, and sometimes you can
• 24:16
  Speaker 2: go back and trace the origins of a modern idea
• 24:19
  Speaker 2: on the fringes of academia or you know, mainstream thought
• 24:23
  Speaker 2: two hundred years ago. Really cool. Yeah, right, So tell
• 24:26
  Speaker 2: us about John Doe and what he was doing. John
• 24:29
  Speaker 2: about John Snow Jeff when he wasn't killing the white walkers, Uh.
• 24:36
  Speaker 1: Whatever that means? All right, So John Snowe was at
• 24:40
  Speaker 1: the time of the outbreak we're going to be talking about.
• 24:42
  Speaker 1: John snow was a forty two year old physician. He
• 24:45
  Speaker 1: was a vegetarian and a teetotaler, so, like some would say,
• 24:49
  Speaker 1: maybe not a ton of fun, but he seems like
• 24:51
  Speaker 1: a cool guy to me. He had made his name
• 24:54
  Speaker 1: by doing a bunch of experiments on ether and chloroform.
• 24:58
  Speaker 1: So we did that episode on anesthesia and how anesthesia
• 25:01
  Speaker 1: sort of came along in the eighteen thirties eighteen forties,
• 25:06
  Speaker 1: So when it came out, there was this massive problem
• 25:09
  Speaker 1: with like sometimes it worked, sometimes it didn't, And John
• 25:12
  Speaker 1: snow realized that probably had a lot to do with
• 25:14
  Speaker 1: like temperature and how it was being delivered. So he
• 25:16
  Speaker 1: did a bunch of very careful experiments and created these
• 25:20
  Speaker 1: charts where like, when the temperature is this, you should
• 25:23
  Speaker 1: give them this much. And he created a device to
• 25:25
  Speaker 1: try to standardize how much ether and chloroform people got
• 25:28
  Speaker 1: so that they could always be anestatized the right amount.
• 25:32
  Speaker 1: And he actually became so famous for being great at
• 25:35
  Speaker 1: anestatizing people that he was able to give chloroform to
• 25:38
  Speaker 1: the Queen when she was giving birth to one of
• 25:40
  Speaker 1: her kids, and so he became sort of famous for this.
• 25:43
  Speaker 1: And despite being a teetotaler, he did a bunch of
• 25:46
  Speaker 1: experiments on himself with chloroform and ether, So he wasn't
• 25:51
  Speaker 1: drinking alcohol, but he was playing around with the chloroform
• 25:55
  Speaker 1: quite a bit, and we think that this actually might
• 25:57
  Speaker 1: have led to his somewhat early demise unfortunately, but this
• 26:01
  Speaker 1: is how he made a name for himself.
• 26:05
  Speaker 2: Well, I've watched this show Victoria, which is about the
• 26:07
  Speaker 2: life and times of Queen Victoria, and John snow makes
• 26:11
  Speaker 2: an appearance in that series quite prominently about the cholera outbreak.
• 26:14
  Speaker 2: But they also portray him in a very interesting manner.
• 26:18
  Speaker 2: He's like awkward. I think he has a stutter. He's
• 26:21
  Speaker 2: really not a very charismatic personality as portrayed by the BBC.
• 26:25
  Speaker 2: I don't know if that's accurate.
• 26:27
  Speaker 1: I don't get the sense that he's a super charismatic
• 26:30
  Speaker 1: person to be honest, but you know, not all of
• 26:33
  Speaker 1: us are super charismatic. Doesn't mean we're not making good contributions, Daniel.
• 26:41
  Speaker 2: I'm just saying you sort of described him in a
• 26:43
  Speaker 2: way that might make people think he was like, you know,
• 26:45
  Speaker 2: swashbuckling or extravagant in some way. But no, I think
• 26:48
  Speaker 2: he really was a data nerd, wasn't he.
• 26:50
  Speaker 1: He was a massive nerd. Yeah, which is awesome.
• 26:52
  Speaker 2: I mean that in the best possible way, right, it's
• 26:55
  Speaker 2: not highest compliment.
• 26:56
  Speaker 1: Yep, no, totally, yeah, No, I don't think he was cool.
• 26:59
  Speaker 1: I think this guy was straight up nerd. But he's
• 27:02
  Speaker 1: a straight up nerd that changed the world. So all
• 27:05
  Speaker 1: hail the nerds.
• 27:06
  Speaker 2: Yes, the nerds can change the world. Thank you to
• 27:08
  Speaker 2: all the nerds out there.
• 27:09
  Speaker 1: Amen. All right, So he makes this observation in eighteen
• 27:13
  Speaker 1: forty eight, So kolera had spread through Europe, but then
• 27:17
  Speaker 1: for a couple of years it had sort of like
• 27:19
  Speaker 1: disappeared from Europe, and then all of a sudden it
• 27:21
  Speaker 1: shows up in Hamburg. And then this boat leaves Hamburg
• 27:26
  Speaker 1: and shows up in London, and then suddenly kolera shows
• 27:30
  Speaker 1: up in this hotel in one room that has a
• 27:35
  Speaker 1: sailor that was on that ship from Hamburg.
• 27:38
  Speaker 2: I got to ask, is Hamburg the German pronunciation or
• 27:41
  Speaker 2: the Kelly pronunciation, because most Americans say Hamburg.
• 27:45
  Speaker 1: I don't know. I can't be like Hamburg like Hamburger,
• 27:48
  Speaker 1: could it?
• 27:49
  Speaker 2: Is it?
• 27:50
  Speaker 1: That just seems too American? King?
• 27:51
  Speaker 2: I don't know. I mean, that's what Americans usually say
• 27:54
  Speaker 2: when they're talking to each other. But I wasn't sure
• 27:55
  Speaker 2: if you were being all, you know, like correct German pronunciation.
• 27:59
  Speaker 1: I think I'm over compensating because I was in the
• 28:01
  Speaker 1: Middle East recently and I kept saying Iran and everyone
• 28:04
  Speaker 1: would be like Iran Americans, and I was like, oh,
• 28:09
  Speaker 1: I guess you guys don't say Iran over here. But
• 28:13
  Speaker 1: so you think it's Hamburg.
• 28:14
  Speaker 2: I mean, I think Americans say Hamburg. I don't know
• 28:17
  Speaker 2: what Germans say to each other.
• 28:18
  Speaker 1: All right, Well, that German city, there was a German
• 28:22
  Speaker 1: city that Colera popped up in, and a boat left
• 28:26
  Speaker 1: with sailors from that German city showed up in London.
• 28:29
  Speaker 1: One of those sailors had rented a room, got Calera
• 28:33
  Speaker 1: died in that room before.
• 28:35
  Speaker 2: He could invent the hamburger.
• 28:37
  Speaker 1: That's right, I know, no, thank goodness, somebody else did,
• 28:40
  Speaker 1: because what would Americans be without their Hamburgers. And then
• 28:43
  Speaker 1: sometime later somebody else ends up in that room and
• 28:47
  Speaker 1: they get Calera and they die. And that's despite the
• 28:50
  Speaker 1: fact that there hadn't been Colera in London for a
• 28:53
  Speaker 1: really long time, right, Okay, And so John Snow thinks
• 28:56
  Speaker 1: to himself, this is not good for the diasthma theory, right,
• 29:01
  Speaker 1: because why would cholera jump from that German city that
• 29:08
  Speaker 1: I'm not going to say again ever, and then all
• 29:12
  Speaker 1: of a sudden end up in London in this one
• 29:14
  Speaker 1: room where the German sailor was like, he didn't bring
• 29:19
  Speaker 1: the bad air with him, right, Doesn't it seem much
• 29:21
  Speaker 1: more likely that there was some other way that the
• 29:25
  Speaker 1: German brought the disease with him to London and then
• 29:30
  Speaker 1: left it behind and gave it to somebody else. And
• 29:33
  Speaker 1: he's like, I don't necessarily know how he gave it
• 29:36
  Speaker 1: to somebody else. And there was a doctor that visited
• 29:38
  Speaker 1: both men and he didn't get it, and so that's
• 29:40
  Speaker 1: a little concerning. I'm not really sure what happened there.
• 29:42
  Speaker 1: But also the doctor should have gotten it if it
• 29:45
  Speaker 1: was bad air that happened to be in that hotel room.
• 29:48
  Speaker 1: And so he's like, all right, I feel like the
• 29:49
  Speaker 1: miasma theory isn't really explaining things. We need something else.
• 29:53
  Speaker 2: So the thing I don't understand about the miasma theory
• 29:57
  Speaker 2: is if it's just in the air and and it's
• 30:00
  Speaker 2: not like moving around, it's that connected to the place,
• 30:03
  Speaker 2: how in that theory does color ever spread from India
• 30:07
  Speaker 2: or whatever to Europe? Right, Like, doesn't that theory fundamentally
• 30:10
  Speaker 2: conflict with their observations.
• 30:12
  Speaker 1: Oh man, Okay, this could be a really long answer.
• 30:14
  Speaker 1: I'll try to keep it short. So all right, So
• 30:16
  Speaker 1: it depends on the time and the place. So like
• 30:19
  Speaker 1: way back, like when Hippocrates or like you know the
• 30:22
  Speaker 1: many people who go by the name Hippocrates, were like
• 30:24
  Speaker 1: writing about disease, they would say something to the effect of, like,
• 30:27
  Speaker 1: if you want to understand disease, you need to understand
• 30:31
  Speaker 1: which way the winds are blowing and how that changes seasonally.
• 30:34
  Speaker 1: Because the winds were blowing diseases in from different places,
• 30:38
  Speaker 1: and so understanding how the winds were blowing would impact
• 30:41
  Speaker 1: what diseases people would get depending on what season. And
• 30:44
  Speaker 1: so this idea sort of morphed over time and depending
• 30:48
  Speaker 1: on where you were and when the exact specifics would change.
• 30:51
  Speaker 1: But I found a report from eighteen fifty which was
• 30:54
  Speaker 1: written by the health professionals living in London, reporting on
• 30:59
  Speaker 1: the epidemic in eighteen forty eight and eighteen forty nine.
• 31:03
  Speaker 1: So this is when John Snow was like starting to
• 31:05
  Speaker 1: collect his data, and eighteen fifty four is when he
• 31:08
  Speaker 1: really like collected the data. You know, the broad Street
• 31:10
  Speaker 1: pump data and so this is like the time and
• 31:13
  Speaker 1: place that's sort of relevant to your question. And they
• 31:16
  Speaker 1: were saying that what mattered was that like the winds
• 31:19
  Speaker 1: blowing out of India were like hot and moist, and
• 31:22
  Speaker 1: so that's what was blowing the cholera and that it
• 31:25
  Speaker 1: happened to be a time when you know, first the
• 31:28
  Speaker 1: winds that were blowing into Russia were hot and moist,
• 31:30
  Speaker 1: and then they were blowing into these other regions. So
• 31:32
  Speaker 1: essentially they were saying, hot moist air was taking cholera
• 31:36
  Speaker 1: on this journey. But and this is kind of amazing.
• 31:40
  Speaker 1: After doing this like long explanation of how the winds
• 31:42
  Speaker 1: had brought cholera you know, around the world, then they say,
• 31:46
  Speaker 1: but also, you know, Scotland had colera in January and
• 31:49
  Speaker 1: it was really cold moving on and then they out
• 31:53
  Speaker 1: and then they don't deal with it, and then they
• 31:56
  Speaker 1: say they start talking about how like it's complicated, right,
• 31:59
  Speaker 1: so you have to have the wind blowing cholera in,
• 32:03
  Speaker 1: but then it needs to meet a population that has
• 32:06
  Speaker 1: been impacted by something, and so like foul air could
• 32:10
  Speaker 1: be the thing. So they talk about, for example, if
• 32:12
  Speaker 1: people live in an area where there's lots of people
• 32:16
  Speaker 1: for few square feets. So for example, if you have
• 32:19
  Speaker 1: like twenty people in a small room, they're going to
• 32:22
  Speaker 1: start breathing out bad air, like decaying matter as they
• 32:25
  Speaker 1: put it, and that is going to start to poison
• 32:28
  Speaker 1: the air. And the poison air that you're breathing in
• 32:31
  Speaker 1: is going to make you more susceptible when cholera comes through.
• 32:35
  Speaker 1: And it was really interesting. There's like this motivated reasoning
• 32:38
  Speaker 1: that they find. So, for example, there was a girls
• 32:40
  Speaker 1: school where the girls got sick and a boys' school
• 32:43
  Speaker 1: where the boys didn't, and they claimed that that's because
• 32:46
  Speaker 1: the boys kept breaking the windows in their school and
• 32:50
  Speaker 1: they were getting better ventilation than the girls and that's
• 32:53
  Speaker 1: why they didn't get it, because they weren't breathing in
• 32:55
  Speaker 1: as much poison vapors as the girls were.
• 32:58
  Speaker 2: So this is fascinating because I'm trying to understand the
• 33:01
  Speaker 2: difference essentially in the two theories. John Snow is thinking
• 33:04
  Speaker 2: it's basically transmitted from person to person by something created
• 33:09
  Speaker 2: by the person and then transmitted through the water, and
• 33:11
  Speaker 2: the contrasting theory is that it's not really person a person,
• 33:14
  Speaker 2: it's just like comes through the air but now there's
• 33:17
  Speaker 2: this other part of it where people can make it
• 33:20
  Speaker 2: more likely that you get it from the air if
• 33:23
  Speaker 2: you're also breeding out poison vapors. So in the miasma theory,
• 33:26
  Speaker 2: it's not that they're breathing out cholera and passing it
• 33:30
  Speaker 2: to each other in their breath. It's that they are
• 33:34
  Speaker 2: making it more likely that the other girls are going
• 33:36
  Speaker 2: to get it by being cooped up with their poisonous vapors.
• 33:40
  Speaker 1: Right, that's so complicated, and it's very complicate. I mean,
• 33:42
  Speaker 1: you could also get those poisonous vapors by living above
• 33:45
  Speaker 1: assess pits, or by living too close to a graveyard
• 33:50
  Speaker 1: at a time when the graveyard is stinky. Like, the
• 33:52
  Speaker 1: graveyard has to be stinky. It can't be like a
• 33:53
  Speaker 1: graveyard from three hundred years ago where everybody has like
• 33:57
  Speaker 1: long sin skeletonized. It needs to be a stinky.
• 33:59
  Speaker 2: Grip or a graveyard that smells wonderful.
• 34:02
  Speaker 1: Yeah, right, or a graveyard with lots of flowers or something.
• 34:05
  Speaker 1: But but you know it's interesting because then they'll say, like,
• 34:08
  Speaker 1: but you know, there was this other recent color pandemic
• 34:11
  Speaker 1: where it seemed to only hit healthy, middle class people
• 34:16
  Speaker 1: who weren't living in bad conditions, moving on.
• 34:20
  Speaker 2: Yeah, And like, I guess this is like the epicycles
• 34:23
  Speaker 2: of cholera, right, It's like you have this idea, you
• 34:25
  Speaker 2: want to make a fit to the data. You keep
• 34:27
  Speaker 2: adding bits and pieces to it and whirly gigs until
• 34:30
  Speaker 2: eventually you just look, this isn't working and we have
• 34:32
  Speaker 2: to tear it down and start from something else.
• 34:34
  Speaker 3: Yeah.
• 34:34
  Speaker 1: But so so this report was written by Edwin Chadwick,
• 34:36
  Speaker 1: who was like the guy in charge of like public
• 34:38
  Speaker 1: health decisions in London at the time, and he, for
• 34:42
  Speaker 1: a long time, even after John Snow like came out
• 34:44
  Speaker 1: with his big theory, would continue to push the miasma theory.
• 34:47
  Speaker 1: There was even a section where the report noted that
• 34:50
  Speaker 1: there were people who were sharing the same air and
• 34:53
  Speaker 1: they differed in the water that they were drinking, and
• 34:56
  Speaker 1: one group was drinking water that you know, appeared to
• 34:59
  Speaker 1: have given them cholera because that group got cholera, and
• 35:02
  Speaker 1: another group drinking a different drinking water from a different
• 35:05
  Speaker 1: source didn't get calera. And it was as though he
• 35:08
  Speaker 1: was trying to support John Snow's theory, and then he
• 35:11
  Speaker 1: just moved on without like, you know, digging into it anymore.
• 35:15
  Speaker 1: And so there's all of these inconsistencies in the reports,
• 35:18
  Speaker 1: but at the end of the day, the guy who
• 35:20
  Speaker 1: writes the report continues to be a miasma person, making
• 35:24
  Speaker 1: massive and important public health decisions in support of trying
• 35:29
  Speaker 1: to get stinks out of the area, even if those
• 35:32
  Speaker 1: decisions result in more sewage in the Thames, which is
• 35:35
  Speaker 1: what is actually contributing to cholera.
• 35:37
  Speaker 2: Wow.
• 35:37
  Speaker 1: And so anyway, the miasma theory is sort of inconsistent.
• 35:40
  Speaker 1: Has to do with the wind and the stinks and
• 35:43
  Speaker 1: maybe some other stuff that we can't explain. And so yeah,
• 35:46
  Speaker 1: the answer is it's not a very like internally consistent theory.
• 35:51
  Speaker 2: Yeah. And it's tempting to judge these folks and be like,
• 35:53
  Speaker 2: how could you believe this when the data was saying
• 35:55
  Speaker 2: the opposite, But it's so easy to do that in
• 35:58
  Speaker 2: hindsight when we know the truth and it's clear. Yeah,
• 36:01
  Speaker 2: and you know, they're at the forefront of human knowledge.
• 36:03
  Speaker 2: They don't understand. They were doing their best to make
• 36:04
  Speaker 2: sense of the data and nobody's perfect, so it's easy
• 36:07
  Speaker 2: to criticize, but who knows what we would say in
• 36:09
  Speaker 2: their shops?
• 36:09
  Speaker 1: Yeah, I mean absolutely, And this was an era, you know,
• 36:12
  Speaker 1: before the germ theory really was established. And you know,
• 36:14
  Speaker 1: you get a school where the windows were broken and
• 36:17
  Speaker 1: the kids were fine, and another where they weren't. Like
• 36:19
  Speaker 1: I can totally get thinking like, okay, maybe maybe ventilation
• 36:23
  Speaker 1: did matter. And I don't know. I don't judge them
• 36:26
  Speaker 1: too harshly, but it is a bummer that they didn't
• 36:28
  Speaker 1: listen to John Snow because people died.
• 36:31
  Speaker 2: So then basically John Snow's big idea is that somehow
• 36:35
  Speaker 2: the disease is moving with the person, right that it's
• 36:38
  Speaker 2: coming with him, He's carrying something with him, and it
• 36:41
  Speaker 2: can then go from person to person. And his hypothesis
• 36:44
  Speaker 2: is maybe it's water based.
• 36:46
  Speaker 1: Yes, cool. And he had also had a little bit
• 36:48
  Speaker 1: of prior experience with cholera because he in the prior pandemic,
• 36:51
  Speaker 1: he had been training as a physician, and he had
• 36:53
  Speaker 1: worked with some coal miners and they weren't experiencing the
• 36:58
  Speaker 1: right kind of bad air that was popped is an
• 37:00
  Speaker 1: idea for transmitting cholera at the time, and they happened
• 37:04
  Speaker 1: to be working in an area where their food and
• 37:06
  Speaker 1: their water was mixing with human waste while they were
• 37:08
  Speaker 1: down in the coal mines. And that was getting his
• 37:11
  Speaker 1: mind on this idea of like cantamination as a way
• 37:15
  Speaker 1: of transmitting cholera. And so at this point he starts
• 37:18
  Speaker 1: to get water on the brain, and so to follow
• 37:21
  Speaker 1: up on this idea, he collects two sets of data
• 37:24
  Speaker 1: in eighteen forty nine to start getting this water borne
• 37:27
  Speaker 1: idea of rolling.
• 37:28
  Speaker 2: I think this is a really important moment here actually,
• 37:30
  Speaker 2: because he doesn't have enough evidence to conclude that it's
• 37:34
  Speaker 2: water based or it's a contaminant. He just kind of
• 37:36
  Speaker 2: got a hunch, right, and turns out he's right, and
• 37:38
  Speaker 2: he does the experiments which prove it. But your hunch
• 37:41
  Speaker 2: doesn't have to be but your hunch doesn't always have
• 37:43
  Speaker 2: to be like based in evidence. Right. Science is about
• 37:47
  Speaker 2: taking these leaps and asking questions and then backing it
• 37:49
  Speaker 2: up with data. Right. But there are important moments of
• 37:51
  Speaker 2: just like kind of guesswork.
• 37:53
  Speaker 1: Yeah, Well, in this first moment was just him thinking, well,
• 37:57
  Speaker 1: wait a minute, the prominent idea of the time right
• 37:59
  Speaker 1: now now just doesn't make sense with this observation, So
• 38:03
  Speaker 1: what else might make sense? And so like these first
• 38:06
  Speaker 1: two mini experiments that he does that we're not even
• 38:09
  Speaker 1: talking about the big Broad Street pump experiment. Yet these
• 38:12
  Speaker 1: are just like little places where he dips his toe
• 38:14
  Speaker 1: in to be like, could something else make sense? And
• 38:18
  Speaker 1: so the first thing he did was he went to
• 38:20
  Speaker 1: essentially like a slum in London in eighteen forty nine,
• 38:24
  Speaker 1: and he finds this row of cottages that are all
• 38:26
  Speaker 1: connected and they all share a well and there's like
• 38:30
  Speaker 1: a crack and that allows essentially sewage to seep into
• 38:34
  Speaker 1: the well when it gets too rainy, and everybody in
• 38:37
  Speaker 1: those cottages had died of cholera. And then right nearby
• 38:41
  Speaker 1: he finds like the exact same setup of cottages, but
• 38:45
  Speaker 1: their well is more sound and when rain comes they
• 38:48
  Speaker 1: don't get sewage in their will and only one person
• 38:51
  Speaker 1: in that row of cottages got cholera. And so he's like, well,
• 38:55
  Speaker 1: it looks like you get sewage in the well, and
• 38:58
  Speaker 1: then you drink from the well, you get colera.
• 39:00
  Speaker 2: So he's solid theory, poopy water kills you.
• 39:02
  Speaker 1: Poopy water death, and so he's so he collects those
• 39:05
  Speaker 1: data and then the next set of data that he
• 39:07
  Speaker 1: collects looks at the Thames. So the Thames is the
• 39:10
  Speaker 1: big river that flows through London.
• 39:12
  Speaker 2: Correctly, the way.
• 39:14
  Speaker 1: I've been to London I'm sure if I hadn't, I
• 39:20
  Speaker 1: would have said Sames or something.
• 39:22
  Speaker 2: But if you had, we would make you famous for it.
• 39:27
  Speaker 1: Ah. Thanks. Uh yeah, No, I definitely saw it on
• 39:30
  Speaker 1: a map and then heard someone say it and had
• 39:31
  Speaker 1: a like had a moment where id I was like,
• 39:35
  Speaker 1: I'm going to be quiet until I convinced myself that
• 39:38
  Speaker 1: these are the same things. And anyway, okay, so so
• 39:41
  Speaker 1: uh based on where the sewage was being emptied into
• 39:44
  Speaker 1: the Thames, and the Thames ended up being the source
• 39:47
  Speaker 1: of the Great Stink years later because so much sewage
• 39:50
  Speaker 1: was emptied into it that it like killed the fisheries
• 39:53
  Speaker 1: and stuff like that. So anyway, based on where the
• 39:56
  Speaker 1: sewage was being emptied into the Thames, John Snow hypothesized
• 39:59
  Speaker 1: that that casualties from cholera should be much higher and
• 40:03
  Speaker 1: the South part of the Thames for people that are
• 40:06
  Speaker 1: getting the water from the south part of the Thames,
• 40:08
  Speaker 1: then if you're getting it from the north, And what
• 40:10
  Speaker 1: he found was that if you are getting your water
• 40:12
  Speaker 1: from the South part of the Thames, eight out of
• 40:14
  Speaker 1: a thousand people are dying there, and if you get
• 40:17
  Speaker 1: it from the north or the west, one out of
• 40:19
  Speaker 1: a thousand people are dying.
• 40:20
  Speaker 2: The idea being that the north has less poop in
• 40:23
  Speaker 2: it because it's like upstream.
• 40:24
  Speaker 1: Yep, exactly. But if you live on the East End
• 40:29
  Speaker 1: of London, the East End is an area that was
• 40:32
  Speaker 1: like super destitute and super stinky, right, So if you
• 40:35
  Speaker 1: believe in the miasma theory, that's where most people should
• 40:39
  Speaker 1: be dying, but they should maybe have an intermediate amount
• 40:42
  Speaker 1: of sewage in their water. And they only had four
• 40:46
  Speaker 1: out of a thousand people dying from cholera, and so
• 40:48
  Speaker 1: he's arguing that like, this is actually pretty good data
• 40:53
  Speaker 1: suggesting that this it's that cholera is coming from the
• 40:56
  Speaker 1: water and not coming from the air.
• 40:58
  Speaker 2: Because the death rate follows the river. The more downstream
• 41:00
  Speaker 2: you are, the more likely you are to.
• 41:02
  Speaker 1: Die, exactly right, So it follows that like the sewage gredients.
• 41:06
  Speaker 1: So he publishes these results. The reviews are pretty positive,
• 41:10
  Speaker 1: but they're also pretty skeptical, and so there are people
• 41:12
  Speaker 1: who are saying, like, look, you found a correlation, but
• 41:16
  Speaker 1: you haven't actually found a cause.
• 41:18
  Speaker 2: Good points, solid critique, that's.
• 41:20
  Speaker 1: True, and so the London Medical Gazette in particular says,
• 41:23
  Speaker 1: you know what we'd really love to see we would
• 41:26
  Speaker 1: love to see you find a case where somebody takes
• 41:30
  Speaker 1: water that's contaminated and goes way far away and then
• 41:34
  Speaker 1: drinks it and then gets sick, like way far away
• 41:36
  Speaker 1: from what could have been the source of contaminated air,
• 41:39
  Speaker 1: and then get sick and dies. Yeah, and we'd also
• 41:42
  Speaker 1: like to see some people who are in an area
• 41:44
  Speaker 1: where there could be bad air, but they didn't drink
• 41:47
  Speaker 1: the water and they don't die. That kind of stuff
• 41:50
  Speaker 1: might convince us that it's not miasma that happens to
• 41:53
  Speaker 1: be in the same area that's actually causing the problem.
• 41:56
  Speaker 2: I agree these are all insightsive experiments, but they feel
• 41:58
  Speaker 2: so unethical to me because we're talking about people dying.
• 42:02
  Speaker 1: Right, But he's not doing these experiments. They're like, if
• 42:04
  Speaker 1: you could get observational data that eat these criteria, And
• 42:08
  Speaker 1: so John Snow is like, oh my gosh, where am
• 42:10
  Speaker 1: I going to get these observational data? Right? This is
• 42:12
  Speaker 1: going to be really hard and so and this is amazing.
• 42:15
  Speaker 1: This is like two geeks in the night meeting together
• 42:18
  Speaker 1: in magic happening. So he goes to the London Registrar General.
• 42:22
  Speaker 1: This is like the guy who keeps track of the
• 42:24
  Speaker 1: birth and death stats, and this guy is a stats nerd,
• 42:28
  Speaker 1: and so nerd another nerd, and his job was just
• 42:32
  Speaker 1: to keep track of like when people are born and
• 42:33
  Speaker 1: when people die. But he was like, you know what,
• 42:35
  Speaker 1: these data could be so much more useful if I
• 42:38
  Speaker 1: knew more stuff, And so he started encouraging doctors to
• 42:41
  Speaker 1: not just tell him when someone died, but why they died,
• 42:44
  Speaker 1: how old they are, what was their occupation, where did
• 42:47
  Speaker 1: they live. And after talking to John Snow, he starts
• 42:50
  Speaker 1: also collecting information on where they were getting their water,
• 42:55
  Speaker 1: which was amazingly useful because Londoners were getting their water
• 42:59
  Speaker 1: from like a hand of different companies that had pipes
• 43:02
  Speaker 1: that were like crisscrossing their way under London, and so
• 43:05
  Speaker 1: you know, you could live in a house and get
• 43:08
  Speaker 1: your water from one company and next door could get
• 43:10
  Speaker 1: their water from a totally different company. And these companies
• 43:13
  Speaker 1: had very different standards for how they treated their water
• 43:17
  Speaker 1: where the water came from. But there were two main
• 43:19
  Speaker 1: companies that were servicing an area that was kind of
• 43:21
  Speaker 1: near near where Snow lived. One of the companies had
• 43:26
  Speaker 1: upgraded where they were sucking the water from so that
• 43:28
  Speaker 1: it was less likely to be sucking in sewage and
• 43:31
  Speaker 1: the other one hadn't done that yet. And these companies
• 43:35
  Speaker 1: also differed in how saline the water was, and so
• 43:38
  Speaker 1: you could tell the difference between the water by doing
• 43:41
  Speaker 1: a water test. And one of them was a little
• 43:43
  Speaker 1: saltier than the other, and so it was possible to
• 43:46
  Speaker 1: know who was getting what kind of water, either by
• 43:49
  Speaker 1: asking who do you pay your water bill to or
• 43:51
  Speaker 1: by taking a water sample and checking to see how
• 43:53
  Speaker 1: much salt was in it. And with this setup, John
• 43:58
  Speaker 1: Snow five years later, when a massive outbreak came a
• 44:04
  Speaker 1: couple blocks away from his home, he was prepared to
• 44:07
  Speaker 1: collect the data that would show that cholera was a
• 44:10
  Speaker 1: water board disease.
• 44:12
  Speaker 2: And when we come back from break, we'll hear all
• 44:14
  Speaker 2: about how nerds save the world.
• 44:17
  Speaker 3: Nerds.
• 44:37
  Speaker 2: All right, we're back, and we're hearing the story of cholera,
• 44:40
  Speaker 2: how it kills you, how it spreads, and how nerds
• 44:44
  Speaker 2: figure it all out. So is John Snow at this
• 44:47
  Speaker 2: moment when he has his idea and he's waiting for
• 44:49
  Speaker 2: his data, is he still like a real outlier in
• 44:52
  Speaker 2: the community. Nobody's really taking it seriously because it feels
• 44:55
  Speaker 2: like if this is a possibility, even then somebody should
• 44:59
  Speaker 2: like do something about it, you know, work hard on
• 45:02
  Speaker 2: reducing the poopy water that people are drinking, because it's
• 45:05
  Speaker 2: we're talking about lots of lives.
• 45:07
  Speaker 1: Yeah, he's still kind of an outlier, like the main
• 45:09
  Speaker 1: people who are in charge of, like the public health
• 45:11
  Speaker 1: are much more concerned about the stinkiness. So at the moment,
• 45:15
  Speaker 1: the way waste is sort of managed in London is
• 45:18
  Speaker 1: a lot of people have what are called cess pits
• 45:20
  Speaker 1: underneath their houses, and so you know, poop in a
• 45:24
  Speaker 1: bowl and then you dump it in a pit underneath
• 45:26
  Speaker 1: your house, and when that pit fills up, you pay
• 45:28
  Speaker 1: somebody to come scoop it out and haul it away,
• 45:32
  Speaker 1: which is part of why everything stinks a lot. And
• 45:34
  Speaker 1: so to try to get rid of that stink, people
• 45:37
  Speaker 1: are starting to create a sewage system that pipes it
• 45:40
  Speaker 1: all into the Thames. And that if you believe that
• 45:43
  Speaker 1: stink causes cholera, dumping the waste into the Thames sounds
• 45:48
  Speaker 1: like a good idea. But if water borne contamination causes cholera,
• 45:55
  Speaker 1: you are killing people by pumping waste into the Thames. Yeah,
• 45:59
  Speaker 1: And so at the moment they are changing the system
• 46:03
  Speaker 1: and essentially dumping the waste into the Thames instead of
• 46:06
  Speaker 1: using this cesspit system. So yes, snow is pushing against
• 46:11
  Speaker 1: the tide at the moment.
• 46:12
  Speaker 2: Fascinating.
• 46:13
  Speaker 1: All right, all right, So it turns out that this
• 46:16
  Speaker 1: giant outbreak happens at broad Street Pump. So Broad Street
• 46:19
  Speaker 1: Pump is this very popular source of water. It's well
• 46:22
  Speaker 1: known because it's a very hot summer in eighteen fifty four,
• 46:25
  Speaker 1: and this pump produces cool water that is supposed to
• 46:28
  Speaker 1: taste way better than the nearby pump. People really like it.
• 46:31
  Speaker 1: So a lot of people come to this pump. An
• 46:34
  Speaker 1: outbreak starts at this pump, and John Snow runs to
• 46:38
  Speaker 1: his friend, the statistician, and he says, all right, you've
• 46:41
  Speaker 1: got data on the people who are dying. Can I
• 46:44
  Speaker 1: have that data? And his friend shares the data and
• 46:47
  Speaker 1: John Snow looks at the data and he says, all right.
• 46:50
  Speaker 1: These people are like, they're near the broad Street pump,
• 46:53
  Speaker 1: and he starts knocking on their doors. He's like, where
• 46:54
  Speaker 1: you get in your water? Where you getting your water?
• 46:56
  Speaker 1: Where you're getting your water? And he realizes that the
• 46:58
  Speaker 1: broad Street pump seems to be the sore of the death,
• 47:01
  Speaker 1: the source of the cholera, and so he starts like
• 47:04
  Speaker 1: following up on all of the deaths whenever he can,
• 47:06
  Speaker 1: but sometimes he's too late and everyone in the family
• 47:09
  Speaker 1: has passed away and he can't get the data that
• 47:10
  Speaker 1: he needs. But by following up, he starts to find
• 47:13
  Speaker 1: some sort of interesting situations that are interesting and that
• 47:16
  Speaker 1: they help fulfill the criteria that folks had set forth
• 47:20
  Speaker 1: for him previously, which is to say, we want you
• 47:23
  Speaker 1: to give us examples where water was taken from the
• 47:26
  Speaker 1: pump far away from the area where there might be
• 47:29
  Speaker 1: stinky air, and then consumed and then kill people. And
• 47:33
  Speaker 1: so there were these brothers called the Eli Brothers. They
• 47:36
  Speaker 1: had a factory in town. The factory made percussion caps.
• 47:39
  Speaker 1: These are caps that make it so that when you
• 47:40
  Speaker 1: shoot a gun, if you shoot it even in the rain,
• 47:43
  Speaker 1: it's going to go off anyway. So it essentially like
• 47:46
  Speaker 1: protects the gun under wet conditions, which is important because
• 47:49
  Speaker 1: the Crimean war was happening. They had brought Broad Street
• 47:52
  Speaker 1: water pump to give to their factory workers, because again
• 47:55
  Speaker 1: this is supposed to be like the best water around,
• 47:58
  Speaker 1: and a bunch of their factory workers are dying. They
• 48:01
  Speaker 1: also brought it to their mother, who lived in a
• 48:03
  Speaker 1: town farther out, and the mother then shared it with
• 48:08
  Speaker 1: their niece, and both their mother and their niece died.
• 48:11
  Speaker 2: Oh my gosh, they're basically poisoning everybody they know.
• 48:14
  Speaker 1: All these people that they love and care for, right,
• 48:16
  Speaker 1: And so that ended up being pretty good data for them, unfortunately.
• 48:20
  Speaker 2: And why again, is this water so famous and popular
• 48:23
  Speaker 2: like that they're carrying across town to share with people.
• 48:25
  Speaker 1: So the other water in a nearby pump came from
• 48:28
  Speaker 1: a different source, and it was notoriously kind of like
• 48:31
  Speaker 1: stinky and gross and maybe a little bit warmer.
• 48:34
  Speaker 2: But this broad Street water must have had poop in it, right,
• 48:37
  Speaker 2: That's why it's killing people, But it's also famously delicious.
• 48:40
  Speaker 2: This is the thing I'm struggling to reconcile.
• 48:42
  Speaker 1: Well, so you know, probably at this time, Daniel, everything
• 48:45
  Speaker 1: was gross, and this was just had a good reputation
• 48:48
  Speaker 1: for being less gross, I see. And also I think
• 48:51
  Speaker 1: it came from a little bit deeper, so it was
• 48:52
  Speaker 1: cooler during a particularly hot summer. And also if it
• 48:56
  Speaker 1: was the one that's like right in front of your house,
• 48:58
  Speaker 1: you probably just you know, go for it.
• 49:00
  Speaker 2: No offense to all of our listeners in London. I
• 49:02
  Speaker 2: was just curious what flavor of poopy water Londoner's perceh.
• 49:05
  Speaker 1: Well, I hope that things have gotten better, you know,
• 49:09
  Speaker 1: all right.
• 49:09
  Speaker 2: So he figures out that there's a cluster connected to
• 49:12
  Speaker 2: this one pump, and then he finds this example of
• 49:15
  Speaker 2: people carrying that water from that pump two places far away,
• 49:19
  Speaker 2: and those people also dying.
• 49:20
  Speaker 1: Yes, And then he finds some exceptions to the rules.
• 49:22
  Speaker 1: So he finds a workhouse that is very close to
• 49:25
  Speaker 1: the pump, and so he would have expected a bunch
• 49:28
  Speaker 1: of the people working at the workhouse to be dying
• 49:30
  Speaker 1: of cholera, but pretty much no one is dying of
• 49:33
  Speaker 1: cholera there. So he goes to the workhouse and he's like,
• 49:35
  Speaker 1: what's going on here, and they're like, oh, actually, we
• 49:37
  Speaker 1: have our own private supply of water and we have
• 49:39
  Speaker 1: our own well, so we don't go to Broad Street pump.
• 49:42
  Speaker 1: They're in the same area, breathing in the same bad air,
• 49:45
  Speaker 1: but they're drinking different water, so they're fine.
• 49:47
  Speaker 2: So the color is following the water and not the.
• 49:49
  Speaker 1: Air exactly, yes, And then something similar is happening at
• 49:52
  Speaker 1: a local brewery. Turns out the broad Street brewery guys
• 49:55
  Speaker 1: are mostly just drinking malt liquor and not drinking Broad
• 49:59
  Speaker 1: Street pump water, so they're okay. So he's got this
• 50:05
  Speaker 1: list of eighty three people who had died. Seventy three
• 50:08
  Speaker 1: of them are really close to the pump, and so
• 50:10
  Speaker 1: he's thinking, like, Okay, probably these are people who drank
• 50:12
  Speaker 1: from the pump because it's the closest pump. Why wouldn't
• 50:14
  Speaker 1: they have drank from it. Sixty one of them he's
• 50:17
  Speaker 1: able to confirm that they definitely drink from broad Street pump,
• 50:21
  Speaker 1: so they almost certainly died from that. Six of them
• 50:24
  Speaker 1: say they're definitely not Broad Street pump drinkers, so maybe
• 50:28
  Speaker 1: they got it from somewhere else. Six were mysteries he
• 50:31
  Speaker 1: just couldn't track down, you know, any living members or
• 50:35
  Speaker 1: anything like that. And then he had ten cases that
• 50:37
  Speaker 1: were far enough away from the broad Street pump that
• 50:40
  Speaker 1: he's like, well, like, you maybe went to a different
• 50:42
  Speaker 1: there was probably another pump that was a little bit closer.
• 50:45
  Speaker 1: But he still ended up thinking that those people had
• 50:47
  Speaker 1: probably drank from the broad Street pump because, for example,
• 50:51
  Speaker 1: it looked like they frequented a coffee house that used
• 50:54
  Speaker 1: the Broad Street pump water to make a special thing
• 50:57
  Speaker 1: that they called Sherbert, where they had mixed broad stret
• 51:00
  Speaker 1: pump water with some other stuff, and then their customers
• 51:03
  Speaker 1: had started dying.
• 51:04
  Speaker 2: You say a special thing like Sherbert, as if nobody's
• 51:07
  Speaker 2: heard of Sherbert.
• 51:08
  Speaker 1: They called it Sherbert. It wasn't like Sherbert like we
• 51:10
  Speaker 1: would call it today. They were mixing like a effervescent
• 51:14
  Speaker 1: I don't remember exactly what it was. Maybe I even
• 51:16
  Speaker 1: shouldn't have used the word Sherbert. They called it Sherbert,
• 51:18
  Speaker 1: but it wasn't the description. Wasn't any Sherbert that I recognized.
• 51:24
  Speaker 1: So he's essentially pulled together this list of people who
• 51:27
  Speaker 1: have definitely died of cholera. A very high percent of
• 51:30
  Speaker 1: them had drank from the pump. He's got an extra
• 51:33
  Speaker 1: list of people who have like drank cholera far away
• 51:37
  Speaker 1: from the area where it could have been explained by
• 51:39
  Speaker 1: just bad air, and they also died from the water.
• 51:42
  Speaker 1: You've got people who are close by the pump were
• 51:45
  Speaker 1: breathing in the air, but they didn't die. So he's
• 51:47
  Speaker 1: pulling all these data together, but there's still some people
• 51:50
  Speaker 1: who are missing that he can't really figure out like
• 51:52
  Speaker 1: they left town. He wants to know if they died
• 51:55
  Speaker 1: or not. And he's really trying to track down like
• 51:57
  Speaker 1: the first case that started everything, but he just doesn't
• 52:00
  Speaker 1: have the like knowledge of the town that he needs
• 52:03
  Speaker 1: to do this. But he starts talking to this reverend,
• 52:07
  Speaker 1: Reverend Whitehead, and this reverend knows this community intimately. This
• 52:12
  Speaker 1: is his flock. He's been actually like in the houses
• 52:15
  Speaker 1: with a bunch of these people as they've been passing away.
• 52:17
  Speaker 1: He's been, you know, holding their hands. He knows everybody
• 52:20
  Speaker 1: here really well. So he's able to track down a
• 52:22
  Speaker 1: bunch of the cases that are missing and confusing because
• 52:25
  Speaker 1: he knows everybody. He's like, oh, you know, yes, that
• 52:27
  Speaker 1: person left and they went to you know, this town,
• 52:30
  Speaker 1: and I know their grandma, so I'll try to figure
• 52:32
  Speaker 1: out where they went. And by going through old records,
• 52:34
  Speaker 1: he's able to figure out the first case that brought
• 52:38
  Speaker 1: colera into town. And it turned out there was a
• 52:41
  Speaker 1: baby that got colera and the mom was washing the
• 52:44
  Speaker 1: diapers out and she dumped the pails of dirty water
• 52:48
  Speaker 1: into the cess pit in the bottom of their house.
• 52:52
  Speaker 1: And then they had the cesspit examined and it turned
• 52:54
  Speaker 1: out there was a crack and the water was seeping
• 52:57
  Speaker 1: into the well that served Broad Street pump. And so
• 53:02
  Speaker 1: usually Broad Street pump did have pristine water, but this
• 53:06
  Speaker 1: one cess pit was leaking and when colera got dumped
• 53:10
  Speaker 1: into it. For a very short period of time, calera
• 53:13
  Speaker 1: was introduced into the pump, but it was just this
• 53:16
  Speaker 1: one case. And so actually the cases of cholera were
• 53:19
  Speaker 1: starting to go down when John Snow went and talked
• 53:22
  Speaker 1: to like the public Health board and was like, you
• 53:23
  Speaker 1: guys have to remove the handle to Broad Street pump
• 53:26
  Speaker 1: because this is what's giving everybody cholera. And they listened
• 53:29
  Speaker 1: and they took the handle off, and so usually this
• 53:31
  Speaker 1: story goes John Snow saved everybody by removing the broad
• 53:35
  Speaker 1: Street pump. At this point, the pandemic was already wrapping
• 53:38
  Speaker 1: itself up because the baby had died and there wasn't
• 53:41
  Speaker 1: more colera being introduced. But the dad ends up getting calera,
• 53:46
  Speaker 1: and presumably his waist would have also been put into
• 53:49
  Speaker 1: the cess pit, and that might have started up another
• 53:52
  Speaker 1: round of cholera. So he could have saved the town
• 53:54
  Speaker 1: from another round of cholera. But the rest of the
• 53:56
  Speaker 1: people in the house, and this is disgusting. Instead of
• 53:59
  Speaker 1: throwing their waste into the cesspit, they were throwing it
• 54:02
  Speaker 1: into the backyard because they didn't want to, like they
• 54:04
  Speaker 1: didn't have access to the downstairs cesspit. London was super gross.
• 54:10
  Speaker 1: So anyway, with this information and the extra information that
• 54:14
  Speaker 1: the reverend gave him by having this like amazing social
• 54:18
  Speaker 1: network that he was able to use to like fill
• 54:21
  Speaker 1: in the gaps that John Snow wasn't able to fill
• 54:23
  Speaker 1: in on his own, John Snow was able to publish
• 54:26
  Speaker 1: this data and make a really good case that it's
• 54:30
  Speaker 1: not foul air, it's waterborne contamination. And so what do
• 54:35
  Speaker 1: you think, Daniel, do you think after that everybody was like,
• 54:38
  Speaker 1: we will never speak of the miasthma theory again.
• 54:42
  Speaker 2: I think it takes a long time for a new
• 54:44
  Speaker 2: idea to become mainstream, doesn't it.
• 54:47
  Speaker 1: Yeah, it does yep. So it wasn't immediate. There was
• 54:50
  Speaker 1: still pushback. There were you know, even in the city
• 54:53
  Speaker 1: of London, there were people like health officials who were like,
• 54:56
  Speaker 1: it's my asthma. You didn't you didn't really show anything all.
• 55:00
  Speaker 1: But by like eighteen sixty six, which is about a
• 55:03
  Speaker 1: decade later, the Lancet Is Final, which is a huge
• 55:06
  Speaker 1: medical journal was finally saying something like, all right, yeah,
• 55:09
  Speaker 1: John Snow he was probably onto something with that theory,
• 55:13
  Speaker 1: and it's getting broader acceptance. And in eighteen sixty seven
• 55:18
  Speaker 1: Lister is coming up with his antiseptic technique. So this
• 55:21
  Speaker 1: is where you like, you know, if you're going to
• 55:23
  Speaker 1: do an amputation, you should probably clean it off to
• 55:25
  Speaker 1: make sure there's no bacteria in there before you close
• 55:27
  Speaker 1: up the wounds, so you don't kill people with infections.
• 55:31
  Speaker 1: And then in eighteen seventy six Robert Coke does this
• 55:34
  Speaker 1: amazing work showing that anthrax is caused by a bacteria,
• 55:37
  Speaker 1: and then we're really off to the races with the
• 55:39
  Speaker 1: germ theory of disease.
• 55:40
  Speaker 2: Yeah, that's really fascinating to see how long it takes
• 55:43
  Speaker 2: a new idea to be accepted. And you know, some
• 55:46
  Speaker 2: people hear this and then they say, bl academa is
• 55:49
  Speaker 2: too slow and it takes forever, And that's probably true,
• 55:51
  Speaker 2: but it doesn't mean that every idea that hasn't been
• 55:54
  Speaker 2: adopted is valid and should be taken seriously. Right, The
• 55:58
  Speaker 2: lesson is to follow the data. Yeah, right, The data
• 56:00
  Speaker 2: should speak. The data will tell you the truth about
• 56:02
  Speaker 2: the universe, and it sometimes takes academics a while to
• 56:06
  Speaker 2: come around to the data because they have other theories
• 56:09
  Speaker 2: in their minds. But every new idea needs data to
• 56:12
  Speaker 2: support it.
• 56:12
  Speaker 1: And the other thing here is, you know, like John
• 56:14
  Speaker 1: Snow was able to get moderately convincing data, yeah, in
• 56:18
  Speaker 1: eighteen forty nine during one pandemic, and then he had
• 56:21
  Speaker 1: to wait another five years for like the you know,
• 56:23
  Speaker 1: the right set of conditions to come about. Unfortunately, the
• 56:26
  Speaker 1: right set of conditions was people lying, was people dying.
• 56:30
  Speaker 2: That baby killing all those people?
• 56:32
  Speaker 1: Yeah, babies, Shake my fist at babies.
• 56:35
  Speaker 2: The other fascinating thing there is that the pandemics end
• 56:38
  Speaker 2: on their own. Is that a feature of the thing
• 56:40
  Speaker 2: we were talking about earlier, that color kills you so
• 56:42
  Speaker 2: quickly that it's not optimized for spreading continuously.
• 56:48
  Speaker 1: I don't think it's always self limiting. So in this case,
• 56:50
  Speaker 1: it was self limiting because there was only one family
• 56:52
  Speaker 1: that had access to the cesspit that could leak into
• 56:56
  Speaker 1: the well that fed Broad Street pump. I think if
• 56:59
  Speaker 1: the entire commuit unity had their waist emptying into the
• 57:02
  Speaker 1: broad Street pump, maybe it would have figured it out faster,
• 57:05
  Speaker 1: because then it would have been really obvious that there
• 57:07
  Speaker 1: was poop in the pump. But I mean, in general,
• 57:10
  Speaker 1: I think I read that when one person gets sick
• 57:12
  Speaker 1: with cholera, they can produce a trillion cholera bacteria that
• 57:17
  Speaker 1: can then get into the water. And so, you know,
• 57:19
  Speaker 1: I think as long as cholera is getting into the
• 57:22
  Speaker 1: water and people continue to drink that water, and you've
• 57:25
  Speaker 1: got more people who are you know, contributing more bacteria,
• 57:29
  Speaker 1: I think it can keep going for a while.
• 57:31
  Speaker 2: All right, Well, tune in next week for more details
• 57:35
  Speaker 2: on color. If you haven't had enough twenty liters of
• 57:38
  Speaker 2: cholera details, it's not satisfying you. We're going to learn
• 57:41
  Speaker 2: more about how cholera works, how we can treat it,
• 57:44
  Speaker 2: and the biological and chemical mechanisms underlying all that diarrhea.
• 57:49
  Speaker 1: YY Nerds, see you next time. Daniel and Kelly's Extraordinary
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