There is no graceful segue from the groaning Thanksgiving table to an excellent book about a dread disease, so I'll just jump in.

I loved The Strange Case of the Broad Street Pump, subtitled "John Snow and the Mystery of Cholera" by British journalist Sandra Hempel. It's a great piece of writing on a subject that could be better known.

How the riddle of cholera transmission was puzzled out by Dr. John Snow in London in the mid 19th century is an heroic tale about a most unlikely hero.

Hempel writes, "If you mention the Broad Street pump, or more specifically, a London doctor who took the handle off a pump during an epidemic, many people will say yes, they do vaguely remember hearing something about it. Hardly anyone who doesn't have a specialist's interest in the subject, however, knows the name of the doctor, or where and when the incident happened, or the disease involved."

In the 19th century the dread disease cholera began to spread from its origins in the swamps of India's Ganges Delta "where, in all probability, it had been mutating for millennia," through the continent of Asia, into Europe, and finally across the channel to England on its way around the world. No one had a clue how to stop it.

Cholera was a shocking disease. It struck so fast patients said it was "like being hit with a club..." Half those afflicted died, with painful and grotesque symptoms. Even strong and healthy individuals could became sick and die in less than a day. Mysteriously, entire neighborhoods could be wiped out while others nearby remained untouched.

All guesses about the cause of cholera epidemics were wrong. All treatments failed.

"The medical men did their best, putting victims through every possible combination of torments. One woman "was subjected to what the doctors described as a very varied treatment, including brandy, laudanum, calomel, cajeput oil, rhubarb, jalap, turpentine, bleeding... a mustard poultice and a turpentine enema. Another patient had "... in addition... to endure ammonia, sulphuric ether, scalding bricks on his feet, hands and stomach, and bladders of boiling water on his head... and in nearly every case, it was all for nothing."

By 1849, "ideas that (Dr. John) Snow had long been pondering about cholera's method of attack and means of transmission began to come together in his mind to form a coherent theory."

John Snow had been an effective practitioner of the new medical science of anaesthesia. He attended two of Queen Victoria's births, politely holding a chloroformed handkerchief to the queen's nose.

Snow applied scientific insight and dogged leg-work to his theories. He was a highly intelligent man without social standing or wide reputation. He was undeterred by the ridicule of fellow doctors, who believed foul disease was caused by "miasma" or foul air. Even after Snow's theories were published, London water companies and their shareholding supporters in parliament denied sewage-laden drinking water could cause disease.

Snow's theories remained essentially ignored and untested until 1854 when Snow created a "disease map" that pointed to a single source for an out-of-control cholera outbreak near Snow's own house. "The result of Snow's foot-in-the-door investigation was the discovery that in (virtually all cases) the victim either always or sometimes drank (water) from the (Broad Street) pump."

In a wonderful scene direct from the movie that ought to be made of this book, Snow "made his way to the Vestry Hall in Piccadilly, less than a minute's walk from his home... and asked for permission to address the meeting of the Board of Guardians of St. James Parish.

"Carefully he explained his investigations to the parishmen and told them what he wanted them to do -- they must take the handle off the Broad Street pump. The Guardians listened open-mouthed. Who was this strange fellow who had turned up unannounced with such a bizarre story to tell? They really didn't find him at all convincing."

To this day epidemiologists look to Snow as the first effective practitioner of their life-saving craft. "When (modern researchers) are looking for a straightforward solution to... a problem they are sometimes heard to ask: "Where is the handle on this pump?"

Treat yourself to a copy of The Strange Case of the Broad Street Pump and read a tale that has much to teach us about the uses of science and politics today.

Aired Sunday November 19, 2006 at 10:55 am and Wednesday November 22, 2006 at 1:00 pm

Orders/Information:

The Strange Case of the Broad Street Pump: John Snow and the Mystery of Cholera by Sandra Hempel. University of California Press hardcover $24.95. ISBN 0520250494.
First published in 2006 in Britain by Granta Books as The Medical Detective: John Snow and the Mystery of Cholera.

Excellent as Hempel's book is, it is far from the only one on the subject. There has been at least one children's book telling this story, and Penguin has just published another version of the Dr. John Snow story by Steven Johnson, author of Everything Bad is Good for You.

The Ghost Map: The Story of London's Most Terrifying Epidemic And How It Changed Science, Cities, and the Modern World by Steven Johnson. Riverhead Books hardcover $26.95. ISBN 1594489254.

Wikipedia on the Broad Street pump, along with a photo: http://en.wikipedia.org/wiki/Broadwick_Street

The UCLA home page on John Snow: http://www.ph.ucla.edu/epi/snow.html#SNOW%20PUB which also has photographs of the Broad Street Pump memorial and the original pump site: http://www.ph.ucla.edu/EPI/snow/phototour3.html