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The mortality rates and the space-time patterns of John
Snow’s cholera epidemic map
Abstract
Background: Snow’s work on the Broad Street map is widely known as a pioneering example of spatial epidemiology. It lacks, however, two significant attributes required in contemporary analyses of disease incidence: population at risk and the progression of the epidemic over time. Despite this has been repeatedly suggested in the literature, no systematic investigation of these two aspects was previously carried out. Using a series of historical documents, this study constructs own data to revisit Snow’s study to examine the mortality rate at each street location and the space-time pattern of the cholera outbreak.
Results: Data on mortality rates and space-time distribution of the victims were collected from various sources and were successfully merged and digitised, thus allowing the production of new map outputs and new interpretation of the 1854 cholera outbreak in London, covering more cases than Snow’s original report and also adding new insights into their space-time distribution. They confirmed that areas in the immediate vicinity of the Broad Street pump indeed suffered from excessively high mortality rates, which has been suspected for the past 160 years but remained unconfirmed. No distinctive pattern was found in the space-time distribution of victims’ locations.
Mortality was highest in the streets nearest the pump
areas in the immediate vicinity of the Broad Street pump indeed suffered from excessively high mortality ratesShiode et al. 2015 · p. 1
Suspected for 160 years from the bars on the map, confirmed only when Shiode and colleagues put a population under each house.
The method was the address list, not the theory
He needed an address for every death.The map and the pump · 12:41
Shiode’s 2015 study does the same thing with better records: a population under every house.
Workpeople at the percussion-cap manufactory
eighteen of these workpeople died of cholera at their own homes, sixteen men and two womenSnow 1855 · p. 29
Two hundred employed; eighteen died at home, sixteen men and two women.
The brewery workmen
He informed me that there were above seventy workmen employed in the brewerySnow 1855 · p. 29
Above seventy men, two slightly indisposed, none dead.
Inmates of the Poland Street workhouse
out of five hundred and thirty-five inmates only five died of choleraSnow 1855 · p. 29
Five hundred and thirty-five people; five died.
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John Snow
Argued from 1849 that cholera is swallowed, not breathed.
The outbreak spread through the water of the Broad
Street pump
except among the persons who were in the habit of drinking the water of the above-mentioned pump-wellSnow 1855
Miasma
Disease as a poison in the air, given off by decaying matter.
The infant at No. 40 falls ill
Attacked on 28 August, three days before the general outburst.
The well was fouled by the cesspool at No. 40
It clearly established the general fact of percolation of fluidCholera Inquiry Committee 1855
Mortality was highest in the streets nearest the pump
Suspected for 160 years from the bars on the map.
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