One of my co-authors on a recently published biography of John Snow (1) sent me an attachment in February, which contained an article in Tidsskriftet no. 24/2003 by Magne Nylenna (2). I found Nylenna’s interpretation of dr. Stockmann og dr. Snow very enlightening. Among other things, I learned that Ibsen’s protagonist in Enemy of the People – a play I’ve often used in European intellectual history courses at Michigan State University as an exemplar of late nineteenth-century aristocratic radicalism – serves as a model of public health activism in Norway. In addition, Nylenna’s assessment of Snow’s tour-de-force pragmatism as a social medicine investigator during the Golden Square/Broad Street cholera outbreak in 1854 seems reasonable to me. For Snow’s initial investigation lasted a scant four days, during which he took water samples from several pumps at different times, narrowed the likely suspect to one source, personally compiled a list of recent deaths at the Registrar General’s office (the official list would not be published for ten days), conducted house-to-house investigations (but made no map, as far as we know), convinced the parish vestry to lock down the Broad Street pump as an interim measure, and then sent a brief report of his findings to one of the London medical journals (3). Compared to these accomplishments, Stockmann’s (fictional) discovery process was less comprehensive, his interactions with the local authority and media more confrontational, and the immediate outcome practically unsuccessful.
Consequently, my reading of the article differs dramatically from Knut Arne Holtedahl’s in Tidsskriftet no. 7/2004 (4). He read that Stockmann is passé; I read that Stockmann is very relevant as a symbolic beacon in the night for modern public health activists, whereas Snow may be a better model for scientific, pragmatic interventions in crisis situations. He accuses Nylenna of relying on outdated scholarly information, but substitutes anecdotes for a systematic search of the literature; I assumed that Nylenna’s reference to a 1967 source made his generalization sufficiently conditional. While I agree with Holtedahl’s comment that few public health problems are solved by removing a pump handle, Nylenna never said they were. Nor did Snow, despite the mythology that has emerged about this episode. First, he noted in his letter to Medical Times and Gazette that mortality was decreasing before the pump was immobilized. And once the immediate crisis was managed, Snow re-visited the area several times that autumn in search of the precise cause of the outbreak. He, personally, never identified an index case.
