Monday, August 28, 1854.
At 6 a.m., after another sweltering summer night, the residents of the city of London wanted to sleep more.
The little baby girl of the Louis family, who was less than six months old, began to vomit and pull, and her stool was green and watery, squirting, and foul-smelling.
Mother Sarah hurried to ask someone to ask a doctor.
While her daughter was still asleep, Sarah crept into the basement at 40 Wide Street and poured the warm water from her freshly washed diaper into the pit.
A London nightmare began.
(Picture and text are irrelevant, image source: soogif)
On Wednesday, The Tailor, Who also lives at 40 Wide Street, Felt Sick to His Stomach, which he thought was food poisoning.
And on Thursday, Old G began to squirt wildly and constantly pull out rice soup-like stools with white particles.
Source: Popular science short film "The Story of Cholera"
On Friday morning, his pulse was too weak to be able to take it out.
Man is still alive, but the flesh has been "dehydrated" into a blue dry corpse.
The skin was wrinkled, the eye sockets were deeply sunken, the face seemed to be wearing a blue rough leather mask, and only a pair of eyes were still staring straight up, like a frightened soul, looking out through a corpse.
(A 23-year-old girl, changes within 1 hour of illness.) Source: The Sick Rose: The Art of Disease and Medical Illustration)
At 1 p.m., Old G died.
In the three days of his illness, hundreds of people had "diarrhea to death" throughout the wide street.
In the 40 years since the beginning of the 19th century, this plague of unknown origin and incurable origin has killed millions of people.
People at that time believed that the plague was a punishment of the gods, that the feces in the soil and the poisonous miasma emitted by the corpses invaded the human body.
A resident who lived southwest of Wide Street had been concerned about the plague for 6 years but had been skeptical of the miasma.
His name was John Snow and he worked as a surgeon.
Hearing that the plague was nearby, in the evening, Lao Nuo set off from his home, strode through the empty streets, straight to the center of the plague, and visited door to door.
To facilitate research, he recorded the number of deaths in each home on a map.
(Source: udel.edu)
After the map was drawn, he found several strange phenomena on it:
If it is airborne, the scope of death should be a circle, but the circle on the map is crooked, why would Death inexplicably miss several houses with many people? (For example, the 500-poor workhouse in the north, the brewery with more than 80 workers in the west...) ）
The survivors of the residential areas are mainly widows and the elderly, which is the complete opposite of the government's long-promoted assertion that "the poor are susceptible to disease because the poor are dirty".
While Noor was looking at the death lists in other parts of London, a widow named Suzanne Elie caught his attention on a street far from Wide Street.
She was the first person to die of the plague on this street.
Within two days, the servants and nieces of the family died one after another, but apart from that, no one was sick for several miles.
Where did Suzanne's illness come from? Why is it only her family that is sick?
Old Nuo suddenly thought that there was a factory on Wide Street that had suffered heavy casualties, and the owner was also named Eli.
Upon inquiry, Suzanne Elie turned out to be the mother of the Elie brothers.
In the interview, the two brothers talked about how in order to show compassion for their mother, they would regularly send her water from the Wide Street well, and the mother fell ill after their last delivery.
And when Lao Nuo continued to investigate along the "water source" line, he found that:
The workhouse, which is crowded with 500 poor people but almost no one is sick, has its own independent water source;
The workers of the brewery drank almost only beer and did not drink well water;
Widows and elderly survivors are many because they are old and weak, live alone, and do not have the strength to hit the well water of wide streets;
Cross Street, far from Wide Street, among the dozen people who died: 4 people came from the same family, the father loved the well water of Wide Street, and the night before the onset of illness, he asked his son to fetch water in the middle of the night to get rid of heat...
At the end of Tuesday's investigation, Lao Nuo found that of the 83 people who died Monday, only 6 were not directly related to The Wide Street Well Water.
But in a chat with the owner of a nearby café after dinner, he again found the 6 people's connection to the well water on Wide Street:
The deceased had all visited the café before they fell ill and had ordered a new type of drink called frozen sherbet.
The secret to the deliciousness of this drink is that it is prepared with sweet Wide Street well water.
Within a day, Lao Nuo had sufficient evidence to prove:
The Wide Street well was the source of this unexplained pollution.
The source of the pollution is likely to be the bodily fluids of plague patients.
On Thursday, Lao Nuo unveiled his findings at a regional meeting.
The Council did not believe that the Water of Wide Street, which had always been known for its clarity and sweetness, could it be poisonous.
But in the face of conclusive evidence, they were dumbfounded.
On Friday, Sept. 8, the handle of the Wide Street pump was removed and the plague was gradually brought under control.
(Wide Street pump handle removed, Source: Network)
But afterwards, a local pastor questioned:
If the patient's bodily fluids pollute the water source, then as the number of patients increases, the well water should become more and more "poisonous"!
But why did the number of people sick in Wide Street drop after Monday, before the pumps were removed?
In November, the results of a street test on a wide street well solved his questions.
The survey found that:
The well "is not connected to any drainage pipes or sewers, and there is no possibility of a large amount of dirt entering the water source."
That said, not everyone's bodily fluids can enter the well.
According to epidemiology, there was a patient zero (also the first patient to get an infectious disease and start spreading). It should be his bodily fluids that entered the well in some unknown way...
△ Contaminated water, spreading diseases, Source: Network
Who exactly polluted the wells?
A message from The Wide Street Medical Archives caught their attention:
"On September 2, the five-month-old baby girl began to have diarrhea four days before her death, and died of exhaustion."
And this baby girl, mentioned at the beginning, 40 Wide Street, the daughter of Sarah's family.
She fell ill on August 28, predates all the patients of this Wide Street plague.
Lao Nuo immediately summoned workers to test the pit at 40 Wide Street, the same pit where Sarah had poured her daughter's diaper water.
(In the early 19th century, families would use septic tanks in their homes to hold liquid waste and sewage.) Typically, these septic tanks are made of bricks, about six feet deep and four feet wide, and placed under the toilet. Most families put them in the garden or basement. ）
Workers found a wide street well not far from the septic tank.
The tank was badly blocked, the scene was unsightly, the brick walls that had long been decayed were ripped open, and the 2 feet of soil between the well and the septic tank was soaked with leaking manure...
Since then, the truth has come out.
It was from here that the plague germ in Sarah's daughter entered the well, into the intestines of nearly a thousand people in Wide Street and even London.
Source: Fruit shell
On September 19, 17 days after her daughter's death, her father, a young policeman, also died of the plague.
He lasted 11 days, and finally left his wife alone in this devastated street.
More than 10,000 people were killed in London during the plague.
And that was one of the most terrible plagues in the world at the time— "cholera."
△ The tragic situation of cholera patients, source: network
But even so, Lao Nuo's discovery still did not change the mainstream perception of society at that time.
The Lancet even openly mocked him for his obsession:
"His love of wells has gone too far and he has fallen out of them."
Until the sweltering heat of June 1858, the temperature of the Thames River soared to nearly 40 ° C, and the dung in the river seemed to boil, and the stench filled the city, known as the "Great Stench of London".
(Source: gettyimages)
But when counting the number of deaths that month, the government found that the plague mortality rate was the same as usual, which completely slapped the miasma theory that they had always insisted on, "the more stinky the disease, the more disease".
If Lao Nuo knew, he would definitely write a report immediately to prove his point of view again.
But he had no chance.
On June 10, just as the Great Stench was in full swing on the River Thames, Old Nuo was revising his paper in the office and died of a sudden stroke at the age of 45.
The Lancet's obituary only downplays that he was a famous physician and makes no mention of his contribution to cholera.
Fortunately, stimulated by the great stench, the London government finally embarked on one of the greatest projects of the 19th century:
It took 6 years to build the 1,800-mile London sewer system.
In 1897, the chlorine supply network was used for the first time in the United Kingdom for disinfection.
Since then, London has not been hit by cholera.
More than 160 years later, London's Wide Street has changed dramatically, and only one bar has survived to this day, but the name has changed, called "John Snow".
In front of the bar, there was a black water pump missing the handle.
A replica of a cholera pump on Blauwick Avenue (formerly Wide Street) and a John Snow bar Credit: UCLA fielding school of public health
It was this little well that drove change throughout London and the world.
Chat with ordinary people, draw maps, and look at data.
Recording the distribution of the disease in the population in detail, Holmes analyzes its internal laws.
It was in this way that John Snow saved countless lives
He was the first person in the world to use epidemiological investigation research methods and is known as a "pioneer in epidemiology".
Even today, when science and technology are so developed, the circulation work is still continuing in this traditional way.
During the plague more than 160 years ago, Lao Nuo single-handedly identified the culprit of cholera.
Today, countless disease controllers are still running on the front line, like the ancestor John Snow, relying on professional knowledge and a keen brain, stripping away the cocoon, tracking the source of infection, and cutting off the chain of infection at the first time.
No one knows how long it will take us to truly defeat COVID-19, or when the next infectious disease will break out.
But there is no doubt that in the process of fighting infectious diseases again and again,
There is always a group of people who are always ready to stand up for the protection of public health.
A few small details about Lao Nuo are added (swipe to view):
1. Lao Nuo suspected that it was a problem of water at the beginning, but he was suffering from no evidence, did not dare to disclose, he loved to drink boiled water every day, and everyone drank raw water in that year, so people who used to love tea and drink wine lived longer.
2. Why would Lao Nuo suspect miasma? Because his greatest research of his life was besides cholera, and anesthesia.
He was the first to invent anesthesia apparatus and the first to give a painless birth to a woman, and the woman was also a celebrity, Queen Victoria.
And what was used for anesthesia at that time was diethyl ether, ether was actually similar to miasma, but also a toxic, smelling irritating gas, so a master who usually plays miasma, how can he believe the miasma?
3. The priest who questioned Old Nord was named White, and he helped Old Nuo a lot later, and the two changed from opposites to friends.
After the cholera outbreak, many people ran away, the number of people surveyed by the old Nuoneng was very small, the sample size was not convincing enough, White was more familiar with the pastor and the residents, he visited the whole of London, even the residents who fled to other cities he wrote to ask, and finally tracked down the information of 497 households in Wide Street, which was more than half of the population before the cholera in Wide Street.
The data from the final survey confirmed Lao Nuo's conclusion: Residents who drank Wide Street water were 6 times more likely to get cholera than those who did not drink.
4. Although Lao Nuo was unable to immediately convince the government at that time, his "death map" was on fire in the civil society, and all records of cholera in Wide Street at that time were attached.
No matter how cunning the government is, even illiterate people can understand the relationship between wells and cholera from this picture, which promotes the acceptance of the view that cholera is a water source disease and begins to pay attention to drinking water safety.
5. In 2013, The Lancet magazine published a special obituary correction indicating recognition and recognition of Snow's contributions.
6. For lao nuo's death, there has been speculation that Lao Nuo died young because he smelled too much ether in the study, after all, his research method of ether anesthesia is often: he counts the dose and smells a little, looks at the clock, faints, and wakes up to see how long the clock himself fainted...
Born poor, 14 years old as a surgeon apprentice, 23 years old walked 200 miles alone to London to study medicine, after becoming famous, he had no interest in the temptation of high society, and what really attracted him has always been the outstanding questions in the medical world.
bibliography
1. Death Map / [Us] steven Johnson; Translator: Xiong Tingyu - Electronic Industry Press, 2017.01
2. Tracking Cholera, Epidemiological Investigation of British Doctors 170 Years Ago / Zhu Shisheng - Corporate Magazine, No. 5, 2020