>>In today's lecture we're going to look at water and health. We're going to look at three
case studies that helped us understand the historical context of how we first learned
about the importance of water as it relates to health. One of those in the mid-1800s in
London, a second we'll look at Chicago in the late 1800s, and then we'll fast-forward
to 1993 in Milwaukee. In each of these case studies, we'll see how the connection between
water and health first became apparent, and how it's even very much still an issue in
more recent times.
We'll start in London in the mid-1800s. We didn't yet understand why disease was transmitted
from one person to another, from one location to another. It was an outbreak of cholera
in London that really helped to highlight these issues. At this time it was thought
that poison somehow transferred around through the atmosphere or through the soil or somehow.
But it didn't quite fit with the transfer of the disease, and so it was in 1854 that
John Snow, a medical doctor in London, did a systematic study to try and understand what
was the cause of this spread of disease. And what Dr. Snow did was he did a survey of the
people that died from cholera, and he asked those people that knew them, where did they
live, where did they work, where did they get their food, where did they go to church,
where did they get their water, and just a long list of questions. And in the process
of this study, what Dr. Snow realized is the one thing that all the victims had in common
was they got their water from the same well, a public well. At this point in time there
was a community well in the center of the town area in the SoHo district of London,
and the people would come and they would pump the handle on the well and they would get
their water. And the one thing that all the victims had in common was they had gotten
their drinking water from this same source. So famously Dr. Snow went down and he took
the handle off that pump, and that helped to curb the spread of the epidemic of cholera
in London at that time. It turned out that the the cause was identified as a a diaper,
an infant diaper, that had been disposed in a cesspool, this is a cement block tank below
ground. And the cesspool leaked, and it leaked water into the ground. Then that water ended
up in the wells, and so people would drink the water, they would get sick, and then that
cycle would continue. Now as Dr. Snow studied the deaths over time, what began to appear
is a trend: a a few cholera deaths and then those numbers picked up. And so you can see
a graph of time on the X-axis and cholera deaths on the Y-axis. You see a slow increase,
and then all of a sudden a rapid increase. And then as the intervention happened, as
the handle was removed from the pump, as people began to remove away from that area, the number
of deaths began to drop off. And this is a classical diagram that's used in public health
to understand the occurrence and and the decline of an epidemic. The interesting thing about
this is, in studying the people that died of the cholera, some of the people didn't
necessarily live right in that area. There was one person that lived several kilometers
away. Well, it turned out this person used to live in that area of London, and they really
liked the water from that well, and so they would periodically get water from that well
and take it to their home. And so unfortunately this person was impacted by the cholera even
though they no longer lived in that area.
So Dr. Snow, John Snow has become known as the father of epidemiology. Epidemiology is
the study, systematic study of disease and how disease spreads, and his systematic study
was the first example of this type of approach to studying public health. He's also known
as the father of water treatment because he was the first to recognize that disease, cholera
in this case, could be spread through the water. And so all of a sudden the importance
of treating the water and making the water safe became paramount. And so we know him
in these two respects. If you visit London, as I did on my first trip to London, one of
the places I most wanted to go in London was to the Broad Street well and to see where
this famous episode occurred. And you can go there today, and there's a a pump in tribute
to this great discovery, and there's actually no handle on the pump. Ceremonially the handle
is removed from that pump to demonstrate what Dr. Snow did back in the 1850s. And you can
also go right next to this, and there's a plaque on the side of the John Snow Pub. So
you can do as I did, go in and have a brew in honor of John Snow and the major discovery
that he made.
So cholera is a a major source of disease. It's something that we don't know so much
in the US anymore or in London as we did in former times. There's two movies that help
to depict the the devastating effect of cholera. One movie is Horeseman on the Roof, and this
movie depicts France in the middle 1800s. And it's a it's a love story of sorts, but
it's set in the backdrop of a major cholera epidemic in France, showing that France at
that time was very vulnerable to the spread of cholera. And the second movie, The Painted
Veil, depicts China in the 1900s, and again shows the devastating affects of cholera and
also shows in that movie the realization that the cholera was being spread through the water.
So these are two popular movies that you could watch to see a depiction of cholera in former
times.
But let's move forward now to Chicago in the late 1800s. Chicago on Lake Michigan was impacted
not by cholera in this case, but by typhoid fever. The people got their drinking water
from Lake Michigan, but as it turned out, their waste also would flow into Lake Michigan.
And so as the people would get sick and that would go into Lake Michigan, that waste, and
then people would bring their water from the lake, and they would the cycle would continue.
And so we see again a graph of typhoid death, deaths due to typhoid favor, versus time in
Chicago. And we see these numbers were very high in the late 1800s. Interestingly, there
were several things the city of Chicago did to try and help respond to this situation.
One thing they did was they moved the water intake two miles out into Lake Michigan. So
rather than getting the drinking water right from the shores of Lake Michigan where the
waste was going into, they were now getting the water from two miles out away from the
shore, and that helped to reduce the number of deaths due to typhoid fever. They also
reversed the flow of the the sewage canal. They actually raised the city of Chicago so
that the canal would flow in the opposite direction, and that also reduced the deaths
due to typhoid fever. There were incidents though that caused an increase in the number
of deaths due to typhoid fever. A famous example is the Great Chicago Fire. You may remember
the story of Ms. O'Leary's cow knocked over the lantern, and the great Chicago fire happened.
And as the firefighters were trying to put out these fires, all the water they were putting
on the buildings washed waste into Lake Michigan, and so there was an increase in the number
of deaths due to typhoid fever. So this is an example of something that actually caused
an increase in the number of deaths. In Chicago one of the few buildings that survived that
Great Chicago Fire is the water tower, the Chicago water tower. And so if you're there,
you can, as I did, go to visit this landmark, and you can see one of the only buildings
that survived the Great Chicago Fire. So it really shows the resilience of the city of
Chicago to be able to come back after that devastating fire, but also points to the importance
that safe water had to the health and the vitality and the growth of the city of Chicago.
And it's now a historic landmark as well as an icon for the city of Chicago.
So now we've looked at cholera in London in the mid-1800s. We've looked at typhoid fever
in Chicago in the late 1800s. Now let's fast forward to Milwaukee in 1993. So we learned
about the spread of disease—cholera, typhoid fever, and it implemented water treatment,
and that had great improvement in health and great reductions in the number of deaths.
But now we find ourselves in 1993 in Milwaukee. And Milwaukee, 600,000 people in Milwaukee
at this time. Again on Lake Michigan as Chicago, and there was an outbreak of Cryptosporidium,
yet another pathogen that causes a disease and deaths. And there were 400,000 people
in 1993 that reported getting sick from this outbreak. And there were on the order of 50
to 70 people that died, and many many thousands of people hospitalized. This was a time before
we really understood Cryptosporidium. It was a more recent pathogen of concern, and it
was a time when we learned, several things happened all at the same time to lead to these
deaths. There was record rainfall, and the lake was turbid, was murky because of all
this runoff and all this erosion, and so that happened. And then the water treatment plant
had just changed the chemical that they were using to treat the water. Up to this time,
chlorine was the most common way of disinfecting the water and making it safe to drink. But
since this time we've realized that chlorine's not as effective with Cryptosporidium as it
is with cholera and typhoid fever, and so this has led to ozone, and UV light as other
ways of disinfecting the water. But here we see in more recent times the outbreak of disease,
and we see that it only takes a couple things going wrong all at the same time. And we see
this when there's a national a natural catastrophe—a tornado or flood, and the system is compromised.
All of a sudden the water's unsafe, and so we find ourselves back in the 1800s, if you
will, in those times. Or we find ourselves in the same situation as people in developing
countries today, who where you still have 2 million deaths a year, mainly children dying,
because of these waterborne diseases.
So we find that we've seen through these three case studies: London in the mid-1800s, Chicago
the late 1800s, Milwaukie 1993 the importance of water and health and the importance of
preventing wastewater sanitation from harming our water supply and causing the spread of
disease. And this is most, one of the most important things we do. The British Medical
Society did a study to evaluate what medical advance has saved more lives than any other
medical advance in the last 150 years. And the thing that came out number one in that
study was water and sanitation, critical to public health that we know the today. And
just one final comment: one of my hobbies is reading Abraham Lincoln biographies, and
Abraham Lincoln had four sons. Only one of those four sons lived to adulthood. One died
in Springfield, Missouri before Lincoln went to become president, one died while he was
in the White House of typhoid fever in Washington DC, and then one died actually after Lincoln
was assassinated of tuberculosis. Only one of his four sons lived to adulthood. You see,
you could say that we were a developing country, the United States, at this time period, but
we've had the good fortune of medical advances, and we have the resources, the economy to
support good public health. And that makes us think of those people in developing countries
who are less fortunate and we need to help them to come to where we are today. So hopefully
you have a better understanding through this lecture of the importance, the critical importance
of water and health and the role that it plays in the health that we enjoy today.