Our sense of Snow: the myth of John Snow in medical geography

In 1854, Dr. John Snow identified the Broad Street pump as the source of an intense cholera outbreak by plotting the location of cholera deaths on a dot-map. He had the pump handle removed and the outbreak ended...or so one version of the story goes. In medical geography, the story of Snow and the Broad Street cholera outbreak is a common example of the discipline in action. While authors in other health-related disciplines focus on Snow's "shoe-leather epidemiology", his development of a water-borne theory of cholera transmission, and/or his pioneering role in anaesthesia, it is the dot-map that makes him a hero in medical geography. The story forms part of our disciplinary identity. Geographers have helped to shape the Snow narrative: the map has become part of the myth. Many of the published accounts of Snow are accompanied by versions of the map, but which map did Snow use? What happens to the meaning of our story when the determinative use of the map is challenged? In his book On the Mode of Communication of Cholera (2nd ed., John Churchill, London, 1855), Snow did not write that he used a map to identify the source of the outbreak. The map that accompanies his text shows cholera deaths in Golden Square (the subdistrict of London's Soho district where the outbreak occurred) from August 19 to September 30, a period much longer than the intense outbreak. What happens to the meaning of the myth when the causal connection between the pump's disengagement and the end of the outbreak is examined? Snow's data and text do not support this link but show that the number of cholera deaths was abating before the handle was removed. With the drama of the pump handle being questioned and the map, our artifact, occupying a more illustrative than central role, what is our sense of Snow? (C) 2000 Elsevier Science Ltd. All rights reserved.