John Snow, William Farr and the 1849 outbreak of cholera that affected London: a reworking of the data highlights the importance of the water supply

Objectives. This paper examines why Snow's contention that cholera was principally spread by water was not accepted in the 1850s by the medical elite. The consequence of rejection was that hundreds in the UK continued to die. Methods. Logistic regression was used to re-analyse data, first published in 1852 by William Farr, consisting of the 1849 mortality rate from cholera and eight potential explanatory variables for the 38 registration districts of London. Results. Logistic regression does not support Farr's original conclusion that a district's elevation above high water was the most important explanatory variable. Elevation above high water, water supply and poor rate each have an independent significant effect on district cholera mortality rate, but in terms of size of effect, it can be argued that water supply most strongly 'invited' further consideration. Conclusions. The science of epidemiology, that Farr helped to found, has continued to advance. Had Logistic regression been available to Farr, its application to his 1852 data set would have changed his conclusion. (C) 2004 The Royal Institute of Public Health. Published by Elsevier Ltd. All rights reserved.