Gallons of Prevention: Worth 300 Milligrams of Cure

Gallons of Prevention
Worth 300 Milligrams of Cure

The Good Old Days

Civil War field hospital near
Petersburg, Virginia. Patients
here were more likely to be
suffering from disease than
battle wounds.

In the U.S. Civil War, more soldiers died in their camps from diseases than died in combat. In such camps, soldiers often used open pit latrines. Waste soaked into the ground water that fed the wells where soldiers got their drinking water. Flies landed on feces in the open pits, and then landed on the soldiers' food. It's no wonder that disease spread so fast in the army camps.

People in industrialized countries live longer now than they did 100 years ago. That is documented fact. Say what you will about the good old days, but people have more days on earth now than they did back then. Infectious disease doesn't kill nearly as many people today as in the 1800s, and it shows in our increased life-expectancy.

The discovery of antibiotics is one of the more glamorous contributions science has made to improving our health and extending our lives. Vaccines are another amazing gift of science that has made us healthier and given us longer lifespans. But there is a much less exciting strategy in our struggle with infectious disease, and it may be the most important of all.
Have a Sip of Cholera

John Snow

Many infectious diseases are spread by drinking contaminated water. Cholera is one example. Cholera causes massive vomiting and diarrhea, which can lead to death from dehydration. In 1854, a cholera epidemic broke out in London's Soho neighborhood. Over 600 people died of the disease in a mere ten days. One person investigating the outbreak was a doctor named John Snow. Snow had been hypothesizing that cholera was spread by contaminated drinking water, and he jumped on this epidemic as an opportunity to put his hypothesis to the test. Of the people who died in the outbreak, Snow found that the majority lived near one certain water pump. (In those days, most homes didn't have running water, and people often pumped their drinking water from wells, even in cities.) But there were more observations to be explained. Some people got sick who didn't live near the pump. Snow interviewed the families of those victims, and learned that nearly all had gone out of their way to get water from the pump because they preferred the taste of its water.

Even more intriguing was the evidence from people who didn't get sick. There was a jail in the neighborhood, and over 500 inmates were held there. The jail had its own well, and only five deaths were reported. The neighborhood had a brewery, too. There were perks to working there, as all brewery employees were given a certain amount of free beer every day. The workers then had no need to drink water, from the local well or any other, and none got sick.

Cartoon from the 1800s
attacking the quality
of London's drinking
water.

All this supported Snow's hypothesis that contaminated water spread cholera. The authories agreed, and removed the water pump's handle to prevent further spread of the disease. Eventually it was learned that chlorea had been seeping into the pump's well, either from nearby cesspits or from a sewer that ran near the well. Remember that in those days there were no flushing toilets. In London, people used privy pots that they either emptied into a basement cesspit or into sewers that drained into the River Thames without being treated.

This set up a viscious cycle. One person would drink contaminated water and would come down with cholera. From the cesspits or sewers, their infected body waste (remember cholera causes massive diarrhea) would eventually infect the drinking water. This put more cholera bacteria back into the drinking water supply, and the disease could spread to even more people.
Finishing the Job

Shutting down one contaminated well was just a short-term fix. It was obvious that the real solution was to ensure a clean water supply and to provide a sanitary way of dealing with human wastes to keep them from contaminating that water supply. This wasn't quick in coming. John Snow himself died a few years after his triumph at the well. It was left to another scientist, chemist Edward Frankland (1825-1899) to continue the struggle for safe water. In the 1860s Frankland began working for the city of London to ensure the safety of its water. While it was known that cholera was spread by fecal matter, it would not be until 1883 that Robert Koch discovered the bacterium that caused cholera. Until that discovery was made, Frankland used what knowledge he had, testing water for ammonia and urea. He knew that these compounds were found in animal and human wastes, and high levels of them in drinking water were a good sign that the water was unsafe to drink. The discovery of the cause of cholera in 1883 only made water testing even more effective. Frankland campaigned tirelessly to shut down the water sources that were found to be contaminated. During his own lifetime he lived to see modern water treatment used to further ensure the safety of drinking water.
Flushing Disease

Cholera and other water-borne diseases are almost unknown in developed nations, and this is because of two factors. First, water treatment kills most disease-causing microbes in the drinking water supply. Before water from a well, lake, or river reaches your faucet, it is treated by your local water company. Filtration is a first step, and then the water is often treated with chlorine or ozone. Chlorine traditionally has been the most common compound for killing germs in drinking water, but ozone is becoming more popular, especially in Europe. This is because ozone may be safer than chlorine. Either way, chlorine and ozone are both much safer than Vibrio cholerae, so if you're worried about chlorine, just use a faucet water filter to remove the chlorine from your water before you drink it.



  The humble flushing
  toilet is a cornerstone
  of public health.

The second factor that keeps cholera out of developed nations is the use of flushing toilets and sewage treatment. Flushing toilets carry human waste away from our homes. Meanwhile, sewage treatment kills any disease-causing microbes that are flushed down the toilet before the raw sewage is returned to the environment.

In developing nations where drinking water often isn't treated to kill the microorganisms living in it, cholera outbreaks can be deadly. These outbreaks are a problem especially in India and Bangladesh. In such places, the cycle of disease occurs today as it did in London in the 1850s. First, one person gets sick from drinking infected water. Without flushing toilets and sewage treatment, that person's diarrhea returns to the water supply along with a large amount of cholera bacteria, ready to infect others. Bringing clean water and good sanitation to the world's poorest nations is a pressing need, to say the least.
Prevention and Cure

While milligram doses of wonder drugs can save lives, many more lives have been saved by the less glamorous work that goes on at water and sewage treatment plants everywhere. In these plants billions of gallons of drinking water are made clean and safe. Billions of gallons of sewage are treated to prevent infection of water supplies. The world is undeniably a better place thanks to antibiotics and other medicines. But the longer lives and better health of people in developed nations today is as much the result of good disease prevention as good cures.
For more information, at other Web sites...

Charles F. Chandler — biographical sketch of the public health pioneer who brought clean water and indoor plumbing to New York City, part of Chemical Achievers from the Chemical Heritage Foundation.
John Snow: A Historical Giant in Epidemiology — extensive site on the life and work of John Snow, created by Professor Ralph R. Frerichs of the University of California at Los Angeles School of Public Health, Department of Epidemiology.
Sir Edward Frankland (1825-1899) — a short biographical sketch, written by Victoria Grosvenor, Lancaster University.

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References

McGrayne, Sharn Bertsch. Prometheans in the Lab. New York: McGraw-Hill, 2001.

Image Credits

Civil war field hospital...: Courtesy National Library of Medicine.
John Snow: Courtesy National Library of Medicine.
Cartoon from the 1800s...: Courtesy National Library of Medicine.
The humble flushing toilet...: Courtesy State of Utah Department of Natural Resources, Department of Water Resources.

Copyright ©2002 The Chemical Heritage Foundation