Commentary: Behind the Broad Street pump: aetiology, epidemiology and prevention of cholera in mid-19th century Britain

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Abstract
Introductory epidemiology text books and courses generally contain little epidemiological history, but an exception is made for the story of John Snow, the water-born transmission of cholera, and the handle of the Broad Street pump. 1– 5 Snow’s 1855 book, On The Mode Of Communication Of Cholera, 6 is indeed a beautiful demonstration of ‘the epidemiological imagination’ 7 in action, and continues to provide example and inspiration to people entering the discipline. However, it appeared amidst a veritable spate of speculation, experiment, investigation and recommendations regarding cholera, and some of these less celebrated (at least now) contributions remain instructive. Therefore, in the current issue of the International Journal of Epidemiology we reprint a section of Dr John Sutherland’s report for the General Board of Health on the 1848–1849 British cholera epidemic (Figure 1 ), together with a series of commentaries. 8– 10 The extracts from Sutherland’s report include his investigation of the effect of water source on cholera risk in Salford, Manchester, which was briefly referred to by Snow 6 and has occasionally been recognized as a seminal investigation. 11, 12 The discussion by Sutherland of the implications of his finding are clearly at variance with those of Snow, who more strongly emphasized the necessary transmissible element in generating cholera (and thus in triggering epidemics), but Sutherland’s utilization of quantitative data is striking.