1
00:00:08,040 --> 00:00:16,830
They just weren't listening. It paced the streets of London door to door tracking poor, emaciated faces, people he knew, people he cared for.

2
00:00:16,830 --> 00:00:22,410
And it was all pointing in the same direction. He'd found the link, even drawn them a map to show it.

3
00:00:22,410 --> 00:00:32,610
But still nothing. So now it was time to take action if they weren't going to do anything about this growing terror than he would Mr. Snow.

4
00:00:32,610 --> 00:00:40,230
See here, Mr. Snow, he turns to find the man he posted at Broad Street, sprinting, half falling through the mud towards him.

5
00:00:40,230 --> 00:00:47,820
Mr. Snow, we're ready. We've got everything you need. John nodded and followed the man back in the direction he'd come from.

6
00:00:47,820 --> 00:01:01,590
He had a new bounce in his step. This was it. The day they had to hear him, he'd rip off that water pump handle and then they'd see.

7
00:01:01,590 --> 00:01:09,100
You've now joined us in the 19th century and in the sixth episode of our history of pandemic season.

8
00:01:09,100 --> 00:01:12,810
Some say that the man you just heard from plays a central role.

9
00:01:12,810 --> 00:01:20,610
The story we're about to tell. And some say that he was just one of many trying to tackle that century's foremost threat.

10
00:01:20,610 --> 00:01:28,160
Either way, that threat is one which you probably heard of, not least because it's still around in our own time.

11
00:01:28,160 --> 00:01:33,460
Cholera. So let's begin by finding out more about this devastating disease.

12
00:01:33,460 --> 00:01:38,080
From our medical experts Lúcio Kuji and Brian Angus.

13
00:01:38,080 --> 00:01:47,860
Cholera is an acute diarrhoeal disease caused by intestinal infection with toxin producing gram negative bacterium vibrio cholerae.

14
00:01:47,860 --> 00:01:56,800
So there are many Scerri groups of empathy, cholerae, but only two oh one and oh one six nine caused outbreaks.

15
00:01:56,800 --> 00:02:06,670
And currently, I think V Cholerae O one is cause all the recent outbreaks and in fact there's some evidence that the disease itself

16
00:02:06,670 --> 00:02:15,220
probably relates to the fact that the Vibrio is pick up some extra genetic material that switches onto the toxin production.

17
00:02:15,220 --> 00:02:23,560
So some people have argued that in fact there is cholera epidemics of the stage that invades the bacteria and causes the bacteria to become toxic.

18
00:02:23,560 --> 00:02:29,350
Janick, produce toxin. Cholera is very much is the archetypal toxin.

19
00:02:29,350 --> 00:02:37,300
Disease induces cholera toxin which binds to the gut and causes that not to secrete lots and lots of fluid.

20
00:02:37,300 --> 00:02:42,340
And so, again, I've seen patients with cholera in Thailand, for example.

21
00:02:42,340 --> 00:02:47,830
They just have massive diarrhoea and people die of shock.

22
00:02:47,830 --> 00:02:56,080
Basically, they just lose huge amounts of volume. And so management of cholera really involves giving lots of fluids to people as soon as possible.

23
00:02:56,080 --> 00:03:01,150
Usually intravenously. And then there's a little bit of a role for for antibiotics.

24
00:03:01,150 --> 00:03:08,330
But that's really to stop its spread from person to person. And again, this thing about it's a water borne disease.

25
00:03:08,330 --> 00:03:13,380
It's very much related to drinking contaminated water.

26
00:03:13,380 --> 00:03:18,850
And it's very much a human human to human through the water transmission,

27
00:03:18,850 --> 00:03:27,640
essentially spread by eating or drinking food or water contaminated by the theses of infected persons shedding the various Hillary.

28
00:03:27,640 --> 00:03:34,660
That's not great for, is it, either in low resource environments with poor sewerage facilities.

29
00:03:34,660 --> 00:03:40,660
And this is the perfect environment which causes efficient spread of cholera.

30
00:03:40,660 --> 00:03:50,260
The typical risk area is a kind of Perry urban slums, camps for internally displaced persons or refugees,

31
00:03:50,260 --> 00:03:55,810
where there's only minimum requirements of clean water and sanitation which aren't being met.

32
00:03:55,810 --> 00:03:59,650
The consequences of latest humanitarian crises that cause, say,

33
00:03:59,650 --> 00:04:06,010
disruption of water and sanitation systems, displacement of populations, inadequate, overcrowded camps.

34
00:04:06,010 --> 00:04:09,190
These are where you have your increased risk of cholera transmission because

35
00:04:09,190 --> 00:04:14,380
people are defaecating out in the open and getting into the water systems,

36
00:04:14,380 --> 00:04:18,760
the drinking systems and essentially provision of safe water and sanitation is

37
00:04:18,760 --> 00:04:24,490
critical to control the transmission of cholera and also other waterborne diseases.

38
00:04:24,490 --> 00:04:29,590
The hallmark of cholera is a kind of profuse watery diarrhoea.

39
00:04:29,590 --> 00:04:35,680
And it's actually dehydration from the severe diarrhoea, which is the most dangerous clinical feature.

40
00:04:35,680 --> 00:04:44,920
Sanitation is really important for control of outbreaks of these sorts of waterborne diseases, particularly cholera and also things like typhoid.

41
00:04:44,920 --> 00:04:50,740
That's the disease we're dealing with. So let's find out how and when it emerged.

42
00:04:50,740 --> 00:04:56,320
Time to introduce my main guests today, Dr. Class Curcio, Oxford Martin,

43
00:04:56,320 --> 00:05:01,690
fellow from the Programme on Collective Responsibility for Infectious Disease.

44
00:05:01,690 --> 00:05:12,390
Cholera pandemics of the 19th century are really the kind of big band of international health they kick off starting at age 17 to 18 24.

45
00:05:12,390 --> 00:05:17,530
And the kind of Gulf of Bengal area and colour has been endemic there probably for a long time.

46
00:05:17,530 --> 00:05:23,470
But this time something's new and the disease spreads over large parts of the Indian subcontinent.

47
00:05:23,470 --> 00:05:27,940
And there's then also perceived to be spreading across Asia towards Europe.

48
00:05:27,940 --> 00:05:32,170
Initially, people aren't really aware that this is a new disease.

49
00:05:32,170 --> 00:05:37,660
They are really aware that this is something unique or special and very gradually an age before there's any knowledge

50
00:05:37,660 --> 00:05:43,960
of microbiology whatsoever and lots of conflict about whether disease is caused by kind of climatic exhalations,

51
00:05:43,960 --> 00:05:49,240
humoral imbalance or filth, whether you know, how one could even think of this disease.

52
00:05:49,240 --> 00:05:59,020
So historians have seen that during this period there's a growth of temples being built dedicated to specific fever goddesses in the

53
00:05:59,020 --> 00:06:06,970
Indian subcontinent and increasingly European colonial authorities and the fortunes of the East India Company start picking up that.

54
00:06:06,970 --> 00:06:09,400
Something's going on and they're sending reports back.

55
00:06:09,400 --> 00:06:15,500
So by the end of the 18th, 17, 1824 period when there have been thousands of fatalities in these areas,

56
00:06:15,500 --> 00:06:20,380
there is an awareness that this was something you and this fear of cholera, something new,

57
00:06:20,380 --> 00:06:25,150
something that is very dangerous, gets reinforced or the subsequent pandemic waves.

58
00:06:25,150 --> 00:06:29,090
There are numerous pandemic waves of cholera during the 19th century. And so.

59
00:06:29,090 --> 00:06:37,790
After this initial 18, 17, 18, 24 events, subsequent pandemic waves really drive home this narrative that there is a danger of

60
00:06:37,790 --> 00:06:43,040
new kinds of disease spreading from parts of the world to other parts of the world.

61
00:06:43,040 --> 00:06:47,690
And in the European consciousness, often enough, you know, you get references to the Black Death, etc.,

62
00:06:47,690 --> 00:06:55,580
but there's cholera pandemics that really spark a new kind of way of thinking about disease, something that connects distinct societies.

63
00:06:55,580 --> 00:07:02,960
Disease is something that is related to rapid travel. Disease is something that affects, obviously, European populations as well.

64
00:07:02,960 --> 00:07:06,290
That's very important for the imperial imaginary during this period.

65
00:07:06,290 --> 00:07:16,230
And as a consequence, it triggers by 1851, faced with, again, new research and cholera pandemics, attempts by imperial authorities here,

66
00:07:16,230 --> 00:07:23,870
notably the French, British, Spanish and also some other imperial authorities to devise some kind of international framework of how to deal with it.

67
00:07:23,870 --> 00:07:29,450
I mean, similar to nowadays. A pandemic is a hugely disruptive event for trade.

68
00:07:29,450 --> 00:07:32,810
It causes fear. It causes social unrest and tensions.

69
00:07:32,810 --> 00:07:41,390
And so in 1851, there's really a consolidated international attempt to develop a legal framework to a degree what colour actually is.

70
00:07:41,390 --> 00:07:45,380
But this is before you can see colour under a microscope or, you know, do anything with it.

71
00:07:45,380 --> 00:07:50,630
And there's also a really big attempt to think about how to deal with quarantine.

72
00:07:50,630 --> 00:07:55,430
And that's something that we're still thinking about. We've covered 19. So how long is an appropriate quarantine?

73
00:07:55,430 --> 00:08:00,560
How should a port deal with ships with suspected cholera victims on board?

74
00:08:00,560 --> 00:08:03,800
How do you treat ships flying, you know, with under a different flag?

75
00:08:03,800 --> 00:08:10,550
So all of these things get debated in a sign of the times that there's no definitive agreement reached on this.

76
00:08:10,550 --> 00:08:17,390
It's actually owned in 1892 when microbiologists start coming in and showing you that the pathogen causing cholera.

77
00:08:17,390 --> 00:08:25,430
That's much more sophisticated understands how disease spreads, that new conventions are really reached that span large parts of the globe.

78
00:08:25,430 --> 00:08:30,260
But this wasn't, of course, the only outbreak of cholera in the 19th century.

79
00:08:30,260 --> 00:08:37,200
There are a series of cholera pandemics that sweep around the world. So the first one is from 18, 17 to 18, 24.

80
00:08:37,200 --> 00:08:45,260
Another one is from 1829 to age 47. Then another one from 1846, 1860, from 1863 to 1875.

81
00:08:45,260 --> 00:08:50,870
And then from 1881 to 1896 and from 1899 to 1923.

82
00:08:50,870 --> 00:08:54,410
Now, these don't all hit England in the same way.

83
00:08:54,410 --> 00:08:59,660
Or, you know, the British Isles don't hit Europe in the same way because of the global interconnectedness.

84
00:08:59,660 --> 00:09:02,780
There is really this awareness of cholera as a major challenge.

85
00:09:02,780 --> 00:09:08,360
And increasingly, when it the more it becomes associated as a kind of disease that is spread by filth,

86
00:09:08,360 --> 00:09:16,100
it becomes a sign of your civil, literary, but also moral progress by not having cholera incidence within your cities.

87
00:09:16,100 --> 00:09:16,490
And again,

88
00:09:16,490 --> 00:09:25,730
cholera is kind of the menace lurking in the shadow of people's mind when they offer us large scale spending on sanitation and sewerage upgrades,

89
00:09:25,730 --> 00:09:32,390
which really start gathering steam in the UK from the 1860, 1870, 1880 onwards,

90
00:09:32,390 --> 00:09:39,170
where there's large scale expenditure and it really does result in a measurable decrease of the spread of waterborne pathogens.

91
00:09:39,170 --> 00:09:44,640
I particularly wanted to focus in on England around the middle of the 19th century

92
00:09:44,640 --> 00:09:49,040
and ask class to paint a picture of what public health was like in the country.

93
00:09:49,040 --> 00:09:55,580
At this time, the cholera pandemics hit England in a very unique point in time.

94
00:09:55,580 --> 00:10:00,050
So since the early 19th century, late 18th century,

95
00:10:00,050 --> 00:10:05,810
there's been quite big changes that have happened in terms of thinking about disease coming out of specifically France.

96
00:10:05,810 --> 00:10:12,080
There's this increasingly rigorous concept of disease as something that you can localise within your body.

97
00:10:12,080 --> 00:10:16,310
So since the 18th, 17th century disease, older mediaeval notions of diseases,

98
00:10:16,310 --> 00:10:25,040
kind of imbalance of the body are being displaced by increasingly systematic pathological examinations of the body and increasing this notion,

99
00:10:25,040 --> 00:10:31,250
OK, we can look less disease in a specific point of the body. So disease is no longer something that just arises spontaneously.

100
00:10:31,250 --> 00:10:35,330
But there are distinct diseases and we can differentiate between them.

101
00:10:35,330 --> 00:10:36,320
And at the same time,

102
00:10:36,320 --> 00:10:46,070
there's this enlargement post French revolutionary hope in a kind of rational reconstruction of societies and an increasing trust in maths.

103
00:10:46,070 --> 00:10:51,050
So people start counting deaths. Science is not particularly revolutionary,

104
00:10:51,050 --> 00:10:59,600
but actually having robust data sets of deaths in specific localities that he can then analyse statistically.

105
00:10:59,600 --> 00:11:03,700
So we know the difference between an endemic disease and that led epidemic is just really,

106
00:11:03,700 --> 00:11:08,030
you know, that can rise over what you would expect in the number of deaths occurring.

107
00:11:08,030 --> 00:11:14,120
These two changes start bringing in a kind of new way of conceptualising disease.

108
00:11:14,120 --> 00:11:18,920
And there's a young generation of often quite radical medical doctors, public health doctors,

109
00:11:18,920 --> 00:11:23,660
who are starting to emphasise that states should take care of their citizens,

110
00:11:23,660 --> 00:11:28,860
that it is part of state's interest to boost the welfare of societies by taking specific.

111
00:11:28,860 --> 00:11:35,430
Forms of sanitary intervention further. So in the UK, there is a group of influential people smoking.

112
00:11:35,430 --> 00:11:43,110
For example, Chadwick. You are using these statistics to press for senator reform and cholera in this situation is almost, I should say, godsend,

113
00:11:43,110 --> 00:11:49,110
but it definitely boosts the cause of these public health practitioners because it is such an explosive disease.

114
00:11:49,110 --> 00:11:53,760
It causes terror and the repeated waves of introduction in the UK during this period.

115
00:11:53,760 --> 00:11:59,000
And it boosts the political weight of the demands of public health reformers who can

116
00:11:59,000 --> 00:12:03,180
now successfully press for the case that some kind of sanitary reform is necessary.

117
00:12:03,180 --> 00:12:08,400
There may be disagreement about the cause of cholera, but it is increasingly linked to filthy,

118
00:12:08,400 --> 00:12:14,770
stagnant water, specific forms of poverty in the Victorian mind, also specific forms of amoral behaviour.

119
00:12:14,770 --> 00:12:18,370
So drunkards and, you know, people are living squalid lifestyles.

120
00:12:18,370 --> 00:12:23,520
The blame for contracting the disease because of their of their lacking morality there, too.

121
00:12:23,520 --> 00:12:30,810
So it's kind of a comprehensive reform programme of boosting health health defined here no long as the health of the individual.

122
00:12:30,810 --> 00:12:35,520
But as of the population. And it really feeds into this new narrative of nation states,

123
00:12:35,520 --> 00:12:39,960
modern young nation states emerging during this period who are concerned with boosting

124
00:12:39,960 --> 00:12:45,120
the efficiency of their population and also obviously preventing social unrest.

125
00:12:45,120 --> 00:12:52,460
So that's the public health system. But I still wondered how the wider society reacted to this growing threat.

126
00:12:52,460 --> 00:12:55,260
The cholera pandemics initially trigger moral panic.

127
00:12:55,260 --> 00:13:03,180
So large parts of the initial, how shall I say, official communication that isn't really modern public health communication in a way,

128
00:13:03,180 --> 00:13:05,820
combines national calls to prayer,

129
00:13:05,820 --> 00:13:16,110
begging for forgiveness and other kind of spiritual interventions with suggestions like keeping clean, being moderate in your diet.

130
00:13:16,110 --> 00:13:23,430
So against some kind of effect, your constitution and not drinking to excess washing your hands.

131
00:13:23,430 --> 00:13:32,800
So it's kind of a potpourri of different recommendations of kind of tried and trusted 18th, 19th century attempts to kerb disease.

132
00:13:32,800 --> 00:13:36,150
There's also a flourishing market of private preventative measures.

133
00:13:36,150 --> 00:13:42,570
And as the 19th century progresses, this becomes ever more colourful with kind of new concepts of germ theory,

134
00:13:42,570 --> 00:13:45,570
intermingling of all the concepts of my asthmatic fear.

135
00:13:45,570 --> 00:13:53,310
So you'll get people advertising carbonic acid as a kind of disinfection that you can use internally and externally.

136
00:13:53,310 --> 00:13:58,710
You'll have rose petals, dust because of its great smell, dispersing cholera germs.

137
00:13:58,710 --> 00:14:05,160
In our typhoid exhibition, we had a great example of people simultaneously advertising hair lotion to restore hair,

138
00:14:05,160 --> 00:14:10,330
which allegedly folds out pennies from Colorado. Typhoid and cure you of the cholera at the same time.

139
00:14:10,330 --> 00:14:18,210
So there's there's a huge variety of medical interventions. But what does seem to be an emerging consensus within the public health,

140
00:14:18,210 --> 00:14:26,610
emerging public health discipline of the time is that sanitary interventions seem to offer a good chance of prevention,

141
00:14:26,610 --> 00:14:29,430
regardless of whether you agree on germ theory or you agree.

142
00:14:29,430 --> 00:14:36,450
My asthma or, you know, other forms of kind of contagion ism, you will probably agree that getting rid of stagnant water,

143
00:14:36,450 --> 00:14:42,600
getting rid of exhalations filth achieves a kind of common goal.

144
00:14:42,600 --> 00:14:51,340
It seemed like a good time to bring into the story that physician John Snow, along with his famous water pump moment.

145
00:14:51,340 --> 00:14:56,290
I'm aware from my own research that such historical narratives can be misleading,

146
00:14:56,290 --> 00:15:03,010
giving the false impression with hindsight that the line of progress suddenly became clear after some

147
00:15:03,010 --> 00:15:09,640
crucial experiment or insight such as Galileo was falling cannonballs or Newton's falling apple.

148
00:15:09,640 --> 00:15:15,410
I think in general, it's wrong to think of no knowledge progressing inevitably to a certain point.

149
00:15:15,410 --> 00:15:21,370
And if you're looking back at history, there's always a temptation to always, you know, yell at your source and say, isn't it obvious?

150
00:15:21,370 --> 00:15:25,300
Why can't you see this? And that ends up with you asking wrong questions.

151
00:15:25,300 --> 00:15:31,150
It ends up with you the kind of jargon we say, creating a tautology where, you know, progress is inevitable.

152
00:15:31,150 --> 00:15:34,980
Only people that follow John Snow. At the time, everything would have been clear.

153
00:15:34,980 --> 00:15:41,590
John Snow is one of a number of physicians during this time employing maths and point statistics

154
00:15:41,590 --> 00:15:48,370
and employing epidemiological kind of leather shoe epidemiology to trace the origins of outbreaks.

155
00:15:48,370 --> 00:15:54,940
And he's a physician in London during this period and becomes concerned about cholera spreading in London.

156
00:15:54,940 --> 00:16:03,050
And he starts investigating going to the households, asking where water has been taken from notes asking numerous other questions.

157
00:16:03,050 --> 00:16:08,710
And he links off claims that he has found a link.

158
00:16:08,710 --> 00:16:13,580
Again, this is before you have any kind of microbiological proof that what he's claiming is actually true,

159
00:16:13,580 --> 00:16:20,560
that cholera outbreaks are linked to this one. You know, to this one water company supplying water.

160
00:16:20,560 --> 00:16:26,260
He then creates a map which is specifically designed to prove his points to the map is less a piece

161
00:16:26,260 --> 00:16:32,740
of rigorous science as we now can retrospectively claim to be a more kind of political statements.

162
00:16:32,740 --> 00:16:37,630
It does blend out specific points of information that you wouldn't blend up nowadays to really drive home the

163
00:16:37,630 --> 00:16:43,510
point he is hoping to make and at the end of the cholera outbreak has really died down at the end of this,

164
00:16:43,510 --> 00:16:55,070
then spectacularly removes the handle off the Broad Street pump. John Snow mapped where the cases where basic epidemiology looked at the risk factors.

165
00:16:55,070 --> 00:17:01,180
This what we do with any outbreak is we have it. We try to make a case definition of what the diseases.

166
00:17:01,180 --> 00:17:06,220
And then we will look at people who meet our case definitions and then we'll ask the most questions

167
00:17:06,220 --> 00:17:10,810
about what the what they did do mean contact question where they've been and what they've been doing.

168
00:17:10,810 --> 00:17:21,370
And he tried to do it was a common water source that these people were using and he tried to get it shut down and didn't manage.

169
00:17:21,370 --> 00:17:29,890
And so took matters into his own hands and to create a pump handle and registered the cholera transmission in removing it,

170
00:17:29,890 --> 00:17:35,620
he kind of starts setting a precedent for, you know, thinking of cholera as something that is water related.

171
00:17:35,620 --> 00:17:40,810
Snow isn't that prominence during his time.

172
00:17:40,810 --> 00:17:48,520
And this is not because. You know, there's some kind of evil conspiracy going on against epidemiology during this period,

173
00:17:48,520 --> 00:17:53,920
it's because there are very plausible alternative, according to the current state of science knowledge.

174
00:17:53,920 --> 00:17:56,260
Competing theories of disease ongoing.

175
00:17:56,260 --> 00:18:04,750
Snow is writing again during this time period when there seems to be very plausible evidence that diseases are spread by specific climatic variations.

176
00:18:04,750 --> 00:18:08,800
So there are also lots of hybrid fairy circulating.

177
00:18:08,800 --> 00:18:13,800
So, for example, one of Oxford's most famous physicians during this period,

178
00:18:13,800 --> 00:18:20,800
Sir Henry Jaclyn's, better becomes the Regis professor of medicine in Oxford. He investigates Oxford's column Colour Outbreaks.

179
00:18:20,800 --> 00:18:26,080
And in the 1850 he publishes, another looks almost identical to Snow's map.

180
00:18:26,080 --> 00:18:35,850
Goes from house to house, gathers the case reports, produces his beautifully coloured map of Oxford with different slum districts coloured in.

181
00:18:35,850 --> 00:18:42,120
And when I show it to my students with Mononoke to say, oh, this is snow, it's clearly bacteriological thinking linked into the water,

182
00:18:42,120 --> 00:18:46,530
but then you look closer and you actually see that he's drawn in altitude lines.

183
00:18:46,530 --> 00:18:55,920
What he's saying is, yes, water may be a factor, but actually it's specific climatic conditions that also then cannot allow dangerous poisonous

184
00:18:55,920 --> 00:19:01,170
wrappers or toxic wrappers to stay in specific areas that I'm not as present at higher level.

185
00:19:01,170 --> 00:19:06,720
So it's a time of great competition between different theories of disease.

186
00:19:06,720 --> 00:19:11,520
So snow is he makes an interesting point. It is not conclusive evidence.

187
00:19:11,520 --> 00:19:16,020
Not even by the standards of the time that that is really the cause of the cholera pandemics.

188
00:19:16,020 --> 00:19:18,720
He is, however, later in the early 20th century,

189
00:19:18,720 --> 00:19:29,910
put on a pedestal by rapidly establishing group of public health practitioners at universities who, you know, see him as the founding father.

190
00:19:29,910 --> 00:19:35,490
And as with lots of farming, this you have lots of heroic narratives arising around them.

191
00:19:35,490 --> 00:19:42,800
And, you know, I research a lot of antibiotics that could tell you a lot of stuff about Alexander Fleming, too, you know, in this context.

192
00:19:42,800 --> 00:19:45,420
But to sum up Snowies place in this narrative,

193
00:19:45,420 --> 00:19:52,530
I still felt that we could legitimately consider him to have played an important role in the history of epidemiology.

194
00:19:52,530 --> 00:19:58,650
So, yes, knows William importance. He is one of the first to really highlight Water-borne Connexions.

195
00:19:58,650 --> 00:20:03,900
His epidemiological method is rigorous according to the current standards.

196
00:20:03,900 --> 00:20:11,250
However, it is not, as you know, according to the scientific knowledge of the time, it is not a conclusive proof.

197
00:20:11,250 --> 00:20:17,250
And it is more of an outlier theory in contrast to other, more established fearis like the one Åkerlund is proposing in Oxford,

198
00:20:17,250 --> 00:20:21,570
which often presume a kind of hybrid between Contagion's 90 contingence causes the

199
00:20:21,570 --> 00:20:26,790
modern notion of the scientists we now have is emerges during the 19th century.

200
00:20:26,790 --> 00:20:31,730
But you cannot compare John Snow to a modern scientist and the way modern science is conducted.

201
00:20:31,730 --> 00:20:37,380
The biomedical sciences, as we now know, this fusion of the biologic and the medical sciences.

202
00:20:37,380 --> 00:20:43,500
And that does not exist. When, when, when when Snow's doing these these investigations,

203
00:20:43,500 --> 00:20:50,700
a large part of a science in the 19th century is carried out by people we would

204
00:20:50,700 --> 00:20:54,780
perhaps now characterise as amateurs and seemingly individual investigators,

205
00:20:54,780 --> 00:21:00,330
although very well network once and often enough is relying on considerable sources of wealth,

206
00:21:00,330 --> 00:21:04,800
either privately or from other sources to conduct these investigations.

207
00:21:04,800 --> 00:21:14,220
The modern notion of the kind of biomedical scientists we have now that emerges as a result of the bacteriological revolution,

208
00:21:14,220 --> 00:21:21,840
but also the revolution of industry and the biomedical sciences and of state interest in that that accompanies that.

209
00:21:21,840 --> 00:21:27,180
A part perhaps that also makes it easier for us to envision these people. United is almost Sherlock Holmes like people.

210
00:21:27,180 --> 00:21:33,990
You know, if the hunch that one wanders London finds finds the Broadstreet handle and takes it off.

211
00:21:33,990 --> 00:21:39,900
I think it both allows us to romanticise. In some way,

212
00:21:39,900 --> 00:21:46,800
the work and I think actually take the actual practise of doing this work less seriously and also underestimate how revolutionary this was,

213
00:21:46,800 --> 00:21:49,170
how radical it was. Perhaps that's the better word for it.

214
00:21:49,170 --> 00:21:58,440
In the 19th century, snow was an outlier initially and the consensus that his feary was right emerged gradually.

215
00:21:58,440 --> 00:22:04,620
But there is this tendency nowadays to mistake the way he mobilised evidence with our way of mobilising

216
00:22:04,620 --> 00:22:09,630
evidence and then to presume that society should have automatically snap the finger and say,

217
00:22:09,630 --> 00:22:15,450
no, this is this is what's causing the disease. He's a good retrospective hero.

218
00:22:15,450 --> 00:22:18,990
If there were a number of key figures around this time,

219
00:22:18,990 --> 00:22:26,160
I was keen to understand from Flosse who else was contributing significantly to the understanding of this disease?

220
00:22:26,160 --> 00:22:30,600
Well, as a German, I have to say, well, but Cofferati, you know, he is the person to isolate the Veber.

221
00:22:30,600 --> 00:22:36,630
They are right. And his investigations in Hamburg, even though there are still a lot of contestation during this period,

222
00:22:36,630 --> 00:22:44,370
whether something is is jumbo or not, his is new mode of presenting evidence, the kind of.

223
00:22:44,370 --> 00:22:48,030
Even though he actually doesn't invent it. But it goes back to his students deeply.

224
00:22:48,030 --> 00:22:55,730
Luffler the cost postulates of linking a microbe to a disease in a way that we probably wouldn't do any more.

225
00:22:55,730 --> 00:22:59,640
But not that kind of new way of mobilising evidence.

226
00:22:59,640 --> 00:23:03,270
Using the laboratory to make decisive claims about this is the.

227
00:23:03,270 --> 00:23:04,200
This is how it spreads.

228
00:23:04,200 --> 00:23:11,790
The disease is the pathogen rather than the kind of wider climatic constitution and the insight in the individual's constitution.

229
00:23:11,790 --> 00:23:19,380
That is what makes a huge difference. And in 1890 to the time when those first sanitary conventions are reached,

230
00:23:19,380 --> 00:23:24,180
that is also the year when he in Hamburg has a major breakthrough in terms of

231
00:23:24,180 --> 00:23:27,680
cholera prevention during a pen during an epidemic that occurs in Hamburg.

232
00:23:27,680 --> 00:23:34,610
So British bacteriology in the 19th century also has lots of heroic figures.

233
00:23:34,610 --> 00:23:39,300
But if you really want to see how germ theory takes off.

234
00:23:39,300 --> 00:23:46,440
Gosh, look to the European continent, the labs of Pasteur and to the kind of Corkins cool of bacteriology,

235
00:23:46,440 --> 00:23:52,110
both of whom got to dominate international bacteriology up until the First World War.

236
00:23:52,110 --> 00:23:58,060
And Cok also found himself challenged by competing theories about the nature of this disease.

237
00:23:58,060 --> 00:24:03,180
The very famous story, of course, there's a very famous competition with Max Petten Kaufer,

238
00:24:03,180 --> 00:24:12,480
who was a very famous advocate of sanitary feary, again thinking that ventilation was a key driver of of public health.

239
00:24:12,480 --> 00:24:18,450
And he famously tried to disprove cough. And actually, it's a sign it's a successful challenge for him.

240
00:24:18,450 --> 00:24:27,810
He drinks a solution of cholera. Bacterium doesn't fall ill, allowing him to claim that cholera clearly can't be proved by a germ.

241
00:24:27,810 --> 00:24:35,340
I mean that these scientific rivalry's doing, the period the way lots of people like Pasteur mobilise evidence is very selective.

242
00:24:35,340 --> 00:24:42,720
We shouldn't mistake it with the way, for example, clinical evidence is evaluated nowadays.

243
00:24:42,720 --> 00:24:47,620
It's often much less rigorous. The way statistics is used is very different.

244
00:24:47,620 --> 00:24:54,290
This is before really modern bio statistics emerge there much towards the end of the 19th century.

245
00:24:54,290 --> 00:24:55,920
It's a different world.

246
00:24:55,920 --> 00:25:03,510
It's a different world again, in which, you know, you can have this outsized reputation of not being this individual genius walking around.

247
00:25:03,510 --> 00:25:09,810
There is obviously a large associated body of other people gathering evidence during this period.

248
00:25:09,810 --> 00:25:16,770
I would say actually much more important than Jon Snow is the work of William Farr in the General Office of Statistics in Britain.

249
00:25:16,770 --> 00:25:26,910
Just by compiling mortality reports, which gives people an increasing body of evidence to draw on when it comes to epidemiological analysis,

250
00:25:26,910 --> 00:25:32,550
that is also an increasingly powerful when the mass becomes better was the end of the 19th century

251
00:25:32,550 --> 00:25:38,040
in cities where disease comes from and also showing which interventions may be effective or not.

252
00:25:38,040 --> 00:25:43,710
So yeah, that there is a large kind of underbody of the people working in this area.

253
00:25:43,710 --> 00:25:44,910
It's very contested.

254
00:25:44,910 --> 00:25:53,560
Other people mobilised my sematic theory using just the same numbers, just like Reactant did later convert to bacteriology in Oxford.

255
00:25:53,560 --> 00:25:59,220
But in the 1960s and 70s, he is convinced it's Poison's oxidase Medical Office of Health.

256
00:25:59,220 --> 00:26:04,170
Up until nineteen or two does not believe in drugs. He believes in poisons.

257
00:26:04,170 --> 00:26:09,300
It's a political choice on my behalf. What I say bacteriological revolution or not?

258
00:26:09,300 --> 00:26:10,850
It's a slow burning thing, right?

259
00:26:10,850 --> 00:26:17,460
So there are there are changes to the way disease is understood, but they filter even through the scientific and medical establishment.

260
00:26:17,460 --> 00:26:24,300
They filter even more unevenly frou frou popular knowledge.

261
00:26:24,300 --> 00:26:29,790
And this means that what we usually end up being confronted with is a very hybrid world world consisting of

262
00:26:29,790 --> 00:26:36,510
medical pluralism with older traditions of sensemaking existing next to modern traditions of sensemaking.

263
00:26:36,510 --> 00:26:45,000
There are fierce rivalries going on. The same time, and often enough, you only really realise that something is happening at a specific point.

264
00:26:45,000 --> 00:26:51,990
Twenty years into the future, when you look back retrospectively, it's not obvious necessarily that things are going on at the moment.

265
00:26:51,990 --> 00:26:56,670
Another thing I was keen to know more about, hopefully in the light of our modern experience,

266
00:26:56,670 --> 00:27:05,120
Koven was to what extent certain groups or nations were blamed for the spread of cholera 19th century England.

267
00:27:05,120 --> 00:27:11,520
The disease is always politicised. I mean, think of cholera and the Asian cholera as it is then label.

268
00:27:11,520 --> 00:27:17,760
It comes with all kinds of racist assumptions against the supposed causes.

269
00:27:17,760 --> 00:27:22,690
This this notion of sanitation as a civil attari achievement in the language of that,

270
00:27:22,690 --> 00:27:26,970
the justification it also gives you to intervene in other people's lives is a great global

271
00:27:26,970 --> 00:27:30,990
history called a history of global health interventions into the lives of other people.

272
00:27:30,990 --> 00:27:35,730
Because disease is a social phenomenon, because it affects humans, it goes through our bodies,

273
00:27:35,730 --> 00:27:41,310
we shape its environment, take the drugs, etc. It is ease's necessarily a political entity.

274
00:27:41,310 --> 00:27:50,400
And I'm also very sceptical at the moment of chords to take the politics out of science that you often read on unacademic Twitter now,

275
00:27:50,400 --> 00:28:00,090
because the first thing, the first thing people should have learnt about the history of pandemics is that you cannot divorce science from politics.

276
00:28:00,090 --> 00:28:05,160
And the good science in this context is science that is politically aware and manages

277
00:28:05,160 --> 00:28:09,000
to navigate the political streams rather than say we are completely apolitical,

278
00:28:09,000 --> 00:28:14,470
don't touch us. I think that's the wrong ivory tower notion of science that never existed in the metric.

279
00:28:14,470 --> 00:28:16,680
We never will exist in this context.

280
00:28:16,680 --> 00:28:24,420
It was time to move to the end of the century and start to understand how countries began to get this disease under control.

281
00:28:24,420 --> 00:28:32,400
Sanitary infrastructures, which are put in place in the 19th century, play an absolutely crucial role in reducing cholera and typhoid incidents.

282
00:28:32,400 --> 00:28:36,390
Now, for example, typhoid. You can also contract by contaminated food.

283
00:28:36,390 --> 00:28:41,040
Cholera can also be transmitted by other kinds of roads or faecal exposure, et cetera.

284
00:28:41,040 --> 00:28:46,980
So this kind of mass societal susceptibility to explosive spreads of water borne

285
00:28:46,980 --> 00:28:51,660
disease that we still see in low and middle income countries around the world,

286
00:28:51,660 --> 00:28:56,280
that goes down as a result of the quote unquote,

287
00:28:56,280 --> 00:29:01,830
sanitary revolution during the period and also the development of vaccines,

288
00:29:01,830 --> 00:29:08,310
which play an increasing role in protecting European troops abroad and

289
00:29:08,310 --> 00:29:13,740
increasingly play a role in kind of stopping travellers from reimporting disease.

290
00:29:13,740 --> 00:29:19,260
But sadly, unlike smallpox, cholera has not been eradicated.

291
00:29:19,260 --> 00:29:23,310
Cholera is still an ongoing pandemic, one could not say.

292
00:29:23,310 --> 00:29:30,750
So there is the classic cholera pandemics that sweep around the world in the 19th century.

293
00:29:30,750 --> 00:29:37,700
Those classic types gets planted from 1961 by a new cholera type called Tor.

294
00:29:37,700 --> 00:29:44,940
And between 1961 and 1975, there's this really sweeping around the globe of a new L'Étoile pandemic strain of Guinea.

295
00:29:44,940 --> 00:29:54,990
Not now. Wait. What areas of the world where water and sanitation hygiene systems wash in the kind of professional speak are absent or insufficient?

296
00:29:54,990 --> 00:29:58,800
So that starts sweeping around the world in the 1990s, early 1990s.

297
00:29:58,800 --> 00:30:05,430
There's actually global panic about the introduction of these strains into South America.

298
00:30:05,430 --> 00:30:11,550
And you still have regular reports of outbreaks in Yemen, for example, Africa.

299
00:30:11,550 --> 00:30:15,840
African countries have reported outbreaks such as Zimbabwe.

300
00:30:15,840 --> 00:30:21,510
In the 2000s. And there have been also reported cases in the Asian countries, too.

301
00:30:21,510 --> 00:30:28,800
There are currently and three and WHL qualified cholera vaccines that are around.

302
00:30:28,800 --> 00:30:32,610
And they don't always get to the right places because obviously, as we've talked about,

303
00:30:32,610 --> 00:30:40,800
and cholera tends to have outbreaks in places where there are disruptions in the political and social systems.

304
00:30:40,800 --> 00:30:45,310
And you can then treat severe cholera with intravenous fluids.

305
00:30:45,310 --> 00:30:46,940
So antibiotics,

306
00:30:46,940 --> 00:30:55,830
but mass administration of antibiotics isn't recommended because there's no proven effect that really helps with the spread of cholera camera juice,

307
00:30:55,830 --> 00:31:03,990
the duration of story if someone has it. But having mass administration of the antibiotics could contribute to anti-microbial resistance.

308
00:31:03,990 --> 00:31:07,920
There's always a fear during humanitarian crises,

309
00:31:07,920 --> 00:31:18,270
which are set in floods on flooded areas that the dead bodies are floating in the water can spread to cholera.

310
00:31:18,270 --> 00:31:25,840
Actually, there's no evidence that uninfected dead bodies can spread cholera, which is which is quite important to know.

311
00:31:25,840 --> 00:31:33,850
All of this was hugely concerning, and I wondered out loud class whether the cholera had ever really ended.

312
00:31:33,850 --> 00:31:37,840
So in a way, we are still in the middle of a pandemic.

313
00:31:37,840 --> 00:31:44,440
And I think the interesting question to ask here about a pandemic is what's the appropriate timescale to think of a pandemic?

314
00:31:44,440 --> 00:31:52,330
That's the historians question, I think, in this regard. Corona virus Colvard 19 makes everything seem very explosive.

315
00:31:52,330 --> 00:31:56,320
Right. But my work on antimicrobial resistance, for example,

316
00:31:56,320 --> 00:32:01,870
you do start asking yourself the question said, when do we stop, start speaking about a pandemic.

317
00:32:01,870 --> 00:32:12,220
Just because the timescale may be slightly off, in a way, we are seeing a slowly emerging rise of a completely new cast of very difficult to treat

318
00:32:12,220 --> 00:32:17,710
bacterial organisms sharing the same genetic elements that are spreading around the world.

319
00:32:17,710 --> 00:32:21,110
And so clearly, this is also a temporal question that we have to ask ourselves.

320
00:32:21,110 --> 00:32:28,720
And we clearly, as humans, geared towards prioritising explosive events, the immediacy of action, alternate political systems.

321
00:32:28,720 --> 00:32:36,580
But as cases that cholera or, you know, antimicrobial resistance show there are very slow burning or, you know,

322
00:32:36,580 --> 00:32:45,130
comparatively slow burning outbreaks that span borders that are still ongoing and that are just as dangerous as as Colvert 19.

323
00:32:45,130 --> 00:32:54,520
Pandemics can also lead to significant longer term change as class outcome pandemic events, the ones that we remember from the 19th century onwards,

324
00:32:54,520 --> 00:33:00,340
are usually associated with some kind of change to global governance with regard to international health.

325
00:33:00,340 --> 00:33:01,570
So the third plague pandemic,

326
00:33:01,570 --> 00:33:08,140
which starts in the late 19th century or starts in the middle 19th century and then becomes a global problem in the late 19th century,

327
00:33:08,140 --> 00:33:15,910
triggers additional safeguards for parts such as the shields that we still use on ships, for example,

328
00:33:15,910 --> 00:33:21,670
to prevent rats from kind of jumping on ships and then popping up somewhere else in the world.

329
00:33:21,670 --> 00:33:27,370
We see the same happening with experiences of the so-called Asian flu, Hong Kong flu,

330
00:33:27,370 --> 00:33:33,220
leading to upgrades and changes of international sanitary arrangements or international health regulations.

331
00:33:33,220 --> 00:33:41,740
So there is a long history of linking pandemic events to often quite old and longstanding

332
00:33:41,740 --> 00:33:46,720
demands for changes to regulations which are then implemented after a pandemic.

333
00:33:46,720 --> 00:33:58,420
So we've covered 19. I wouldn't be surprised if after this we see changes in the way reporting requirements for countries are stipulated.

334
00:33:58,420 --> 00:34:04,330
We saw a big change of that already in 2005 after the 2000 freeze ourselves outbreak.

335
00:34:04,330 --> 00:34:12,820
And I think another thing we may see, and this is pure speculation on my part, historians are notoriously bad at predicting the future,

336
00:34:12,820 --> 00:34:22,240
is that we'll probably also see a formalisation of some of the emergency licencing mechanisms that we've seen for new diagnostics, vaccines.

337
00:34:22,240 --> 00:34:26,640
The information sharing of the scientific community, which has been.

338
00:34:26,640 --> 00:34:30,750
It was already very impressive in 2009 and 2003 during preceding pandemics.

339
00:34:30,750 --> 00:34:34,860
But the scale at which we see this now is so unprecedented that I think we'll probably

340
00:34:34,860 --> 00:34:39,840
soon see some kind of formalisation of that being put into place after this.

341
00:34:39,840 --> 00:34:44,980
But again, this is pure speculation. Historians are not good at predicting the future.

342
00:34:44,980 --> 00:34:55,180
Just before our conversation, I was curious to what extent class felt a society's collective memory was impacted by the experience of a pandemic.

343
00:34:55,180 --> 00:35:02,830
So, I mean, prevailing notions of disease are obviously already a result of existing cultural traditions, of thinking about health and disease.

344
00:35:02,830 --> 00:35:10,840
But experiences of explosive disease outbreaks usually end up having some kind of effect within collective memory.

345
00:35:10,840 --> 00:35:16,870
But this varies. So it's very difficult to predict what kind of aspect of memory will end up taking hold.

346
00:35:16,870 --> 00:35:24,460
Well, we can say is that, you know, there has been a massive shift in how we as a society, as a global society,

347
00:35:24,460 --> 00:35:30,130
think about disease in terms of just thinking of them as microbes following the 19th century shift of abridgements,

348
00:35:30,130 --> 00:35:32,920
which is, you know, if we actually think about it is pretty profound.

349
00:35:32,920 --> 00:35:38,920
The way we interact with surfaces where we structure food protocols, the way our mannerisms have changed.

350
00:35:38,920 --> 00:35:47,290
I'm not sure how long these things last, how long anything will last after Colvert 19 after this experience there.

351
00:35:47,290 --> 00:35:55,750
It's very difficult to predict how how a pandemic event is incorporated into a society's institutional memory.

352
00:35:55,750 --> 00:36:03,580
It's often speculated why, for example, the 1918 to 1920 Spanish flu didn't seem to have left more imprints on collective memory.

353
00:36:03,580 --> 00:36:09,550
And there's lots of competing explanations, for example, that the First World War,

354
00:36:09,550 --> 00:36:14,830
which was obviously also another very, very important global event that was going on at the same time.

355
00:36:14,830 --> 00:36:19,800
At the end of the day, probably overshadowed some forms of such a memory of it.

356
00:36:19,800 --> 00:36:25,510
So it's it's difficult. I think it's very difficult to generalise from one pandemic event to the other.

357
00:36:25,510 --> 00:36:36,430
I might speculate that perhaps facemasks would become more and more customers site in Western culture then than they were before.

358
00:36:36,430 --> 00:36:42,990
But that's that's kind of as far as I will lean out of the window.

359
00:36:42,990 --> 00:36:50,010
Next time on Future Moon is you'll meet the first of two influenza pendants that we'll be covering.

360
00:36:50,010 --> 00:36:56,740
The so-called Russian flu. This is perhaps the most controversial selection of the series.

361
00:36:56,740 --> 00:37:03,310
Many would argue that other diseases like typhoid have had a far greater impact on human history.

362
00:37:03,310 --> 00:37:12,900
Others, but this wasn't even a pandemic. More localised flu outbreak and some recent studies hint that this might not have been the flu at all.

363
00:37:12,900 --> 00:37:19,210
It's a strain of corona virus. See what you think after joining.

364
00:37:19,210 --> 00:37:32,770
For our next episode in our history of Pandemic's season. I'm Peter Milliken, and you've been listening to Future Makers.

365
00:37:32,770 --> 00:37:42,600
Future Makers was created in-house at the University of Oxford and presented by Professor Peter Milliken from Hartford College.

366
00:37:42,600 --> 00:37:51,160
A voice set to today was Ben Murrell, and the series is written and produced by Steve Pritchard and Ben Harwood.

367
00:37:51,160 --> 00:37:56,020
The score for the series was designed and created by me, Richard Watts.

368
00:37:56,020 --> 00:38:07,656
I hope you enjoyed it. Thank you. On behalf of the whole team for listening to the history of Pandemic's.