John Snow: the first hired gun?

The 1854 English cholera outbreak led to reform of Victorian public health legislation, including the Nuisances Removal and Diseases Prevention Act. The reforms threatened the closure of many factories whose fumes were considered hazardous to the public's health. The second witness to appear before the Parliamentary committee considering the reforms was Dr. John Snow. Snow testified on behalf of the manufacturers threatened by the reforms. He stated that the fumes from such establishments were not hazardous. He contended that the workers in these factories did not become ill as a result of their exposures, and therefore these fumes could not be a hazard to the general public's health. Snow also presented data from the 1854 cholera outbreak as the basis for his belief that epidemic diseases were transmitted by water, not air. Although the data concerned cholera, Snow extended the inference to all epidemic diseases. When the committee's report was published, The Lancet chastised Snow in a stinging editorial. Parliament subsequently revised the bill in favor of the manufacturers and passed it into law. The implications of this particular episode in the history of epidemiology are discussed.