"The Blue Death" is an outstanding study of waterborne diseases.
Interestingly, the last third of the book, primarily set in Milwaukee, Wisconsin, circa 1993, is the mirror image of the first third of the book, set in mid-nineteenth century London, England. The players and the situations are different, but the question is the same: "How can we harness the tools of both epidemiology and microbiology to preserve public health during an epidemic?"
Dr. Morris's study begins with the heroic efforts of Dr. John Snow (1813–1858), a mid-nineteenth-century London physician. Dr. Snow spent his life collecting data to prove that cholera is a waterborne disease. He has been referred to as the "father of modern epidemiology," and used it to prove his point. He went to the houses of the dead and the dying; he collected water samples; he recorded details—he noted who succumbed and who escaped the blue death (so called because people turned blue from lack of oxygen). Due to vested interests, the people who studied his evidence chose not to be persuaded. It suited them to think that cholera was airborne, caused by "miasma," a foul-smelling airborne disease.
Dr. Snow gathered impressive empirical data for over 20 years. He funded his research from his own meager earnings; he circulated his findings to medical people as well as municipal authorities. But year after year, epidemic after epidemic, the evidence did not convince the regulatory authorities. Instead, vast sums of money were spent by people who believed that cholera was airborne.
After Dr. Snow's untimely death from a stroke on June 16, 1858, a German physician, Robert Koch, succeeded by uniting Snow's epidemiology with his own more modern tools of microbiology. When Koch's erstwhile rival, Louis Thuilier died of cholera in Egypt, Koch gave him a hero's burial.
After drawing a blank in Europe and Egypt, Koch was able to isolate the bacteria (Vibrio cholerae) in his laboratory in Calcutta. After more uphill battles, Koch was able to persuade scientists all over Europe that cholera was a waterborne disease. He returned to Germany a hero.
Economic and political forces were the entrenched enemies of Dr. Snow. Similarly, we see in the last third of the book, the author is up against the same forces of vested interests. In the 19th century, no one would accept that sewage from humans and animals that drained into the Thames was the main cause of cholera and typhoid. Tragic as that was, imagine the reader's surprise in learning that politics and money stand in the way of saving people's lives in our own times.
The question is still the same: How can doctors and scientists persuade the regulatory agencies to make known the evidence that they already possess. The story continues to be highly charged. It took the massive Milwaukee gastroenteritis epidemic of 1993 to force independent researchers to continue their work, despite all impediments.
The pathogens are microscopic. The protozoan Cryptosporidium has a hard shell that protects it from chlorine. Initially, if was difficult to detect by laboratory diagnosis. Finally, an inspired idea from a microbiologist saved the day—she used fluorescent dyes to make the organisms visible.
The West had relied on chlorine to kill bacteria. Dr. Morris calls chlorine a "two-edged sword." It can kill some pathogens, but it has side effects. Once a chemical is in use, it is difficult to discontinue it. Money and politics are in the way.
As in Dr. Snow's time, we learn that in our own times, water distributed to the public has sewage in it, but the new pathogens cannot be easily detected nor eliminated by chlorine.
"The Blue Death" reads like a medical thriller, and it offers a "modest proposal" for a safer water supply.
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