Book reviews

The Medical Detective – John Snow, Cholera and the Mystery of the Broad Street Pump

• By Sandra Hempel
• Published by Granta Publications
• Reviewed by Philip Walker, Communications Project Manager at MPS.

Sandra Hempel’s book is a fascinating account of how cholera spread to the UK, the fear that this caused when it first landed on Britain’s shores and the man who dedicated a huge part of his life to investigating the disease.

No-one knows how the cholera bacteria evolved, but it first appeared in its deadly form in north-east India in 1817. By September 1830, the disease had reached Moscow and British authorities knew that it posed a serious threat to the British population. During this outbreak, John Snow was working in Newcastle as a surgeon’s apprentice and he saw at first hand the devastating effects of the disease when it hit Britain in October 1831.

Moving to London to finish his training, he specialised in anaesthesia and established himself as a prominent member of the medical establishment, even attending royal births to administer chloroform to Queen Victoria.

The country’s second and most terrible cholera epidemic, which killed 52,000 people, started in 1848. At this time Snow embarked on a programme of field study to prove his theory that the disease was spread by water contaminated by sewage, rather than the popular misconception that nasty smells and vapours were the cause.

By concentrating on one area of London (Broad Street) and mapping the deaths that took place there, Snow was convinced that the water pump from where residents obtained drinking water was the source of the disease. However, Snow’s theory was dismissed. The medical establishment were not convinced about Snow’s theory and he spent the next few years continuing his research into the disease.

John Snow died of kidney failure in 1858, before his work won the acclaim it deserved. It wasn’t until a further outbreak of cholera in 1866 that confidence in his theory grew and instructions to boil water before drinking and other measures – such as the long-term development of proper sewage systems – were introduced. As a consequence, Britain was never to be at the mercy of a great cholera epidemic again. Snow is now acknowledged as a pioneering pidemiologist.

A selection of single colour integrated images, a lengthy sources section and a wide-ranging index make this a comprehensive, entertaining and enjoyable read.

Healing spaces: The science of place and well-being

• By Esther M. Sternberg, M.D.
• Published by Belknap/Harvard Publishing
• Reviewed by Dr Rachel Hooke, Medical Management Consultant.

A wonderful sense of tranquillity and calm descends when you first start reading this book. You are instantly transported by descriptions of lying in a hospital bed while gazing out of a large window into spacious countryside. This appears to be based on the author’s actual experience as a patient.

She argues that atmosphere and surroundings are more important to recovery than perhaps realised; we have all heard of evidence-based medicine, but have you heard of evidence-based design? The author argues that an optimum hospital setting can aid healing: I think we would all desire this. However, on the overcrowded island of Great Britain where I live, so unlike the United States of America where the author is based, inner-city hospitals are more the norm.

There is extensive narrative about the stress response and immune factors, including recent research. This refreshes any knowledge from medical school that the reader has subsequently forgotten. The author has an interesting way of relating the different researchers and lecturers’ physical appearances, which is entertaining, but slightly inappropriate.

I did not know the difference between a maze and a labyrinth, which can, apparently, have opposite effects on your stress levels. There is a whole chapter devoted to this. A maze consists of twists, turns and dead ends, over which you have no control if it is new to you: you may not be able to see over the walls and you can become disorientated. Hence, this causes anxiety and tension.

In contrast, “a true labyrinth has only one path in and one path out.” The one in leads to the centre and the one out leads back to the starting point. There are no decisions to be made, no blind alleys and, most importantly, you can see the path ahead. Unlike a maze, a labyrinth calms you. The terms “maze” and "labyrinth” are not interchangeable, contrary to popular belief. Nor did I know that Disney’s theme parks have been specifically aesthetically-designed. The Hampton Court Maze in England is also mentioned – which is interesting, as the author is American.

I would recommend this book if you have got time to read, but I would not necessarily make it a work priority.