Daniel and Kelly’s Extraordinary Universe - To swill or to smell: How John Snow determined the cause of cholera

Episode Date: March 24, 2026

Daniel and Kelly dive into the history of medicine, and discuss the data John Snow collected to argue that cholera is transmitted through contaminated water and not foul-smelling air. These data bolstered the emerging germ theory of disease.See omnystudio.com/listener for privacy information.

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Follow the Amy and T.J. podcast, a one-stop news and pop culture shop to get you caught up and on with your day. And listen to Amy and T.J. on the IHeart Radio app, Apple Podcasts, or wherever you listen to podcasts. Howdy, Extraordinaries? Just a quick heads up that in today's episode we're going to be talking about cholera, which is a particularly unpleasant disease that still close. claims lives today. On with today's episode. Since 1817, there have been seven cholera pandemics. Many of us listening to this podcast are probably lucky enough to be blissfully unaware

that the seventh pandemic is actually not over yet and continues to claim lives in sub-Saharan Africa and Southeast Asia. The World Health Organization, or WHO, which the U.S. officially withdrew from recently to my absolute dismay, reported that in 2023 there were over half a million cases of cholera and over 4,000 deaths across 45 countries. The WHO suspects that this is an underestimate, in part because some regions are hesitant to report cholera because of how that might impact trade in their region. The WHO estimates that the numbers are probably closer to 1.3 to 4 million cases of cholera, resulting in somewhere between 21,000 and 143,000 deaths annually. We're going to look at the state of things today in the next episode, but today we're going to go to

the past, to a time when people had no idea how cholera picked its victims, so there was nothing you could do to protect yourself from death visiting you and your family. And death's visits were often short and to the point, taking away entire families in less than a week. To help put into perspective what it was like living in a time before we knew how cholera was transmitted and how to treat it, I'm going to read to you a short passage from Stephen Johnson's 2006 book, The Ghost Map. This book is also a major source that I drew from while researching today's episode, and I definitely recommend it. Okay, here's the passage. To live in such a world was to live with the shadow of death hovering over your shoulder at every moment.

To live was to not be dead yet. From our vantage point more than a century later, it's hard to tell how heavily that fear weighed upon the minds of individual Victorians. As a matter of practical reality, the threat of sudden devastation, your entire extended family wiped out in a matter of days, was far more immediate than the terror threats of today. At the height of a 19th century cholera outbreak, 1,000 Londoners would often die of the disease in a matter of weeks out of a population that was a quarter of the size of modern New York. Imagine the terror and panic if a biological attack killed 4,000 otherwise healthy New Yorkers over a 20-day period. Living amid cholera in 1854 was like living in a world where urban tragedies on that scale happened week after week, year after.

after year. A world where it was not at all out of the ordinary for an entire family to die in the space of 48 hours, children suffering alone in the arsenic lit dark, next to the corpses of their parents. Today, we're going to take a stroll through the history of medicine, and in particular we're going to chat about Dr. John Snow's amazing work, showing that cholera is transmitted through drinking contaminated water. This work played a role in finally overturning the the idea that cholera and a bunch of other diseases were something that you caught by breathing foul-smelling air. This helped usher in the germ theory of disease. Welcome to Daniel and Kelly's germ-filled universe.

I'm Daniel. I'm a particle physicist, and I know so many biologists that I've become desensitized to poop talk. Hello, I'm Kelly Wiener-Smith. I study parasites and space, and I can't even remember a time when poop talk used to bother me anymore. That's how far gone I am. I realized this recently when we were at dinner at friends' houses, and I started bringing up some poop-related stories. And Katrina was like, giving me funny looks like, that's not appropriate. And then I realized, wow, she has context sensitivity to this, and I've lost it. Oh, no. Oh, no.

Do you think that being a physicist played a role? Like lack of social skills sort of thing? Oh, wow. Ooh, make it personal. Sorry. No, I think that she's just aware that she talks about it at dinner. She talks about it at work, but she doesn't talk about it at friends' dinners or out in public. And I've just totally lost that because I hear about it all the time.

I got invited to give a talk at this like Smithsonian Magazine event. And they brought me out for like a fancy dinner and a bunch of people were eating lobster afterwards. And at the end of the dinner, I looked around the table and a bunch of people still had the lobster in front of them. And it took me a second. I was like, oh, was the lobster not delicious? and I asked, one of the people was my friend, and I was like, why didn't know one eat the lobster? And they said, why did you talk about parasites all dinner? I was like, oh, I'm so sorry.

I mean, you guys invited me here to do that. That's why I did. I'm sorry. So you were like talking about parasites while stuffing your face with shellfish? Nice. I mean, I don't eat shellfish, so I was eating something else, and it wasn't bothering me. And so, anyway, I do need to be reminded that not every. conversation is dinner conversation.

Well, today we are having a very context-sensitive conversation. Take it away, Kelly. Well, today we are talking about cholera, and since Daniel usually asks, what does that word come from? And usually I just stare at him blankly and then have to jump onto Google. Look at that. You had developed a little internal Daniel to help you in your life. That's right.

What would Daniel do? WWDDD. So cholera comes from the Greek. word for bile. Very long ago, Galen was the one who popularized this idea that we had to keep in balance the four humors in our bodies. And bile, which again, the Greek word for it sounded sort of like cholera. When you were having diarrhea or vomiting that was interpreted as your body trying to get back into balance the right amount of bile in your body. And so a long time ago, anytime you had a diarrheal disease, people would say you had cholera. And over time, cholera became the quintessential diarrheal disease. But now it's one specific one. Yes. Now it is specifically the disease caused by vibrio cholerae.

And is it like the champion diarrheal disease? Is it like the most diuretic of all diarrheal diseases? It is, yeah. Yeah. Unfortunately, it wins that race. Yeah. Yeah, that's sad. So why are we talking about cholera today?

What is it about cholera that you find extraordinary? Well, there are some stories about cholera that I was particularly interested in for another project that I'm working on. And as I dug in, I was like, oh my gosh, there's so much about cholera that I didn't know. And to be honest, I'm like kind of a huge John Snow fan girl. And this was my opportunity. John Snow from Game of Thrones. No, no. Actually, fun fact, have not watched Game of Thrones.

Nor read the books. One day, I feel like if I'm between projects and I have like a month and a half, I want to watch all of the all of the episodes, but that day may never come. All right. But no, Dr. John Snow, physician in London in 1842, that John Snow. Real person. Real person. Yep, absolutely amazing.

And I thought this was a great opportunity to talk about his amazing experiments, which helped overturn this idea that often we get sick because we're breathing in stinky air. And there were multiple, quote, great stinks, end quote. In Europe, there were two, I think, great stinks in Paris. and at least one great stink in London because we were not very good at containing our sewage for a long time there and our cities were growing exponentially and we were not keeping up.

And at the same time, diseases were rampantly spreading because we were just not doing a good job in containing our sewage. There were lots of people. Diseases were just bouncing between these people. And we thought there was this correlation between the stankiness in our cities and the fact that we were all getting sick. I see, fascinating.

Well, we've had some great stinks over here. usually after I eat too much garlic for dinner. But it doesn't usually get anybody like physically ill. But I love this story because it shows the triumph of like data science and reason and rationality and solving problems. It's like a triumph of empiricism, you know, penetrating all these vague ideas and showing you like the data will tell you the answer, right? The universe speaks to you through data.

It's wonderful. So where does this start? How long have people been suffering from? cholera. Yeah, so it's hard to know exactly. We have very ancient records of people having absolutely horrific diarrheal diseases, which could be cholera. But our best records on cholera start around 1817.

And even for the first handful of pandemics, which is essentially when this disease goes global, that's what we mean by a pandemic. We can't be 100% sure because nobody actually looked, you know, at the diarrhea under a microscope to actually identify the bacteria because this was before we knew that bacteria was the cause. But based on symptoms, we think that around 1817, this disease left India. So it was common in the Ganges region of India. And it was, it's what we call endemic, which is like an area where you find this disease over and over again, you know, seasonally, for example. And around 1817, it started spreading. And why it started spreading, we think, is because, you know, the world was

becoming a lot more connected. There were pilgrimages happening. There were, importantly, the East India Company was doing a lot of trade in the region. The British Navy was in there, and they were, you know, bringing their boats, and then they were traveling all over the world. And what sources you read will impact who is getting blamed for bringing cholera. But at the end of the day, it is our connectedness that is spreading cholera. And there have been seven major pandemics where cholera started in India and started spreading way far out there. The seventh pandemic is actually still happening today. Oh. I know, right? We're in the middle of a cholera pandemic right now? Yes. Yeah. Sub-Saharan Africa and some parts of Asia still have a lot of cholera issues going on right now.

The World Health Organization is, you know, working on trying to tackle these problems. But yeah, we still have a cholera pandemic going on right now. And in each case, is it leaving India or are there now other pockets that can spark pandemics. It can start in other places, like the seventh pandemic appears to have started in Indonesia. But now it is, you know, pretty common in some parts of Africa and it's just kind of sticking around. Fascinating. Wow.

So probably people have been suffering from cholera in India for thousands and thousands of years. And now in our new modern interconnected world, you can get cholera anywhere. Yeah. Yeah. At least hundreds, maybe even thousands of years. It's been a problem in India. Yeah. And that's right.

So this has become a common. an experience around the world. So let's share with our listeners. What does it like to have cholera, Kelly? Oh, my God. Walk us through the experience. It sounds absolutely horrible. A paper that I was reading today says the cardinal manifestation of the disease is the voluminous outpouring of fluid.

Oh. And so, yeah, essentially the deal here is you accidentally consume the bacteria in, usually in water. Sometimes it can be because, like, the fruits or vegetables that you're eating didn't, like, they They got maybe fertilized with water that had the color of bacteria. They didn't get rinsed off. And then you eat it and you happen to eat a bunch of the bacteria. And then maybe you'll start hearing Borberigmi. Have you heard this word before, Daniel?

I've never heard of Borberugny. I hadn't either. Apparently this is... It sounds like a Polish delicacy to me. Apparently it's the gurgling sound that your tummy makes. Oh, no, just before. It's like the warning noise just before you explode. No, it's just like generally the gurgling noise that your tummy makes.

But when you have cholera, you tend to get a lot of those noises before the massive diarrhea onsets. And like, just think for a second. So like if you lived in, for example, London in the 1850s when like food sanitation standards were like non-existent, you probably got Borberigme all the time. You know, and like, so can you imagine every time your stomach or your child's stomach Like when I'm making a great face right now for everybody, wondering. Can you imagine wondering, like, is this, am I about to get cholera?

Like, is this the end? Like, that must have been petrifying. Do you think people in 1815 London were saying the word borberigby to each other? I doubt it. You know, like, you know, person one is like, and person two is like, are you having the borerigmy? I know, I know. I can't imagine that.

It doesn't seem like an English word. Cheerio, Chep, you got a touch of the bull berigby. No, I don't know. All right, so stage one, or berigmi gone wild. Yeah, okay. All right. So stage two is just massive diarrhea that can hit with essentially, like, no warning. I was reading an 1893 description written by a physician who worked in the United States,

and he worked two different cholera outbreaks, so he had quite a bit of experience. And his description was, it often happens that without warning, a large water stool is evacuated, and the diarrhea sets in with sudden violence. Violence is not a word you ever want to associate with stool. No, no, absolutely not. He says that there's no pain or anything like that, but it's fluid evacuation pours out noisily. And there's rather a relief there, isn't there? Yes, right, from distension.

I guess your tummy was, you know, feeling like it really needed to let go of something. And another characteristic is what they call rice water stools. It's got these little white things in it, and it turns out those white things are the lining of your intestine, which is being shed off in this massive quantity of stools. And it comes on so suddenly that you often, you don't have a chance to get to the restroom, wherever you are when it happens, that's where you are.

And so clothing and bedding are stained, and, you know, it's a very unpleasant thing. What did you skip over the juiciest detail? What? This is a look into Daniel's psychology. Well, I thought that maybe the quote was too long, so I jumped. What was the juiciest detail that I skipped, Daniel? Well, this doctor describes it as thin, light and color, yeasty in appearance, and with a mouse-like odor.

Oh, okay. Yeah, mouse-like odor is no good. I don't like the smell of mice. I don't know what that means. Like, wow, your diarrhea smells like mice. That's fascinating. Oh, see, I used to work with a lot of snakes, and so I know exactly what a mouse-like odor is. Do you, is it hard for you to imagine a mouse-like odor?

We had rats, and so I know a little bit about what rats smell like. Is it related? Ah. Is there a rodenty aroma? Yeah, I think mice have a slightly different smell. So there are no perfumes inspired by, like, the rodenty aroma? No, no. Not a business idea?

No, I don't think so. I'm not going into business with you. All right. So basically, you have mass. watery diarrhea, right? This isn't even stool. This is just like your body's just dumping water. That's fascinating, right? Like what's happening inside you chemically to make your body just like eject all of its fluids. Yeah, I'm going to make you wait because next week we're going to talk about the science behind what the bacteria is doing to make this happen.

The delicious chemistry of cholera. Yeah, that's right. But like very quickly you go from having, you know, like stools the color you would expect to, as you said, just it essentially being like clear or white. with these white splatches of bits of your intestine, like your epithelium, which is like, you know, the skin lining your intestine that have just sloughed off. And at the same time, you also are vomiting. There's just so much fluid that it's, you know,

starts coming out of both ends. And the main problem that you end up having here is that your blood starts to get very thick because there's not enough water in it. And it gets difficult for your heart to pump it to all the places it needs to go. So you stop getting oxygen to all the places that you need to get the oxygen to.

So organs start shutting down. You start like your skin starts sort of sinking in. Your pulse starts to slow. Your heart needs to work a lot harder. And essentially in a lot of cases you go into a coma as your organs shut down and you die. And death can happen in some cases like in a day. Like literally, you know, at midday you can start having this like absolutely massive diarrhea. Adults can lose something like 20 liters.

20 liters. 20 liters. That's an enormous amount. Wow. And that is why you die in a day. And, you know, they can be dead by the end of the day. And, you know, families can get this. And, you know, you read stories about, like, the parents dying and, you know, like, just they're hoping that they can outlive their kids by a few hours.

And they don't. And it's just absolutely tragic the way this disease very quickly, you know, destroys families essentially just by dehydrating everybody very rapidly. There was this quote in the book that I was looking at that, like, you know, so he's describing just. just how horrible it is to have this disease. Mm-hmm. And then there's this moment of levity where he says, he describes what some of his patients were doing in this state of, like, near death. He's describing, like, the end stages.

Oh, man. So here's a quote. He says, although lying thus in the lowest state compatible with existence, sometimes his muscular strength is preserved to a marvelous degree. Without pulse at the wrist, patients have been known to get up unexpectedly and want under about, and some in bed alongside each other have been heard to make bets regarding the distance to which they could eject the vomit and onto the dexterity with which they could deposit it in a given receptacle.

I love the idea that our species is like, all right, this is it. This is the end for me. But in my last shot of vomit, I'm putting a 20 on that bucket. Yeah, I'm getting it in that pot over there. And, like, you know, I love the idea that, like, I'm going out with a laugh. People can find joy even in suffering. Yes, right. So, anyway, go our species.

Well, it's amazing to me that people die so quickly because for a disease to spread, people have to, like, live long enough to spread it. So it's fascinating to me that it kills you so rapidly, right? So let's take a break. But when we come back, we're going to hear more about cholera, specifically how it gets around. You know Roll Doll, the writer who thought up Willie Wonka, Matilda, and the BFG. But did you know he was also a spy?

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And next we're going to hear about how cholera goes from person to. person. How does it all work? When we understood cholera, was that pre-germ theory or post-germ theory? So this was pre-wide acceptance of the germ theory. And so at the time, we mostly thought that diseases were caught by, you know, like as we talked about a little bit earlier, by stinky air. But we had some sense that there could be contagious diseases. So for a long time, we knew that this disease called leprosy was something that could pass from person to person. So the idea of contagious stuff was something that we could handle. Also, Van Luhenhook, whose name I will never say correctly. Let's have some Dutch listeners send in a correct

pronunciation for comparison. Okay, great. And we'll send them to our audio engineer. And every time I have to say it in the future, he can just pick one of those and cover up my voice in the future. Okay. So in 1673, so like 200 years earlier, he had looked under the microscope and noted that there's a tiny microscopic world that, you know, none of us had seen before. Amazing. But this connection between that tiny microscopic world could make us sick and kill us had not been made by a lot of people. There were some people out there who were maybe starting to think about it. But this idea that stinky air could make people sick was just really hard to shake and was much, much, much, much, much, much more popular. That's really fascinating.

Do you think that revealing that microscopic world also connected with, like, existing ideas about reductionism, you know, that like our world at this scale is controlled by the behavior at a smaller scale? It's sort of in the same century as like atomic theory, which, you know, leads to reductionism in particle physics. But do you think that sort of thinking was widespread that we're like looking at the internal mechanisms of the world by seeing the microscopic view? No, I don't think that that had really taken hold with the biology folks yet, unfortunately. Like, you know, because the miasma theory was still so big, and it wouldn't be until, like, I think 1890 is when Cook's Post-Gillots came out. And Lister's antiseptic technique doesn't come out until, like, I have something like a decade after John Snow does this experiments we're about to talk about. I think it took a while for those connections to be made. It seems so obvious to us now, but I think that's an example of how much modern philosophical

assumptions we're carrying with us all the time. And so when we look back at what people were doing 200 years ago, like the connections and the conclusions seem obvious to us in hindsight. But at the time, like, that's a big ingredient in understanding how the world works. So anyway, it's fascinating. So that means that in early days of cholera, we didn't really understand the, germ-based mechanism for how this disease spread. I do think it's tempting to paint broad strokes, though, for an era and, you know, assume that

everybody sort of had the same ideas. And there were some people in the era who were, you know, sort of thinking along the lines that John Snow would be thinking. So, for example, I'm going to jump ahead a little bit. In the same year, John Snow does his experiments, there's an Italian guy named Felipe Pacini, my apologies to every Italian out there, because I probably... That sounded correct. Oh, yeah.

Nice. Okay. All right. At the University of Florence in 1854, he publishes a paper microscopal. And that's where I blow it. Oh, no. I'm not going to go back. I'm moving forward.

Observations and pathological deductions on cholera. He actually identifies the cholera bacteria and publishes on it. But the rest of the community was not ready to move past the miasma theory. And so for 30 years, his paper is essentially just totally. ignored. So like there are people out there were other people out there. Like this idea was in the air that like germs could be causing diseases. But like as a whole, the community was just not really ready to embrace this idea. But you know, John Snow's paper is part of what helps turn the tide. Yeah, that's a really important point that there's a huge diversity of thinking

and ideas, right? And sometimes you can go back and trace the origins of a modern idea on the fringes of academia or, you know, mainstream thought 200 years ago. Really cool. All right. So tell us about John Doe and what he was doing. John Snow. Tell us about John Snow what he was doing when he wasn't killing the White Walkers. Whatever that means. All right. So John Snow was at the time of the outbreak we're going to be talking about, John Snow was a 42-year-old physician. He was a vegetarian and a teetotaler. So like some would say maybe not a ton of fun, but he seems like a cool guy to me. He had made his name by doing a bunch of experiments on ether and chloroform. So we did that episode on anesthesia

and how anesthesia sort of came along in the 1830s, 1840s. So when it came out, there was this massive problem with like, sometimes it worked, sometimes it didn't. And John Snow realized that that probably had a lot to do with like temperature and how it was being delivered. So he did a bunch of very careful experiments and created these like charts where like when the temperature is this, you should give them this much. And he created a device to try to standardize

how much ether and chloroform people got so that they could always be anesthetized the right amount. And he actually became so famous for being great at anesthetizing people that he was able to give chloroform to the queen when she was giving birth to one of her kids.

And so he became sort of famous for this. And despite being a teetotaler, he did a bunch of experience on himself with chloroform in ether. So he wasn't drinking alcohol, but he was playing around with the chloroform quite a bit. And we think that this actually might have led to his somewhat early demise, unfortunately. But this is how he made a name for himself. Well, I've watched this show Victoria, which is about the life and times of Queen Victoria.

And John Snow makes an appearance in that series quite prominently about the cholera outbreak. but they also portray him in a very interesting manner. He's, like, awkward. I think he has a stutter. He's really not a very charismatic personality as portrayed by the BBC. I don't know if that's accurate. I don't get the sense that he's a super charismatic person, to be honest. But, you know, not all of us are super charismatic.

Doesn't mean we're not making good contributions, Daniel. I'm just saying you sort of described him in a way that might make people think he was like, you know, swash buckling or extravagant in some way. But, no, I think he really was a data nerd, wasn't he? He was a massive nerd, yeah. Which is awesome. I mean that in the best possible way, right? It's my highest compliment. Yep, no, totally. Yeah, no, I don't think he was cool. I think this guy was a straight up nerd. But he's a straight up nerd that changed the world. So all hail the nerds. Yes, nerds can change the world. Thank you to all the nerds out there. Amen. All right. So he makes this observation in 1848. So,

cholera had spread through Europe, but then for a couple years it had sort of like disappeared from Europe. And then all of a sudden it shows up in Hamburg. And then this boat leaves Hamburg and shows up in London. And then suddenly cholera shows up in this hotel in one room that has a sailor that was on that ship from Hamburg. I got to ask, is Hamburg the German pronunciation or the Kelly pronunciation? Because most Americans say, Hamburg. I don't know. I can't be like Hamburg, like hamburger, could it? Is it? That just seems too American. I don't know. I mean, that's what Americans usually say when they're talking to each other, but I wasn't sure if you were being all, you know, like correct German pronunciation.

I think I'm overcompensating because I was in the Middle East recently and I kept saying Iran and everyone would be like, I ran, Americans. And I was like, oh, I guess you guys don't say I ran over here. But so you think it's Hamburg? I mean, I think Americans say Hamburg. I don't know what Germans say to each other. All right. Well, that German city, there was a German city that cholera popped up in and a boat left with sailors from that German city.

Showed up in London. One of those sailors had rented a room, got cholera, died in that room. Before he could invent a hamburger. That's right. I know. What a tragedy. Thank goodness somebody else did. Because what would Americans be without their hamburgers?

And then sometime later, somebody else ends up in that room and they get cholera and they die. And that's despite the fact that there hadn't been cholera in London for a really long time. Right. Okay. And so John Snow thinks to himself, this is not good for the miasma theory, right? Because why would cholera jump from that German city that I'm not going to say again ever? and then all of a sudden end up in London, in this one room where the German sailor was. Like, he didn't bring the bad air with him, right?

Doesn't it seem much more likely that there was some other way that the German brought the disease with him to London and then left it behind and gave it to somebody else? And he's like, I don't necessarily know how he gave it to somebody else. And there was a doctor that visited both men and he didn't get it. And so that's a little concerning. I'm not really sure what happened there. But also the doctor should have gotten it

if it was bad air that happened to be in that hotel room. And so he's like, all right, I feel like the miasma theory isn't really explaining things. We need something else. So the thing I don't understand about the miasma theory is if it's just in the air and it's not like moving around, it's like connected to the place,

how in that theory does cholera ever spread from India? or whatever to Europe, right? Like, doesn't that theory fundamentally conflict with their observations? Oh, man. Okay, this could be a really long answer. I'll try to keep it short. So, all right, so it depends on the time and the place.

So, like, way back, like, when Hippocrates or, like, you know, the many people who go by the name Hippocrates were, like, writing about disease, they would say something to the effect of, like, if you want to understand disease, you need to understand which way the winds are blowing and how that changes seasonally, because the winds were blowing diseases in.

from different places. And so understanding how the winds were blowing would impact what diseases people would get depending on what season. And so this idea sort of morphed over time and depending on where you were and when, the exact specifics would change. But I found a report from 1850,

which was written by the health professionals living in London reporting on the epidemics in 1848 and 1849. So this is when John Snow was like starting to collect his data. and 1854 is when he really like collected the data, you know, the Broad Street pump data. And so this is like the time and place that's sort of relevant to your question. And they were saying that what mattered was that like the winds blowing out of India were like hot and moist.

And so that's what was blowing the cholera and that it happened to be a time when, you know, first the winds that were blowing into Russia were hot and moist. And then they were blowing into these other regions. And so essentially they were saying hot, moist air was taking cholera on this journey. But, and this is kind of amazing, after doing this, like, long explanation of how the winds had brought cholera, you know, around the world, then they say, but also, you know, Scotland had cholera in January, and it was really cold. Moving on. Outlier. And then they don't deal with it. And then they say, they start talking about how, like, it's complicated, right?

So first you have to have the wind blowing cholera in. but then it needs to meet a population that has been impacted by something. And so like foul air could be the thing. So they talk about, for example, if people live in an area where there's lots of people for a few square feet. So for example, if you have like 20 people in a small room, they're going to start breathing out bad air, like decaying matter, as they put it. And that is going to start to poison the air. And the poison air that you're breathing in is going to make you more sense. susceptible when cholera comes through. And it was really interesting. There's like this motivated

reasoning that they find. So for example, there was a girls school where the girls got sick and a boy school where the boys didn't. And they claimed that that's because the boys kept breaking the windows in their school. And they were getting better ventilation than the girls. And that's why they didn't get it because they weren't breathing in as much poison vapors as the girls were. So this is fascinating because I'm trying to understand the difference essentially. in the two theories. John Snow is thinking it's basically transmitted from person to person by something created by the person and then transmitted through the water. And the contrasting theory is it's not really person to person. It's just like comes through the air. But now there's this other

part of it where people can make it more likely that you get it from the air if you're also breathing out poison vapor. So in the miasma theory, it's not that they're breathing out cholera and passing it to each other in their breath. it's that they are making it more likely that the other girls are going to get it by being cooped up with their poisonous vapors. Right. That's so complicated.

It's very complicated. I mean, you could also get those poisonous vapors by living above a cesspit or by living too close to a graveyard at a time when the graveyard is stinky. Like the graveyard has to be stinky. It can't be like a graveyard from 300 years ago where everybody has like long since skeletonized.

It needs to be a stinky graveyard. Or a graveyard that smells one. Wonderful. Yeah, right. Or a graveyard with lots of flowers or something. But, but, you know, it's interesting because then they'll say like, but, you know, there was this other recent cholera pandemic where it seemed to only hit healthy middle class people who weren't living in bad conditions.

Moving on. Yeah. And like, I guess this is like the epicycles of cholera, right? It's like you have this idea, you want to make a fit to the data, you keep adding bits and pieces to it and whirling gigs until eventually you just look, this isn't working. and we have to tear it down and start from something else. Yeah, but so this report was written by Edwin Chadwick, who was like the guy in charge of like public health decisions in London at the time.

And he for a long time, even after John Snow like came out with his big theory, would continue to push the miasma theory. There was even a section where the report noted that there were people who were sharing the same air and they differed in the water that they were drinking. And one group was drinking water that, you know, appeared to have given them cholera because that group got cholera. and another group drinking a different, drinking water from a different source didn't get cholera. And it was as though he was trying to support John Snow's theory.

And then he just moved on without, like, you know, digging into it anymore. And so there's all of these inconsistencies in the report. But at the end of the day, the guy who writes the report continues to be a miasma person, making massive and important public health decisions in support of trying to get stinks out of the area, Even if those decisions result in more sewage in the Thames, which is what is actually contributing to cholera. Wow. And so anyway, the miasma theory is sort of inconsistent, has to do with the wind and the stinks, and maybe some other stuff that we can't explain. And so, yeah, the answer is it's not a very, like, internally consistent theory.

Yeah, and it's tempting to judge these folks and be like, how could you believe this when the data was saying the opposite? But it's so easy to do that in hindsight when we know the truth and it's clear. And, you know, they're at the forefront of human knowledge. They don't understand. They're doing their best to make sense of the data and nobody's perfect. So it's easy to criticize, but who knows what we would say in their shoes. Yeah, I mean, absolutely. And this was an era, you know, before the germ theory really was established.

And, you know, you get a school where the windows were broken and the kids were fine and another where they weren't. Like, I can totally get thinking like, okay, maybe ventilation did matter. And I don't know. I don't judge them too harshly. But it is a bummer that they didn't listen to John Snow because people don't. died. So then basically, Johnson's big idea is that somehow the disease is moving with a person, right, that it's coming with him. He's carrying something with him, and it can then go from person to person. And his hypothesis is maybe it's water-based. Yes. Cool. And he had also had a little bit of prior experience with cholera because he, in the prior pandemic, he had been training as a physician and he had worked with some coal miners. And they weren't experiencing the right kind of bad air that was popular as an idea. for transmitting cholera at the time.

And they happened to be working in an area where their food and their water was mixing with human waste while they were down in the coal mines. And that was getting his mind on this idea of like contamination as a way of transmitting cholera. And so at this point,

he starts to get water on the brain. And so to follow up on this idea, he collects two sets of data in 1849 to start getting this waterborne idea of rolling. I think this is a really important moment here, actually because he doesn't have enough evidence to conclude that it's water-based or it's a contaminant. He just kind of got a hunch, right? And it turns out he's right. And he does the experiments, which prove it. But your hunch doesn't have to be, but your hunch doesn't always have

to be, like, based in evidence, right? Science is about taking these leaps and asking questions and then backing it up with data, right? But there are important moments of just, like, kind of guesswork. Yeah. And this first moment was just him thinking, well, wait a minute. The prominent idea of the time right now just doesn't make sense with this observation. So what else might make sense? Very cool. And so like these first two mini experiments that he does, we're not even talking about the big Broad Street pump experiment yet. These are just like little places where he dips his toe in to be like, could something else make sense? And so the first thing he did was he went to essentially like a slum in London in 1849 and he finds this row of cottages that are all connected and they

all share a well. And there's like a crack that allows essentially sewage to seep into the well when it gets too rainy. And everybody in those cottages had died of cholera. And then right nearby he finds like the exact same setup of cottages. But their well is more sound. And when rain comes, they don't get sewage in their well. And only one person in that row of cottages got cholera.

And so he's like, well, it looks like you get sewage in the well. and then you drink from the well, you get cholera. And so he's... Solid theory. Poopi water kills you. Poopi water death. And so he's... So he collects those data.

And then the next set of data that he collects looks at the Thames. So the Thames is the big river that flows through London. Correctly pronounced by Kelly, by the way. I've been to London. Ding, ding, ding, ding. Ding, ding. I'm sure if I hadn't, I would have said Thames or something.

But... If you had, we would make you famous for it. Oh, thanks. Yeah, no, I definitely saw it on a map and then heard someone say it and had a, like, had a moment where I was like, I'm going to be quiet until I convinced myself that these are the same things. And anyway, okay, so, so based on where the sewage was being emptied into the Thames, and the Thames ended up being the source of the great stink years later because so much sewage was emptied into it that it, like, killed the fisheries and stuff like that. So anyway, based on where the sewage was being emptied into the Thames, John Snow hypothesized that casualties from cholera should be much higher in the south part of the Thames for people that are getting the water from the south part of the Thames than if you're getting it from the north.

And what he found was that if you are getting your water from the south part of the Thames, eight out of a thousand people are dying there. And if you get it from the north or the west, one out of a thousand people are dying. The idea being that the north has less poop in it because it's like upstream, Yep, exactly. But if you live on the east end of London, the east end is an area that was like super destitute and super stinky, right? So if you believe in the miasma theory, that's where most people should be dying. But they like should maybe have an intermediate amount of sewage in their water.

And they only had four out of a thousand people dying from cholera. And so he's arguing that like this is actually pretty good data suggesting that, It's that cholera is coming from the water and not coming from the air. Because the death rate follows the river. The more downstream you are, the more likely you want to die. Exactly, right. So it follows the sewage gradient. So he publishes these results.

The reviews are pretty positive, but they're also pretty skeptical. And so there are people who are saying, like, look, you found a correlation, but you haven't actually found a cause. Good point. Solid critique. That's true. And so the London Medical Gazette in particular says, you know what we'd really? really love to see. We would love to see you find a case where somebody takes water that's contaminated and goes way far away and then drinks it and then get sick, like way far away from what could

have been the source of contaminated air and then get sick and dies. And we'd also like to see some people who are in an area where there could be bad air, but they didn't drink the water and they don't die. That kind of stuff might convince us that it's not my asthma that happens to be in the same area that's actually causing the problem. I agree these are all incisive experiments, but they feel so unethical to me because we're talking about people dying. Right, but he's not doing these experiments. They're like, if you could get observational data that meet these criteria.

And so John Snow is like, oh, my gosh, where am I going to get these observational data, right? This is going to be really hard. And so, and this is amazing. This is like two geeks in the night meeting together and magic happening. So he goes to the London Registrar General. This is like the guy who keeps track of the birth and death stats. And this guy is a stats nerd.

Another nerd, awesome. Another nerd. And his job was just to keep track of like when people are born and when people die. But he was like, you know what? These data could be so much more useful if I knew more stuff. And so he started encouraging doctors to not just tell him when someone died, but why they died, how old they are. What was their occupation? Where did they live?

And after talking to John Snow, he starts also collecting information. on where they were getting their water, which was amazingly useful because Londoners were getting their water from like a handful of different companies that had pipes that were like crisscrossing their way under London. And so, you know, you could live in a house and get your water from one company

and next door could get their water from a totally different company. And these companies had very different standards for how they treated their water, where the water came from. But there were two main companies that were servicing an area that was kind of near near where snow lived.

One of the companies had upgraded where they were sucking the water from so that it was less likely to be sucking in sewage, and the other one hadn't done that yet. And these companies also differed in how saline the water was, and so you could tell the difference

between the water by doing a water test, and one of them was a little saltier than the other. And so it was possible to know who was getting what kind of water either by asking, who do you pay your water bill to, or by taking a water sample and checking to see how much salt was in it. And with this setup, John Snow, five years later, when a massive outbreak came a couple blocks away from his home,

he was prepared to collect the data that would show that cholera was a waterborne disease. And when we come back from break, we'll hear all about how nerds saved the world. Nerds! You know Roll Doll, the writer who thought up Willie Wonka, Matilda, and the BFG. But did you know he was also a spy? Was this before he wrote his stories? It must have been. Our new podcast series, The Secret World of Roll Doll, is a wild journey through the hidden chapters of his extraordinary, controversial life.

His job was literally to seduce the wives of powerful Americans. What? And he was really good at it. You probably won't believe it either. Okay. I don't think that's. That's true. I'm telling you.

I was a spy. Did you know Dahl got cozy with the Roosevelt's? Played poker with Harry Truman and had a long affair with a congresswoman. And then he took his talents to Hollywood, where he worked alongside Walt Disney and Alfred Hitchcock before writing a hit James Bond film. How did this secret agent wind up as the most successful

children's author ever? And what darkness from his covert past seeped into the stories we read as kids. The true story is stranger than anything he ever wrote. Listen to the Secret. world of Roll Doll on the IHeartRadio app, Apple Podcasts, or wherever you get your podcasts. I'm Bailey Taylor, and this is It Girl. You may know me from my It Girl series I've done on the streets of New York over the years. Well, I've got good news. I am bringing those interviews and

many more to this podcast. Yes, we will talk about the style and the success, but we are also talking about the pressure, the expectations, and the real work with the women's shaping culture right now. As a woman in the industry, you're always underestimated. So you have to work extra hard and you have to push the narrative in a way that doesn't compromise who you are in your integrity. You know, I like to say I was kind of like a silent ninja. Each week I have unfiltered conversations with female founders, creatives, and leaders to talk about ambition, visibility, and what it really takes to build something meaningful in the public eye. Because being a it girl isn't about the spotlight, it's about owning it. I think the negatives need to be discussed and they

need to be told to people who maybe don't do this every day just so they know what's really going on. I feel like pulling the curtain back is important. Listen to It Girl with Bailey Taylor on the IHeart Radio app, Apple Podcasts, or wherever you get your podcasts. Marsh Madness is here, and if you're trying to keep up with everything happening on and off the court, we've got you covered on the podcast, flagrant and funny. You look at the top four number one seeds.

What do you think UCLA is going to do? Break down that for me, my friend. I do think UCLA has a really good chance of getting back to the final four. Obviously, Yukon is the overwhelming favorite in this tournament. But I'll be honest, I think people are kind of sleeping on Texas. Experts are suggesting that UCLA is the number one challenger to Yukon and that right after that would be Texas. SEC is so deep and so thick and just about everything.

It really is annoying. So it's UCLA, Texas, South Carolina, LSU, only ones that could possibly upset Yukon. On Flagrant and Funny, we're giving our unfiltered takes on the biggest moments the conversations everyone's having. So whether your bracket is busted or you just, want the latest on the tournament. We got you. Listen to Flakran and Funny with Carrie Champion and Jamel Hill on the IHart Radio app, Apple Podcasts, or wherever you get your podcast.

Presented by Capital One, founding partner of IHart Women's Sports. I became a millionaire overnight, but lost everything that actually mattered. Wait a minute, Sophia. Did you just say he lost everything? That's right. It's inheriting too much drama week on the OK Storytime podcast, so we'll find out soon. This person writes, I just inherited a fortune after losing my mom, and now my girlfriend's entire family. is coming out of nowhere with their hands out. One sibling wants me to fund their whole lifestyle. Another vanished for four years and suddenly reappeared.

And my girlfriend is already giving my money away. Hold on, Sophia. So the girl he wants to marry is already sending money out the door. And that's just the beginning. He makes a plan, sets up a trust, and finally thinks he has everything under control. Okay, so things work out then? Let's just say the people he trusted the most

are the ones who ended up shocking him the most. So does the money end up being worth going through all that? To find out, listen to the OK Storytime podcast on the Iheart radio app, Apple Podcasts, or wherever you get your podcasts. In 2023, former bachelor star Clayton Eckerd found himself at the center of a paternity scandal. The family court hearings that followed revealed glaring inconsistencies in her story. This began a years-long court battle to prove the truth. You doctored this particular test twice in someone's, correct? I doctored the test ones. It took an army of internet detectives to crack the

case. I wanted people to be able to see what their tax dollars were being used for. Sunlight's the greatest disinfected. They would uncover a disturbing pattern. Two more men who'd been through the same thing. Greg Gillespie and Michael Marantini. My mind was blown. I'm Stephanie Young. This is Love Trap. Laura, Scottsdale Police. As the season continues, Laura Owens finally faces consequences. Ladies and gentlemen, breaking news at Americopa County as Laura Owens has been indicted. on fraud charges. This isn't over until justice is served in Arizona.

Listen to Love Trapped Podcast on the Iheart Radio app, Apple Podcasts, or wherever you get your podcasts. All right, we're back and we're hearing the story of cholera, how it kills you, how it spreads, and how nerds figured it all out. So is John Snow at this moment when he has his idea and he's waiting for his data, is he still like a real outlier in the community? Nobody's really taking it seriously. Because it feels like if this is a possibility even, then somebody should like do something about it, you know, work hard on reducing the poopy water that people are drinking because it's, we're talking about lots of lives. Yeah, he's still kind of an outlier. Like the main people who are in charge of like the public health are much more concerned about the stinkiness. So at the moment, the way waste is sort of managed in London is a lot of people have what are called cess pits underneath their houses.

And so you, you know, poop in a bowl. and then you dump it in a pit underneath your house. And when that pit fills up, you pay somebody to come, scoop it out, and haul it away, which is part of why everything stinks a lot. And so to try to get rid of that stink, people are starting to create a sewage system that pipes it all into the Thames. And that if you believe that stink causes cholera, dumping the waste into the Thames sounds like a good idea. But if waterborne contamination causes cholera, you are killing people by pumping waste into the Thames.

Yeah. And so at the moment, they are changing the system and essentially dumping the waste into the Thames instead of using this cesspit system. So yes, snow is pushing against the tide at the moment. Fascinating. All right. All right. So it turns out that this giant outbreak happens at Broad Street Pump.

So Broad Street pump is this very popular source of water. It's well known because it's a very hot summer in 1854, and this pump produces cool water that is supposed to taste way better than the nearby pump. People really like it. So a lot of people come to this pump. An outbreak starts at this pump, and John Snow runs to his friend, the statistician. And he says, all right, you've got data on the people who are dying. Can I have that data? And his friend shares the data.

And John Snow looks at the data and he says, all right, these people are like, they're near the Broad Street pump and he starts knocking on their doors. He's like, where are you getting your water? Where are you getting your water? Where are you getting your water? And he realizes that the Broad Street pump seems to be the source of the death, the source of the cholera. And so he starts, like, following up on all of the deaths whenever he can, but sometimes he's too late. And everyone in the family has passed away, and he can't get the data that he needs.

But by following up, he starts to find some sort of interesting situations that are interesting and that they help fulfill the criteria that folks had set forth for him previously, which is to say, we want you to give us example. where water was taken from the pump, far away from the area where there might be stinky air, and then consumed and then kill people. And so there were these brothers called the Eli brothers. They had a factory in town.

The factory made percussion caps. These are caps that make it so that when you shoot a gun, if you shoot it even in the rain, it's going to go off anyway. So it essentially protects the gun under wet conditions, which is important because the Crimean War was happening. They had brought Broad Street water pump to give to their factory workers, because again, this is supposed to be like, the best water around.

And a bunch of their factory workers started dying. They also brought it to their mother who lived in a town farther out. And the mother then shared it with their niece. And both their mother and their niece died. Oh, my gosh. They're basically poisoning everybody they know. All these people that they love and care for. Right.

And so that ended up being pretty good data for them, unfortunately. And why again is this water so famous and popular? that they're carrying it across town to share with people? So the other water in a nearby pump came from a different source, and it was notoriously kind of like stinky and gross, and maybe a little bit warmer. But this Broad Street water must have had poop in it, right? That's why it's killing people.

But it's also famously delicious. This is the thing I'm struggling to reconcile. Well, so, you know, probably at this time, Daniel, everything was gross. And this was just had a good reputation for being less gross. I see. And also, I think it came from a little bit deeper, so it was cooler during a particularly hot summer. And also, if it was the one that's like right in front of your house, you probably just, you know, go for it.

No offense to all of our listeners in London. I was just curious, what flavor of poopy water Londoners per sure. Yeah, well, I hope that things have gotten better, you know. All right. So he figures out that there's a cluster connected to this one pump. And then he finds this example of people carrying that water from that pump two places far away and those people also dying. Yes. And then he finds some exception.

to the rule. So he finds a workhouse that is very close to the pump. And so he would have expected a bunch of the people working at the workhouse to be dying of cholera. But pretty much no one is dying of cholera there. So he goes to the workhouse and he's like, what's going on here? And they're like, oh, actually, we have our own private supply of water and we have our own well. So we don't go to Broad Street pump. They're in the same area, breathing in the same bad air, but they're drinking different water, so they're fine. So the cholera is following the water and not the air. Exactly. Yes. And then something similar is happening at a local brewery. Turns out the Broad Street brewery guys are mostly just drinking malt liquor and not drinking Broad Street pump water.

So they're okay. So he's got this list of 83 people who had died. 73 of them are really close to the pump. And so he's thinking like, okay, probably these are people who drank from the pump because it's the closest pump. Why wouldn't they have drank from it? 61 of them, he's able to confirm that they definitely drink from Broad Street. pump. So they almost certainly died from that. Six of them say they're definitely not Broad Street Pump drinkers. So maybe they, you know, got it from somewhere else. Six were mysteries. He just

couldn't track down, you know, any living members or anything like that. And then he had 10 cases that were far enough away from the Broad Street pump that he's like, well, like, you maybe went to a different, there was probably another pump that was a little bit closer. But he still ended up thinking that those people had probably drank from the Broad Street pump because, for example, It looked like they frequented a coffee house that used the Broad Street pump water to make a special thing that they called Sherbert, where they had mixed Broad Street Pump water with some other stuff, and then their customers had started dying. You say a special thing like Sherbert as if nobody's heard of Sherbert? They called it Sherbert. It wasn't like Sherbert like we would call it today. They were mixing like effervescent. I don't remember exactly what it was. Maybe I even shouldn't have used the word sherbet. They called it Sherbert, but it wasn't. The description wasn't any Sherbert. that I recognize.

I see. All right. So he's essentially pulled together this list of people who have definitely died of cholera. A very high percent of them had drank from the pump. He's got an extra list of people

who have, like, drank cholera far away from the area where it could have been explained by just bad air, and they also died from the water. You've got people who are close by the pump were breathing in the air, but they didn't die.

So he's pulling all these data together. But there's still some people who are, missing, that he can't really figure out, like, they left town, he wants to know if they died or not, and he's really trying to track down, like, the first case that started everything. But he just doesn't have the, like, knowledge of the town that he needs to do this. But he starts talking to this reverend, Reverend Whitehead. And this Reverend knows this community intimately.

This is his flock. He's been actually, like, in the houses with a bunch of these people as they've been passing away. He's been, you know, holding their hands. He knows everybody. really well. So he's able to track down a bunch of the cases that are missing and confusing because he knows everybody. He's like, oh, you know, yes, that person left and they went to this town and I know their grandma, so I'll try to figure out where they went. And by going through old records, he's able to figure out the first case that brought cholera in to town. And it

turned out there was a baby that got cholera and the mom was washing the diapers out and she dumped the pails of dirty water into the cess pit in the bottom of their house. And then they had the cess pit examined. And it turned out there was a crack. And the water was seeping into the well that served Broad Street Pump. And so usually Broad Street Pump did have pristine water. But this one cess pit was leaking. And when cholera got dumped into it, for a very short period of time, cholera was introduced into the pump. But it was just, just this one case. And so actually the cases of cholera were starting to go down when John Snow went and talked to, like, the public health board and was like, you guys have to remove the handle to Broad Street Pump because this is what's giving everybody cholera. And they listened and they took the handle off. And so usually this story goes, John Snow saved everybody by removing the broad street pump. At this point, the pandemic was already wrapping itself up because the baby had died. And there wasn't more cholera being introduced. But the dad ends up getting cholera and presumably his

waste would have also been put into the cess pit and that might have started up another round of cholera so he could have saved the town from another round of cholera but the rest of the people in the house and this is disgusting instead of throwing their waste into the cesspit they were throwing it into the backyard because they didn't

want to like they didn't have access to the downstairs cesspit. London was super gross so anyway with this information and the extra information that the reverend gave him by having this amazing social network

that he was able to use to, like, fill in the gaps that John Snow wasn't able to fill in on his own. John Snow was able to publish this data and make a really good case that it's not foul air, it's waterborne contamination. And so what do you think, Daniel, do you think after that everybody was like, we will never speak of the miasma theory again?

I think it takes a long time for a new idea to become mainstream. dream, doesn't it? Yeah, it does. Yep, so it wasn't immediate. There was still pushback. There were, you know, even in the city of London, there were people like health officials who were like, it's my asthma, you didn't really show anything at all.

But by like 1866, which is about a decade later, the Lancet is final, which is a huge medical journal, was finally saying something like, all right, yeah, John Snow, he was probably on to something with that theory. And it's getting broader acceptance. And in 1867, Lister is coming up with his antiseptic technique. So this is where you like, you know, if you're going to do an amputation, you should probably clean it off to make sure there's no bacteria in there before you close up the wounds. So you don't kill people with infections.

And then in 1876, Robert Koch does this amazing work showing that anthrax is caused by a bacteria. And then we're really off to the races with the germ theory of disease. Yeah, that's really fascinating to see how long it takes a new idea to be accepted. And, you know, some people hear this and then they say, well, academia is too slow and it takes forever. And that's probably true. But it doesn't mean that every idea that hasn't been adopted is valid and should be taken seriously, right? The lesson is to follow the data. Yeah.

Right? The data should speak. The data will tell you the truth about the universe. And it sometimes takes academics a while to come around to the data because they have other theories in their minds. But every new idea needs data to support it. And the other thing here is, you know, like John Snow was able to get. moderately convincing data in 1849 during one pandemic. And then he had to wait another five years for like the, you know, the right set of conditions to come about. Unfortunately,

the right set of conditions was people dying. That baby killing all those people. Yeah, babies. Shake my fist at babies. The other fascinating thing there is that the pandemics end on their own. Is that a feature of the thing we were talking about earlier that cholera kills you so quickly that it's not optimized for spreading continuously? I don't think it's always self-limiting. So in this case, it was self-limiting because there was only one family that had access to the cess pit that could leak into the well that fed Broad Street pump. I think if the entire community had their waste emptying into the Broad Street pump,

maybe you would have figured it out faster because then it would have been really obvious that there was poop in the pump. But, I mean, in general, I think I read that when one person gets something, sick with cholera, they can produce a trillion cholera bacteria that can then get into the water. And so, you know, I think as long as cholera is getting into the water and people continue to drink that water and you've got more people who are, you know, contributing more bacteria, I think it can keep going for a while. All right.

Well, tune in next week for more details on cholera. If you haven't had enough, 20 liters of cholera details is not satisfying you. We're going to learn more about how cholera works, how we can treat it, and the biological and chemical mechanisms underlying all that diarrhea. Yay, nerds. See you next time. Daniel and Kelly's Extraordinary Universe is produced by IHeart Radio. We would love to hear from you. We really would.

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