Following Snow's testimony, the Committee for the amended Nuisances Removal Act deliberated into May 1855 and issued a report in June 1855. Reacting to this report was The Lancet, the major medical journal of that time which was owned and edited by Thomas Wakley (see figure). Wakley had established a colorful reputation as a social reformer who relished confrontations. As a result, his life was littered with court cases. His son James Wakley (see figure) had joined The Lancet in 1852, intending to assist his father who by then was overworked and exhausted. The journal in earlier years had been supportive of the germ theory, but with the partial retirement of Thomas Wakley and the emergence of his son, seemed to side with the environmental sanitation policies of the miasmatic theorists. The journal was highly critical of Dr. Snow, but did not clarify the scientific basis for its vitriolic dissent, nor the identity of the editorial writer (see below). In contrast, The Lancet was very supportive of Dr. William Farr who at that time did not favor the germ theory, but instead used existing mortality data in support of the miasma theory.
Conflicts of Absolute Thinking
Two lengthy editorials appeared in the June 23 and June 30, 1855 issues of The Lancet, responding to Dr. Snow's testimony. Excerpts are presented below in maroon, with comments in black.
The Lancet, June 23, 1855
THE PUBLIC HEALTH AND NUISANCES REMOVAL BILL: DR. SNOW'S EVIDENCE
It is the misfortune of Medicine, in its conflict with the prejudices of society, that it is continually exposed to discomfiture, through the perverse, crotchety, or treasonable behavior of certain of its own disciples. This is never more true than when it is striving, in the purest and most disinterested spirit, to promote the welfare of society. A kind of antagonism is aroused and kept alive in the public mind, which is not less prejudicial to the public than unjust to medicine. The free progress of science is always sure to advance the interests of humanity. Society but wounds itself when it seeks to discredit the teachings of science, by setting against the comprehensive and well-weighed decisions of her true representatives, the crude opinions and hobbyistic dogmas of men whose perceptions are dimmed by the gloom of the den in which they think and move.
The editorial refers first to an earlier case that aroused their ire and then proceeds to the subject at hand.
We have another example in the conduct of the Committee on the Public Health and Nuisances Removal Bills, now before Parliament. It is known that these bills have encountered formidable opposition from a host of “vested interests” in the production of pestilent vapors, miasms, and loathsome abominations of every kind. These unsavory persons, trembling for the conservation of their right to fatten upon the injury of their neighbors, came in a crowd, reeking with putrid grease, redolent of stinking bones, fresh from seething heaps of stercoraceous deposits to lay their “case” before the Committee. They were eloquent upon the health-bestowing properties wafted in the air that had been enriched in its playful transit over depots of rotten hones, stinking fat, steaming dungheaps, and other accumulations of animal matter, decomposing into wealth, such as the imagination shrinks from picturing, and which language cannot describe. The Committee had before it a soap-boiler...this tallow-chandler had the misfortune to grow rich; the insane ambition of retiring seized him; he sold his business, and bid adieu to happiness, until he had negotiated with his successor, at the cost of two hundred a year, for the privilege of assisting on melting-dais! Mr. Archibald Kintrea (why should his name not live?) is a soap-boiler. He denies that soap-boiling produces disagreeable effluvia; he "rather likes it himself;" nay, more, "he means to say, that people generally enjoy it" -- ladies especially. And as to its being prejudicial to health, he only knows, that whilst he and his children lived upon the premises, they reveled in exuberant health, and have fallen off since they left. The fact is, it is all a matter of association or of fashion. The odor of putrefying fat is not only salubrious, but agreeable, if you can only make up your mind to discard vulgar prejudices.
Some ladies live in an atmosphere of Eau de Cologne or Rimmer's Vinegar; others -- Mr. Kintrea's fair friends -- dote upon the delicious fragrance of the copper "when the soap-boiling is going on with intensity."
But Mr. Kintrea and his colleagues do not rely upon these acts alone. They have “scientific” evidence! They bring before the Committee a doctor and a barrister. They have formed an Association. They have a Secretary, a bone merchant, who has read the writings of Dr. Snow. Now, the theory of Dr. Snow tallies wonderfully with the views of the “Offensive Trades’ Association” — we beg pardon if that is not the right appellation — and so the Secretary puts himself in communication with Dr. Snow. And they could not possibly get a witness more to their purpose. Dr. Snow tells the Committee that the effluvia from bone-boiling are not in any way prejudicial to the health of the inhabitants of the district; that “ordinary decomposing matter will not produce disease in the ‘human subject.’” He is asked by Mr. Adderley (of the Committee), "Have you never known the blood poisoned by inhaling putrid matter?" (Snow's response) "No; but by dissection-wounds the blood may be poisoned." (Adderley asked) "Never by inhaling putrid gases?" (Snow responded) "No; gases produced by decomposition, when very concentrated, will produce sudden death; but when the person is not killed, if he recovers, he has no fever or illness."
Dr. Snow next admits that gases from the decay of animal matter may produce vomiting but says this would not be injurious unless frequently repeated.
Is this scientific evidence? Is it consistent with itself? It is in accordance with the experience of men who have studied the question without being blinded by theories?
Let it first be observed that Dr. Snow admits that the gases from decomposing matter may kill outright — a pretty convincing proof of their potency. He also admits that in a less concentrated form they may cause vomiting. And here he stops, assuring us, that if the don't kill us, or cause repeated vomiting, they do us no harm. Now, as a matter of mere reasoning, we think the conclusion inevitable, that agents capable, when in a certain degree of concentration, of killing or causing vomiting, will in a lesser degree of concentration, also act on the animal economy; albeit in a less sudden and perceptible manner. It will be very difficult to persuade us that the long-continued action of gases known to have such lethal powers, if concentrated, is not injurious to health, when in a state of dilution. We shall not easily be reconciled, on the assurance of Dr. Snow, to endure a leakage in our house drains.
After criticizing Snow, the editorial goes on to opine...
We have a strong conviction, that as soon as our noses give us intimation of a communication between those conduits of decomposing animal and vegetable matter and our dwellings, it is time to call in bricklayer and plumber. We decline to wait until repeat vomiting, or a sudden death amongst our children, satisfy us that the gases evolved are in a highly concentrated state. Our professional avocations have, indeed, frequently given us the opportunity of tracing failing strength, flabby muscles, pallid cheeks, lassitude of body and torpidity of mind to this cause. We have felt it our duty to urge removal from the houses so affected, when the drains could not be repaired effectively, and we have commonly been gratified by observing a restoration to bodily and mental vigor. And we presume that there is hardly a practitioner of experience and average powers of observation who does not daily observe the same thing.
The editorial next addresses Snow's views of cholera and seems skeptical of the germ theory and supportive of the miasma theory.
Why is it then, that Dr. Snow is singular in his opinion? Has he any fact to show in proof? No! But he has a theory, to the effect that animal matters are only injurious when swallowed! The lungs are proof against animal poisons; but the alimentary canal affords a ready inlet. Dr. Snow is satisfied that every case of cholera for instance, depends upon a previous case of cholera, and is caused by swallowing the excrementitious matter voided by cholera patients. Very good! But if we admit this, how does it follow that the gases from decomposing animal matter are innocuous? We cannot tell. But Dr. Snow claims to have discovered that the law of propagation of cholera is the drinking of sewage water. His theory, of course, displaces all other theories. Other theories attribute great efficacy in the spread of cholera to bad drainage and atmospheric impurities. Therefore, says Dr. Snow, gases from animal and vegetable decompositions are innocuous! If this logic does not satisfy reason, it satisfies a theory; and we all know that theory is often more despotic than reason. The fact is, that the well whence Dr. Snow draws all sanitary truth is the main sewer. His specus, or den, is a drain. In riding his hobby very hard, he has fallen down through a gully-hole and has never since been able to get out again. And to Dr. Snow an impossible one: so there we leave him.
In that dismal Acherontic stream is contained the one and only true cholera germ, and if you take care not to swallow that you are safe from harm. Smell it if you may, breathe it fearlessly, but don’t eat it.
Now we do not think it necessary to prove, by adducing evidence in opposition to Dr. Snow, that decomposing animal and vegetable matters are injurious to health. They ought not to be suffered to be stored in inhabited localities. We are not acquainted with a single medical practitioner of established reputation who would not consider that the removal of deposits of decomposing animal and vegetable matters was an essential condition for the improvement of the health of towns. We have adverted to the evidence of Dr. Snow, for the purpose of repudiating it as the expression of the teaching of medical science. ...The Committee seems to have contented itself with listening to the statements and objections of those who are interested in opposing the Bills. Those objections it was of coarse bound to hear. If it did not for any scientific evidence in reply, we hope it was because the statements of the dirt-and-effluvium-interest contained their own refutation.
The editorial goes on to support Dr. William Farr, a firm believer at that time in the miasma theory of cholera, and an early user of existing mortality data to guide public policy.
The only thoroughly scientific witness examined was Dr. Farr, and his evidence bore upon a totally distinct question. He did not deal with the causes of mortality, but with the rates of mortality in different districts. The facts he adducted went to prove that there is a natural mortality which does not exceed 17 in 1000; that whensoever that rate is exceeded there are noxious and generally removable causes in operation, and therefore that any excess of deaths above this proportion ought to be the signal for applying the resources of science to the improvement of the health of the district. In the original Public Health Bill it was proposed that a mortality of 23 in 1000 should warrant the extension of the Act to any locality. After hearing the objection of the great Bone and Stench interest, and the evidence of Dr. Farr, which proves to demonstration that anything over 17 in 1000 is unnatural, the Committee has amended the Bill by raising the rate which shall bring the Board of health into action to 27 in 1000! Verily the Committee has small faith, or little courage.
We shall review this branch of the subject next week.
In a follow-up editorial of June 30, 1855, The Lancet went on once more to deride Dr. Snow ("retained by the great dirt and effluvium interest") and support Dr. William Farr ("the accomplished head of the Statistics Department of the Register Office") and his use of mortality statistics to identify districts where death levels are abnormally high, requiring attention and intervention.
A third hearing for the Nuisances Removal and Disease Prevention Act was held in July 1855. The bill underwent considerable revision, including changes as supported by John Snow (but opposed by The Lancet) that were favorable to those supporting the germ theory of disease, and became law on August 14, 1855. Manufacturers were not required to alter their aerial discharges and thus found much to like in the new law.
The Lancet's Rath
When Dr. Snow died on June 16, 1858, The Lancet issued a short, terse notice of his death. They made mention of his work with anesthetic agents, but ignored his thoughts on the germ theory and enormous contributions to the epidemiology of cholera. Five months later, in reviewing Snow's book after his death (On Chloroform and other Anesthetics: Their Action and Administration), The Lancet stated, "On reading this memoir it occurs to us that it would have been only graceful and becoming if its writer had, at least, alluded to the active part taken by The Lancet, in bringing Dr. Snow's merits before the professional world at a time when such an encouragement was all-important to him -- when he was comparatively unnoticed and unknown, and struggling at the painful commencement of what must always be an arduous career." The Lancet seemed resentful of John Snow's success, perhaps still focusing on Snow's 1855 testimony which disregarded their favored miasma theory.
It now is clear that diseases are caused by various factors including microbial agents (as stated by the germ theory) and environmental pollutants (as supported by the miasma theory). Snow appeared to have extended his theories on the microbial origin of cholera to other diseases, and refused to consider that fumes from bone-boiling factories or similar establishments could cause ill health. In the absence of scientific data, all sides testifying on the Act seemed to rely on intuition and even emotion, including advocates of the germ theory, supporters of the miasma theory, and The Lancet which seemed strangely moralistic and intolerant in its editorial attitude towards John Snow.