John Snow was a founding member of the London Epidemiological Society, one of the first professional organizations devoted to the field of epidemiology.  The seal of the organization (see figure) includes the Latin phrase penned by the Roman poet Persius (34-64 AD), venienti occurrite morbo, translated into English as confront disease at its onset. How did this important movement get started?  What were their contributions during Snow's life, and in the years that followed? 

ORIGIN OF SOCIETY

In February 1848, three and a half years after John Snow received his MD degree, an intriguing letter to the editor appeared in The Lancet.  England at the time was very concerned with the possible appearance of a second cholera epidemic (the first ever occurred in 1831-32). The letter started, "Will that dreadful scourge the cholera visit our island again?  If so, are medical men prepared to wage a war against it?" The letter proceeded to suggest that "meetings [to address this disease] should be held in different localities."  Finally the letter concluded with the suggestion that medical journals should report "a statistical account of deaths and recoveries."  The signer was mysteriously identified as "Pater" (a British term for father). 

In July 1849, after cholera had again appeared in England, the same Pater wrote once more to The Lancet, but this time to propose "...the formation of a new society, which might be styled the Asiatic-Cholera Medical Society, or the Epidemic Medical Society, the object of which would be to investigate epidemics..." 

The identity of Pater was finally revealed in The Lancet as J. H. Tucker, a concerned physician practicing in London.  His stimulating words lead to a meeting on March 6, 1850 in Hanover Square, within walking distance of the Broad Street pump in the Soho region of London.  It was here that the London Epidemiological Society was born, perhaps in the building shown below to the right.

 

 

 

 

A second meeting was held in Hanover Square on July 30, 1850 to create a constitution and appoint the founding members and officers (likely at the building site to the right; for a more detailed view, click here). 

The first president was Dr. Benjamin G. Babington (shown here),  a prominent physician at Guy's Hospital in London and member  of the medical board that was expected to advise the London government on ways to address the cholera epidemic.  John Snow (shown below at right) attended this organizing meeting of the London Epidemiological Society and is considered one of the founding member. He was 37 years old.

After another four months had past, Dr. Babington held on December 2, 1850 the first professional meeting of the London Epidemiological Society, 33 months after the initial Pater letter appeared in The Lancet.  About 100 members and visitors were present.  Among the most famous were Thomas Addison (1793-1860), the British physician who discovered pernicious anemia (now termed Addison's anemia) and adrenal cortex deficiency (now called Addison's disease); and Richard Bright (1789 -1858), his British colleague who first described the disease characterized by edema and presence of albumin in urine, now termed Bright's disease.  For others, including John Snow, fame would come later. Notable in this latter group was Dr. John Simon (later to become Sir John Simon) who in 1848 had become the first medical officer of health of London (he remained in that position until 1855); and Gavin Milroy who in 1864 on Babington's retirement, would become the second president of the London Epidemiological Society. 

ORIGINAL PURPOSE OF THE ORGANIZATION

When the constitution of the London Epidemiological Society was created, the founders had three major purposes all related to epidemics as a broad notion, not specific to a cholera epidemic, the threat of which had stimulated the earlier letters of Pater. 

  • to institute rigid examination into the causes and conditions which influence the origin, propagation, mitigation, and prevention of epidemic diseases;

  • to institute...original and comprehensive researches into the nature and laws of disease; and

  • to communicate with government and legislature on matters connected with the prevention of epidemic diseases.

The founders also recognized that having ideas without public or professional communication is a self-centered undertaking.  To avoid this end they advocated:

  • to publish original papers; 

  • to issue queries; 

  • to publish reports; 

  • to form statistical tables; 

  • to prepare illustrative maps; and 

  • to collect works relative to epidemic diseases.

These purposes and undertakings remain appropriate today.

ACTIVITIES OF THE ORGANIZATION

Papers were regularly presented at the monthly meeting of the London Epidemiological Society such as one in 1851 on the use of statistics and statistical methodology in the study of epidemic diseases. Between 1851 and 1853, most meetings had considerable discussion about whether or not a specific disease was caused by a contagion, . with cholera and yellow fever being common example cited by both opponents and proponents of the germ theory (i.e., disease is caused by a microorganism or germ).  In 1853, John Snow (shown at right) presented a paper on "The Comparative Mortality of Large Towns and Rural Districts, and the Causes by Which it is Influenced" which featured the application of statistics to epidemiology.   

In 1852, Dr. Benjamin W. Richardson (shown below), a close friend of Snow's, joined the London Epidemiological Society.  Being an intellectual comrade, Dr. Richardson supported Snow in his theory of water propagation of cholera, an idea that was quickly accepted by the medical community.  Later after the death of his friend in 1858, Richardson would write the lengthy account of Snow's life that enriches our current understanding of the life and times of the man.  Richardson founded the Journal of Public Health in 1855, where the transactions of the London Epidemiological Society were first published.  Four years later, however, the journal was discontinued for financial reasons.  Thereafter the Society published its own proceedings as the Transactions of the Epidemiological Society of London, which remained until 1907.

In 1861, three years after the death of John Snow, Gavin Milroy presented "The Influence of Contagion on the Rise and Spread of Epidemic Diseases."  In this important work he joined John Snow in dismissing the miasmatic theory of disease causation (i.e., the idea that poisonous atmosphere rises from swamps and putrid matter and cause disease) because of its inconsistency with the spread of epidemics. 

DEMISE AND REBIRTH

At end of the century as infectious diseases continued their inevitable decline, the London Epidemiological Society came to a temporary end.  Its successor was the Section on Epidemiology and State Medicine of the Royal Society of Medicine.  Later still this became the Section on Epidemiology and Preventive Medicine, also of the Royal Society of Medicine.  In more modern times, emphasis was placed on prevention of such non-infectious conditions as accidents involving motor vehicles, heart disease, cancer and even mental illness.  In addition, this new section of the Royal Society of Medicine stressed the use of quantitative epidemiological methods and principles, and held discussions on topics such as ethical questions relating to public health. Likely if John Snow had lived another 142 years, he would have approved, and enthusiastically participated in the continuing drama of epidemiology.

Sources: 

Babington, BG. The Lancet 2, 639-642, 1850.

Hunting, P. The History of the Royal Society of Medicine, 2002.

Lilienfeld, D. Bulletin Hist Med 52(4), 503-28, 1978.

Paul JR. Yale J Biology Med 46(1), 29-31, 1973.

Pater. The Lancet 1, 242, 1848.

Pater. The Lancet 2, 301-302, 1849.

Tucker, JH. The Lancet 2, 592, 1849.

Simon, J. English Sanitary Institutions, Cassell, London, 1890.

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