The Manson Lecture Theatre at the London School of Hygiene and Tropical Medicine (LSHTM) was crowded on Wednesday 8th September 1995, with Society members and other interested parties, keen to hear Dr Sandy Cairncross of the LSHTM deliver the third annual Pumphandle Lecture, entitled “Turning the Worm”, on the Guinea Worm eradication programme.The Manson Lecture Theatre at the London School of Hygiene and Tropical Medicine (LSHTM) was crowded on Wednesday 8th September 1995, with Society members and other interested parties, keen to hear Dr Sandy Cairncross of the LSHTM deliver the third annual Pumphandle Lecture, entitled “Turning the Worm”, on the Guinea Worm eradication programme.
Dr Cairncross was a member of a UNICEF/WHO joint eradication team who worked in Ouagadougou between 1992 and 1995. The guinea worm is a “good” parasite in that it does not kill its host but nevertheless 0.5% of patients are handicapped for life and 30% have some degree of pain and suffering even after losing the worm. The economic consequences for regions where it is found are vast.
Larvae escape from infected humans into water where they are ingested by water fleas (Cyclops spp.). Humans who ingest an infected water flea in their drinking water are likely to become infected, the worm, which may reach two feet long maturing a year later ready to shed larvae. The whole life cycle outside humans therefore takes place in water, the only human parasite in which this is the case.
This parasite is widely distributed throughout central Africa and into central Asia. The slave trade led to its brief introduction into the Americas. The disease is seasonal. In the Sahel belt of Africa cases peak in the rainy season, but in forest areas, where water is always present, it peaks in the dry season. Its seasonality and lack of annual vector mean that eradication programmes can be targeted at that time of year.
No vaccine has been developed against the disease; eradication programmes are aimed either at the vector or the human host. Two major methods have been used:
Insecticidal treatment aimed at the vector. Insecticides such as Temephos, which are harmless to humans, are effective against Cyclops and can provide effective cover at a local level. However, the costs of staff, equipment and insecticide for treatment of large areas is prohibitive.
Production of safe water. This has two components, the first involving educating infected persons not to go into water – and hence not transmit the larvae; and the second the provision of simple water filter to remove Cyclops from drinking water and break the chain of transmission.
These measures, particularly the latter, combined with a detailed community based surveillance programme have proved successful in reducing the incidence of the disease. A valuable sideline of the eradication programme, which trains local people to undertake the work, has been that the availability of these trained personnel has had an impact on other diseases and has improved local health care.
Dr Stanwell-Smith gave the vote of thanks after which the meeting was formally brought to an end by the ceremonial removal of the handle of the society’s pump. A large group then moved to the John Snow pub in Broadwick Street, Soho, for the customary toast to Snow’s name, examination and signing of the visitor’s book.
Professor Paul Fine, the Pumphandle President, welcomed members and non-members alike to an overflowing Manson theatre at the London School of Hygiene and Tropical Medicine on Thursday 8th September 1994 to commemorate the 140th anniversary of John Snow’s removal of the pump handle.
He introduced the speaker, Dr Spence Galbraith, who founded the Epidemiological Research laboratory (later CDSC) of which he was the director for a decade. Dr Galbraith gave a scintillating lecture entitled “Dr John Snow – Early Life and Later Triumphs. An exploration of Snow’s work from the epidemiological perspective”, a talk based on his original researches around the country.
Dr Galbraith had obtained photographs of Snow’s birth certificate and gravestone thus confirming at last the correct date of Snow’s birth. In fact, Snow was born on 15th March 1813 in York, near the site of the Rowntrees chocolate factory. After living on a farm near York during his childhood, he was apprenticed to a surgeon in Newcastle, where he attended tuition at Bell’s Court, the doorway of which is now incorporated into the structure of Newcastle Medical School. Whilst in Newcastle, Snow first encountered cholera which had spread from Sunderland in 1831/32. Later he was to write graphically about the impact of cholera in the coal pits at Killingworth, where he may have met Robert and George Stevenson of railway fame.
After spells in County Durham and Pateley Bridge, where he developed his taste for nature walks and teetotalism, Snow moved to London. He collected qualifications (LRCS May 1838, LSA October 1838, MB 1843, MD 1844), contracted nephritis (for which he was treated by Richard Bright), and started giving anaesthetics, mainly at St George’s Hospital. He continued his interest in cholera, writing very accurately about the transmission of the infection in 1849, and becoming involved in the Golden Square outbreak in 1854. The story is too well known to need repeating but Dr Galbraith pointed out how Snow founded “boot leather” epidemiology by actually visiting the area, drawing a map, using a questionnaire and conducting retrospective etiological study. It is intriguing that no mention is made of the outbreak in Snow’s own casebooks for the period, nor is there any mention of his famous visit to the local vestry records. He later went on to show by use of a cohort study that the incidence of cholera was ten-fold higher in households supplied by one water company (the Vauxhall and Southwark) as compared to those supplied by another (the Lambeth), the water extraction point of the former being close to a major sewer.
Snow became president of the Medical Society of London in 1855 and, according to his memorial, died on June 16th 1858.
Dr Ros Stanwell-Smith proposed the vote of thanks and presented Dr Galbraith with a silver pump tie pin on behalf of the Society. Professor Fine then removed the handle of the Society’s pump, thus declaring the meeting over. Many of the members then repaired to the John Snow public house in Soho for a convivial member’s evening, with refreshments courtesy of the Open University Press, who were promoting “The Epidemiological Imagination”, a recently published book by Professor John Ashton, a member of the Society, which features a section on Snow.
There was an expectant buzz of excitement around the crowded Manson Lecture Theatre at the London School of Hygiene and Tropical Medicine on Wednesday 8th September 1993.
On the bench in front of the audience stood the society’s ceremonial cast iron water pump. There was standing room only as Professor Paul Fine, the Inaugural President, opened the first annual Pumphandle Lecture of the newly formed John Snow Society. This meeting commemorated the 139th anniversary of what may be the most famous action in the history of public health – the removal by John Snow of the handle of the water pump in Broad Street which was at the centre of the cholera epidemic in Soho in 1854.
The guest speaker was Dr Nick Ward of the World Health Organization Polio Eradication Task Force, whose title was ‘Global Polio Eradication: a call for action’.
Dr Ward gave an inspiring and erudite speech in which he discussed the history and implications of the smallpox eradication campaign and the considerable achievements to date of the polio campaign, that there has not been a single case of polio reported from the Americans in the past two years. He did not shrink from discussing the problems that remain if the disease is to be eradicated elsewhere, in particular the cost and poor infrastructures. He identified practical achievable targets and measures for the road ahead.
Dr Ros Stanwell-Smith, secretary of the society, gave the vote of thanks, after which the President ceremoniously removed the handle of the pump thus bringing the meeting to an end.
A large group then moved on to the John Snow pub in Broadwick Street, Soho, for the rest of the evening. Plans were laid for future meetings – including the Blessed Chloroform lecture (to be arranged by anaesthetist members of the society and to be held on or about 7th April to commemorate John Snow’s administration of chloroform to Queen Victoria at the birth of Prince Leopold).