Friday, 28 April 2006

The Medical Detective – Sandra Hempel ****

With the terrible disease cholera at its heart, this is anything but a pleasant book to read – but that doesn’t stop it being horribly fascinating.
Sandra Hempel has a gift for taking the reader into the heart of period medicine. Primarily a biography of John Snow, the man who cracked the mechanism for cholera’s spread, The Medical Detective also gives us a good deal of (sometimes graphic) description of the impact of cholera, an in-depth consideration of the UK political reaction to the cholera outbreaks, and a good feeling for the working environment that Snow would be familiar with. Although the US title, The Strange Case of the Broad Street Pump, is more effective in bringing out the medical Sherlock Holmes mystery aspect of the story, the Broad Street incident, of which more later, is very much the climax of the book, not cropping up until over half way through.
Perhaps the most shattering aspect of Hempel’s story is the description of the Tooting child farm. One of the places cholera would break out, this was a location that would make Oliver Twist’s early experiences seem relatively mild. Hundreds of destitute children, crammed into insanitary and disgusting conditions, simply to collect the fee the government paid for looking after them, then to keep them on a fraction of it, making a huge profit. It’s somehow not surprising that Dickens was one of the journalists who wrote about this disgrace after it was discovered.
Back on the case, Snow’s great breakthrough was to uncover the way that cholera spread, thanks to some classic detective work. The mechanism for cholera’s progress had always been something of a mystery. Sometimes it spread gradually in a tight knit community – but would leave pockets untouched. Sometimes it would jump hundreds of miles. It seemed different from something like plague, with its clear person-to-person spread. Although John Snow had made his name as an early exponent of anaesthesia, he had from his early days in medicine had a strongly-felt need to investigate the causes of cholera. Relatively early he developed a theory that it was spread through tainted drinking water. He was able to perform an early piece of epidemiology, getting statistics for the different attack rates for an area before and after conversion to a clean water supply, compared with other boroughs who water was little more than dilute sewage. But the big breakthrough came by studying an outbreak in an area of central London, plotting cases on a map like a modern forensic scientist, Snow would find the epicentre – a water pump in Broad Street. A conclusive argument for the mechanism of cholera’s spreading would follow, though sadly, despite the myth of Snow’s last minute saving of the district, too late to help much in this particularly virulent outbreak, and not widely accept for several years to come.
Broad Street has since been re-christened Broadwick Street, and now houses two of the UK’s biggest magazine companies. Somehow it’s appropriate that the home of Good Housekeeping and House Beautiful should be the very street where it was discovered that inappropriate handling of sewage and water supplies could result in the spread of this terrible disease.
Throughout, Hempel maintains an interesting thread, and though the early chapters on the background of cholera and the ventures into politics aren’t as gripping as those where we get the central character of John Snow involved, she tells a powerful and engaging story of this classic piece of medical detective work. Recommended.
Hardback:  
Review by Brian Clegg

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