Dear Ms. Jennifer Reynoso,
It is with many thanks that I accept your invitation to dine and will arrive tonight at seven o’clock in the evening. I look forward to discovering the subject of our meeting.
Kindest regards,
John Snow, M.D.
I hadn’t received his reply in time. Which is why when Dr. John Snow, the Father of Modern Epidemiology, arrived at my house all prim and proper, and exactly on time, I was in my sweatpants, elbow deep in a bag of cheese puffs, surrounded by a pile of books- each one with his picture on the cover.
As I rolled off the couch to answer the door I caught a glimpse of him through the living room window. Oh no. There he was mutton chops and all, the man in the pictures standing on my doorstep. I was immediately in a state of panic. I surveyed the living room. What a mess, I thought to myself. I looked down at my sweatpants and crumb covered shirt—not exactly the meeting I had envisioned. Perhaps he would chalk my filthiness up to some kind of scholarly eccentricity? I’d have to take my chances. I pushed as many books as would fit under the couch- lest he fear me as some kind of stalker- and tossed the bag of cheese puffs into the bedroom and closed the door.
I paused, wiped my hands on my shirt, and opened the door to greet him. He was very clearly perplexed by my personal presentation, and I am fairly certain that he shuddered when I outstretched my artificially orange, cheesy hand to welcome him, but he was gracious nonetheless and thanked me for the invitation. As he stepped past me to come inside, I looked out through the doorway. Had he arrived in a car, a horse and buggy? And where had he come from really? He wasn’t particularly dusty or covered in cobwebs. Where had he been for the last one hundred and fifty years? Oh well, no clues.
The next few minutes were somewhat awkward as I clumsily scavenged through the refrigerator searching for anything that could be called “dinner”. Dr. Snow looked through some of his own works scattered across the dining table. I apologized profusely after preparing him a roast beef sandwich, which he had to turn down on account of being a vegetarian. Right, should have remembered that. Finally, I presented him with a salad which, after ascertaining how I had washed the lettuce and from what source the water came, he gladly accepted and sat down.
Naturally, our discussion began with my attempts to explain my invitation. This was somewhat awkward on my part, as a large piece of lettuce was stuck to my front tooth throughout my monologue, but hopefully he got the point. I explained my interest in the field of public health and my personal commitment to promoting the health and welfare of people across the globe. Epidemiology, I explained, is the first cornerstone of public health. “What better way to delve into the roots and methods of epidemiology than to become acquainted with their very father!”, I blurted out with an awkward inflection. He seemed surprised by the title, and I assured him that I would explain how that had come to be, eventually.
Drawing on my research, I began to ask him about the early days of his work. He told me about growing up in York and then joining Mr. Hardcastle, a surgeon, as his apprentice in Newcastle-upon-Tyne. He said these had been formative years for him. During that time he had begun to form his beliefs about health, the importance of diet and temperance, and first encountered cholera- the infamous disease he had previously only heard of and which would later monopolize so much of his time.
I asked him about his years of training and he described the year, 1838, in which he finally became a certified physician and apothecary. He reminisced about his years in obstetrics and his initial interest in the research side of medicine. He suddenly grew more animated talking about research and fumbled in his pocket, “Do you have a quill?” A quill? Ah yes, a pen! I handed him a pen and he began to feverishly scribble diagram after diagram of his greatest discoveries and inventions on his napkin, explaining each as he went. When he had used up every bit of space on the napkin he stopped suddenly, embarrassed, and apologized for having destroyed my “linen”. I responded with something about it being disposable, to which he gave an enthusiastic, “Brilliant!”
As I got up to begin clearing the table he started to share about his work with anesthetics. His days were quite busy, he explained, having dominated the market in London for much of his career. “I anesthetized Queen Victoria you know. Twice!” he shouted after me as I walked toward the kitchen.
As I scavenged through the refrigerator in search of “dessert”, I was unaware that Dr. Snow had moved to the living room and had discovered the half-hazardly hidden pile of books below the couch. As I rounded the corner with two dishes of ice cream, I found him scratching his head, pouring over the unfamiliar books with his name in the title. I reassured him that he need not be alarmed and began to explain what had come of his career and why he had been declared, by some, The Father of Epidemiology.
It was his work with cholera, not anesthetics—I explained as I sat down next to him on the couch—that had in today’s world made him noteworthy. His growing fascination with the mode of transmission of cholera which had prompted his many writings and inquiries into the matter had been justified with the discovery of the causal organism Vibrio cholerae in 1883. To this he gave a quick response, “Well of course!” appearing both ecstatically vindicated and offended at the same time. It was, I explained, his strict commitment to the theory of contagion as the single mode of transmission of disease which made him stand out in his era of history. Though others had supported similar theories, he had boldly rejected any theory that married contagion with miasmatic theory and beyond that, actually provided epidemiological data to support his theory that cholera was spread person to person by direct contact with a causal organism. Even further, he suggested the implementation of a practical and successful intervention—in the case of the Broad Street cholera outbreak the removal of the water pump handle to stop the ingestion of contaminated water—which further supported his theory. The process by which he came to his conclusions- gathering data from the study of a population- is the very essence of modern epidemiology, and for that reason, he played a pivotal role in the development of modern public health. “That’s brilliant” I declared in my best English accent.
He sat quietly thinking for a moment and his expression slowly melted from one of satisfaction to that of great disappointment. Maybe the poorly executed accent was a bad idea? “But you make it sound so simple, years of observation and study”, he said staring blankly at his own picture. I was a little taken aback by his sudden sensitivity and wasn’t sure of what to say. Perhaps some hot fudge? I thought.
I tried, for a moment, to offer something more beneficial than hot fudge and responded that though his story was popularly simplified, I had learned many lessons from studying the finer points of his career. He looked intrigued. “Your career was overwhelmingly defined by commitment”, I explained.
A commitment to the scientific processes of observation and discovery- whether reading the works of scientists that came before him, observing a trend in a human population, or discovering physiology through animal models, his commitment to a lifestyle of learning was evident and undoubtedly led to his great success.
A commitment to practical interventions for practical problems- his unwillingness to settle for the current standards of care and prevention, his true belief that better methods existed, continually pushed him to investigate and create. His ability to synthesize his learning beyond understanding to the point of innovation and application were pivotal to his success.
His strong commitment to his theories and the integrity of data- whether defending his theories before his professional organization, Parliament, or in a scholarly journal, Dr. Snow continually risked both his professional and social standing. I explained to him that though this made him unpopular, particularly within the circles of his profession, it made him a man of scientific integrity. Ultimately, it was probably this unbending persistence which set him apart from other theorists that supported contagion in his day. “And that is why”, I explained, “I invited you and not them!” With that we both laughed, and he finally looked somewhat relieved.
As he got up to leave I praised him once more for his contributions to my future profession and offered him a few of the books, which he gladly accepted. I knew that my time with him—awkward as it was—had served its purpose. He thanked me for the meal and made some comment about cholera deaths thankfully being a thing of the past. I didn’t have the heart to correct him, but hoped that instead, perhaps at our next meeting I might be able to give him the good news that they finally are.
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