McLeod K S
Yale University School of Medicine, Section of the History of Medicine, New Haven, CT 06520-8015, USA.
Soc Sci Med. 2000 Apr;50(7-8):923-35. doi: 10.1016/s0277-9536(99)00345-7.
In 1854, Dr. John Snow identified the Broad Street pump as the source of an intense cholera outbreak by plotting the location of cholera deaths on a dot-map. He had the pump handle removed and the outbreak ended...or so one version of the story goes. In medical geography, the story of Snow and the Broad Street cholera outbreak is a common example of the discipline in action. While authors in other health-related disciplines focus on Snow's "shoe-leather epidemiology", his development of a water-borne theory of cholera transmission, and/or his pioneering role in anaesthesia, it is the dot-map that makes him a hero in medical geography. The story forms part of our disciplinary identity. Geographers have helped to shape the Snow narrative: the map has become part of the myth. Many of the published accounts of Snow are accompanied by versions of the map, but which map did Snow use? What happens to the meaning of our story when the determinative use of the map is challenged? In his book On the Mode of Communication of Cholera (2nd ed., John Churchill, London, 1855), Snow did not write that he used a map to identify the source of the outbreak. The map that accompanies his text shows cholera deaths in Golden Square (the subdistrict of London's Soho district where the outbreak occurred) from August 19 to September 30, a period much longer than the intense outbreak. What happens to the meaning of the myth when the causal connection between the pump's disengagement and the end of the outbreak is examined? Snow's data and text do not support this link but show that the number of cholera deaths was abating before the handle was removed. With the drama of the pump handle being questioned and the map, our artifact, occupying a more illustrative than central role, what is our sense of Snow?
1854年，约翰·斯诺博士通过在点状地图上标注霍乱死亡病例的位置，确定宽街水泵是一场严重霍乱疫情的源头。他让人拆除了水泵把手，疫情便结束了……至少故事的一个版本是这样讲的。在医学地理学中，斯诺与宽街霍乱疫情的故事是该学科实际应用的一个常见例子。虽然其他健康相关学科的作者关注的是斯诺的“实地调查流行病学”、他对霍乱传播水媒理论的发展，以及他在麻醉领域的开创性作用，但正是这张点状地图让他成为了医学地理学领域的英雄。这个故事构成了我们学科身份的一部分。地理学家们塑造了斯诺的故事：这张地图已成为神话的一部分。许多关于斯诺的已发表记述都配有这张地图的不同版本，但斯诺用的是哪张地图呢？当这张地图的决定性作用受到质疑时，我们故事的意义会发生什么变化？在他的《霍乱的传播方式》（第二版，约翰·丘吉尔出版社，伦敦，1855年）一书中，斯诺并没有写道他用地图来确定疫情源头。书中附带的地图展示了8月19日至9月30日黄金广场（伦敦苏豪区发生疫情的分区）的霍乱死亡病例，这一时期比疫情高峰期长得多。当审视水泵把手拆除与疫情结束之间的因果联系时，这个神话的意义又会怎样呢？斯诺的数据和文字并不支持这种联系，而是表明在水泵把手被拆除之前，霍乱死亡人数就已经在减少。随着水泵把手事件的戏剧性受到质疑，而我们的人工制品——地图，所起的作用更多是说明性而非核心性，我们对斯诺是怎样的看法呢？
