Koch Tom, Denike Kenneth
University British Columbia, Vancouver, BC, Canada.
Soc Sci Med. 2009 Oct;69(8):1246-51. doi: 10.1016/j.socscimed.2009.07.046. Epub 2009 Aug 27.
Few cases in the history of epidemiology and public health are more famous than John Snow's investigation of a neighborhood cholera outbreak in the St. James, Westminster, area of London in 1854. In this study Snow is assumed to have proven that cholera was water rather than airborne through a methodology that became, and to a great extent remains, central to the science and social science of disease studies. And yet, Snow's work did not satisfy most of his contemporaries who considered his proof of a solely waterborne cholera interesting but unconvincing. Uniquely, this paper asks whether the caution of Snow's contemporaries was reasonable, and secondly, whether Snow might have been more convincing within the science of the day. The answers significantly alter our understanding of this paradigmatic case. It does so in a manner offering insights both into the origins of nineteenth century disease analysis and more generally, the relation of mapping in the investigation of an outbreak of uncertain origin. The result has general relevance-pedagogically and practically-in epidemiology, medical geography, and public health.
在流行病学和公共卫生史上，很少有案例比约翰·斯诺在1854年对伦敦威斯敏斯特圣詹姆斯区一场社区霍乱疫情的调查更为著名。在这项研究中，斯诺被认为通过一种方法证明了霍乱是经水传播而非空气传播的，这种方法在很大程度上一直是疾病研究的科学和社会科学的核心。然而，斯诺的研究并未令他的大多数同时代人满意，他们认为他关于霍乱仅通过水传播的证据虽有趣但缺乏说服力。本文独辟蹊径，首先探讨斯诺同时代人的谨慎态度是否合理，其次研究斯诺在当时的科学领域是否可能更具说服力。答案显著改变了我们对这个典范案例的理解。它以一种既能深入了解19世纪疾病分析的起源，又能更广泛地揭示在调查起源不明的疫情时绘图的作用的方式做到了这一点。这一结果在流行病学、医学地理学和公共卫生的教学及实践方面都具有普遍意义。
