Public health officials save lives. Public health officials kill.

I recently finished reading a very satisfying book titled The Ghost Map by Steven Johnson. The book looks at how London was able to solve the cholera epidemic which struck the city in the mid-nineteenth century. The book chronicles how John Snow and Henry Whitehead were able to discover that cholera is transmitted from drinking water contaminated with feces.

One of the most interesting motifs of the book is that of scale. The book looks at the cholera outbreak from a microscopic level (the Vibrio cholerae bacteria) moves to the scale of the individual lives of John Snow, Henry Whitehead, William Farr and Edwin Chadwick, and finally to the statistically analysis conducted at the bird’s-eye, metropolitan level.

The book documents the work of John Snow and how he was able to stop the spread of cholera by convincing public officials to remove the pump handle of the cholera-inflected water well on Broad Street.

The book also chronicles the life of Edwin Chadwick.

“Chadwick helped solidify, if not outright invent, an ensemble of categories that we now take for granted: that the state should directly engage in protecting the health and well-being of its citizens, particularly the poorest among them; that a centralized bureaucracy of experts can solve societal problems that free markets either exacerbate or ignore; that public health issues often require massive state investment in infrastructure or prevention. For better or worse, Chadwick’s career can be seen as the very point of origin for the whole concept of ‘big government’ as we know it today.”

Chadwick erroneously believed that “the air of London was killing Londoners…and thus the route to public health had to begin with removing noxious smells.” This was done by dumping all of London’s sewage into the Thames river.

“Within a period of about six years, thirty thousand cesspools were abolished, and all home and street refuse was turned into the river…Herein lies the dominant irony of the state of British public health in the late 1840s. Just as Snow was concocting his theory of cholera as a waterborne agent that had to be ingested to do harm, Chadwick was building an elaborate scheme that would deliver the cholera bacteria directly to the mouths of Londoners. (A modern bioterrorist couldn’t have come up with a more ingenious and far-reaching scheme.)”

When public health officials are right, they can save thousand of lives. When they are wrong, they can just as easily kill those very same individuals.