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STUDENT OVERVIEW London 1854: Cesspits, Cholera and Conflict Over

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STUDENT OVERVIEW London 1854: Cesspits, Cholera and Conflict Over STUDENT OVERVIEW London 1854: Cesspits, Cholera and Conflict over the Broad Street Pump A Chapter-length RTTP Science Game for Biology and General Science Courses Marshall L. Hayes ([email protected]) and Eric B. Nelson ([email protected]) Dept. of Plant Pathology and Plant-Microbe Biology Cornell University ‘The first victim to die of cholera in Sunderland’ reproduced in Snow (2002) Int J Epidemiol 31: 908 Cesspits, Cholera and Conflict takes place on the evening of September 7, 1854 at Vestry Hall in Soho, Greater London. You are a member of a special emergency response committee of the local Board of Governors and Directors of the Poor of St. James Parish, who have convened to respond to the deadly outbreak of Cholera that has claimed the lives of more than 500 parish residents over the preceding eight days. Historically, the outcome of this meeting was the decision to remove the pump handle from a contaminated neighborhood pump on Broad Street. This decision and the events leading up to it are considered a defining moment in the development of modern approaches to public health, epidemiology and municipal waste management. This role play is designed to highlight various aspects of the historical debate. In your role as a Board member, you and your colleagues will debate three central questions: • What is the source of this disease outbreak? • How is cholera communicated from person to person? • What steps should be taken to contain the outbreak? 1 You are asked to complete the following four tasks over the course of the role play: 1. Introduce your character to the group and discuss your specific perspective on Cholera. 2. Debate and vote on the issue of removing the pump handle from the Broad Street pump. 3. Revise and/or amend the language of a precautionary handbill given to parish residents. 4. Achieve a “secret objective” related to making a particular contribution to the debate. This Reacting to the Past (RTTP) game will be played over two class sessions with two additional class sessions devoted to introductory set-up and post-mortem discussion. In the first of the two role-playing sessions, you will deliver an opening statement on the nature and origins of this disease outbreak from the specific standpoint of your assigned character. You and your colleagues will then engage in active debate, and the second of the two sessions will conclude with a vote on specific action(s) that St. James Parish can take to deal with the outbreak. This game will immerse you in the scientific debates and methodologies that led to the founding of the modern fields of microbiology and epidemiology in the mid-to-late 1800’s. It places particular emphasis on the dichotomy and tension between believers of miasma theory (the prevailing idea at the time that disease was caused by miasma or unhealthy odors) and advocates of germ theory (that later attributed a specific disease to being caused by a specific organism). Central characters in this debate included Dr. John Snow (resident physician in St. James Parish and believer that cholera was a contagious and waterborne disease), the Rev. Henry Whitehead (curate of the local Church of St. Luke’s and a staunch supporter of miasma theory) and Dr. William Farr (vital records statistician for the General Register Office). While Dr. Snow, Rev. Whitehead and Dr. Farr are not represented as figures in this game, their ideas are channeled through the perspectives of various other roles. This activity will also introduce you the importance of sanitation in modern society and the eventual implementation of municipal water- treatment systems in urban planning. You are encouraged to engage in as much independent and team research as you deem appropriate in order to play your role effectively. You will find extensive information is available online and in print format. In addition, there may be laboratory activities for this game that will allow you to visualize “microbes” in liquids using period-specific microscopes. You will also be given the opportunity to work with original morbidity and mortality data on the outbreak, so that you may generate your own figures and disease maps of London neighborhoods at the time. This parallels the approaches that Drs. Snow and Farr used in their pioneering efforts to understand the spatial and temporal aspects of Cholera epidemics. Your student packet of game materials includes: 1. Your initial instructions, detailing relevant resources and offering general insights about how the game may be played. 2. An introductory narrative intended to orient you to the mindset of a Board member on the night of September 7, 1854. 2 3. An 1853 Handbill from the Parish of St. James, Westminster providing residents with resources and advice for avoiding Cholera. Use the specific language in this handbill as helpful discussion material you and your colleagues begin your debate. 4. Two data figures that will be central to your debate and discussion: a) John Snow’s map of Cholera mortalities in St. James Parish (Snow, J. 1855. On the Mode of Communication of Cholera. London: Churchill) and b) William Farr’s correlation of elevation and Cholera mortalities (Farr, W. 1852. Report on the Mortality of Cholera in England, 1848-1849. London: Clowes). You are expected to examine these figures closely and formulate any arguments about the origins and transmission of Cholera that are consistent with the viewpoints of your character. 5. A separate Microsoft Excel spreadsheet containing raw data relating to 1) mortalities in St. James Parish from 26 July to 7 September, 1854 and 2) Farr’s 1852 study on elevation and Cholera fatalities (Farr, W. 1852. Influence of Elevation on the Fatality of Cholera. J. Statistical Society London 15: 155-183). Again, you are encouraged to examine these data closely and formulate convincing arguments about the origins and transmission of Cholera. A few final words of encouragement: if you have any concerns about role playing, please do not hesitate to discuss them with your instructor and fellow classmates. For example, you may feel intimidated at the idea of researching your character, or you may have reservations about debating in public. Most importantly, this RTTP experience is a very unique approach to teaching and learning, and a highly effective one if you invest the time and energy. Have fun, and good luck! 3 GENERAL INSTRUCTIONS FOR STUDENTS 1. Brief Introductions to Reacting Pedagogy and to Victorian England For general context on role-playing, please visit the Reacting to the Past site at Barnard College. http://reacting.barnard.edu/ As needed, please consult the online Victorian Dictionary: A Social History of Victorian London. http://www.victorianlondon.org 2. Required Readings Chapter One – “Monday, August 28: The Night-Soil Men” In Johnson, SJ (2006). The Ghost Map: The Story of London's Most Terrifying Epidemic - and How It Changed, Science, Cities, and the Modern World. New York: Riverhead Books. Chapters Two and Ten – “Mapping Symptoms, Making Disease” and “Choleric Broad Street: The Neighborhood Disease” In Koch, T (2011). Disease Maps: Epidemics on the Ground. Chicago: University of Chicago Press. Ackerknecht, EH (1948). Anticontagionism between 1821 and 1867. Reprinted in Int J Epidemiol 38: 7-21 (2009). OPTIONAL Chapter Five – “Downhill All the Way” In Summers, J (1989). Soho: A History of London's Most Colourful Neighbourhood. London: Bloomsbury Publishing. PLUS specific online resources mentioned on your individual role sheet. These suggested resources represent a useful starting point for developing the motivations and viewpoints of your character. If you have enough time, you should feel free to do additional reading and research beyond these suggestions. **SPECIAL NOTE** In your own research, you may also find it helpful to pay particular attention to the following specific reference by Dr. John Snow: Snow, J. (1855). On the mode of communication of cholera (Second Edition, Much Enlarged). London: J. Churchill. Available as an E-book at: http://books.google.co.uk/books/about/On_the_Mode_of_Communic ation_of_Cholera.html?id=-N0_AAAAcAAJ 4 3. Sites on Cholera, John Snow and the 1854 Epidemic in London Cholera Online: A Modern Pandemic in Texts and Images U.S. National Library of Medicine. http://www.nlm.nih.gov/exhibition/cholera/index.html Harvard University’s Collection on Contagion: Historical Views of Diseases and Epidemics http://ocp.hul.harvard.edu/contagion/cholera.html The John Snow Site at UCLA http://www.ph.ucla.edu/epi/snow.html The John Snow Archive and Research Companion at MSU http://johnsnow.matrix.msu.edu/index.php The John Snow Case Study site at UNC http://courses.sph.unc.edu/john_snow/ The City of Westminster Archives: Cholera and the Thames Online Resource http://www.choleraandthethames.co.uk/ 4. Additional Sites that May be Useful for Character Research Association Medical Journal (1853-56). PubMed Central, National Library of Medicine. http://www.ncbi.nlm.nih.gov/pmc/journals/3/ British Medical Journal (1857-). PubMed Central, National Library of Medicine. http://www.ncbi.nlm.nih.gov/pmc/journals/3/ London Journal of Medicine (1849-52). PubMed Central. National Library of Medicine. http://www.ncbi.nlm.nih.gov/pmc/journals/3/ The Lancet Archive (1820-present) http://www.thelancet.com/journals/lancet/issue/current?tab=past 5. Parliamentary Procedures and Rules of Order The discussion and debates that will unfold over your two class meetings will take place in a structured fashion. All role players will be expected to follow a standard procedure for introducing motions and subsequent voting: A) There will be a motion on the floor, an issue that is raised by one of the Board members (i.e. the Chair or other committee members) and proposed for a vote. B) The Chair will open the floor for discussion on the issue.
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