Cholera and Contingency

While reading about the cholera epidemics in the mid and late 19^th century, I could clearly see the connections between the necessity of dealing with the disease and the developments of the public health field. This connection was fairly blatant and by no means new. Yet for the first time, I was struck by it. The contingency of the situation was for the first time amazing. The two most important factors are inseparably intertwined. These are first that conditions in the city be so terrible that disease can arise and second that a disease which passes almost exclusively due to these conditions comes along. Another necessary factor is that the cure for the disease be on par with the science of the time. If, for example, a disease which can pass through human-to-human contact had struck at the time of the cholera epidemics, the development of the sewers might have taken longer and instead other conditions demonstrated to relieve the situation be given more attention. Granted, the final completion of the sewage system, only ten years after Snow’s deductions on cholera were made, was not motivated solely by concern for disease. Yet, this brings us to another important factor in the health policy and engineering advances of the sewage system which was the almost universal public support for the alleviation of the situation. It can be safely taken that the creation of the public health field could not have happened in such a manner if all these contingencies had not come together. Due to my interest in the field, I was greatly struck by the fair amount of contingent factors from which it came.