Speaker 1: As we passed along the reeking banks of the sewer,
Speaker 1: the sun shone upon a narrow slip of the water.
Speaker 1: In the bright light, it appeared the color of strong
Speaker 1: green tea, and positively looked as solid as black marble
Speaker 1: in the shadow. Indeed, it was more like watery mud
Speaker 1: than muddy water. And yet we were assured that this
Speaker 1: was the only water the wretched inhabitants had to drink.
Speaker 1: As we gazed in horror at it, we saw drains
Speaker 1: and sewers emptying their filthy contents into it. We saw
Speaker 1: a whole tier of doorless privies in the open road,
Speaker 1: common to men and women built over it. We saw
Speaker 1: a little child from one of the galleries opposite lower
Speaker 1: a tin can with a rope to fill a large
Speaker 1: bucket that stood beside her. As the little thing dangled
Speaker 1: her tin cup as gently as possible into the stream,
Speaker 1: a bucket of night soil was poured down from the
Speaker 1: next gallery.
Speaker 2: Well, I want to say two things. Yes, One, I
Speaker 2: support the use of the words privy and night soil.
Speaker 1: Both night soil, by the way, is human feces used
Speaker 1: as compost poop poopy poop poop.
Speaker 2: Also, that's disgusting. That's my second point.
Speaker 1: So I'm going to give you a little context to that.
Speaker 1: That came from an article describing the ground zero of
Speaker 1: eighteen forty nine's cholera outbreak in London.
Speaker 2: That was London.
Speaker 1: It was London.
Speaker 2: That's a city, and it was that just whoop.
Speaker 1: Everywhere there are a lot of cities that continue to
Speaker 1: be very poor sanitation just due to lack of funds
Speaker 1: for public health infrastructure. Oh my god, Welcome to this
Speaker 1: podcast Will Kill You.
Speaker 2: Episode four. Today we're talking about cholera. I'm Aaron and
Speaker 2: I'm also Aaron.
Speaker 1: And before we get into the meet of this week's episode,
Speaker 1: we want to ask you, dear listeners.
Speaker 2: Dearest darling listeners.
Speaker 1: To rate, review and subscribe.
Speaker 2: Because we love you and we want to know how
Speaker 2: much you love us. Just kidding, but not really. Rating,
Speaker 2: reviewing and subscribing is how other people are able to
Speaker 2: find our podcast. So wherever you listen to your podcast,
Speaker 2: please please please take a moment to just you know,
Speaker 2: click five stars or whatever, or.
Speaker 1: You know, anything you want, whatever is in your heart.
Speaker 1: And also we are on all the social media's. We're
Speaker 1: on Twitter, Instagram, Facebook, so you know, if you want
Speaker 1: to keep up to date on little trivia about whatever
Speaker 1: infectious diseases.
Speaker 2: You know where to find us see some growdy photos,
Speaker 2: and also get our drink recipes.
Speaker 1: Oh yeah, that's important. Yeah, okay, Arin, Yeah, I want
Speaker 1: to hear about cholera. Now tell me all about it.
Speaker 2: Let's talk about it as it turns out, which I
Speaker 2: did not know before doing this research. Colera is really complicated.
Speaker 2: It's a complicated little bug. Yeah. So I'm going to
Speaker 2: hit on the real basics of the biology of this disease.
Speaker 2: And I want to encourage y'all to read more. Or heck,
Speaker 2: if you research cholera and I get it wrong, give
Speaker 2: us a shout out. Let me know that we're so
Speaker 2: incorrect about things.
Speaker 1: We are open to being corrected, very open.
Speaker 2: Okay, So cholera. Cholera is a disease that's caused by
Speaker 2: a bacteria called Vibrio cholera, which is a facultative pathogen.
Speaker 2: So that means that in addition to causing disease in humans,
Speaker 2: it also can persist in the environment and reproduce in
Speaker 2: the environment, usually in water, especially brackish water, so like
Speaker 2: at river mouth near the ocean, and things like that
Speaker 2: is where it persists.
Speaker 1: Can you give me an example of an obligate pathogen smallpox? Okay,
Speaker 1: So smallpox, it can exist in the environment, but it
Speaker 1: can only persist if there is a human host for
Speaker 1: it to infect.
Speaker 2: Exactly, it can't reproduce without infecting a host, whereas cholera
Speaker 2: can actually reproduce in the environment. But there are also bacteria,
Speaker 2: maybe leprosy bacteria, which also can't reproduce without being in
Speaker 2: a host. It's also an obligate pathogen.
Speaker 1: Rocky Mountain spotted fever, Yeah, definitely.
Speaker 2: Right, cool, Okay. So generally cholera is transmitted fecally orally,
Speaker 2: which means you have to ingest fecally contaminated water or food,
Speaker 2: especially shellfish which live in water. Really yeah, itcky because
Speaker 2: a lot of shellfish are filter feeders, so they just
Speaker 2: filter all the poop out of the water and then
Speaker 2: you eat it. Yeah, you wanna get some clams after this,
Speaker 2: So that's how you actually get infected. The infectious dose
Speaker 2: of cholera is actually really high, which means that you
Speaker 2: have to ingest a whole bunch of the cholera bacteria
Speaker 2: to actually get infected. And there are a bunch of
Speaker 2: different strains of the Vibrio cholera bacteria, but only two
Speaker 2: of them actually cause the vast majority of the disease.
Speaker 2: And part of the reason that the infectious dose is
Speaker 2: so high for cholera is first because it has to
Speaker 2: survive the super acidic environment of your stomach, because you
Speaker 2: ingest it, right.
Speaker 1: I think I actually read something about how people who
Speaker 1: take anti acids, yeah, have higher chances of getting cholera. Yeah,
Speaker 1: I preempt you.
Speaker 2: No, not at all. I wasn't going to talk about that,
Speaker 2: but I definitely saw that too. So if you lower
Speaker 2: the acidity in your stomach, it makes it easier for
Speaker 2: the cholera to get through that really harsh environment. Super cool.
Speaker 1: I've also heard something about that along the same lines
Speaker 1: with stomach cancer.
Speaker 2: Oh really, just because there's like various bacteria that can
Speaker 2: be associated with stomach cancer.
Speaker 1: No, well, potentially that, but also because acid will kill
Speaker 1: off the more like bad cells basically earlier.
Speaker 2: Oh that's really interesting.
Speaker 1: And so if you don't have that pressure, Yeah, I
Speaker 1: don't know. I mean this is all like me, this
Speaker 1: is what scientists shouldn't do, which is just reading abstracts of.
Speaker 2: Things should happen though, Okay. And the other reason that
Speaker 2: there's a really high infectious dose is that after a
Speaker 2: cholera bacteria survives your stomach, it actually has to swim
Speaker 2: all the way through the rest of your gi tract
Speaker 2: and into your small intestine. So it has a little flagellum,
Speaker 2: which is a tail. So these bacteria actually look like spermes,
Speaker 2: a little sperms that.
Speaker 1: They make giant microbes of cholera. I think that did
Speaker 1: really cute.
Speaker 2: Not probably as cute as Gerardia, because that's the cutest. Oh,
Speaker 2: it's so cute. It looks like a little rostafarian. So
Speaker 2: once the little spermy bacteria get to your small intestine,
Speaker 2: they attach themselves to your intestine wall and they begin
Speaker 2: producing cholera toxin. And this is what actually makes you sick.
Speaker 2: So it's not the bacteria alone, it's the fact that
Speaker 2: the bacteria produces this toxin. And what's super crazy and
Speaker 2: cool about this toxin is that it is actually produced
Speaker 2: by a bacteria phage. A bacteria phage is pretty much
Speaker 2: a virus that infects bacteria. I don't know why we
Speaker 2: have to call bacteria viruses something different, but we do.
Speaker 1: They look really cool.
Speaker 2: They are really amazing. One time in college, we got
Speaker 2: like Hannah paint and we were all painting Hennah and
Speaker 2: my roommate Jocelyn, who's awesome, painted the most beautiful bacteria
Speaker 2: phage on her arm and I was like, that should
Speaker 2: be a I want to it's beautiful.
Speaker 1: Oh that's great.
Speaker 2: Yeah. So anyways, this bacteria phage has basically inserted part
Speaker 2: of its genome into the cholera genome, and that is
Speaker 2: what's actually producing this toxin, which is super interesting to me.
Speaker 1: That's fascinating.
Speaker 2: Yeah.
Speaker 1: And also, are you going to tell me how how
Speaker 1: this toxin works because I need to know. Yeah.
Speaker 2: So, basically, this toxin essentially prevents your body from absorbing
Speaker 2: any water and forces you to push out all of
Speaker 2: the water in your body out of your intestine, which
Speaker 2: means you're basically pooping water.
Speaker 1: Oh my gosh.
Speaker 2: Yeah, I'll talk more about it in just a minute.
Speaker 1: Okay.
Speaker 2: So the incubation period, which we've talked about before as
Speaker 2: the period from when you get infected until when you
Speaker 2: show symptoms for cholera, is about one and a half days.
Speaker 1: Wow, that's very fast.
Speaker 2: They're super fast little swimmers and they usually attach themselves
Speaker 2: to your small intestine within twelve to seventy two hours
Speaker 2: of infection, so they're super quick. And another thing that's
Speaker 2: interesting is that there's kind of a range of symptoms.
Speaker 2: So some people who get infected are almost entirely asymptomatic,
Speaker 2: some people have a rather mild infection, and the ones
Speaker 2: that we'll talk about the most today have very very
Speaker 2: severe infections. And the severity of the illness is likely
Speaker 2: based both on prior exposure, so if you got it
Speaker 2: when you were young and then you get it again
Speaker 2: when you're older, you're a little better off, but also
Speaker 2: on infectious dose, since like I said previously, it actually
Speaker 2: takes quite a lot of bacteria to really get you infected.
Speaker 2: But in the severe cases, which let's face it, that's
Speaker 2: what we're here form HM, Basically, what happens is you
Speaker 2: just start pooping your guts out. Oh boy, so really
Speaker 2: like you just poop all of your water out. Adults
Speaker 2: that have severe infections can poop out get this more
Speaker 2: than a leader a fluid per hour.
Speaker 1: Oh my god, are you serious?
Speaker 2: I'm totally serious.
Speaker 1: I have so many questions right now. Yeah, how long
Speaker 1: can you live by pooping out?
Speaker 3: A leader?
Speaker 1: Of fluid an hour.
Speaker 2: I'm so glad you asked, because I did some research.
Speaker 2: So we have four and a half to five liters
Speaker 2: of blood in our body, right, and that's the fluid
Speaker 2: that's the most available for you to get water out of. Oh,
Speaker 2: if you think about that, whoa, right, and then we've
Speaker 2: got another fifteen of fluid or maybe ten liters of
Speaker 2: fluid that's surrounding all of our cells. That's that we
Speaker 2: call it interstitial fluid in between our cells. Right, So
Speaker 2: that's fifteen liters. But that's like all the fluid that
Speaker 2: you have available until you start sucking your actual cells dry.
Speaker 1: Whoa, Oh my god. Yeah, So is this where the
Speaker 1: disease got its characteristic symptom?
Speaker 2: It does?
Speaker 1: And what's that called?
Speaker 2: It's called rice water steol.
Speaker 1: Why is it called that?
Speaker 2: Because the poop that you're pooping out is literally all bacteria.
Speaker 2: It's just like tons of bacteria and water and dead cells.
Speaker 1: And it looks like what murky flaky.
Speaker 2: It looks like. So if you took a bag of
Speaker 2: rice and you soaked it and then you drained the
Speaker 2: rice out.
Speaker 1: And what are we drinking right now? Actually, because we
Speaker 1: forgot to do quarantinies. You're really so right about that.
Speaker 2: Tonight we're drinking rice water stool.
Speaker 1: Oh I can I provide a little correction. We're drinking
Speaker 1: a quarantini that we named rice water stool. It actually
Speaker 1: is composed of cholera bacteria. No, just kidding. It's composed
Speaker 1: of rum chatta.
Speaker 2: About one and a half ounces of rum chatta chai,
Speaker 2: three ounces of chai concentrate or a really strong chai tea, and.
Speaker 1: A half an ounce of whiskey.
Speaker 2: Yep, feel free to add more whiskey. It'll just look
Speaker 2: more realistic.
Speaker 1: Because it will curdle. Yeah, but the most important part
Speaker 1: of this recipe is to gently warm it to body temperature.
Speaker 1: It's actually pretty delicious.
Speaker 2: It's surprisingly good, you guys. I don't like warm drinks
Speaker 2: that are like alcoholic, but this is its taste.
Speaker 1: It's perfect for this time of year.
Speaker 2: It is. It's really oh, happy Thanksgiving.
Speaker 1: Happy Thanksgiving.
Speaker 2: Yeah, rice water stool cheers cheers with our mugs. So
Speaker 2: severely ill patients will have poop that is literally a
Speaker 2: trillion individual bacteria per gram of poop. Whoa, whoa, yeah,
Speaker 2: whoa is right? I did that like one hundred times
Speaker 2: to make sure I was getting the number right. It's
Speaker 2: absolutely ridiculous.
Speaker 1: Which also makes sense why epidemics happen and are so
Speaker 1: easy to spread.
Speaker 2: And the other reason is because, like I said, not
Speaker 2: everyone gets the severe illness, So people who have a
Speaker 2: mild illness are still pooping out about a million bacteria
Speaker 2: program of poop, and even patients who are completely asymptomatic
Speaker 2: can be shedding about ten to one hundred thousand bacteria
Speaker 2: program of poop.
Speaker 1: That's really interesting.
Speaker 2: Yes, the biggest range. I mean, obviously there's a huge
Speaker 2: range in the number of bacteria program of poop. But
Speaker 2: also people who are severely ill are not just shedding
Speaker 2: while they're having massive diarrhea. They're shedding for up to
Speaker 2: one to two weeks after symptoms have alleviated, and people
Speaker 2: who have mild illness are shedding for less time, and
Speaker 2: people who are asymptomatic tend to shed for only about
Speaker 2: a day or two. Okay, so yeah, it's crazy. It's
Speaker 2: they're just tons and tons of this bacteria that are
Speaker 2: getting into the environment. And the other thing is that
Speaker 2: since this is a pathogen that can persist in the environment,
Speaker 2: the types of Vibrio cholera bacteria that you're likely to
Speaker 2: find in the environment, meaning whether they are toxogenic or
Speaker 2: non toxogenic will largely depend on how many severely ill
Speaker 2: people you have in that environment. So it's this vicious cycle.
Speaker 2: Once you have people who are ill in a certain area,
Speaker 2: they're shedding so forking much virus, I mean bacteria. Oh shoot,
Speaker 2: that's embarrassing. How many times do you think I've said virus?
Speaker 2: I don't think you have, Okay, So once you have
Speaker 2: people who are ill in a specific they are shedding
Speaker 2: so forking much bacteria that if you don't have proper sanitation.
Speaker 2: For example, if you're living in London in eighteen fifty.
Speaker 1: Or many places today, right, if.
Speaker 2: You're say, pooping in a river and then drinking from
Speaker 2: that river downstream, or even if you you know, have
Speaker 2: like an outhouse or something, but that hole is near
Speaker 2: a well or upstream of a river, you're just spreading
Speaker 2: that infection like wildfire. What else do you want to know?
Speaker 2: So treatment for cholera, well, the good news is that
Speaker 2: treatment for cholera color is a very treatable disease. So
Speaker 2: the World Health Organization basically calls for oral rehydration solution,
Speaker 2: which is just like salty, sugary water gatorid kind of. Yeah,
Speaker 2: pretty much, they have like a proprietary blend. I'm sure
Speaker 2: i v iv if for severe infections definitely need treatment
Speaker 2: up to like six liters in the first day. Severe
Speaker 2: cases might need more than that, so it's quite a
Speaker 2: lot of liquid that you need. Generally, they don't reckon
Speaker 2: antibiotics except in super severe cases, primarily because a antibiotics
Speaker 2: are wiping out all of the good bacteria in your gut,
Speaker 2: which can make it so that you're very susceptible to
Speaker 2: other potentially more serious diseases.
Speaker 1: Well, and cholera has kind of done that, Like if
Speaker 1: you have a severe infection of cholera, it pretty much
Speaker 1: has taken over your entire intestine right way.
Speaker 2: Yeah, And the other thing is that because this is
Speaker 2: a bacteria that can persist in the environment, antibiotic resistance
Speaker 2: is a real concern.
Speaker 1: And it's really kind of cool that it can be
Speaker 1: treated with just rehydration there, right.
Speaker 2: Yeah, it's generally like a fairly short course of disease.
Speaker 2: The severe cases without treatment, fatality rate is about fifty percent.
Speaker 2: With treatment it can be as low as one percent,
Speaker 2: which is amazing.
Speaker 1: What about a vaccine?
Speaker 2: So there is an oral cholera vaccine. There are actually
Speaker 2: three different types of ocvs, and who does have a
Speaker 2: stockpile of these in case of severe outbreaks and emergencies,
Speaker 2: which we'll probably talk more about when we talk about
Speaker 2: what's happening with cholera today.
Speaker 1: That's good that there's a vaccine.
Speaker 2: Yeah, it's great.
Speaker 1: Do you know anything about whether it provides long term?
Speaker 2: As far as I know, it's not long term, but
Speaker 2: it is short term, and so that's why it's generally
Speaker 2: used in case of outbreaks.
Speaker 1: Yeah.
Speaker 2: So, I mean I feel like that's pretty much the
Speaker 2: biology of cholera? Am I right?
Speaker 1: You better be?
Speaker 3: I hope, I am.
Speaker 1: So can I tell you about the history? Then?
Speaker 3: Oh?
Speaker 2: I cannot forking?
Speaker 1: Wait, Okay, it's a good one. Good. I mean they're
Speaker 1: all good. Well, yeah, but this is a good one.
Speaker 2: It's a I think, as we are both epidemiologists, this
Speaker 2: is especially close to our heart. Am I right?
Speaker 1: Yeah, because you can't really talk about the history of
Speaker 1: cholera without talking about the birth of epidemiology as a field.
Speaker 1: The struggle for germ theory to prevail over my asthmatism,
Speaker 1: which is Okay, this word is miasmatim. I'm not saying
Speaker 1: my asthma. Just fyi, it's not my asthma. Yeah. And
Speaker 1: also the role that modern sanitation practices have played and
Speaker 1: continue to play in reducing disease burdens.
Speaker 2: Yeah, definitely huge.
Speaker 1: But let's start a little more simply than that. Let's
Speaker 1: start with what we know about the origins of the
Speaker 1: bacterium itself. Since cholera doesn't leave any physical mark on
Speaker 1: the body that would remain after death, you can't really
Speaker 1: detect it and skeletal remains the way that researchers have
Speaker 1: been able to with like leprosy and smallpox, what else
Speaker 1: we've mentioned.
Speaker 2: I had never thought about that. Yeah, that is so interesting.
Speaker 1: It's really cool to look at how you can trace
Speaker 1: the physical evidence of certain bacteria, because this means that
Speaker 1: we have to rely more on ancient texts and writings
Speaker 1: which may or may not refer to the same disease
Speaker 1: that we call coller today.
Speaker 2: Oh that's so interesting.
Speaker 1: Yeah, it makes the history of cholera a little murky.
Speaker 2: Oh, just like.
Speaker 1: The first mention of cholera comes from the father of
Speaker 1: western medicine himself, Hippocrates, in around five hundred BC, he
Speaker 1: uses the word cholera to describe an intestinal illness that
Speaker 1: causes diarrhea. In fact, it's thought that the word cholera
Speaker 1: itself comes from the Greek word for gutter kalidra. Yeah. Yeah, yeah,
Speaker 1: that's so cool. So he may have chosen this word
Speaker 1: cholera to describe the way poop water gushes out of
Speaker 1: you if you have cholera, Oh my god, like the
Speaker 1: way water gush is out of a gutter. Wow. There
Speaker 1: are some other loose mentions of cholera prior to the
Speaker 1: eighteen hundred. Your puns are killing me right now, But
Speaker 1: any that were written outside of India were probably just
Speaker 1: using the term cholera to refer to any die real disease. Okay.
Speaker 1: It would be like saying, oh, man, I ate taco
Speaker 1: bell last night, and I've had cholera all day.
Speaker 2: To day, every time, every time.
Speaker 1: So it wasn't until the early eighteen hundreds that the
Speaker 1: word cholera was directly linked to one disease caused by
Speaker 1: one organism, the cholera bacterium. Cool. Yeah, eighteen hundreds, eighteen hundred.
Speaker 2: From Hippocrates to the eighteen hundreds.
Speaker 1: It was just in the Indian subcontinent. Interesting in fact,
Speaker 1: until eighteen seventeen, cholera was confined entirely to India.
Speaker 2: Wow, when it.
Speaker 1: Would pop up occasionally and cause an epidemic, particularly during
Speaker 1: religious pilgrimages.
Speaker 2: Wonder why I wonder?
Speaker 1: Oh, I'm about to tell you, because during these pilgrimages
Speaker 1: there would usually be a lot of people in a
Speaker 1: very small place, and so a disease like cholera, which
Speaker 1: relies on high population density, can really take hold and
Speaker 1: tear through a population.
Speaker 2: Just thousands of people shedding trillions at bacteria and they drinking.
Speaker 1: Water per gram.
Speaker 2: Yeah, per gram. Isn't that crazy.
Speaker 1: That's a lot of that's a lot of poop. It
Speaker 1: explains why it spread so rapidly. Really, the world in
Speaker 1: eighteen seventeen was pretty perfect in terms of opportunities for
Speaker 1: color pandemics.
Speaker 2: So you were just going to leave it at perfect.
Speaker 2: I was like pretty perfect.
Speaker 4: I mean, yeah, women had the right to vote everywhere,
Speaker 4: Global population density was higher than it had ever been
Speaker 4: in eighteen seventeen, and trade routes were really well established.
Speaker 1: So basically bringing the furthest reaches of the world to
Speaker 1: the doorstep. You know, you could go anywhere, much more
Speaker 1: rapidly than you ever had before or ever could before.
Speaker 1: But something happened in eighteen seventeen to tip the scales
Speaker 1: from colera epidemic to color a pandemic. Maybe one or
Speaker 1: two colera victims hitched a ride on a ship or
Speaker 1: a caravan heading east. Who knows, and they continue to
Speaker 1: shed the collar of bacteria even if they felt okay.
Speaker 2: Can you remind us the difference between an epidemic and
Speaker 2: pandemic for those people who maybe haven't listened to every
Speaker 2: one of our episodes.
Speaker 1: Basically all the difference between epidemic and pandemic has to
Speaker 1: do with spatial scale, So epidemic is a lot smaller
Speaker 1: regional outbreak, and epidemiologists tend to define pandemic as being
Speaker 1: either countrywide or global multiple countries. Yeah. In any case,
Speaker 1: Cholera raged for the next seven years in India, China,
Speaker 1: the Philippines, Mediterranean countries, et cetera, all of which had
Speaker 1: probably except for India, had never seen the disease before.
Speaker 2: Oh Man, so no immunity, no immunity.
Speaker 1: People were dying all over the place. It was really bad.
Speaker 1: And this marked the start of the first of seven
Speaker 1: cholera pandemics that historians and epidemiologists describe, and they would
Speaker 1: happen one right after the other pretty much in all
Speaker 1: corners of the world. Yeah, I'm not sure how they
Speaker 1: defined like the edges.
Speaker 2: I was trying to find that too, and I couldn't.
Speaker 1: So. I mean, so we're currently in the seventh pandemic
Speaker 1: right now, and that started a little bit later, which
Speaker 1: we'll get into more later in the episode. The rest
Speaker 1: of them were sort of almost separated by a year
Speaker 1: or two. How could you say?
Speaker 2: I wonder if it's just that if reports dropped below
Speaker 2: a certain level, then they considered that epidemic or pandemic
Speaker 2: over and then the next one started or whatever.
Speaker 1: I mean, that could be it. It's not like we're
Speaker 1: eputy me all just start anything.
Speaker 3: What we are.
Speaker 1: During the third pandemic in Walks. One of the heroes
Speaker 1: of this story.
Speaker 2: Could just keep going. I'll saying it, John Snow.
Speaker 1: No, this is not fantasy disease ecology crossover fan fiction.
Speaker 2: Oh that'd be great though, I mean, let's start it.
Speaker 1: This dude's name really was John Snow, but this John
Speaker 1: Snow was an English physician being in London in eighteen
Speaker 1: fifty four when a cholera epidemic broke out. Ooh, allow
Speaker 1: me to set the stage for you, Aerin.
Speaker 3: Thanks.
Speaker 1: Okay, close your eyes closed. It's eighteen fifty four.
Speaker 2: Okay, I'm probably wearing like a large dress and a corset.
Speaker 1: You probably smell really bad because bathing.
Speaker 2: Was never showered.
Speaker 1: Yeah, never showered. You're living in London, Oh, I might,
Speaker 1: along with two point five million other people. Okay, let
Speaker 1: me give it. Let me give a little perspective. The
Speaker 1: population of London today is eight point seven oh million.
Speaker 2: Okay, so just a few friends and I.
Speaker 1: Yeah, but the city has never been bigger in terms
Speaker 1: of population density, and as a result, it's been unable
Speaker 1: to keep up with the rapid population waste output. Oh yeah,
Speaker 1: and there's no solution. The vast majority of people were
Speaker 1: just tossing out their poop, their food scraps, and their
Speaker 1: dead pets or other animals into open cesspools that led
Speaker 1: to the sewer, which was often right next to a
Speaker 1: water pump. Oh, I got not a water pump for
Speaker 1: drinking water. I really appreciate that.
Speaker 2: Thinks I was just trying to get in the mood.
Speaker 1: Also, horse poop was everywhere.
Speaker 2: Oh god.
Speaker 1: Yeah. The waste problem of London and other populous cities
Speaker 1: at the time was so enormous that there was an
Speaker 1: entire industry based on sorting through the stuff that got
Speaker 1: tossed out. Wow, bone pickers.
Speaker 2: I was gonna say pickers, So that's pretty close.
Speaker 1: Bone pickers.
Speaker 2: Yeah, night soil men, oh, just shoveling through the poop.
Speaker 1: They would collect the poop and then use it for fertilizer.
Speaker 1: Cool sewer hunters. These were actual names.
Speaker 2: I feel like I could be a sewer hunter.
Speaker 1: Yeah, you could be.
Speaker 2: I feel like I feel like that's a profession that
Speaker 2: I could do.
Speaker 1: Would you want to?
Speaker 2: I don't know.
Speaker 1: Well, you can be just kidding.
Speaker 2: Yeah.
Speaker 1: So and that that was just to name a few.
Speaker 1: There were many more like in that same ilk.
Speaker 2: Wow.
Speaker 1: If you were to travel back in time to this London,
Speaker 1: the first thing you would notice was the putrid, pervasive
Speaker 1: smell of rotten filth.
Speaker 2: Oh god.
Speaker 1: And this London is the London that our hero John
Speaker 1: Snow experienced every day as he walked to patient's houses.
Speaker 2: Wow.
Speaker 1: Like the John Snow of HBO, this John Snow was
Speaker 1: also quiet and methodical, and he was also really curious.
Speaker 2: Did he have a great jawline?
Speaker 1: No, he didn't. Does the John Stow HBO? Yeah? Does he?
Speaker 2: Oh my god, yeah, I feel.
Speaker 1: Like he always has facial hair covering it.
Speaker 2: In the early episodes he just had little wispys. He's
Speaker 2: got a good jawline, all right.
Speaker 1: Anyway, while the epidemic, the color epidemic was raging, John
Speaker 1: Snow set out to do some detective work to see
Speaker 1: if he could track the pattern of spread to see
Speaker 1: where the outbreak originated and out he went, notebook and
Speaker 1: pen in hand doing so, uh, what do you call it?
Speaker 1: A cheerio?
Speaker 2: Mike? Can I get a sample of your poop? Their love?
Speaker 1: Kind of like that, kind of like that, but also
Speaker 1: shoe leather epidemiology, which is what it's a true it's
Speaker 1: actually like a real term. It's what people say to
Speaker 1: do when they do on the ground epidemiology.
Speaker 2: Yeah.
Speaker 1: So, when he went out to try to figure out
Speaker 1: what the cause of this outbreak was, what he was
Speaker 1: doing was interviewing people who had any sort of experience
Speaker 1: with cholera during that time, and what he was looking
Speaker 1: for was a common thread in all of their stories
Speaker 1: to see if he could find the cause of this
Speaker 1: horrible disease, and why was he so interested in this?
Speaker 2: What poop poop everywhere?
Speaker 1: Because he loved poop.
Speaker 3: Uh No.
Speaker 1: At the time, the prevailing thought was that all disease
Speaker 1: was spread by my asthma m ias ma, not my asthma,
Speaker 1: which is in other words, unpleasant atmosphere. This was what
Speaker 1: scientist physicians thought at the time caused all disease. The
Speaker 1: wind blew in the wrong way today, the foul I
Speaker 1: can't do.
Speaker 2: A British accent. I should stop trying. Maybe, I don't know,
Speaker 2: I should really stop it.
Speaker 1: It's better than I could ever do.
Speaker 2: I was like really trying really hard to think of
Speaker 2: something to say there, and I just I'm gonna, yeah, we're.
Speaker 1: Losing all listeners in the UK. Sorry loves Oh goodness. Yeah. So, basically,
Speaker 1: miasthmatists were people who believed that my asthma was what
Speaker 1: spread disease, and they thought that epidemics could be caused
Speaker 1: by the right weather conditions or proximity to the foul
Speaker 1: smell coming from the sewer. My asthma or my asthmatism
Speaker 1: to disease biology is kind of like astrology to personality psychology.
Speaker 1: It has it has a whiff of science. It has
Speaker 1: a whiff of science in its logic, but is mostly
Speaker 1: based in nonsense. Yeah, but the logic of miasthmatism didn't
Speaker 1: quite make sense to snow at least who recognize that
Speaker 1: the rate of disease wasn't any higher in the people
Speaker 1: you'd expect it to be, like the people who spent
Speaker 1: so much time in the filth, such as bone pickers,
Speaker 1: night soil men, etc.
Speaker 2: Which is interesting when you think about it, just because
Speaker 2: they were probably getting so much poop water on their
Speaker 2: hands that it could have been that they had higher
Speaker 2: rates of disease just from being exposed. But I guess
Speaker 2: when you have exposure just across all boards then it's
Speaker 2: kind of it washes out well.
Speaker 1: Or they could have been exposed in low enough dosages.
Speaker 1: That's very true that they would have had an increased resistance.
Speaker 2: Yeah, that's true. Good point.
Speaker 1: Instead, though the disease seemed to strike somewhat randomly. Entire
Speaker 1: families would be wiped out in some houses, seriously entire families,
Speaker 1: but others would be completely unscathed. To try to make
Speaker 1: sense of this, he mapped out the cases, which is
Speaker 1: not the first time that maps had been used to
Speaker 1: study disease. But it was one of the most remarkable.
Speaker 2: I don't think I knew that. I thought that was
Speaker 2: like I thought so too. It was like the John
Speaker 2: Snow went his maps. It was like a big deal
Speaker 2: in all of our classes.
Speaker 1: It is a big deal because of some of the
Speaker 1: techniques he used. Yeah, but there were maps that had
Speaker 1: been used by the miasmontist at the time to show, oh, cases.
Speaker 2: Up on this hill versus down in this valley, and
Speaker 2: that kind of a thing, especially for malaria.
Speaker 1: Right right. And so when he looked at the map,
Speaker 1: he saw a geographical component for sure, with most of
Speaker 1: the cases appearing in a certain neighborhood. But it was
Speaker 1: the anomalies that struck out to him. A woman across
Speaker 1: town who died during the peak of the epidemic with
Speaker 1: no other cases around her. A brewery smack dab in
Speaker 1: the area with the highest prevalence, but without any cases
Speaker 1: at the brewery itself. Oh yeah, what was going on?
Speaker 2: What was going on?
Speaker 1: Wow? During his interviews, Snow gathered info on daily habits
Speaker 1: of those afflicted with cholera, including where they got their water.
Speaker 1: You see, in eighteen fifty four, there was no indoor
Speaker 1: plumbing in London, and people got their water from public
Speaker 1: water pumps, some of which had a better reputation than others.
Speaker 1: The pump on broad Street was considered to be one
Speaker 1: of the higher quality pumps.
Speaker 2: I'm just feeling so excited, but because this is such
Speaker 2: a fun.
Speaker 1: Story, and some people went out of their way to load.
Speaker 2: Up on the sweet, sweet.
Speaker 1: Tasting water from the Broad Street pump. Unfortunately for them,
Speaker 1: because that's where all the colera came from. In his interviews,
Speaker 1: Snow heard Broad Street mentioned over and over again, and
Speaker 1: sure enough, when he marked the side of the Broad
Speaker 1: Street pump on his case map, he was basically marking
Speaker 1: the epicenter of the outbreak. Yeah, with cases just spilling
Speaker 1: out from there.
Speaker 2: It's so cool.
Speaker 1: Well, all told, seven hundred people living within two hundred
Speaker 1: and fifty yards of the Broad Street pump had died.
Speaker 2: Seven hundred people.
Speaker 1: Seven hundred people within two hundred and fifty yards.
Speaker 2: Wow.
Speaker 1: And on Broad Street itself, the population had literally been decimated.
Speaker 1: Ninety of its nearly nine hundred residents died.
Speaker 2: That's ten percent.
Speaker 1: Yeah, decimated, dang wow. Yeah. And the anomalies he noticed, well,
Speaker 1: the lone case far away from the pump was a
Speaker 1: woman whose sons brought her Broad Street water every week,
Speaker 1: as it was her favorite.
Speaker 2: Oh yeah, isn't that more lady, and her son's just
Speaker 2: trying to be nice. Yeah, I'll bring you the best water, mama.
Speaker 2: That was better. That was better.
Speaker 1: I don't think Snow told them eventually, I mean, which
Speaker 1: is probably a kindness. Yeah.
Speaker 2: Probably.
Speaker 1: And the workers at the brewery they never drank water
Speaker 1: during their shift, only beer.
Speaker 2: Oh that's the moral of our story.
Speaker 1: Yeah. And so Snow took his findings to the Board
Speaker 1: of Governors, who, actually, I was shocked about this, did
Speaker 1: something about it. They ordered that the handle of the
Speaker 1: Broadstreet pump be removed. Of course, by the time they
Speaker 1: actually removed it, it was pretty much over the epidemic. Still,
Speaker 1: it was a victory for germ theory that marked the
Speaker 1: birth of epidemiology, which is, as we've mentioned before, the
Speaker 1: study of patterns of disease and populations. So you would
Speaker 1: think that by removing the handle of the pump, they were,
Speaker 1: you know, acknowledging that maybe John Snow was right about something.
Speaker 2: Yeah, I mean he was the king in the North
Speaker 2: after all, I mean, yeah, north of London.
Speaker 1: Ben the knee ben the knee pe to germ theory.
Speaker 2: Oh that was good. It's terrible. That was on the fly,
Speaker 2: I know it.
Speaker 1: Yeah it was, and they probably agreed that. Yeah, cholera
Speaker 1: was transmitted by drinking contaminated water. John Snow was almost
Speaker 1: pretty much unique. Yeah in his assertion that that was
Speaker 1: how it was transmitted. But like Circe Lanister of Season
Speaker 1: seven Game of Thrones, they remained firm in their denial.
Speaker 1: Oh my god, cholera was transmitted by foul air slash.
Speaker 1: White Walkers weren't a real threat. I had to dig
Speaker 1: deep for that one.
Speaker 2: That was good.
Speaker 1: It wasn't until a couple of decades later that Snow
Speaker 1: would be vindicated, or until next season for the other
Speaker 1: John Snow we anticipate.
Speaker 2: I just can't wait.
Speaker 1: Oh it's like two years from now.
Speaker 2: Yeah yeah. Yeah.
Speaker 1: Sadly, Snow the epidemiologist would not live to witness his vindication.
Speaker 2: Oh yeah, does he die of cholera? No, too bad.
Speaker 1: He died of a stroke at the age of forty five.
Speaker 2: Oh dear.
Speaker 1: When the causative agent of cholera was described in eighteen
Speaker 1: eighty three, the germ theory had taken its rightful place
Speaker 1: on the iron throne of disease.
Speaker 2: Biology, never going to stop. Nope.
Speaker 1: And there were still though a few, more than a
Speaker 1: few miasmatists lingering on, and one of them pent and
Speaker 1: Coffer drank an entire flask of cholera bacteria to prove
Speaker 1: that it wasn't the causative agent of the disease.
Speaker 2: Did he die? Did he die?
Speaker 1: Unfortunately?
Speaker 2: No?
Speaker 1: No, he didn't get sick, probably though, because he had
Speaker 1: cholera as a youth, and so it didn't matter really
Speaker 1: either like.
Speaker 2: A mild or an asymptomatic infection. Probably so he might
Speaker 2: have killed somebody else by pooping into dirty water, his
Speaker 2: bacteria filled poop. That's a great guy.
Speaker 1: What was the same car Corf Pentan Coffer Coffer. Either way,
Speaker 1: though jerom theory had won, that guy is not. There's
Speaker 1: nothing that that guy could actually have done. And pent
Speaker 1: And Coffer met his death in a very game of thrones. Way,
Speaker 1: oh maybe I don't know if it's that game of thrones.
Speaker 1: After realizing that his entire scientific career was based on
Speaker 1: a fallacy because he spent so much energy promoting my asthmatism,
Speaker 1: he killed himself.
Speaker 2: Oh now I feel really bad. Yeah, he's sad.
Speaker 1: Yeah, that's really sad.
Speaker 2: On a happier note, I don't know if you were
Speaker 2: going to mention this, but I'd just like to point
Speaker 2: out for all the fans out there that you can
Speaker 2: visit the Broadstreet Pump.
Speaker 1: Yes you can.
Speaker 2: There is a little monument to John Snow there and
Speaker 2: I want to go so badly. If you've been there
Speaker 2: or if you live near there, can you like tweet
Speaker 2: us a picture because it's one of my favorite things.
Speaker 1: That would be incredible.
Speaker 2: I love it.
Speaker 1: Bucket list, bucket Lets not poop bucket list.
Speaker 2: Night soiled bucket list.
Speaker 1: Okay, back to cholera. Linking the spread of cholera to
Speaker 1: unclean water was a huge motivator for developing sewage systems,
Speaker 1: and in wealthier countries, the disease pretty much disappeared.
Speaker 2: Wow.
Speaker 1: Yeah, this the eighteen fifty four epidemic in London marked
Speaker 1: one of the last real epidemics in that area.
Speaker 2: That's awesome.
Speaker 1: Yeah, because they were able to isolate the reason why
Speaker 1: it was being transmitted and stop that.
Speaker 2: That's great news.
Speaker 1: Tea drinking also may have helped what boiled water. Oh
Speaker 1: isn't that crazy?
Speaker 2: That's really cool. Yeah, just like beer, Just like beer.
Speaker 1: On a sad note, the problem of waste management does
Speaker 1: not belong in the past by any.
Speaker 2: Means, definitely not.
Speaker 1: There are many economically poor countries today that are still
Speaker 1: struggling with waste disposal and sanitation practices where diseases such
Speaker 1: as cholera are still very prevalent. Yeah, And in these places,
Speaker 1: it's kind of like a positive feedback loop. So these
Speaker 1: countries are unable to maintain or build adequate sanitation infrastructure
Speaker 1: because of the expense, and then cholera can take hold
Speaker 1: more easily, which then reduces people's ability to work, which
Speaker 1: then further destabilizes the economy. So cholera gets worse, and
Speaker 1: so on and so on.
Speaker 2: Ye cycles, cycles, cycle cycles.
Speaker 1: So Erin, I'm guessing that you've got some stuff to
Speaker 1: tell me about where we stand with cholera today.
Speaker 2: I sure do.
Speaker 1: So.
Speaker 2: As you mentioned, we're basically currently in what is considered
Speaker 2: the seventh pandemic of cholera. So all the cholera in
Speaker 2: the world today can actually be traced back to a
Speaker 2: single origin that happened in nineteen sixty one. And so
Speaker 2: my guess is that for most of our listeners when
Speaker 2: they hear the word cholera today in twenty seventeen, they
Speaker 2: probably think Haiti.
Speaker 1: Yeah, I do.
Speaker 2: And it's likely because one of the most publicized outbreaks
Speaker 2: of cholera in recent history happened in Haiti in twenty ten.
Speaker 2: And if you haven't heard of it, or even if
Speaker 2: you have, this outbreak happened pretty directly as a result
Speaker 2: of UN peacekeepers who came to Hayda after the devastating
Speaker 2: earthquake that happened in January of twenty ten. And these
Speaker 2: peacekeepers had come from Nepal, where an outbreak of cholera
Speaker 2: had been happening, and they brought it with them.
Speaker 1: Oh okay, I was wondering where they came from. Yeah,
Speaker 1: that had cholera.
Speaker 2: Okay, So, So coolera has been endemic in Nepal for
Speaker 2: a very long time, in the whole Yeah, that whole region.
Speaker 2: And so the UN still hasn't technically admitted that they
Speaker 2: were responsible, really, even after epidemiological research and molecular strain
Speaker 2: typing of the cholera bacteria has pretty conclusively shown that
Speaker 2: that is where this epidemic came from. They did issue
Speaker 2: an apology in December of last year about the way
Speaker 2: that they handled Haiti after the earthquake.
Speaker 1: That kind of sounds like.
Speaker 2: But yeah, I'm sorry that you were hurt.
Speaker 1: By what I said.
Speaker 2: Yeah, that's kind of how like they didn't directly take
Speaker 2: the blame for it. But anyways, that's probably a story
Speaker 2: for it. In the outbreak in Haiti, which to be clear,
Speaker 2: is not over. It's still going on. Cholera is still
Speaker 2: a problem today. Over nine thousand people since twenty ten
Speaker 2: have died, and over seven hundred thousand people, which is
Speaker 2: about seven percent of the population of Haiti, have been sickened.
Speaker 2: They're averaging the stat that I saw is that to
Speaker 2: this day they're averaging thirty seven people a month dying
Speaker 2: from cholera.
Speaker 1: Oh my god.
Speaker 2: And if you think of all of the hurricanes and
Speaker 2: everything that have been happening in the Caribbean at this time,
Speaker 2: like because cholera is a disease that is very strongly
Speaker 2: associated with contaminated sources of drinking water and lack of sanitation.
Speaker 2: Any time that you see destabilization of infrastructure, whether that's
Speaker 2: due to natural disasters or war man made conflicts, you
Speaker 2: see outbreaks of diseases such as cholera. Right today or
Speaker 2: in twenty fifteen, rather, since that's the most recent stats
Speaker 2: that the WHO had on their website for two trees
Speaker 2: reported one hundred and seventy two thousand cases of cholera
Speaker 2: that resulted in one three hundred and four deaths in
Speaker 2: twenty fifteen, in one year. Okay, But what's really astonishing
Speaker 2: to me, especially in doing this research, is that estimates
Speaker 2: of how many cases there actually are two point nine million.
Speaker 1: Interesting. Yeah, so, and this has to do with asymptomatic
Speaker 1: cases or so it's probably seeking treatment, probably both.
Speaker 2: So, probably there are some asymptomatic cases, but a lot
Speaker 2: of it has to do with a lack of surveillance
Speaker 2: and a lack of reporting in a lot of areas.
Speaker 2: You also, because this is a disease that can strike
Speaker 2: so rapidly, you can have people falling ill and dying
Speaker 2: in remote areas long before they have time to get
Speaker 2: to a hospital facility or anything like that. Estimates of
Speaker 2: the number of deaths that likely happen each year due
Speaker 2: to cholera are ninety five thousand. WHOA Yeah, And this
Speaker 2: information is from a paper that used mathematical modeling and
Speaker 2: a bunch of disease data to make these estimates. So
Speaker 2: they estimate that it's actually happening, that cholera is likely
Speaker 2: endemic in about sixty over sixty countries, not just the
Speaker 2: forty two that actually report it. And the estimates range
Speaker 2: from one point four to four million cases per year. Wow,
Speaker 2: and between twenty one thousand to one hundred and forty
Speaker 2: three thousand deaths. WHOA, Yeah, I mean it's a really
Speaker 2: big range because this is there's not super great data
Speaker 2: from a lot of places. But still, but still, it's
Speaker 2: definitely a lot more than the one thousand deaths that
Speaker 2: are actually reported.
Speaker 1: Yeah.
Speaker 2: So, in addition to estimating the number of cases of cholera,
Speaker 2: this study also looked at what the most important risk
Speaker 2: factors were. My voice correct, I noticed that, Yeah, unsexed post.
Speaker 2: Oh thanks, thanks, appreciate it. But unsurprisingly, the two most
Speaker 2: important risk factors. Do you want to guess what they are?
Speaker 2: The two most important risk factors for cholera in a country.
Speaker 1: I think I'm going to try.
Speaker 2: Okay, sanitation, definitely, water infrastructure, access to exactly the percentage
Speaker 2: of the population without sustainable access to improved sanitation and
Speaker 2: improve drinking water sources. And blood type and not blood type.
Speaker 1: But there are there are differences in susceptibility to cholera
Speaker 1: with different blood types.
Speaker 2: Right, Weirdly, Yeah, what blood type you are can actually
Speaker 2: affect the likelihood that you get infected with cholera and
Speaker 2: how severe the case is once you are infected. That's
Speaker 2: so weird, it's super weird. So people who are blood
Speaker 2: type OH like me, like me, I'm abe you're so rare,
Speaker 2: I'm so common. So people who are type OH are
Speaker 2: less likely to get infected with cholera, which sounds great,
Speaker 2: uh huh, But if they get infected, they actually are
Speaker 2: much more likely to have severe symptoms. Okay, that's a bummer,
Speaker 2: it's a bummer. Yeah. So what's cool is that in
Speaker 2: some parts of the world, for example, in the Ganges
Speaker 2: River delta, where cholera is endemic and has been for
Speaker 2: a very long time, you see a very very low
Speaker 2: prevalence of people who are blood type OH.
Speaker 1: Interesting.
Speaker 2: So one hypothesis is that this is at least in
Speaker 2: part because there is selection against this blood type because
Speaker 2: it's associated with higher risk of severe symptoms.
Speaker 1: I've always wondered about the geographical distribution of blood types.
Speaker 2: It's really interesting. We were just looking at maps of
Speaker 2: that like, yeah, it's so weird that there's I had
Speaker 2: no idea there was such a range in distribution that's huge.
Speaker 2: And so in Latin America, for example, there's a really
Speaker 2: high prevalence of blood type. Oh, so all of like
Speaker 2: North and South America is like really high prevalence of
Speaker 2: blood type. Oh, and so we see much more severe
Speaker 2: disease due to cholera. You have greater need for rehydration
Speaker 2: treatment and much greater rates of hospitalization. WHOA, yeah, it's
Speaker 2: really interesting.
Speaker 1: That is really fascinating. Yeah, So how worried do we
Speaker 1: need to be about cholera?
Speaker 2: It's a good question.
Speaker 1: It's a tricky one.
Speaker 2: It's a tricky one. I would say overall, the biggest
Speaker 2: thing that we can do to prevent and majorly reduce
Speaker 2: the burden of cholera is improve access to sanitation and
Speaker 2: water worldwide. And that's something that's very doable. It just
Speaker 2: honestly takes investment, you know, right to make that happen.
Speaker 1: People on the ground going out and trying to help
Speaker 1: create clean water sources exactly. The Gates Foundation is big
Speaker 1: and trying to do that.
Speaker 2: There are a lot of organizations that are doing that
Speaker 2: that I wish I had looked up the names of
Speaker 2: all of them. So maybe what we'll do is post
Speaker 2: on our Facebook page some of the organizations that are
Speaker 2: doing really great work on both sanitation and water improvement.
Speaker 1: The Carter Center, which last episode I kept saying was
Speaker 1: the Carter Foundation. I was confusing with the Gates Foundation.
Speaker 1: It's pretty close actually, the Carter Center. They also do
Speaker 1: a lot of work in terms of reducing the burden
Speaker 1: and neglected tropical diseases in countries.
Speaker 2: Yeah, so yeah, I say overall, cholera definitely is still
Speaker 2: prevalent in a lot of parts of the world. It's
Speaker 2: still something that's killing people every day, and it doesn't
Speaker 2: need to be, which is what's really sad about it
Speaker 2: is that it is treatable and it's preventable.
Speaker 1: Could it be eradicated?
Speaker 2: That's a really good question. It's an interesting question. I
Speaker 2: don't know, to be honest, because it can persist in
Speaker 2: the environment. I think it would be really really hard.
Speaker 2: There are some interesting therapies out there that we don't
Speaker 2: have time to get into that could make a really
Speaker 2: big dent, because in theory, if you could eliminate this
Speaker 2: bacteria phase from the cholera then you're not going to
Speaker 2: be having symptomatic infections, so then it just becomes another
Speaker 2: microbe in your gut. Okay, But because it does persist
Speaker 2: in the environment, it's a disease that would be very,
Speaker 2: very difficult to eradicate. I do think we could certainly
Speaker 2: reduce the disease burden and the mortality rate to basically zero. Right,
Speaker 2: maybe that happened in our lifetime. Who knows.
Speaker 1: Wouldn't that be wonderful?
Speaker 2: It would be really wonderful.
Speaker 3: Is that it? What books did you read?
Speaker 1: Okay?
Speaker 2: This week?
Speaker 1: I've got a few. If you want a big overview
Speaker 1: of cholera itself, there's a book called Cholera the Biography
Speaker 1: by Christopher Hamlin. And if you want to learn more
Speaker 1: about the non HBO john snow, you should check out
Speaker 1: The Ghost Map by Stephen Johnson. It's a pretty thrilling
Speaker 1: book actually about the race to try to find out
Speaker 1: what was the cause of cholera, the quite frankly shocking
Speaker 1: pushback from the miasmatists about germ theory. And also in
Speaker 1: the Ghost Map is where the quote from the beginning
Speaker 1: of this episode came from a couple of other places
Speaker 1: that I looked for info is The Power of Plagues
Speaker 1: by Irwin Sherman and The Cambridge History of Human Disease
Speaker 1: by Kenneth Kipple. And a bonus is Love and the
Speaker 1: Time of Cholera by Gabrielle Garcia Marcuz, which is a
Speaker 1: great fiction book.
Speaker 2: And most of the information about the biology of cholera
Speaker 2: I got from this really interesting paper called Cholera Transmission,
Speaker 2: the Host, Pathogen and Bacteria phage Dynamic by Neilson at
Speaker 2: All in Nature Reviews Microbiology that was published in two
Speaker 2: thousand and nine. It's a really nice review paper, and
Speaker 2: there's a bunch of other ones out there as well.
Speaker 2: And most of the data about the mathematical modeling to
Speaker 2: estimate the actual burden of cholera worldwide comes from the
Speaker 2: article Updated Burden of Cholera and Endemic Countries and that
Speaker 2: was in the Journal Plus Neglected Tropical Diseases that was
Speaker 2: published in twenty fifteen by Ali at All, so you
Speaker 2: can find that.
Speaker 1: Before we go, I thought of the most brilliant idea
Speaker 1: to me. Kit Harrington, who plays John Snow in HBO's
Speaker 1: Game of Thrones, needs to play John Snow, the epidemiologist
Speaker 1: in a.
Speaker 2: Biopic that would be really funny.
Speaker 1: I'm serious.
Speaker 2: I mean, are you listening, kit, Are.
Speaker 1: You listening screenwriters everywhere?
Speaker 2: Yeah, I mean we gave you this. We gave you
Speaker 2: a plug last episode, you know, the Smallpox movie. We're
Speaker 2: basically doing your jobs for you.
Speaker 1: Yep, yep, you're welcome. Welcome, and speaking of more, thanks
Speaker 1: and welcomes. Thank you to Bloodmobile, who provided the music
Speaker 1: for this and all of our episodes.
Speaker 2: Yep, thanks, you're the best Bloodmobile, and.
Speaker 1: Also a big thank you to the band Cholera, who
Speaker 1: let us use their song The Answer to Infection as
Speaker 1: the fade out song at the end of this episode.
Speaker 1: It's awesome. You guys should totally check them out.
Speaker 2: Just wait for it. It's so good.
Speaker 1: Once again, rate review and subscribe.
Speaker 2: Yep, we'll do it again. We'll tell you more, and
Speaker 2: thanks so much for listening. We hope you are having
Speaker 2: fun because we are. Wash your hands, you filthy animals.