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INSTRUCTOR 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 (mlh66@cornell.edu) and Eric B. Nelson (ebn1@cornell.edu) Dept. of Plant Pathology and Plant-Microbe Biology Cornell University

Plant Pathology and Plant-Microbe Biology Cornell University ‘The first victim to die of cholera in Sunderland’

‘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. The event is a meeting 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 and epidemiology.

Student role players 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?

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In its recommended format, this RTTP game is 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, students deliver opening statements on the nature and origins of this disease outbreak from the specific standpoint of their assigned character. Active debate follows, and the second of the two sessions concludes with a vote on specific action(s) that St. James Parish can take to deal with the outbreak.

This game immerses students 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). With slight modifications, this game can also be used to achieve secondary scientific objectives highlighting the role of sanitation in modern society and the eventual implementation of municipal water-treatment systems in urban planning.

Students are encouraged to engage in as much independent and team research as they deem appropriate for effective role-playing. Extensive information is available online and in print format. Additional laboratory activities for this game might include allowing students to visualize

“microbes” in liquids using period-specific microscopes. Students may also be given the opportunity to work with original morbidity and mortality data on the outbreak, so as to generate their own figures and 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.

The game is appropriate for biology, microbiology and general science courses and can be implemented for non-majors and science majors at all levels depending on the depth of treatment. It is designed for a class size of approximately 16 students. However, the game can accommodate larger student numbers simply by duplicating character assignments. This strategy also works well to foster collaborative learning and teamwork among players.

This game is in stage 2 development and materials are currently available for restricted use via the RTTP STEM website. The current packet of game materials includes:

1. Initial instructions for instructors and students, detailing relevant resources and offering general insights about how the game may be played.

2. Two-page role sheets depicting sixteen different characters affiliated with one of three factions (Anti-contagionist, Contagionist, Indeterminate).

3. A document of “table tent” nametags for all characters, intended to be printed out on single sheets of cardstock. Two names are included on each sheet. A single vertical cut across the page will produce two halves that can each be folded, again in half, to stand on a table or desk.

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The character names have been color-coded with Red boxes for the Anti-contagionists, Blue boxes for the Contagionists and Green boxes for the Indeterminates.

4. An introductory narrative intended to orient role players to the mindset of a Board member on the night of September 7, 1854.

5. An 1853 Handbill from the Parish of St. James, Westminster providing residents with resources and advice for avoiding Cholera. The specific language in this handbill is helpful discussion material for the role players as they begin their debate.

6. A 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).

7. Two central data figures for distribution 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).

and Cholera mortalities (Farr, W. 1852. Report on the Mortality of Cholera in England, 1848-1849. London:

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GENERAL INSTRUCTIONS FOR INSTRUCTORS

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.

Chapter Five – “Downhill All the Way” In Summers, J (1989). Soho: A History of London's Most Colourful Neighbourhood. London: Bloomsbury Publishing.

Ackerknecht, EH (1948). Anticontagionism between 1821 and 1867. Reprinted in Int J Epidemiol 38: 7-21 (2009).

PLUS specific online resources mentioned on individual role sheets. These suggested resources represent a useful starting point for developing the motivations and viewpoints of individual characters. If students have enough time, they may do additional research beyond these suggestions.

**SPECIAL NOTE**

In their own research, students may 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

Also reproduced online at:

http://www.ph.ucla.edu/epi/snow/snowbook.html

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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 characters of the Vestry Clerk (Mr. George Buzzard), the Committee Chairman (Mr. Frederick Crane) and the Committee Vice-chairman (Mr. Edward Rice) are responsible for conducting the two meetings in a structured fashion. All role players should be capable of following 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.

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B) The Chair will ask committee members if someone will second the motion.

C) If the motion is seconded, then the Chair will put the motion to a vote with no further debate. Otherwise, the motion is declined and debate continues.

D) If the motion is brought to a vote, there will be a three-step procedure:

a. The Chair will first ask for all voting 'yea' or 'in favor' to raise their hands. The Clerk will record the numbers of these votes, as well as all subsequent votes.

b. Next, the Chair and Clerk will ask for all voting 'no' or 'opposed'.

c. Finally, the Chair and Clerk will do the same for abstentions.

E) Based on the vote numbers the Clerk and the Chair will then announce whether the motion passes (is accepted) or fails (is rejected).

This outline is a simplified excerpt of Parliamentary Procedure as detailed in Robert's Rules of Order, and a useful summary is available online at http://www.robertsrules.org/

6. Historical Consistency and the “Rules” of Gameplay

For the purposes of remaining true to the notion and “rules” of historical gameplay, we are limited to the knowledge, ideas and resources that were available in 1854. In certain circumstances, students may justify taking certain liberties. For example, Dr. John Snow’s seminal work On the Mode of Communication of Cholera was published as a second edition in 1855. Students may assume that characters had access to an advance draft; given that Dr. Snow did publish an earlier version of this treatise in 1849, his arguments were known throughout the medical community of the day.

Also, as students develop their characters’ arguments, it will be useful for them to consult the online version of the report by the Cholera Inquiry Committee for relevant supporting material (http://johnsnow.matrix.msu.edu/work.php?id=15-78-AA). It will simply be necessary to disregard any data or events that occurred after September 7, 1854.

7. Cholera Data Manager

Students may be given Dr. Snow's graphical map (showing the locations of individual Cholera mortalities and pump locations on London streets) and original data (as an Excel spreadsheet). There is also an interactive online visualization tool that allows students to manipulate morbidity and mortality data for the neighborhood and the rest of London:

http://www.ppath.cornell.edu/Courses/PLPA2950/PLPA2950_cholera.html

FINAL WORDS

The RTTP approach is designed to be an engaging and challenging means to explore complex issues. It is also creative and unpredictable. Students should be encouraged to embrace the nature of role-playing as enthusiastically as they wish. The role sheets provide the overall context for different characters and their intentions. Beyond these details, students may take the liberty of expanding on any aspect of a character’s personality and backstory. For example, they may adopt any mannerisms, wear any clothing, or develop any backstory that they feel will add to the appeal and/or presence of their character.

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ADDITIONAL COMMENTS TO INSTRUCTORS

A. Student Numbers

This game has been successfully played with up to 32 students, simply by duplicating role assignments. The results were encouraging and only minimally disruptive to game play; obviously, additional time must be spent encouraging character “pairs” to invest in collaborative learning.

In Spring 2013, the authors will be experimenting with game play in the context of a large- enrollment (~400 students) first-year introductory biology class. This document will be updated with additional advice and insights once game play has concluded.

B. Diversity Issues (e.g. Gender, Religion, Socioeconomics, etc.)

Because of the nature of the Cholera game-play scenario, sensitivity should be given toward various diversity issues – particularly relating to the gender roles, overt religious tones and socioeconomic stereotyping that were prevalent in Victorian England.

For example, the authors have had several of our students comment on the facts that all of the characters in the game are male and/or Anglo-Saxon and/or upper class and/or religiously motivated. These circumstances present both serious and subtle challenges for students, and it may be useful to address these challenges explicitly and prior to game play).

C. Initial Gameplay and Guidance to Committee Chairpersons

The characters of George Buzzard, Frederick Crane and Edward Rice are crucial to initiating gameplay and keeping the discussion flowing smoothly. Students with these characters should be coached to a certain extent before gameplay begins, with respect to how the meeting and debate will unfold (refer to Item 5. Parliamentary Procedures and Rules of Order). It is particularly useful to assign specific responsibilities to these characters beforehand (i.e. Buzzard will gavel the meeting to order and initiate a role call; Crane will issue the general directive to the Committee and will call on Committee members one-by-one to give opening statements; for each vote, Rice will tally ‘yeas’ and ‘nays’ and will ensure that rules of order are followed; etc.).

D. The Use of Period Data from John Snow and William Farr

As often as possible, students should be encouraged to examine and question the original data of John Snow, William Farr and other ideological references that are involved in this scenario. Such data are included as a Microsoft Excel spreadsheet and are meant to be used to reproduce figures and evidence upon which character arguments are based. Manipulation of online datasets is also a powerful teaching tool, when it can be utilized effectively.

Simply put, the authors strive to stimulate active debate over trends in actual data and authentic observations from London’s Cholera outbreaks, rather than simply rely on unfounded or unsubstantiated commentary.

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E. The Character of John Snow

A character of John Snow has been designed and tested in game play. However, the authors have found that Snow’s character is such a dominant force in the game that the voices of other characters are marginalized. For this reason, the current version of the game focuses on Committee members and only involves John Snow peripherally. That is, John Snow’s contributions are made “off-stage” and incorporated into gameplay between the two role playing sessions (see description of “Interlude” in Meeting Agenda on the role sheets).

For the additional John Snow character sheet, please contact the authors. However, please be advised that the game, as designed, functions best without the John Snow character.

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version 5A.091613

YOU ARE CHARLES ABBOTT.

Faction: Anti-contagionist Ideological Reference: Thomas Sydenham

Your views on the causes of Cholera are consistent with the historical arguments of Thomas Sydenham, who argued that an ‘epidemic constitution’ results from fluctuating atmospheric conditions and changes in season. This epidemic constitution acts upon an individual’s internal humoral condition, and the influence of the two ultimately determines whether someone falls ill or not.

two ultimately determines whether someone falls ill or not. GENERAL DIRECTIVE: You are a member of

GENERAL DIRECTIVE: You are a member of the special Sanitary Committee of the Board of Governors and Directors of the Poor of St. James Parish. On 14 August 1854, you and your colleagues on the General Board of Governors and Directors of the Poor voted to forgo standard meeting protocols and form this special emergency response committee to address any threat of Malignant Cholera throughout the parish. Collectively, you wield the power and financial backing to make whatever arrangements you deem necessary regarding administrative courses of action, medical responses, future meetings, etc.

REQUIRED READINGS

• Chapter 1 of The Ghost Map by Steven Johnson (2006).

• Chapters 2 and 10 of Disease Maps: Epidemics on the Ground by Tom Koch (2011).

Anticontagionism between 1821 and 1867 by Erwin Ackerknecht (1948).

CHARACTER-SPECIFIC ONLINE RESOURCES

http://archive.org/details/worksofthomassyd02sydeiala

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2066736/

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1933874/

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2101773/

YOU ARE IN THE “Anti-contagionist” FACTION.

You and the other Anti-contagionist members of the Board believe that the Cholera outbreak may be explained by a number of physical, chemical and social factors, including: classic Hippocratic epidemic constitution, atmospheric influences, elevation above sea level, miasmas arising from exposure to decaying animal or vegetable matter, diet, lifestyle and socioeconomic status. No human-to-human transmission is involved.

The Contagionist members of the Board believe that Cholera is transmitted by the direct passage of some chemical, physical or biological agent originating from a sick person and transmitted to a susceptible victim by contact or fomites or, for relatively short distances, through the atmosphere.

The Indeterminate members of the Board do not have fixed opinions as to the origins of Cholera. As such, sound scientific arguments made by members of the other factions may sway the opinion of these Board members.

PLEASE NOTE: Although you and your faction colleagues may agree as to the general Anti-contagionist notions of disease, your specific beliefs may be quite different. Over the course of our debate, and even outside of class, you may (and should) consult with one another to identify those issues upon which you can agree as well as those upon which you disagree. For the purposes of final voting on any measures of remediation and prevention, some degree of consensus is required; it is particularly clear that you cannot advance the Anti-contagionist agenda without soliciting the support of other, dissenting Board members. So, it will be important to develop arguments that will be convincing to Indeterminate Board members, whose votes will allow you to champion your own beliefs. Once you identify who are the Indeterminates, wisely use you time during the debate sessions and outside of class, via emails and in person as necessary, to compel them to join your cause.

London 1854: Cesspits, Cholera, and Conflict over the Broad Street Pump

Marshall L. Hayes and Eric B. Nelson • Cornell University

version 5A.091613

SPECIFIC INSTRUCTIONS: The format of the meeting is divided into two class sessions. For Session I, you will prepare a short (< 1 page) written statement that introduces your character and your ideologies on Cholera. You will deliver this statement as a speech of roughly 1-2 minutes, detailing your position and making specific suggestions that can be debated and brought to a vote in Session II. You should address three questions: What is the source of the outbreak? How is Cholera communicated from person to person? And, what steps should be taken to contain the outbreak?

MEETING AGENDA

CLASS SESSION I: OPENING STATEMENTS AND PROPOSED RESPONSES The Special Committee convenes on the evening of Thursday, 7 September 1854. In the course of your research, you should familiarize yourself with what has occurred over the past week. When invited by Chairman Frederick Crane, you will stand and deliver your personal statement. Also, listen intently and take notes as your colleagues make their presentations. Be sure to propose any specific remedial actions by the end of Session I so that these issues may be debated and brought to a final vote at the end of Session II.

INTERLUDE: JOHN SNOW GIVES HIS TESTIMONY AND RECOMMENDATION Between the two class sessions, Dr. John Snow has requested to be heard by the Board and has testified that the Cholera outbreak is being driven by contaminated water originating from the pump located on Broad Street. He has recommended that the Board remove the handle from the Broad Street pump immediately, so as to interrupt public access to what he considers as a tainted water supply. In preparation for Session II, use the online Cholera Data Manager to examine closely the data upon which Dr. Snow bases his arguments. Also consult Dr. Snow’s map and the accompanying Excel spreadsheets to conduct your own analyses of these data and raise further questions and/or support for your arguments. You should also examine William Farr’s data and figures and utilize them similarly.

CLASS SESSION II: DEBATE AND FINAL VOTING ON PROPOSED COURSES OF ACTION Whenever necessary, you will argue strongly for Anti-contagionist causes of the current Cholera outbreak. Question the utility of removing the pump handle from the Broad Street pump, and point out that this will be a significant inconvenience Parish residents. Also, be sure to coordinate your perspectives with your fellow Anti-contagionists so that, together, you can gain the support of the Indeterminates and defeat the Contagionist agenda. Keep in mind that there are inconsistencies in the various Contagionist arguments you will hear over the course of the debate. Counter these with logical rebuttals and any compelling quantitative data that you can gather.

“Anti-contagionist” FACTION STRATEGY

Your faction, the Anti-contagionists, will likely vote against Dr. Snow’s recommendation, but you may be swayed by any particularly strong arguments or data that are presented. Consider the different perspectives of Thomas Sydenham, T. Southwood Smith, William Farr and the Rev. Henry Whitehead (from internet sources and fellow Board members). You are generally supportive of any remedial or preventive measure that was widely in use at the time (e.g. the use of chlorine or chloride of lime for washing). You are also in favor of persistent communication with Parish residents about the virtues of pure air, cleanliness of person, of house and of premises, and temperance with respect to the consumption of spirituous liquors. You should endorse that the Board recirculate among Parish residents handbills with language to this effect. In your arguments, make specific references to existing language in the draft handbill that has been circulated among Board members and suggest any changes to the handbill language that you feel are warranted.

SECRET OBJECTIVE

To earn bonus credit for this role-playing activity, you must also achieve your secret objective:

When it is announced that Dr. John Snow wishes to address the committee, propose and have the Board vote against having Dr. John Snow testify. As far as you are concerned, Dr. Snow’s ideas about the communication of Cholera are not founded in the prevalent thinking of the day and should be dismissed outright.

London 1854: Cesspits, Cholera, and Conflict over the Broad Street Pump

Marshall L. Hayes and Eric B. Nelson • Cornell University

version 5B.010214

YOU ARE GEORGE BUZZARD.

Faction: Anti-contagionist Ideological Reference: Rev. Henry Whitehead

As Clerk of the Vestry of St. James, Westminster you are close to Rev. Henry Whitehead, the deacon of St. Luke’s Parish, and you share his belief in the miasma theory of disease. You will make arguments that are consistent with a miasmatic explanation for this Cholera outbreak. You will also assist Chairman Crane in calling the meeting to order and in keeping everyone on time, particularly as they give their 1-2 minute opening statements.

as they give their 1-2 minute opening statements. GENERAL DIRECTIVE: You are a member of the

GENERAL DIRECTIVE: You are a member of the special Sanitary Committee of the Board of Governors and Directors of the Poor of St. James Parish. On 14 August 1854, you and your colleagues on the General Board of Governors and Directors of the Poor voted to forgo standard meeting protocols and form this special emergency response committee to address any threat of Malignant Cholera throughout the parish. Collectively, you wield the power and financial backing to make whatever arrangements you deem necessary regarding administrative courses of action, medical responses, future meetings, etc.

REQUIRED READINGS

• Chapter 1 of The Ghost Map by Steven Johnson (2006).

• Chapters 2 and 10 of Disease Maps: Epidemics on the Ground by Tom Koch (2011).

Anticontagionism between 1821 and 1867 by Erwin Ackerknecht (1948).

CHARACTER-SPECIFIC ONLINE RESOURCES

http://www.ph.ucla.edu/epi/snow/whitehead.html http://www.ph.ucla.edu/epi/snow/choleratheories.html

http://collections.nlm.nih.gov/bookviewer?PID=nlm:nlmuid-101169980-bk

YOU ARE IN THE “Anti-contagionist” FACTION.

You and the other Anti-contagionist members of the Board believe that the Cholera outbreak may be explained by a number of physical, chemical and social factors, including: classic Hippocratic epidemic constitution, atmospheric influences, elevation above sea level, miasmas arising from exposure to decaying animal or vegetable matter, diet, lifestyle and socioeconomic status. No human-to-human transmission is involved.

The Contagionist members of the Board believe that Cholera is transmitted by the direct passage of some chemical, physical or biological agent originating from a sick person and transmitted to a susceptible victim by contact or fomites or, for relatively short distances, through the atmosphere.

The Indeterminate members of the Board do not have fixed opinions as to the origins of Cholera. As such, sound scientific arguments made by members of the other factions may sway the opinion of these Board members.

PLEASE NOTE: Although you and your faction colleagues may agree as to the general Anti-contagionist notions of disease, your specific beliefs may be quite different. Over the course of our debate, and even outside of class, you may (and should) consult with one another to identify those issues upon which you can agree as well as those upon which you disagree. For the purposes of final voting on any measures of remediation and prevention, some degree of consensus is required; it is particularly clear that you cannot advance the Anti-contagionist agenda without soliciting the support of other, dissenting Board members. So, it will be important to develop arguments that will be convincing to Indeterminate Board members, whose votes will allow you to champion your own beliefs. Once you identify who are the Indeterminates, wisely use you time during the debate sessions and outside of class, via emails and in person as necessary, to compel them to join your cause.

London 1854: Cesspits, Cholera, and Conflict over the Broad Street Pump

Marshall L. Hayes and Eric B. Nelson • Cornell University

version 5B.010214

SPECIFIC INSTRUCTIONS: The format of the meeting is divided into two class sessions. For Session I, you will prepare a short (< 1 page) written statement that introduces your character and your ideologies on Cholera. You will deliver this statement as a speech of roughly 1-2 minutes, detailing your position and making specific suggestions that can be debated and brought to a vote in Session II. You should address three questions: What is the source of the outbreak? How is Cholera communicated from person to person? And, what steps should be taken to contain the outbreak?

MEETING AGENDA

CLASS SESSION I: OPENING STATEMENTS AND PROPOSED RESPONSES The Special Committee convenes on the evening of Thursday, 7 September 1854. In the course of your research, you should familiarize yourself with what has occurred over the past week. When invited by Chairman Frederick Crane, you will stand and deliver your personal statement. Also, listen intently and take notes as your colleagues make their presentations. Be sure to propose any specific remedial actions by the end of Session I so that these issues may be debated and brought to a final vote at the end of Session II.

INTERLUDE: JOHN SNOW GIVES HIS TESTIMONY AND RECOMMENDATION Between the two class sessions, Dr. John Snow requested to be heard by the Board and has testified that the Cholera outbreak is being driven by contaminated water originating from the pump located on Broad Street. He has recommended that the Board remove the handle from the Broad Street pump immediately, so as to interrupt public access to what he considers as a tainted water supply. In preparation for Session II, use the online Cholera Data Manager to examine closely the data upon which Dr. Snow bases his arguments. Also consult Dr. Snow’s map and the accompanying Excel spreadsheets to conduct your own analyses of these data and raise further questions and/or support for your arguments. You should also examine William Farr’s data and figures and utilize them similarly.

CLASS SESSION II: DEBATE AND FINAL VOTING ON PROPOSED COURSES OF ACTION Whenever necessary, you will argue strongly for Anti-contagionist causes of the current Cholera outbreak. Question the utility of removing the pump handle from the Broad Street pump, and point out that this will be a significant inconvenience Parish residents. Also, be sure to coordinate your perspectives with your fellow Anti-contagionists so that, together, you can gain the support of the Indeterminates and defeat the Contagionist agenda. Keep in mind that there are inconsistencies in the various Contagionist arguments you will hear over the course of the debate. Counter these with logical rebuttals and any compelling quantitative data that you can gather.

“Anti-contagionist” FACTION STRATEGY

Your faction, the Anti-contagionists, will likely vote against Dr. Snow’s recommendation, but you may be swayed by any particularly strong arguments or data that are presented. Consider the different perspectives of Thomas Sydenham, T. Southwood Smith, William Farr and the Rev. Henry Whitehead (from internet sources and fellow Board members). You are generally supportive of any remedial or preventive measure that was widely in use at the time (e.g. the use of chlorine or chloride of lime for washing). You are also in favor of persistent communication with Parish residents about the virtues of pure air, cleanliness of person, of house and of premises, and temperance with respect to the consumption of spirituous liquors. You should endorse that the Board recirculate among Parish residents handbills with language to this effect. In your arguments, make specific references to existing language in the draft handbill that has been circulated among Board members and suggest any changes to the handbill language that you feel are warranted.

SECRET OBJECTIVE

To earn bonus credit for this role-playing activity, you must also achieve your secret objective:

Have the Board vote in favor of 1) the immediate and widespread Limewashing of all houses, privies and streets and 2) the burning of tar and vinegar mixtures in the streets to cleanse the area and to remove nauseating smells from the local air.

London 1854: Cesspits, Cholera, and Conflict over the Broad Street Pump

Marshall L. Hayes and Eric B. Nelson • Cornell University

version 5A.091613

YOU ARE BENJAMIN COX.

Faction: Contagionist Ideological Reference: Edward Oke Spooner

Contagionist Ideological Reference: Edward Oke Spooner You are well versed on the evidence supporting the view

You are well versed on the evidence supporting the view that Cholera is caused by contagion. In particular, you are very familiar and articulate on the infection theories postulated by Edward Oke Spooner of Blandford, who was strongly committed to the idea of inhalation as a principal means of infection. You believe that the policies of London’s Board of Health and Sanitary Commissioners defy both common sense and scientific observation.

GENERAL DIRECTIVE: You are a member of the special Sanitary Committee of the Board of Governors and Directors of the Poor of St. James Parish. On 14 August 1854, you and your colleagues on the General Board of Governors and Directors of the Poor voted to forgo standard meeting protocols and form this special emergency response committee to address any threat of Malignant Cholera throughout the parish. Collectively, you wield the power and financial backing to make whatever arrangements you deem necessary regarding administrative courses of action, medical responses, future meetings, etc.

REQUIRED READINGS

• Chapter 1 of The Ghost Map by Steven Johnson (2006).

• Chapters 2 and 10 of Disease Maps: Epidemics on the Ground by Tom Koch (2011).

Anticontagionism between 1821 and 1867 by Erwin Ackerknecht (1948).

CHARACTER-SPECIFIC ONLINE RESOURCES

http://collections.nlm.nih.gov/muradora/objectView.action?pid=nlm:nlmuid-64750940R-bk

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2551835/

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2487696/

YOU ARE IN THE “Contagionist” FACTION.

You and your fellow Contagionist members of the Board believe that Cholera is transmitted by the direct passage of some chemical, physical or biological agent originating from a sick person and transmitted to a susceptible victim by contact or fomites or, for a relatively short distance, through the atmosphere.

The Anti-contagionist members of the Board believe that the Cholera outbreak may be explained by a number of factors, including: classic Hippocratic epidemic constitution, atmospheric influences, elevation above sea level, miasma arising from exposure to decaying animal or vegetable matter, diet, lifestyle and socioeconomic status. No human-to-human transmission is invoked.

The Indeterminate members of the Board do not have fixed opinions as to the origins of Cholera. As such, sound scientific arguments made by members of the other factions may sway the opinion of these Board members.

PLEASE NOTE: Although you and your faction colleagues may agree as to the general Contagionist notions of disease, your specific beliefs may be quite different. Over the course of our debate, and even outside of class, you may (and should) consult with one another to identify those issues upon which you can agree as well as those upon which you disagree. For the purposes of final voting on any measures of remediation and prevention, some degree of consensus is required; it is particularly clear that you cannot advance the Contagionist agenda without soliciting the support of other, dissenting Board members. So, it will be important to develop arguments that will be convincing to Indeterminate Board members, whose votes will allow you to champion your own beliefs. Once you learn who are the Indeterminates, wisely use you time during the debate sessions and outside of class, via emails and in person as necessary, to compel them to join your cause.

London 1854: Cesspits, Cholera, and Conflict over the Broad Street Pump

Marshall L. Hayes and Eric B. Nelson • Cornell University

version 5A.091613

SPECIFIC INSTRUCTIONS: The format of the meeting is divided into two class sessions. For Session I, you will prepare a short (< 1 page) written statement that introduces your character and your ideologies on Cholera. You will deliver this statement as a speech of roughly 1-2 minutes, detailing your position and making specific suggestions that can be debated and brought to a vote in Session II. You should address three questions: What is the source of the outbreak? How is Cholera communicated from person to person? And, what steps should be taken to contain the outbreak?

MEETING AGENDA

CLASS SESSION I: OPENING STATEMENTS AND PROPOSED RESPONSES The Special Committee convenes on the evening of Thursday, 7 September 1854. When invited by the Chairman and Senior Churchwarden Frederick Crane, you will stand and offer your personal statement, and you will point out Spooner’s observation that the 1817 Cholera epidemic followed well-established trade and travel routes, advancing no quicker than humans could travel. You may also openly mock the miasmatists. By the end of Session I, you should make specific proposals that will be addressed by the Committee in Session II, being debated and brought to a final vote at the end of the discussion.

INTERLUDE: JOHN SNOW GIVES HIS TESTIMONY AND RECOMMENDATION Between the two class sessions, Dr. John Snow requested to be heard by the Board and has testified that the Cholera outbreak is being driven by contaminated water originating from the pump located on Broad Street. He has recommended that the Board remove the handle from the Broad Street pump immediately, so as to interrupt public access to what he considers as a tainted water supply. In preparation for Session II, use the online Cholera Data Manager to examine closely the data upon which Dr. Snow bases his arguments. Also consult Dr. Snow’s map and the accompanying Excel spreadsheets to conduct your own analyses of these data and raise further questions and/or support for your arguments. You should also examine William Farr’s data and figures and utilize them similarly.

CLASS SESSION II: DEBATE AND FINAL VOTING ON COURSES OF ACTION Whenever necessary, you must strongly argue for contagion as the cause of the current Cholera outbreak. You will not question the utility of removing the pump handle from the Broad Street pump, and you will point out the evidence that Dr. Snow has presented as being consistent with a reasonable explanation of Cholera communication.

“Contagionist” FACTION STRATEGY

Your faction, the Contagionists, may disagree as to the specific nature of contagion, but you will likely vote for Dr. Snow’s recommendation. Personally, you believe that Snow’s arguments will lead to the committee taking relevant, decisive action at minimal expense to the Parish, and you will do everything possible provide supporting arguments once debate continues in Session II. You might also argue that the current “Anti-contagionist” approach of widespread limewashing of buildings throughout London has done little to stem Cholera outbreaks. Of course, you anticipate opposition but are also confident in your understanding of E.O. Spooner’s theories and steadfast in your convictions. Be prepared to influence the Indeterminates with solid arguments based on scientific data.

SECRET OBJECTIVE

To earn bonus credit for this role-playing activity, you must also achieve your secret objective:

Propose and have the Board vote on the implementation of widespread zones of quarantine around all houses, privies and streets that have been touched by the Cholera.

London 1854: Cesspits, Cholera, and Conflict over the Broad Street Pump

Marshall L. Hayes and Eric B. Nelson • Cornell University

version 5A.091613

YOU ARE FREDERICK CRANE.

Faction: Anti-contagionist Ideological Reference: James Kay-Shuttleworth

You are Senior Churchwarden of the Vestry of St. James, Westminster, and you chair this special Sanitary Committee. Once the Clerk, Mr. Buzzard, calls the meeting to order and completes a roll call, you will give a short speech summarizing the goals of this meeting and then call on Board members one by one to express their views. Assert your belief in the philosophies of Kay-Shuttleworth and Friedrich Engels.

philosophies of Kay-Shuttleworth and Friedrich Engels . GENERAL DIRECTIVE: You are a member of the special

GENERAL DIRECTIVE: You are a member of the special Sanitary Committee of the Board of Governors and Directors of the Poor of St. James Parish. On 14 August 1854, you and your colleagues on the General Board of Governors and Directors of the Poor voted to forgo standard meeting protocols and form this special emergency response committee to address any threat of Malignant Cholera throughout the parish. Collectively, you wield the power and financial backing to make whatever arrangements you deem necessary regarding administrative courses of action, medical responses, future meetings, etc.

REQUIRED READINGS

• Chapter 1 of The Ghost Map by Steven Johnson (2006).

• Chapters 2 and 10 of Disease Maps: Epidemics on the Ground by Tom Koch (2011).

Anticontagionism between 1821 and 1867 by Erwin Ackerknecht (1948).

CHARACTER-SPECIFIC ONLINE RESOURCES

http://archive.org/details/moralphysicalcon00kaysuoft

http://www.spartacus.schoolnet.co.uk/PHkay.htm

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1447946/

YOU ARE IN THE “Anti-contagionist” FACTION.

You and the other Anti-contagionist members of the Board believe that the Cholera outbreak may be explained by a number of factors, including: classic Hippocratic epidemic constitution, atmospheric influences, elevation above sea level, miasma arising from exposure to decaying animal or vegetable matter, diet, lifestyle and socioeconomic status.

The Contagionist members of the Board believe that Cholera is transmitted by the direct passage of some chemical, physical or biological agent originating from a sick person and transmitted to a susceptible victim by contact or fomites or, for a relatively short distance, through the atmosphere.

The Indeterminate members of the Board do not have fixed opinions as to the origins of Cholera. As such, sound scientific arguments made by members of the other factions may sway the opinion of these Board members.

PLEASE NOTE: Although you and your faction colleagues may agree as to the general Anti-contagionist notions of disease, your specific beliefs may be quite different. Over the course of our debate, and even outside of class, you may (and should) consult with one another to identify those issues upon which you can agree as well as those upon which you disagree. For the purposes of final voting on any measures of remediation and prevention, some degree of consensus is required; it is particularly clear that you cannot advance the Anti-contagionist agenda without soliciting the support of other, dissenting Board members. So, it will be important to develop arguments that will be convincing to Indeterminate Board members, whose votes will allow you to champion your own beliefs. Once you learn who are the Indeterminates, wisely use you time during the debate sessions and outside of class, via emails and in person as necessary, to compel them to join your cause.

London 1854: Cesspits, Cholera, and Conflict over the Broad Street Pump

Marshall L. Hayes and Eric B. Nelson • Cornell University

version 5A.091613

SPECIFIC INSTRUCTIONS: The format of the meeting is divided into two class sessions. For Session I, you will prepare a short (< 1 page) written statement that introduces your character and your ideologies on Cholera. You will deliver this statement as a speech of roughly 1-2 minutes, detailing your position and making specific suggestions that can be debated and brought to a vote in Session II. You should address three questions: What is the source of the outbreak? How is Cholera communicated from person to person? And, what steps should be taken to contain the outbreak?

MEETING AGENDA

CLASS SESSION I: OPENING STATEMENTS AND PROPOSED RESPONSES The Special Committee convenes on the evening of Thursday, 7 September 1854. The Clerk of the Committee, George Buzzard, will call the meeting to order and hand over direction to you and Junior Churchwarden Thomas Henry Rice. Throughout this meeting, you have the responsibility of allowing each member 1-2 minutes to present a prepared statement. After all statements are read, you will allow Board members to confer and then entertain any proposals for later debate and voting in Class Session II.

INTERLUDE: JOHN SNOW GIVES HIS TESTIMONY AND RECOMMENDATION Between the two class sessions, Dr. John Snow requested to be heard by the Board and has testified that the Cholera outbreak is being driven by contaminated water originating from the pump located on Broad Street. He has recommended that the Board remove the handle from the Broad Street pump immediately, so as to interrupt public access to what he considers as a tainted water supply. In preparation for Session II, use the online Cholera Data Manager to examine closely the data upon which Dr. Snow bases his arguments. Also consult Dr. Snow’s map and the accompanying Excel spreadsheets to conduct your own analyses of these data and raise further questions and/or support for your arguments. You should also examine William Farr’s data and figures and utilize them similarly.

CLASS SESSION II: DEBATE AND FINAL VOTING ON COURSES OF ACTION Whenever necessary, you will argue strongly that disease and social conditions are intimately connected, echoing the opinions of Kay-Shuttleworth and Engels. You will question the utility of removing the pump handle from the Broad Street pump when social reform is the true necessity. You will also point out the inconvenience that this will cause to Parish residents that frequent that pump for water. Be prepared to finalize any voting no later than 10 minutes before the end of this session.

“Anti-contagionist” FACTION STRATEGY

Your faction, the Anti-contagionists, will likely vote against Dr. Snow’s recommendation, but you may be swayed by any strong arguments or data that are presented. Consider the different perspectives of Kay-Shuttleworth, Engels, Thomas Sydenham, T. Southwood Smith, William Farr and the Rev. Henry Whitehead (from internet sources and fellow Board members). You support any remedial or preventive measure that was widely in use at the time (e.g. the use of chlorine or chloride of lime for washing). You are also in favor of persistent communication with Parish residents about the virtues of pure air, cleanliness of person, of house and of premises, and temperance with respect to the consumption of spirituous liquors. You should endorse that the Board recirculate among Parish residents handbills with language to this effect. In your arguments, make references to existing language in the draft handbill that has been circulated among Board members and suggest any changes to the handbill language that you feel are warranted.

SECRET OBJECTIVE

To earn bonus credit for this role-playing activity, you must also achieve your secret objective:

Have the Board vote in favor of 1) the immediate and widespread Limewashing of all houses, privies and streets and 2) including language in handbills encouraging the working classes to pursue shorter working hours and to better themselves through education.

London 1854: Cesspits, Cholera, and Conflict over the Broad Street Pump

Marshall L. Hayes and Eric B. Nelson • Cornell University

version 5A.091613

YOU ARE ROBERT DOWNES.

Faction: Indeterminate Ideological Reference: William O’Shaughnessy

You are well informed of the scientific evidence of the effects of Cholera on the human body and very knowledgeable of the pioneering work of William Brooke O’Shaughnessy, Thomas Latta and Alfred Baring Garrod, who studied the chemistry of the blood of Cholera patients. Summarize their findings and explain the relevance of these findings to any treatment methods that you will propose. What do these findings tell us about the mode of communication of Cholera?

findings tell us about the mode of communication of Cholera? GENERAL DIRECTIVE: You are a member

GENERAL DIRECTIVE: You are a member of the special Sanitary Committee of the Board of Governors and Directors of the Poor of St. James Parish. On 14 August 1854, you and your colleagues on the General Board of Governors and Directors of the Poor voted to forgo standard meeting protocols and form this special emergency response committee to address any threat of Malignant Cholera throughout the parish. Collectively, you wield the power and financial backing to make whatever arrangements you deem necessary regarding administrative courses of action, medical responses, future meetings, etc.

REQUIRED READINGS

• Chapter 1 of The Ghost Map by Steven Johnson (2006).

• Chapters 2 and 10 of Disease Maps: Epidemics on the Ground by Tom Koch (2011).

Anticontagionism between 1821 and 1867 by Erwin Ackerknecht (1948).

CHARACTER-SPECIFIC ONLINE RESOURCES

http://emj.bmj.com/content/20/4/316.full

http://www.jstor.org/stable/25493731

http://bji.sagepub.com/content/10/1_suppl/s3.short?rss=1&ssource=mfr

YOU ARE IN THE “Indeterminate” FACTION.

You and the other Indeterminate members of the Board do not have fixed opinions as to the origins of Cholera. As such, your opinions may be influenced by compelling scientific arguments made by members of the other factions.

Anti-contagionist members of the Board believe that the Cholera outbreak may be explained by a number of factors, including: classic Hippocratic epidemic constitution, atmospheric influences, elevation above sea level, miasma arising from exposure to decaying animal or vegetable matter, diet, lifestyle and socioeconomic status. No human-to-human transmission is involved.

The Contagionist members of the Board believe that Cholera is transmitted by the direct passage of some chemical, physical or biological agent originating from a sick person and transmitted to a susceptible victim by contact or fomites or, for a relatively short distance, through the atmosphere.

PLEASE NOTE: Although you and your faction colleagues do not have fixed ideas on specific notions of disease, your specific agendas may be quite different. Over the course of our debate, and even outside of class, you may (and should) consult with one another to identify those issues upon which you can agree as well as those upon which you disagree. For the purposes of final voting on any measures of remediation and prevention, some degree of consensus will be required. It will be important to listen closely to arguments so that you may determine your own position. At every opportunity, press your Anti-contagionist and Contagionist colleagues for evidence and scientific data to support their arguments. For final voting, however, you may remain Indeterminate and abstain if you so choose.

London 1854: Cesspits, Cholera, and Conflict over the Broad Street Pump

Marshall L. Hayes and Eric B. Nelson • Cornell University

version 5A.091613

SPECIFIC INSTRUCTIONS: The format of the meeting is divided into two class sessions. For Session I, you will prepare a short (< 1 page) written statement that introduces your character and your ideologies on Cholera. You will deliver this statement as a speech of roughly 1-2 minutes, detailing your position and making specific suggestions that can be debated and brought to a vote in Session II. You should address three questions: What is the source of the outbreak? How is Cholera communicated from person to person? And, what steps should be taken to contain the outbreak?

MEETING AGENDA

CLASS SESSION I: OPENING STATEMENTS AND PROPOSED RESPONSES The Special Committee convenes on the evening of Thursday, 7 September 1854. In the course of your research, you should familiarize yourself with what has occurred over the past week. When invited by Chairman Frederick Crane, you will stand and deliver your personal statement on O’Shaugnessy’s work. Also, listen intently and take notes as colleagues make their presentations. Be sure to propose any specific remedial actions by the end of Session I so that these issues may be debated and brought to a final vote at the end of Session II.

INTERLUDE: JOHN SNOW GIVES HIS TESTIMONY AND RECOMMENDATION Between the two class sessions, Dr. John Snow requested to be heard by the Board and has testified that the Cholera outbreak is being driven by contaminated water originating from the pump located on Broad Street. He has recommended that the Board remove the handle from the Broad Street pump immediately, so as to interrupt public access to what he considers as a tainted water supply. In preparation for Session II, use the online Cholera Data Manager to examine closely the data upon which Dr. Snow bases his arguments. Also consult Dr. Snow’s map and the accompanying Excel spreadsheets to conduct your own analyses of these data and raise further questions and/or support for your arguments. You should also examine William Farr’s data and figures and utilize them similarly.

CLASS SESSION II: DEBATE AND FINAL VOTING ON COURSES OF ACTION Whenever necessary, you will strongly advocate for discussion based on sound scientific opinions. The experimental and clinical work of O’Shaugnessy is one example. You will respectfully question the utility of removing the pump handle from the Broad Street pump unless accompanied by sound scientific justifications, and you will seek to have your fellow Committee members generate proposals having a solid scientific basis. Raise questions and challenge your colleagues when you feel that their comments are lacking scientific support. You should consider yourself open to particularly strong arguments and/or sound use of scientific data.

“Indeterminate” FACTION STRATEGY

Your faction, the Indeterminates, will consider Dr. Snow’s recommendation thoughtfully, and you will scrutinize any data that is presented during the debate. Most importantly, however, you and your faction colleagues recognize that action must be taken and ideologies should not interfere with your decision making. Specific steps must be implemented promptly, and you are seeking to embrace compelling arguments that strike you as common sensical, practical and effective. Challenge your colleagues on the Board if they seem unreasonable, unclear or unconvincing in their arguments. Ask insightful questions so that you may form your own opinions. You may reserve the right to abstain from any final votes; in this respect, also realize that your faction holds the power to sway the outcomes of votes in one direction or another.

SECRET OBJECTIVE

To earn bonus credit for this role-playing activity, you must also achieve your secret objective:

Have the Board vote to offer to Parish residents afflicted with Cholera a novel therapy, intravenous injection of salts and fluids, based on the work of William Brooke O’Shaughnessy, Thomas Latta and Alfred Baring Garrod.

London 1854: Cesspits, Cholera, and Conflict over the Broad Street Pump

Marshall L. Hayes and Eric B. Nelson • Cornell University

version 5A.091613

YOU ARE BERNARD DRAKE.

Faction: Anti-contagionist Ideological Reference: T. Southwood Smith

You are concerned about Cholera in St. James Parish, and you are also passionate about Britain’s involvement in the Crimean War. Familiarize yourself with descriptions and discussions of Cholera on the war front. You are particularly swayed by the theories of T. Southwood Smith, who attributed disease to local miasmas that appeared in some localities leaving others untouched.

that appeared in some localities leaving others untouched. GENERAL DIRECTIVE: You are a member of the

GENERAL DIRECTIVE: You are a member of the special Sanitary Committee of the Board of Governors and Directors of the Poor of St. James Parish. On 14 August 1854, you and your colleagues on the General Board of Governors and Directors of the Poor voted to forgo standard meeting protocols and form this special emergency response committee to address any threat of Malignant Cholera throughout the parish. Collectively, you wield the power and financial backing to make whatever arrangements you deem necessary regarding administrative courses of action, medical responses, future meetings, etc.

REQUIRED READINGS

• Chapter 1 of The Ghost Map by Steven Johnson (2006).

• Chapters 2 and 10 of Disease Maps: Epidemics on the Ground by Tom Koch (2011).

Anticontagionism between 1821 and 1867 by Erwin Ackerknecht (1948).

CHARACTER-SPECIFIC ONLINE RESOURCES

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1896581/

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2646604/

http://www.sciencedirect.com/science/article/pii/S0305748802000841

YOU ARE IN THE “Anti-contagionist” FACTION.

You and the other Anti-contagionist members of the Board believe that the Cholera outbreak may be explained by a number of physical, chemical and social factors, including: classic Hippocratic epidemic constitution, atmospheric influences, elevation above sea level, miasmas arising from exposure to decaying animal or vegetable matter, diet, lifestyle and socioeconomic status. No human-to-human transmission is involved.

The Contagionist members of the Board believe that Cholera is transmitted by the direct passage of some chemical, physical or biological agent originating from a sick person and transmitted to a susceptible victim by contact or fomites or, for relatively short distances, through the atmosphere.

The Indeterminate members of the Board do not have fixed opinions as to the origins of Cholera. As such, sound scientific arguments made by members of the other factions may sway the opinion of these Board members.

PLEASE NOTE: Although you and your faction colleagues may agree as to the general Anti-contagionist notions of disease, your specific beliefs may be quite different. Over the course of our debate, and even outside of class, you may (and should) consult with one another to identify those issues upon which you can agree as well as those upon which you disagree. For the purposes of final voting on any measures of remediation and prevention, some degree of consensus is required; it is particularly clear that you cannot advance the Anti-contagionist agenda without soliciting the support of other, dissenting Board members. So, it will be important to develop arguments that will be convincing to Indeterminate Board members, whose votes will allow you to champion your own beliefs. Once you identify who are the Indeterminates, wisely use you time during the debate sessions and outside of class, via emails and in person as necessary, to compel them to join your cause.

London 1854: Cesspits, Cholera, and Conflict over the Broad Street Pump

Marshall L. Hayes and Eric B. Nelson • Cornell University

version 5A.091613

SPECIFIC INSTRUCTIONS: The format of the meeting is divided into two class sessions. For Session I, you will prepare a short (< 1 page) written statement that introduces your character and your ideologies on Cholera. You will deliver this statement as a speech of roughly 1-2 minutes, detailing your position and making specific suggestions that can be debated and brought to a vote in Session II. You should address three questions: What is the source of the outbreak? How is Cholera communicated from person to person? And, what steps should be taken to contain the outbreak?

MEETING AGENDA

CLASS SESSION I: OPENING STATEMENTS AND PROPOSED RESPONSES The Special Committee convenes on the evening of Thursday, 7 September 1854. In the course of your research, you should familiarize yourself with what has occurred over the past week. When invited by Chairman Frederick Crane, you will stand and deliver your personal statement. Also, listen intently and take notes as your colleagues make their presentations. Be sure to propose any specific remedial actions by the end of Session I so that these issues may be debated and brought to a final vote at the end of Session II.

INTERLUDE: JOHN SNOW GIVES HIS TESTIMONY AND RECOMMENDATION Between the two class sessions, Dr. John Snow requested to be heard by the Board and has testified that the Cholera outbreak is being driven by contaminated water originating from the pump located on Broad Street. He has recommended that the Board remove the handle from the Broad Street pump immediately, so as to interrupt public access to what he considers as a tainted water supply. In preparation for Session II, use the online Cholera Data Manager to examine closely the data upon which Dr. Snow bases his arguments. Also consult Dr. Snow’s map and the accompanying Excel spreadsheets to conduct your own analyses of these data and raise further questions and/or support for your arguments. You should also examine William Farr’s data and figures and utilize them similarly.

CLASS SESSION II: DEBATE AND FINAL VOTING ON COURSES OF ACTION You will argue strongly for unsanitary conditions and local miasmas as the causes of the current Cholera outbreak. Question the utility of removing the pump handle from the Broad Street pump, and point out that this will be a significant inconvenience Parish residents. Also, be sure to coordinate your perspectives with your fellow Anti-contagionists so that, together, you can gain the support of the Indeterminates and defeat the Contagionist agenda. Keep in mind that there are inconsistencies in the various Contagionist arguments you will hear over the course of the debate. Counter these with logical rebuttals and any compelling quantitative data that you can gather.

“Anti-contagionist” FACTION STRATEGY

Your faction, the Anti-contagionists, will likely vote against Dr. Snow’s recommendation, but you may be swayed by any strong arguments or data that are presented. Consider the different perspectives of Edwin Chadwick, Thomas Sydenham, T. Southwood Smith, William Farr and the Rev. Henry Whitehead (from internet sources and fellow Board members). You are supportive of any remedial or preventive measure that was widely in use at the time (e.g. the use of chlorine or chloride of lime for washing). You are also in favor of persistent communication with Parish residents about the virtues of pure air, cleanliness of person, of house and of premises, and temperance with respect to the consumption of spirituous liquors. You should endorse that the Board recirculate among Parish residents handbills with language to this effect. In your arguments, make specific references to existing language in the draft handbill that has been circulated among Board members and suggest any changes to the handbill language that you feel are warranted.

SECRET OBJECTIVE

To earn bonus credit for this role-playing activity, you must also achieve your secret objective:

You are a bellicose gentleman, and you believe that disputes should be settled by physical confrontations and/or tests of wit or strength. At some point during the debate, choose a Contagionist or Indeterminate Board member who disagrees with you and challenge them to a public competition as a way to settle the disagreement (e.g. an arm-wrestling match, a feat of strength, a verbal logic game). You need not win this challenge to earn your credit.

London 1854: Cesspits, Cholera, and Conflict over the Broad Street Pump

Marshall L. Hayes and Eric B. Nelson • Cornell University

version 5A.091613

YOU ARE JOHN GEORGE FRENCH.

Faction: Contagionist Ideological Reference: John Snow

You currently serve as the medical officer of the Poland Street Workhouse. You are distinguished in your discipline, having been granted Fellowship in the Royal College of Surgeons – your field’s highest qualification. At every opportunity you will argue in strong support of your colleague, John Snow, that Cholera is transmitted via contaminated food and water.

Cholera is transmitted via contaminated food and water . GENERAL DIRECTIVE: You are a member of

GENERAL DIRECTIVE: You are a member of the special Sanitary Committee of the Board of Governors and Directors of the Poor of St. James Parish. On 14 August 1854, you and your colleagues on the General Board of Governors and Directors of the Poor voted to forgo standard meeting protocols and form this special emergency response committee to address any threat of Malignant Cholera throughout the parish. Collectively, you wield the power and financial backing to make whatever arrangements you deem necessary regarding administrative courses of action, medical responses, future meetings, etc.

REQUIRED READINGS

• Chapter 1 of The Ghost Map by Steven Johnson (2006).

• Chapters 2 and 10 of Disease Maps: Epidemics on the Ground by Tom Koch (2011).

Anticontagionism between 1821 and 1867 by Erwin Ackerknecht (1948).

CHARACTER-SPECIFIC ONLINE RESOURCES

http://openlibrary.org/books/OL6329689M/The_nature_of_cholera_investigated

http://jhmas.oxfordjournals.org/content/XXVII/4/373.full.pdf

YOU ARE IN THE “Contagionist” FACTION.

You and your fellow Contagionist members of the Board believe that Cholera is transmitted by the direct passage of some chemical, physical or biological agent originating from a sick person and transmitted to a susceptible victim by contact or fomites or, for a relatively short distance, through the atmosphere.

The Anti-contagionist members of the Board believe that the Cholera outbreak may be explained by a number of factors, including: classic Hippocratic epidemic constitution, atmospheric influences, elevation above sea level, miasma arising from exposure to decaying animal or vegetable matter, diet, lifestyle and socioeconomic status. No human-to-human transmission is invoked.

The Indeterminate members of the Board do not have fixed opinions as to the origins of Cholera. As such, sound scientific arguments made by members of the other factions may sway the opinion of these Board members.

PLEASE NOTE: Although you and your faction colleagues may agree as to the general Contagionist notions of disease, your specific beliefs may be quite different. Over the course of our debate, and even outside of class, you may (and should) consult with one another to identify those issues upon which you can agree as well as those upon which you disagree. For the purposes of final voting on any measures of remediation and prevention, some degree of consensus is required; it is particularly clear that you cannot advance the Contagionist agenda without soliciting the support of other, dissenting Board members. So, it will be important to develop arguments that will be convincing to Indeterminate Board members, whose votes will allow you to champion your own beliefs. Once you learn who are the Indeterminates, wisely use you time during the debate sessions and outside of class, via emails and in person as necessary, to compel them to join your cause.

London 1854: Cesspits, Cholera, and Conflict over the Broad Street Pump

Marshall L. Hayes and Eric B. Nelson • Cornell University

version 5A.091613

SPECIFIC INSTRUCTIONS: The format of the meeting is divided into two class sessions. For Session I, you will prepare a short (< 1 page) written statement that introduces your character and your ideologies on Cholera. You will deliver this statement as a speech of roughly 1-2 minutes, detailing your position and making specific suggestions that can be debated and brought to a vote in Session II. You should address three questions: What is the source of the outbreak? How is Cholera communicated from person to person? And, what steps should be taken to contain the outbreak?

MEETING AGENDA

CLASS SESSION I: OPENING STATEMENTS AND PROPOSED RESPONSES The Special Committee convenes on the evening of Thursday, 7 September 1854. As one of the medical officers active in the Parish, your opening statement will make your colleagues aware of your function and your observations from daily practice. Throughout the meeting, you have a primary responsibility to intervene in discussion of specific issues that have a medical origin or relevance, including the options for treating those with Cholera. At the end of Session I, you will announce to everyone that Dr. John Snow wishes to hold audience with the committee, and you will make a brief and direct appeal to have him heard.

INTERLUDE: JOHN SNOW GIVES HIS TESTIMONY AND RECOMMENDATION Between the two class sessions, Dr. John Snow requested to be heard by the Board and has testified that the Cholera outbreak is being driven by contaminated water originating from the pump located on Broad Street. He has recommended that the Board remove the handle from the Broad Street pump immediately, so as to interrupt public access to what he considers as a tainted water supply. In preparation for Session II, use the online Cholera Data Manager to examine closely the data upon which Dr. Snow bases his arguments. Also consult Dr. Snow’s map and the accompanying Excel spreadsheets to conduct your own analyses of these data and raise further questions and/or support for your arguments. You should also examine William Farr’s data and figures and utilize them similarly.

CLASS SESSION II: DEBATE AND FINAL VOTING ON COURSE(S) OF ACTION Whenever necessary, you will argue that contagion and contaminated food and water is the cause of the current Cholera outbreak. You will not question the utility of removing the pump handle from the Broad Street pump, and you will argue against the perceived “inconvenience” that this will cause to Parish residents that frequent that pump for water. Most importantly, you are steadfast in your convictions and training as a medical professional, and you will be most swayed by particularly strong arguments and/or sound use of scientific data.

“Contagionist” FACTION STRATEGY

Your faction, the Contagionists, may disagree as to the specific nature of contagion, but you will likely vote for Dr. Snow’s recommendation. Personally, you believe that Snow’s arguments will lead to the committee taking relevant, decisive action at minimal expense to the Parish, and you will do everything possible provide supporting arguments once debate continues in Session II. You might also argue that the current “Anti-contagionist” approach of widespread limewashing of buildings throughout London has done little to stem Cholera outbreaks. Of course, you anticipate opposition but are also confident in your reputation and steadfast in your convictions. Be prepared to influence the Indeterminates with solid arguments based on scientific data from John Snow and William Farr, as needed.

SECRET OBJECTIVE

To earn bonus credit for this role-playing activity, you must also achieve your secret objective:

At the end of Session I, strongly urge the Board to vote in favor of having Dr. Snow testify in front of the committee (at the“Interlude”). Also propose and have the Board vote on additional rooms in the Church being arranged to receive any new Cholera cases and that Nurses be appointed to handle these patients.

London 1854: Cesspits, Cholera, and Conflict over the Broad Street Pump

Marshall L. Hayes and Eric B. Nelson • Cornell University

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YOU ARE WILLIAM GEESIN. Faction: Indeterminate Ideological Reference: William Carpenter In your personal habits, you

YOU ARE WILLIAM GEESIN.

Faction: Indeterminate Ideological Reference: William Carpenter

In your personal habits, you subscribe to Teetotalism and believe that one’s personal behavior helps reduce the threat of falling victim to Cholera. This opinion is consistent with the arguments of William Carpenter, who wrote about temperance and its influence on health.

You will seek to have the tenets of Teetotalism incorporated into the messages that the Committee will send to Parish residents.

GENERAL DIRECTIVE: You are a member of the special Sanitary Committee of the Board of Governors and Directors of the Poor of St. James Parish. On 14 August 1854, you and your colleagues on the General Board of Governors and Directors of the Poor voted to forgo standard meeting protocols and form this special emergency response committee to address any threat of Malignant Cholera throughout the parish. Collectively, you wield the power and financial backing to make whatever arrangements you deem necessary regarding administrative courses of action, medical responses, future meetings, etc.

REQUIRED READINGS

• Chapter 1 of The Ghost Map by Steven Johnson (2006).

• Chapters 2 and 10 of Disease Maps: Epidemics on the Ground by Tom Koch (2011).

Anticontagionism between 1821 and 1867 by Erwin Ackerknecht (1948).

CHARACTER-SPECIFIC ONLINE RESOURCES

http://books.google.com/books/about/Temperance_and_teetotalism.html?id=Tp8pAAAAYAAJ

http://johnsnow.matrix.msu.edu/work.php?id=15-78-1

http://collections.nlm.nih.gov/muradora/objectView.action?pid=nlm:nlmuid-64760070R-bk

YOU ARE IN THE “Indeterminate” FACTION.

You and the other Indeterminate members of the Board do not have fixed opinions as to the origins of Cholera. As such, your opinions may be influenced by compelling scientific arguments made by members of the other factions.

Anti-contagionist members of the Board believe that the Cholera outbreak may be explained by a number of factors, including: classic Hippocratic epidemic constitution, atmospheric influences, elevation above sea level, miasma arising from exposure to decaying animal or vegetable matter, diet, lifestyle and socioeconomic status. No human-to-human transmission is involved.

The Contagionist members of the Board believe that Cholera is transmitted by the direct passage of some chemical, physical or biological agent originating from a sick person and transmitted to a susceptible victim by contact or fomites or, for a relatively short distance, through the atmosphere.

PLEASE NOTE: Although you and your faction colleagues do not have fixed ideas on specific notions of disease, your specific agendas may be quite different. Over the course of our debate, and even outside of class, you may (and should) consult with one another to identify those issues upon which you can agree as well as those upon which you disagree. For the purposes of final voting on any measures of remediation and prevention, some degree of consensus will be required. It will be important to listen closely to arguments so that you may determine your own position. At every opportunity, press your Anti-contagionist and Contagionist colleagues for evidence and scientific data to support their arguments. For final voting, however, you may remain Indeterminate and abstain if you so choose.

London 1854: Cesspits, Cholera, and Conflict over the Broad Street Pump

Marshall L. Hayes and Eric B. Nelson • Cornell University

version 5A.091613

SPECIFIC INSTRUCTIONS: The format of the meeting is divided into two class sessions. For Session I, you will prepare a short (< 1 page) written statement that introduces your character and your ideologies on Cholera. You will deliver this statement as a speech of roughly 1-2 minutes, detailing your position and making specific suggestions that can be debated and brought to a vote in Session II. You should address three questions: What is the source of the outbreak? How is Cholera communicated from person to person? And, what steps should be taken to contain the outbreak?

MEETING AGENDA

CLASS SESSION I: OPENING STATEMENTS AND PROPOSED RESPONSES The Special Committee convenes on the evening of Thursday, 7 September 1854. When given the opportunity, you are eager to present your opinions to your colleagues about the merits of the Teetotalist approach to food and drink. Although you are an Indeterminate and relatively undecided as to the exact cause of Cholera, your comments and any proposals you raise during Session I will reflect your belief that a healthy lifestyle and diet are the best means of staving off disease. In this respect you may risk aligning closer to Anti- contagionist thinking, though you are reluctant to embrace an explanation such as miasma.

INTERLUDE: JOHN SNOW GIVES HIS TESTIMONY AND RECOMMENDATION Between the two class sessions, Dr. John Snow requested to be heard by the Board and testified that the Cholera outbreak is being driven by contaminated water originating from the pump located on Broad Street. He has recommended that the Board remove the handle from the Broad Street pump immediately, so as to interrupt public access to what he considers as a tainted water supply. In preparation for Session II, use the online Cholera Data Manager to examine closely the data upon which Dr. Snow bases his arguments. Also consult Dr. Snow’s map and the accompanying Excel spreadsheet to conduct your own analyses of these data and raise further questions and/or support for your arguments.

CLASS SESSION II: DEBATE AND FINAL VOTING ON COURSES OF ACTION Whenever necessary, you must strongly argue for Teetotalism as a long-term solution to current and future Cholera outbreaks. You will not question the utility of removing the pump handle from the Broad Street pump, because you feel that consuming tainted food and water is the root cause of many ill effects. You are also particularly swayed by Dr. Snow’s arguments as you know him to be a practicing Teetotaler himself.

“Indeterminate” FACTION STRATEGY

Your faction, the Indeterminates, will consider Dr. Snow’s recommendation thoughtfully, and you will scrutinize any data that is presented during the debate. Most importantly, however, you and your faction colleagues recognize that action must be taken and ideologies should not interfere with your decision making. Specific steps must be implemented promptly, and you are seeking to embrace compelling arguments that strike you as common sensical, practical and effective. Challenge your colleagues on the Board if they seem unreasonable, unclear or unconvincing in their arguments. Ask insightful questions so that you may form your own opinions. You may reserve the right to abstain from any final votes; in this respect, also realize that your faction holds the power to sway the outcomes of votes in one direction or another.

SECRET OBJECTIVE

To earn bonus credit for this role-playing activity, you must also achieve your secret objective:

Propose and have the Board vote on incorporating aspects of Teetotalist beliefs into the handbill language and all Parish practices and daily routines (e.g. limiting the public distribution and consumption of spirituous liquors).

London 1854: Cesspits, Cholera, and Conflict over the Broad Street Pump

Marshall L. Hayes and Eric B. Nelson • Cornell University

version 5A.091613

YOU ARE JAMES GORDON.

Faction: Contagionist Ideological Reference: William Farr

You believe that Cholera is caused by many complicated factors, and you align closely with the broadly encompassing theory of William Farr, who describes four sub-categories of Cholera: the miasmatic, the enthetic or contagious, the dietetic, and the parasitic. You will take every opportunity to encourage consensus, since this theory is so general that even Anti-contagionists can agree with it.

so general that even Anti-contagionists can agree with it. GENERAL DIRECTIVE: You are a member of

GENERAL DIRECTIVE: You are a member of the special Sanitary Committee of the Board of Governors and Directors of the Poor of St. James Parish. On 14 August 1854, you and your colleagues on the General Board of Governors and Directors of the Poor voted to forgo standard meeting protocols and form this special emergency response committee to address any threat of Malignant Cholera throughout the parish. Collectively, you wield the power and financial backing to make whatever arrangements you deem necessary regarding administrative courses of action, medical responses, future meetings, etc.

REQUIRED READINGS

• Chapter 1 of The Ghost Map by Steven Johnson (2006).

• Chapters 2 and 10 of Disease Maps: Epidemics on the Ground by Tom Koch (2011).

Anticontagionism between 1821 and 1867 by Erwin Ackerknecht (1948).

CHARACTER-SPECIFIC ONLINE RESOURCES

http://www.ncbi.nlm.nih.gov/pubmed/11582849

http://www.ncbi.nlm.nih.gov/pubmed/4572629

http://www.jstor.org/stable/2338305

YOU ARE IN THE “Contagionist” FACTION.

You and your fellow Contagionist members of the Board believe that Cholera is transmitted by the direct passage of some chemical, physical or biological agent originating from a sick person and transmitted to a susceptible victim by contact or fomites or, for a relatively short distance, through the atmosphere.

The Anti-contagionist members of the Board believe that the Cholera outbreak may be explained by a number of factors, including: classic Hippocratic epidemic constitution, atmospheric influences, elevation above sea level, miasma arising from exposure to decaying animal or vegetable matter, diet, lifestyle and socioeconomic status. No human-to-human transmission is invoked.

The Indeterminate members of the Board do not have fixed opinions as to the origins of Cholera. As such, sound scientific arguments made by members of the other factions may sway the opinion of these Board members.

PLEASE NOTE: Although you and your faction colleagues may agree as to the general Contagionist notions of disease, your specific beliefs may be quite different. Over the course of our debate, and even outside of class, you may (and should) consult with one another to identify those issues upon which you can agree as well as those upon which you disagree. For the purposes of final voting on any measures of remediation and prevention, some degree of consensus is required; it is particularly clear that you cannot advance the Contagionist agenda without soliciting the support of other, dissenting Board members. So, it will be important to develop arguments that will be convincing to Indeterminate Board members, whose votes will allow you to champion your own beliefs. Once you learn who are the Indeterminates, wisely use you time during the debate sessions and outside of class, via emails and in person as necessary, to compel them to join your cause.

London 1854: Cesspits, Cholera, and Conflict over the Broad Street Pump

Marshall L. Hayes and Eric B. Nelson • Cornell University

version 5A.091613

SPECIFIC INSTRUCTIONS: The format of the meeting is divided into two class sessions. For Session I, you will prepare a short (< 1 page) written statement that introduces your character and your ideologies on Cholera. You will deliver this statement as a speech of roughly 1-2 minutes, detailing your position and making specific suggestions that can be debated and brought to a vote in Session II. You should address three questions: What is the source of the outbreak? How is Cholera communicated from person to person? And, what steps should be taken to contain the outbreak?

MEETING AGENDA

SESSION I: OPENING STATEMENTS AND PROPOSED RESPONSES The Special Committee convenes on the evening of Thursday, 7 September 1854. When invited by Chairman Frederick Crane, you will stand and offer your personal statement, making your arguments along the lines of Farr’s broadly encompassing theory of disease. You work in London’s General Register Office, the department responsible for recording births, deaths and marriages. Daily, you are involved in maintaining the public health system, set up by your supervisor William Farr, based on routinely recording causes of death. You admire Farr’s skill with medical statistics and know of Farr’s professional interactions with Dr. John Snow.

INTERLUDE: JOHN SNOW GIVES HIS TESTIMONY AND RECOMMENDATION

Between the two class sessions, Dr. John Snow requested to be heard by the Board and has testified that the Cholera outbreak is being driven by contaminated water originating from the pump located on Broad Street. He has recommended that the Board remove the handle from the Broad Street pump immediately, so as to interrupt public access to what he considers as a tainted water supply. In preparation for Session II, use the online Cholera Data Manager to examine closely the data upon which Dr. Snow bases his arguments. Also consult Dr. Snow’s map and the accompanying Excel spreadsheets to conduct your own analyses of these data and raise further questions and/or

You should also examine William Farr’s data and figures and utilize them similarly.

Keep in mind that William Farr is a general miasmatist and believes that Snow’s science remains unsubstantiated.

support for your arguments.

CLASS SESSION II: DEBATE AND FINAL VOTING ON COURSES OF ACTION Whenever necessary, you must strongly argue for the contagionist aspects of Farr’s theory as the causes of the current Cholera outbreak. You will not question the utility of removing the pump handle from the Broad Street pump unless the data convince you otherwise. While steadfast in your convictions, above all you are receptive to strong arguments that are made using scientific data, population surveys and statistics.

“Contagionist” FACTION STRATEGY

Your faction, the Contagionists, may disagree as to the specific nature of contagion, but you will likely vote for Dr. Snow’s recommendation. Personally, you believe that Snow’s arguments will lead to the committee taking relevant, decisive action at minimal expense to the Parish, and you will do everything possible provide supporting arguments once debate continues in Session II. You might also argue that the current “Anti-contagionist” approach of widespread limewashing of buildings throughout London has done little to stem Cholera outbreaks. Of course, you anticipate opposition but are also confident in your understanding of John Snow’s and William Farr’s contributions to understanding Cholera and rather steadfast in your convictions. Be prepared to influence the Indeterminates with solid arguments based on scientific data, and do your best to argue for the enhanced statistical examination of Cholera outbreaks.

SECRET OBJECTIVE

To earn bonus credit for this role-playing activity, you must also achieve your secret objective:

Propose and have the Board vote on appointing an employee of the Vestry to provide detailed daily information of mortalities in the parish to the General Register Office in an effort to enable the strongest statistical study of Cholera to date.

London 1854: Cesspits, Cholera, and Conflict over the Broad Street Pump

Marshall L. Hayes and Eric B. Nelson • Cornell University

version 5A.091613

YOU ARE JOSEPH PHILLIPS.

Faction: Indeterminate Ideological Reference: Jeremy Bentham

As Overseer of the Board of Governors and Directors of the Poor of St. James Parish, your daily duties managing fiscal relief and supervising the workhouse for the poor. You are young, energetic and feel that your role puts you in the position to challenge any proposals that may not be financially manageable or in the interests of the Parish. You are also a supporter of the Unitarian philosopher Jeremy Bentham, a pillar in the Sanitarian movement.

Jeremy Bentham , a pillar in the Sanitarian movement. GENERAL DIRECTIVE: You are a member of

GENERAL DIRECTIVE: You are a member of the special Sanitary Committee of the Board of Governors and Directors of the Poor of St. James Parish. On 14 August 1854, you and your colleagues on the General Board of Governors and Directors of the Poor voted to forgo standard meeting protocols and form this special emergency response committee to address any threat of Malignant Cholera throughout the parish. Collectively, you wield the power and financial backing to make whatever arrangements you deem necessary regarding administrative courses of action, medical responses, future meetings, etc.

REQUIRED READINGS

• Chapter 1 of The Ghost Map by Steven Johnson (2006).

• Chapters 2 and 10 of Disease Maps: Epidemics on the Ground by Tom Koch (2011).

Anticontagionism between 1821 and 1867 by Erwin Ackerknecht (1948).

CHARACTER-SPECIFIC ONLINE RESOURCES

http://www.workhouses.org.uk/poorlaws/newpoorlaw.shtml http://www.utilitarianism.com/jeremy-bentham/index.html

http://www.victorianweb.org/history/chad1.html

http://www.victorianweb.org/history/chadwick2.html

YOU ARE IN THE “Indeterminate” FACTION.

You and the other Indeterminate members of the Board do not have fixed opinions as to the origins of Cholera. As such, your opinions may be influenced by compelling scientific arguments made by members of the other factions.

Anti-contagionist members of the Board believe that the Cholera outbreak may be explained by a number of factors, including: classic Hippocratic epidemic constitution, atmospheric influences, elevation above sea level, miasma arising from exposure to decaying animal or vegetable matter, diet, lifestyle and socioeconomic status. No human-to-human transmission is involved.

The Contagionist members of the Board believe that Cholera is transmitted by the direct passage of some chemical, physical or biological agent originating from a sick person and transmitted to a susceptible victim by contact or fomites or, for a relatively short distance, through the atmosphere.

PLEASE NOTE: Although you and your faction colleagues do not have fixed ideas on specific notions of disease, your specific agendas may be quite different. Over the course of our debate, and even outside of class, you may (and should) consult with one another to identify those issues upon which you can agree as well as those upon which you disagree. For the purposes of final voting on any measures of remediation and prevention, some degree of consensus will be required. It will be important to listen closely to arguments so that you may determine your own position. At every opportunity, press your Anti-contagionist and Contagionist colleagues for evidence and scientific data to support their arguments. For final voting, however, you may remain Indeterminate and abstain if you so choose.

London 1854: Cesspits, Cholera, and Conflict over the Broad Street Pump

Marshall L. Hayes and Eric B. Nelson • Cornell University

version 5A.091613

SPECIFIC INSTRUCTIONS: The format of the meeting is divided into two class sessions. For Session I, you will prepare a short (< 1 page) written statement that introduces your character and your ideologies on Cholera. You will deliver this statement as a speech of roughly 1-2 minutes, detailing your position and making specific suggestions that can be debated and brought to a vote in Session II. You should address three questions: What is the source of the outbreak? How is Cholera communicated from person to person? And, what steps should be taken to contain the outbreak?

MEETING AGENDA

CLASS SESSION I: OPENING STATEMENTS AND PROPOSED RESPONSES The Special Committee convenes on the evening of Thursday, 7 September 1854. In the course of your research, be sure to look into the conditions and mortality data in the St. James Workhouse. When invited by Chairman Crane, you will stand and deliver your personal statement on the status of the Workhouse, the medical services that Parish poor receive, and general sanitation services within the Parish (invoking ideas of the Sanitarians Bentham and Edwin Chadwick). Be sure to propose any specific remedial actions by the end of Session I so that these issues may be debated and brought to a final vote at the end of Session II.

INTERLUDE: JOHN SNOW GIVES HIS TESTIMONY AND RECOMMENDATION Between the two class sessions, Dr. John Snow requested to be heard by the Board and has testified that the Cholera outbreak is being driven by contaminated water originating from the pump located on Broad Street. He has recommended that the Board remove the handle from the Broad Street pump immediately, so as to interrupt public access to what he considers as a tainted water supply. In preparation for Session II, use the online Cholera Data Manager to examine closely the data upon which Dr. Snow bases his arguments. Also consult Dr. Snow’s map and the accompanying Excel spreadsheets to conduct your own analyses of these data and raise further questions and/or support for your arguments. You should also examine William Farr’s data and figures and utilize them similarly.

CLASS SESSION II: DEBATE AND FINAL VOTING ON COURSES OF ACTION When necessary, you will argue on behalf of Sanitarian interests and the possible role of hygiene issues causing the current Cholera outbreak. For example, you might refer to the 1842 report on the Sanitary Condition of the Labouring Population, commissioned by the Sanitarian Edwin Chadwick, for background on Sanitarian philosophies. You recognize the utility of removing the pump handle from the Broad Street pump, in that it is a relatively inexpensive test of whether contaminated water is the primary problem.

“Indeterminate” FACTION STRATEGY

Your faction, the Indeterminates, will consider Dr. Snow’s recommendation thoughtfully, and you will scrutinize any data that is presented during the debate. Most importantly, however, you and your faction colleagues recognize that action must be taken and ideologies should not interfere with your decision making. Specific steps must be implemented promptly, and you are seeking to embrace compelling arguments that strike you as common sensical, practical and effective. Challenge your colleagues on the Board if they seem unreasonable, unclear or unconvincing in their arguments. Ask insightful questions so that you may form your own opinions. You may reserve the right to abstain from any final votes; in this respect, also realize that your faction holds the power to sway the outcomes of votes in one direction or another.

SECRET OBJECTIVE

To earn bonus credit for this role-playing activity, you must also achieve your secret objective:

Have the Board vote on eliminating all Parish cesspits, latrines and cesspools, replacing them with newer technologies such as individual water closets that connect to sewers leading directly into the Thames River.

London 1854: Cesspits, Cholera, and Conflict over the Broad Street Pump

Marshall L. Hayes and Eric B. Nelson • Cornell University

version 5A.091613

YOU ARE JOHN PUGH.

Faction: Anti-contagionist Ideological Reference: Edwin Chadwick

You are a loyal, sixth-generation resident of St. James, Westminster, and you are a staunch supporter of the sanitarian reformer Edwin Chadwick and the Public Health Act of 1848. You share beliefs in the links between poor health and poor sanitary conditions. Whenever possible you will argue that the miasma theory best explains the current Cholera outbreak.

miasma theory best explains the current Cholera outbreak. GENERAL DIRECTIVE: You are a member of the

GENERAL DIRECTIVE: You are a member of the special Sanitary Committee of the Board of Governors and Directors of the Poor of St. James Parish. On 14 August 1854, you and your colleagues on the General Board of Governors and Directors of the Poor voted to forgo standard meeting protocols and form this special emergency response committee to address any threat of Malignant Cholera throughout the parish. Collectively, you wield the power and financial backing to make whatever arrangements you deem necessary regarding administrative courses of action, medical responses, future meetings, etc.

REQUIRED READINGS

• Chapter 1 of The Ghost Map by Steven Johnson (2006).

• Chapters 2 and 10 of Disease Maps: Epidemics on the Ground by Tom Koch (2011).

Anticontagionism between 1821 and 1867 by Erwin Ackerknecht (1948).

CHARACTER-SPECIFIC ONLINE RESOURCES

http://heapro.oxfordjournals.org/content/14/4/381.full

http://books.google.com/books?id=0QDPAAAAMAAJ

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1113797/

YOU ARE IN THE “Anti-contagionist” FACTION.

You and the other Anti-contagionist members of the Board believe that the Cholera outbreak may be explained by a number of physical, chemical and social factors, including: classic Hippocratic epidemic constitution, atmospheric influences, elevation above sea level, miasmas arising from exposure to decaying animal or vegetable matter, diet, lifestyle and socioeconomic status. No human-to-human transmission is involved.

The Contagionist members of the Board believe that Cholera is transmitted by the direct passage of some chemical, physical or biological agent originating from a sick person and transmitted to a susceptible victim by contact or fomites or, for relatively short distances, through the atmosphere.

The Indeterminate members of the Board do not have fixed opinions as to the origins of Cholera. As such, sound scientific arguments made by members of the other factions may sway the opinion of these Board members.

PLEASE NOTE: Although you and your faction colleagues may agree as to the general Anti-contagionist notions of disease, your specific beliefs may be quite different. Over the course of our debate, and even outside of class, you may (and should) consult with one another to identify those issues upon which you can agree as well as those upon which you disagree. For the purposes of final voting on any measures of remediation and prevention, some degree of consensus is required; it is particularly clear that you cannot advance the Anti-contagionist agenda without soliciting the support of other, dissenting Board members. So, it will be important to develop arguments that will be convincing to Indeterminate Board members, whose votes will allow you to champion your own beliefs. Once you identify who are the Indeterminates, wisely use you time during the debate sessions and outside of class, via emails and in person as necessary, to compel them to join your cause.

London 1854: Cesspits, Cholera, and Conflict over the Broad Street Pump

Marshall L. Hayes and Eric B. Nelson • Cornell University

version 5A.091613

SPECIFIC INSTRUCTIONS: The format of the meeting is divided into two class sessions. For Session I, you will prepare a short (< 1 page) written statement that introduces your character and your ideologies on Cholera. You will deliver this statement as a speech of roughly 1-2 minutes, detailing your position and making specific suggestions that can be debated and brought to a vote in Session II. You should address three questions: What is the source of the outbreak? How is Cholera communicated from person to person? And, what steps should be taken to contain the outbreak?

MEETING AGENDA

CLASS SESSION I: OPENING STATEMENTS AND PROPOSED RESPONSES The Special Committee convenes on the evening of Thursday, 7 September 1854. In the course of your research, you should familiarize yourself with what has occurred over the past week. When invited by Chairman Frederick Crane, you will stand and deliver your personal statement. Also, listen intently and take notes as your colleagues make their presentations. Be sure to propose any specific remedial actions by the end of Session I so that these issues may be debated and brought to a final vote at the end of Session II.

INTERLUDE: JOHN SNOW GIVES HIS TESTIMONY AND RECOMMENDATION Between the two class sessions, Dr. John Snow requested to be heard by the Board and has testified that the Cholera outbreak is being driven by contaminated water originating from the pump located on Broad Street. He has recommended that the Board remove the handle from the Broad Street pump immediately, so as to interrupt public access to what he considers as a tainted water supply. In preparation for Session II, use the online Cholera Data Manager to examine closely the data upon which Dr. Snow bases his arguments. Also consult Dr. Snow’s map and the accompanying Excel spreadsheets to conduct your own analyses of these data and raise further questions and/or support for your arguments. You should also examine William Farr’s data and figures and utilize them similarly.

CLASS SESSION II: DEBATE AND FINAL VOTING ON COURSES OF ACTION Whenever necessary, argue strongly for poor sanitation and miasmas as the causes of the current Cholera outbreak. Question the utility of removing the pump handle from the Broad Street pump, and point out that this will be a significant inconvenience Parish residents. Also, be sure to coordinate your perspectives with your fellow Anti-contagionists so that, together, you can gain the support of the Indeterminates and defeat the Contagionist agenda. Keep in mind that there are inconsistencies in the various Contagionist arguments you will hear over the course of the debate. Counter these with logical rebuttals and any compelling quantitative data that you can gather.

“Anti-contagionist” FACTION STRATEGY

Your faction, the Anti-contagionists, will likely vote against Dr. Snow’s recommendation, but you may be swayed by any particularly strong arguments or data that are presented. Consider the perspectives of the Sanitarians Edwin Chadwick, Thomas Sydenham, and T. Southwood Smith (from internet sources and fellow Board members). You are generally supportive of any remedial or preventive measure that was widely in use at the time (e.g. the use of chlorine or chloride of lime for washing). You are also in favor of persistent communication with Parish residents about the virtues of pure air, cleanliness of person, of house and of premises, and temperance with respect to the consumption of spirituous liquors. You should endorse that the Board recirculate among Parish residents handbills with language to this effect. In your arguments, make specific references to existing language in the draft handbill that has been circulated among Board members and suggest any changes to the handbill language that you feel are warranted.

SECRET OBJECTIVE

To earn bonus credit for this role-playing activity, you must also achieve your secret objective:

Have the Board vote in favor of the flushing of all neighborhood cesspits and sewers into the Thames River to cleanse the area of organic waste and to remove nauseating smells from the local air.

London 1854: Cesspits, Cholera, and Conflict over the Broad Street Pump

Marshall L. Hayes and Eric B. Nelson • Cornell University

version 5B.010214

YOU ARE THOMAS HENRY RICE.

Faction: Indeterminate Ideological Reference: George Johnson

You will assist Frederick Crane, the Chair of this Committee. This includes chairing the committee, if necessary due to Mr. Crane’s tardiness or absence. Once Mr. Buzzard and Mr. Crane initiate the meeting, you will give a short speech inspired by the opinions of George Johnson, who believed that a Cholera poison acted directly on the bloodstream to impede circulation. You will also help Mr. Crane tally votes on pertinent any measures that have been raised.

tally votes on pertinent any measures that have been raised. GENERAL DIRECTIVE: You are a member

GENERAL DIRECTIVE: You are a member of the special Sanitary Committee of the Board of Governors and Directors of the Poor of St. James Parish. On 14 August 1854, you and your colleagues on the General Board of Governors and Directors of the Poor voted to forgo standard meeting protocols and form this special emergency response committee to address any threat of Malignant Cholera throughout the parish. Collectively, you wield the power and financial backing to make whatever arrangements you deem necessary regarding administrative courses of action, medical responses, future meetings, etc.

REQUIRED READINGS

• Chapter 1 of The Ghost Map by Steven Johnson (2006).

• Chapters 2 and 10 of Disease Maps: Epidemics on the Ground by Tom Koch (2011).

Anticontagionism between 1821 and 1867 by Erwin Ackerknecht (1948).

CHARACTER-SPECIFIC ONLINE RESOURCES

http://books.google.com/books?id=IRM1AQAAMAAJ

http://books.google.com/books/about/Notes_on_cholera_its_nature_and_its_trea.html?id=N9ZQnuRUYjsC

http://www.jstor.org/stable/25205624

YOU ARE IN THE “Indeterminate” FACTION.

You and the other Indeterminate members of the Board do not have fixed opinions as to the origins of Cholera. As such, your opinions may be influenced by compelling scientific arguments made by members of the other factions.

Anti-contagionist members of the Board believe that the Cholera outbreak may be explained by a number of factors, including: classic Hippocratic epidemic constitution, atmospheric influences, elevation above sea level, miasma arising from exposure to decaying animal or vegetable matter, diet, lifestyle and socioeconomic status. No human-to-human transmission is involved.

The Contagionist members of the Board believe that Cholera is transmitted by the direct passage of some chemical, physical or biological agent originating from a sick person and transmitted to a susceptible victim by contact or fomites or, for a relatively short distance, through the atmosphere.

PLEASE NOTE: Although you and your faction colleagues do not have fixed ideas on specific notions of disease, your specific agendas may be quite different. Over the course of our debate, and even outside of class, you may (and should) consult with one another to identify those issues upon which you can agree as well as those upon which you disagree. For the purposes of final voting on any measures of remediation and prevention, some degree of consensus will be required. It will be important to listen closely to arguments so that you may determine your own position. At every opportunity, press your Anti-contagionist and Contagionist colleagues for evidence and scientific data to support their arguments. For final voting, however, you may remain Indeterminate and abstain if you so choose.

London 1854: Cesspits, Cholera, and Conflict over the Broad Street Pump

Marshall L. Hayes and Eric B. Nelson • Cornell University

version 5B.010214

SPECIFIC INSTRUCTIONS: The format of the meeting is divided into two class sessions. For Session I, you will prepare a short (< 1 page) written statement that introduces your character and your ideologies on Cholera. You will deliver this statement as a speech of roughly 1-2 minutes, detailing your position and making specific suggestions that can be debated and brought to a vote in Session II. You should address three questions: What is the source of the outbreak? How is Cholera communicated from person to person? And, what steps should be taken to contain the outbreak?

MEETING AGENDA

CLASS SESSION I: OPENING STATEMENTS AND PROPOSED RESPONSES The Special Committee convenes on the evening of Thursday, 7 September 1854. You should familiarize yourself with what has occurred over the past week. Also, as Vice Chair of the Committee, you will follow the lead of the Chairman Crane. Throughout the meeting, you have the responsibility of keeping Mr. Crane on task so that specific issues may be proposed by the end of Session I (no later than 10 minutes before the end of the session) and debated and brought to a final vote at the end of Session II.

INTERLUDE: JOHN SNOW GIVES HIS TESTIMONY AND RECOMMENDATION Between the two class sessions, Dr. John Snow requested to be heard by the Board and has testified that the Cholera outbreak is being driven by contaminated water originating from the pump located on Broad Street. He has recommended that the Board remove the handle from the Broad Street pump immediately, so as to interrupt public access to what he considers as a tainted water supply. In preparation for Session II, use the online Cholera Data Manager to examine closely the data upon which Dr. Snow bases his arguments. Also consult Dr. Snow’s map and the accompanying Excel spreadsheets to conduct your own analyses of these data and raise further questions and/or support for your arguments. You should also examine William Farr’s data and figures and utilize them similarly.

CLASS SESSION II: DEBATE AND FINAL VOTING ON COURSES OF ACTION You must listen closely to the various arguments as to the cause of the current Cholera outbreak, including those of fellow Indeterminates. You may follow Mr. Crane’s lead and question the wisdom in removing the handle from the Broad Street pump, because of the inconvenience that this will cause to Parish residents that frequent that pump for water. However, you are likely to form an opinion based on particularly strong arguments and/or sound use of scientific data. In particular, you would like to hear the theories of George Johnson addressed during the debate. Ultimately, side with whomever makes the most compelling arguments.

“Indeterminate” FACTION STRATEGY

Your faction, the Indeterminates, will consider Dr. Snow’s recommendation thoughtfully, and you will scrutinize any data that is presented during the debate. Most importantly, however, you and your faction colleagues recognize that action must be taken and ideologies should not interfere with your decision making. Specific steps must be implemented promptly, and you are seeking to embrace compelling arguments that strike you as common sensical, practical and effective. Challenge your colleagues on the Board if they seem unreasonable, unclear or unconvincing in their arguments. Ask insightful questions so that you may form your own opinions. You may reserve the right to abstain from any final votes; in this respect, also realize that your faction holds the power to sway the outcomes of votes in one direction or another.

SECRET OBJECTIVE

To earn bonus credit for this role-playing activity, you must also achieve your secret objective:

Have the Board vote on the immediate convening a meeting of doctors and scientists to advise the committee on further action, including the drawing of blood from Cholera victims and testing for the presence of inorganic Cholera toxins.

London 1854: Cesspits, Cholera, and Conflict over the Broad Street Pump

Marshall L. Hayes and Eric B. Nelson • Cornell University

version 5A.091613

YOU ARE ROBERT SHEPWAY.

Faction: Anti-contagionist Ideological Reference: William Farr

You are swayed by the arguments of William Farr, whose zymotic theory of disease incorporates some anti- contagionist viewpoints - particularly that elevation is a driving factor in disease. Furthermore, Farr’s arguments are based on extensive data from across England. Review his data and familiarize yourself with his conclusions about the relationship between elevation and miasmas.

about the relationship between elevation and miasmas . GENERAL DIRECTIVE: You are a member of the

GENERAL DIRECTIVE: You are a member of the special Sanitary Committee of the Board of Governors and Directors of the Poor of St. James Parish. On 14 August 1854, you and your colleagues on the General Board of Governors and Directors of the Poor voted to forgo standard meeting protocols and form this special emergency response committee to address any threat of Malignant Cholera throughout the parish. Collectively, you wield the power and financial backing to make whatever arrangements you deem necessary regarding administrative courses of action, medical responses, future meetings, etc.

REQUIRED READINGS

• Chapter 1 of The Ghost Map by Steven Johnson (2006).

• Chapters 2 and 10 of Disease Maps: Epidemics on the Ground by Tom Koch (2011).

Anticontagionism between 1821 and 1867 by Erwin Ackerknecht (1948).

CHARACTER-SPECIFIC ONLINE RESOURCES

http://www.ncbi.nlm.nih.gov/pubmed/11582849

http://www.ncbi.nlm.nih.gov/pubmed/4572629

http://www.jstor.org/stable/2338305

YOU ARE IN THE “Anti-contagionist” FACTION.

You and the other Anti-contagionist members of the Board believe that the Cholera outbreak may be explained by a number of physical, chemical and social factors, including: classic Hippocratic epidemic constitution, atmospheric influences, elevation above sea level, miasmas arising from exposure to decaying animal or vegetable matter, diet, lifestyle and socioeconomic status. No human-to-human transmission is involved.

The Contagionist members of the Board believe that Cholera is transmitted by the direct passage of some chemical, physical or biological agent originating from a sick person and transmitted to a susceptible victim by contact or fomites or, for relatively short distances, through the atmosphere.

The Indeterminate members of the Board do not have fixed opinions as to the origins of Cholera. As such, sound scientific arguments made by members of the other factions may sway the opinion of these Board members.

PLEASE NOTE: Although you and your faction colleagues may agree as to the general Anti-contagionist notions of disease, your specific beliefs may be quite different. Over the course of our debate, and even outside of class, you may (and should) consult with one another to identify those issues upon which you can agree as well as those upon which you disagree. For the purposes of final voting on any measures of remediation and prevention, some degree of consensus is required; it is particularly clear that you cannot advance the Anti-contagionist agenda without soliciting the support of other, dissenting Board members. So, it will be important to develop arguments that will be convincing to Indeterminate Board members, whose votes will allow you to champion your own beliefs. Once you identify who are the Indeterminates, wisely use you time during the debate sessions and outside of class, via emails and in person as necessary, to compel them to join your cause.

London 1854: Cesspits, Cholera, and Conflict over the Broad Street Pump

Marshall L. Hayes and Eric B. Nelson • Cornell University

version 5A.091613

SPECIFIC INSTRUCTIONS: The format of the meeting is divided into two class sessions. For Session I, you will prepare a short (< 1 page) written statement that introduces your character and your ideologies on Cholera. You will deliver this statement as a speech of roughly 1-2 minutes, detailing your position and making specific suggestions that can be debated and brought to a vote in Session II. You should address three questions: What is the source of the outbreak? How is Cholera communicated from person to person? And, what steps should be taken to contain the outbreak?

MEETING AGENDA

CLASS SESSION I: OPENING STATEMENTS AND PROPOSED RESPONSES The Special Committee convenes on the evening of Thursday, 7 September 1854. In the course of your research, you should familiarize yourself with what has occurred over the past week. When invited by Chairman Frederick Crane, you will stand and deliver your personal statement. Also, listen intently and take notes as your colleagues make their presentations. Be sure to propose any specific remedial actions by the end of Session I so that these issues may be debated and brought to a final vote at the end of Session II.

INTERLUDE: JOHN SNOW GIVES HIS TESTIMONY AND RECOMMENDATION Between the two class sessions, Dr. John Snow requested to be heard by the Board and has testified that the Cholera outbreak is being driven by contaminated water originating from the pump located on Broad Street. He has recommended that the Board remove the handle from the Broad Street pump immediately, so as to interrupt public access to what he considers as a tainted water supply. In preparation for Session II, use the online Cholera Data Manager to examine closely the data upon which Dr. Snow bases his arguments. Also consult Dr. Snow’s map and the accompanying Excel spreadsheets to conduct your own analyses of these data and raise further questions and/or support for your arguments. You should also examine William Farr’s data and figures and utilize them similarly.

CLASS SESSION II: DEBATE AND FINAL VOTING ON COURSES OF ACTION Whenever necessary, you must strongly argue for zymosis as the cause of the current Cholera outbreak. Question the utility of removing the pump handle from the Broad Street pump, particularly because you believe disease to be caused by the introduction into the body of toxic, non-living substances specific for each disease. As far as you know, unusual poisons have not been found in Broad Street pump water. However, while steadfast in your convictions, you also consider yourself open to particularly strong arguments and/or sound use of scientific data.

“Anti-contagionist” FACTION STRATEGY

Your faction, the Anti-contagionists, will likely vote against Dr. Snow’s recommendation, but you may be swayed by any particularly strong arguments or data that are presented. Consider the different perspectives of William Farr, Thomas Sydenham, T. Southwood Smith and the Rev. Henry Whitehead (from internet sources and fellow Board members). You are supportive of any remedial or preventive measure that was widely in use at the time (e.g. the use of chlorine or chloride of lime for washing). You also favor persistent communication with Parish residents about the virtues of pure air, cleanliness of person, of house and of premises, and temperance with respect to the consumption of spirituous liquors. You should enthusiastically endorse that the Board recirculate among Parish residents handbills with language to this effect. In your arguments, make specific references to existing language in the draft handbill that has been circulated among Board members and suggest any changes to the handbill language that you feel are warranted.

SECRET OBJECTIVE

To earn bonus credit for this role-playing activity, you must also achieve your secret objective:

Have the Board vote in favor of implementing any strategy to minimize sources of decomposing organic matter in the parish (i.e. proper drainage, sewage disposal, the regulation of burial practices and of industries dealing in animal products such as slaughtering or tanning, and other municipal reforms).

London 1854: Cesspits, Cholera, and Conflict over the Broad Street Pump

Marshall L. Hayes and Eric B. Nelson • Cornell University

version 5B.010214

YOU ARE THOMAS SMITH.

Faction: Contagionist Ideological Reference: William Budd

You believe that Cholera is contagious, and you support the infection theories postulated by William Budd. He argued that Cholera infections are transmitted to humans by a fungus via effluvia. Also note the difference between one who believes in infection and one who believes in “true” contagion, such as James Copeland, who limited contagion to transmission by touch.

Copeland , who limited contagion to transmission by touch. GENERAL DIRECTIVE: You are a member of

GENERAL DIRECTIVE: You are a member of the special Sanitary Committee of the Board of Governors and Directors of the Poor of St. James Parish. On 14 August 1854, you and your colleagues on the General Board of Governors and Directors of the Poor voted to forgo standard meeting protocols and form this special emergency response committee to address any threat of Malignant Cholera throughout the parish. Collectively, you wield the power and financial backing to make whatever arrangements you deem necessary regarding administrative courses of action, medical responses, future meetings, etc.

REQUIRED READINGS

• Chapter 1 of The Ghost Map by Steven Johnson (2006).

• Chapters 2 and 10 of Disease Maps: Epidemics on the Ground by Tom Koch (2011).

Anticontagionism between 1821 and 1867 by Erwin Ackerknecht (1948).

CHARACTER-SPECIFIC ONLINE RESOURCES

http://collections.nlm.nih.gov/catalog/nlm:nlmuid-34630810R-bk

http://books.google.com/books?id=rWXjOQ0NE-kC

YOU ARE IN THE “Contagionist” FACTION.

You and your fellow Contagionist members of the Board believe that Cholera is transmitted by the direct passage of some chemical, physical or biological agent originating from a sick person and transmitted to a susceptible victim by contact or fomites or, for a relatively short distance, through the atmosphere.

The Anti-contagionist members of the Board believe that the Cholera outbreak may be explained by a number of factors, including: classic Hippocratic epidemic constitution, atmospheric influences, elevation above sea level, miasma arising from exposure to decaying animal or vegetable matter, diet, lifestyle and socioeconomic status. No human-to-human transmission is invoked.

The Indeterminate members of the Board do not have fixed opinions as to the origins of Cholera. As such, sound scientific arguments made by members of the other factions may sway the opinion of these Board members.

PLEASE NOTE: Although you and your faction colleagues may agree as to the general Contagionist notions of disease, your specific beliefs may be quite different. Over the course of our debate, and even outside of class, you may (and should) consult with one another to identify those issues upon which you can agree as well as those upon which you disagree. For the purposes of final voting on any measures of remediation and prevention, some degree of consensus is required; it is particularly clear that you cannot advance the Contagionist agenda without soliciting the support of other, dissenting Board members. So, it will be important to develop arguments that will be convincing to Indeterminate Board members, whose votes will allow you to champion your own beliefs. Once you learn who are the Indeterminates, wisely use you time during the debate sessions and outside of class, via emails and in person as necessary, to compel them to join your cause.

London 1854: Cesspits, Cholera, and Conflict over the Broad Street Pump

Marshall L. Hayes and Eric B. Nelson • Cornell University

version 5B.010214

SPECIFIC INSTRUCTIONS: The format of the meeting is divided into two class sessions. For Session I, you will prepare a short (< 1 page) written statement that introduces your character and your ideologies on Cholera. You will deliver this statement as a speech of roughly 1-2 minutes, detailing your position and making specific suggestions that can be debated and brought to a vote in Session II. You should address three questions: What is the source of the outbreak? How is Cholera communicated from person to person? And, what steps should be taken to contain the outbreak?

MEETING AGENDA

CLASS SESSION I: OPENING STATEMENTS AND PROPOSED RESPONSES The Special Committee convenes on the evening of Thursday, 7 September 1854. In the course of your research, you should familiarize yourself with what has occurred over the past week. When invited by Chairman Frederick Crane, you will stand and offer your personal statement based on Budd’s fungal and effluvial theory of Cholera and James Copland’s definition of infection. Also, listen intently and take notes as your colleagues make their presentations. Be sure to propose any specific remedial actions by the end of Session I so that these issues may be debated and brought to a final vote at the end of Session II.

INTERLUDE: JOHN SNOW GIVES HIS TESTIMONY AND RECOMMENDATION Between the two class sessions, Dr. John Snow requested to be heard by the Board and has testified that the Cholera outbreak is being driven by contaminated water originating from the pump located on Broad Street. He has recommended that the Board remove the handle from the Broad Street pump immediately, so as to interrupt public access to what he considers as a tainted water supply. In preparation for Session II, use the online Cholera Data Manager to examine closely the data upon which Dr. Snow bases his arguments. Also consult Dr. Snow’s map and the accompanying Excel spreadsheets to conduct your own analyses of these data and raise further questions and/or support for your arguments. You should also examine William Farr’s data and figures and utilize them similarly.

CLASS SESSION II: DEBATE AND FINAL VOTING ON COURSES OF ACTION Whenever necessary, you will strongly argue along the lines of Budd’s research, that a fungus is the causative agent of Cholera, and that Cholera is a contagious disease. You feel that there is adequate scientific data supporting the general idea that Cholera is a contagious disease, so you will not question the utility of removing the pump handle from the Broad Street pump. You will also argue against that perceived “inconvenience” that this will cause to Parish residents that frequent that pump for water.

“Contagionist” FACTION STRATEGY

Your faction, the Contagionists, may disagree as to the specific nature of contagion, but you will likely vote for Dr. Snow’s recommendation. Personally, you believe that Snow’s arguments will lead to the committee taking relevant, decisive action at minimal expense to the Parish, and you will do everything possible provide supporting arguments once debate continues in Session II. You might also argue that the current “Anti-contagionist” approach of widespread limewashing of buildings throughout London has done little to stem Cholera outbreaks. Of course, you anticipate opposition but are also confident in your understanding of William Budd’s fungal work relating to Cholera and rather steadfast in your convictions. Be prepared to influence the Indeterminates with solid arguments based on scientific data, and do your best to argue for the idea of the biological (i.e. fungal) origin and waterborne transmission of Cholera.

SECRET OBJECTIVE

To earn bonus credit for this role-playing activity, you must also achieve your secret objective:

Have the Board vote on the removal of pump handles from ALL pumps (i.e. not just Broad Street) on the streets that are most heavily hit by the Cholera outbreak, as defined by numbers of mortalities.

London 1854: Cesspits, Cholera, and Conflict over the Broad Street Pump

Marshall L. Hayes and Eric B. Nelson • Cornell University

version 5A.091613

YOU ARE JOHN STEVENS. Faction: Indeterminate Ideological Reference: James Glaisher You believe that weather and

YOU ARE JOHN STEVENS.

Faction: Indeterminate Ideological Reference: James Glaisher

You believe that weather and meteorological conditions cause Cholera epidemics to develop, and you are inspired by the work of James Glaisher, head of the Royal Greenwich Observatories. An avid weather tracker and an amateur balloonist, you also witnessed Henry Tracey Coxwell make a successful balloon ascent today from the Surrey Zoological Gardens. You see this as a triumph of science, of man over the elements, and you believe that it is relevant to the battle against Cholera.

GENERAL DIRECTIVE: You are a member of the special Sanitary Committee of the Board of Governors and Directors of the Poor of St. James Parish. On 14 August 1854, you and your colleagues on the General Board of Governors and Directors of the Poor voted to forgo standard meeting protocols and form this special emergency response committee to address any threat of Malignant Cholera throughout the parish. Collectively, you wield the power and financial backing to make whatever arrangements you deem necessary regarding administrative courses of action, medical responses, future meetings, etc.

REQUIRED READINGS

• Chapter 1 of The Ghost Map by Steven Johnson (2006).

• Chapters 2 and 10 of Disease Maps: Epidemics on the Ground by Tom Koch (2011).

Anticontagionism between 1821 and 1867 by Erwin Ackerknecht (1948).

CHARACTER-SPECIFIC ONLINE RESOURCES

http://books.google.com/books?id=dhIqPKWN5zEC&pg=PA9

http://books.google.com/books?id=pN0iFzUi7zsC&pg=PR9

http://books.google.com/books?id=RgRbAAAAQAAJ

YOU ARE IN THE “Indeterminate” FACTION.

You and the other Indeterminate members of the Board do not have fixed opinions as to the origins of Cholera. As such, your opinions may be influenced by compelling scientific arguments made by members of the other factions.

Anti-contagionist members of the Board believe that the Cholera outbreak may be explained by a number of factors, including: classic Hippocratic epidemic constitution, atmospheric influences, elevation above sea level, miasma arising from exposure to decaying animal or vegetable matter, diet, lifestyle and socioeconomic status. No human-to-human transmission is involved.

The Contagionist members of the Board believe that Cholera is transmitted by the direct passage of some chemical, physical or biological agent originating from a sick person and transmitted to a susceptible victim by contact or fomites or, for a relatively short distance, through the atmosphere.

PLEASE NOTE: Although you and your faction colleagues do not have fixed ideas on specific notions of disease, your specific agendas may be quite different. Over the course of our debate, and even outside of class, you may (and should) consult with one another to identify those issues upon which you can agree as well as those upon which you disagree. For the purposes of final voting on any measures of remediation and prevention, some degree of consensus will be required. It will be important to listen closely to arguments so that you may determine your own position. At every opportunity, press your Anti-contagionist and Contagionist colleagues for evidence and scientific data to support their arguments. For final voting, however, you may remain Indeterminate and abstain if you so choose.

London 1854: Cesspits, Cholera, and Conflict over the Broad Street Pump

Marshall L. Hayes and Eric B. Nelson • Cornell University

version 5A.091613

SPECIFIC INSTRUCTIONS: The format of the meeting is divided into two class sessions. For Session I, you will prepare a short (< 1 page) written statement that introduces your character and your ideologies on Cholera. You will deliver this statement as a speech of roughly 1-2 minutes, detailing your position and making specific suggestions that can be debated and brought to a vote in Session II. You should address three questions: What is the source of the outbreak? How is Cholera communicated from person to person? And, what steps should be taken to contain the outbreak?

MEETING AGENDA

CLASS SESSION I: OPENING STATEMENTS AND PROPOSED RESPONSES The Special Committee convenes on the evening of Thursday, 7 September 1854. Prior to the meeting you have taken the time to look into the atmospheric conditions over the past two weeks. When invited by Chairman Frederick Crane, you will stand and deliver your personal statement on weather and Cholera. Also, listen intently and take notes as colleagues make their presentations. Be sure to propose any specific remedial actions by the end of Session I so that these issues may be debated and brought to a final vote at the end of Session II.

INTERLUDE: JOHN SNOW GIVES HIS TESTIMONY AND RECOMMENDATION Between the two class sessions, Dr. John Snow requested to be heard by the Board and has testified that the Cholera outbreak is being driven by contaminated water originating from the pump located on Broad Street. He has recommended that the Board remove the handle from the Broad Street pump immediately, so as to interrupt public access to what he considers as a tainted water supply. In preparation for Session II, use the online Cholera Data Manager to examine closely the data upon which Dr. Snow bases his arguments. Also consult Dr. Snow’s map and the accompanying Excel spreadsheets to conduct your own analyses of these data and raise further questions and/or support for your arguments. You should also examine William Farr’s data and figures and utilize them similarly.

CLASS SESSION II: DEBATE AND FINAL VOTING ON COURSES OF ACTION Whenever necessary, you must argue for anything that you see connecting weather and the current Cholera outbreak. You will question the utility of removing the pump handle from the Broad Street pump, unless you see some pattern in the mortality data that is also apparent in local weather data. How important do Dr. Snow and his Contagionist colleagues consider atmospheric conditions in their theories? In your opinion, it is necessary that any explanation to be grounded in the sound use of scientific data.

“Indeterminate” FACTION STRATEGY

Your faction, the Indeterminates, will consider Dr. Snow’s recommendation thoughtfully, and you will scrutinize any data that is presented during the debate. Most importantly, however, you and your faction colleagues recognize that action must be taken and ideologies should not interfere with your decision making. Specific steps must be implemented promptly, and you are seeking to embrace compelling arguments that strike you as common sensical, practical and effective. Challenge your colleagues on the Board if they seem unreasonable, unclear or unconvincing in their arguments. Ask insightful questions so that you may form your own opinions. You may reserve the right to abstain from any final votes; in this respect, also realize that your faction holds the power to sway the outcomes of votes in one direction or another.

SECRET OBJECTIVE

To earn bonus credit for this role-playing activity, you must also achieve your secret objective:

Propose and have the Board vote on deploying a permanent system of weather balloons throughout the Parish to monitor weather at regular intervals and possibly detect weather anomalies that could indicate extreme disease risk.

London 1854: Cesspits, Cholera, and Conflict over the Broad Street Pump

Marshall L. Hayes and Eric B. Nelson • Cornell University

version 5A.091613

YOU ARE PETER WAGGETT.

Faction: Indeterminate Ideological Reference: William Lauder Lindsay

Your personal beliefs are aligned with Anti-contagionism, and you are a supporter of the work of William Lauder Lindsay who has argued that strong emotions such as fear make humans susceptible to diseases. However, Lauder Lindsay has also conducted experiments demonstrating that Cholera can be communicated to plants and lower animals. Use the debate to reconcile these apparently disparate notions of disease, and seek to find clarity among your fellow Indeterminates.

and seek to find clarity among your fellow Indeterminates. GENERAL DIRECTIVE: You are a member of

GENERAL DIRECTIVE: You are a member of the special Sanitary Committee of the Board of Governors and Directors of the Poor of St. James Parish. On 14 August 1854, you and your colleagues on the General Board of Governors and Directors of the Poor voted to forgo standard meeting protocols and form this special emergency response committee to address any threat of Malignant Cholera throughout the parish. Collectively, you wield the power and financial backing to make whatever arrangements you deem necessary regarding administrative courses of action, medical responses, future meetings, etc.

REQUIRED READINGS

• Chapter 1 of The Ghost Map by Steven Johnson (2006).

• Chapters 2 and 10 of Disease Maps: Epidemics on the Ground by Tom Koch (2011).

Anticontagionism between 1821 and 1867 by Erwin Ackerknecht (1948).

CHARACTER-SPECIFIC ONLINE RESOURCES

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2486225/

http://books.google.com/books?id=HwpbAAAAQAAJ

http://books.google.com/books?id=CgRbAAAAQAAJ

YOU ARE IN THE “Indeterminate” FACTION.

You and the other Indeterminate members of the Board do not have fixed opinions as to the origins of Cholera. As such, your opinions may be influenced by compelling scientific arguments made by members of the other factions.

Anti-contagionist members of the Board believe that the Cholera outbreak may be explained by a number of factors, including: classic Hippocratic epidemic constitution, atmospheric influences, elevation above sea level, miasma arising from exposure to decaying animal or vegetable matter, diet, lifestyle and socioeconomic status. No human-to-human transmission is involved.

The Contagionist members of the Board believe that Cholera is transmitted by the direct passage of some chemical, physical or biological agent originating from a sick person and transmitted to a susceptible victim by contact or fomites or, for a relatively short distance, through the atmosphere.

PLEASE NOTE: Although you and your faction colleagues do not have fixed ideas on specific notions of disease, your specific agendas may be quite different. Over the course of our debate, and even outside of class, you may (and should) consult with one another to identify those issues upon which you can agree as well as those upon which you disagree. For the purposes of final voting on any measures of remediation and prevention, some degree of consensus will be required. It will be important to listen closely to arguments so that you may determine your own position. At every opportunity, press your Anti-contagionist and Contagionist colleagues for evidence and scientific data to support their arguments. For final voting, however, you may remain Indeterminate and abstain if you so choose.

London 1854: Cesspits, Cholera, and Conflict over the Broad Street Pump

Marshall L. Hayes and Eric B. Nelson • Cornell University

version 5A.091613

SPECIFIC INSTRUCTIONS: The format of the meeting is divided into two class sessions. For Session I, you will prepare a short (< 1 page) written statement that introduces your character and your ideologies on Cholera. You will deliver this statement as a speech of roughly 1-2 minutes, detailing your position and making specific suggestions that can be debated and brought to a vote in Session II. You should address three questions: What is the source of the outbreak? How is Cholera communicated from person to person? And, what steps should be taken to contain the outbreak?

MEETING AGENDA

CLASS SESSION I: OPENING STATEMENTS AND PROPOSED RESPONSES The Special Committee convenes on the evening of Thursday, 7 September 1854. In the course of your research, you should familiarize yourself with what has occurred over the past week. When invited by Chairman Frederick Crane, you will stand and deliver your personal statement on Lauder Lindsay’s work. Also, listen intently and take notes as colleagues make their presentations. Be sure to propose any specific remedial actions by the end of Session I so that these issues may be debated and brought to a final vote at the end of Session II.

INTERLUDE: JOHN SNOW GIVES HIS TESTIMONY AND RECOMMENDATION Between the two class sessions, Dr. John Snow requested to be heard by the Board and has testified that the Cholera outbreak is being driven by contaminated water originating from the pump located on Broad Street. He has recommended that the Board remove the handle from the Broad Street pump immediately, so as to interrupt public access to what he considers as a tainted water supply. In preparation for Session II, use the online Cholera Data Manager to examine closely the data upon which Dr. Snow bases his arguments. Also consult Dr. Snow’s map and the accompanying Excel spreadsheets to conduct your own analyses of these data and raise further questions and/or support for your arguments. You should also examine William Farr’s data and figures and utilize them similarly.

CLASS SESSION II: DEBATE AND FINAL VOTING ON COURSES OF ACTION Whenever necessary, you will argue that transmission (e.g. Snow’s theory) is a possible mechanism driving the current Cholera outbreak. In addition, you will comment on the effects of Cholera on plants and lower animals. You may choose to question the utility of removing the pump handle from the Broad Street pump, if you feel that scientific justifications are not being made. Since you are not fully steadfast in your convictions, you may be swayed by particularly strong arguments and/or sound use of scientific data.

“Indeterminate” FACTION STRATEGY

Your faction, the Indeterminates, will consider Dr. Snow’s recommendation thoughtfully, and you will scrutinize any data that is presented during the debate. Most importantly, however, you and your faction colleagues recognize that action must be taken and ideologies should not interfere with your decision making. Specific steps must be implemented promptly, and you are seeking to embrace compelling arguments that strike you as common sensical, practical and effective. Challenge your colleagues on the Board if they seem unreasonable, unclear or unconvincing in their arguments. Ask insightful questions so that you may form your own opinions. You may reserve the right to abstain from any final votes; in this respect, also realize that your faction holds the power to sway the outcomes of votes in one direction or another.

SECRET OBJECTIVE

To earn bonus credit for this role-playing activity, you must also achieve your secret objective:

Have the Board vote in favor of removing the Broad Street pump handle as a temporary measure rather than a permanent one. Given the evidence of Cholera’s communicability, you feel that an experiment of 3-4 days in duration has merit and is of minimal inconvenience to the parish.

London 1854: Cesspits, Cholera, and Conflict over the Broad Street Pump

Marshall L. Hayes and Eric B. Nelson • Cornell University

version 5B.010214

YOU ARE PETER DUFF.

Faction: Anti-contagionist Ideological Reference: Florence Nightingale

You are aware of Cholera striking throughout St. James Parish, and you have also heard of Florence Nightingale, a local nurse treating Cholera patients at nearby Middlesex Hospital. A miasmatist, Nightingale argues to “keep the air the patient breathes as pure as the external air.” Familiarize yourself with the role of Middlesex Hospital and Ms. Nightingale’s beliefs regarding health and hygiene.

Ms. Nightingale’s beliefs regarding health and hygiene. GENERAL DIRECTIVE: You are a member of the special

GENERAL DIRECTIVE: You are a member of the special Sanitary Committee of the Board of Governors and Directors of the Poor of St. James Parish. On 14 August 1854, you and your colleagues on the General Board of Governors and Directors of the Poor voted to forgo standard meeting protocols and form this special emergency response committee to address any threat of Malignant Cholera throughout the parish. Collectively, you wield the power and financial backing to make whatever arrangements you deem necessary regarding administrative courses of action, medical responses, future meetings, etc.

REQUIRED READINGS

• Chapter 1 of The Ghost Map by Steven Johnson (2006).

• Chapters 2 and 10 of Disease Maps: Epidemics on the Ground by Tom Koch (2011).

Anticontagionism between 1821 and 1867 by Erwin Ackerknecht (1948).

CHARACTER-SPECIFIC ONLINE RESOURCES

https://archive.org/details/florencenighting00wood

Page 112 of books.google.com/books?isbn=1554581699

http://cid.oxfordjournals.org/content/40/12/1799.full

YOU ARE IN THE “Anti-contagionist” FACTION.

You and the other Anti-contagionist members of the Board believe that the Cholera outbreak may be explained by a number of physical, chemical and social factors, including: classic Hippocratic epidemic constitution, atmospheric influences, elevation above sea level, miasmas arising from exposure to decaying animal or vegetable matter, diet, lifestyle and socioeconomic status. No human-to-human transmission is involved.

The Contagionist members of the Board believe that Cholera is transmitted by the direct passage of some chemical, physical or biological agent originating from a sick person and transmitted to a susceptible victim by contact or fomites or, for relatively short distances, through the atmosphere.

The Indeterminate members of the Board do not have fixed opinions as to the origins of Cholera. As such, sound scientific arguments made by members of the other factions may sway the opinion of these Board members.

PLEASE NOTE: Although you and your faction colleagues may agree as to the general Anti-contagionist notions of disease, your specific beliefs may be quite different. Over the course of our debate, and even outside of class, you may (and should) consult with one another to identify those issues upon which you can agree as well as those upon which you disagree. For the purposes of final voting on any measures of remediation and prevention, some degree of consensus is required; it is particularly clear that you cannot advance the Anti-contagionist agenda without soliciting the support of other, dissenting Board members. So, it will be important to develop arguments that will be convincing to Indeterminate Board members, whose votes will allow you to champion your own beliefs. Once you identify who are the Indeterminates, wisely use you time during the debate sessions and outside of class, via emails and in person as necessary, to compel them to join your cause.

London 1854: Cesspits, Cholera, and Conflict over the Broad Street Pump

Marshall L. Hayes and Eric B. Nelson • Cornell University

version 5B.010214

SPECIFIC INSTRUCTIONS: The format of the meeting is divided into two class sessions. For Session I, you will prepare a short (< 1 page) written statement that introduces your character and your ideologies on Cholera. You will deliver this statement as a speech of roughly 1-2 minutes, detailing your position and making specific suggestions that can be debated and brought to a vote in Session II. You should address three questions: What is the source of the outbreak? How is Cholera communicated from person to person? And, what steps should be taken to contain the outbreak?

MEETING AGENDA

CLASS SESSION I: OPENING STATEMENTS AND PROPOSED RESPONSES The Special Committee convenes on the evening of Thursday, 7 September 1854. In the course of your research, you should familiarize yourself with what has occurred over the past week. When invited by Chairman Frederick Crane, you will stand and deliver your personal statement. Also, listen intently and take notes as your colleagues make their presentations. Be sure to propose any specific remedial actions by the end of Session I so that these issues may be debated and brought to a final vote at the end of Session II.

INTERLUDE: JOHN SNOW GIVES HIS TESTIMONY AND RECOMMENDATION Between the two class sessions, Dr. John Snow requested to be heard by the Board and has testified that the Cholera outbreak is being driven by contaminated water originating from the pump located on Broad Street. He has recommended that the Board remove the handle from the Broad Street pump immediately, so as to interrupt public access to what he considers as a tainted water supply. In preparation for Session II, use the online Cholera Data Manager to examine closely the data upon which Dr. Snow bases his arguments. Also consult Dr. Snow’s map and the accompanying Excel spreadsheets to conduct your own analyses of these data and raise further questions and/or support for your arguments. You should also examine William Farr’s data and figures and utilize them similarly.

CLASS SESSION II: DEBATE AND FINAL VOTING ON COURSES OF ACTION You will argue strongly for unsanitary conditions and local miasmas as the causes of the current Cholera outbreak. Question the utility of removing the pump handle from the Broad Street pump, and point out that this will be a significant inconvenience Parish residents. Also, be sure to coordinate your perspectives with your fellow Anti-contagionists so that, together, you can gain the support of the Indeterminates and defeat the Contagionist agenda. Keep in mind that there are inconsistencies in the various Contagionist arguments you will hear over the course of the debate. Counter these with logical rebuttals and any compelling quantitative data that you can gather.

“Anti-contagionist” FACTION STRATEGY

Your faction, the Anti-contagionists, will likely vote against Dr. Snow’s recommendation, but you may be swayed by any particularly strong arguments or data that are presented. Consider the different arguments of T. Southwood Smith, William Farr, Edwin Chadwick, Florence Nightingale and the Rev. Henry Whitehead (from internet sources and fellow Board members). You are supportive of any remedial or preventive measure that was widely in use at the time (e.g. the use of chlorine or chloride of lime for washing). You also favor persistent communication with Parish residents about the virtues of pure air, cleanliness of person, of house and of premises, and temperance with respect to the consumption of spirituous liquors. You should endorse that the Board recirculate among Parish residents handbills with language to this effect. In your arguments, make specific references to existing language in the draft handbill that has been circulated among Board members and suggest any changes to the handbill language that you feel are warranted.

SECRET OBJECTIVE

To earn bonus credit for this role-playing activity, you must also achieve your secret objective:

Boldly challenge any member of the Contagionist faction arguing that the Broad Street Pump water is contaminated to provide proof by some disease-causing material, whether a living organism or otherwise. You will even provide a microscope for them to make their case.

London 1854: Cesspits, Cholera, and Conflict over the Broad Street Pump

Marshall L. Hayes and Eric B. Nelson • Cornell University

version 5A.091613

YOU ARE HENRY BIDGOOD. Faction: Indeterminate Ideological Reference: James Ansley Hingeston You believe that Cholera

YOU ARE HENRY BIDGOOD.

Faction: Indeterminate Ideological Reference: James Ansley Hingeston

You believe that Cholera epidemics are associated with certain particular states of weather and specific meteorological conditions, and you are aware of the works of James Ansley Hingeston on these subjects. As an avid weather tracker and an amateur balloonist like your fellow Boardmember John

Stevens, you too witnessed Henry Tracey Coxwell make a successful balloon ascent today from the Surrey Zoological Gardens. Can improvements in weather tracking aid in the battle against Cholera?

GENERAL DIRECTIVE: You are a member of the special Sanitary Committee of the Board of Governors and Directors of the Poor of St. James Parish. On 14 August 1854, you and your colleagues on the General Board of Governors and Directors of the Poor voted to forgo standard meeting protocols and form this special emergency response committee to address any threat of Malignant Cholera throughout the parish. Collectively, you wield the power and financial backing to make whatever arrangements you deem necessary regarding administrative courses of action, medical responses, future meetings, etc.

REQUIRED READINGS

• Chapter 1 of The Ghost Map by Steven Johnson (2006).

• Chapters 2 and 10 of Disease Maps: Epidemics on the Ground by Tom Koch (2011).

Anticontagionism between 1821 and 1867 by Erwin Ackerknecht (1948).

CHARACTER-SPECIFIC ONLINE RESOURCES

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2485840/

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2438686/

http://books.google.com/books/about/Topics_of_the_day_medical_social_and_sci.html?id=0hADAAAAQAAJ

YOU ARE IN THE “Indeterminate” FACTION.

You and the other Indeterminate members of the Board do not have fixed opinions as to the origins of Cholera. As such, your opinions may be influenced by compelling scientific arguments made by members of the other factions.

Anti-contagionist members of the Board believe that the Cholera outbreak may be explained by a number of factors, including: classic Hippocratic epidemic constitution, atmospheric influences, elevation above sea level, miasma arising from exposure to decaying animal or vegetable matter, diet, lifestyle and socioeconomic status. No human-to-human transmission is involved.

The Contagionist members of the Board believe that Cholera is transmitted by the direct passage of some chemical, physical or biological agent originating from a sick person and transmitted to a susceptible victim by contact or fomites or, for a relatively short distance, through the atmosphere.

PLEASE NOTE: Although you and your faction colleagues do not have fixed ideas on specific notions of disease, your specific agendas may be quite different. Over the course of our debate, and even outside of class, you may (and should) consult with one another to identify those issues upon which you can agree as well as those upon which you disagree. For the purposes of final voting on any measures of remediation and prevention, some degree of consensus will be required. It will be important to listen closely to arguments so that you may determine your own position. At every opportunity, press your Anti-contagionist and Contagionist colleagues for evidence and scientific data to support their arguments. For final voting, however, you may remain Indeterminate and abstain if you so choose.

London 1854: Cesspits, Cholera, and Conflict over the Broad Street Pump

Marshall L. Hayes and Eric B. Nelson • Cornell University

version 5A.091613

SPECIFIC INSTRUCTIONS: The format of the meeting is divided into two class sessions. For Session I, you will prepare a short (< 1 page) written statement that introduces your character and your ideologies on Cholera. You will deliver this statement as a speech of roughly 1-2 minutes, detailing your position and making specific suggestions that can be debated and brought to a vote in Session II. You should address three questions: What is the source of the outbreak? How is Cholera communicated from person to person? And, what steps should be taken to contain the outbreak?

MEETING AGENDA

CLASS SESSION I: OPENING STATEMENTS AND PROPOSED RESPONSES The Special Committee convenes on the evening of Thursday, 7 September 1854. Prior to the meeting you have taken the time to look into the atmospheric conditions over the past two weeks. When invited by Chairman Frederick Crane, you will stand and deliver your personal statement on weather and Cholera. Also, listen intently and take notes as colleagues make their presentations. Be sure to propose any specific remedial actions by the end of Session I so that these issues may be debated and brought to a final vote at the end of Session II.

INTERLUDE: JOHN SNOW GIVES HIS TESTIMONY AND RECOMMENDATION Between the two class sessions, Dr. John Snow requested to be heard by the Board and has testified that the Cholera outbreak is being driven by contaminated water originating from the pump located on Broad Street. He has recommended that the Board remove the handle from the Broad Street pump immediately, so as to interrupt public access to what he considers as a tainted water supply. In preparation for Session II, use the online Cholera Data Manager to examine closely the data upon which Dr. Snow bases his arguments. Also consult Dr. Snow’s map and the accompanying Excel spreadsheets to conduct your own analyses of these data and raise further questions and/or support for your arguments. You should also examine William Farr’s data and figures and utilize them similarly.

CLASS SESSION II: DEBATE AND FINAL VOTING ON COURSES OF ACTION Whenever necessary, you must argue for anything that you see connecting weather and the current Cholera outbreak. You will question the utility of removing the pump handle from the Broad Street pump, unless you see some pattern in the mortality data that is also apparent in local weather data. How important do Dr. Snow and his Contagionist colleagues consider atmospheric conditions in their theories? In your opinion, it is necessary that any explanation to be grounded in the sound use of scientific data. Be prepared to offer data of your own based upon your own research.

“Indeterminate” FACTION STRATEGY

Your faction, the Indeterminates, will consider Dr. Snow’s recommendation thoughtfully, and you will scrutinize any data that is presented during the debate. Most importantly, however, you and your faction colleagues recognize that action must be taken and ideologies should not interfere with your decision making. Specific steps must be implemented promptly, and you are seeking to embrace compelling arguments that strike you as common sensical, practical and effective. Challenge your colleagues on the Board if they seem unreasonable, unclear or unconvincing in their arguments. Ask insightful questions so that you may form your own opinions. You may reserve the right to abstain from any final votes; in this respect, also realize that your faction holds the power to sway the outcomes of votes in one direction or another.

SECRET OBJECTIVE

To earn bonus credit for this role-playing activity, you must also achieve your secret objective:

Propose and have the Board vote on a local ordinance requiring the shuttering of all windows and closing of doors upon first notice of harmful weather conditions, such as heavy mists forming at low elevations, that might favor Cholera.

London 1854: Cesspits, Cholera, and Conflict over the Broad Street Pump

Marshall L. Hayes and Eric B. Nelson • Cornell University

version 5A.091613

YOU ARE CHARLES RICHARDSON.

Faction: Contagionist Ideological Reference: John Snow

You are the brother-in-law of John Wilson, 16 Great Ryder Street, one of the neighborhood doctors who has been designated by Parish authorities to attend to local residents experiencing distress of the bowels. You are aware of John Snow’s work, and you support his theory that Cholera is transmitted via contaminated food and water.

Cholera is transmitted via contaminated food and water . GENERAL DIRECTIVE: You are a member of

GENERAL DIRECTIVE: You are a member of the special Sanitary Committee of the Board of Governors and Directors of the Poor of St. James Parish. On 14 August 1854, you and your colleagues on the General Board of Governors and Directors of the Poor voted to forgo standard meeting protocols and form this special emergency response committee to address any threat of Malignant Cholera throughout the parish. Collectively, you wield the power and financial backing to make whatever arrangements you deem necessary regarding administrative courses of action, medical responses, future meetings, etc.

REQUIRED READINGS

• Chapter 1 of The Ghost Map by Steven Johnson (2006).

• Chapters 2 and 10 of Disease Maps: Epidemics on the Ground by Tom Koch (2011).

Anticontagionism between 1821 and 1867 by Erwin Ackerknecht (1948).

CHARACTER-SPECIFIC ONLINE RESOURCES

http://openlibrary.org/books/OL6329689M/The_nature_of_cholera_investigated

http://jhmas.oxfordjournals.org/content/XXVII/4/373.full.pdf

YOU ARE IN THE “Contagionist” FACTION.

You and your fellow Contagionist members of the Board believe that Cholera is transmitted by the direct passage of some chemical, physical or biological agent originating from a sick person and transmitted to a susceptible victim by contact or fomites or, for a relatively short distance, through the atmosphere.

The Anti-contagionist members of the Board believe that the Cholera outbreak may be explained by a number of factors, including: classic Hippocratic epidemic constitution, atmospheric influences, elevation above sea level, miasma arising from exposure to decaying animal or vegetable matter, diet, lifestyle and socioeconomic status. No human-to-human transmission is invoked.

The Indeterminate members of the Board do not have fixed opinions as to the origins of Cholera. As such, sound scientific arguments made by members of the other factions may sway the opinion of these Board members.

PLEASE NOTE: Although you and your faction colleagues may agree as to the general Contagionist notions of disease, your specific beliefs may be quite different. Over the course of our debate, and even outside of class, you may (and should) consult with one another to identify those issues upon which you can agree as well as those upon which you disagree. For the purposes of final voting on any measures of remediation and prevention, some degree of consensus is required; it is particularly clear that you cannot advance the Contagionist agenda without soliciting the support of other, dissenting Board members. So, it will be important to develop arguments that will be convincing to Indeterminate Board members, whose votes will allow you to champion your own beliefs. Once you learn who are the Indeterminates, wisely use you time during the debate sessions and outside of class, via emails and in person as necessary, to compel them to join your cause.

London 1854: Cesspits, Cholera, and Conflict over the Broad Street Pump

Marshall L. Hayes and Eric B. Nelson • Cornell University

version 5A.091613

SPECIFIC INSTRUCTIONS: The format of the meeting is divided into two class sessions. For Session I, you will prepare a short (< 1 page) written statement that introduces your character and your ideologies on Cholera. You will deliver this statement as a speech of roughly 1-2 minutes, detailing your position and making specific suggestions that can be debated and brought to a vote in Session II. You should address three questions: What is the source of the outbreak? How is Cholera communicated from person to person? And, what steps should be taken to contain the outbreak?

MEETING AGENDA

CLASS SESSION I: OPENING STATEMENTS AND PROPOSED RESPONSES The Special Committee convenes on the evening of Thursday, 7 September 1854. As one of the medical officers active in the Parish, your opening statement will make your colleagues aware of your function and your observations from daily practice. Throughout the meeting, you have a primary responsibility to intervene in discussion of specific issues that have a medical origin or relevance, including the options for treating those with Cholera. At the end of Session I, you will learn that Dr. John Snow wishes to hold audience with the committee, and you and your fellow Contagionists will appeal to have him heard.

INTERLUDE: JOHN SNOW GIVES HIS TESTIMONY AND RECOMMENDATION Between the two class sessions, Dr. John Snow requested to be heard by the Board and has testified that the Cholera outbreak is being driven by contaminated water originating from the pump located on Broad Street. He has recommended that the Board remove the handle from the Broad Street pump immediately, so as to interrupt public access to what he considers as a tainted water supply. In preparation for Session II, use the online Cholera Data Manager to examine closely the data upon which Dr. Snow bases his arguments. Also consult Dr. Snow’s map and the accompanying Excel spreadsheets to conduct your own analyses of these data and raise further questions and/or support for your arguments. You should also examine William Farr’s data and figures and utilize them similarly.

CLASS SESSION II: DEBATE AND FINAL VOTING ON COURSE(S) OF ACTION Whenever necessary, you will argue that contagion and contaminated food and water is the cause of the current Cholera outbreak. You will not question the utility of removing the pump handle from the Broad Street pump, and you will argue against the perceived “inconvenience” that this will cause to Parish residents that frequent that pump for water. Most importantly, you are steadfast in your convictions and training as a medical professional, and you will be most swayed by particularly strong arguments and/or sound use of scientific data.

“Contagionist” FACTION STRATEGY

Your faction, the Contagionists, may disagree as to the specific nature of contagion, but you will likely vote for Dr. Snow’s recommendation. Personally, you believe that Snow’s arguments will lead to the committee taking relevant, decisive action at minimal expense to the Parish, and you will do everything possible provide supporting arguments once debate continues in Session II. You might also argue that the current “Anti-contagionist” approach of widespread limewashing of buildings throughout London has done little to stem Cholera outbreaks. Of course, you anticipate opposition but are also confident in your reputation and steadfast in your convictions. Be prepared to influence the Indeterminates with solid arguments based on scientific data from John Snow and William Farr, as needed.

SECRET OBJECTIVE

To earn bonus credit for this role-playing activity, you must also achieve your secret objective:

Propose and have the Board vote to increase remuneration to Parish doctors for treating patients afflicted by Cholera from the current rate of £ 2.2 to £ 5.0 per week on account of the extreme nature of this work. In addition, at some point in the debate, challenge your fellow Board members – particularly the Anti-contagionists – to drink freshly drawn water from the Broad Street pump. Water and glasses will be provided for the purpose of this challenge.

London 1854: Cesspits, Cholera, and Conflict over the Broad Street Pump

Marshall L. Hayes and Eric B. Nelson • Cornell University

version 5A.091613

YOU ARE GEORGE FOXLEY.

Faction: Anti-contagionist Ideological Reference: Joseph Bazalgette

You believe that proper hygiene is one’s best defense against the dreaded Asiatic Cholera, and you support the current efforts by engineers and city planners to improve London’s miserable system of sewers and cesspits. Be prepared to discuss the steps that engineer Joseph Bazalgette and the Metropolitan Commission of Sewers are taking to improve the city’s sewer and drainage infrastructure.

to improve the city’s sewer and drainage infrastructure. GENERAL DIRECTIVE: You are a member of the

GENERAL DIRECTIVE: You are a member of the special Sanitary Committee of the Board of Governors and Directors of the Poor of St. James Parish. On 14 August 1854, you and your colleagues on the General Board of Governors and Directors of the Poor voted to forgo standard meeting protocols and form this special emergency response committee to address any threat of Malignant Cholera throughout the parish. Collectively, you wield the power and financial backing to make whatever arrangements you deem necessary regarding administrative courses of action, medical responses, future meetings, etc.

REQUIRED READINGS

• Chapter 1 of The Ghost Map by Steven Johnson (2006).

• Chapters 2 and 10 of Disease Maps: Epidemics on the Ground by Tom Koch (2011).

Anticontagionism between 1821 and 1867 by Erwin Ackerknecht (1948).

CHARACTER-SPECIFIC ONLINE RESOURCES

http://books.google.com/books?hl=en&lr=&id=Lz41AAAAMAAJ&oi=fnd&pg=PA1

http://pmj.bmj.com/content/77/914/802.full

http://johnsnow.matrix.msu.edu/work.php?id=15-78-7E

YOU ARE IN THE “Anti-contagionist” FACTION.

You and the other Anti-contagionist members of the Board believe that the Cholera outbreak may be explained by a number of physical, chemical and social factors, including: classic Hippocratic epidemic constitution, atmospheric influences, elevation above sea level, miasmas arising from exposure to decaying animal or vegetable matter, diet, lifestyle and socioeconomic status. No human-to-human transmission is involved.

The Contagionist members of the Board believe that Cholera is transmitted by the direct passage of some chemical, physical or biological agent originating from a sick person and transmitted to a susceptible victim by contact or fomites or, for relatively short distances, through the atmosphere.

The Indeterminate members of the Board do not have fixed opinions as to the origins of Cholera. As such, sound scientific arguments made by members of the other factions may sway the opinion of these Board members.

PLEASE NOTE: Although you and your faction colleagues may agree as to the general Anti-contagionist notions of disease, your specific beliefs may be quite different. Over the course of our debate, and even outside of class, you may (and should) consult with one another to identify those issues upon which you can agree as well as those upon which you disagree. For the purposes of final voting on any measures of remediation and prevention, some degree of consensus is required; it is particularly clear that you cannot advance the Anti-contagionist agenda without soliciting the support of other, dissenting Board members. So, it will be important to develop arguments that will be convincing to Indeterminate Board members, whose votes will allow you to champion your own beliefs. Once you identify who are the Indeterminates, wisely use you time during the debate sessions and outside of class, via emails and in person as necessary, to compel them to join your cause.

London 1854: Cesspits, Cholera, and Conflict over the Broad Street Pump

Marshall L. Hayes and Eric B. Nelson • Cornell University

version 5A.091613

SPECIFIC INSTRUCTIONS: The format of the meeting is divided into two class sessions. For Session I, you will prepare a short (< 1 page) written statement that introduces your character and your ideologies on Cholera. You will deliver this statement as a speech of roughly 1-2 minutes, detailing your position and making specific suggestions that can be debated and brought to a vote in Session II. You should address three questions: What is the source of the outbreak? How is Cholera communicated from person to person? And, what steps should be taken to contain the outbreak?

MEETING AGENDA

CLASS SESSION I: OPENING STATEMENTS AND PROPOSED RESPONSES The Special Committee convenes on the evening of Thursday, 7 September 1854. In the course of your research, you should familiarize yourself with what has occurred over the past week. When invited by Chairman Frederick Crane, you will stand and deliver your personal statement. Also, listen intently and take notes as your colleagues make their presentations. Be sure to propose any specific remedial actions by the end of Session I so that these issues may be debated and brought to a final vote at the end of Session II.

INTERLUDE: JOHN SNOW GIVES HIS TESTIMONY AND RECOMMENDATION Between the two class sessions, Dr. John Snow requested to be heard by the Board and has testified that the Cholera outbreak is being driven by contaminated water originating from the pump located on Broad Street. He has recommended that the Board remove the handle from the Broad Street pump immediately, so as to interrupt public access to what he considers as a tainted water supply. In preparation for Session II, use the online Cholera Data Manager to examine closely the data upon which Dr. Snow bases his arguments. Also consult Dr. Snow’s map and the accompanying Excel spreadsheets to conduct your own analyses of these data and raise further questions and/or support for your arguments. You should also examine William Farr’s data and figures and utilize them similarly.

CLASS SESSION II: DEBATE AND FINAL VOTING ON COURSES OF ACTION You will argue strongly for unsanitary conditions and local miasmas as the causes of the current Cholera outbreak. Question the utility of removing the pump handle from the Broad Street pump, and point out that this will be a significant inconvenience Parish residents. Also, be sure to coordinate your perspectives with your fellow Anti-contagionists so that, together, you can gain the support of the Indeterminates and defeat the Contagionist agenda. Keep in mind that there are inconsistencies in the various Contagionist arguments you will hear over the course of the debate. Counter these with logical rebuttals and any compelling quantitative data that you can gather.

“Anti-contagionist” FACTION STRATEGY

Your faction, the Anti-contagionists, will likely vote against Dr. Snow’s recommendation, but you may be swayed by any particularly strong arguments or data that are presented. Consider the different arguments of T. Southwood Smith, William Farr, Edwin Chadwick, Florence Nightingale and the Rev. Henry Whitehead (from internet sources and fellow Board members). You support any remedial or preventive measure that was widely in use at the time (e.g. the use of chlorine or chloride of lime for washing). You also favor persistent communication with Parish residents about the virtues of pure air, cleanliness of person, of house and of premises, and temperance with respect to the consumption of spirituous liquors. You should enthusiastically endorse that the Board recirculate among Parish residents handbills with language to this effect. In your arguments, make specific references to existing language in the draft handbill that has been circulated among Board members and suggest any changes to the handbill language that you feel are warranted.

SECRET OBJECTIVE

To earn bonus credit for this role-playing activity, you must also achieve your secret objective:

Have the Board vote in favor of 1) the widespread Limewashing of all parish houses, privies and streets and 2) immediate pumping and/or flushing of all parish cesspits, sewers and gutters to cleanse the area and to remove nauseating smells from the local air.

London 1854: Cesspits, Cholera, and Conflict over the Broad Street Pump

Marshall L. Hayes and Eric B. Nelson • Cornell University

version 5A.091613

YOU ARE THOMAS PRATT. Faction: Indeterminate Ideological Reference: F. Hervey Foster Quin At the moment,

YOU ARE THOMAS PRATT.

Faction: Indeterminate Ideological Reference: F. Hervey Foster Quin

At the moment, you remain undecided as to the cause of Cholera epidemics, but you are fiercely supportive of the work of Frederick Hervey Foster Quin and Edward Hamilton on homeopathic remedies that can be used to treat those stricken with Cholera. In this debate, make reference to

the local London Homeopathic Hospital and the success rates that they have in treating Cholera patients, as compared to the more accepted allopathic approaches in use at the Middlesex Hospital.

GENERAL DIRECTIVE: You are a member of the special Sanitary Committee of the Board of Governors and Directors of the Poor of St. James Parish. On 14 August 1854, you and your colleagues on the General Board of Governors and Directors of the Poor voted to forgo standard meeting protocols and form this special emergency response committee to address any threat of Malignant Cholera throughout the parish. Collectively, you wield the power and financial backing to make whatever arrangements you deem necessary regarding administrative courses of action, medical responses, future meetings, etc.

REQUIRED READINGS

• Chapter 1 of The Ghost Map by Steven Johnson (2006).

• Chapters 2 and 10 of Disease Maps: Epidemics on the Ground by Tom Koch (2011).

Anticontagionism between 1821 and 1867 by Erwin Ackerknecht (1948).

CHARACTER-SPECIFIC ONLINE RESOURCES

http://books.google.com/books/about/A_memoir_of_Frederick_Hervey_Foster_Quin.html?id=Owrn7ER3h5AC

http://www.homeoint.org/morrell/londonhh/

http://books.google.com/books?id=XsFbBEcvGwAC&pg=PA101&lpg=PA101

YOU ARE IN THE “Indeterminate” FACTION.

You and the other Indeterminate members of the Board do not have fixed opinions as to the origins of Cholera. As such, your opinions may be influenced by compelling scientific arguments made by members of the other factions.

Anti-contagionist members of the Board believe that the Cholera outbreak may be explained by a number of factors, including: classic Hippocratic epidemic constitution, atmospheric influences, elevation above sea level, miasma arising from exposure to decaying animal or vegetable matter, diet, lifestyle and socioeconomic status. No human-to-human transmission is involved.

The Contagionist members of the Board believe that Cholera is transmitted by the direct passage of some chemical, physical or biological agent originating from a sick person and transmitted to a susceptible victim by contact or fomites or, for a relatively short distance, through the atmosphere.

PLEASE NOTE: Although you and your faction colleagues do not have fixed ideas on specific notions of disease, your specific agendas may be quite different. Over the course of our debate, and even outside of class, you may (and should) consult with one another to identify those issues upon which you can agree as well as those upon which you disagree. For the purposes of final voting on any measures of remediation and prevention, some degree of consensus will be required. It will be important to listen closely to arguments so that you may determine your own position. At every opportunity, press your Anti-contagionist and Contagionist colleagues for evidence and scientific data to support their arguments. For final voting, however, you may remain Indeterminate and abstain if you so choose.

London 1854: Cesspits, Cholera, and Conflict over the Broad Street Pump

Marshall L. Hayes and Eric B. Nelson • Cornell University

version 5A.091613

SPECIFIC INSTRUCTIONS: The format of the meeting is divided into two class sessions. For Session I, you will prepare a short (< 1 page) written statement that introduces your character and your ideologies on Cholera. You will deliver this statement as a speech of roughly 1-2 minutes, detailing your position and making specific suggestions that can be debated and brought to a vote in Session II. You should address three questions: What is the source of the outbreak? How is Cholera communicated from person to person? And, what steps should be taken to contain the outbreak?

MEETING AGENDA

CLASS SESSION I: OPENING STATEMENTS AND PROPOSED RESPONSES The Special Committee convenes on the evening of Thursday, 7 September 1854. Prior to the meeting you have taken the time to look into the atmospheric conditions over the past two weeks. When invited by Chairman Frederick Crane, you will stand and deliver your personal statement on weather and Cholera. Also, listen intently and take notes as colleagues make their presentations. Be sure to propose any specific remedial actions by the end of Session I so that these issues may be debated and brought to a final vote at the end of Session II.

INTERLUDE: JOHN SNOW GIVES HIS TESTIMONY AND RECOMMENDATION Between the two class sessions, Dr. John Snow requested to be heard by the Board and has testified that the Cholera outbreak is being driven by contaminated water originating from the pump located on Broad Street. He has recommended that the Board remove the handle from the Broad Street pump immediately, so as to interrupt public access to what he considers as a tainted water supply. In preparation for Session II, use the online Cholera Data Manager to examine closely the data upon which Dr. Snow bases his arguments. Also consult Dr. Snow’s map and the accompanying Excel spreadsheets to conduct your own analyses of these data and raise further questions and/or support for your arguments. You should also examine William Farr’s data and figures and utilize them similarly.

CLASS SESSION II: DEBATE AND FINAL VOTING ON COURSES OF ACTION Whenever necessary, you must argue for anything that you see connecting weather and the current Cholera outbreak. You will question the utility of removing the pump handle from the Broad Street pump, unless you see some pattern in the mortality data that is also apparent in local weather data. How important do Dr. Snow and his Contagionist colleagues consider homeopathic approaches to Cholera treatment? Do they offer opinions at all? In your mind, it is necessary that any argument be grounded in the sound use of scientific data.

“Indeterminate” FACTION STRATEGY

Your faction, the Indeterminates, will consider Dr. Snow’s recommendation thoughtfully, and you will scrutinize any data that is presented during the debate. Most importantly, however, you and your faction colleagues recognize that action must be taken and ideologies should not interfere with your decision making. Specific steps must be implemented promptly, and you are seeking to embrace compelling arguments that strike you as common sensical, practical and effective. Challenge your colleagues on the Board if they seem unreasonable, unclear or unconvincing in their arguments. Ask insightful questions so that you may form your own opinions. You may reserve the right to abstain from any final votes; in this respect, also realize that your faction holds the power to sway the outcomes of votes in one direction or another.

SECRET OBJECTIVE

To earn bonus credit for this role-playing activity, you must also achieve your secret objective:

Propose and have the Board vote on a local ordinance requiring parish physicians who receive Cholera patients to apply both allopathic and homeopathic treatments in their attempts to treat sickened individuals.

London 1854: Cesspits, Cholera, and Conflict over the Broad Street Pump

Marshall L. Hayes and Eric B. Nelson • Cornell University

version 5A.091613

YOU ARE THOMAS WATKINS.

Faction: Contagionist Ideological Reference: John Snow

You have followed John Snow’s work over the past five years, and you are in strong support his theory that Cholera is transmitted via contaminated food and water. In particular, you have read Dr. Snow’s recent commentary on the water quality of the Thames River and its relationship to Cholera epidemics (see reading list on second page). Reference this work in the debate.

list on second page). Reference this work in the debate. GENERAL DIRECTIVE: You are a member

GENERAL DIRECTIVE: You are a member of the special Sanitary Committee of the Board of Governors and Directors of the Poor of St. James Parish. On 14 August 1854, you and your colleagues on the General Board of Governors and Directors of the Poor voted to forgo standard meeting protocols and form this special emergency response committee to address any threat of Malignant Cholera throughout the parish. Collectively, you wield the power and financial backing to make whatever arrangements you deem necessary regarding administrative courses of action, medical responses, future meetings, etc.

REQUIRED READINGS

• Chapter 1 of The Ghost Map by Steven Johnson (2006).

• Chapters 2 and 10 of Disease Maps: Epidemics on the Ground by Tom Koch (2011).

Anticontagionism between 1821 and 1867 by Erwin Ackerknecht (1948).

CHARACTER-SPECIFIC ONLINE RESOURCES

http://johnsnow.matrix.msu.edu/work.php?id=15-78-51

http://johnsnow.matrix.msu.edu/work.php?id=15-78-56

YOU ARE IN THE “Contagionist” FACTION.

You and your fellow Contagionist members of the Board believe that Cholera is transmitted by the direct passage of some chemical, physical or biological agent originating from a sick person and transmitted to a susceptible victim by contact or fomites or, for a relatively short distance, through the atmosphere.

The Anti-contagionist members of the Board believe that the Cholera outbreak may be explained by a number of factors, including: classic Hippocratic epidemic constitution, atmospheric influences, elevation above sea level, miasma arising from exposure to decaying animal or vegetable matter, diet, lifestyle and socioeconomic status. No human-to-human transmission is invoked.

The Indeterminate members of the Board do not have fixed opinions as to the origins of Cholera. As such, sound scientific arguments made by members of the other factions may sway the opinion of these Board members.

PLEASE NOTE: Although you and your faction colleagues may agree as to the general Contagionist notions of disease, your specific beliefs may be quite different. Over the course of our debate, and even outside of class, you may (and should) consult with one another to identify those issues upon which you can agree as well as those upon which you disagree. For the purposes of final voting on any measures of remediation and prevention, some degree of consensus is required; it is particularly clear that you cannot advance the Contagionist agenda without soliciting the support of other, dissenting Board members. So, it will be important to develop arguments that will be convincing to Indeterminate Board members, whose votes will allow you to champion your own beliefs. Once you learn who are the Indeterminates, wisely use you time during the debate sessions and outside of class, via emails and in person as necessary, to compel them to join your cause.

London 1854: Cesspits, Cholera, and Conflict over the Broad Street Pump

Marshall L. Hayes and Eric B. Nelson • Cornell University

version 5A.091613

SPECIFIC INSTRUCTIONS: The format of the meeting is divided into two class sessions. For Session I, you will prepare a short (< 1 page) written statement that introduces your character and your ideologies on Cholera. You will deliver this statement as a speech of roughly 1-2 minutes, detailing your position and making specific suggestions that can be debated and brought to a vote in Session II. You should address three questions: What is the source of the outbreak? How is Cholera communicated from person to person? And, what steps should be taken to contain the outbreak?

MEETING AGENDA

CLASS SESSION I: OPENING STATEMENTS AND PROPOSED RESPONSES The Special Committee convenes on the evening of Thursday, 7 September 1854. As one of the medical officers active in the Parish, your opening statement will make your colleagues aware of your function and your observations from daily practice. Throughout the meeting, you have a primary responsibility to intervene in discussion of specific issues that have a medical origin or relevance, including the options for treating those with Cholera. At the end of Session I, you will learn that Dr. John Snow wishes to hold audience with the committee, and you and your fellow Contagionists will appeal to have him heard.

INTERLUDE: JOHN SNOW GIVES HIS TESTIMONY AND RECOMMENDATION Between the two class sessions, Dr. John Snow requested to be heard by the Board and has testified that the Cholera outbreak is being driven by contaminated water originating from the pump located on Broad Street. He has recommended that the Board remove the handle from the Broad Street pump immediately, so as to interrupt public access to what he considers as a tainted water supply. In preparation for Session II, use the online Cholera Data Manager to examine closely the data upon which Dr. Snow bases his arguments. Also consult Dr. Snow’s map and the accompanying Excel spreadsheets to conduct your own analyses of these data and raise further questions and/or support for your arguments. You should also examine William Farr’s data and figures and utilize them similarly.

CLASS SESSION II: DEBATE AND FINAL VOTING ON COURSE(S) OF ACTION Whenever necessary, you will argue that contagion and contaminated food and water is the cause of the current Cholera outbreak. You will not question the utility of removing the pump handle from the Broad Street pump, and you will argue against the perceived “inconvenience” that this will cause to Parish residents that frequent that pump for water. Most importantly, you are steadfast in your convictions and training as a medical professional, and you will be most swayed by particularly strong arguments and/or sound use of scientific data.

“Contagionist” FACTION STRATEGY

Your faction, the Contagionists, may disagree as to the specific nature of contagion, but you will likely vote for Dr. Snow’s recommendation. Personally, you believe that Snow’s arguments will lead to the committee taking relevant, decisive action at minimal expense to the Parish, and you will do everything possible provide supporting arguments once debate continues in Session II. You might also argue that the current “Anti-contagionist” approach of widespread limewashing of buildings throughout London has done little to stem Cholera outbreaks. Of course, you anticipate opposition but are also confident in your reputation and steadfast in your convictions. Be prepared to influence the Indeterminates with solid arguments based on scientific data from John Snow and William Farr, as needed.

To win, you must also achieve your secret objective:

SECRET OBJECTIVE

At the end of Session I, have the Board vote in favor of having Dr. Snow testify in front of the committee (at the “Interlude”). Also propose and have approved a thorough investigation into the water quality of the Thames River, as well as the integrity of the water suppliers to the southern districts of London, such as the Lambeth, Southwark and Vauxhall Companies.

London 1854: Cesspits, Cholera, and Conflict over the Broad Street Pump

Marshall L. Hayes and Eric B. Nelson • Cornell University

version 5A.091613

YOU ARE JOHN CHEWS.

Faction: Contagionist Ideological Reference: Edwin Lankester

You have followed the work of J.G. Swayne and Edwin Lankester over the past five years, and you are in strong support of the theory that Cholera is transmitted via impure water. Both men discuss the issues of organic and inorganic impurities in London’s water supply in various microscopic studies. Reference their work in the debate.

microscopic studies. Reference their work in the debate. GENERAL DIRECTIVE: You are a member of the

GENERAL DIRECTIVE: You are a member of the special Sanitary Committee of the Board of Governors and Directors of the Poor of St. James Parish. On 14 August 1854, you and your colleagues on the General Board of Governors and Directors of the Poor voted to forgo standard meeting protocols and form this special emergency response committee to address any threat of Malignant Cholera throughout the parish. Collectively, you wield the power and financial backing to make whatever arrangements you deem necessary regarding administrative courses of action, medical responses, future meetings, etc.

REQUIRED READINGS

• Chapter 1 of The Ghost Map by Steven Johnson (2006).

• Chapters 2 and 10 of Disease Maps: Epidemics on the Ground by Tom Koch (2011).

Anticontagionism between 1821 and 1867 by Erwin Ackerknecht (1948).

CHARACTER-SPECIFIC ONLINE RESOURCES

http://www.sciencedirect.com/science/article/pii/S0140673602718187

http://jcs.biologists.org/content/s1-4/16/270.short

YOU ARE IN THE “Contagionist” FACTION.

You and your fellow Contagionist members of the Board believe that Cholera is transmitted by the direct passage of some chemical, physical or biological agent originating from a sick person and transmitted to a susceptible victim by contact or fomites or, for a relatively short distance, through the atmosphere.

The Anti-contagionist members of the Board believe that the Cholera outbreak may be explained by a number of factors, including: classic Hippocratic epidemic constitution, atmospheric influences, elevation above sea level, miasma arising from exposure to decaying animal or vegetable matter, diet, lifestyle and socioeconomic status. No human-to-human transmission is invoked.

The Indeterminate members of the Board do not have fixed opinions as to the origins of Cholera. As such, sound scientific arguments made by members of the other factions may sway the opinion of these Board members.

PLEASE NOTE: Although you and your faction colleagues may agree as to the general Contagionist notions of disease, your specific beliefs may be quite different. Over the course of our debate, and even outside of class, you may (and should) consult with one another to identify those issues upon which you can agree as well as those upon which you disagree. For the purposes of final voting on any measures of remediation and prevention, some degree of consensus is required; it is particularly clear that you cannot advance the Contagionist agenda without soliciting the support of other, dissenting Board members. So, it will be important to develop arguments that will be convincing to Indeterminate Board members, whose votes will allow you to champion your own beliefs. Once you learn who are the Indeterminates, wisely use you time during the debate sessions and outside of class, via emails and in person as necessary, to compel them to join your cause.

London 1854: Cesspits, Cholera, and Conflict over the Broad Street Pump

Marshall L. Hayes and Eric B. Nelson • Cornell University

version 5A.091613

SPECIFIC INSTRUCTIONS: The format of the meeting is divided into two class sessions. For Session I, you will prepare a short (< 1 page) written statement that introduces your character and your ideologies on Cholera. You will deliver this statement as a speech of roughly 1-2 minutes, detailing your position and making specific suggestions that can be debated and brought to a vote in Session II. You should address three questions: What is the source of the outbreak? How is Cholera communicated from person to person? And, what steps should be taken to contain the outbreak?

MEETING AGENDA

CLASS SESSION I: OPENING STATEMENTS AND PROPOSED RESPONSES The Special Committee convenes on the evening of Thursday, 7 September 1854. As one of the medical officers active in the Parish, your opening statement will make your colleagues aware of your function and your observations from daily practice. Throughout the meeting, you have a primary responsibility to intervene in discussion of specific issues that have a specific medical origin or relevance, including the options for treating those with Cholera. At the end of Session I, you will learn that Dr. John Snow wishes to hold audience with the committee, and you and your fellow Contagionists will appeal to have him heard.

INTERLUDE: JOHN SNOW GIVES HIS TESTIMONY AND RECOMMENDATION Between the two class sessions, Dr. John Snow requested to be heard by the Board and has testified that the Cholera outbreak is being driven by contaminated water originating from the pump located on Broad Street. He has recommended that the Board remove the handle from the Broad Street pump immediately, so as to interrupt public access to what he considers as a tainted water supply. In preparation for Session II, use the online Cholera Data Manager to examine closely the data upon which Dr. Snow bases his arguments. Also consult Dr. Snow’s map and the accompanying Excel spreadsheets to conduct your own analyses of these data and raise further questions and/or support for your arguments. You should also examine William Farr’s data and figures and utilize them similarly.

CLASS SESSION II: DEBATE AND FINAL VOTING ON COURSE(S) OF ACTION Whenever necessary, you will argue that contagion and contaminated food and water is the cause of the current Cholera outbreak. You will not question the utility of removing the pump handle from the Broad Street pump, and you will argue against the perceived “inconvenience” that this will cause to Parish residents that frequent that pump for water. Most importantly, you are steadfast in your convictions and training as a medical professional, and you will be most swayed by particularly strong arguments and/or sound use of scientific data.

“Contagionist” FACTION STRATEGY

Your faction, the Contagionists, may disagree as to the specific nature of contagion, but you will likely vote for Dr. Snow’s recommendation. Personally, you believe that Snow’s arguments will lead to the committee taking relevant, decisive action at minimal expense to the Parish, and you will do everything possible provide supporting arguments once debate continues in Session II. You might also argue that the current “Anti-contagionist” approach of widespread limewashing of buildings throughout London has done little to stem Cholera outbreaks. Of course, you anticipate opposition but are also confident in your reputation and steadfast in your convictions. Be prepared to influence the Indeterminates with solid arguments based on scientific data from John Snow and William Farr, as needed.

SECRET OBJECTIVE

To earn bonus credit for this role-playing activity, you must also achieve your secret objective:

At the end of Session I, strongly urge the Board to vote in favor of having Dr. Snow testify in front of the committee (at the“Interlude”). Also at some point during the ensuing debate, propose and bring to a vote a thorough investigation into the water quality of the Thames River, as well as the integrity of the water suppliers to the southern districts of London, such as the Lambeth, Southwark and Vauxhall Companies.

London 1854: Cesspits, Cholera, and Conflict over the Broad Street Pump

Marshall L. Hayes and Eric B. Nelson • Cornell University

version 5A.091613

YOU ARE JOSEPH HAYNES.

Faction: Anti-contagionist Ideological Reference: Charles Maclean

You believe that climate exerts the ultimate influence on whether or not disease occurs. You have been influenced in particular by Charles Maclean, whose ideologies were central to the debates between anti-contagionists and contagionists earlier this century (i.e. the 19 th century). Consider how Maclean defines and distinguishes “contagion” and introduce this notion into our Cholera debate.

and introduce this notion into our Cholera debate. GENERAL DIRECTIVE: You are a member of the

GENERAL DIRECTIVE: You are a member of the special Sanitary Committee of the Board of Governors and Directors of the Poor of St. James Parish. On 14 August 1854, you and your colleagues on the General Board of Governors and Directors of the Poor voted to forgo standard meeting protocols and form this special emergency response committee to address any threat of Malignant Cholera throughout the parish. Collectively, you wield the power and financial backing to make whatever arrangements you deem necessary regarding administrative courses of action, medical responses, future meetings, etc.

REQUIRED READINGS

• Chapter 1 of The Ghost Map by Steven Johnson (2006).

• Chapters 2 and 10 of Disease Maps: Epidemics on the Ground by Tom Koch (2011).

Anticontagionism between 1821 and 1867 by Erwin Ackerknecht (1948).

CHARACTER-SPECIFIC ONLINE RESOURCES

http://pds.lib.harvard.edu/pds/view/5687183

http://books.google.com/books?id=onoEAAAAQAAJ&pg=PA153

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2646603/

YOU ARE IN THE “Anti-contagionist” FACTION.

You and the other Anti-contagionist members of the Board believe that the Cholera outbreak may be explained by a number of physical, chemical and social factors, including: classic Hippocratic epidemic constitution, atmospheric influences, elevation above sea level, miasmas arising from exposure to decaying animal or vegetable matter, diet, lifestyle and socioeconomic status. No human-to-human transmission is involved.

The Contagionist members of the Board believe that Cholera is transmitted by the direct passage of some chemical, physical or biological agent originating from a sick person and transmitted to a susceptible victim by contact or fomites or, for relatively short distances, through the atmosphere.

The Indeterminate members of the Board do not have fixed opinions as to the origins of Cholera. As such, sound scientific arguments made by members of the other factions may sway the opinion of these Board members.

PLEASE NOTE: Although you and your faction colleagues may agree as to the general Anti-contagionist notions of disease, your specific beliefs may be quite different. Over the course of our debate, and even outside of class, you may (and should) consult with one another to identify those issues upon which you can agree as well as those upon which you disagree. For the purposes of final voting on any measures of remediation and prevention, some degree of consensus is required; it is particularly clear that you cannot advance the Anti-contagionist agenda without soliciting the support of other, dissenting Board members. So, it will be important to develop arguments that will be convincing to Indeterminate Board members, whose votes will allow you to champion your own beliefs. Once you identify who are the Indeterminates, wisely use you time during the debate sessions and outside of class, via emails and in person as necessary, to compel them to join your cause.

London 1854: Cesspits, Cholera, and Conflict over the Broad Street Pump

Marshall L. Hayes and Eric B. Nelson • Cornell University

version 5A.091613

SPECIFIC INSTRUCTIONS: The format of the meeting is divided into two class sessions. For Session I, you will prepare a short (< 1 page) written statement that introduces your character and your ideologies on Cholera. You will deliver this statement as a speech of roughly 1-2 minutes, detailing your position and making specific suggestions that can be debated and brought to a vote in Session II. You should address three questions: What is the source of the outbreak? How is Cholera communicated from person to person? And, what steps should be taken to contain the outbreak?

MEETING AGENDA

CLASS SESSION I: OPENING STATEMENTS AND PROPOSED RESPONSES The Special Committee convenes on the evening of Thursday, 7 September 1854. In the course of your research, you should familiarize yourself with what has occurred over the past week. When invited by Chairman Frederick Crane, you will stand and deliver your personal statement. Also, listen intently and take notes as your colleagues make their presentations. Be sure to propose any specific remedial actions by the end of Session I so that these issues may be debated and brought to a final vote at the end of Session II.

INTERLUDE: JOHN SNOW GIVES HIS TESTIMONY AND RECOMMENDATION Between the two class sessions, Dr. John Snow requested to be heard by the Board and has testified that the Cholera outbreak is being driven by contaminated water originating from the pump located on Broad Street. He has recommended that the Board remove the handle from the Broad Street pump immediately, so as to interrupt public access to what he considers as a tainted water supply. In preparation for Session II, use the online Cholera Data Manager to examine closely the data upon which Dr. Snow bases his arguments. Also consult Dr. Snow’s map and the accompanying Excel spreadsheets to conduct your own analyses of these data and raise further questions and/or support for your arguments. You should also examine William Farr’s data and figures and utilize them similarly.

CLASS SESSION II: DEBATE AND FINAL VOTING ON COURSES OF ACTION You will argue strongly for unsanitary conditions and local miasmas as the causes of the current Cholera outbreak. Question the utility of removing the pump handle from the Broad Street pump, and point out that this will be a significant inconvenience Parish residents. Also, be sure to coordinate your perspectives with your fellow Anti-contagionists so that, together, you can gain the support of the Indeterminates and defeat the Contagionist agenda. Keep in mind that there are inconsistencies in the various Contagionist arguments you will hear over the course of the debate. Counter these with logical rebuttals and any compelling quantitative data that you can gather.

“Anti-contagionist” FACTION STRATEGY

Your faction, the Anti-contagionists, will likely vote against Dr. Snow’s recommendation, but you may be swayed by any particularly strong arguments or data that are presented. Consider the different arguments of William Maclean, T. Southwood Smith, William Farr, Edwin Chadwick, Florence Nightingale and the Rev. Henry Whitehead (see internet sources). You are generally supportive of any remedial or preventive measure that was widely in use at the time (e.g. the use of chlorine or chloride of lime for washing). You are also in favor of persistent communication with Parish residents about the virtues of pure air, cleanliness of person, of house and of premises, and temperance with respect to the consumption of spirituous liquors. You should enthusiastically endorse that the Board recirculate among Parish residents handbills with language to this effect. In your arguments, make specific references to existing language in the draft handbill that has been circulated among Board members and suggest any necessary changes.

SECRET OBJECTIVE

To earn bonus credit for this role-playing activity, you must also achieve your secret objective:

Have the Board vote on taking steps to identifying and remedying (e.g. filling marshes and damp low-lying areas) areas in the Parish that serve as sources of dangerous effluvia and could corrupt the air during specific, disease-causing seasons.

London 1854: Cesspits, Cholera, and Conflict over the Broad Street Pump

Marshall L. Hayes and Eric B. Nelson • Cornell University

version 5A.091613

YOU ARE JOHN SNOW.

Faction: Contagionist

You are a local physician and specialist in anesthesiology as well as Cholera, having investigated the disease ever since your first encounter in 1832 during your medical apprenticeship in the mining village of Killingworth. You learned of tonight’s meeting of the Sanitary Committee via Dr. John George French, a Board member and your friend and colleague of many years. You aim to convince the Board that Cholera is transmitted via contaminated food and water.

Cholera is transmitted via contaminated food and water . GENERAL DIRECTIVE: You are not a member

GENERAL DIRECTIVE: You are not a member of the special Sanitary Committee of the Board of Governors and Directors of the Poor of St. James Parish, but you appeal to be heard tonight. On 14 August 1854, the General Board of Governors and Directors of the Poor voted to form a special emergency response committee to address the threat of Malignant Cholera throughout the parish. This Board wields the power and financial backing to make whatever arrangements they deem necessary regarding administrative courses of action, medical responses, future meetings, etc. You intend to argue that contamination of Broad Street pump water is feeding this Cholera outbreak.

REQUIRED READINGS

• Chapter 1 of The Ghost Map by Steven Johnson (2006).

• Chapters 2 and 10 of Disease Maps: Epidemics on the Ground by Tom Koch (2011).

Anticontagionism between 1821 and 1867 by Erwin Ackerknecht (1948).

CHARACTER-SPECIFIC ONLINE RESOURCES

http://johnsnow.matrix.msu.edu/work.php?id=15-78-51

http://johnsnow.matrix.msu.edu/work.php?id=15-78-56

YOU ARE IN THE “Contagionist” FACTION.

You and your fellow Contagionist members of the Board believe that Cholera is transmitted by the direct passage of some chemical, physical or biological agent originating from a sick person and transmitted to a susceptible victim by contact or fomites or, for a relatively short distance, through the atmosphere.

The Anti-contagionist members of the Board believe that the Cholera outbreak may be explained by a number of factors, including: classic Hippocratic epidemic constitution, atmospheric influences, elevation above sea level, miasma arising from exposure to decaying animal or vegetable matter, diet, lifestyle and socioeconomic status. No human-to-human transmission is invoked.

The Indeterminate members of the Board do not have fixed opinions as to the origins of Cholera. As such, sound scientific arguments made by members of the other factions may sway the opinion of these Board members.

PLEASE NOTE: Although you and your faction colleagues may agree as to the general Contagionist notions of disease, your specific beliefs may be quite different. Over the course of our debate, and even outside of class, you may (and should) consult with one another to identify those issues upon which you can agree as well as those upon which you disagree. For the purposes of final voting on any measures of remediation and prevention, some degree of consensus is required; it is particularly clear that you cannot advance the Contagionist agenda without soliciting the support of other, dissenting Board members. So, it will be important to develop arguments that will be convincing to Indeterminate Board members, whose votes will allow you to champion your own beliefs. Once you learn who are the Indeterminates, wisely use you time during the debate sessions and outside of class, via emails and in person as necessary, to compel them to join your cause.

London 1854: Cesspits, Cholera, and Conflict over the Broad Street Pump

Marshall L. Hayes and Eric B. Nelson • Cornell University

version 5A.091613

SPECIFIC INSTRUCTIONS: The format of the meeting is divided into two class sessions. For Session I, you will prepare a short (< 1 page) written statement that introduces your character and your ideologies on Cholera. If the Board votes and allows you to speak, you will deliver your statement as a speech of roughly 1-2 minutes, detailing your position and making specific suggestions that can be debated and brought to a vote in Session II. You should address three questions: What is the source of the outbreak? How is Cholera communicated from person to person? And, what steps should be taken to contain the outbreak?