Share this article on:

“The Pump Don't Work, ’cause the Vandals Took the Handles.”1

Kuh, Diana

doi: 10.1097/01.ede.0000135913.25938.48

From the MRC National Survey of Health and Development, Royal Free and University College Medical School, Department of Epidemiology and Public Health, London, UK.

Correspondence: Diana Kuh, MRC National Survey of Health and Development, Royal Free and University College Medical School, Department of Epidemiology and Public Health, Gower Street Campus, 1-19 Torrington Place, London WC1E 6BT, UK. E-mail:

At the request of Epidemiology, a group of epidemiologists celebrated the anniversary of the removal of the Broad Street pump handle by paying a visit to the John Snow Pub, just next to the famous pump. We gathered in the upstairs bar to sign the visitors’ book (under the names of many other epidemiologists through the years) and inspected the Snow memorabilia. We dedicated the first round of drinks to the controversy between the miasma theory and the germ theory of disease.

With our second round of drinks, we celebrated the centenary of the 1904 report that explored why so many young British working-class men were physically unfit for military service.2 This report ushered in a new era that emphasized the childhood origins of adult health. Scientific controversy in this era centered around the relative importance of nature and nurture.3

The pub hosting our celebrations had marked the centenary of the Broad Street pump in 1954 by changing its name from the “Newcastle-upon-Tyne” to the “John Snow” (an ironic commemoration, given that Snow himself was a teetotaller). Sir Austin Bradford-Hill had unveiled the new inn sign. So, with our third round of drinks, we toasted the jubilee of Doll and Hill's 1954 first report from their prospective study of smoking and cancer.4 Described as one of the “intellectual levers” of modern epidemiology,5 this study exemplified the adult-lifestyle model of disease causation.

Like the connections Snow made between contaminated water and cholera, the link between cigarette smoking and lung cancer was challenged by medical and statistical scientists and took time to be accepted by the general public. Scientific controversies, the emergence of scientific facts, and the closure of scientific debates are all social processes.6 The title of this piece (courtesy of Bob Dylan) serves as a reminder that public health interventions are not always appreciated by the people they are intended to benefit.

The etiologic models of disease causation represented by these 3 anniversaries of 1854, 1904, and 1954 all remain relevant today. What model emerging in 2004 might be singled out by future epidemiologists as the most influential in 50 or 100 years? Our nonrandom sample of U.K. epidemiologists dragged from the John Snow Pub for a photograph around the famous pump would not be drawn on these vexing questions. It was left to George Davey Smith, absent for once from a drinking session, to propose Mendelian randomization as a current major advance for epidemiology!

Back to Top | Article Outline


DIANA KUH is co-editor of A Life Course Approach to Chronic Disease Epidemiology (Oxford University Press, 2004). Her research uses data from the MRC National Survey of Health and development, the oldest of the British national birth cohorts, to investigate the early origins of adult disease. She has a special interest in the history of epidemiology and related disciplines in life course research.

Back to Top | Article Outline


1. Dylan B. Subterranean Homesick Blues, 1965 (with thanks to Peter Kuh).
    2. Great Britain Parliamentary Papers. Report of the Interdepartmental Committee on Physical Deterioration. Volume I: Report and Appendix Cmnd 2175, HMSO, London; 1904.
    3. Kuh D, Davey Smith G. When is mortality risk determined? Historical insights into a current debate. Soc Hist Med. 1993;6:101–123.
    4. Doll R, Hill AB. The mortality of doctors in relation to their smoking habits. A preliminary report. BMJ. 1954;1:1451–1455.
    5. Susser M. Epidemiology in the United States after World War II: the evolution of a technique. Epidemiol Rev. 1985;7:147–177.
    6. Latour B. Science in Action: How to Follow Scientists and Engineers Through Society. Open University Press; Milton Keynes, 1987.


    © 2004 Lippincott Williams & Wilkins, Inc.