B - JARDIM,J.(2014) - John Snow s Behaviorsphere

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SKETCH

John Snow's Behaviorsphere

Joo Bosco Jardim

# Association of Behavior Analysis International 2014

Abstract The near-legendary narratives of the scientific

achievements of John Snow, a pioneer English epidemiologist

who famously identified the source of the London's BroadStreet pump cholera epidemic in 1854, has a behavioral facet

which has not been duly explored by historians of public

health. In this article, the story of Snow's investigations into

the case of the infamous water pump is used as a backdrop to

highlight the disciplinary continuum of psychological and

biological even ts, according to the perspec tiv e of J.R.

Kantors philosophy of interbehaviorism.

Keywords John Snow. Behavior. Individual history.

Interbehavioral psychology. Interdisciplinary science

cooperation

If, in fact, individual history plays a major role in psycholog-

ical behavior (Kantor 1959; Mountjoy 1976), psychologists

might well claim academic disciplinary rights over the behav-

ioral fair share of the achievements of John Snow (1813

1858), the physician who famously identified sewage-

contaminated water as a source of cholera transmission and

helped pioneer the science of epidemiology in the mid-

nineteenth century.

Why should psychologists involve themselves with the

esteemed legacy of a hero of epidemiology? After all, epidemi-

ologists rely to a great extent on biomedical sciences to under-

stand disease processes, and the history of public health credits

Snow, among other achievements, with having anticipated the

evidence of the bacterial nature of an infection, rather than

something outside the disciplinary branches of biology. As a

rule, despite the relevance of human behavior in biomedical

disciplines, a behavioral addressing of cholera transmission

might sound like psychological nonsense, even considering thatepidemiology is in part a behavioral discipline.

It is all very well that the disciplinary accounts of Snows

achievements have been informed predominantly by biomed-

ical knowledge. But it would make total sense to assert that the

man who is regarded by many as a founding father of epide-

miology managed to achieve the success he eventually

achieved also because, at a certain point, the guiding focus

of his investigations went on to be the role played by a

naturally occurring psychological behavior (as distinct from

biological behavior) in the ancient routine of collecting drink-

ing water from public pumps.

It is not the aim here to discuss issues of disease causation,

much less presumed psychological underlying mechanisms

and other tricky questions. The intent of this essay is to bring

to the fore and briefly examine, from my point of view, the

not-so-noticeable spatiotemporal locus of psychological be-

havior in the historical accounts of Snows investigations.

Certainly, the behavioral sphere has not been duly noted by

historians, but it may be well viewed through a psychologists

eyes. One may even suggest that the disciplinary context of

the story of John Snow relative to cholera has as much

psychology as medical geography, just to give a slightly

provocative example of an interdisciplinary input unquestion-

ably linked to the deeds of the revered English doctor.

Before I go on, though, it is necessary to bypass the

conventional wisdom of psychology in order to make clear

that I am not talking about mental phenomena or wanting to

make interpretations, or theorize. Academic psychologists are

always at loggerheads with each other because of the

entrenched mind-body dualism that blurs their disciplinary

object of study (Hineline 2013). However, in one way or

another, all psychologists finish by observing behavior if

nothing else (and this is one aspect of my Snow argument),

J. B. Jardim (*)

Laboratory of Health Education and Environment, Ren Rachou

Research Center, Oswaldo Cruz Foundation, Avenida Augusto de

Lima 1715, Barro Preto, 30190-002 Belo Horizonte, MG, Brazil

e-mail: [email protected]

Psychol Rec

DOI 10.1007/s40732-014-0082-3


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what people say, for instance, in response to questions

(Delprato and Midgley 1992). Behavior qua behavior pro-

vides an outcome that is directlyconfrontable, autonomous,

evident in its own right (McPherson 1992), albeit of an onto-

logically different type from any biological sort (Kantor and

Smith1975).

According to the late systematist Jacob Robert Kantor (1888

1984), an eminent professor and history scholar who pioneered anon-dualistic system called interbehavioral psychology (Kantor

1959,1981; Kantor and Smith 1975), the phenomena that are

commonly deemed psychological are de facto species of mutual

interactions between what individuals doi.e., behaviorand

things (stimulus objects) and events of their natural and built

environments in a given space-time boundary. This means, just

to introduce a central aspect of my Snow argument, that when a

person has to choose one of two or more functionally equivalent

neighboring objects, like water pumps in a particular spatiotem-

poral arrangement of things and events, behavior and object are

influencing each otherin a sense, the object appeals to the

person and the person either moves towards the object or comesinto contact with it or otherwise explores its surroundings

(Kantor1971; Kantor and Smith1975).

The resemblance of such a mutuality of participating fac-

tors in a certain space-time locus with mechanistic learning

frameworks, although apparent, seems to me to be non-

existent (interbehaviorists are critical of what Kantor labelled

learnology). But, still, someone may argue that biological

disciplines already study transmission of communicable dis-

ease in a person-environment interaction framework, includ-

ing social environments, and that, therefore, a psychological

approach to Snows achievements in epidemiology would not

ultimately be distinct from a biology-based one. This is a

crucial point.

Interbehavioral psychology holds that psychological and

biological interactions distinguish themselves chiefly by the

historical character of the former, meaning that with the term

historical there is an ongoing sequence of interactions be-

tween the behaving individual and its stimulating environment

which encompasses not only events immediately antecedent

to the behavior observed, but also the remote ones. From the

standpoint of interbehaviorists, psychological interactions are

distinctively historical, and whatever individuals dowhich-

ever behavior, current or pastis engendered by their history

of mutual interactions with a stimulating environment (Kantor

1959; Kantor and Smith 1975; Midgley and Morris 2006;

Moore1984; Parrott1983; Verplanck1998).

That is not to say there is a demarcation line between

psychological and biological interactions or that they do exist

as separate phenomena. Rather, an aspect of the natural world is

picked out by psychologists as their object of study and, some-

what arbitrarily, called psychological (Hayes and Fryling

2009a). Though the vastness of the phenomena on each side

of the border usually calls for biologists and psychologists to

stick to their respective disciplinary fair shares, biological and

psychological interactions are in reality continuous and merge

naturally into each other (Mountjoy1976).

I would like now to elaborate further on Snows success.

Speaking of behavior, a significant moment in his efforts in

relation to cholera was when someone, maybe a party of

workmen, after much debate and controversy, removed the

handle of a street water pump. This passage, often recountedin heroic tones, has been somewhat romanticized as a happy

ending to a merciless process of cholera transmission which

replicated itself mortally hundreds of times under harsh,

poverty-stricken living contingencies. The story, not necessar-

ily simple, not necessarily genuineand for the rest exhaus-

tively re-recounted on the occasion of Snow's 200th anniver-

sary on March 2013goes more or less like this:

In the late English summer of 1854 a cholera epidemic

ravaged the Parish of St. James's, Westminster, claiming

some five hundred lives in the first few days. Snow

indicated to local health authorities that one potentialsource of the problem was the likely sewage-

contaminated water of a public pump at London's now

fashionable Soho district. He had long contended that

some of the pump wells in the parish yielded water

contaminated by cholera evacuations that passed along

the sewers near to the wells. By plotting the location of

the houses of those who died from the disease on a dot

map (and making by way of the map the first ever spatial

analysis of an epidemic), Snow was able to show that

the great majority of the deaths were correlated with the

distance that separated the dead persons houses from

the suspected pump. The map data were obtained from a

house-to-house survey that Snow did himself all around

the affected area to ascertain orally where the dead had

collected their drinking water. Suggestive of the prefer-

ence of most parishioners for one particular pump

(which went down in history as the Broad Street pump)

over others was the tendency of cholera deaths to cluster

in the streets close to it while decreasing, roughly speak-

ing, at streets that required people to walk further to

collect water from another pump. Snows survey rein-

forced his view that the Broad Street pump was the most

likely source of the epidemic. Although the aquatic

bacterium Vibrio cholerae had not yet been identified,

the survey ended up being also instrumental in bolster-

ing his assumption that water was a vehicle for trans-

mission of a sort of evacuation poison, which he

described as small white, flocculent particles that

caused cholera, once ingested. It was then that Snow

eventually persuaded the parish authorities to remove

the pump handle, thereby (the story goes) preventing

people from coming into contact with the contami-

nated water.

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Despite some variations here and there, the many versions

of this story have in common the anecdotal account of the way

in which Snows investigations anticipated later epidemiolog-

ical studies on how Vibrio cholerae is transmitted through

water. His approach to the prevention and control of disease

outbreaks confronted directly the then-widely disseminat-

ed belief that transmission was due to a poisonous

atmosphere thought to issue from the swamps and pu-trid matter rife in London at the time. This, as might be

expected, greatly contributed to his reputation and suc-

cess (Edwards 1959).Now, disease transmission is a fairly discussed topic, but

psychologica l behavior, a critical component, is usually

overlooked as an object of study in its own right when dealing

with it (Epstein 1992). In most academic circles, even in

psychology, behavior is customarily thought of not as a pri-

mary health outcome, butto paraphrase a wry appraisal of

the foremost advocate of behavioral psychology, B.F. Skinner

(19041990)as a mere expression ofmore important hap-

penings inside the behaving person(Skinner1987). Is it anywonder, therefore, that having to demonstrate his pathologic

rationale, Snow endeavored to relate cholera mortality to

parishioners' beha vior with res pect to an environing

objector, as he put it, independently of the patholo-

gy (Snow 1855).

In effect, Snow assumed a direct relationship between

contaminated water and cholera transmission. He posited that

transmission was linked to the ingestion of the evacuation

poison, which reproduced itself in the abdomen, and in many

cases led to death as the result of the loss of fluid through the

intestinal walls. However, and importantly, his survey indicat-

ed that in 83 % of the cases the dead parishioners had been

drinking the water from the pump on Broad Street (Snow

2002). Since people were free to visit several pumps, this

outcome means that a significant portion of those who rou-

tinely collected water for drinking and culinary purposes had

developed a selective interaction with one pump over their

alternatives. In other words (taking it for granted that the

survey actually captured what happened), they manifest-

ly chose, or preferred, to collect water from the Broad

Street pump.

This development was an essentially psychological phe-

nomenon. In contemporary psychological research, it could be

dealt with by analyzing the observed frequency of visits to the

Broad Street pump (and the operations of the handle would be

an accurate measure for it) relative to the frequency of visits to

other pumps at multiple time scales (e.g., Baum 2004,

2010)something obviously unthinkable in the nineteenth

century. Snow, however, as would any venturesome academ-

ic, sought to understand the behavior fact with the means at his

disposal, i.e., an extensive survey of the neighborhood, plus

the dot map which he made from the orally obtained informa-

tion. It was through these means that he succeeded in putting

the focus of his investigations on the role played by people's

water collection behavior with respect to the suspicious pump.

One might wonder whether in the absence of the behavioral

information Snow would have achieved his biological break-

through. Probably not, considering that it would take some

time, nearly three decades, until Vibrio choleraewas eventu-

ally identified (by Robert Koch) under the microscope. Most

narratives of Snows achievements, both popular and academ-ic, are correct when it comes to giving credit to a likely cause-

effect relationship between cholera mortality and the Broad

Street pump. However, the generality of authors typically fail

to notice that a psychological behavior had to evolve first, or

concomitantly, in order for such a relationship to exist. Given

that most scholars of epidemiology and related disciplines are

generally not as familiar with a behavioral approach to health

as they are with their own disciplinary approaches, this failure

is not surprising. Indeed, the word behavior is virtually

absent in Snow academic narratives (see, for instance, Brody

et al.1999; Brown1964; Cameron and Jones1983; McLeod

2000; Paneth2004; Winkelstein1995. For a comprehensivelist of writings about John Snow, see Frerichs2001).

Going back now to what I called disciplinary fair share, it

seems reasonable to argue that while investigating the cholera

epidemic in the Parish of St. James's, Snow moved among two

juxtaposed spheres or provinces of scientific inquiry. In one,

he investigated cholera by looking for a link between the

ingestion of what he saw as an evacuation poison and the

transmission of the disease. This quota of research efforts

composed the biological fair share of his achievements, i.e.,

a well-recognized, responsive, and unidirectional person-

environment interaction.

After much work, and still lacking direct evidence of

sewage contamination of the Broad Street pump water,

Snow moved on to the other sphere. He realized that to

demonstrate fully his ideas about cholera transmission in the

parish, he needed not only to understand how the poison was

ingested and absorbed and excreted through drinking water,

but also to go back in history to examine additionally a

peculiar interaction, orinterbehavior, as Kantor would say,

through which a street pump (albeit unsanitary) had been

chosen by a great number of parishioners. Such endeavor fits

in with the psychological fair share. In other words, by

searching for cases in history to support his ideas, Snow

naturally guided his investigations to a mutual, bi-directional

and, therefore, distinct interaction which evolved during the

course of peoples continued contact with an object conducive

to disease.

Psychology and biology have different approaches to and

conceptions of behavior as an object of study (Kantor and

Smith 1975; McPherson 1992). In Kantor's system,

psychological behavior, in addition to being interactive, is a

mutual and historical construct referring, in his words (1982),

to a complete and total operation of individuals (see also

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Parrott1983; S et al.2004). Except for analytical purposes,

any noninteractive, nonmutual, ahistorical, or segmented de-

scription of behavior falls outside the disciplinary fair share of

interbehavioral psychologists.

The ingestion, absorption, and excretion of a bacterium may

be thought of as behavior. But in a continuum of biological and

psychological disciplines, they pertain to the evolutionary history

of species. The choice of a stimulus object like a water pump, inits turn, however prosaic it may seem to a non-psychologist, is

germane to ontogenetic evolution, that is, to individual life

historyeven though the stimulus function (water supply), in

such a case, directly affects survival and reproduction.

Obviously, the interested psychologist can do no more than

wonder how the Broad Street pump was chosen. It is unrea-

sonable to think that the choice was a momentary collective

event. Instead, one may imagine it evolved over time, perhaps

while the pump attracted some word-of-mouth attention in its

social surroundingwho knows? Water from Broad Street

reportedly tasted better than water from other neighboring

wells, a circumstance that can be loosely interpreted as anincrement to the stimulus function, or to the discriminative

appeal of the pump. Response effort, a technical term mean-

ing the physical endeavor required to engage in a behavior,

could also be a factor since Snows map indicated that the

deaths, as he wrote, either very much diminished or ceased

altogether at every point where it was nearer to go to

another pump than to the one in Broad Street (Snow1855).

A valuable aspect of interdisciplinary science cooperation

is the information that emerges when old subject matter is

viewed from a different sphere. It may be instructive for any

behavior scholar if a knowledgeable and curious author de-

veloped a psychological narrative of Snows story, despite the

mythology that surrounds the hero (e.g., Brody et al. 2000;

Brown1964; McLeod2000; Snow2008). However preten-

tious this initiative may appear to be in the eyes of a non-

psychologist, it can point towards new angles of approach and

perhaps suggest a novel direction for historical research on the

subject (refer to Hayes and Fryling 2009a,b for a comment

and a substantial review of the nature of interdisciplinary

science from an interbehavioral perspective).

Of course, I cannot estimate the diversity of psychological

behaviors related to water collection that there were in Snows

behaviorsphere (the name I am giving it). What I know is that,

in the numerous narratives of his scientific achievements, an

account of such behaviors has been overlooked, although they

played an absolutely primary role in the cholera epidemic that

has made him famous. This should not be read as a hostile

remark toward John Snow narratives. Maybe in the moment

when psychological behavior becomes more noticeable, more

easily seen by public health historians, there may be room for a

richer version of Snows work on cholera than has traditionally

been presented. My main goal in writing this article was to

contribute to this development.

Acknowledgment Preparation of this article was supported by

Fundao de Amparo Pesquisa do Estado de Minas Gerais and

Conselho Nacional de Desenvolvimento Cientfico e Tecnolgico. Cor-

respondence should be addressed to Joo Bosco Jardim, Centro de

Pesquisa Ren Rachou, Fundao Oswaldo Cruz, Avenida Augusto de

Lima 1715, Barro Preto, 30190002 Belo Horizonte, MG, Brazil. E-mail:

[email protected]

The author is grateful to Dr. Virgnia T. Schall, Liz Andrade and

Katherine Titley for their comments on an earlier version of this article.

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B - JARDIM,J.(2014) - John Snow s Behaviorsphere