SKETCH

John Snow's Behaviorsphere

João Bosco Jardim

# Association of Behavior Analysis International 2014

Abstract The near-legendary narratives of the scientificachievements of John Snow, a pioneer English epidemiologistwho famously identified the source of the London's BroadStreet pump cholera epidemic in 1854, has a behavioral facetwhich has not been duly explored by historians of publichealth. In this article, the story of Snow's investigations intothe case of the infamous water pump is used as a backdrop tohighlight the disciplinary continuum of psychological andbiological events, according to the perspective of J.R.Kantor’s philosophy of interbehaviorism.

Keywords John Snow . Behavior . Individual history .

Interbehavioral psychology . Interdisciplinary sciencecooperation

If, in fact, individual history plays a major role in psycholog-ical behavior (Kantor 1959; Mountjoy 1976), psychologistsmight 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 andhelped pioneer the science of epidemiology in the mid-nineteenth century.

Why should psychologists involve themselves with theesteemed 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 creditsSnow, among other achievements, with having anticipated theevidence of the bacterial nature of an infection, rather thansomething outside the disciplinary branches of biology. As a

rule, despite the relevance of human behavior in biomedicaldisciplines, a behavioral addressing of cholera transmissionmight sound like psychological nonsense, even considering thatepidemiology is in part a behavioral discipline.

It is all very well that the disciplinary accounts of Snow’sachievements have been informed predominantly by biomed-ical knowledge. But it wouldmake total sense to assert that theman who is regarded by many as a founding father of epide-miology managed to achieve the success he eventuallyachieved also because, at a certain point, the guiding focusof his investigations went on to be the role played by anaturally occurring psychological behavior (as distinct frombiological 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 mechanismsand other tricky questions. The intent of this essay is to bringto the fore and briefly examine, from my point of view, thenot-so-noticeable spatiotemporal locus of psychological be-havior in the historical accounts of Snow’s investigations.Certainly, the behavioral sphere has not been duly noted byhistorians, but it may be well viewed through a psychologist’seyes. One may even suggest that the disciplinary context ofthe story of John Snow relative to cholera has as muchpsychology as medical geography, just to give a slightlyprovocative 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 theconventional wisdom of psychology in order to make clearthat I am not talking about mental phenomena or wanting tomake interpretations, or theorize. Academic psychologists arealways at loggerheads with each other because of theentrenched mind-body dualism that blurs their disciplinaryobject of study (Hineline 2013). However, in one way oranother, all psychologists finish by observing behavior ifnothing else (and this is one aspect of my Snow argument),

J. B. Jardim (*)Laboratory of Health Education and Environment, René RachouResearch Center, Oswaldo Cruz Foundation, Avenida Augusto deLima 1715, Barro Preto, 30190-002 Belo Horizonte, MG, Brazile-mail: jardim@cpqrr.fiocruz.br

Psychol RecDOI 10.1007/s40732-014-0082-3

what people say, for instance, in response to questions(Delprato and Midgley 1992). Behavior qua behavior pro-vides an outcome that is directly “confrontable”, autonomous,evident in its own right (McPherson 1992), albeit of an onto-logically different type from any biological sort (Kantor andSmith 1975).

According to the late systematist Jacob Robert Kantor (1888–1984), an eminent professor and history scholar who pioneered anon-dualistic system called interbehavioral psychology (Kantor1959, 1981; Kantor and Smith 1975), the phenomena that arecommonly deemed psychological are de facto species of mutualinteractions between what individuals do—i.e., behavior—andthings (stimulus objects) and events of their natural and builtenvironments in a given space-time boundary. This means, justto introduce a central aspect of my Snow argument, that when aperson has to choose one of two or more functionally equivalentneighboring objects, like water pumps in a particular spatiotem-poral arrangement of things and events, behavior and object areinfluencing each other—in a sense, the object “appeals” to theperson and the person either moves towards the object or comesinto contact with it or otherwise explores its surroundings(Kantor 1971; Kantor and Smith 1975).

The resemblance of such a mutuality of participating fac-tors in a certain space-time locus with mechanistic learningframeworks, although apparent, seems to me to be non-existent (interbehaviorists are critical of what Kantor labelled“learnology”). But, still, someone may argue that biologicaldisciplines already study transmission of communicable dis-ease in a person-environment interaction framework, includ-ing social environments, and that, therefore, a psychologicalapproach to Snow’s achievements in epidemiology would notultimately be distinct from a biology-based one. This is acrucial point.

Interbehavioral psychology holds that psychological andbiological interactions distinguish themselves chiefly by thehistorical 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 environmentwhich encompasses not only events immediately antecedentto the behavior observed, but also the remote ones. From thestandpoint of interbehaviorists, psychological interactions aredistinctively historical, and whatever individuals do—which-ever behavior, current or past—is engendered by their historyof mutual interactions with a stimulating environment (Kantor1959; Kantor and Smith 1975; Midgley and Morris 2006;Moore 1984; Parrott 1983; Verplanck 1998).

That is not to say there is a demarcation line betweenpsychological and biological interactions or that they do existas separate phenomena. Rather, an aspect of the natural world ispicked out by psychologists as their object of study and, some-what arbitrarily, called “psychological” (Hayes and Fryling2009a). Though the vastness of the phenomena on each sideof the border usually calls for biologists and psychologists to

stick to their respective disciplinary fair shares, biological andpsychological interactions are in reality continuous and mergenaturally into each other (Mountjoy 1976).

I would like now to elaborate further on Snow’s success.Speaking of behavior, a significant moment in his efforts inrelation to cholera was when someone, maybe a party ofworkmen, after much debate and controversy, removed thehandle of a street water pump. This passage, often recountedin heroic tones, has been somewhat romanticized as a happyending to a merciless process of cholera transmission whichreplicated itself mortally hundreds of times under harsh,poverty-stricken living contingencies. The story, not necessar-ily simple, not necessarily genuine—and for the rest exhaus-tively re-recounted on the occasion of Snow's 200th anniver-sary on March 2013—goes more or less like this:

In the late English summer of 1854 a cholera epidemicravaged the Parish of St. James's, Westminster, claimingsome five hundred lives in the first few days. Snowindicated to local health authorities that one potentialsource of the problem was the likely sewage-contaminated water of a public pump at London's nowfashionable Soho district. He had long contended thatsome of the pump wells in the parish yielded watercontaminated by cholera evacuations that passed alongthe sewers near to the wells. By plotting the location ofthe houses of those who died from the disease on a dotmap (andmaking byway of the map the first ever spatialanalysis of an epidemic), Snow was able to show thatthe great majority of the deaths were correlated with thedistance that separated the dead persons’ houses fromthe suspected pump. The map data were obtained from ahouse-to-house survey that Snow did himself all aroundthe affected area to ascertain orally where the dead hadcollected 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 clusterin the streets close to it while decreasing, roughly speak-ing, at streets that required people to walk further tocollect water from another pump. Snow’s survey rein-forced his view that the Broad Street pump was the mostlikely source of the epidemic. Although the aquaticbacterium 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 hedescribed as “small white, flocculent particles” thatcaused cholera, once ingested. It was then that Snoweventually persuaded the parish authorities to removethe pump handle, thereby (the story goes) preventingpeople from coming into contact with the contami-nated water.

Psychol Rec

Despite some variations here and there, the many versionsof this story have in common the anecdotal account of the wayin which Snow’s investigations anticipated later epidemiolog-ical studies on how Vibrio cholerae is transmitted throughwater. His approach to the prevention and control of diseaseoutbreaks confronted directly the then-widely disseminat-ed belief that transmission was due to a poisonousatmosphere thought to issue from the swamps and pu-trid matter rife in London at the time. This, as might beexpected, greatly contributed to his reputation and suc-cess (Edwards 1959).

Now, disease transmission is a fairly discussed topic, butpsychological behavior, a critical component, is usuallyoverlooked as an object of study in its own right when dealingwith it (Epstein 1992). In most academic circles, even inpsychology, behavior is customarily thought of not as a pri-mary health outcome, but—to paraphrase a wry appraisal ofthe foremost advocate of behavioral psychology, B.F. Skinner(1904–1990)—as a mere expression of “more important hap-penings inside the behaving person” (Skinner 1987). Is it anywonder, therefore, that having to demonstrate his pathologicrationale, Snow endeavored to relate cholera mortality toparishioners' behavior with respect to an environingobject—or, as he put it, “independently of the patholo-gy” (Snow 1855).

In effect, Snow assumed a direct relationship betweencontaminated water and cholera transmission. He posited thattransmission was linked to the ingestion of the evacuationpoison, which reproduced itself in the abdomen, and in manycases led to death as the result of the loss of fluid through theintestinal walls. However, and importantly, his survey indicat-ed that in 83 % of the cases the dead parishioners had beendrinking the water from the pump on Broad Street (Snow2002). Since people were free to visit several pumps, thisoutcome means that a significant portion of those who rou-tinely collected water for drinking and culinary purposes haddeveloped a selective interaction with one pump over theiralternatives. In other words (taking it for granted that thesurvey actually captured what happened), they manifest-ly chose, or preferred, to collect water from the BroadStreet pump.

This development was an essentially psychological phe-nomenon. In contemporary psychological research, it could bedealt with by analyzing the observed frequency of visits to theBroad Street pump (and the operations of the handle would bean accurate measure for it) relative to the frequency of visits toother pumps at multiple time scales (e.g., Baum 2004,2010)—something obviously unthinkable in the nineteenthcentury. Snow, however, as would any venturesome academ-ic, sought to understand the behavior fact with the means at hisdisposal, i.e., an extensive survey of the neighborhood, plusthe 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'swater collection behavior with respect to the suspicious pump.

Onemight wonder whether in the absence of the behavioralinformation Snow would have achieved his biological break-through. Probably not, considering that it would take sometime, nearly three decades, until Vibrio cholerae was eventu-ally identified (by Robert Koch) under the microscope. Mostnarratives of Snow’s 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 BroadStreet pump. However, the generality of authors typically failto notice that a psychological behavior had to evolve first, orconcomitantly, in order for such a relationship to exist. Giventhat most scholars of epidemiology and related disciplines aregenerally not as familiar with a behavioral approach to healthas they are with their own disciplinary approaches, this failureis not surprising. Indeed, the word “behavior” is virtuallyabsent in Snow academic narratives (see, for instance, Brodyet al. 1999; Brown 1964; Cameron and Jones 1983; McLeod2000; Paneth 2004; Winkelstein 1995. For a comprehensivelist of writings about John Snow, see Frerichs 2001).

Going back now to what I called disciplinary fair share, itseems reasonable to argue that while investigating the choleraepidemic in the Parish of St. James's, Snowmoved among twojuxtaposed spheres or provinces of scientific inquiry. In one,he investigated cholera by looking for a link between theingestion of what he saw as an evacuation poison and thetransmission of the disease. This quota of research effortscomposed 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 ofsewage contamination of the Broad Street pump water,Snow moved on to the other sphere. He realized that todemonstrate fully his ideas about cholera transmission in theparish, he needed not only to understand how the poison wasingested and absorbed and excreted through drinking water,but also to go back in history to examine additionally apeculiar interaction, or “interbehavior”, as Kantor would say,through which a street pump (albeit unsanitary) had beenchosen by a great number of parishioners. Such endeavor fitsin with the psychological fair share. In other words, bysearching for cases in history to support his ideas, Snownaturally guided his investigations to a mutual, bi-directionaland, therefore, distinct interaction which evolved during thecourse of people’s continued contact with an object conduciveto disease.

Psychology and biology have different approaches to andconceptions of behavior as an object of study (Kantor andSmith 1975; McPherson 1992). In Kantor's system,psychological behavior, in addition to being interactive, is amutual and historical construct referring, in his words (1982),to a “complete and total operation” of individuals (see also

Psychol Rec

Parrott 1983; Sá et al. 2004). Except for analytical purposes,any noninteractive, nonmutual, ahistorical, or segmented de-scription of behavior falls outside the disciplinary fair share ofinterbehavioral psychologists.

The ingestion, absorption, and excretion of a bacterium maybe thought of as behavior. But in a continuum of biological andpsychological disciplines, they pertain to the evolutionary historyof species. The choice of a stimulus object like a water pump, inits turn, however prosaic it may seem to a non-psychologist, isgermane to ontogenetic evolution, that is, to individual lifehistory—even though the stimulus function (water supply), insuch a case, directly affects survival and reproduction.

Obviously, the interested psychologist can do no more thanwonder how the Broad Street pump was chosen. It is unrea-sonable to think that the choice was a momentary collectiveevent. Instead, one may imagine it evolved over time, perhapswhile the pump attracted some word-of-mouth attention in itssocial surrounding—who knows? Water from Broad Streetreportedly tasted better than water from other neighboringwells, 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 termmean-ing the physical endeavor required to engage in a behavior,could also be a factor since Snow’s map indicated that thedeaths, as he wrote, “either very much diminished or ceasedaltogether” at every point where it was “nearer” to go toanother pump than to the one in Broad Street (Snow 1855).

A valuable aspect of interdisciplinary science cooperationis the information that emerges when old subject matter isviewed from a different sphere. It may be instructive for anybehavior scholar if a knowledgeable and curious author de-veloped a psychological narrative of Snow’s story, despite themythology that surrounds the hero (e.g., Brody et al. 2000;Brown 1964; McLeod 2000; Snow 2008). However preten-tious this initiative may appear to be in the eyes of a non-psychologist, it can point towards new angles of approach andperhaps suggest a novel direction for historical research on thesubject (refer to Hayes and Fryling 2009a, b for a commentand a substantial review of the nature of interdisciplinaryscience from an interbehavioral perspective).

Of course, I cannot estimate the diversity of psychologicalbehaviors related to water collection that there were in Snow’sbehaviorsphere (the name I am giving it). What I know is that,in the numerous narratives of his scientific achievements, anaccount of such behaviors has been overlooked, although theyplayed an absolutely primary role in the cholera epidemic thathas made him famous. This should not be read as a hostileremark toward John Snow narratives. Maybe in the momentwhen psychological behavior becomes more noticeable, moreeasily seen by public health historians, there may be room for aricher version of Snow’s work on cholera than has traditionallybeen presented. My main goal in writing this article was tocontribute to this development.

Acknowledgment Preparation of this article was supported byFundação de Amparo à Pesquisa do Estado de Minas Gerais andConselho Nacional de Desenvolvimento Científico e Tecnológico. Cor-respondence should be addressed to João Bosco Jardim, Centro dePesquisa René Rachou, Fundação Oswaldo Cruz, Avenida Augusto deLima 1715, Barro Preto, 30190–002 Belo Horizonte, MG, Brazil. E-mail:jardim@cpqrr.fiocruz.br

The author is grateful to Dr. Virgínia T. Schall, Liz Andrade andKatherine Titley for their comments on an earlier version of this article.

References

Baum, W. M. (2004). Molar and molecular views of choice. BehaviouralProcesses, 66(3), 349–359.

Baum, W. M. (2010). Dynamics of choice: A tutorial. Journal of theExperimental Analysis of Behavior, 94(2), 161–174.

Brody, H., Vinten-Johansen, P., Paneth, N., & Rip, M. R. (1999). John Snowrevisited:Getting a handle on theBroad Street pump.Pharos, 62(1), 2–8.

Brody, H., RIP, M. R., Vinten-Johansen, P., Paneth, N., & Rachman, S.(2000). Map-making andmyth-making in Broad Street: The Londoncholera epidemic, 1854. Lancet, 356(9223), 64–68.

Brown, P. E. (1964). Another look at John Snow. Anesthesia andAnalgesia, 43(6), 646–654.

Cameron, D., & Jones, I. G. (1983). John Snow, the Broad Street pumpand modern epidemiology. International Journal of Epidemiology,12(4), 393–396.

Delprato, D. J., & Midgley, B. D. (1992). Some fundamentals of B. F.Skinner’s behaviorism. American Psychologist, 47(11), 1507–1520.

Edwards, G. (1959). John Snow, M.D. (1813–1858). Anaesthesia, 14(2),113–126.

Epstein, L. H. (1992). Role of behavior theory in behavioral medicine.Journal of Consulting and Clinical Psychology, 60(4), 493–498.

Frerichs, R. R. (2001). History, maps and the internet: UCLA’s JohnSnow site. SoC Bulletin, 34(2), 3–7.

Hayes, L. J., &Fryling,M. J. (2009a). Guest editorial: Interdisciplinary sciencein interbehavioral perspective. Behavior and Social Issues, 18, 5–9.

Hayes, L. J., & Fryling, M. J. (2009b). Toward an interdisciplinaryscience of culture. The Psychological Record, 59(4), 679–700.

Hineline, P. N. (2013). The evolving behaviorist/mentalist disagreements.Mexican Journal of Behavior Analysis, 39(2), 81–98.

Kantor, J. R. (1959). Interbehavioral psychology (2nd ed.). Chicago:Principia Press.

Kantor, J. R. (1971). The evolution of mind. In J. R. Kantor (Ed.), Theaim and progress of psychology and other sciences (pp. 265–272).Chicago: Principia Press.

Kantor, J. R. (1981). Interbehavioral philosophy. Chicago: PrincipiaPress.

Kantor, J. R. (1982). Cultural psychology. Chicago: Principia Press.Kantor, J. R., & Smith, N. W. (1975). The science of psychology: An

interbehavioral survey. Chicago: Principia Press.McLeod, K. S. (2000). Our sense of Snow: The myth of John Snow in

medical geography. Social Science & Medicine, 50(7–8), 923–935.McPherson, M. W. (1992). Is psychology the science of behavior?

American Psychologist, 47(2), 329–335.Midgley, B. D., &Morris, E. K. (Eds.). (2006).Modern perspectives on J.

R. Kantor and interbehaviorism. Reno: Context Press.Moore, J. (1984). Conceptual contributions of Kantor’s interbehavioral

psychology. Behavior Analyst, 7(2), 183–187.Mountjoy, P. T. (1976). Science in psychology: J. R. Kantor’s field theory.

Mexican Journal of Behavior Analysis, 2(1), 3–21.Paneth, N. (2004). Assessing the contributions of John Snow to epide-

miology: 150 years after removal of the Broad Street pump handle.Epidemiology, 15(5), 514–516.

Psychol Rec

Parrott, L. J. (1983). On the differences between Skinner’s radical behav-iorism and Kantor’s interbehaviorism.Mexican Journal of BehaviorAnalysis, 9(2), 95–115.

Sá, L. M., Delgado, D. M., & Hayes, L. J. (2004). The functional natureof the behavior segment. Mexican Journal of Behavior Analysis,30(2), 181–187.

Skinner, B. F. (1987). Whatever happened to psychology as the science ofbehavior? American Psychologist, 42(8), 780–786.

Snow, J. (1855). On the mode of communication of cholera (2nd ed.).London: John Churchill.

Snow, S. J. (2002). Commentary: Sutherland, Snow and water: thetransmission of cholera in the nineteenth century. InternationalJournal of Epidemiology, 31(5), 908–911.

Snow, S. J. (2008). John Snow: the making of a hero? Lancet, 372(9632),22–23.

Verplanck, W. S. (1998). A scientist's view of the philosophy of science.Paper presented at the 106th Annual Convention of the AmericanPsychological Association, San Francisco.

Winkelstein, W., Jr. (1995). A new perspective on John Snow's communica-ble disease theory. American Journal of Epidemiology, 142(9), S3–S9.

Psychol Rec