Psychol Rec

DOI 10.1007/s40732-014-0082-3

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 Broad
Street 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 events, according to the perspective 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 psychological behavior (Kantor 1959; Mountjoy 1976), psychologists
might well claim academic disciplinary rights over the behavioral fair share of the achievements of John Snow (1813
1858), the physician who famously identified sewagecontaminated water as a source of cholera transmission and
helped pioneer the science of epidemiology in the midnineteenth century.
Why should psychologists involve themselves with the
esteemed legacy of a hero of epidemiology? After all, epidemiologists rely to a great extent on biomedical sciences to understand 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
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: jardim@cpqrr.fiocruz.br

rule, despite the relevance of human behavior in biomedical

disciplines, a behavioral addressing of cholera transmission
might sound like psychological nonsense, even considering that
epidemiology is in part a behavioral discipline.
It is all very well that the disciplinary accounts of Snows
achievements have been informed predominantly by biomedical knowledge. But it would make total sense to assert that the
man who is regarded by many as a founding father of epidemiology 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 drinking 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 behavior 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 unquestionably 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),

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what people say, for instance, in response to questions

(Delprato and Midgley 1992). Behavior qua behavior provides an outcome that is directly confrontable, autonomous,
evident in its own right (McPherson 1992), albeit of an ontologically different type from any biological sort (Kantor and
Smith 1975).
According to the late systematist Jacob Robert Kantor (1888
1984), an eminent professor and history scholar who pioneered a
non-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 spatiotemporal 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 comes
into contact with it or otherwise explores its surroundings
(Kantor 1971; Kantor and Smith 1975).
The resemblance of such a mutuality of participating factors in a certain space-time locus with mechanistic learning
frameworks, although apparent, seems to me to be nonexistent (interbehaviorists are critical of what Kantor labelled
learnology). But, still, someone may argue that biological
disciplines already study transmission of communicable disease in a person-environment interaction framework, including 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 between 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 dowhichever 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;
Moore 1984; Parrott 1983; Verplanck 1998).
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, somewhat 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 (Mountjoy 1976).
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 recounted
in 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 necessarily simple, not necessarily genuineand for the rest exhaustively re-recounted on the occasion of Snow's 200th anniversary 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 potential
source of the problem was the likely sewagecontaminated 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 preference 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 speaking, at streets that required people to walk further to
collect water from another pump. Snows survey reinforced 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 bolstering his assumption that water was a vehicle for transmission 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 contaminated 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 epidemiological studies on how Vibrio cholerae is transmitted through
water. His approach to the prevention and control of disease
outbreaks confronted directly the then-widely disseminated belief that transmission was due to a poisonous
atmosphere thought to issue from the swamps and putrid matter rife in London at the time. This, as might be
expected, greatly contributed to his reputation and success (Edwards 1959).
Now, disease transmission is a fairly discussed topic, but
psychological 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 primary health outcome, butto paraphrase a wry appraisal of
the foremost advocate of behavioral psychology, B.F. Skinner
(19041990)as a mere expression of more important happenings inside the behaving person (Skinner 1987). Is it any
wonder, therefore, that having to demonstrate his pathologic
rationale, Snow endeavored to relate cholera mortality to
parishioners' behavior with respect to an environing
objector, as he put it, independently of the pathology (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 indicated 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 routinely 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 manifestly chose, or preferred, to collect water from the Broad
Street pump.
This development was an essentially psychological phenomenon. 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 academic, 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 information. 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 breakthrough. Probably not, considering that it would take some
time, nearly three decades, until Vibrio cholerae was eventually identified (by Robert Koch) under the microscope. Most
narratives of Snows achievements, both popular and academic, are correct when it comes to giving credit to a likely causeeffect 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; Brown 1964; Cameron and Jones 1983; McLeod
2000; Paneth 2004; Winkelstein 1995. For a comprehensive
list of writings about John Snow, see Frerichs 2001).
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 personenvironment 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, or interbehavior, 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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Parrott 1983; S et al. 2004). Except for analytical purposes,

any noninteractive, nonmutual, ahistorical, or segmented description 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, in
its 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 unreasonable 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 an
increment to the stimulus function, or to the discriminative
appeal of the pump. Response effort, a technical term meaning 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 (Snow 1855).
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 developed a psychological narrative of Snows story, despite the
mythology that surrounds the hero (e.g., Brody et al. 2000;
Brown 1964; McLeod 2000; Snow 2008). However pretentious this initiative may appear to be in the eyes of a nonpsychologist, 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. Correspondence 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:
jardim@cpqrr.fiocruz.br
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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