{'fraction_non_alphanumeric': 0.016031646887362066, 'fraction_numerical': 0.009785550697480742, 'mean_word_length': 4.753293413173653, 'pattern_counts': {'":': 0, '<': 0, '<?xml version=': 0, '>': 0, 'https://': 0, 'lorem ipsum': 0, 'www.': 0, 'xml': 0}, 'pii_count': 0, 'substrings_counts': 0, 'word_list_counts': {'cursed_substrings.json': 0, 'profanity_word_list.json': 0, 'sexual_word_list.json': 0, 'zh_pornsignals.json': 0}}
Commentary: William Budd on cholera.

William Budd published his paper on malignant cholera a month after Snow’s paper entitled On the Mode of Communication of Cholera appeared. As Budd explains in a footnote on page 19, Snow’s paper came into his hand while preparing his own work. With reference to transmission of the disease by faecally contaminated water, Budd clearly states that Snow must have ‘the whole merit’ of being the first to develop the conclusion ‘as to the part which water plays in diffusion of the disease’. The question as to priority was to occur again in 1856 with the publication of an address to the Manchester Medical School by Sir James KayShuttleworth, in which he gave credit to Budd for first putting forward the faecally contaminated water theory. Allison had made the same assertion in the Edinburgh Medical Journal. Snow, a sensitive character, wrote at once to repudiate these views, writing in the Lancet ‘As my researches respecting cholera were conducted with great labour and very much to the detriment of my more immediate interest (i.e. private practice) I feel it a duty not to allow the credit for them to pass from me by a mere mistake’. This letter was promptly followed by one from Budd stating ‘There can be no question the Dr Snow was the first to publish the view that cholera is propagated by the specific discharges from the sick’. Yet it is certain that Budd from his experiences as a student in Paris from 1828 to 1832 was fully cognisant of the danger of contaminated water. He set up practice in Bristol in 1842, at that time a city filled with insanitary dwellings, fever-ridden streets and narrow dark lanes. The houses were crowded together round damp courts with no decent drainage and water only available from a single pump. Many houses in the centre of the city backed onto the river Frome and their privies discharged into this stream that supplied many of these pumps. There were frequent outbreaks of diarrhoea, typhoid was endemic and the city was an easy prey to cholera. A parliamentary commission took evidence from Budd and he gave them a vivid description of conditions in the city. To rectify this situation, the Bristol Waterworks Company was established in 1845 with Budd as one of the original directors. Before accepting this appointment he insisted that the water should be drawn from sources beyond the reach of sewage contamination and that it should be delivered under constant pressure. This was achieved by bringing water from the Dundry hills outside the city. Thus it is apparent that, before the 1848 epidemic of cholera, William Budd was fully aware of the lethal properties of contaminated water. Budd delayed publication of his paper on cholera to allow his colleagues Joseph G. Swayne and Frederick Brittan to announce their microscopical observations on the stools in the disease. This was a time when greatly improved compound microscopes were becoming readily available. The Bristol Microscopical Society had been founded in 1843 and became closely linked with the Bristol Medico-Chirurgical Society and was commissioned to investigate the stools in cholera. The objects they observed, illustrated in Figure 1 of Budd’s paper, were thought to be fungi and they concluded that these were the cause of the disease. This was an idea proposed by a Dr Charles Cowdell in 1848, and Budd and his colleagues enthusiastically embraced it. Alas, it was a mistake that was to influence Budd for many years and was said to delay the publication of his views on the infectious nature of tuberculosis. The second erroneous conclusion Budd drew, mentioned in both his 1849 and 1856 papers, was that, in addition to propagation by water, cholera was also caused by contaminated air. These two misconceptions should not detract from the other conclusions that he enunciated in his papers. His description of the pathogenesis of the disease is as apt today as it was in 1849. He stated that cholera was a disease caused by a living organism of distinct species and this, before the days of clinical bacteriology, was not a concept universally accepted. It is unfortunate that the observations of the Bristol microscopists did not include the masses of the Vibrio that are indeed to be found in the stools of cholera patients. Budd’s realization that the infecting organism was confined to the alimentary canal, and was not found in the blood, was crucial to understanding cholera. This was in contrast to many other infectious diseases, in particular typhoid, where he realized that spread of organisms in the blood was an essential feature. This lack of involvement of the cholera organisms in the blood provided one reason why later Published by Oxford University Press on behalf of the International Epidemiological Association