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Escrito por Francesc Roca   
Saturday, 21 de October de 2006
Indice de Artículos
Cólera y el Banco Mundial
Cólera en Sudáfrica
La pandemia de El Tor
Causalidad Estrcutural

El agua promete ser en el siglo XXI lo que fue el petróleo para el siglo XX, el bien precioso que determina la riqueza de las naciones.

Agua, el bien precioso
Agua, el bien precioso
En 1855 Londres fue azotada por una grave epidemia de cólera que ocasionó al menos 500 muertos en menos de 10 días. Sir John Snow intentaba determinar la causa de la epidemia en un esfuerzo para detenerla. Examinando las listas de mortalidad y morbilidad en busca de factores comunes se dio cuenta de que la epidemia era más grave en una zona concreta de Londres y que, si bien se habían registrado casos en varias áreas, la mayoría de ellos ocurrían en las proximidades de Broad Street.

Sir John Snow
Sir John Snow
Al entrevistar a los familiares de los fallecidos, descubrió un único factor común: el pozo de Broad Street, del que las víctimas habían bebido en todos los casos. Esto se confirmó al observar que en el Hospicio local, también en la zona de Broad Street, sólo unos pocos residentes habían contraído el cólera, y que, en todos los casos, lo contrajeron antes de entrar en el hospicio. Snow formuló y confirmó la hipótesis de que el hospicio obtenía su agua de otro manantial distinto. Hallazgos similares se hicieron en lugares distintos.

Unos de los méritos de Snow es su análisis de la mortalidad comparando las cifras de 71 por 10.000 en el área cubierta por los acueductos de Southwark y Vauxhall y sólo de 5 en la población servida por la compañía Lambeth con un riesgo relativo de 14, anticipándose a las medidas de riesgo del modelo de la caja negra.

organización gráfica de la información
organización gráfica de la información
El segundo mérito fué la organización gráfica de la información, construyendo un mapa de mortalidad, siguiendo los métodos de la topografía o geografía médica. Ver un ejemplo español en el artículo publicado en ANALES del Sistema Sanitario de Navarra Dr. D. Nicasio Landa, médico oficial de epidemias en la de cólera de 1854-1855.

El resultado final de la minuciosa investigación fue que convencido de que el agua impura del pozo de Broad Street era la causa del cólera, y que el problema se centraba en la bomba de agua,  sugiriendo a los oficiales que quitaran la manigueta de la bomba, de modo que los vecinos no pudieran consumir esa agua contaminada. La epidemia se detuvo.

Lo sorprendente de esta investigación es que el propio Snow había publicado un panfleto en el cual sugería que el cólera era una enfermedad causada por una toxina que se reproduce en el cuerpo humano y que se encuentra en el vómito o las heces fecales de los enfermos. Él creía que la principal, aunque no la única, forma de transmisión era el agua contaminada con esa toxina. En la época, se creía que las enfermedades se transmitían por la inhalación de los vapores de los enfermos, de modo que la hipótesis de Snow no tuvo gran acogida.

bacilo del cólera
bacilo del cólera
Debe recordarse que el paradigma de la teoría miasmiática estuvo vigente hasta la primera mitad del siglo XIX, la teoría microbiana de gran impulso con Pasteur y Koch durante la última parte del siglo XIX y principios del siglo XX, el modelo de la caja negra en la última parte del siglo XX, cuando el riesgo relativo se impone como aproximación analítica.
La existencia del bacilo del cólera fue descubierto por Koch 28 años más tarde, 1874, lo que significa que la lógica bien usada, aunque la teoría sea errónea, puede comportar efectos positivos.



 
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