Academic journal article Journal of College Science Teaching

The Mystery of the Blue Death: A Case Study in Epidemiology and the History of Science

Academic journal article Journal of College Science Teaching

The Mystery of the Blue Death: A Case Study in Epidemiology and the History of Science

Article excerpt

This case study introduces students to John Snow, considered to be one of the founders of both epidemiology and anesthesiology, and a remarkable figure in the history of science. Snow has been the subject of two recent books and an extensive web resource (Morris 2007; Johnson 2006; Frerichs 2008). Although historical case studies are often less popular with students than contemporary issues (Herreid 1998), a number of aspects of this case make it attractive to students. First, students have told me that they find "detective stories" about important medical discoveries to be inherently appealing. Second, the questions and methods that Snow used to demonstrate the causes of cholera outbreaks are the basis for those used in contemporary epidemiological investigations. Third, although the case study is built around a historical event, there are contemporary cholera outbreaks with some parallels to those studied by Snow (e.g., WHO 2008).

Course context

This case study was written for a 200-level undergraduate class in global health taught in a biology department, with a full year of introductory biology for biology majors as the prerequisite. The class size ranges from 30-50 students, and includes both biology majors and nonmajors, most of whom are biology minors or elementary education majors with a science concentration.


The Global Health class was designed with a multicultural emphasis to challenge students to develop a better understanding of the relationship between science and culture, as well as the relationship between culture and concepts of health and disease. Areas of study include non-western scientific traditions, contemporary issues where science affects policy, and contemporary science in non-Western cultures, with examples from Asia, Africa, and Latin America. Although this case study is not multicultural in focus, it introduces students to a period of time in which ideas that now have wide acceptance in Western culture (e.g., the germ theory) were still forming. This creates an opportunity to consider the relationship between science and culture first in students' own culture before broadening the focus to consider other cultures.

This case study can also be used in a variety of other contexts, including courses in microbiology and in introductory biology for either majors or nonmajors. Because it addresses the nature of science, it is also appropriate for courses in the history, philosophy, or sociology of science.


1. Students will apply terminology and concepts from epidemiology and public health from a text reading through discussion of the case.

2. During class sessions, students will discuss several aspects of the nature of science using the cholera case study. These may include the role of models in hypothesis testing, nonexperimental tests of hypotheses, and populational thinking.

3. During class sessions, students will discuss the relationship between science and the surrounding culture, and cultural and class influences on the practice of science.

4. Students will write a summary assignment after class on one or more of the topics below, depending on class setting and instructor interests:

a. History of models of disease in Western culture

b. Nonexperimental tests of hypotheses

c. Populational thinking in epidemiology and in biology in general

d. Cultural and social context of science

e. Health inequities and contemporary cholera outbreak

Classroom management

As with many case studies, building from factual elements of the case (e.g., how cholera is transmitted and the symptoms of disease) to the larger issues is important (Herreid 2000). The student questions in the case study build the base of factual knowledge, and start to move students in the direction of addressing the larger issues. These include nonexperimental tests of hypotheses and epidemiological methods, the environmental conditions that promote cholera outbreaks, and the interpretation of the cause of cholera under different models of disease. …

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