They say that the road to hell is paved with good intentions, and nobody has better intentions than we do in public health. Let others blather on about evidence while we spend our time removing pump handles. And so it was that the well intentioned public health leaders in Hamburg, Germany faced a cholera epidemic in 1892 and sprang to action. They dutifully exhumed all of the carcasses underneath slaughterhouses, in accordance with Max von Pettenkofer's miasma theory, and carted them away. Sadly for them, this intervention was wholly misguided, and nearly nine thousand people died (Evans, 1987). In fact, Snow had published his work on the transmission of cholera through fecally contaminated water decades earlier. Cholera was associated with a great many things, including poverty and crowding, and so on the basis of these patterns, the miasma theory seemed perfectly reasonable. But Snow's innovation, for which he is considered to be the father of modern scientific thinking in our field, was to rely not on these observed associations, but instead on a natural experiment in which houses were "randomly" assigned a contaminated or an uncon-taminated water supply. Only on the basis of this quasi-experimental evidence was Snow confident of what public health action needed to be taken (Freedman, 1999).
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机译：他们说通向地狱的道路充满了良好的意愿，在公共卫生领域，没有人比我们有更好的意愿。当我们花时间抽出泵的手柄时，请让其他人对证据evidence之以鼻。因此，德国汉堡善意的公共卫生领导人于1892年面对霍乱流行，并采取了行动。他们按照Max von Pettenkofer的as割理论，尽职尽责地挖掘了屠宰场下的所有尸体，并将其运走。对于他们而言，可悲的是，这种干预完全被误导了，近九千人丧生（埃文斯，1987年）。实际上，斯诺（Snow）早在几十年前就发表了有关霍乱通过粪便污染水传播的工作。霍乱与很多事情有关，包括贫穷和拥挤，因此在这些模式的基础上，as气理论似乎是完全合理的。但是斯诺的创新（他被认为是本领域现代科学思想之父）不依靠这些观察到的联系，而是依靠一种自然的实验，在这种实验中，“随机”分配了受污染或不受污染的房屋。污水供应。斯诺仅基于这种准实验证据才确信需要采取何种公共卫生行动（Freedman，1999）。
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