The Blue Death: Disease, Disaster, and the Water We Drink

With the keen eyes of a scientist and the sensibilities of a seasoned writer, Dr. Robert Morris chronicles the fascinating and at times frightening story of our drinking water. His gripping narrative vividly recounts the epidemics that have shaken cities and nations, the scientists who reached into the invisible and emerged with controversial truths that would save millions of lives, and the economic and political forces that opposed these researchers in a ferocious war of ideas.

In the gritty world of nineteenth-century England, amid the ravages of cholera, Morris introduces John Snow, the physician who proved that the deadly disease could be hidden in a drop of water. Decades later in the deserts of Africa, the story follows Louis Pasteur and Robert Koch as they raced to find the cause of cholera and a means to prevent its spread. In the twentieth century, burgeoning cities would subdue cholera and typhoid by bending rivers to their will, building massive filtration plants, and bubbling poisonous gas through their drinking water. However, with the arrival of the new millennium, the demon of waterborne disease is threatening to reemerge, and a growing body of research has linked the chlorine relied on for water treatment with cancer and stillbirths.

In The Blue Death, Morris dispels notions of fail-safe water systems. Along the way he reveals some shocking truths: the millions of miles of leaking water mains, constantly evolving microorganisms, and the looming threat of bioterrorism, which may lead to catastrophe. Across time and around the world, this riveting account offers alarming information about the natural and man-made hazards present in the very water we drink.

"'In this engrossing and disquieting book, the author, who specializes in drinking water epidemiology, raises the alarm about hidden perils in our water. He traces the history of the search for water-borne pathogens from the mid-19th century, when doctors discovered the bacterium that causes cholera (the blue death), to the 20th century, when it was found that chlorination and filtration would block many of the organisms responsible for diseases such as typhoid fever, dysentery and cholera. But today, our water supply is far from safe. Some pathogens elude conventional filters; others are resistant to chlorine; and chlorinated drinking water may increase the risk of certain cancers. Climate change, emerging diseases, toxic chemicals, decaying pipes and terrorism also threaten our water. To dramatize his thesis, Morris describes devastating outbreaks of gastrointestinal disease, such as the one caused by a parasite in Milwaukee's drinking water that sickened 400,000 people in 1993. During the 19th century, doctors had to overcome opposition from those who refused to believe that diseases could be waterborne. Now, epidemiologists and researchers who advocate for tighter controls on drinking water must battle drinking water industry lobbyists who resist regulatory efforts. Morris argues persuasively that unless we do more to protect the water we drink, we court disaster. (Aug.)' Publishers Weekly (Copyright Reed Business Information, Inc.)" Publishers Weekly (Copyright Reed Business Information, Inc.)

"With all the recent talk about childhood obesity and juvenile diabetes, it is hard to remember that the modern public health movement began with the Great Sanitary Awakening of the mid-19th century. Reformers in England and elsewhere convincingly argued that the environment served as a major source of disease and needed to be cleaned up. Now two new books remind us that toxins and other waste products... Washington Post Book Review (read the entire Washington Post review) are producing new and frightening threats to public health. Like Al Gore's arguments about oil dependence and the ozone layer, these concerns are surely inconvenient. But are they also true?

The hero of Robert D. Morris' 'The Blue Death' is John Snow, the British epidemiologist who proved in the 1850s that epidemic cholera was spread by waste products in drinking water. Snow reached his conclusions, which initially were mocked, decades before the discovery of the cholera bacillus. His work eventually led to the modern system of purifying tap water, which involves both filtering and treatment with chlorine.

But success has bred complacency, according to Morris. His book is full of examples of recent health problems traceable to inadequate supervision of our water supply. For instance, the majority of pipes that supply major urban centers — including Washington — are close to 100 years old and full of leaks that allow contamination. Morris puts into this broader context the now-familiar story of what happened in the District in 2004, when officials added phosphoric acid to the city's water system in an attempt to reduce lead levels and instead created a new headache by loosening a layer of slime and microorganisms, known as the biofilm, and flooding the system with bacteria. He also describes how a 1993 outbreak of diarrhea in Milwaukee was caused by cryptosporidium, an organism experts insisted could not be present.

Morris is no impartial observer. An epidemiologist who specializes in drinking water, he is the author of a controversial paper suggesting that chlorine might increase the rates of several cancers. Indeed, some of his narrative describes his David-like efforts to challenge the Goliaths of water, ranging from the Environmental Protection Agency to the drinking-water industry, which he suggests are cutting corners on water purification to save money.

Still, it is hard not to be sympathetic to Morris' claims, which rely in part on the same crack epidemiological detective work used by Snow 150 years ago. Indeed, I switched from tap to bottled water while reading his book (although Morris also warns that bottled water 'is less closely regulated than tap water and is not required to meet stricter standards for purity').

Loretta Schwartz-Nobel is a journalist, not a scientist, but if anything her outrage is even greater than Morris'. In 'Poisoned Nation,' she describes a series of diseases, ranging from asthma to cancer, that she believes are on the rise due to pollution. Her book has a much more conspiratorial tone. She is largely uninterested in presenting both sides of the issues in question, even when defenders of the status quo are respected scientists and government agencies.

For example, she tells the now familiar story of how childhood vaccines containing the mercury additive thimerosal supposedly led to an enormous rise in cases of autism. Similarly, she charges that companies in the forefront of breast cancer awareness campaigns produce the very environmental toxins that cause the disease.

To be sure, Schwartz-Nobel is right when she points out how profits and politics led industry to conceal the potential dangers of mercury in tuna and other foods. Similarly, the breast cancer movement only recently has turned from a focus on mammography and chemotherapy to investigating the connection between toxic waste and cancer rates. And she tells compelling stories about individuals with autism and breast cancer whose diseases seem to have emerged just after a toxic exposure. One such person was Chris, a bright 2-year-old who, after a reaction to a vaccine, 'could no longer concentrate on his books or anything else for more than a few seconds.' Eventually, he was diagnosed as having severe learning disabilities.

But what does one do with this information when organizations such as the esteemed Institute of Medicine, one of the four U.S. National Academies, have found no association between thimerosal and autism? Or when the Long Island Breast Cancer Study did not find evidence that toxins were responsible for high rates of the disease? It is hard to accept, as Schwartz-Nobel apparently does, that the scientists involved in these studies make decisions based mostly on industrial connections and political pressure.

A big part of the problem, both books acknowledge, is the difficulty of achieving definitive scientific proof when trying to determine causes of disease outbreaks. Such studies, which rely on retrospective data and participants' recollections, are notoriously difficult to carry out.

So it is disappointing that neither book mentions the so-called precautionary principle, a moral and political argument often invoked by activists when there is no scientific consensus about potential harms. In this case, the principle would argue that society should err on the side of cleaning up possibly toxic environmental waste.

Rather than characterizing industry as villains, it is time for critics such as Morris and Schwartz-Nobel to enlist activists, government and business in constructive partnerships. But this effort will require engaging the public, which can then put pressure on politicians. In making this point, Schwartz-Nobel quotes longtime breast cancer activist Barbara Brenner: 'We figured that if people really knew what was happening with the Cancer Industry, they would be furious.'

Unfortunately, such anger has not yet materialized over breast cancer or other diseases with possible environmental causes. If, despite their limitations, these books alert the public to such environmental connections, they are doing a great service.

" Reviewed by Barron H. Lerner, the author of 'When Illness Goes Public: Celebrity Patients and How We Look at Medicine', Washington Post Book World (Copyright 2006 Washington Post Book World Service/Washington Post Writers Group)
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Writing for a general audience, environmental epidemiologist Morris reviews past and present dangers posed to human health from drinking water. His narrative traces the rise of waterborne epidemics in the growth of the industrial cities together with the efforts of epidemiologists and other scientists to understand the sources of such epidemics and fashion suitable responses. It also reviews the possibility of future threats, whether from deteriorating water systems or international terrorism. Annotation ©2007 Book News, Inc., Portland, OR (booknews.com)

Combining the fast-paced narrative of "The Hot Zone" with the impressive scope of "The Great Influenza," a world-renowned expert presents the fascinating history and uncertain future of drinking water and the deadly diseases that hide in a single drop.

Dr. Robert D. Morris is an internationally recognized expert in the field of drinking water and health. His work has been featured throughout the media, including Dateline NBC, the New York Times, the BBC, and The Times of London. He lives in Seattle, Washington.