London, 1854. It is late summer. In the crowded neighborhood of Soho, an infant gets sick, and her distracted and tired mother tosses the baby’s soiled diapers in a cesspool in the apartment building’s basement. Within three weeks, as a direct result of that action, over 600 people will be dead.
Those three weeks spanned the Broad Street Cholera Outbreak of 1854. It is by no means the deadliest or largest cholera outbreak in history; some historical outbreaks count their dead in the tens – or even hundreds – of thousands. Neither was the 1854 Outbreak the first or last of its kind. It is, however, the most important cholera outbreak in history. Why? Because of this man.
His name was Dr. John Snow, and his work has saved untold multitudes from a horrific death. Odds are that you’ve never even heard of him (though you probably have heard of Jon Snow, the nine-hundred and ninety-eighth head of the Night’s Watch; totally different guy). But let me back up a bit and say a few words about scientific thought at the time.
Though the idea of germs, viruses, and bacteria seem so simple and obvious to us, they are comparatively recent discoveries and took even longer to gain widespread acceptance. While germ theory, the notion that some diseases are caused by teeny tiny creatures that invade us, had been proposed in the mid-16th century, in 1854 London, most educated
people still firmly believed that disease was caused either by physical contact or by miasma, poisoned air that floated around, settled over an area, and proceeded to make those in the area sick with whatever disease it held. The idea of miasma dates back to ancient times in various areas of the world. Endemic to the idea of miasma is a certain amount of snobbery: since the poor were considered to be dirty, living in filth, and of lower moral and mental character than the well-to-do, they were, of course, more likely to attract this poisoned air to their dwellings. Now, 1850s London probably smelled pretty terrible, and bad enough smells can indeed make you feel ill to the point of nausea, so I, at least, can definitely understand how people working without our modern knowledge and instruments might come to a conclusion that strikes us as, frankly, silly.
So there it is. When people started falling ill in Soho in 1854 and dying within a matter of hours (often having lost up to 1/3 of their body weight in that short time), the consensus was that a cloud of poisoned air was hovering over the neighborhood, striking down the residents. Enter Dr. John Snow, a local and well-respected physician who was already admired for his groundbreaking work on anesthesiology; he believed that cholera was spread, not through noxious gases, but rather, through water. He had first publicized this theory 6 years earlier, in 1849, but his essay to that effect went all but unnoticed (academics of the time did not find his proof compelling enough in light of hundreds of years of belief in miasma). Now, however, Dr. Snow was there at Ground Zero, as it were, with the ability to go door-to-door, mapping the pattern of the outbreak and examining what those who fell ill had in common: they all drank from the Broad Street water pump, which had a reputation for tasting better than the other nearby pumps, thus causing London residents to go out of their way to use its water. He created one of the earliest known dot
maps (image to the right) in order to set down and study the geographic relationships of the deaths. His studies of the pattern of the outbreak were enough to convince the local council to temporarily disable the pump by removing the handle, which may not have been the cause of the end of the outbreak (as the number of deaths were decreasing already), but certainly punctuated it nicely. While not all were convinced of Snow’s waterborne theory – in fact, most weren’t, including the council that had removed the pump handle, and many clung to the idea of miasma for a while longer – this was the first time that cholera’s disease vector had been correctly identified. Snow, however, never lived to see the widespread adoption of his theory, dying at the age of 45 a mere four years after the outbreak.
Unfortunately, cholera is not a disease that we can discuss solely in the past tense yet. While virtually unknown, unseen, and easily cured in the United States (and most developed nations) today, cholera still kills tens of thousands of people every year. This very month (September 2015) there is an ongoing cholera epidemic in Tanzania that has killed at least 13 and sickened almost 1000 people.
The story of cholera, Dr. John Snow and the Broad Street Outbreak is capably retold by The Ghost Map: The Story of London's Most Terrifying Epidemic--and How It Changed Science, Cities, and the Modern World by Steven Johnson. Though first-hand accounts of the outbreak are rare (most documentation of the outbreak is in dry and perfunctory death notices), Johnson manages to evoke an accurate, unflinching, and surprisingly emotional image of the loss, helplessness, and terror that ruled Soho while the disease raged unchecked in those last weeks of summer in 1854. He includes fascinating asides that add context and flavor to the story, ranging from the history of the London underclass and the construction of London’s sanitation system, to discussion of possible modern parallels and of the sustainability of large cities in the modern era. While his attempt to connect his paean to city life towards the end of the book to the story of the outbreak was a bit thin (this guy really loves living in New York), his points were interesting enough that I forgive him the indulgence. Unless you’ve got a really weak stomach (the descriptions of what cholera sufferers endure before their inevitable deaths are pretty rough), I highly recommend this book.