The Curious Case of Cholera

SOHO, LONDON, 1854

It was the fall of 1854. A deadly epidemic of cholera had gripped the city of London. The worst affected would be the area around Broad Street, in particular, around a water pump. This water pump would later be a defining ‘focus of disease’ for what we call today as the Cholera epidemic of 1854. This story in history goes back in time to trace the early beginnings of epidemiology and public health sciences.

In the early 19th century, the city of London had a very poor sewerage system. This essentially meant that most of the waste generated would eventually be discarded in the Thames. Near most houses, waste would collect in cesspools that would infiltrate and leach into the nearby water sources contaminating the water supply. Needless to say, the city continued to function in these unsanitary conditions until the epidemic of 1854.


City of London, 1850s
Source Credit: npr.org


DR. JOHN SNOW

This was the time when London was hit with a series of Cholera epidemics, starting in 1849 and continuing until 1854, with increasing severity, killing 600 people in the area. Cholera is a deadly water borne disease that causes voluminous diarrhea and if untreated, even death due to dehydration. While there was no means of treatment back in the day, most people afflicted with the disease would often succumb to it, resulting in a large case- fatality load. Deeply disturbed by the deaths of the epidemic, was a young doctor named Dr. John Snow.

Dr. John Snow
Source Credit: Alamy stock

Dr. John Snow had been a child prodigy. A physician and surgeon by profession, Dr. Snow had an insightful understanding in the process of disease. Back in the day, the cause of the epidemic had been attributed to ‘Miasma,’ a kind of foul smell that lingered in the atmosphere coming from rotten vegetables, animal and human excrete and other waste. Most health executives at the time blamed Miasma for the spreading epidemic. However, John Snow felt otherwise. An anesthesiologist by profession, his detailed study on the nature of gases had let him to understand the intrinsic nature of gases and he had concluded that the epidemic of 1854 may not have been because of foul smelling gases but due to a form of ingested infective agent. This would go on to lay the foundation for the “Germ Theory of Disease,” later postulated by Robert Koch in 1880.


THE EPIDEMIC

                        
Newspaper articles on the epidemic
Source Credit: imgbin.com

John Snow was a curious man. He would not accept the prevailing Miasma theory and even sacrificed his reputation as a doctor to prove his theory of water transmission of cholera. To prove his case, Dr. Snow went from house to house in the Soho area around Broad Street to map the houses affected by Cholera. He would later publish this as the famous ‘Dot Map.’He closely studied the water distribution systems and found that the area was supplied with water from companies that directly pulled water from Thames with very little filtration - the Southwark and Vauxhall Waterworks Company and the Lambeth Waterworks Company. On further study, found that it was the areas closest to the water pump on Broad Street that were affected by Cholera. He dove deep into questionnaires with the residents of Soho to find that it had been a cloth diaper of a young baby that was washed with the water of the hand pump that eventually led to the spread of the disease. The germ must have leached into the water supply and caused contaminated the local water table.


The Dot Map
Source credit: thehistoryproject.uk

                                           

Interestingly, there was a small pocket of brewery workers in the area that had not been affected by Cholera. Apparently, these workers were remunerated with beer at the end of each day’s work and claimed to never have consumed water from the pump. Additionally, a small family who had recently relocated from the area continued to consume water from the hand pump despite shifting out and had developed Cholera. These cases further strengthened the eventual cause of the epidemic as coming from a hand pump and not merely inhaling foul smelling gases.


EPIDEMIOLOGY TODAY

Dr. John Snow compiled his findings in a document tilted - ‘On the Mode of Communication of Cholera,’ however continued to argue his case about the likely etiology of Cholera until his death. Unfortunately, he never lived to see the acknowledgement of his contribution to the world of epidemiology. Due to his untiring efforts and continued persuasion, the public health authorities of Soho, broke the handle of the pump preventing further consumption of water from the pump eventually bringing an end to the epidemic.

Modern day epidemiology owes its humble beginnings to the relentless efforts by Dr. John Snow. In his quest for truth, he unknowingly unearthed one of the greatest tools to Modern day epidemiology – the Double-blind experiment – when he compared the families affected with water supply from the hand pump against houses with a separate water supply. His search for cause – now known as ‘etiology’ remains one of the key questions before starting the investigation for any epidemic.


IN CONCLUSION

Today the city of London has changed, and Soho is one of the of the busiest areas downtown. Broad Street is now Broadwick Street and has dedicated the John Snow Pub at the corner to the legacy of Dr. John Snow. The handpump has been replaced with another during renovations of the area in recent day. Today, you will find a red granite kerbstone near the handpump stating – “The red granite kerbstone marks the site of the historic Broad Street pump associated with Dr. John Snow's discovery in 1854 that cholera is conveyed by water.”

                     

 The handpump on Broad Street

Source credit: Atlas Obscura




REFERENCES

1.       BBC World Service - Witness History, The doctor who discovered how cholera spread. (2020, July 6). BBC. https://www.bbc.co.uk/programmes/w3cszmk2

2.       Conocimiento, V. A. (2020, June 17). John Snow and the Origin of modern epidemiology | OpenMind. OpenMind. https://www.bbvaopenmind.com/en/science/leading-figures/john-snow-the-origin-new-medicine-time-of-cholera/

3.       1854 Broad Street cholera outbreak. (2023, June 23). Wikipedia. https://en.wikipedia.org/wiki/1854_Broad_Street_cholera_outbreak

4.       Tulchinsky TH. John Snow, Cholera, the Broad Street Pump; Waterborne Diseases Then and Now. Case Studies in Public Health. 2018:77–99. doi: 10.1016/B978-0-12-804571-8.00017-2. Epub 2018 Mar 30. PMCID: PMC7150208.

5.       PredictionX: John Snow and the Cholera Epidemic of 1854. (n.d.). edX. https://www.edx.org/learn/history/harvard-university-predictionx-john-snow-and-the-cholera-epidemic-of-1854

6.       V. (2020, June 12). The 1850s map that changed how we fight outbreaks. YouTube. https://www.youtube.com/watch?v=VJ86D_DtyWg

 

 

 

 

 

 

 

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