A late-nineteenth-century physician, formally trained as an obstetrician who dabbled in many other areas of science, puts his experience and keen sense of detection to work, solving one of the biggest mystery killer’s origins of his time, eventually convincing his skeptical colleagues of the deadly disease’s true source…
Baby Lewis was just five months old when she became ill with diarrhea on August 29th, 1854. The little girl named Frances was barely out of her mother’s womb and less than halfway through infancy when her condition acutely worsened. She died on September 2nd, five days later.
Just six days after, her father, a local police constable, became infected. His suffering would last much longer – eleven days, before succumbing to a deadly illness on the 19th, leaving his poor wife Sarah, widowed and childless.
By the middle of fall of 1854, at least 616 total were dead. Killed by a baffling sickness that had already taken the lives of tens of thousands of men, women, and children, beginning in 1831. Cases spiked in fits and starts since that time, then fell off, as residents, fearful for their safety, fled infected areas. Some would eventually return, while others opted to restart their lives in different neighborhoods or far away parts of the country.
The cause of this widespread death was cholera, an illness of epidemic proportions, and now, it was on the loose in south England, particularly in Soho. An area of the city that was possibly named for a hunting cry or, the call to arms yelled by James Scott, the first Duke of Monmouth, when he led his troops in the Battle of Sedgemoor on July 6th, 1685. Now, doctors and scientists alike were convinced the disease was spread through the air, in what was known as a “miasma in the atmosphere.” (Miasma being an extremely unpleasant, unhealthy vapor lingering in or permeating the air.)
Regardless of how victims contracted the illness, it ran its fatal course mostly the same. Dull pain in the abdomen gradually increased as nausea and dehydration set in, then increasingly became more intense and frequent.
Vomiting and diarrhea followed, almost incessantly, then lethargy. As the dehydration became more severe, the kidneys would fail. But, if that didn’t happen, shock and coma would lead to death.
The entire process, from infection to mortal expiration, could only take hours, maybe a day or two, representing twenty-four to forty-eight hours of pure suffering and misery. For some though, the symptoms persisted much longer – up to a week or two. It even gained a macabre nickname, making it all the more foreboding.
Dubbed the “blue death” because its dehydration effects left the skin bluish-grey, its mortality rate ranged between 25% and 50%, and even mild cases could seriously injure. The lucky ones, who were exposed to mild bouts, would survive, usually suffering the symptoms for a fortnight. But, they were in a very small minority. Much more often, anyone contracting the bacteria suffered an extraordinarily painful death sentence and nothing available at the time would even mitigate their agony.
It was the middle of the 19th century, in the city of London, an urban area with a population of two and a half million. By today’s standards, that’s relatively small, but at that time, it was the single largest city by population on the planet. A city of that size would be incredibly advanced, so one would think, and it was in terms of technology. The Second Industrial Revolution was well underway, yet, many modern conveniences and even public safety and health protocols had yet to exist.
For instance, denizens lived in houses or apartment buildings with indoor cesspools, as deep as two feet – two putrid feet of floating stench produced by rotting human waste and debris. As unbelievable as it is now, it wasn’t just people living in their own filth, livestock was also quite common in the city. Not just the horses and carriages on the street, but also, some people went so far as to house cows right in their residences, using them as a source of milk, and eventually, beef when too old to produce milk. The useless bovines were taken to the butcher or bone boiler. Indoor plumbing wouldn’t even become available until 4 years later, in 1858.
The result of all these unclean conditions was inevitable. So, the public health advocates of the time, who were primarily concerned with the unbearable stink, directed everyone in the city with a cesspool to drain its contents into the River Thames through the nuisance act.
This merely transferred the existing problem from one place to another, shifting the pollution from leaking out on the street right into the main public potable water source. In turn, the cases of cholera necessarily spiked rapidly, and scientific confusion abound, not being able to pinpoint the cause.
Doctors and scientists of the time still steadfastly believed that miasma in the atmosphere carried cholera and not the contaminated water supply. Though, one man, an obstetrician by trade and experimental hobby scientist, warned polluted water was indeed the culprit. But, despite his well-reasoned articles and public lobbying, none of his peers believed in his sound theory.
Born in Yorkshire on the 15th of March in 1813 in one of the poorest neighborhoods of the time, Dr. John Snow showed an amazing aptitude for mathematics and a fascination with chemistry.
By the time he turned 14, he obtained a medical apprenticeship, a very sought-after position, with Dr. William Hardcastle, a physician who treated the coal mining village of Killingworth.
Snow himself would serve three years as a colliery surgeon from 1832 to 1835, then enroll in the Hunterian School of Medicine in 1836. One year later, Snow started working at the Westminster Hospital, where he encountered a number of cholera patients.
By 1843, Dr. John Snow began his own experimentation with ether and other organic compounds, studying their effects on respiration. He also carefully studied chloroform, learning through much research, as well as trial and error, that the anesthesia had to be meticulously administered to be most effective and not endanger the lives of patients.
In 1849, Snow published an article in a medical journal, outlining his theory about the source of cholera. Though widely read, his proposal was ignored by other doctors and scientists – to the great detriment of the public, who lived in abject fear from one day to the next. Every sunset could be their last.
“They haven’t listened all these years. And, I very much fear, many more will pass before I am proved correct. Sadly, by that time, hundreds, probably thousands will die unnecessarily. If only I could get them to temporarily divorce themselves from this misconception that cholera is spread through the stench in the air, Minister!”
“I’ve heard your reasoning time and time again. Unfortunately, Dr. Snow, I am not the one you need to convince. Perhaps you could demonstrate, in some quantifiable way, the disease does reside and spread through contaminated water.”
“I appreciate your faith in me and the Good Lord above, Reverend Whitehead. But, faith alone won’t be sufficient to change their minds. Even my work to advance the safety and health of childbirth through the proper administration of anesthesia isn’t enough to convince the scientific community of my theory’s gravitas. What more must accomplish to get them to take my warnings seriously?”
“I understand your frustration and am more than willing to help, to be of service in your endeavor. After all, I too, am in the business of saving lives. My heart aches when I must go to comfort families who have suffered the loss of loved ones due to this most dreaded disease!”
“Yes, I’ve seen those dour, hopeless facial expressions more times than I dare care to count. I, a man of science and healing, could only stand by helpless as the infected anguished from this mortal infection. What do I say to these desperate folks, Pastor?”
“You can only offer them solace through faith. And pray divinity will see fit to intervene, Dr. Snow. I understand it’s no longer acceptable in modern medicine to simply rely on such practices. But, in the face of such a horrific, unseen natural foe, I believe optimism does provide at least a modicum of solace.”
“I suppose, so my friend, I suppose so.”
Reverend Henry Whitehead had sought out Dr. John Snow shortly after the cholera outbreak of 1854. A minister serving the Church of England, he was looking for answers anywhere he could find them. Many of his parishioners came to him seeking comfort and he was happy to oblige. But his reassurances did not assuage their trepidation. He thought if the disease came as the result of God’s anger, surely there was a way to alleviate the Almighty’s fury.
Snow had repeatedly attempted to sound the alarm where and when most appropriate. The physician concluded by initial data, that within only two-hundred and fifty meters of the corner of Cambridge and Broad streets there were already five hundred cholera fatalities in ten days’ time. He once wrote, “As soon as I became acquainted with the situation and extent of this irruption (sic) of cholera, I suspected some contamination of the water of the much-frequented street pump in Broad Street.”
The young obstetrician wouldn’t rest, practically working around the clock to record all the data and collect any records available. But, this was made all the more difficult due to the mass departure of residents living in the immediate area. They fled, some never to return, causing big gaps in his research because they weren’t around to tell him if they had or had not drunk from the suspect pump.
“Dr. Snow, I am growing ever more desperate to bring at least a little bit of good news to my parishioners. To this end, might I inquire, what are the means? What would you have me do to help with your pursuit of the truth?”
“Thanks, Reverend Whitehead. If you would be so good, I’d like you to put your personal rapport toward our mutual benefit, for the betterment of public health. Speak with as many residents as you can. Be sure to keep an accurate record. I’ll do the same, first with the people who live nearby and then, surrounding businesses.”
Reverend Henry Whitehead set out to speak with his church members while Dr. Snow went to talk with his neighbors, for he too, lived near the pump he believed was delivering the contaminated water. Both men, armed with a map of the city, focused on Soho and adjacent communities to detail as many data points as possible.
“Hello, good afternoon, Ma’am. My name is John Snow, I’m a physician investigating the outbreak of diarrhea and cholera. Tell, me, if you please, does your family drink the water from the pump on Broad Street?”
“No. Oh, no, Dr. Snow. My husband brings water home from work, from the brewery down the street – the one owned by Mr. Huggins.”
“I see. And, you and your family only drink the water he gets from the brewery, is that right?”
“Yes. He doesn’t like the taste of the water that comes out of the Broad Street pump.”
“Thank you for your time. Good day!”
Dr. Snow continued on, going door to door down the street while Reverend Whitehead canvassed in the other direction. He would speak to a number of his parishioners, including a young boy, who recently lost both of his parents to the disease. At nine years old, he would soon have to live in an orphanage, if he didn’t die of cholera himself.
“I am truly sorry to hear about your parents. Do you happen to know where they got the water for your house?”
“I think the pump right over there.”
“You mean, here on Broad Street?”
“Yes, Reverend…the pump on Broad Street.”
“Did they drink the water from the pump?”
“Yes, they did.”
“And, how are you feeling?”
“Not so well, but I’m not sick.”
“Okay. Let’s get you to the church and I’ll have someone take you to hospital.”
The men interviewed dozens of people that day and did the same for days after, recording every bit of information obtained. Snow went on to speak with other groups who had not been infected. The fact that they did not contract the disease meant something was different and he wanted to know why. More particularly, it would assist him in eliminating other possible sources of cholera. Demonstrating this distinction would help convince local town officials of the merits of his claims. He began with a workhouse or prison with over five hundred inmates, then onto the brewery where the woman’s husband got their water, and finally, a factory located at 37 Broad Street.
“Good morning, Warden! I’m Dr. John Snow. Minister Whitehead and I are pursuing an investigation into the cholera outbreak and I was wondering if you’d be so good as to give me a few minutes of your time?”
“Sure thing, Doctor Snow.”
“Exactly how many prisoners are kept here?”
“Precisely five-hundred, thirty-five.”
“Hmm…five-hundred, thirty-five men?”
“That’s right, Governor. I mean…I mean Doctor.”
“And, of those, how many have cholera?”
“Livin’ or dead, Sir?”
“Both. How many in the last few weeks have died from cholera or contracted it?”
“Oh, not that many. I think less than twenty.”
“And, of those twenty, how many dead, Warden?”
“Well, Governor. At least half. Actually, eleven. Yeah, eleven dead from cholera.”
“The rest?”
“Of the nine left, five of them are infected, Doctor.”
“Then, what about the other four?”
“Not sure. They’re sick. But, I’m not sure it’s cholera.”
“Good observation. Of those five with the disease, how many got it while in here?”
“None of then, Sir. All five were just brought in from the outside.”
“You mean, they were only recently incarcerated?”
“‘Incarcerated’ Governor?”
“Imprisoned.”
“Sorry, Doctor, I apologize for me ignorance.”
“That’s okay, Warden.”
“So, where does the workhouse get its water?”
“From the well right over there.”
Dr. Snow quickly realized the prison well water wasn’t contaminated. It bolstered his claim about the pump on Broad Street. If the brewery didn’t use the same pump, it would be even more evidence to support his theory. That afternoon, he paid a visit to Mr. Huggins’ brewery. He knew the wife he previously interviewed already told him that her spouse brought water home from the distillery.
“Mr. Huggins, I presume?”
“Yes, I’m Huggins. What can I do for you mister, uh mister?”
“Doctor John Snow; thank you.”
“How can I help, Dr. Snow?”
“I am investigating this horrible outbreak of cholera.”
“That’s great to hear! I hope I am able to be of some small service.”
“Now, Mr. Huggins, how many of your employees have contracted or died from the disease?”
“Oh, very few, Doctor. Maybe a dozen or less?”
“And, where is it you get the water for your workers to drink?”
“We have an on-site well.”
“I’m told by one of your employee’s spouses that you allow your people to bring that same water home?”
“Yes, it’s convenient for them, you see.”
“That’s admirable, Mr. Huggins.”
“Of those who were infected, how many would you say got water at any point from the pump on Broad Street?”
“I would think every single one of them, Doctor.”
“Tell me, do you know of any of your workers who’ve taken water from this well home, how many of their immediate family members have gotten cholera?”
“None, Dr. Snow; not a one.”
The doctor took copious notes, detailing each interview for future reference. He could only hope that Reverend Whitehead was doing the same. It wasn’t that he didn’t believe the man of God didn’t want to help, it was the fact the Minister had publicly cast doubt on the physician’s theory.
Whitehead had already told his church members the disease was a punishment from above, due to some wrong committed against Heaven itself. But, Snow thought if presented enough evidence, the Reverend would indeed accept the fact that tainted water was actually the source. Moreover, if the factory statistics backed up his theory, it would be ample proof for everyone.
“Good evening, there, may I speak with the owner or a manager?”
“Sure, sir, wait right here and I’ll bring someone over…mister…mister?”
“Snow, Dr. John Snow.”
The doctor waited as requested, taking note of the factory’s overall conditions. Located at 37 Broad Street, it was practically right next door to the suspect pump. Snow presumed the factory suffered a number of worker deaths, a supposition that proved true, further reinforcing his theory.
“Doctor Snow, I’m the factory foreman, how may I help you today?”
“I am conducting a survey related to public health, more particularly, to the cholera outbreak, and wondered if any of the workers here have been ill or have passed away recently?”
“Well, yes, Dr. Snow. I believe sixteen.”
“And, how do those sixteen individuals break down?”
“What do you mean, doctor?”
“How many of the sixteen ill and how many dead?”
“All of them – all sixteen have passed, Dr. Snow.”
“Tell me, where do the workers get their water when in the factory?”
“We keep a couple of big buckets for them to draw water.”
“And, where does that water come from? The water that’s used to fill these two big buckets?”
“The pump right on Broad Street.”
“I see. Would you be so kind to do me a favor, my good man?”
“Not at all, Doc.”
“Empty those water pales and fill them at another pump. Please, do not use the one on Broad Street. I fear it may be contaminated in some way.”
“I can certainly accommodate that request. I’ll have it done straight away!”
Snow was more convinced of his theory than ever. Neither the workhouse nor the brewery had any substantial cases of cholera. But, the factory, right near the polluted pump, serving water from the very same source, had suffered a number of casualties. It all aligned with his data, on the map, at every point. It just had to be the pump directly outside of 40 Broad Street.
When he met again with Minister Whitehead, Snow compared notes. They all aligned in the same way. Soho residents who lived away from the pump experienced very few cases of the illness. Conversely, the fatalities were all concentrated around a single water source. Still, there was a sticking point that Snow could not explain.
“One member of my church states his mother and his mother’s niece both died quite recently of cholera.”
“And, what makes this so peculiar to you, Reverend?”
“Because the aunt and niece don’t live near the pump you claim is the source of the outbreak. In fact, the two didn’t live on Broad Street or in Soho, for that matter!”
“What did this member of your church tell you?”
“When I was asking around about anyone with family members who had died in the last few weeks, he approached me. He told me that his mother had moved away, not long before the latest recurrence of cholera.”
“Is that so, Minister?”
“Yes, she and her niece moved prior to the breakout.”
Snow couldn’t believe it. Although he could regard this as a pure anomaly, he had to know how the aunt and niece contracted the disease if they did not live near the suspect pump. It was truly puzzling. Thus far, almost every case could easily be tied to the same water source. But, these deaths might lead him to another conclusion – an alternate theory.
“I must meet this man as soon as possible, Reverend!”
Whitehead agreed to set up a meeting the very next day, though a bit apprehensive because he still clung to the belief the onset of this epidemic was a direct result of divine involvement. On the other hand, if it did prove the obstetrician’s theory, it would bring some closure to the matter, tamping down the debate in the scientific community and therefore, compel town officials to finally take decisive, consequential action to stop this plague from taking any more innocent lives.
“Pleased to meet you, Dr. Snow. The Reverend here tells me that I may be of help.”
“Yes, I do hope so.”
“Minister Whitehead tells me that your mother and her niece have died of cholera – is that true?”
“It is, doctor, both of them, unfortunately.”
“And they both moved out of Soho before the latest bout of blue death hit the neighborhood?”
“That is true…they didn’t like being here any longer. Plus, they were afraid of getting sick and preferred the fresh air of the countryside.”
“So, where did your mother and her niece get their water, might I ask?”
“Oh, from the pump on Broad Street.”
“The Broad Street pump? The one right by 40 Broad Street?”
“Yes, that’s the one!”
“How is it they got water from there?”
“I took it to them.”
“You brought water from that pump to your mother and her niece?”
“Yes, that’s right.”
“But, why?”
“Well, because they both used to live in Soho and they really liked the taste of the water from the Broad Street pump – mostly my mother.”
The revelation floored Snow. He went on to learn the aunt and niece died on September 1st, after initially becoming ill on August 31st, just a day earlier. It help confirm his theory – the water out of the Broad Street pump was infected with the disease and responsible for spreading cholera through the Soho neighborhood.
When Snow and Whitehead compared their maps, detailing all the deaths in the community, it was clear the greatest number of fatalities was heavily concentrated around the pump. What’s more, so very few people died from the disease or were even ill who did not drink water from the contaminated pump. It was the proof he need to get town officials to shut down the pump. But, when Snow took his findings to the town administrators on September 7th, they still refused to believe his theory.
“Dr. Snow, we greatly appreciate your work. But, many other scientists and doctors tell us that cholera isn’t in the water. Rather, it exists primarily, if not exclusively, in the air – ‘miasma of the atmosphere.’”
“I respectfully disagree. Cholera is spread through water. And the pump located nearest 40 Broad Street is infecting people, even as we speak!”
“But, if it’s in the water, as you insist, Dr. Snow, then why isn’t everyone getting sick after drinking it on a daily basis? Why is it that some water is tainted, and others are not? Moreover, why hasn’t everyone who has drunk water from the pump on 40 Broad Street not died from cholera?”
Snow was at a total loss. It was a great point. What made this pump different? After all, the other pumps carried water too, and not everyone was ill with the disease. Perhaps there just might be some truth to the stench in the air was indeed to blame after all. However, if the latter was true, then why were the most deaths, the most cases of illness, all concentrated around this particular pump on Broad Street?
“I grant you, that not everyone who has ingested the water from the 40 Broad Street pump has died from cholera, or even become sick with the illness. But, why are the fatalities so heavily concentrated around this very water source?”
“All right, all right! We’ll have the pump shut off immediately. Please direct the town constables to turn off the pump on 40 Broad Street straight away – have them remove the handle.”
“Thank you, gentlemen! I believe you’ve just saved a lot of lives!”
In a very short time, after the handle from the pump near 40 Broad Street was removed, the number of new cases dropped dramatically. It served as vindication for Dr. Snow but did not explain why this particular pump was different from the rest around Soho and in other London neighborhoods. The actual source of contamination still alluded the determined physician. The town officials were right in one respect. So, he continued to track all the cholera cases. And, what he found, astonished him.
Dr. Snow discovered a cabinetmaker, who did not live anywhere near the pump or Soho also died of cholera during the last outbreak. But, subsequently learned the tradesman did temporarily work in the area and also drank from the pump before it was shut off. The same held true for children who died from the dreaded disease but also didn’t live near the suspect pump. Although, they did pass by it on their way to school and did indeed drink from it.
Still, it begged the question, why this pump and not the others in Soho? Snow meticulously went back through his notes and combed over the maps he and Reverend Whitehead made. Suddenly, it became apparent the largest spike occurred at the beginning of September. Over just a seven-day period, a full 10% of all the residents living around this tainted pump would die from cholera. Yet, there were almost no cases from pumps that drew water upstream.
After many months of study and analysis, it became clear. The 1854 outbreak occurred as a result of contaminated water. Practically all of the cholera fatalities were people who drank from pumps supplied by the portion of the Thames River where cesspools were routinely emptied – downstream. On the contrary, pumps supplied with water from upstream were free of the disease.
Unfortunately, even these findings weren’t enough to completely convince the public health authorities of his theory. Dr. John Snow would die only four years later at the age of 45 in London, on June 16th, 1858, six days after suffering from a stroke while working in his office on June 10th.
By 1866, local authorities and public health officials finally realized that Dr. Snow was indeed right and ordered people to boil any water before drinking it immediately after the next cholera outbreak surfaced, twelve years later.
