Living in London during the middle of the 19th century was a precarious, day-to-day journey, especially if you happened to live in the poorer areas of the city. Rampant overcrowding, lacklustre sanitation, and an overall absence of disease control created the perfect breeding ground for all manner of pandemics. One disease that held a particularly harmful grip on the London population was cholera. During the decades between 1830s and the 1860s, cholera cast a wide net of death and destruction over London. Within the span of thirty years, it ravaged communities, created widespread panic, and was responsible for nearly forty thousand deaths.
Cholera was extremely prevalent in London in the 19th century due to the manner in which it was spread. Cholera is a water-borne disease that emerges from a bacterium called Vibrio cholerae. Once someone contracts the disease, they can experience symptoms ranging from extreme dehydration, to diarrhoea, to vomiting. If not treated immediately, cholera can lead its victim into a prolonged and painful death. Though cholera had flourished in parts of Asia for centuries, it flourished in London due to the city’s lack of an efficient sewage system. The city’s waste poured directly into the Thames, which in essence, became a giant sewer. Had the misuse of the Thames been the only issue facing Londoners at the time, the problem of cholera would not have been as widespread. Yet in 19th century London, the entire city’s drinking supply was taken from the Thames. People were literally drinking and bathing in each other’s waste!
When cholera first emerged, no one thought to identify the poisoned drinking water as the source of the contagion. In fact, the idea that cholera was water-based would not be introduced until nearly two decades after its initial outbreak. The most commonly held theory was that cholera was spread via the air through a cloud-like miasma. Others firmly believed that, since the disease spread more rapidly through the poorer districts, that the wealthy were purposely poisoning the poor. Still more believed that cholera was a visitation from God and that He was exacting a punishment to the community on behalf of their sins. Such beliefs might seem far-fetched today, but at the time were not wholly unusual. Knowledge of microbes and bacteria was just beginning to emerge and only a scientific elite were aware of their existence.
The first cholera outbreak in Britain was in Sunderland during the autumn of 1831. From there the disease made its way northward into Scotland and southward toward London. Before it had run its course it claimed 52,000 lives nationwide. From its point of origin in Bengal it had taken five years to cross Europe, so that when it reached Sunderland, British doctors were well aware of its nature, if not its cause. The disease was unlike anything then known. One doctor recalled:
"Our other plagues were home-bred, and part of ourselves, as it were; we had a habit of looking at them with a fatal indifference, indeed, inasmuch as it led us to believe that they could be effectually subdued. But the cholera was something outlandish, unknown, monstrous; its tremendous ravages, so long foreseen and feared, so little to be explained, its insidious march over whole continents, its apparent defiance of all the known and conventional precautions against the spread of epidemic disease, invested it with a mystery and a terror which thoroughly took hold of the public mind, and seemed to recall the memory of the great epidemics of the middle ages."
It is not hard to see why the public in their ignorance and fear became desperate for a solution. The prevailing miasma theory led to Parliament passing in 1846, The Nuisances Removal and Diseases Prevention Act, which the press quickly renamed The Cholera Bill. It was used during the cholera epidemic of 1848-9 to encourage property owners to clean their dwellings and connect them to sewers.
The man who inspired this bill was Edwin Chadwick, one of the great pioneering public health campaigners but a man totally in thrall to the miasma theory. In his Report on the Sanitary Condition of the Labouring Population of Gt. Britain, Chadwick had included figures to show that in 1839 for every person who died of old age or violence, eight died of specific diseases. He believed that the solution to tackling disease came through dealing with public hygiene. In short, if we could eradicate the smells that engulfed our cities we could help to eradicate disease.
Chadwick also believed that actions spoke louder than words. Consequently, he became an officer of the London Metropolitan Sewers Commission, and ordered all cesspools and sewage pits around London to be cleared from the streets and dumped into the Thames. The thought was that by getting rid of the fetid air the problem of cholera would diminish until it eventually disappeared. Yet once the cesspools were cleared the death tolls only succeeded in jumping to their highest level yet. Fourteen thousand people died as a result of Chadwick’s decision and the numbers only continued to increase as the months dragged on.
Chadwick’s local sewers merely became a more efficient system of dumping London’s sewage waste into the Thames, its main source of drinking water. The impact of his decision was exacerbated by the increasing popularity of the flushing toilet amongst London’s middle classes which only increased the amounts of sewage reaching the river. The inevitable result of Chadwick’s enlarged system of local sewers being connected up to its main artery, the Thames, was the Great Stink of 1858. Rather than creating a sweeter smelling city he had inadvertently led to a situation where even M.P.s in the newly built Houses of Parliament were considering abandoning their palatial home to escape the toxic stench of the Thames.
One area that fell within the compass of The Nuisances Removal and Diseases Prevention Act, was Soho. The replacement of its sewers in 1849 was blamed by some people for the subsequent cholera outbreak in the area in 1854. Local rumour had it that the new sewers had released deadly odours from hidden burial pits left from the Great Plague of 1665. However, despite these fanciful claims it would be this outbreak of cholera in Broad Street that the force of reason would triumph. From out of these same Soho streets John Snow would put forward his water borne theory of the transmission of the disease and revolutionise the medical approach to cholera. Snow’s triumph was to be far from an overnight success. Despite the evidence he presented those in favour of the miasma theory continued to hold sway for decides to come. Indeed, one of Chadwick’s key allies in getting the Cholera Bill passed, Sir Benjamin Hall, (the man who Big Ben is named after) ended up in direct confrontation with Dr John Snow.
Sir Benjamin Hall became President of the Board of Health in 1854 and set about immediately to try and regulate industries such as gas and bone-boiling works who he felt were polluting the metropolis and were the mina agents of disease amongst its people. Dr. John Snow was asked by various manufacturers to testify against Hall’s proposals. This he did as the second witness on March 5, 1855 to a Parliamentary committee chaired by Sir Benjamin Hall. Snow’s convincing arguments did little to persuade Hall to alter his beliefs. This was hardly a surprise. Snow’s theories were very much in the minority. Shortly after the debate the Crimean War began and showed just how far Snow had to go to overcome public skepticism. The heroine of the Crimea was Florence Nightingale, who would achieve such a level of fame through her role as a nurse in the war that her miasma based theories of nursing would hold sway over English medicine for the rest of the century.
Almost by chance Hall, the leading miasmatist, would introduce an Act of Parliament which would do more than any single act in the 19th century to improving the health of Londoners. He established the Metropolitan Board of Works, which would be responsible for many environmental and sanitary improvements in London, none more so than the employment of Joseph Bazalgette as its Chief Engineer. Hall’s Metropolitan Board of Works was able to overcome centuries of vested interests bound up in the parochial nature of London’s government based as it was around tiny church parishes. This form of government had been the main reason for inertia in dealing with London’s burgeoning public health problems. The Parish Vestries narrow self-interest centered on keeping the local rates low and would certainly have not been in favour of the expensive engineering solution to London’s sewage problem that Bazalgette would propose.
The knowledge of how water borne diseases were spread that resulted from Dr John Snow’s investigations in Broad Street, Soho and the building its sewage system by the Metropolitan Board of Works enabled London to avoid further outbreaks of cholera —including a particularly nasty typhoid outbreak that hit Germany in the early 20th century. In the years that followed the construction of Bazalgette’s masterpiece the Thames finally lost its reputation as the dirtiest and most polluted river in the entire world. Today, it is considered one of the cleanest metropolitan rivers in the world and cases of cholera have not been reported in London since the late 1860s.