Investigating Cholera in Broad Street: A History in Documents

(From the Broadview Sources Series)

Peter Vinten-Johansen

• Publisher: Broadview Press
• Year: 2020
• eBook ISBN: 9781460406908
• Topic: History
• Subtopic: Modern British History
• Index: History

This book features various accounts of a cholera outbreak in West London that killed over 500 people in ten days during the late summer of 1854. What had caused the outbreak? Local authorities of the time were flummoxed about the mode by which the disease had spread. What has become known as "the Broad Street pump episode" is one of the most significant early examples of a team-oriented investigation into the causes of an epidemic—a hallmark of epidemiology and public health today.

This collection includes documents from the five separate investigations that were conducted into the possible causes. John Snow and Henry Whitehead made independent investigations; inspectors from the General Board of Health and the Sewer Commission, as well as a parish inquiry committee, also scrutinized the outbreak. This volume traces competing notions of how this disease was transmitted, starting with the first pandemic, which reached England in 1831, and it documents how they developed over time.

PART I

The Thomas Street Cholera Outbreak of 1849—A Contested Natural Experiment

DOCUMENT 1:

Asiatic Cholera Approaches the British Isles: General Board of Health, Guidelines for Managing Epidemic Cholera (7 October 1848)¹

The General Board of Health established by the Public Health Act of 1848 had three members: A president, George Howard (7th Earl of Carlisle), and two commissioners, Anthony Ashley-Cooper (Lord Ashley) and Edwin Chadwick. Henry Austin, a civil engineer, served as secretary. Thomas Southwood Smith (a physician) was medical advisor. John Sutherland (a physician) and Richard Grainger (a surgeon) were the chief medical inspectors.

The Board was constituted on 22 September 1848, the very day the first fatal case of Asiatic cholera appeared in London. Six days later, the government invoked an emergency clause which granted the General Board of Health temporary power to impose its guidelines for nuisance removal and disease prevention throughout the kingdom (except the City of London, which had a new, independent medical officer of health).² The board issued its first notification on 5 October 1848. The London Gazette, the official record for the United Kingdom, published it the following day, major newspapers shortly thereafter.

George Howard: Member of Parliament from northern England and called Viscount Morpeth after the family borough he had represented early in his career in the House of Commons. He became an earl on the death of his father in October 1848, after which he entered the House of Lords.

Lord Ashley: Member of Parliament who had sponsored legislation to reform laws on treatment of the mentally ill and children working in factories and mines.

Henry Austin: Austin was also the secretary of the Health of Towns Association, which advanced a sanitary reform agenda via public education and political lobbying.

Thomas Southwood Smith: Unitarian minister, physician to the London Fever Hospital, and founder of the Health of Towns Association.

John Sutherland: Sutherland was Health of Towns advocate from Liverpool.

Richard Grainger: Grainger was a lecturer in anatomy and physiology at St. Thomas Hospital.

The General Board of Health, having considered the official accounts which have been received of the course of Asiatic cholera, … have now to represent that the experience obtained with this disease during its former invasions of this country in the years 1831 and 1832, and the still larger experience acquired during its recent progress through Persia, Egypt, Syria, Russia, Poland, and Prussia, appears to afford ground for the correction of some views formerly entertained concerning it….

The extent, uniform tenor, and undoubted authority of the evidence obtained from observers of all classes in different countries and climates … appear to discredit the once prevalent opinion that cholera is, in itself, contagious; an opinion which, if fallacious, must be mischievous since it diverts attention from the true source of danger and the real means of protection, and fixes it on those which are imaginary; creates panic; leads to the neglect and abandonment of the sick; occasions great expense for what is worse than useless; and withdraws attention from that brief but important interval between the commencement and the development of the disease during which remedial measures are most effective in its cure.

once prevalent opinion … contagious: The view of the Board’s predecessor, the Central Board of Health, as well as the Royal College of Physicians, and many medical practitioners that cholera was only transmitted when people inhaled morbid matter emanating from the bodies of the sick—a mode of contagious communication termed infection; see “Contagion” and “Infection” in Glossary, and Introduction, 2.

Although it is so far true that certain conditions may favour its spread from person to person, as when great numbers of the sick are crowded together in close, unventilated apartments, yet this is not to be considered as affecting the general principle of its non-contagious nature. Nor are such conditions likely to occur in this country. Moreover, the preventive measures founded on the theory of contagion—namely, internal quarantine regulations, sanitary cordons, and isolation of the sick on which formerly the strongest reliance was placed, have been recently abandoned in all countries where cholera has appeared….

certain conditions … person to person: Contingent contagion via infection; see “Contingent contagion” in Glossary.

general principle of its non-contagious nature: Because the “certain conditions” are contingent—”happening by chance …, not fixed by necessity” (OED); therefore, non-contagionists called this exception to the rule contingent contagion and believed that removing the victim from such contingent conditions rendered the disease non-contagious again.

The evidence also proves that cholera almost always affords by premonitory symptoms warning of its approach in time for the employment of means capable of arresting its progress. Indeed, in certain situations—as where there is an unusual concentration of the poison, or in certain individuals who are peculiarly predisposed to the disease—the attack may sometimes appear to be instantaneous. Still, the general conclusions that cholera is not in itself contagious and that it commonly gives distinct warning of its approach, are two great facts well calculated to divest this disease of its chief terrors and to show the paramount importance of the means of prevention, so much more certain than those of cure.

premonitory symptoms: Signs of exposure to the choleraic principle when Asiatic cholera is present, such as occasional vomiting and diarrhea.

The proved identity of the causes which promote the origin and spread of epidemic diseases in general with those that favour the introduction and spread of Asiatic cholera, appear to indicate the true measures of precaution and prevention against a pestilence which, after an absence of 16 years, and at a season when other formidable epidemic diseases are unusually prevalent and deadly, menaces [another] visitation…. The General Board of Health recommends that the guardians of the poor … should hold themselves in readiness to execute such directions as the General Board of Health may see fit to issue from time to time … under the provisions of the act “for the more speedy removal of certain nuisances and the prevention of contagious and epidemic diseases.”

epidemic diseases: Sydenham’s epidemic constitution of the season; see Document 7 and the Glossary.

act: The amended Nuisances Removal and Disease Prevention Act of 1848.

epidemic: Non-contagious in this context.

The guardians of the poor … will probably be required, either by themselves individually or by persons employed or specially appointed by them, … to make examinations from house to house of … the state of each locality as far as regards the prevalent sickness and the removable causes upon which [cholera] may appear to depend…. It is to be kept in mind that every district or place is dangerous in which typhus and other epidemic diseases have regularly occurred…. Great benefit having been derived from the cleansings that were resorted to on the former [1831–32] visitation of cholera, … the boards of guardians should carry into immediate effect all practical measures of external and internal cleansing of dwellings in the ill-conditioned districts.

The chief predisposing causes of every epidemic, especially of cholera, are damp moisture, filth, animal and vegetable matters in a state of decomposition, and, in general, whatever produces atmospheric impurity. All … have the effect of lowering the health and vigour of the system and of increasing the susceptibility to disease, particularly among the young, the aged, and the feeble. The attacks of cholera are uniformly found to be most frequent and virulent in low lying districts, on the banks of rivers, in the neighbourhood of sewer mouths, and wherever there are large collections of refuse, particularly amidst human dwellings…. Householders of all classes should be warned that their first means of safety lies in the removal of dung heaps and … filth of every description from beneath or about their houses and premises. Persons long familiarized to the presence of such refuse may not perceive its offensiveness nor believe in its noxious properties. Yet all who desire to secure themselves from danger should labour for the entire removal of filth and the thorough cleansing of their premises, which the law requires of each person for the protection of his neighbours as well as for his own safety. Next to the perfect cleansing of the premises, dryness ought to be carefully promoted, which will of course require the keeping up of sufficient fires [in stoves, etc.]…. But while a certain amount of cleansing can be effected by every householder, … the means of thoroughly purifying the densely populated districts are beyond the power of private individuals. Accordingly, … in cases of inability, insufficiency, or neglect, the law has charged the cleansing operations upon certain public bodies … [such as] “commissioners for the drainage, paving, lighting or cleansing, … [and] sewers, or guardians of the poor.”

predisposing causes: Environmental factors that increase susceptibility; see Glossary.

charged: Imposed, or entrusted, with a task.

By this act, it is provided that upon notice in writing, signed by two or more inhabitant householders, that any dwelling-house or building is in a filthy and unwholesome condition, or that there are upon such premises any foul and offensive cesspool, drain, gutter, or ditch, or any accumulations of filth, or that swine are so kept as to be a nuisance or injurious to health, the authorities shall examine or cause the premises to be examined. And if upon examination, or upon a medical certificate of two legally qualified practitioners, it appears that the nuisance exists, the public authority shall make complaint before two justices who are required to make order for the removal of such nuisance….

Union medical officers, whose duties take them to the relief of the destitute sick, are necessarily familiar with the places in which disease is most prevalent and fatal. These are invariably found to be the dirtiest localities where … cleansing operations are most required…. In several districts, the police in going their usual rounds have been employed with great advantage in reporting daily as to the houses, courts, alleys, passages, and streets … in need of cleansing…. Highly important services have been rendered by the parochial clergy and other ministers of religion, in association with lay committees, for the purpose of maintaining a system of house-to-house visitation in the more depressed districts….

Union medical officers: Physicians, surgeons, and apothecaries employed under the New Poor Law.

The General Board of Health is required to frame rules and regulations to assist and direct the guardians of the poor and other local authorities in the performance of the special duties imposed upon them whenever the country is visited or ...

Table of contents

• Cover
• Title Page
• Copyright
• Dedication
• Contents
• Preface
• Acknowledgements
• Abbreviations
• Introduction
• Chronology
• Questions to Consider
• A Note on the Text
• Part I: The Thomas Street Cholera Outbreak of 1849—A Contested Natural Experiment
• Part II: Contagious or Non-contagious—A Cholera Mystery
• Part III: Filth, Elevation, and Impure Water—The Chief Causal Contenders at Mid-century
• Part IV: “A Remarkable Outbreak”
• Part V: What Exactly Happened, and Why?
• Glossary
• Select Bibliography