The Reverend Henry Whitehead said a short and mumbled prayer over the body of John James Morters and quickly re-covered his own nose and mouth with a scented hankie. He turned and nodded to the undertakers. They took the shrouded body and half threw it into the waiting cart. They didn’t want to hang around in a cholera house; neither did the Reverend. He had attended a few such deaths recently. He thought there were far too many deaths. He walked out into the stench filled air of Soho’s Broad Street, took a short breath and covered his face again.
The undertaker coughed and forcefully spat out a gobbet of phlegm, wiped his mouth with the back of his hand and looked at the Reverend,
‘’Pologies Sir. It’ll be the stink what gets ‘em too Sir. Taken a few from round ‘ere.’
‘I don’t subscribe to the theory of bad air my good man. It may stink but it carries no disease.’
‘That’s as well as like Sir. But we seen ‘em all off. Usually from places such as this stinking hole.’
‘Have you had many locally taken with this disease?’
The undertakers looked at each other. Then one spoke,
‘One from Lexington Street, two from Marshall street, two from Silver Place, Christ that one stank, three from Bridle Lane that’s just today. Is that it, Tom?’
‘Did you say Silver Place Tom? Tell ‘im about the stink there.’
‘Told him that one Art. Told him ‘bout that one. A right pen and ink. I fink it’s abaht 20 or more all in all over the past few weeks.’
The two men looked hopefully at the Reverend. Both were hoping for a coin or two. Information was usually paid for in their world.
‘Thank you, gentlemen. No doubt we shall meet again. Shall I see you in church?’ The reverend had a half smile on his face, knowing full well these two men would never cross over the threshold of his church.
Art and Tom nodded, climbed onto the cart and cracked the whip over the horse’s backs. The horses pulled away with their load of bodies to go off to the graveyard in Islington. The Reverend made his way back to the relative safety of St Luke’s Church as quickly as he possibly could. At least there the stink of London was reduced by its heavy doors, velvet clad windows and wafts of incense. On his walk back to the church the Reverend mulled over the street names the undertakers had just reeled off. They were clustered around one area in Soho. He had the aberrant thought that perhaps the stink was concentrated around those areas and had taken the poor souls with the cholera. He dismissed that thought as soon as it had developed in his mind. His work with Dr John Snow on the poor of Soho showed no link causal link with disease and the foul odours around the area. There must be, in the minds of the two men a more common link than just the smell; the miasma as it was known. Dr Snow and he were trying to prove an association beyond the great stench of London. Neither believed that the transmission of disease was through the air.
As he walked, he ran the names through his head, Silver Place, Bridle Lane, Marshall Street, then took out his notebook and wrote them down. He would look on a parish map to see how they were linked or if they were, indeed, linked apart from proximity to each other. He would tell Dr Snow of the recent deaths as soon as he could so he wrote to him that night and had it delivered by a choirboy. Dr Snow received the letter the very next morning and made his way down to St John’s church.
John Snow knocked on the vestry door and stood back. The door swung open,
‘John. Good to see you again. I have some figures for you.’
‘Ah, Henry, good to see you again.’ At that John tipped his hat and extended his hand.
The Reverend invited Mr Snow in to the church and they both took a seat at the vestry table.
‘I have written down the names of the streets where the dead were collected from yesterday and over the past few days.’ He passed the note book to John. John read the list of street names and looked at the Reverend.
‘What is the link Sir? The common factor?’ He furrowed his brow and looked again at the street names before him.
‘I have seen your work on the poor of London and the tabulations of the dead you have made. I thought you may be interested in this cluster of deaths. All of the houses are poor, all are in area of the great stink. But you and I know the stink, the miasma does not, in theory, cause disease.’
John Snow nodded and looked at the notebook and then at the Parish map. He ran his finger across the map and then asked,
‘May I draw on the map Henry?’
‘You may do so, here is a pencil.’
John drew some dots on the map on the streets that the undertakers had indicated they had collected bodies that previous day. He drew some lines on the map and looked at the street names in the note book again. He drew lines to join up the street names. They formed a definite pattern, quite what it signified puzzled him.
He puzzled over the map for a few minutes.
‘There are no public houses, no hostelries, nor as far as I know flop houses in that vicinity. All could potentially pass on the disease by social intercourse.’
Henry looked at the map and the lines and dots that John had drawn. He could see no connection to the cholera outbreak. John kept looking at the map and then said,
‘If I have it right, Henry. This symbol is a water pump.’ He pointed a small symbol on the map of a water pump. He looked at the Reverend, ‘The commonality to all these deaths is the Broad Street water pump. It is the one thing that all the houses have in common; the pump. The water they are drinking is infecting them with the cholera. Our figures suggest that there have been fewer deaths in areas that other pumps serve. With regard to the deaths occurring in the locality belonging to the pump in question, there have now been 61 instances in which we can see that the deceased persons used to draw water from the pump in Broad Street, either constantly or occasionally.’
‘The water John? How could drinking water give someone a disease?’ the Reverend looked puzzled.
‘The water in Soho is taken from the lower reaches of the Thames. The effluvia of the upper reaches of the Thames is then drawn into the pumps of Soho and beyond. This water may hold the key to the infections.’ He stopped for a moment pondering on a thought. ‘I have a memory that Filipo Pacini discovered a microscopic organism which he called a bacillus. He proposed that the creature passed on its deadly infection to humans. Of course, he was ignored by the scholars and still is. I believe that we may have stumbled on the causation of the deaths. The water is foul or otherwise fouled and thereby infected. We must alert someone in authority to this realisation.’
Henry thought for a moment then replied,
‘We will have to convince the great Dr William Farr of that theory, John. He holds all the power and authority with regard to the supply and sanitation of water in this city. I have heard he is a very difficult and powerful man. He, as you know, subscribes to the miasmatic and the zymotic theory of disease transmissions. He alone holds the key to halting disease in the city. He is hand in glove with the water companies too, so will have the power to halt any unintended pollution of the supplies. Conversely that alliance may work against us.’
In their fervour they both hadn’t noticed that Mrs Cramp, the reverend’s housekeeper, had brought sherry into the room just after they had sat down. She knew when the Reverend has a visitor, he always had a glass of sherry to offer them. The Reverend seeing his glass by his side took a sip of his sherry and crossed his hands over his lap, he felt good that they had possibly solved the conundrum.
John took a sip of his sherry,
‘I know of Dr Farr’s beliefs. He will buck against anything that opposes his long-held confidence Henry. He will fight tooth and nail to convince the world that his theory is the right model. He will quote the empirical knowledge from Miss Nightingale in the Crimea to add weight to his theory. I cannot deny that she has done good work and some will not allow an indirect criticism of her or her endeavours.’
John took a sip of his sherry. Henry took a sip too and said,
‘But she employs carbolic soap to clean her way to half sanitary conditions. I think Dr Farr conveniently forgets that fact. If he had his way, he would clean the poor from Soho, he asserts that their filth and squalor is a contribution to their mortality rate. I know there is a stink around those street’s but I remain convinced by you John, that it has little or nothing to do with cholera.’
‘I have a dear friend and ally in you Henry. We shall, together, prove my theory, our theory against the tide of miasmatic, zymotic theories. I will write to and then visit the Board of Guardians of St Johns’ Parish and have the pump disabled. Then we will see if the outbreak is connected or otherwise stymied by that action.’
With that he stood up and shook the Reverend’s hand, turned and bid him ‘Adieu’ then left the church.
The Parish council received a letter from John Snow setting out his theory that the water was, in his opinion, ‘fouled by external interventions’ and requesting that the Broad Street pump handle be removed or disabled. Soon after this letter was received John was called in to an interview with the Guardians of the Parish. He convinced the council of his view and they removed the pump handle the very next day. However, the people local to the pump vehemently objected to having to walk another two hundred yards to collect water. The incidences of cholera decreased; the Reverend visited fewer houses for prayers in the following months that the pump was out of use. He reported as much to John Snow.
John was delighted by the news and requested an urgent meeting with Dr William Farr to discuss his findings. The good doctor made excuses and put off quite a few planned meetings. In the end he capitulated to John’s constant requests. Capitulation is probably the wrong word, he wanted to meet with this upstart and quash his theory and prove his own notion of miasmatics. The theory Dr Farr subscribed to, had a long standing in science and the medical world, Galen had proposed it many centuries ago and it was now a fully accepted principle.
The meeting between the two men was set for October the fourth 1848 at the offices of the Southwark and Vauxhall Waterworks Company. Dr Farr had requested the meeting be held in their offices, as he knew that he could call on their opinions as to the quality of their water supplies to the city. He also wanted to demonstrate to Dr John Snow whom he was opposing in this matter.
John Snow on being informed of the date immediately wrote to Dr. Thomas Greenhow in Newcastle. He knew Dr. Greenhow had had similar findings with regard to a cholera outbreak in Newcastle. He too had noticed a correlation between a certain water pump and the incidences of cholera in the town. Together, John thought, they might persuade Dr Farr and the waterworks company that they must pay regard to the quality of the water being supplied to the water pumps in the major cities. Thomas Greenhow accepted the invitation with delight. His theory had been disregarded by the Parish Councils in Newcastle and the outbreaks of cholera continued unabated. He now thought he had a chance to influence opinion.
On the morning of October 4th 1848 John Snow, Dr Thomas Greenhow and the Reverend Henry Whitehead attended the offices of the Southwark and Vauxhall Waterworks Company. They were shown up to the boardroom of the company by a secretary. The secretary opened the huge, heavy oak double doors and bowed as the three men entered the room. Seated at the far end of the boardroom table were Dr William Farr, Sir Oliver Scratchwell, the Reverend Dr Peter Hobson, Dr Michael Pelling, Dr James Eyler and various members of the governing board of the waterworks company. The three men were faced with some seventeen people all of whom had a strong belief in the miasmatic theory in the transmission of disease.
They sat down and faced their opposition. They all knew that this was going to be an uphill battle but sense and science would prevail over folklore they thought.
Dr Farr looked sternly at the three men and smiled a half smile, a smirk in fact. He knew he had victory in his hands. He turned to Sir Oliver Scratchwell, who was the senior board member in the room, and whispered something to him. Sir Oliver nodded and smiled.
Dr Farr stood up,
‘May I welcome Dr John Snow, Dr Thomas Greenhow and the Reverend Henry Whitehead to this meeting. Sirs, I remained totally unconvinced by your specious arguments that cholera is transmitted in the fine water that this city provides. The good gentleman to my left and right are defensive of the quality of water their company supplies.’ The entire company sat at the table nodded in agreement. He continued, ‘They too remain unconvinced by your arguments and indeed your findings. These gentlemen all subscribe, as resolutely do I, that disease is spread by a miasma. I say again Sirs, disease is spread by a miasma, nothing else; save for the squalor and filth the people of this city choose to tenant themselves in. You have our attention Sir.’ with that he sat down and looked at the men to left and right.
John Snow stood up; he was trembling with the weight of opposition he had in front of him but he was sure of his facts. He held his papers up and read from them,
‘Sirs, The Reverend and I noticed a direct correlation between the outbreak of cholera and the preponderance of deaths in the locality of a water pump in Broad Street, Soho. The deaths all occurred within walking distance of the pump in the close surrounding streets of that very pump.’
Dr Farr interrupted John,
‘Speak up Sir, we cannot hear you.’
‘My apologies Sir. I was relating that the deaths all occurred within walking distance of the Broad Street pump. This, we believe, was not a coincidence. Some mortalities further from the pump were shewn to be because of the very fact, the very fact, that that person had drawn water from and drank water drawn from the Broad Street pump.’
Dr Farr impatiently waved his hand for John to sit down. He turned to his right then left and spoke to each person and made notes.
‘My colleagues inform me; you sir, with the aid of the Parish Council, had the handle of the pump removed and in doing so, you Sir, compelled the local people to walk to another pump to draw water. What have you to say?’
John stood up again,
‘I did Sir. And in doing so, proved that the link to the outbreak of this vile disease was directly conjoined to the water supplied at that pump. I have not long had a pit dug close to that pump and have found a cesspit to be in close proximity to the pump. That cesspit, I contend, contaminates the water with what the Italian scientist Dr Filipo Pacini calls Bacillus. The bacillus is prevalent in the faecal matter of the inhabitants of Soho. He asserts that these organisms excreted via and in the faeces of the local people infect the water and pass on the disease we know as cholera. My good friend Dr Greenhow’ John put out his hand towards the doctor, ‘had the same findings in Newcastle, he too found the proximity of cesspits and human waste to water supplies thereby contaminates the water supply and infects the inhabitants of the city. By removing that pernicious inclusion, we have shown a marked decrease in the incidences of infection by the cholera.’
Dr Greenhow stood up and pulled some papers from his attaché case. Dr Farr glanced up at him and imperiously waved his hand in a ‘sit down’ motion. Dr Greenhow did so.
Dr Farr coughed and put his hand down flat on the table, he moved his fingers in a rhythmic tapping motion.
‘I shall not stand and give your idiotic theories the credence you so clearly crave. Disease, Sirs, is transmitted in a miasmatic way. Sir, what would your Dr Paycernee be looking for? Disease is invisible!’
John and Dr Greenhow both stood up, John spoke first;
‘Dr Pacini, sir. He is an Italian scientist. He has seen a bacillus with his own eyes, sir.’
William Farr went red and formed a fist.
‘I am speaking Sir. It matters not. If, and I say if, your Dr Paycenee is correct about his microscopic creatures and the transmittal of diseases, then I assert that they travel to the host in the foul air that pollutes this city. No more, no less. Human waste has been used since time immemorial to fertilise fields. How then does it contain organisms malicious to human life? The squalor that the people of that environ generate provides a host for the cholera to breed in. Their very filth generates malodorous air. The Miasmatic Principle of transmission came from no less an authority as Galen. If you gentlemen wish to oppose that ancient rule of transmission; I will call you fools and scoundrels. You are mistaken Sirs. The very air we breathe holds the key to infection. The cool night air provides a zymotic route to infection. Miasmatic and Zymotic, the route to infection is proven and accepted. Infection comes from rotting organic materials that generate foul air. I suppose that you do not accept either that obesity is caused by the inhalation of food odours? I laugh in your faces gentlemen.’
John stood up his knees were trembling.
‘Sir, do not the populace of this great city and beyond deserve the benefit of clean water, free from disease?’
Dr Farr looked to his left and right then straight at John.
‘They Sir, deserve what they can afford! You impugn the gentlemen present at this meeting. These good gentlemen to my left and right need to put bread on their tables. You will have them swept into poverty with your ridiculous ideas. Sit down sir!’
The Reverend stood up and read from the Bible,
‘Isaiah 55, Sirs, Come, all you who are thirsty, come to the waters; and you who have no money, come and drink. The poor deserve to drink clean clear water gentlemen. Split the rock Sirs, let the water flow out.’
Dr Farr shook his head and looked at his committee.
‘Gentlemen, what say you? Shall you supply clear water for free?’
The committee all shook their heads and muttered a low,
‘No Sir, we shan’t.’
‘Dr Farr, I say he who has compassion on them will lead them and will guide them to springs of clean water. You Sirs, seem to have no compassion and will not lead unless there is a profit.’
The Reverend sat down and closed his Bible.
John immediately stood up as the Reverend Whitehead sat down. He wasn’t going to give Dr Farr time to respond to the Reverend’s scolding. Dr Farr’s face reddened in anger.
‘Sirs, will you not take the time and consider the work of Dr Greenhow, my work and the empirical findings of both myself and the Reverend Whitehead?’
‘No Sir. I will not! Sit down Sir, I have heard enough!’
John resignedly sat down and looked at Dr Farr. He knew that he and his companions were losing the case.
Dr Farr slapped the table again and started to stand, then sat down again and continued,
‘You three pseudo-scientific vagabonds will have every water pump in this fair city disabled! Every outbreak of the cholera will have you take up the hue and cry of ‘Shut down the water pumps’! You will take the bread from the very mouths of the fair gentlemen sat at this table. Your theory that faecal matter, I can hardly bear to say that word, infects and pollutes the very water that every man, woman and child in this city relies on, is sheer poppycock. Disease is airborne!’
Dr Farr again banged the table with his open hand and looked angrily at the three men opposite him. He continued, ‘Do the people of this city who have worked hard and provided a good life for themselves succumb to cholera? They do not! They do not! And why? Because Sirs, they choose not live in filth and squalor. They choose to have clean air surrounding themselves. They choose the fairer parts of this city to reside in. They choose to keep the air they breathe warm and unpolluted. That is why they do not succumb to the cholera.’
John stood up and picked up his papers again. Henry touched John’s arm in a gesture of support and looked up at him. John took Dr Greenhow’s papers and bundled them all together.
‘Sir, Dr Farr and the members present in this room, may I respectfully leave you with the papers of our findings? This is important to all the inhabitants of this fair city and cities beyond. They will show you….’ He didn’t have time to finish the sentence. Dr Farr angrily stood up and half shouted his reply,
‘No Sir, you may not. I, Sir am the authority on human health in this city. You may not pollute this boardroom with your ignorance and deceit. I cannot see why you continue to fly in the face accepted wisdom, of accepted facts, of putative understanding of the nature of the transmission of disease by miasmatic means. Return them to your drawer Sir, put them in your fire grate, dispose of them how you will; for gentlemen I will not foul my mind with such things. I will not foul this fair committee with such hokum! You are wrong. You are all wrong! History will prove that my theory, that the accepted premise is correct. Disease is airborne!’
Dr Greenhow stood up,
‘Respectfully, Sir William, as Dr Snow has informed you, I have found the same. Will you therefore decide to ignore our, I say OUR, a collective agreement?’
Dr Farr irately interrupted him,
‘Sit down Sir! Sit down! I will hear no more! Sir Oliver have the pump handle reinstated forthwith.’
‘Will you sir not accept our empirical argument that the water is corrupted by foul matter?’
‘Will you sir not accept that the collective empiricism of this committee is that the miasma creates the cholera? We sir, are right. You sir, are wrong.’
Dr Greenhow stood for a few moments that realised that Dr Farr would hear no more from him than he would from his companions. John touched Thomas’ back and gestured to have sit down.
He sat down and angrily shoved his papers back into his attaché case.
Sir Oliver nodded at Dr Farr and spoke to the person to his left who spoke to the person on his left who made a note of the request.
As Thomas sat down John whispered,
‘We have lost Thomas. Our argument is to be ignored. We have lost. Our wasted breath will now join the miasma.’
Dr Farr banged a gavel on the table, stood up, turned and left the room; the members of the committee all followed him like sheep. The three men stood and bowed to the committee and then left the room.
The pump handle in Broad Street was replaced the very next day.
The three men walked out of the Waterworks Building and stood in the street for a few moments. They were all, in truth, crestfallen. John rallied himself,
‘This incident will not deter me from this reflection.’ he extended his hand to Dr Greenhow and then to the Reverend.
‘Nor me.’ Dr Greenhow replied as he shook John’s hand.
‘I will not swerve from this thought either John. I will stay by your side.’ The Reverend Whitehead held on to John’s hand in a moment of consolation. They all knew that they had all been brow beaten in the boardroom. They all knew things would not change in the short term, but perhaps one day they hoped their theory of transmission would be accepted.
Dr Greenhow thoroughly disheartened, travelled back to Newcastle by the very next coach. He remained a physician and often prescribed that his patients boil water if anyone in the household was taken ill. He was later appointed physician at the Devon and Exeter Hospital and also worked at the Magdalen Hospital and The Lying In Charity and St Thomas' Hospital for Lunatics. Dr Greenhow led an active public life later becoming Mayor of Exeter. When cholera again posed a threat in Exeter, he believed in his findings and those of John Snow and tried as best as he could to put those principles into action by advocating the boiling of water and the drawing of water from fresher aquafers. The rate of cholera decreased by adopting those measures. He was re-elected Mayor the following year.
In the weeks after the meeting, the cholera epidemic subsided in Soho and vindicated Dr William Farr; there was no link to water and disease in his mind. To that end he victoriously published a paper in the British Medical Journal.
‘The Cholera Epidemic and Assertions &c by Dr. John Snow & Others.
After careful inquiry, We see no reason to adopt the belief of Dr Snow et al: That of transmission by water borne organisms in relation to the cholera epidemic. We do not feel it established that the water was contaminated in the manner alleged; nor is there before us any sufficient evidence to show whether inhabitants of that district, drinking from that well, [Broad Street in Soho] suffered in proportion more than other inhabitants of the district who drank from other sources. I therefore call a halt to this debate and do hereby close the matter in favour of the zymotic and of miasmatics principle of the transmission of disease.
Dr William Farr DM BMA.’
The status quo was returned: the water companies continued unabated to pump filthy water from the Thames and other water courses into the contaminated water pumps of London.
The Reverend Whitehead soon after the meeting at the water board accepted a posting in the Cumbrian village of Brampton and lived the remainder of his life in the clean, cool air of the countryside. He remained in contact with Dr Snow and Dr Greenhow. He wrote to Dr Snow soon after taking up his post,
‘John,
Do not be too disheartened by our interactions with the bullying, overbearing nature of Dr William Farr and his like-minded cohorts. We both know he, and they are wrong. One day our work, your work will be recognised and acted upon. Stay strong in your belief my dear man. God sometimes takes us into troubled waters not to drown us but to cleanse us.
I have now fresh waters the like of which the inhabitants of Soho will never experience whilst Sir William Farr holds power. It is truly the nectar of God. With each sip I remain thoughtful of the forced ingestion of those foul waters exacted on those poor souls by their cruel masters and figures of authority.
Give us water that we may drink is all they demand and deserve as God’s children.
I remain yours,
Henry Whitehead.’
John Snow kept that letter in the drawer of his desk and would often refer to it when things became impossible for him. Dr Snow remained a passionate advocate of making water cleaner for the inhabitants of the city of London. However, he soon became sought after in the world of surgery as his principles of anaesthesia became more and more accepted. He made a good living for himself in that expression of his talents and became a surgeon to the Royal Household. On 7 April 1853, Dr Snow administered obstetric anaesthesia to Queen Victoria on the birth of Prince Leopold, and again on the birth of Princess Beatrice on the 14 April 1857.
Dr John Snow passed away in 1858 aged 45 having never seen the results of his, Dr Greenhow’s and the Reverend’s findings carried out.
The Reverend Whitehead on learning of John Snow’s death journeyed from Cumbria and conducted the service at his funeral.
Dr Thomas Greenhow travelled up from Exeter to read the eulogy; both men had stayed loyal to John Snow and his findings.
The scourge of cholera continued to plague the streets of London until 1866 when Dr William Farr finally accepted John Snow’s findings; this was after his results from statistics with regard to an outbreak in east London led him to consent John’s assertions. Dr Farr on collating the death figures from cholera in London noticed a higher incidence of the disease in the areas that were served by the Old Ford Reservoir in east London. He immediately ordered that all water drawn from the reservoir be boiled before consumption; in doing so the incidences of cholera reduced and then ceased.
John Snow’s work had finally come to be accepted by his greatest critic.
The undertaker coughed and forcefully spat out a gobbet of phlegm, wiped his mouth with the back of his hand and looked at the Reverend,
‘’Pologies Sir. It’ll be the stink what gets ‘em too Sir. Taken a few from round ‘ere.’
‘I don’t subscribe to the theory of bad air my good man. It may stink but it carries no disease.’
‘That’s as well as like Sir. But we seen ‘em all off. Usually from places such as this stinking hole.’
‘Have you had many locally taken with this disease?’
The undertakers looked at each other. Then one spoke,
‘One from Lexington Street, two from Marshall street, two from Silver Place, Christ that one stank, three from Bridle Lane that’s just today. Is that it, Tom?’
‘Did you say Silver Place Tom? Tell ‘im about the stink there.’
‘Told him that one Art. Told him ‘bout that one. A right pen and ink. I fink it’s abaht 20 or more all in all over the past few weeks.’
The two men looked hopefully at the Reverend. Both were hoping for a coin or two. Information was usually paid for in their world.
‘Thank you, gentlemen. No doubt we shall meet again. Shall I see you in church?’ The reverend had a half smile on his face, knowing full well these two men would never cross over the threshold of his church.
Art and Tom nodded, climbed onto the cart and cracked the whip over the horse’s backs. The horses pulled away with their load of bodies to go off to the graveyard in Islington. The Reverend made his way back to the relative safety of St Luke’s Church as quickly as he possibly could. At least there the stink of London was reduced by its heavy doors, velvet clad windows and wafts of incense. On his walk back to the church the Reverend mulled over the street names the undertakers had just reeled off. They were clustered around one area in Soho. He had the aberrant thought that perhaps the stink was concentrated around those areas and had taken the poor souls with the cholera. He dismissed that thought as soon as it had developed in his mind. His work with Dr John Snow on the poor of Soho showed no link causal link with disease and the foul odours around the area. There must be, in the minds of the two men a more common link than just the smell; the miasma as it was known. Dr Snow and he were trying to prove an association beyond the great stench of London. Neither believed that the transmission of disease was through the air.
As he walked, he ran the names through his head, Silver Place, Bridle Lane, Marshall Street, then took out his notebook and wrote them down. He would look on a parish map to see how they were linked or if they were, indeed, linked apart from proximity to each other. He would tell Dr Snow of the recent deaths as soon as he could so he wrote to him that night and had it delivered by a choirboy. Dr Snow received the letter the very next morning and made his way down to St John’s church.
John Snow knocked on the vestry door and stood back. The door swung open,
‘John. Good to see you again. I have some figures for you.’
‘Ah, Henry, good to see you again.’ At that John tipped his hat and extended his hand.
The Reverend invited Mr Snow in to the church and they both took a seat at the vestry table.
‘I have written down the names of the streets where the dead were collected from yesterday and over the past few days.’ He passed the note book to John. John read the list of street names and looked at the Reverend.
‘What is the link Sir? The common factor?’ He furrowed his brow and looked again at the street names before him.
‘I have seen your work on the poor of London and the tabulations of the dead you have made. I thought you may be interested in this cluster of deaths. All of the houses are poor, all are in area of the great stink. But you and I know the stink, the miasma does not, in theory, cause disease.’
John Snow nodded and looked at the notebook and then at the Parish map. He ran his finger across the map and then asked,
‘May I draw on the map Henry?’
‘You may do so, here is a pencil.’
John drew some dots on the map on the streets that the undertakers had indicated they had collected bodies that previous day. He drew some lines on the map and looked at the street names in the note book again. He drew lines to join up the street names. They formed a definite pattern, quite what it signified puzzled him.
He puzzled over the map for a few minutes.
‘There are no public houses, no hostelries, nor as far as I know flop houses in that vicinity. All could potentially pass on the disease by social intercourse.’
Henry looked at the map and the lines and dots that John had drawn. He could see no connection to the cholera outbreak. John kept looking at the map and then said,
‘If I have it right, Henry. This symbol is a water pump.’ He pointed a small symbol on the map of a water pump. He looked at the Reverend, ‘The commonality to all these deaths is the Broad Street water pump. It is the one thing that all the houses have in common; the pump. The water they are drinking is infecting them with the cholera. Our figures suggest that there have been fewer deaths in areas that other pumps serve. With regard to the deaths occurring in the locality belonging to the pump in question, there have now been 61 instances in which we can see that the deceased persons used to draw water from the pump in Broad Street, either constantly or occasionally.’
‘The water John? How could drinking water give someone a disease?’ the Reverend looked puzzled.
‘The water in Soho is taken from the lower reaches of the Thames. The effluvia of the upper reaches of the Thames is then drawn into the pumps of Soho and beyond. This water may hold the key to the infections.’ He stopped for a moment pondering on a thought. ‘I have a memory that Filipo Pacini discovered a microscopic organism which he called a bacillus. He proposed that the creature passed on its deadly infection to humans. Of course, he was ignored by the scholars and still is. I believe that we may have stumbled on the causation of the deaths. The water is foul or otherwise fouled and thereby infected. We must alert someone in authority to this realisation.’
Henry thought for a moment then replied,
‘We will have to convince the great Dr William Farr of that theory, John. He holds all the power and authority with regard to the supply and sanitation of water in this city. I have heard he is a very difficult and powerful man. He, as you know, subscribes to the miasmatic and the zymotic theory of disease transmissions. He alone holds the key to halting disease in the city. He is hand in glove with the water companies too, so will have the power to halt any unintended pollution of the supplies. Conversely that alliance may work against us.’
In their fervour they both hadn’t noticed that Mrs Cramp, the reverend’s housekeeper, had brought sherry into the room just after they had sat down. She knew when the Reverend has a visitor, he always had a glass of sherry to offer them. The Reverend seeing his glass by his side took a sip of his sherry and crossed his hands over his lap, he felt good that they had possibly solved the conundrum.
John took a sip of his sherry,
‘I know of Dr Farr’s beliefs. He will buck against anything that opposes his long-held confidence Henry. He will fight tooth and nail to convince the world that his theory is the right model. He will quote the empirical knowledge from Miss Nightingale in the Crimea to add weight to his theory. I cannot deny that she has done good work and some will not allow an indirect criticism of her or her endeavours.’
John took a sip of his sherry. Henry took a sip too and said,
‘But she employs carbolic soap to clean her way to half sanitary conditions. I think Dr Farr conveniently forgets that fact. If he had his way, he would clean the poor from Soho, he asserts that their filth and squalor is a contribution to their mortality rate. I know there is a stink around those street’s but I remain convinced by you John, that it has little or nothing to do with cholera.’
‘I have a dear friend and ally in you Henry. We shall, together, prove my theory, our theory against the tide of miasmatic, zymotic theories. I will write to and then visit the Board of Guardians of St Johns’ Parish and have the pump disabled. Then we will see if the outbreak is connected or otherwise stymied by that action.’
With that he stood up and shook the Reverend’s hand, turned and bid him ‘Adieu’ then left the church.
The Parish council received a letter from John Snow setting out his theory that the water was, in his opinion, ‘fouled by external interventions’ and requesting that the Broad Street pump handle be removed or disabled. Soon after this letter was received John was called in to an interview with the Guardians of the Parish. He convinced the council of his view and they removed the pump handle the very next day. However, the people local to the pump vehemently objected to having to walk another two hundred yards to collect water. The incidences of cholera decreased; the Reverend visited fewer houses for prayers in the following months that the pump was out of use. He reported as much to John Snow.
John was delighted by the news and requested an urgent meeting with Dr William Farr to discuss his findings. The good doctor made excuses and put off quite a few planned meetings. In the end he capitulated to John’s constant requests. Capitulation is probably the wrong word, he wanted to meet with this upstart and quash his theory and prove his own notion of miasmatics. The theory Dr Farr subscribed to, had a long standing in science and the medical world, Galen had proposed it many centuries ago and it was now a fully accepted principle.
The meeting between the two men was set for October the fourth 1848 at the offices of the Southwark and Vauxhall Waterworks Company. Dr Farr had requested the meeting be held in their offices, as he knew that he could call on their opinions as to the quality of their water supplies to the city. He also wanted to demonstrate to Dr John Snow whom he was opposing in this matter.
John Snow on being informed of the date immediately wrote to Dr. Thomas Greenhow in Newcastle. He knew Dr. Greenhow had had similar findings with regard to a cholera outbreak in Newcastle. He too had noticed a correlation between a certain water pump and the incidences of cholera in the town. Together, John thought, they might persuade Dr Farr and the waterworks company that they must pay regard to the quality of the water being supplied to the water pumps in the major cities. Thomas Greenhow accepted the invitation with delight. His theory had been disregarded by the Parish Councils in Newcastle and the outbreaks of cholera continued unabated. He now thought he had a chance to influence opinion.
On the morning of October 4th 1848 John Snow, Dr Thomas Greenhow and the Reverend Henry Whitehead attended the offices of the Southwark and Vauxhall Waterworks Company. They were shown up to the boardroom of the company by a secretary. The secretary opened the huge, heavy oak double doors and bowed as the three men entered the room. Seated at the far end of the boardroom table were Dr William Farr, Sir Oliver Scratchwell, the Reverend Dr Peter Hobson, Dr Michael Pelling, Dr James Eyler and various members of the governing board of the waterworks company. The three men were faced with some seventeen people all of whom had a strong belief in the miasmatic theory in the transmission of disease.
They sat down and faced their opposition. They all knew that this was going to be an uphill battle but sense and science would prevail over folklore they thought.
Dr Farr looked sternly at the three men and smiled a half smile, a smirk in fact. He knew he had victory in his hands. He turned to Sir Oliver Scratchwell, who was the senior board member in the room, and whispered something to him. Sir Oliver nodded and smiled.
Dr Farr stood up,
‘May I welcome Dr John Snow, Dr Thomas Greenhow and the Reverend Henry Whitehead to this meeting. Sirs, I remained totally unconvinced by your specious arguments that cholera is transmitted in the fine water that this city provides. The good gentleman to my left and right are defensive of the quality of water their company supplies.’ The entire company sat at the table nodded in agreement. He continued, ‘They too remain unconvinced by your arguments and indeed your findings. These gentlemen all subscribe, as resolutely do I, that disease is spread by a miasma. I say again Sirs, disease is spread by a miasma, nothing else; save for the squalor and filth the people of this city choose to tenant themselves in. You have our attention Sir.’ with that he sat down and looked at the men to left and right.
John Snow stood up; he was trembling with the weight of opposition he had in front of him but he was sure of his facts. He held his papers up and read from them,
‘Sirs, The Reverend and I noticed a direct correlation between the outbreak of cholera and the preponderance of deaths in the locality of a water pump in Broad Street, Soho. The deaths all occurred within walking distance of the pump in the close surrounding streets of that very pump.’
Dr Farr interrupted John,
‘Speak up Sir, we cannot hear you.’
‘My apologies Sir. I was relating that the deaths all occurred within walking distance of the Broad Street pump. This, we believe, was not a coincidence. Some mortalities further from the pump were shewn to be because of the very fact, the very fact, that that person had drawn water from and drank water drawn from the Broad Street pump.’
Dr Farr impatiently waved his hand for John to sit down. He turned to his right then left and spoke to each person and made notes.
‘My colleagues inform me; you sir, with the aid of the Parish Council, had the handle of the pump removed and in doing so, you Sir, compelled the local people to walk to another pump to draw water. What have you to say?’
John stood up again,
‘I did Sir. And in doing so, proved that the link to the outbreak of this vile disease was directly conjoined to the water supplied at that pump. I have not long had a pit dug close to that pump and have found a cesspit to be in close proximity to the pump. That cesspit, I contend, contaminates the water with what the Italian scientist Dr Filipo Pacini calls Bacillus. The bacillus is prevalent in the faecal matter of the inhabitants of Soho. He asserts that these organisms excreted via and in the faeces of the local people infect the water and pass on the disease we know as cholera. My good friend Dr Greenhow’ John put out his hand towards the doctor, ‘had the same findings in Newcastle, he too found the proximity of cesspits and human waste to water supplies thereby contaminates the water supply and infects the inhabitants of the city. By removing that pernicious inclusion, we have shown a marked decrease in the incidences of infection by the cholera.’
Dr Greenhow stood up and pulled some papers from his attaché case. Dr Farr glanced up at him and imperiously waved his hand in a ‘sit down’ motion. Dr Greenhow did so.
Dr Farr coughed and put his hand down flat on the table, he moved his fingers in a rhythmic tapping motion.
‘I shall not stand and give your idiotic theories the credence you so clearly crave. Disease, Sirs, is transmitted in a miasmatic way. Sir, what would your Dr Paycernee be looking for? Disease is invisible!’
John and Dr Greenhow both stood up, John spoke first;
‘Dr Pacini, sir. He is an Italian scientist. He has seen a bacillus with his own eyes, sir.’
William Farr went red and formed a fist.
‘I am speaking Sir. It matters not. If, and I say if, your Dr Paycenee is correct about his microscopic creatures and the transmittal of diseases, then I assert that they travel to the host in the foul air that pollutes this city. No more, no less. Human waste has been used since time immemorial to fertilise fields. How then does it contain organisms malicious to human life? The squalor that the people of that environ generate provides a host for the cholera to breed in. Their very filth generates malodorous air. The Miasmatic Principle of transmission came from no less an authority as Galen. If you gentlemen wish to oppose that ancient rule of transmission; I will call you fools and scoundrels. You are mistaken Sirs. The very air we breathe holds the key to infection. The cool night air provides a zymotic route to infection. Miasmatic and Zymotic, the route to infection is proven and accepted. Infection comes from rotting organic materials that generate foul air. I suppose that you do not accept either that obesity is caused by the inhalation of food odours? I laugh in your faces gentlemen.’
John stood up his knees were trembling.
‘Sir, do not the populace of this great city and beyond deserve the benefit of clean water, free from disease?’
Dr Farr looked to his left and right then straight at John.
‘They Sir, deserve what they can afford! You impugn the gentlemen present at this meeting. These good gentlemen to my left and right need to put bread on their tables. You will have them swept into poverty with your ridiculous ideas. Sit down sir!’
The Reverend stood up and read from the Bible,
‘Isaiah 55, Sirs, Come, all you who are thirsty, come to the waters; and you who have no money, come and drink. The poor deserve to drink clean clear water gentlemen. Split the rock Sirs, let the water flow out.’
Dr Farr shook his head and looked at his committee.
‘Gentlemen, what say you? Shall you supply clear water for free?’
The committee all shook their heads and muttered a low,
‘No Sir, we shan’t.’
‘Dr Farr, I say he who has compassion on them will lead them and will guide them to springs of clean water. You Sirs, seem to have no compassion and will not lead unless there is a profit.’
The Reverend sat down and closed his Bible.
John immediately stood up as the Reverend Whitehead sat down. He wasn’t going to give Dr Farr time to respond to the Reverend’s scolding. Dr Farr’s face reddened in anger.
‘Sirs, will you not take the time and consider the work of Dr Greenhow, my work and the empirical findings of both myself and the Reverend Whitehead?’
‘No Sir. I will not! Sit down Sir, I have heard enough!’
John resignedly sat down and looked at Dr Farr. He knew that he and his companions were losing the case.
Dr Farr slapped the table again and started to stand, then sat down again and continued,
‘You three pseudo-scientific vagabonds will have every water pump in this fair city disabled! Every outbreak of the cholera will have you take up the hue and cry of ‘Shut down the water pumps’! You will take the bread from the very mouths of the fair gentlemen sat at this table. Your theory that faecal matter, I can hardly bear to say that word, infects and pollutes the very water that every man, woman and child in this city relies on, is sheer poppycock. Disease is airborne!’
Dr Farr again banged the table with his open hand and looked angrily at the three men opposite him. He continued, ‘Do the people of this city who have worked hard and provided a good life for themselves succumb to cholera? They do not! They do not! And why? Because Sirs, they choose not live in filth and squalor. They choose to have clean air surrounding themselves. They choose the fairer parts of this city to reside in. They choose to keep the air they breathe warm and unpolluted. That is why they do not succumb to the cholera.’
John stood up and picked up his papers again. Henry touched John’s arm in a gesture of support and looked up at him. John took Dr Greenhow’s papers and bundled them all together.
‘Sir, Dr Farr and the members present in this room, may I respectfully leave you with the papers of our findings? This is important to all the inhabitants of this fair city and cities beyond. They will show you….’ He didn’t have time to finish the sentence. Dr Farr angrily stood up and half shouted his reply,
‘No Sir, you may not. I, Sir am the authority on human health in this city. You may not pollute this boardroom with your ignorance and deceit. I cannot see why you continue to fly in the face accepted wisdom, of accepted facts, of putative understanding of the nature of the transmission of disease by miasmatic means. Return them to your drawer Sir, put them in your fire grate, dispose of them how you will; for gentlemen I will not foul my mind with such things. I will not foul this fair committee with such hokum! You are wrong. You are all wrong! History will prove that my theory, that the accepted premise is correct. Disease is airborne!’
Dr Greenhow stood up,
‘Respectfully, Sir William, as Dr Snow has informed you, I have found the same. Will you therefore decide to ignore our, I say OUR, a collective agreement?’
Dr Farr irately interrupted him,
‘Sit down Sir! Sit down! I will hear no more! Sir Oliver have the pump handle reinstated forthwith.’
‘Will you sir not accept our empirical argument that the water is corrupted by foul matter?’
‘Will you sir not accept that the collective empiricism of this committee is that the miasma creates the cholera? We sir, are right. You sir, are wrong.’
Dr Greenhow stood for a few moments that realised that Dr Farr would hear no more from him than he would from his companions. John touched Thomas’ back and gestured to have sit down.
He sat down and angrily shoved his papers back into his attaché case.
Sir Oliver nodded at Dr Farr and spoke to the person to his left who spoke to the person on his left who made a note of the request.
As Thomas sat down John whispered,
‘We have lost Thomas. Our argument is to be ignored. We have lost. Our wasted breath will now join the miasma.’
Dr Farr banged a gavel on the table, stood up, turned and left the room; the members of the committee all followed him like sheep. The three men stood and bowed to the committee and then left the room.
The pump handle in Broad Street was replaced the very next day.
The three men walked out of the Waterworks Building and stood in the street for a few moments. They were all, in truth, crestfallen. John rallied himself,
‘This incident will not deter me from this reflection.’ he extended his hand to Dr Greenhow and then to the Reverend.
‘Nor me.’ Dr Greenhow replied as he shook John’s hand.
‘I will not swerve from this thought either John. I will stay by your side.’ The Reverend Whitehead held on to John’s hand in a moment of consolation. They all knew that they had all been brow beaten in the boardroom. They all knew things would not change in the short term, but perhaps one day they hoped their theory of transmission would be accepted.
Dr Greenhow thoroughly disheartened, travelled back to Newcastle by the very next coach. He remained a physician and often prescribed that his patients boil water if anyone in the household was taken ill. He was later appointed physician at the Devon and Exeter Hospital and also worked at the Magdalen Hospital and The Lying In Charity and St Thomas' Hospital for Lunatics. Dr Greenhow led an active public life later becoming Mayor of Exeter. When cholera again posed a threat in Exeter, he believed in his findings and those of John Snow and tried as best as he could to put those principles into action by advocating the boiling of water and the drawing of water from fresher aquafers. The rate of cholera decreased by adopting those measures. He was re-elected Mayor the following year.
In the weeks after the meeting, the cholera epidemic subsided in Soho and vindicated Dr William Farr; there was no link to water and disease in his mind. To that end he victoriously published a paper in the British Medical Journal.
‘The Cholera Epidemic and Assertions &c by Dr. John Snow & Others.
After careful inquiry, We see no reason to adopt the belief of Dr Snow et al: That of transmission by water borne organisms in relation to the cholera epidemic. We do not feel it established that the water was contaminated in the manner alleged; nor is there before us any sufficient evidence to show whether inhabitants of that district, drinking from that well, [Broad Street in Soho] suffered in proportion more than other inhabitants of the district who drank from other sources. I therefore call a halt to this debate and do hereby close the matter in favour of the zymotic and of miasmatics principle of the transmission of disease.
Dr William Farr DM BMA.’
The status quo was returned: the water companies continued unabated to pump filthy water from the Thames and other water courses into the contaminated water pumps of London.
The Reverend Whitehead soon after the meeting at the water board accepted a posting in the Cumbrian village of Brampton and lived the remainder of his life in the clean, cool air of the countryside. He remained in contact with Dr Snow and Dr Greenhow. He wrote to Dr Snow soon after taking up his post,
‘John,
Do not be too disheartened by our interactions with the bullying, overbearing nature of Dr William Farr and his like-minded cohorts. We both know he, and they are wrong. One day our work, your work will be recognised and acted upon. Stay strong in your belief my dear man. God sometimes takes us into troubled waters not to drown us but to cleanse us.
I have now fresh waters the like of which the inhabitants of Soho will never experience whilst Sir William Farr holds power. It is truly the nectar of God. With each sip I remain thoughtful of the forced ingestion of those foul waters exacted on those poor souls by their cruel masters and figures of authority.
Give us water that we may drink is all they demand and deserve as God’s children.
I remain yours,
Henry Whitehead.’
John Snow kept that letter in the drawer of his desk and would often refer to it when things became impossible for him. Dr Snow remained a passionate advocate of making water cleaner for the inhabitants of the city of London. However, he soon became sought after in the world of surgery as his principles of anaesthesia became more and more accepted. He made a good living for himself in that expression of his talents and became a surgeon to the Royal Household. On 7 April 1853, Dr Snow administered obstetric anaesthesia to Queen Victoria on the birth of Prince Leopold, and again on the birth of Princess Beatrice on the 14 April 1857.
Dr John Snow passed away in 1858 aged 45 having never seen the results of his, Dr Greenhow’s and the Reverend’s findings carried out.
The Reverend Whitehead on learning of John Snow’s death journeyed from Cumbria and conducted the service at his funeral.
Dr Thomas Greenhow travelled up from Exeter to read the eulogy; both men had stayed loyal to John Snow and his findings.
The scourge of cholera continued to plague the streets of London until 1866 when Dr William Farr finally accepted John Snow’s findings; this was after his results from statistics with regard to an outbreak in east London led him to consent John’s assertions. Dr Farr on collating the death figures from cholera in London noticed a higher incidence of the disease in the areas that were served by the Old Ford Reservoir in east London. He immediately ordered that all water drawn from the reservoir be boiled before consumption; in doing so the incidences of cholera reduced and then ceased.
John Snow’s work had finally come to be accepted by his greatest critic.
As a naïve teenage, I frequently walked the streets of London, especially Carnaby Street, Kings Road and Oxford Street, looking for the latest trends. On a few occasions I saw Stanley Green and like many people walking past him, I looked back and smirked, with a puzzled look, at this small framed old man with a billboard that looked larger than him. One afternoon, my friends and I saw Stanley Green outside the Piccadilly Circus Trocadero and we poked fun at him, only slightly. Now here am I, a poor old guy, who is older than what Stanley Green was when I first met him walking about peacefully with his billboard and I realised that he had a point.
ReplyDeleteAnthony Lewis 11th August 2021