In Which London Gets Cholera (Then Gets it Again...and Again...)

The late 1800s was a turning point in history, especially in Great Britain. With peak of the industrial revolution came not only a massive boom in production, but also a mass migration to large cities in order to meet the new demand for factory workers. To be expected, when you take an already decently sized city and suddenly transform it into the largest city in the world, there are going to be a lot of aspects of living that will lag behind. As more and more people packed themselves into the city, many were forced to live in over-crowded slums with a lack of even the most basic amenities.

A quick reminder: this is the Industrial Revolution. 

Flushing toilets were invented in the 1500s.

A sewage system was in place, no matter how rudimentary (can't have Les Mis without it).

The Bubonic Plague happened over 400 years prior. 

Germ theory exists.

I just need you to remember all of this, because there's a much bigger reason that having so many people packed together was such a big problem:

Sanitation. 

When I say there was shit piled in the streets, I mean literally. Imagine those movies placed in renaissance era where they just slopped their -- *ahem* leftovers -- into the streets through an open window and let it drain into the sewers. Yeah...that's still a thing. Remember: these people are the lowest of the low class. Elementary aged children are forced to work in the factories just to make ends meet at home. Food is scarce, bathing probably happens once a month if you're lucky, and you have no other choice but to live in a tiny room on a crowded street away from the "upper society" (I literally just mean middle class here) crammed together with a dozen or so other people who may or may not even be related to you. You are up before dawn, walk to work in the stinking streets of London where it's almost always wet and cold, work some sort of manual labor all day in a factory where OSHA isn't even a twinkle in their eye, and then walk home after it's dark to lie on a hard mattress on the floor in a room crowded with a million other people's germs. 

A bit of an introduction to Cholera as a disease: it's spread via water (please, for the love of whatever higher being you do or don't believe in, don't fall for "raw water" bs). It's incredibly rapid with symptoms, bringing nausea, vomiting, diarrhea, lethargy, dehydration (ya know...from all the vomiting and diarrhea), erratic heartbeat, sunken eyes, dry skin, and a blue tinge that became characteristic of it. 

Before effective filtration of sewage, that shit (pun intended) was just dumped into their rudimentary systems, which at the time were incredibly thin and couldn't handle massive amounts of waste anyway, and just left to hang out until it seeped back into the groundwater. By the time of the first Cholera outbreak, once they realized that it wasn't just...going away and that they kind of needed those poor people to fulfill their capitalist dreams, the government decided they should probably do something about it. However, they had no idea what was going on. At all. They were under the impression Cholera was an invading disease from Asia (sound familiar?) and really didn't even know where to start. 

In steps: Edwin Chadwick!

He perty dumb. 

Alright, let me clarify...considering he was the expert they brought in to fix everything:

He perty dumb.

Edwin was still a firm believer of Miasma Theory, the idea that disease was spread through the presence of "miasma," or the stench that wafts from decaying things. To his credit, it was through his action that brought about the Public Health Act of 1848 and established the Public Board of Health (of which, of course, he was the head). His goal was, "If we clean up the slums and make people bath more and wash their hands, then they'll stop dying! Maybe then they'll stop using so much dang welfare!" 

Sounds great in theory, right? Clean people, clean living conditions clean drinking water ----

Nope. Not that one. 

Edwin (thinking the biggest problem was that everything just smelled bad) had the bright idea to just, to quote Patrick Star, "Push it somewhere else!" That "somewhere else" happened to be the River Thames, the main source of drinking water for like...everywhere. And where does Cholera come from, ladies and gents?!

That's right. 

Water. 

Our boy, Edwin here, managed to increase the virality of Cholera. We love it. 

Around that time there were two main theories around diseases and another, smaller, theory that was just starting to take hold. 

First, there was the aforementioned Miasma Theory. Prevention included washing you walls and floors, good hygiene and sanitation, and even going so far as to just spray perfume around in a sort of "out of sight out of mind" fix.

Next, there was the Contagion Theory. This was the idea that the main way (possibly only way, who knows) that pathogens spread was person to person, explaining why those who cared for the sick so often fell ill themselves. Prevention included quarantine and preventing any sort of direct contact with the sick, including not letting travelers into a town that was known to carry the disease (this goes back as far as the Bubonic Plague). 

Finally, there was the one that was starting to grasp how it was a little bit of both: Germ Theory. People were starting to recognize that there had to be some sort of disease causing agent and that agent could be transmitted in different ways, though they weren't sure yet why some people were able to walk away unscathed. 

Since Germ Theory was so new and the main consensus of the time was still pretty archaic (remember, we are somehow in the 1800s), anything that differed from the "norm" was almost entirely dismissed. By the third Cholera outbreak (the first appeared in 1831, it's only 1848) a scholar by the name of John Snow (real and fictional hero) published a prediction on why he believed Cholera to be a waterborne pathogen. I managed to find scanned copies of some of his publications, including his infamous On the Mode of Communication of Cholera and I genuinely think I love this man. He managed to deduce that, yes, these people are very dirty, but they are also coming in contact with one another all the time. The people who get infected are dying, the people who live with them are dying, the people who come to visit or care for them, even attend their funerals, are dying. However, the physicians who go in and out of these houses, do not eat or drink with them, and wash their hands before and after are not dying. Snow looked at that and decided that, if that's the case, it couldn't be something in the air, it had to be something they were ingesting. In order for this to become as much of an epidemic as it was and factoring in where the waste goes, assuming that the Cholera can survive passing through the body, Snow decided that the only thing that made sense was that it was in the water. He went throughout infected towns, house to house, and drew extensive maps with copious amounts of data, eventually able to pinpoint where exactly some of these outbreaks were coming from, which water stores had to have been contaminated. It was 1849 (ish) and Snow had figured it out.

So, of course, he was ignored. 

The Committee of Scientific Inquiries can even be quoted saying, "...we see no reason to adopt this belief. We do not find it established that the water was contaminated in the manner alleged...nor is there before us any sufficient evidence."

*they say staring at oodles of sufficient evidence*

Nevertheless, the third outbreak was allowed to happen, and this time it was massive. Snow, who lived around the Broad Street area where there was a large portion, continued his research and once again tracked the source: a single pump in the middle of the square that was shared by one and all. After pushing and pushing he finally got public officials to remove the handle from the pump in an attempt to stop the spread, but at that point the worst of it had already subsided. Our hero really only got his day in the sun postmortem, unfortunately. 

But wait!

There's! One! More!

A fourth and final outbreak in 1866 (because they still haven't listened to the guy that figured it out), finally convinced a member of the General Board of Health, "Hey! Maybe this guy isn't so crazy!" And he, William Farr, published a statistical analysis of the mortality rate of those who drew water from Old Ford Reservoir, proving higher than it should be. Only then were the findings found conclusive. 

I guess that works.

After all those years, they finally managed to find an engineer to redo their sewer system in a way that wouldn't have them drinking literal shit water!

*yay*

Poor citizens in desperate need of work, managers newly in desperate needs of disposable hands, infrastructure that wasn't able to manage the rapid influx of people and their excrement, stubborn intellectuals who are pretty sure they already know everything thank-you-very-much, and a world possibly still recovering just the slightest from the Dark Ages...

a recipe for Cholera, cooked up and ready to go. 

Sources! All super interesting, you really should at least skim the og journals. Historical texts are super cool. 

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7150208/

https://www.cdc.gov/csels/dsepd/ss1978/lesson1/section2.html

https://collections.nlm.nih.gov/ext/cholera/PDF/0050707.pdf

https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(00)02442-9/fulltext?version=printerFriendly

https://www.sciencedirect.com/science/article/abs/pii/S0277953609004845?casa_token=g7ZnYRcYAxkAAAAA:c9pNBmrHB2BCjKmiQYbCbVXM1oAwtg6MnPWjTmRz8zhUEloHM8Qd5P_W4hZyGDzPYrd6SgJkNrI

https://www.sciencedirect.com/science/article/pii/S1353829220303786?casa_token=ettOLu1tZggAAAAA:wMH5OnhWrZAsnU_IUvYYbJ7Mf65qfAO_1a9U_idYalMPrq2mCfg5DXCjXV79bwGj1gcP6wuF0M8

https://www.jstor.org/stable/40543358?casa_token=uATqBPswYb0AAAAA%3Akef-4fIBWtWiTTOYpraeQ1SNdJA0llo3gQko314fmo8PjHTMDzrtDmranaA40i_rjnUlY8H4OiPwq6OJKab8LhBhNrUD7kIra5stFk6FDcJCzOxnOyO0&seq=1#metadata_info_tab_contents

https://www.sciencemuseum.org.uk/objects-and-stories/medicine/cholera-victorian-london