Chapter 50: Public Health Breakthroughs
The 19th Century was fraught with public health challenges – many of them spurred by the Industrial Revolution. In this episode, we look at environmental health, alcoholism, and cholera, in particular. And we see how the scientists, policymakers, and mass movements of the age addressed these challenges.
Sources for this episode include:
“A Nation of Drunkards.” Prohibition. Written by Geoffrey C. Ward. Directed by Ken Burns and Lynn Novick. Florentine Films. 2011.
Allitt, Patrick N. “The Industrial Revolution.” The Great Courses. 2014.
Beach, Brian and W. Walker Hanlon. “Coal Smoke and Mortality in an Early Industrial Economy.” The Economic Journal, vol. 128, 615, pp. 2652-2675.
Beaven, Brad. “The modern phenomenon of the weekend.” BBC: Worklife. 20 Jan 2020. https://www.bbc.com/worklife/article/20200117-the-modern-phenomenon-of-the-weekend
Beecher, Lyman. “The Nature and Occasions of Intemperance.” Six Sermons on Intemperance. R. Marvin. 1828
Bibby, Miriam. “London’s Great Stink.” Historic UK. https://www.historic-uk.com/HistoryUK/HistoryofBritain/Londons-Great-Stink/
Campbell, Richardson. Rechabite History: A Record of the Origin, Rise, and Progress of the Independent Order of Rechabites. The Board of Directors of the Order. 1911.
Daunton, Martin. “London’s ‘Great Stink’ and Victorian Urban Planning.” BBC: History Trails. 4 Nov 2004. http://www.bbc.co.uk/history/trail/victorian_britain/social_conditions/victorian_urban_planning_01.shtml
Hanlon, W. Walker. “Coal Smoke, City Growth, and the Costs of the Industrial Revolution.” The Economic Journal, vol. 130, 626, pp 462-488.
Harrison, Brian. Drink and the Victorians: The Temperance Question in England 1815-1872. (1971) 2nd Edition. Keele University Press. 1994.
Jevons, W. Stanley. The Coal Question; An Inquiry Concerning the Progress of the Nation, and the Probably Exhaustion of our Coal-mines. Edited by A.W. Flux. 3rd Edition, Revised. MacMillan and Co., Ltd. 1906.
Johnson, Steven. The Ghost Map: The Story of London’s Most Terrifying Epidemic – and How it Changed Science, Cities, and the Modern World. Riverhead Books. 2006.
Livesey, Joseph. The Staunch Teetotaler. Tweedie. 1868.
O’Malley, L.B. Florence Nightingale 1820-1856: A Study of Her Life Down to the End of the Crimean War. Thorton Butterworth Ltd. 1931.
Shy, Carl M. “Toxic Substances from Coal Energy: An Overview.” Environmental Health Perspectives, vol. 32, 1979, pp. 291-295.
Stradling, David, and Peter Thorsheim. “The Smoke of Great Cities: British and American Efforts to Control Air Pollution, 1860-1914.” Environmental History, vol. 4, no. 1, 1999, pp. 6–31.
Thompson, E.P. The Making of the English Working Class. Vintage. 1966.
Full Transcript
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Economics is sometimes called “the dismal science” – and, really, can you blame the people who call it that? First comes guys like Thomas Malthus preaching sexual abstinence and the elimination of poor relief as the best ways to prevent mass starvation. Then comes guys like Karl Marx saying the only reason we’re better off today is because all the workers are being exploited by their bosses and the whole system is doomed to collapse anyway.
Well, in 1865, another economist came out with another one of these buzzkill theories. William Stanley Jevons published the book that made him famous: The Coal Question; An Inquiry Concerning the Progress of the Nation, and the Probable Exhaustion of Our Coal Mines.
Now, this episode is not going to be the last we hear about William Stanley Jevons, as he is a giant in the history of economics – and The Coal Question is far from his most important work. But it stood out in it’s time because it acknowledged two important facts which, put together, were pretty terrifying. (1) Coal is critical to our economic growth; and (2) coal is a finite resource – we can’t keep mining it forever.
As Jevons wrote of the situation facing the United Kingdom…
“Coal in truth stands not beside, but entirely above, all other commodities. It is the material source of the energy of the country – the universal aid – the factor in everything we do. With coal almost any feat is possible or easy; without it we are thrown back into the laborious poverty of early times.
“With such facts familiarly before us, it can be no matter of surprise that year by year we make larger draughts upon a material of such myriad qualities – of such miraculous powers. But it is at the same time impossible that men of foresight should not turn to compare with some anxiety the masses yearly drawn with the quantities known or supposed to lie within these islands.”
Now, Jevons was just about the polar opposite of Karl Marx. But like Marx, he was moving economics away from the theoretical abstractions of political economy and into the realm of social science. He turned to natural science and to history to develop his ideas.
In particular, he turned to geological surveys and to coal mine output data going back to the 1700s. He noted that, ever since the efficiencies of the Watt steam engine were made available, coal production was accelerating. It was counterintuitive to be sure. As steam engines became more fuel efficient, fuel consumption should have decreased, not increased. But the steam engines were so beneficial to economic development that they were constantly increasing the demand for coal.
Today, this phenomenon is seen with many new technologies and natural resources, and it’s known as the Jevons Paradox.
Based on the coal that was estimated to be available in the British Isles at the time, and how much coal would be needed to continue economic growth at the rate the British had become accustomed to, Jevons speculated the party would be over within a century.
So, he sounded the alarm bell…
“...the absolute amount of coal in the country rather affects the height to which we shall rise than the time for which we shall enjoy the happy prosperity of progress.
“Suppose our progress to be checked within half a century, yet by that time our consumption will probably be three of four times what it now is; there is nothing impossible or improbable in this; it is a moderate supposition, considering that our consumption has increased eight-fold in the last sixty years. But how shortened and darkened will the prospects of the country appear, with mines already deep, fuel dear, and yet a high rate of consumption to keep up if we are not to retrograde.”
Except, Jevons admits that retrograde is unlikely – especially without government intervening with conservation legislation, something he is opposed to. He explores substituting coal with other kinds of energy sources, but these are also fraught with problems because either (a) these resources are finite too; or (b) if renewable energy technologies become practical (and yes, he is talking about wind and solar power in 1865), then Britain will lose the competitive advantage it enjoys with its coal reserves.
Jevons makes some suggestions about things that can marginally delay the inevitable but, ultimately, he’s kind of at a loss about how to save the UK’s long-term prospects.
The Coal Question serves as one of the first forays into the topic of natural resource conservation – making it one of the first books on environmentalism in the Industrial Age.
But that was just one environmental problem to consider when it came to coal. There was another big one facing the people at the time that Jevons didn’t address: Coal smoke – like other environmental factors and various industrial-era diseases – was literally killing people. But also around this time, scientists, policymakers, and whole mass movements began taking on these challenges with new vigor and new approaches.
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This is the Industrial Revolutions
Chapter 50: Public Health Breakthroughs
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Part 1: Environmental Health
Researchers have, by now, well demonstrated the negative health effects of coal smoke. Sulfur dioxide, particulate aerosols, and other products of coal combustion lead to higher rates of chronic bronchitis, emphysema, asthma, and various other forms of heart and lung disease.
Cities with higher rates of coal burning also have higher rates of human mortality, especially when they also have weaker clean air regulations. One recent study suggests coal smoke was responsible for as much as a third of the urban child mortality cases of the later 19th Century. In the industrial cities of the time, that smoke also stung the eyes of residents, left them short of breath, dirtied their clothing, and left soot on everything they owned.
And the people of the time started complaining, quite a bit, about all the dark, sometimes even yellow coal smog in Britain. Friedrich Engels mentioned it in The Condition of the Working Class in England in 1845. In 1866, The Times in London wrote of how, “Coal smoke forms a continual dark and dense canopy over the town, and causes a murkiness in the streets from which they are never free…The constant inhalation of these black particles…must be highly irritating to the lungs.” In an 1882 article, The Times noted, “There was nothing more irritating than the unburnt carbon floating in the air; it fell on the air tubes of the human system, and formed a dark expectoration which was so injurious to the constitution; it gathered on the lungs and there accumulated.”
And coal smoke was far from the only environmental health problem to be seen.
In the summer of 1858, the stench of the River Thames became too much for the people of London. Sewage and industrial waste lined the banks of the river, sometimes as high as six feet above water level. That June, temperatures reached well over 100 degrees Fahrenheit, baking the organic debris in a dry heat. The curtains in the Houses of Parliament had to be soaked in chlorine of lime to cover the “noxious stench” from the river below the windows. Members of Parliament took just 18 days to rush through a bill to boost spending for a new sewage plan for the nation’s capital.
The episode became known as “The Great Stink” – and it had been years in the making. The city was growing fast. With additional people came additional waste. And the jobs the people went to – in the new factories, tanneries, breweries – were further contributing to the problem. But the infrastructure of the city was, more or less, the same as it had been in the Elizabethan Age. Waste removal was largely the work of homeless scavengers.
Several efforts were made to modernize London’s sewage disposal system over the previous three decades, but the costs associated with them were deemed too high. So, London’s sewers continued dumping raw waste – some human, some horse, some from factories and tanneries and so forth – into to river.
As The Illustrated London News put it:
“We can colonise the remotest ends of the earth; we can conquer India; we can pay the interest of the most enormous debt ever contracted; we can spread our name, and our fame, and our fructifying wealth to every part of the world; but we cannot clean the River Thames.”
Smell aside, it was already suspected that Father Thames was killing his children. At least three cholera outbreaks were blamed on the filthy river. The most poignant image of the Great Stink was an illustration in Punch Magazine called “The Silent Highwayman.” It portrays Death, himself – a hooded skeleton figure – rowing a rowboat along the Thames. Behind him is the London skyline – including smokestacks and the great dome of St. Paul’s Cathedral. Under him are the floating corpses of the river’s inhabitants.
The challenges with urban density were spiraling out of control, all over the country. By 1851, life expectancy for a boy born in central Liverpool was just 26 years, compared to 57 years for a boy born in a small English market town. Cholera, typhus, and typhoid kept breaking out, and no one knew exactly why. “Summer diarrhoea” – an illness spread by the swarms of flies feeding on all the manure in the streets – must have been particularly fun to deal with.
Poor ventilation and damp conditions in the hastily-built homes for the new working class, as well as the worksites they labored in, also contributed to the poor health.
And another urban environmental problem they were increasingly dealing with was noise.
Noise pollution is so reduced nowadays that we barely think about it, but cities used to be considerably louder. Between the sounds of the steam-driven mills and trains, the horses in the cobblestone streets, bells and whistles, and other noises common to urban life, it started to get maddening. But it was more than a nuisance – people were going deaf from it.
So, between the coal smoke, the terrible water, the waste, and the noise, folks, more and more, wanted out. The new railways allowed people to settle themselves further and further out from the centers of the cities. Suburban sprawl had begun.
It would take more than a century of environmental legislation to adequately address these problems. And we are at the point, in this podcast, that that century begins.
Now, as early as 1821, Parliament passed an act banning coal smoke emissions from steam engines within London, although this law was often ignored. In 1863, they passed the Alkali Act, which created the new role of Alkali Inspector, charged with regulating emissions at soda ash factories. The goal was to reduce hydrochloric acid gases coming from these chemical plants. The act was expanded in 1874. All in all, these were among the first efforts to regulate air quality in the Industrial Age.
With the Public Health Acts of 1866 and 1875, Parliament took on other unsanitary conditions in British cities. The first act created new drainage districts and empowered local governments to address the growing debris. The second act went further, demanding local governments tend to their local infrastructure, regulate housing and street conditions, and take control of their water supplies. However, both of these acts fell short of expectations, providing for only small fines and plenty of very large loopholes for polluters.
Similar developments were seen across the pond. In 1869 and 1871, the cities of Pittsburg and Cincinnati passed ordinances to limit coal smoke.
More would come. But, first, let me tell you about another, though very different kind of public health crusade that was taken up in the mid-19th Century.
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Part 2: Temperance
One of things Jevons wanted to get across in The Coal Question was coal’s role in economic development. And the reason he believed this was so important was because economic development – with some redistribution of the gains made, through a new system of general education – could go a long way to improving the conditions of Britain’s working class.
As he put it:
“It is a melancholy fact which no Englishman dare deny or attempt to palliate, that the whole structure of our wealth and refined civilization is built upon a basis of ignorance and pauperism and vice...The ignorance, improvidence, and brutish drunkenness of our lower working classes must be dispelled...”
The upper classes of England had tried reforming the behaviors of its working classes for a long time, by this point.
In 1802, the evangelical Member of Parliament, William Wilberforce, had established something called the Society for the Suppression of Vice. It aimed to eliminate a lot of sins – animal cruelty, prostitution, gambling, naughty language (which sort of derailed it into the realm of political censorship), and public drunkenness. Over the next 50 years, or so, the Society introduced Great Britain to the values system we now describe as “Victorian.”
Combatting drunkenness, in particular, was always high on the list of priorities. Bourgeois masters had, for years, tried reigning in the practice of “Saint Monday” – in which workers would stay home the first day of the work week to get drunk. But it wasn’t until these masters began giving half-days on Saturdays that workers could actually be counted on to show up on Mondays.
Europeans had been drinking alcohol for centuries, of course. Ales and wines were generally safer to drink than the local water supplies. As Britain industrialized and urbanized, that only became a more and more relevant fact of life. But also as Britain industrialized and urbanized, the manufacture of alcoholic beverages became more advanced. Breweries were pumping out more and more beer, which (for a time) became higher in its alcohol content. And distilled spirits were becoming ever more commonplace – and with them, drunkenness.
Looking back on it, of course, we recognize here a different kind of public health crisis on the rise: A disease called alcoholism.
I’ve talked about this a lot on the podcast in the past. And so I want to take a second and make it clear: I’m not a teetotaler or a prohibitionist or anything. I enjoy a pint, or glass of wine, or cocktail as much as the next person. But alcoholism is a legitimate disease suffered by an estimated 100 million people around the world today. And in the 19th Century, alcoholism was way, way bigger problem.
As much as the elites looked down upon the drunkenness of the working classes, though, it was the working classes themselves who first stepped up to combat the disease.
At first, the movement didn’t seek total abstinence from alcohol, only temperance (that is, moderation). But as the years went by, “temperance” became something of an umbrella term for teetotalling and even the prohibition of alcohol.
Joseph Livesey was born in a small village outside Preston in 1794. He came from a family of cloth manufacturers who were getting squeezed out of the market by the increasingly industrial mills of the surrounding area. You probably don’t remember, but I briefly mentioned Livesey back in Chapter 41. He left the increasingly futile work of traditional weaving to sell cheap cheese to his neighbors. Not only did he become a successful merchant, he used the fruits of his success for philanthropic efforts and to advocate for social reform. He began publishing a monthly magazine called The Moral Reformer.
From an early age, Livesey had been surrounded by drunkenness. In his autobiography, he recalled the struggling weavers, navvies, a local gravedigger, and other workers in his community growing up, who went about their lives barely able to stand they were so drunk, so often.
Then in 1832, Livesey and a group of seven Preston workers got together and signed a pledge, vowing never to drink alcohol again. This was at a time when not only was the water foul, but alcohol was a widely prescribed medicine – one that would have been prescribed to people like Livesey, who suffered from rheumatism throughout his life. The Moral Reformer was soon after renamed the Preston Temperance Advocate.
The Temperance movement soon spread.
In 1835, the British Temperance Association formed, following Livesey’s lead. Also that year, a group of Manchester-area workers got fed-up with having to go to a pub for their friendly society meetings. (As Methodists, they wanted to engage in labor organizing without everyone around them binge drinking.) So, they gathered at a coffee house in Salford and established a new friendly society: The Independent Order of Rechabites. Named after a wine-abstaining figure from scripture, the Rechabites soon spread, setting up their “tents” (what they called their lodges) across the country, as well as to North America, Australia, and New Zealand. Workers who abstained from drinking alcohol could contribute to funds for their health, dental, and burial insurance.
In 1837, the new Queen Victoria began supporting the British and Foreign Temperance Society, which had over 85,000 members across England and Wales. Unlike previous anti-drinking movements, it prided itself on trying to help drunkards rather than toughening penalties for drunkenness – a position also taken by Livesey.
Temperance was even a current in the Chartist movement. So-called “temperance chartists” like our old friend, the Trade Unionist William Lovett, encouraged teetotalling. He believed that, by staying sober, workers could prove to the elites that they could be trusted with the vote – that their votes wouldn’t easily be bought with liquor. And this was a real concern. Because – guess what? – that is totally starting to happen over in America during these years, the one country in the world where industrial workers had the right to vote.
Of course, in the U.S., alcohol didn’t have quite the same class distinctions. All sorts imbibed – rich and poor, educated and unskilled. Drinking accompanied activities as common as breakfasts, work breaks at the growing factories, the closing of business deals, etc. By 1830, American men over the age of 15 were drinking, on average, 88 bottles of whiskey per year – roughly three times as much as their descendants consume today.
Like the pubs did in Britain, saloons provided community for the workers coming into the growing American cities, and a refuge from the drudgery of the labor of the Industrial Revolution. Plus, workers could use the saloon to find out who was hiring, to cash their paychecks, to play games, to sing songs, to get a free (albeit salty) lunch, to organize unions and other organizations, to meet with political representatives, and more.
And also like in Britain, America had a temperance movement growing.
Driving it was the Second Great Awakening. (Shout out Chapter 45!) Clergy members encouraged temperance as the use of hard spirits spread across the young country. Among the most famous was the Presbyterian minister Lyman Beecher who, in 1826, published his Six Sermons on Intemperance.
“Intemperance is the sin of our land, and, with our boundless prosperity, is coming in upon us like a flood; and if anything shall defeat the hopes of the world, which hang upon our experiment of civil liberty, it is that river of fire, which is rolling through the land, destroying the vital air, and extending around an atmosphere of death.”
But there was a secular approach to temperance too. In 1840, six alcoholics in Baltimore gathered to establish the Society of Reformed Drunkards. It would eventually be renamed the Washingtonian Society – a precursor to Alcoholics Anonymous. They signed a pledge to never drink again, and to turn to each other for support. To these ends they would share their stories with one another, creating an atmosphere of friendliness and openness.
Many more temperance societies would pop up as the years went by. In the UK, they included the British Temperance League, the Church of England Temperance Society, the United Kingdom Alliance, the Sunday Closing Association, and the Central Association for Stopping the Sale of Intoxicating Liquor on Sundays. In the US, they included the American Temperance Society (founded by Beecher and eventually merged into the American Temperance Union), the Teetotal Abstinence Society, Sons of Temperance, the Cold Water Army, and perhaps most important of all, the Woman’s Christian Temperance Union.
On both sides of the Atlantic, these organizations not only advocated for temperance in public policies, they also worked to support women and children, and to offer alternatives to alcohol. Clean drinking water fountains were established by the London Association and the WCTU. The National Temperance League succeeded in making the Great Exhibition of 1851 (Shout out Chapter 46!) alcohol-free. Drinking fountains and new, mass-produced soft drinks like Schweppes’ soda water and ginger beer were made available instead.
Also in these organizations, we see the peculiar mix of progressive and conservative influences that made up the Temperance Movement. And it makes sense, because the alcohol problem of the 19th Century alarmed different people for different reasons.
Workers were spending money on alcohol rather than providing for their families, even draining their savings for nights out with the boys. And this was happening at the same time that many were talking about strikes for better pay. So, employers had good reason to encourage temperance.
Working men were also coming home drunk and abusing their wives and children. So temperance, and eventually prohibition, became a major issue of the early women’s rights movement. Susan B. Anthony and Elizabeth Cady Stanton were among those who took up the charge of the Temperance Movement. (Shout out Women’s History Month!)
As we’ll discuss more in a few months, this was also an age of massive global migrations. In Britain, many Irish workers had come over to escape the famine, and the native Protestants quickly pointed to these Catholic outsiders as the worst abusers of alcohol. In the U.S., there was also a swelling of Irish immigrants, and Germans too – both of whom brought along their drinking cultures. And for the mostly-WASP citizens here already, the problems they saw in alcohol went hand-in-hand with their xenophobia.
Finally, it really was a public health issue. With super-strong liquors for sale, American states and communities were having to set up so-called “inebriate asylums” for addicts. Similar “reformatories” were proposed in Britain by Donald Dalrymple MP, who described habitual drunkenness as “a disease, which...got possession of the nervous centres” (an increasingly popular belief at the time). Police were (at times) arresting hundreds of thousands of people per year for crimes related to excessive drunkenness.
The results of this movement, though, were mixed.
In the UK, the middle classes were the strongest adherents of Victorian virtues – moderation in alcohol consumption being among them. And class signaling was a major factor of the British temperance movement. As the Radical MP John Arthur Roebuck put it, “It is a mark now that a man is not a gentleman if he gets drunk.”
At most, though, only about one out of 15 Brits were teetotalers in the mid-1800s. (The British Temperance Advocate once estimated it was like one in four, but that was – frankly – ridiculous.) Hard data is incomplete, but there’s records of tens of thousands of pledged teetotalers in various organizations at various points in time.
And although there was not much of a change with the rates of consumption for wine and spirits, beer drinking fell about 40% between 1800 and 1848. But by the 1880s, it was back to its previously high levels. Writers bemoaned that the laboring classes had not given up the sin of drunkenness.
From the 1820s to the 1880s, Parliament passed over 30 bills trying to better regulate the production and sale of alcohol. For example, our old friend, Lord Shaftesbury, tried banning the practice of distributing wages at the pub at the end of the week. In the 1850s, the Gladstone government gradually raised taxes on alcoholic beverages to encourage public morality (as well as to increase revenues), while they lowered taxes on coffee, tea, and sugar. (Shout out chapter 45!)
But the big reform came in 1872, with the passage of the controversial Licensing Act. It regulated beer adulteration, set closing times for pubs, increased fines for public drunkenness (especially when operating machinery), and gave local governments the power to limit the number of pubs per capita, neighborhood by neighborhood.
The Licensing Act met with resistance from liberals (who disagreed with free market intervention), from prohibitionists (who believed the act didn't go far enough), and from tens of thousands of workers who literally rioted in several places when police tried to close the local pub for the night.
But the Licensing Act also seems to have achieved its aims. Alcohol licenses per capita peaked in the 1880s, and then started coming down, as did overall alcohol consumption.
There were other factors that contributed to it. For example, a major debate of the time had to do with whether it was excessive labor or idleness that led to drunkenness. On the one hand, men who worked 12 hours a day, 6 days a week, needed to blow off some steam (figure of speech) on Saturday nights – and that usually involved heavy drinking together at the pub. On the other hand, it was also a common problem to see unemployed workers spending their time at the pub.
But from the 1840s through the 1880s, a major campaign got underway – supported by religious leaders, trade unionists, and even many manufacturers – to provide a half-day on Saturdays. By closing the factories by 2pm, it was argued, you would have a sober and refreshed workforce showing up Monday. Across the country, this practice was gradually adopted by more and more employers. And that’s how the “week-end” became a thing.
Also, the alcohol content of beer started falling. Increasingly, British drinkers were turning to lighter beers like Bass. And American drinkers were turning to a slew of less-alcoholic lagers brewed by German immigrants like Frederick Miller and Adolphus Busch.
In the US, temperance morphed from a social movement into a full-fledged political movement. As early as 1851, the state of Maine banned the sale and manufacture of alcohol – the result of a successful lobbying campaign orchestrated by Portland Mayor Neal Dow. However, the Maine law was off the books by the 1860s.
In the 1870s and on, massive protests would break out against saloons and liquor dealers. Women would block entry to drinking holes, praying, and demanded pharmacists sign pledges to stop fulfilling alcohol prescriptions. Temperance movement leaders used the new railways to travel the country, making speeches, as well as modern communication technologies like mass printing and the telegraph to spread news articles, petitions, etc.
Chief among them was Frances Willard, a self-described “Christian socialist” who fought for women’s suffrage, an eight-hour workday, public education, and children’s rights. (She famously got one state to raise the age of sexual consent from 10 to 16.)
But her most famous work was for the Temperance Movement. A founding member of the Woman’s Christian Temperance Union, Willard worked her way up to the presidency five years later, making it the most prominent organization in the movement. She personally travelled a whopping 30,000 miles per year, making an average of 400 speeches per year, and built one of the country’s first national newspapers, a Prohibitionist weekly called The Union Signal.
Within the WCTU, she founded a Department of Scientific Temperance Instruction, which tapped public schools to spread alcohol abstinence propaganda, teaching kids the infamous chant, “Tremble, King Alcohol, we shall grow up!” Thanks to Willard’s efforts, countless American school children learned frightening (though often categorically false) information about alcohol.
And many of them took the pledge to never touch the stuff. These generations of Americans were primed to support the Prohibitionist cause going into the 20th Century.
Of course, none of these efforts changed one of the underlying facts about alcohol: It was often safer to drink than water. And that wouldn’t change for some time.
But by the 1850s, a major event would get the world of science and medicine to look at water differently.
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Part 3: A Pump Handle
About a month before leaving England for her rise-to-fame in the Crimean War, a nurse named Florence Nightingale joined the staff of Middlesex Hospital in the heart of London. Her mission: Treating the local residents for cholera.
Describing her “so like a saint”, the writer Mrs. Gaskell described Nightingale as “up night and day...receiving the poor creatures (chiefly fallen women of that neighbourhood – they had it the worst) who were being constantly brought in—undressing them—putting them on turpentine stupes, etc. doing it herself to as many as she could manage; and yet she never had a touch of the complaint.”
This cholera outbreak, in neighboring Soho, was particularly severe. Over the first 10 days, about 500 people had died.
It was part of a broader cholera pandemic that had been sweeping across the world since at least 1846. Millions were dying in urban areas from Tokyo to Paris, from Moscow to New Orleans, from Mecca to Rio de Janeiro, and so on. Among the hardest-hit countries was the United Kingdom, especially in the port cities of Liverpool, Hull, and London.
This outbreak began in the early hours of Monday, August 28th, 1854. An infant girl, not quite six months old, started having diarrhea and vomiting. How she was infected, we’ll probably never know. Her parents, Thomas and Sarah Lewis, sent for a local doctor. While they waited for him to arrive, Sarah cleaned her daughter’s cloth diapers in a bucket of water, then went down to the cellar and tossed the bucket’s contents into the cesspool at the front of their house on Broad Street. From there, it somehow seeped into the street’s drinking water source.
And so, for the first time in about five years, London was to face a major spate of cholera.
For the next few days, life in Soho went on as normal. It was a crowded and industrial neighborhood, home to middle class professionals and their families, working class laborers and their families, pubs, storefront shops, machine shops, slaughterhouses, factories, and more.
Then on Wednesday, a Broad Street tailor – who actually worked in the same building where the Lewis family lived – started feeling an upset stomach. His condition worsened. He would have almost certainly experienced diarrhea, dehydration, and a slower heart rate. By 1pm Friday, he was dead. Another dozen Soho residents died before the end of the day. As hundreds laid sick in their beds, panic broke out across the neighborhood.
Of course, at the time, there was little understanding of the disease. It was generally believed to be created by the noxious smells of the cities. Nowadays when we go out into the countryside, we encounter the smells of farms and think, “ugh, gross.” But in the 19th Century, it was the countryside that had the “fresh air.” The cities were the places of foul smells. And this, the people of the time figured, is what caused the urban diseases like cholera.
A more scientific theory along these lines developed: The Miasma Theory. Essentially, it’s proponents argued, it is the organic particles of miasmatic gasses which rise up out of the earth and spread disease. But as a result of the 1854 outbreak, that theory would be proven wrong.
To combat cholera, the primitive pharmaceutical industry pushed all sorts of quack cures in newspaper ads. (Shout out Chapter 38!) But what the doctors of the time didn’t realize is, this wasn’t a typical plague. Cholera doesn’t spread through the air or through human-to-human contact. It spreads in the water. It’s a public health problem because it expands in the public infrastructure of the shared water supply.
John Snow was born to a working-class family in York in 1813. A quiet, serious, and intellectually gifted child, he apprenticed with a doctor in Newcastle, where he saw the horrors of cholera up-front during the epidemic there in 1831. In his research, he also became convinced that alcohol and meat were a lot less healthy to the constitution than people realized, and he became a teetotaler and vegetarian.
Later in the 1830s, he moved to London where he gradually built a name for himself. He formally studied medicine, graduating from the University of London in 1844, and was admitted to the Royal College of Physicians. During these years, he both treated patients and did pioneering research into nutrition and anesthesiology. In fact, his research on ether and chloroform was so important that Dr. Snow was brought in by Queen Victoria to administer chloroform to her during the birth of her eighth child. But I think we’ll discuss that episode more at a later date.
Following the great London cholera outbreak of 1848 to 1849, Snow and a group of like-minded physicians formed the Epidemiological Society of London to find a way to stop it in the future.
Another consequence of that outbreak was that it left Dr. Snow very skeptical about the Miasma Theory. Reviewing the detailed historical record of that outbreak, he was convinced it was being spread – not from gasses – but from person-to-person. But how? Human-to-human contact didn’t quite make sense. Instead, he thought maybe it was being spread via human waste. Maybe people carried a little more in the way of waste on them then they realized and – if they were sick – were spreading it to others that way. But more likely, he suspected, it was sick people’s waste getting into the drinking water.
This was just a hunch, but he felt confident enough to publish this theory after inspecting the houses of the 1849 victims. In one slum neighborhood, he found several large cracks in a drainage channel running through a courtyard, allowing wastewater to flow into a drinking well. He also found several neighborhoods in London’s working-class East End that had the same smelly, miasmatic gas problems, but not the cholera outbreaks that hit South London. Snow recommended filtering and boiling water before drinking it, as a way to prevent the disease.
The medical community received this theory with cautious optimism. The biggest fault they found was insufficient evidence. He hadn’t quite proved a causal link between water and cholera.
So, when cholera broke out in Soho, five years later, Snow made a point of it to investigate once again.
First, he gathered samples of drinking water from the many wells of Soho. A lot of them were pretty gross looking. The water from the pump on Broad Street, though, appeared to be some of the cleanest – even under a microscope. As a result, it was also one of the most popular pumps in the area. But given the scale of this outbreak, it didn’t quite make sense. Surely, one of the popular pumps would be the culprit, right? So, what was going on?
In the decades to come, scientists like Louis Pasteur, Joseph Lister, and Robert Koch, would make some major findings to explain it. More advanced microscopes helped. Soon, the miasma theory was out – and germ theory was in.
But John Snow could not turn to these resources yet. Instead, he turned to the field of statistics.
Over the previous decade or so, another English physician named William Farr had made major headway convincing doctors and bureaucrats to better document mortality and sickness in conjunction with demographic trends. Interestingly, Farr was skeptical of Snow’s theory that cholera spread via the water supply. He believed his research demonstrated a strong correlation between cholera and miasma. It would be Snow’s research from the 1854 cholera epidemic that finally convinced Farr he had been wrong.
On Tuesday, September 5th (Day 8 of the outbreak), Dr. Snow canvassed Soho. He gathered plenty of anecdotal evidence, but was unable to interview most of the hundreds of sick and dead residents. He then headed over to the Registrar General’s Office, where Farr worked. There he asked for the complete data on everyone who died so far, including (critically) their home addresses. And, holy crap, a lot of them lived on Broad Street.
Snow returned to Soho and continued his interviews. He went to some of the major employers in the neighborhood and found some interesting clues.
At the Lion Brewery, for example, only two of the 70 workers showed any symptoms consistent with cholera, and even those two didn’t have it too bad. That the second-largest employer in the neighborhood should be so free from the disease needed an explanation. Among other things, he learned they had a private well and pipeline. Plus, the workers there were mostly drinking the beer anyway.
Similarly, the St. James Workhouse – a home and worksite for more than 500 residents experiencing the worst kinds of poverty – had only a handful of cases. For this neighborhood, the infection rate at the workhouse was disproportionately low – by a lot. And as it turned out, they too had a private water supply.
But when he went to the Eley Brothers factory – where workers were producing percussion caps for Samuel Colt’s new revolvers (shout out Chapter 33) – he found out dozens of employees were out sick. Many had already died. Snow then noticed that the employees had been drinking out of two large water tubs. The water had been coming from the pump on Broad Street.
By the end of the next day, Snow was absolutely convinced that that pump was the source of the cholera outbreak. Nearly 9 out of 10 infected residents lived closer to the Broad Street pump than any other well. Most of them reported using that well as their primary water source. Other cases from outside the vicinity could mostly be traced back to this well too – such as a man who had eaten sherbet at a nearby coffeehouse. (The coffeehouse made its sherbet using water pumped on Broad Street.)
In fact, it was the popularity of the well that was to blame. The water pumped from it was clearer and cooler than most other wells in the area. Ergo, it had a lot of drinkers.
Finally, on the evening of Thursday, September 7th, Snow appeared at an emergency meeting of the Board of Governors of St. James Parish (essentially, a local government council) which was discussing the cholera outbreak. Halfway through the meeting, Snow was allowed to speak. He explained what he had been doing over the past several days, and how he could prove that nearly every case could be traced back to the Broad Street pump.
To be sure, the governors were skeptical. But they must have figured, “Well, what if he’s right?” and “What could it hurt, really, to shut down the pump for the time being?”
The next morning – exactly one week after the first death – the pump handle was removed at the Broad Street well. Dozens more would still die over the coming days, but the spread of cholera ceased.
What’s crazy is, in the grand scheme of things, this outbreak did not claim all that many lives. It’s believed that 616 died in total. But the impact it had on Soho was devastating. Nearly all the victims lived within 750 feet of the pump. More than one out of ten Broad Street residents perished. As the Observer noted, “Such a mortality in so short a time is almost unparalleled in this country.”
That December, Snow presented his findings to the Epidemiological Society. Included in his presentation was a map of the Soho area. For each death, a thick, black bar was drawn on the house of the victim. Also on the map were all the public water pumps. In a compelling, visual medium, Snow demonstrated how the Broad Street pump was the clear epicenter of the outbreak – what epidemiologists now refer to as a “focus of infection.” He subsequently produced additional visual constructions and published them as part of a book: On the Mode of Communication of Cholera.
It would take awhile for his findings to catch on – in fact, it wouldn’t be until the 1930s his work finally became so appreciated. But over the second half of the 19th Century, as germ theory slowly caught on – and as the waterborne transmission theory for cholera caught on – Snow’s maps were a common reference. It helped establish the modern study of epidemiology.
In the years to come, additional surveys and studies of the outbreak were conducted, as the British civil service sought to overhaul its approach to public health – an effort that would really pick up in the wake of the Great Stink. Perhaps if he had lived longer, Snow would have played a major role in the work to come. But sadly, he died of a stroke, at the age of 45, in June 1858 – just as the Great Stink was breaking out.
The Industrial Revolution incentivized people to leave the countryside for the opportunities of the cities. And in the process, it created enormous new challenges of urbanization. Cramming people in close together, along with animals and industry, created an enormous amount of waste. That waste crept into the water supply, putting the urban population at risk of epidemics. Even before germ theory became popular, people understood that alcoholic beverages were a safe alternative to water. So, to avoid getting sick, many abstained from drinking water for that more intoxicating means of quenching thirst.
In a way, to live in a 19th Century city, you had to choose between two risks – diseases like cholera and typhoid on the one hand…or a disease like alcoholism on the other.
But London’s clean water crises of 1854 and 1858 would turn out to be a tipping point. Something had to be done. And in fact, much would be done to clean up the cities and make them livable. All over the industrializing world, civil engineering would be thrust into the future and the new field of urban planning would emerge. It was the dawn of the modern city: Next time, on the Industrial Revolutions.
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For this episode, a special thanks to my friend, the “colonel” (a little inside joke there), for helping me with some research.
I also want to give a special shout out to new patrons Amelia Dunkin, Mac Loveland, and Jonathan Smith, as well as Jim Ankenbrandt, John Bartlett, Chris Bradford, Elizabeth Brooking, Jeppe Burchhardt, Tara Carlson, Molly Des Jardin, Michele Gersich, Jason Hayes, Herbyurby, Jeremy Hoffman, Eric Hogensen, Kyrre Holm, Brian Long, Emeka Okafor, Kristian Sibast, Brandon Stansbury, Alex Strains, Ross Templeton, and Walter Torres.