Doctor John Snow and the truth behind the Victorian cholera epidemic

Jenna Coleman as Queen Victoria and Sam Swainsbury as Doctor Snow 
Jenna Coleman as Queen Victoria and Sam Swainsbury as Doctor Snow 

In 1848, the London-based Anti-Cholera Tincture Depot published a poster advising on the prevention of cholera. The poster's "remedies recommended by Government" included a warning to wear "a flannel or woollen belt... round the belly", the avoidance of "every cause tending to depress the moral and physical energies" and the immediate purchase of "anti-cholera Fumigators, for purifying the Air of Dwellings".

That posters of this sort failed to provoke widespread mirth casts light on the uphill struggle faced by pioneering epidemiologist Dr John Snow in the Soho cholera epidemic of 1854 witnessed by viewers of this week's episode of Victoria.

Snow was a medical prodigy. The eldest of nine children of a York labourer, he began his apprenticeship in medicine at the age of 14 in 1827.

Shortly afterwards, in a hospital in Newcastle-upon-Tyne, he encountered some of the earliest British cases of cholera, which had arrived in this country, probably from China, for the first time in 1831. At this point, the fledgling Yorkshire doctor had little or no knowledge of the disease's causes.

By 1849, however, he had made significant progress towards the theory that persuaded Jenna Coleman's Victoria: that cholera was spread by dirty water.

Sam Swainsbury as Doctor Snow in episode 4 of ITV's Victoria 
Sam Swainsbury as Doctor Snow in episode 4 of ITV's Victoria 

In a pamphlet called "On the Mode of Communication of Cholera", Snow described "a most important way in which the cholera may be widely disseminated, viz., by the emptying of sewers into the drinking water of the community."

Yet what sounds wonderfully obvious to us was anything but to Snow's contemporaries. Indeed a prominent pathologist described his ideas as "peculiar".

Far more popular than Snow's view that cholera was caused by germs in unclean water was a medical theory of airborne infection originating in the Middle Ages. Advocates of the "miasma theory" insisted that a poisonous vapour, or miasma, was the cause of diseases like cholera. The miasma was emitted by rotting organic matter.

It was a theory that appeared to be confirmed by the less salubrious effects of the Industrial Revolution. Industrialisation in the early years of Victoria's reign led to the rapid growth of several British cities, with chronic overcrowding and appallingly insanitary conditions in the poorest areas. A newspaper account of 1853, following reports of cholera deaths in the neighbourhood of London's Drury Lane, recorded "from sixteen to eighteen families living in small, inconvenient apartments, above cow-sheds, donkey and horse stables, etc. Sometimes many cartloads of refuse are allowed to remain in the yard... It is shocking to see the squalid children attempting to play in such a place." 

So much dung - including human waste - exactly fitted the medical beliefs of miasma theorists. In a letter written to the General Board of Health in 1848, a doctor who considered himself forward-thinking explained the spread of cholera as "an atmosphere [that] travels in a poisonous state... and chemically infects exposed water." Even Florence Nightingale was persuaded.

Snow, however, was adamant and set about proving his own contradictory theory vigorously. He had lived and worked in Soho - at 54 Frith Street - for a number of years before the outbreak of cholera deaths in 1854 that provided the backdrop for Victoria and Albert's marital troubles in this week's episode. The deaths that summer of nearly 600 people within a fortnight convinced him he was right. "Within 250 yards of the spot where Cambridge Street joins Broad Street there were upwards of 500 fatal attacks of cholera in ten days," he wrote. "As soon as I became acquainted with the situation and extent of this irruption of cholera, I suspected some contamination of the much-frequented street pump in Broad Street."

The John Snow water pump in Soho, London
The John Snow water pump in Soho, London Credit: Nathaniel Noir/Alamy Stock

Snow drew a map of the area nearest to the water pump. He used hospital records to track fatalities and questioned residents of surrounding streets about their use of the pump. His findings were stark. 'With regard to the deaths occurring in the locality belonging to the pump, there were 61 instances in which I was informed that the deceased persons used to drink the pump water from Broad Street, either constantly or occasionally... The result of the inquiry, then, is that there has been no particular outbreak of cholera in this part of London except among the persons who were in the habit of drinking the water of the above-mentioned pump-well.' On 7 September 1854, he presented his evidence to the Board of Guardians of St James's parish, who, in the face of so  persuasive a conclusion, authorised the immediate removal of the pump's handle.

Casualties of London's 1854 cholera epidemic did not include Queen Victoria's head dresser Marianne Skerrett, who died in 1887, aged 94. It was in her own bed, rather than over Skerrett's, that Victoria first encountered John Snow, when he administered chloroform to her during her labour with her eighth child, Leopold, in 1853. And, yes, Victoria did meet Florence Nightingale - at Balmoral, after several years' correspondence concerning hospital conditions in the Crimean War.

Matthew Dennison is the author of 'Queen Victoria: A Life of Contradictions' 

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