Cholera london 1853

Farr had indicated. I had learnt from the evidence of Mr. Quick in the Health of Towns Reports , that the division of the houses, between the Lambeth Company on the one hand, and the Southwark and Vauxhall Company on the other, was not such as obtains in the north districts of London, where a parish is often divided between two water companies, but where one company always leaves off at the point at which the other begins. Throughout the greater part of Lambeth and Southwark, the whole of Newington, and a part of Camberwell, however, the supply of the two companies above mentioned is actually intermixed, the pipes of both companies going down the same streets, in consequence of the active competition which once existed between three water companies, two of which have since amalgamated and come to an agreement with the other--the Lambeth company.

Observing, therefore when the cholera returned in , that there was the same advantage in favor of the districts partly supplied with water from Thames Ditton, I determined to make an inquiry, the idea of which I had previously entertained. It was obvious that, if the diminished mortality depended on the improved supply of water, the benefit of the whole diminution would be enjoyed by the inhabitants of houses having this supply, whilst the population receiving impure water would suffer as much as that of the districts which received the same water, and no other.

This point could be determined by ascertaining the water supply of every house in which a fatal attack of cholera might occur. After commencing the inquiry I found that the circumstances were calculated for affording even more conclusive evidence than I had anticipated.

The pipes of the two water companies not only passed down all the streets, but into nearly all the courts and alleys. A single house often had a different supply from that of either side. Each water company supplied alike both rich and poor, and thus there was a population of , persons, of various conditions and occupations, intimately mixed together, and divided into two groups by no other circumstance than the difference of water supply.

I took great care to ascertain the nature of the water supply correctly in every instance. I did not rest content with the mere reply of the resident, or the appearance of the water, without other evidence, such as the production of the receipt for the water rate. I was also assisted very much by the application of a chemical test to the water, for throughout all the dry weather, which lasted whilst my inquiries were being made, a mixture of sea mater extended further up the Thames than usual, and the water of the Southwark and Vauxhall Company contained nearly forty grains of common salt per gallon, whilst that of the Lambeth Company contained only.

These analyses were verified in numerous cases where the source of the water could be proved clearly by other evidence. For the first four weeks of the epidemic I employed the list of deaths from cholera published in the Weekly Returns Of the Registrar-General, and for the next three weeks, during which my inquiry extended, I was kindly permitted to copy the addresses of persons dying of cholera at the General Register Office.

My personal inquiry extended over every subdistrict to which the supply of the Lambeth Water Company extended, and it, therefore, included all the area. At the time I was making my inquiry, the entire number of houses supplied by each water company was known, from a return made to Parliament, but the number of houses supplied in each district and subdistrict by each company respectively was not known.

In order, therefore, to see the exact bearing of my results, I found it desirable to extend the inquiry over the districts supplied exclusively by the Southwark and Vauxhall Company; for this purpose I obtained the assistance of Mr.

Whiting, a medical man, who took great pains with his part of the inquiry, which was merely to ascertain whether the houses in which fatal attacks had taken place were supplied by the Southwark Company, or from some other source, as a pump well or tidal ditch.

His inquiry extended over the first four weeks of the epidemic. I gave a copy of the first results of my inquiry to Dr. Farr, to whom I was indebted for facilities very kindly afforded: and Dr. As the registrars could not be expected to make a chemical analysis of the water, or to seek out the landlord or agent in cases where the tenant was not acquainted with the water supply, the question remained unanswered in a considerable number of instances, but the return was obtained for more than three-fourths of the deaths, and shows, no doubt, the correct proportion.

Farr's inquiry commenced from the 27 th of August, and extended to the close of the epidemic; and as my inquiry extended to August 26 th , the water supply was obtained for the whole epidemic of It was only necessary to make a computation of the small number of attacks occurring in houses supplied by pump wells or some other source, in the three weeks--the 5 th to the 7 th inclusive--of the epidemic, in Bermondsey and the other districts which do not receive the Lambeth water.

This computation was made according to the result ascertained in the previous four weeks, and must approach very nearly the truth. In treating of the general results of this inquiry, it is desirable to divide the epidemic into different periods, as the influence of the water supply was found to diminish in relative intensity as the epidemic progressed.

In the first four weeks of the epidemic of , that is, from July 9th to August 5th inclusive, there were deaths from cholera in the districts to which the supply of the two water companies we are considering extends. The water supply in every one of these instances was made a matter of personal inquiry, and the result of each case was published by me in detail in the Appendix to a work on Cholera.

In instances the supply of the house in which the attack took place was that of Southwark and Vauxhall Company; in 14 instances it was that of the Lambeth Company; in 4 cases the supply was from a pump well; in 26 cases the water was drawn direct from the river, or a canal, or a tidal ditch; and in 4 cases the supply could not be ascertained, owing to the address of the deceased persons, prior to the fatal attack, not being known.

It is particularly worthy of remark that, during the four weeks of the epidemic we are now considering, there were but deaths from cholera in the whole metropolis, of which , or more than one-half, occurred amongst the customers of the Southwark and Vauxhall Company, who comprise a little more than one-tenth of London, and a considerable number of the remaining deaths took place amongst mariners, and others employed amongst the shipping, who almost invariably draw their drinking water directly from the river; it is, therefore, evident that at this early period of the epidemic the impure water of the Thames was almost the exclusive means of the propagation of the malady.

In the next three weeks of the epidemic there were 1, deaths from cholera in the districts supplied by the two water companies. Of these, the fatal attack took place in cases in houses supplied bp the Southwark and Vauxhall Company; in 84 cases in houses supplied by the Lambeth company; in instances the supply was from some other source; and in 18 cases it could not be ascertained, for reasons previously stated.

Taking into account the population supplied respectively by each company, the mortality was, at this period of the epidemic, near Vauxhall Company as in that supplied by the Lambeth Company. During the last ten weeks of the epidemic, from August 27 th to November 4 th inclusive, 3, deaths occurred in the districts to which the supply of the two water companies extends, and the returns of the district registrars showed that in 2, cases the water supply of the house in which the fatal attack took place was that of the Southwark and Vauxhall Company; in cases it was that of the Lambeth Company; in instances the supply was from pump wells and other sources independent of the two water companies, and in instances the supply was not ascertained.

The results of my inquiry into the supply of water were, of course, obtained separately for each district and subdistrict in which the inquiry was made, and were so published; but I was unable at the time to show the relation between the supply of houses in which fatal attacks took place, and the entire supply of each district and subdistrict, on account of the latter circumstance not being known.

I expressed myself as follows in an article which I published soon after my inquiry was made: "I hope shortly to learn the number of houses in each subdistrict supplied by each of the water companies respectively, when the effect of the impure water in propagating cholera will be shown in a very striking manner, and with great detail.

Simon, and published by the General Board of Health, there is a statement of the number of houses supplied by each of the water companies respectively in each district and subdistrict. The authorities were poorly prepared for the invasion of a new epidemic and the doctors disagreed bitterly on the measures to be taken.

There was little co-operation between the authorities, and the fact that the urban poor mistrusted the medical profession did not improve the situation. All this resulted in several cholera riots. These riots were not, however, as violent as those in several other cities in Europe. The cholera epidemic claimed 4, to 7, victims in London. The measures that Chadwick introduced were based on the medical thinking of the day, which attributed the spread of infectious diseases to foul smelling air, called miasma.

Cholera was a new and exotic disease from Asia, and brought into sharp relief the two major theories of the time about the pattern and spread of infectious diseases. In miasma theory, it was believed that diseases were caused by the presence in the air of a miasma, a poisonous vapour in which were suspended particles of decaying matter that was characterised by its foul smell.

The theory originated in the Middle Ages and endured for several centuries. The advocates of contagion theories believed that an infective agent was spread from person to person, which would explain why those who cared for the sick often fell sick themselves.

Measures to prevent and control the spread of infectious diseases were based on these two theories. Sanitation and good hygiene practices such as washing walls and floors, removing the foul-smelling sources of miasmas—decaying waste and sewage—were miasmatic measures.

Contagionist measures were those such as quarantine and restriction of movement, preventing direct contact with potentially infected people. In practice, both types of measures were used. During the Black Death , infected houses were quarantined and strangers banned from entering towns, but at the same time, fires were used to destroy infected materials and people wore masks and nosegays to purify the air they breathed.

At the end of the s, germ theory was able to account for both infection through contaminants in air and water and person-to-person contact but it still left unanswered questions—such as why, when two people were exposed to the same source of infection, only one might get the disease and the other appeared untouched.

In s England, the miasma theory made sense to the sanitary reformers. Rapid industrialisation and urbanisation had created many poor, filthy and foul-smelling city neighbourhoods that tended to be the focal points of disease and epidemics. By improving the housing, sanitation and general cleanliness of these existing areas, levels of disease were seen to fall, and to provide evidence that apparently supported the miasma theory.

In —49 there was a second outbreak of cholera, and this was followed by a further outbreak in — Towards the end of the second outbreak, John Snow , a London-based physician, published a paper, On the Mode of Communication of Cholera , in which he proposed that cholera was not transmitted by bad air but by a water-borne infection.

However, little attention was paid to the paper. Following the third cholera outbreak in , Snow published an update to his theory, with statistical evidence that he had collected from an area of London around Broad Street, Soho.

By recording the location of deaths related to cholera in the area, Snow was able to show that the majority were clustered around one particular public water pump in Broad Street. He eventually convinced local officials to remove the handle of the pump, although by that time the worst of the epidemic had actually passed. It was later established that a leaking sewer ran near the well from which the water was drawn.

Unfortunately, Snow failed to convince many in the medical establishment of his theory, including William Farr, who was responsible for medical statistics at the General Register Office. Farr took part in the General Board of Health 's Committee for Scientific Enquiries on the cholera outbreak but although they accepted Snow's data, they dismissed his theory that the mode of transmission for cholera was waterborne.

Farr was finally converted to Snow's theory in the wake of the final London cholera epidemic of