History of Sanitation

by J. J. Cosgrove

On account of its size and lack of sanitary provisions, the London of that period was the kind of place in which, with our present knowledge of disease, we would expect a plague to reach its height. Prior to 1700, the city of London had no sewers and was without water supply, except such as was obtained from wells and springs in the neighborhood. The subsoil of London we can readily believe was foul from cesspool leachings and from slops and household refuse deposited on the surface of the ground, so that water from the wells within the city limits, while cool perhaps and palatable, could not have been wholesome. Many public wells with pumps had been installed at certain intervals on the public highways, and an epidemic of cholera traced to one of these wells, was the means of pointing out the danger to public health, caused by an infected water supply, and of showing the channel by which the infectious matter from people suffering from intestinal diseases was transmitted to healthy individuals. The story is well told by Sedgwick:[5] "One of the earliest, one of the most famous, and one of the most instructive cases of the conveyance of disease by polluted water, is that commonly known as the epidemic of Asiatic cholera connected with the Broad Street, London, well, which occurred in 1854. For its conspicuously circumscribed character, its violence and fatality, and especially for the remarkable skill, thoroughness and success with which it was investigated, it will long remain one of the classical instances of the terrible efficiency of polluted water as a vehicle of disease.

ASIATIC CHOLERA
- AND -
THE BROAD STREET PUMP.
LONDON 1854.

As a monument of sanitary research, of medical and engineering interest and of penetrating inductive reasoning, it deserves the most careful study. No apology therefore need be made for giving of it here a somewhat extended account.[6]

The parish of St. James, London, occupied 164 acres in 1854, and contained 36,406 inhabitants in 1851. It was subdivided into three subdistricts, viz., those of St. James Square, Golden Square and Berwick Street. As will be seen by the map, it was situated near a part of London now well known to travellers, not far from the junction of Regent and Oxford Streets. It was bounded by Mayfair and Hanover Square on the west, by All Souls and Marylbone on the north, St. Anne's and Soho on the east, and Charing Cross and St. Martin's-in-the-Fields on the east and south.

In the cholera epidemics of 1832, 1848, 1849 and 1853, St. James' Parish suffered somewhat, but on the average decidedly less than London as a whole. In 1854, however, the reverse was the case. The inquiry committee estimated that in this year the fatal attacks in St. James' Parish were probably not less than 700, and from this estimate compiled a cholera death rate, during 17 weeks under consideration, of 220 per 10,000 living in the parish, which was far above the highest in any other district. In the adjoining sub-district of Hanover Square the ratio was 9; and in the Charing Cross district of St. Martin's-in-the-Fields (including a hospital) it was 33. In 1848-1849 the cholera mortality in St. James' Parish had been only 15 per 10,000 inhabitants.

Within the parish itself, the disease in 1854 was very unequally distributed. In the St. James Square district, the cholera mortality was only 16 per 10,000, while in the Golden Square district it was 217 and in the Berwick Street district 212. It was plain that there had been a special cholera area, a localized circumscribed district. This was eventually minutely studied in the most painstaking fashion as to population, industries, previous sanitary history, meteorological conditions and other general phenomena common to London as a whole, with the result that it was found to have shared with the rest of London a previous long continued absence of rain, a high state of temperature both of the air and of the Thames, an unusual stagnation of the lower strata of the atmosphere, highly favorable to its acquisition of impurity, and although it was impossible to fix the precise share which each of the conditions enumerated might separately have had in favoring the spread of cholera, the whole history of that malady, as well as of the epidemic of 1854 and indeed of the plague of past epochs, justifies the supposition that their combined operation, either by favoring a general impurity in the air or in some other way, concurred in a decided manner, last summer and autumn (1854) to give temporary activity to the special causes of that disease. The inquiry committee did not, however, rest satisfied with these vague speculations and conclusions, but as previously shown in the history of this local outbreak, the resulting mortality was so disproportioned to that in the rest of the metropolis and more particularly to that in the immediately surrounding districts, that we must seek more narrowly and locally for some peculiar conditions, which may help to explain this serious visitation.

Accordingly special inquiries were made within the district involved in regard to its elevation of site, soil and subsoil, including an extended inquiry into the history of a pest field said to have been located within this area in 1665, 1666, to which some had attributed the cholera of 1854; surface and ground plan; streets and courts; density of population; character of the population; dwelling houses; internal economy as to space, light, ventilation and general cleanliness; dust bins and accumulations in yards, cellars and areas; cesspools, closets and house drains; sewers, their water flow and atmospheric connection; public water supply and well water supply. No peculiar condition or adequate explanation of the origin of the epidemic was discovered in any of these, even after the most searching inquiry, except in the well water supply. Abundant general defects were found in the other sanitary factors, but nothing peculiar to the cholera area, or if peculiar, common to those attacked by the disease, could be found excepting the water supply.

At the very beginning of the outbreak, Dr. John Snow, with commendable energy, had taken the trouble to get the number and location of the fatal cases, as is stated in his own report: