On the mode of communication of cholera

by John Snow

“The crew of the Britannia were at once sent away from the ship, in small parties, into the numerous transports that remained idle; and it appears that, by this procedure, the epidemic influences operating among them have been greatly moderated, if not extirpated.”

THE CHOLERA NEAR GOLDEN SQUARE.

The most terrible outbreak of cholera which ever occurred in this kingdom, is probably that which took place in Broad Street, Golden Square, and the adjoining streets, a few weeks ago. Within two hundred and fifty yards of the spot where Cambridge Street joins Broad Street, there were upwards of five hundred fatal attacks of cholera in ten days. The mortality in this limited area probably equals any that was ever caused in this country, even by the plague; and it was much more sudden, as the greater number of cases terminated in a few hours. The mortality would undoubtedly have been much greater had it not been for the flight of the population. Persons in furnished lodgings left first, then other lodgers went away, leaving their furniture to be sent for when they could meet with a place to put it in. Many houses were closed altogether, owing to the death of the proprietors; and, in a great number of instances, the tradesmen who remained had sent away their families: so that in less than six days from the commencement of the outbreak, the most afflicted streets were deserted by more than three-quarters of their inhabitants.

There were a few cases of cholera in the neighbourhood of Broad Street, Golden Square, in the latter part of August; and the so-called outbreak, which commenced in the night between the 31st August and the 1st September, was, as in all similar instances, only a violent increase of the malady. As soon as I became acquainted with the situation and extent of this irruption of cholera, I suspected some contamination of the water of the much-frequented street pump in Broad Street, near the end of Cambridge Street; but on examining the water, on the evening of the 3rd September, I found so little impurity in it of an organic nature, that I hesitated to come to a conclusion. Further inquiry, however, showed me that there was no other circumstance or agent common to the circumscribed locality in which this sudden increase of cholera occurred, and not extending beyond it, except the water of the above mentioned pump. I found, moreover, that the water varied, during the next two days, in the amount of organic impurity, visible to the naked eye, on close inspection, in the form of small white, flocculent particles; and I concluded that, at the commencement of the outbreak, it might possibly have been still more impure. I requested permission, therefore, to take a list, at the General Register Office, of the deaths from cholera, registered during the week ending 2nd September, in the sub-districts of Golden Square, Berwick Street, and St. Ann’s, Soho, which was kindly granted. Eighty-nine deaths from cholera were registered, during the week, in the three sub-districts. Of these, only six occurred in the four first days of the week; four occurred on Thursday, the 31st August; and the remaining seventy-nine on Friday and Saturday. I considered, therefore, that the outbreak commenced on the Thursday; and I made inquiry, in detail, respecting the eighty-three deaths registered as having taken place during the last three days of the week.

On proceeding to the spot, I found that nearly all the deaths had taken place within a short distance of the pump. There were only ten deaths in houses situated decidedly nearer to another street pump. In five of these cases the families of the deceased persons informed me that they always sent to the pump in Broad Street, as they preferred the water to that of the pump which was nearer. In three other cases, the deceased were children who went to school near the pump in Broad Street. Two of them were known to drink the water; and the parents of the third think it probable that it did so. The other two deaths, beyond the district which this pump supplies, represent only the amount of mortality from cholera that was occurring before the irruption took place.

With regard to the deaths occurring in the locality belonging to the pump, there were sixty-one instances in which I was informed that the deceased persons used to drink the pump-water from Broad Street, either constantly or occasionally. In six instances I could get no information, owing to the death or departure of every one connected with the deceased individuals; and in six cases I was informed that the deceased persons did not drink the pump-water before their illness.

The result of the inquiry then was, that there had been no particular outbreak or increase 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.

I had an interview with the Board of Guardians of St. James’s parish, on the evening of Thursday, 7th September, and represented the above circumstances to them. In consequence of what I said, the handle of the pump was removed on the following day.

Besides the eighty-three deaths mentioned above as occurring on the three last days of the week ending September 2nd, and being registered during that week in the sub-districts in which the attacks occurred, a number of persons died in Middlesex and other hospitals, and a great number of deaths which took place in the locality during the last two days of the week, were not registered till the week following. The deaths altogether, on the 1st and 2nd of September, which have been ascertained to belong to this outbreak of cholera, were one hundred and ninety-seven; and many persons who were attacked about the same time as these, died afterwards. I should have been glad to inquire respecting the use of the water from Broad Street pump in all these instances, but was engaged at the time in an inquiry in the south districts of London, which will be alluded to afterwards; and when I began to make fresh inquiries in the neighbourhood of Golden Square, after two or three weeks had elapsed, I found that there had been such a distribution of the remaining population that it would be impossible to arrive at a complete account of the circumstances. There is no reason to suppose, however, that a more extended inquiry would have yielded a different result from that which was obtained respecting the eighty-three deaths which happened to be registered within the district of the outbreak before the end of the week in which it occurred.

The additional facts that I have been able to ascertain are in accordance with those above related; and as regards the small number of those attacked, who were believed not to have drank the water from Broad Street pump, it must be obvious that there are various ways in which the deceased persons may have taken it without the knowledge of their friends. The water was used for mixing with spirits in all the public houses around. It was used likewise at dining-rooms and coffee-shops. The keeper of a coffee-shop in the neighbourhood, which was frequented by mechanics, and where the pump-water was supplied at dinner time, informed me (on 6th September) that she was already aware of nine of her customers who were dead. The pump-water was also sold in various little shops, with a teaspoonful of effervescing powder in it, under the name of sherbet; and it may have been distributed in various other ways with which I am unacquainted. The pump was frequented much more than is usual, even for a London pump in a populous neighbourhood.