Doctor John Snow and the 1854 Soho cholera epidemic

The replica Broad Street Pump in Soho, with the Sir John Snow pub in the background.

Cholera is a bacterial intestinal infection causing profuse watery diarrhea, vomiting, fever and abdominal pain. The severity of the diarrhea and vomiting can quickly lead to dehydration and electrolyte imbalance. Infection is usually through drinking water contaminated by the watery diarrhea, colloquially called "rice-water stool".

Cholera is a major cause of death world-wide, outside developed countries with advanced water treatment and sanitation. The last major outbreak in the United States was in 1910-1911.

The first cholera pandemic was in 1816-1826. The disease began spreading in Bengal, in the Indian subcontinent. By 1820 it had spread across India, killing 10,000 British troops and many times that number of Indians. The outbreak spread as far as China, Indonesia, and the Caspian Sea basin. An estimated 15 million people died in India between 1817 and 1860, and another 23 million between 1865 and 1917.

The second cholera pandemic was in 1829-1851, reaching Russia, Hungary, and Germany in 1831, and London and Paris in 1832. 6,536 victims died in London, and the bacteria was established in Britain.

There was a second major outbreak in Paris and London in 1849. London's outbreak killed 14,137. It also spread to other British cities, and by ships to North America. Several thousand died in the U.S., including former U.S. President James Polk. Over 150,000 Americans and 200,000 Mexicans died during the pandemics between 1832 and 1849.

Further outbreaks in 1853-1854 killed about 3,500 people in Chicago (5.5% of the city's population) and 10,738 in London.

The 1854 outbreak in London was centered on the Soho area. Doctor John Snow analyzed the available information and determined that the main agent spreading cholera was a public water pump on Broad Street. The spring below the pump had been contaminated by sewage. Snow didn't know what the contaminant was, but he found that the common attribute of victims was the use of water from that pump. Snow's analysis was one of the first examples of epidemiology. Despite objections, he convinced the government officials to remove the pump's handle.

This change stopped that outbreak, but it took many more years before there was wide belief in contaminated water as the cause. "Miasma" or "bad air" was the preferred explanation. The government officials replaced the handle on the contaminated pump after the pandemic had subsided.

Accepting Snow's explanation required accepting the fecal-to-oral transmission of disease, which they thought was too unpleasant for the public (although they seemed to think that the public could handle cholera itself just fine).

The above picture shows a replica pump unveiled in 1992. Things have changed quite a bit in Soho since the 1850s. The pump was at the intersection of Broad Street and Cambridge Street — now renamed Broadwick Street and Lexington Street, respectively. It was close to the rear wall of today's Sir John Snow pub. See that pub in the background of the picture above.

Rose George's The Big Necessity: The Unmentionable World of Human Waste and Why It Matters is a fascinating description of sanitation conditions around the world. "2.6 billion people don't have sanitation. [....] Four in ten people have no access to any latrine, toilet, bucket, or box. [....] Poor sanitation, bad hygiene, and unsafe water — usually unsafe because it has fecal particles in it — cause one in ten of the world's illnesses. [....] Diarrhea — nearly 90 percent of which is caused by fecally contaminated food or water — kills a child every fifteen seconds. The number of children who have died from diarrhea in the last decade [1998-2008] exceeds the total number of people killed by armed conflict since the Second World War.

In September 2009, Morna Gregory and Sian James published a book titled Toilets of the World. It's pretty much the same theme that you find here — photographs and commentary on other people's plumbing.

The Porcelain God: A Social History of the Toilet, by Julie Horan, contends that civilization began with the toilet.

Toilet: Public Restrooms and the Politics of Sharing, edited by Laura Noren and Harvey Molotch, has essays by anthropologists, sociologists, and architects on the importance of the toilet, especially for urban dwellers.

Latrinae Et Foricae: Toilets in the Roman World describes the toilets of the Roman Empire from Iberia to Syria, and from North Africa to Hadrian's Wall in Britannia.

Toilets, Bathtubs, Sinks, and Sewers: A History of the Bathroom, explains the history of personal cleanliness and hygiene to children in grades 5-8.

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