Parched City (6 page)

Caused by the Vibrio Cholerae bacterium, cholera’s symptoms were the same then as they are now in countries with poor sanitation or sewage-contaminated water supplies: Severe diarrhoea, followed by rapid dehydration, the malfunctioning of vital organs and then death within days, if untreated.
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William Marsden, a surgeon at the Free Hospital, founded as a result of the 1832 cholera outbreak, wrote of reactions to the disease’s arrival: ‘On the first appearance of this unknown disease in London, medical men of every grade, more particularly those in the higher walks of the profession, on viewing the afflicted patient, became terrified and panic-struck; and the public, in consequence of their professional advisers being ignorant of the nature of this malady, were completely bewildered and paralysed…the richly-endowed hospitals of this Metropolis closed their doors against the wretched sufferers, the affluent inhabitants fled, and the great wealthy members of the faculty dared not, or would not, condescend to visit the habitation of the afflicted.’
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The Free Hospital provided an open door to those who contracted cholera, in an act that was equally humanitarian and medically pioneering because treatments for cholera were still entirely experimental.

Marsden and his colleagues used a saline solution treatment,
which involved copious rehydration with water before patients ingested the salty fluid.
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Presumably the Grand Junction Company’s supply was not being used if they were to have any success. Records of the hospital’s patients list those treated with the saline therapy as seventy-seven in total. These patients were all discharged. The Free Hospital’s experiment was stunningly important, as cholera’s treatment today is still the oral administration of water and salts.

From the scant coverage of the epidemic in
The Times
, it is clear that the disease was confined, at that point, to the ‘poor, the wretched, the dissipated, and the destitute’, as Marsden collectively referred to the victims.
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The hospital’s work certainly made no headlines. However, the subject was deemed worthy of attention by the satirist George Cruikshank. His 1832 illustration of the
Water-King of Southwark
represented Londoners decrying the condition of the Thames, as the source of their piped water. Crowds gather on the banks, with a chorus exclaiming: ‘Give us clean water!’, ‘Give us pure water!’, ‘We shall all have the cholera.’
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Cruikshank’s representation of a politically vocal public, probably of middle class economic status, was common for satirists at that time and clearly cholera was a current issue. Also in 1832, the first of Britain’s parliamentary Reform Acts was passed, widening the electorate to include all (male) property owners. Instinct told Cruikshank, and the public he was representing, that the condition of Thames and the outbreak of cholera was no coincidence. Connecting a particular water company with the disease suggested a relationship between the fatalities from cholera and the geography of the private water supply. Chelsea Waterworks, with its grand new filter, for example, was not satirised.

On her
Promenades Dans Londres
the radical French socialist Flora Tristan noted Chelsea’s ‘monster filter’, designed to produce ‘clear’ water, as she termed it, for Londoners.
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She critically observed that good quality water was not available to all
citizens. In her
London Journal
, Flora Tristan recorded a lack of ‘sumptuous and monumental fountains’ like Paris but described the alternative: ‘…one does encounter iron pumps in many streets. An iron chain is affixed to the post with a dipper…This dipper is the economical goblet offered to the pauper by his lord and master, the rich man.’
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From Tristan’s interaction with London’s wealthy inhabitants, she gathered that they were not in the habit of water drinking from the pumps. She quoted the following, possibly from an anonymous source but more likely as a shorthand for their general view: ‘“…here water costs the people nothing, they may drink at their convenience without going to draw water from the river”’.
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One gets the impression that what she really felt about the inequity of London’s segregated water supply was not uttered in polite conversation: ‘In a country where scarcely one person in twenty-five can drink wine, and one in seven drink beer, is it not ironically insulting to offer the people of London water which has been dirtied by all the drains in the city?’
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Flora Tristan’s account of 1830s London generally documented some of the living conditions that would preoccupy Britain’s public health movement. As she wrote about St Giles Parish, which was hidden from the view of genteel eyes down an alleyway off Oxford Street: ‘In St Giles one feels asphyxiated by the stench; there is no air to breathe nor daylight to find one’s way. The wretched inhabitants must wash their own rags, and they hang them out to dry on poles that stretch from one side of the alley to the other, so that fresh air and sunlight are completely blocked out.’
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Tristan’s visceral account of the ghetto, a place that became increasingly associated with Irish immigrants post-famine, was consistent with the descriptions of urban squalor that the social researcher Edwin Chadwick would horrify, and entertain, middle and upper class readers with in his 1842 book
The Sanitary Condition of the Labouring Population of Great Britain
.

Edwin Chadwick’s role in Britain’s public health movement is extremely well documented therefore this account only briefly references how his concerns bore on the drinking water debate. Firstly, Chadwick was highly critical of the ‘capitalists’ who sold water in London.
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He believed that water provision should be a municipal affair to improve drainage and support the ‘promotion of civic, household and personal cleanliness’.
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Improving standards of hygiene was closely connected in the sanitary reformer’s mind with improving standards of morality. Chadwick argued that an abundant water supply was the answer to disease amongst the ‘labouring population’. His gaze on water was trained on the quantity needed to wash ones body and home, and drain ‘filth’ away, rather than a concern about the quality of water that might be ingested for drinking or cooking. Legislation soon followed his unsanitary account.

1844’s Metropolitan Buildings Act concurred with the Chadwickian drainage position. All new buildings were to have improved, covered drainage systems but, problematically, waste from properties with water closets was to be drained into the Common Sewer.
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This drainage legislation preceded an effective sewage system. That issue was not considered more deeply until the members of a Royal Commission met in 1847 to discuss how the health of London’s inhabitants might be improved. The same year, the national Towns Improvement Clauses Act was passed, with a clause that would be detrimental to river water. Under its terms, the new Metropolitan Commissioners of Sewers was empowered to ensure that the ‘effectual draining’ of London was carried out.
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To achieve that end, these Commissioners were free to enforce the connection of sewers ‘to communicate with and empty themselves into the Sea or any public River…’.
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Whilst a full scheme for achieving that effectual draining was being planned, the move positively encouraged even more raw sewage to flow into the Lee and Thames. It only added to the problem of water closets becoming ever more normal features of middle
class London homes. The engineers’ task was unenviable and the scale of what had to done and how it could effectively be achieved, would not be resolved overnight. Cholera erupted again in 1849.

In the City of London alone, more than eight hundred people died from the bacterium’s violent assault between June and October.
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The Free Hospital’s treatment method was clearly not in use by the doctors who saw these patients, if they received any treatment at all. One reason for this disconnect between 1832 and 1849 was the rise of an idea from the Chadwickian school of public health.

Miasma theory proposed that fatal diseases such as cholera were being transmitted via the air. This belief laid the blame for disease firmly on the doorsteps of the poor. Their dirty environments were producing the filth that was mobilising in air and infecting not just them, but now other classes too. Only one person ventured to posit a different argument during the 1849 cholera outbreak. This doctor was convinced that cholera was being transmitted via drinking water. His name was John Snow.

Though John Snow’s evidence supporting his theory of cholera’s waterborne transmission was still accruing in 1849, he was moved to publish his work-in-progress,
On the Mode of Communication of Cholera
immediately after the
epidemic
. He dismissed the ‘miasmists’ because their view that cholera could be ‘inhaled and absorbed by the blood passing through the lungs’ necessitated a predisposition for ‘a great number to breathe it without injury’.
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To Snow, this was not plausible because cholera’s symptoms did not manifest in the manner of other blood poisoning diseases. He believed the symptoms pointed to its transmission in the alimentary canal and he suspected the disease’s form was related to ‘the continuity of molecular changes, by which combustion, putrefecation, fermentation, and the various processes in organised beings, are kept up’.
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His interpretation sounded distinctly microbiological,
even though that realm of knowledge was in its infancy. This first published thesis about cholera was drawn from fresh evidence of the 1849 epidemic. Snow believed that it followed the pattern of 1832’s outbreak, in which he saw a connection between company water serving east and south London that was drawn from the sewage-contaminated river. Two neighbourhoods where cholera levels were curiously inconsistent in their spread featured in his pamphlet.

The first neighbourhood was a poor community. Thomas Street in Southwark lay opposite the Tower of London, where two courts of modest housing lay adjacent to each other. As Snow wrote: ‘Now in Surrey Buildings the cholera has committed fearful devastation, whilst in the adjoining court there has been but one fatal case.’
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The only difference that Mr Grant, the assistant surveyor of the Commissioners of Sewers noticed in his report, studied by Snow, was that in the courtyard of Surrey Buildings ‘the slops of dirty water poured down by the inhabitants into a channel in front of the houses got into the well from which they obtained their water’.
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The neighbouring courtyards did not share the water source, but clearly the cheek-by-jowl conditions suggested the air quality shared between the residents was the same. Snow’s second case, significantly, introduced a neighbourhood that would not have been deemed unsanitary by Chadwickian standards into the equation.

Albion Terrace in Wandsworth, as described by John Snow, consisted of ‘genteel suburban dwellings of a number of trades-people’.
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The community’s twenty fatal cases of cholera were blamed, by Snow, on the contamination of a shared water tank by a leaking cesspool which the surveyor Mr Grant found when the ground was opened up. In fact, Snow wrote that the victims themselves ‘attributed their illness to the water’, noticing it was impure but consuming it anyway; obviously without the knowledge that it could be fatal.
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The doctor explained how secondary infection could spread via hands and food once the
cholera ‘evacuations’ had contaminated anything that might be subsequently ingested. He countered Dr Milroy’s report to the General Board of Health that Albion Terrace’s mortality was caused by an open sewer in Battersea Fields transmitting cholera into the air, by pointing out that the houses surrounding the exclusive water supply of the affected houses, were ‘quite free’ from cholera.
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Snow concluded in his pamphlet by a persuasive argument that his theory was more optimistic: ‘What is so dismal as the idea of some invisible agent pervading the atmosphere, and spreading over the world?‘
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He proposed that, ‘if the writer’s opinion be correct, cholera might be checked and kept at bay by simple measure that would not interfere with social or commercial intercourse…’
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Despite Snow’s pragmatic stance, the miasmists were firmly attached to their pessimistic worldview. When cholera vanished again, Chadwick and his colleagues may well have agreed that a storm had simply cleansed the air.

Water became more politicised in London as a result of the epidemic. Educated professional citizens and official sanitary reformers alike sheltered under the umbrella of the Metropolitan Parochial Water Supply Association in 1850. Its concern, liker the Anti-Water Monopoly Association before it, was the control of water by private corporations, rather than the quality of the supply. Publicly controlled water and ‘a constant supply at high pressure’ was the Association’s goal.
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But in London’s scientific community, others were convinced by John Snow’s thesis and were consequently preoccupied with the finer constituents of water.

One result of the waterborne movement was that microscopist Arthur Hill-Hassall examined London’s corporate water supplies, publishing the results of his study in 1850. He qualified that his experiment was needed because of the public focus on the ‘defective condition of the water supply of London’.
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The physician-cum-microscopist was dissatisfied that the only information
chemists produced about organic matter referred to ‘traces’. What were traces? Like Snow, he thought there was more to the science of water analysis: ‘It will become apparent that these traces…are complex in organisation, endowed with life and in many cases possessed of active powers of locomotion.’
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Also referring to these microscopic inhabitants of London’s water supply under their popular title, ‘animalcules’, Hill-Hassall admitted that nobody knew what they were.