London in the Time of Cholera

Image courtesy of NIH

Image courtesy of NIH

Many of you may be familiar with the novel, Love in the Time of Cholera by Gabriel García Márquez. This post is not about that book, but it is a nod to “The Ghost Map” by Steven Johnson. In today’s post, we are visiting London in the mid-19th century, to discuss cholera and one of my historical heroes, Dr. John Snow. Cholera is a bacterial infection caused by Vibrio choleraIt is typically spread through ingestion of contaminated water or food, as well as contact with fecal material of those infected. Cholera is exceedingly rare in developed countries with modern sanitation systems and is relatively easy to prevent and treat. However, there was a time where cholera was deadly and no one seemed to know what caused it.
Cholera pandemics were rampant throughout the 19th century, rolling relentlessly throughout the Eurasia and killing hundreds of thousands of people. By all accounts of the time, cholera was an air-borne disease caused by foul odors that “somehow lingered in the ‘miasma’ of unsanitary spaces” (Johnson, 2006, p. 69). Patents for medicines relied on this theory, giving rise to elixirs to reduce odors.  Physicians created tinctures, some containing ingredients such as opium, morphine, potash, sulphuric acid, laudanum, and castor oil with the juice of limes and lemons. Some even suggested cures that included intravenous injections of whey protein, as well as water and milk enemas (Treatment of Diarrhea–The Cholera, 1854, pp. 266-7).  Right about now, you should be glad that you are living with access to modern medicine.  I know that I do, especially considering that the milk-based treatments would certainly kill me.

Local Health Boards posted signs with various preventative suggestions, which really do not stand up well against our current knowledge. 

Now, back to Dr. Snow. Through mapping incidences and deaths from cholera in a systematic pattern, Dr. Snow was able to find evidence that discounted miasmatic theory. He traced the current outbreak (c. 1854) to a public water source, the Broad Street water pump, which was contaminated by fecal matter. While Snow did attempt water testing to confirm the presence of contagion, his tools were not precise enough to detect the very small bacteria. However, his mapping was convincing enough to remove temporarily the water pump handle, ultimately leading to a rapid decline in new cases of cholera. His methods of investigation into outbreaks gave rise to the field of epidemiology.

References and Additional Reading:

Video–John Snow: Pioneer of Epidemiology (approximately 3 minutes)

Exhibit–Cholera Online: A Modern Pandemic in Texts and Images

Johnson, S. (2006). The Ghost Map. New York: Riverhead Books.

Treatment of Diarrhea–The Cholera. (1854, November 4). The Lancet London: A Journal of British and Foreign Medicine, Surgery, Obstetrics, Physiology, Chemistry, Pharmacology, Public Health and News, II, 266. Retrieved from


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