Cholera in London, 1854: Case Study (Edexcel GCSE History)

The Impact of Cholera on Public Health - Summary

Conditions in London in 1832 were perfect for the arrival of a new epidemic disease called cholera. Punch, a magazine of satirical images, published a cartoon entitled ‘A Court for King Cholera’ in 1852. The cartoon shows the streets crowded with people and children playing in a large pile of waste. This highlights the acceptance and normality of unhygienic living conditions. Anyone, rich or poor could catch cholera. However, the disease spread more easily within London’s slums. Overpopulation meant communal facilities like toilets and water pumps could not cope with the demand. Toilets were often overflowing with sewage and water pumps were contaminated. Cholera, as a waterborne illness, thrived in these conditions. 

Similar to the Black Death and Great Plague, cholera epidemics occurred roughly once every 10 years. The most severe was in 1848-49 when over 53,000 people across England and Wales died. Like the plague in the Medieval and Renaissance periods, cholera was without a cure. Doctors did not understand that dirty water spread cholera and no available treatments worked on the disease. The threat and scale of cholera scared the government and led them to publish the 1848 Public Health Act.

John Snow’s pioneering work in cholera paved the way to understanding the disease. He used the epidemic in London in 1854 to prove that victims caught cholera by drinking contaminated water. In addition, he presented the government with practical solutions to avoid large-scale outbreaks from occurring again. However, the government refused to accept Snow’s suggestions. They continued to believe miasma spread cholera and wanted to avoid spending large sums of money cleaning up Britain’s water supplies. 

Eventually, the work of Pasteur and Koch provided the scientific backing to Snow’s theory on cholera. This changed how the government reacted to issues of public health and epidemic outbreaks in the 20th and 21st centuries. Snow’s investigation into the cholera outbreak in Soho inspired new techniques of epidemiology, the study of how diseases spread

Fighting Cholera

• Cholera was a deadly disease that arrived in Britain in 1831

  • Scientists believe that cholera started in India

  • India was part of the British Empire 

    • It is likely soldiers travelling back to Britain brought the disease with them

• Symptoms usually lasted for two to five days before the victim died of dehydration

• The two causes were:

  • Contact with another person

  • Drinking water contaminated with faeces from a cholera victim

An illustration showing the symptoms of cholera

• In February 1832, cholera hit London, mostly affecting slums, workhouses, prisons and asylums due to the poor hygiene and crowded conditions

  • 5,275 people had died in London by the end of 1832

• Scientists and the government believed miasma was to blame for cholera

  • They believed that rotten material in the streets released miasma, spreading cholera to anyone who breathed in the bad air

  • To reduce miasma, they attempted to clean up the worst areas of London

• In 1848, during a severe cholera outbreak, the government released the first Public Health Act

  • It aimed to improve the cleanliness of towns and cities by advising local authorities to take responsibility for public health

  • It suggested setting up boards of health to monitor diseases in the area and providing clean water

  • The Act was not law. Most local authorities did not want to spend money cleaning their town or city

    • As a result, the Act did not greatly improve people’s living conditions

John Snow

• John Snow was a well-respected surgeon and London’s top anaesthetist

  • He was the doctor responsible for giving Queen Victoria chloroform during the birth of her eighth child in 1851

• Snow lived in an area of London called Soho

  • From the mid-18th century, Soho housed many French and Italian immigrants as well as the poor

  • Many wealthier residents moved out of the area

  • Much of Soho’s housing was poorly built

    • Landlords and builders did not care about the health and safety of the people who rented their rooms

• During the 1848-49 epidemic, Snow observed the disease and wrote On the Mode of Communication of Cholera. He suggested that:

  • Miasma was not responsible for cholera. The disease affected the stomach, not the lungs

  • Victims caught cholera by drinking contaminated water that contained faeces from another person with cholera

• Snow had no scientific evidence to convince others that his theory on how cholera spread was correct

The 1854 Epidemic

A storyboard showing how John Snow researched and stopped the Broad Street cholera epidemic

• In August 1854, a cholera outbreak broke out in Snow’s neighbourhood of Soho

  • 93 people had already died of the disease, which caused Snow to investigate

• Snow created a spot map in an attempt to discover a pattern

  • On a street map of Soho, he drew a spot to represent each death. He placed the spot where the person had lived

• John Snow concluded that deaths centred around the water pump on Broad Street

• To prove that the pump on Broad Street was responsible for the outbreak of cholera, Snow:

  • Investigated the deaths that were outside of Broad Street - all the victims had drunk water from the pump

  • Asked local residents why they had not become ill

    • None of them had drunk water from the Broad Street pump

  • Removed the handle from the pump so no one else could use the water. The cholera outbreak quickly stopped

• Inspections of the well underneath the Broad Street pump showed the water was less than a metre away from a cesspit

  • The cesspit had cracked, spreading human waste into the water

The Impact of John Snow and the Broad Street Pump