Syllabus Edition
First teaching 2024
First exams 2026
Cholera in London, 1854: Case Study (Edexcel GCSE History)
Revision Note
Written by: Zoe Wade
Reviewed by: Bridgette Barrett
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 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 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 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
In February 1832, cholera hit London
It mostly affected slums, workhouses, prisons and asylums due to the poor hygiene and crowded conditions
Approximately 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 rotting 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
Worked Example
Explain one way in which the government's reaction to the Great Plague in 1665 was similar to the government's reaction to the cholera epidemic of 1848-1849
4 marks
Answers:
One way in which the government's reaction to the cholera was similar to the Great Plague was the publishing of rules to slow down their spread (1). In the Great Plague, King Charles II released a decree (1); the decree banned public meetings and ordered the streets to be cleaned (1). Similarly, the government passed the first Public Health Act in 1848. This also encouraged the streets to be cleaned by local authorities (1).
Examiner Tips and Tricks
In this type of question, it is important to ensure there is a clear link between examples but they cannot be the same. In this example, the government released official documents in both examples. This allows the answer to be linked by a similarity but to have different examples to show specific knowledge of each time period.
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 badly 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
In August 1854, a cholera outbreak broke out in Snow’s neighbourhood of Soho
Snow began to investigate after 93 people died of the disease
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 who were not affected 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
Short-term | Long-term |
|---|---|
Snow stopped the epidemic of cholera around Broad Street. He saved many people from dying in the cholera epidemic | Snow died in 1858 without the scientific evidence needed to prove his theory. Three years after Snow’s death, Pasteur released his Germ Theory. This discredited the theory of miasma |
After Snow presented his findings in 1855, the government did not act. The General Board of Health and scientists continued to believe that miasma, not water, was spreading cholera across London | Thirty years after Snow’s death, Robert Koch was able to isolate the bacteria that caused cholera. In 1884, he proved that contaminated water contained cholera |
The Great Stink of 1858 motivated the government to dispose of sewage correctly. They hired Joseph Bazalgette to create a new sewage system. Bazalgette completed this in 1875 | The work of John Snow in cholera proved that the government should intervene in public health. They introduced the second Public Health Act in 1875 and released further laws into the 20th century |
Examiner Tips and Tricks
The theory of miasma was used by scientists for almost 700 years to explain why certain areas or people spread disease. It wasn't until Pasteur's Germ Theory proved that microbes caused disease that miasma was no longer used as an explanation. In the exam, miasma is a useful example of continuity of ideas about the cause and prevention of disease in three of the four time periods you study.
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