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considered to be the source of cholera in the area and subsequently the disease vanished.

However, this is by no means the whole story, and if there was no more to it than what a

student remembers, it would not be worthwhile mentioning it at all in the lecture. In order to

really appreciate the ingenuity of John Snow, it is necessary to recall some fundamental issues

of medical history such as the knowledge and beliefs about the spread of diseases at that time.

Another important issue is that John Snow started investigating the outbreak of cholera

around the pump at No. 40 Broad Street in late August, 1853, but he died in1858 without

knowing the real agent for the disease which was rediscovered by Robert Koch in 1884 and is

now known as Vibrio cholerae. Nevertheless, his investigation into the way the disease was

transmitted by polluted water finally beat the miasma theory. So, what about the miasma

theory and what was important to public health at that time?

Time of industrialism and the sanitary movement

Gorge Rosen

1 i

n his ‘History of Public Health’ categorised the period from 1830 to

1875 as the time of ‘Industrialism and the Sanitary Movement’. Centuries ago the economy of

European countries no longer depended solely on

agricultural production. The Middle Ages saw

technical progression in many fields including

mining, salt works, foundries and glass works.

Industrial enterprises existed especially in urban

settings. At around the time of John Snow,

industrialisation took a big leap forward and became

generally known as the ‘industrial revolution’, a term

introduced in 1837 by Jérôme Blanqui (a French

economist). This development went along with a

massive improvement in infrastructure in terms of roads, canals and railroads. A massive

boost in production was achieved as the result of improvements to the steam engine by the

Scottish instrument maker, James Watt, in the year 1765. It was no longer necessary to

establish factories along streams or use windmills for running machines. The impact was first

felt in England when the work force was drawn from the agricultural sector into the urban

industries. The result was massive crowding in extremely poor living conditions and a

horribly unhygienic situation occurred along with massive environmental pollution, especially

of rivers and streams. The pollution of the Thames flowing through London City was one

telling example. Nowadays it doesn’t come as a surprise to us that in the course of such

development devastating epidemics spread through the population. In those days people did

not understand the connections between poor living conditions, crowding, poverty and illness.

It was up to the Sanitary Movement in the first half of the 19


century in England to draw

attention to these circumstances. The Movement was linked to Edwin Chadwick (1800-1890)

and his fight for social justice for the poor of the labouring classes of Great Britain.

Hygiene in London during the 19



Unhygienic conditions, to term it mildly, were an excellent breeding ground for the

predominant epidemic of the 19


century, which was cholera. This disease was particularly


George Rosen: History of Public Health. Expanded Edition. The John Hopkins University Press, 1993.