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 Rosen1 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.