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Speaker 1: Welcome to Stuff You Missed in History Class from how

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Speaker 1: Stuff Works dot Com. Hello and welcome to the podcast.

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Speaker 1: I'm Katie Lamberg, joined by Sarah Dowdy. How are you, Sarah?

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Speaker 1: I'm great, Katie, How are you? He won't be as

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Speaker 1: great once we start talking about what we're talking about.

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Speaker 1: Which was a listener request Janie from d C wanted

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Speaker 1: to hear all about John Snow and the cholera outbreak

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Speaker 1: in Victorian London. I don't know. I'm kind of a

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Speaker 1: fan of slummy Victorian London, so I think I'm going

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Speaker 1: to enjoy this one. John Snow was born in eighteen

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Speaker 1: thirteen in Yorkshire, England, and he was actually the son

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Speaker 1: of a coal yard laborer, but quickly gets into the

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Speaker 1: medical field at fourteen, when he starts three consecutive apprenticeships

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Speaker 1: and first encounters cholera. Not that long after, while visiting

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Speaker 1: coal miners in eighteen thirty one, he gets, you know,

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Speaker 1: his first exposure to contagious disease. He doesn't begin his

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Speaker 1: formal medical education until eighteen thirty six, but he gets

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Speaker 1: his m d in eighteen forty four from the University

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Speaker 1: of London and by eighteen forty nine He is a

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Speaker 1: licensed specialist of the Royal College of Physicians of London,

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Speaker 1: which was a really elite organization. Yeah, this guy gets

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Speaker 1: big fast. Um. He kind of enters the realm of

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Speaker 1: what today we'd probably call a celebrity doctor, especially when

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Speaker 1: he treats Queen Victoria. That's because he learned about ether

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Speaker 1: being used in America but pioneered how it was dispensed. Right,

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Speaker 1: So he helps Queen Victoria through her childbirth, on the

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Speaker 1: birth of Prince Leopold and Princess Beatrice, and makes the

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Speaker 1: public more accepting of the process at all if Victoria

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Speaker 1: is into it, whether it's Christmas trees or big white

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Speaker 1: weddings or ether. The Kingdom likes to trends center Victoria.

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Speaker 1: But we don't think of him today for his work

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Speaker 1: in anesthesia. We think about him for is pioneering work

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Speaker 1: in germ theory. And to do that will give a

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Speaker 1: little background first about Victorian London, which was really disgustingly dirty.

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Speaker 1: The life expectancy for a gentleman in Victorian London was

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Speaker 1: forty five, but if you were a tradesman it was

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Speaker 1: your mid twenties. So I would be killed off by now,

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Speaker 1: and so would you say, and London was really really stinky,

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Speaker 1: like known worldwide for being stinky. It was the biggest

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Speaker 1: city in the world. But sewage was just piled up everywhere.

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Speaker 1: Toilets drained into basement sesspits, so there would just be

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Speaker 1: piles and piles of sewage in your basement, stinking too

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Speaker 1: high heaven, and the sus pits were flushed into the

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Speaker 1: river if they were cleaned, which of course is where

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Speaker 1: everyone got their water. Maybe you can see where this

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Speaker 1: is going. So needless to say, London, overcrowded, dirty, stinky,

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Speaker 1: a good place for diseases to spread. And at the time,

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Speaker 1: it was thought of that diseases came from my asthma

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Speaker 1: or bad air from decayed organic matter, so bad smells

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Speaker 1: meant disease, and when the entire city stinks, people thought

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Speaker 1: you were getting sick from the sewage. There's also a

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Speaker 1: moral element to the whole myasthma theory, uh that stinky

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Speaker 1: people were you know, unclean and more prone to disease,

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Speaker 1: not just because they were poor and destitute and living

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Speaker 1: in overcrowded pubbles. They were morally unsound, so too bad

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Speaker 1: for you poor people to Victoria in London, everyone thought

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Speaker 1: your illness was your own darn fault. So Snow doesn't

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Speaker 1: buy this though. He thinks that diseases are caused by

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Speaker 1: some agent, not by a smell, right, So they started

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Speaker 1: calling that germ theory. And so we've got these two

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Speaker 1: philosophies that are kind of going head to head, and

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Speaker 1: they go head to head for for decades, surprisingly enough

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Speaker 1: to to us, who you know, my asthma sounds like

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Speaker 1: such a bad idea, um, But people aren't quick to

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Speaker 1: buy germ theory. So there have been a few outbreaks

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Speaker 1: of cholera in London. The eighteen forty eighteen forty nine

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Speaker 1: Color outbreak killed fifty thousand people. And this is where

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Speaker 1: John Snow wants to figure out how this is happening.

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Speaker 1: Color is not a pretty disease. You die from basically

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Speaker 1: diarrhea that's unstoppable, and various digestive ills. You die from

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Speaker 1: dehydration because your body doesn't have any fluid left, and

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Speaker 1: you can die really quickly, like within a day. So

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Speaker 1: John Snow wants to figure out this germ theory and

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Speaker 1: see if he can prove it. But in that particular outbreak,

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Speaker 1: there weren't a public death records and he couldn't figure

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Speaker 1: out who was giving water to witch households, so this

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Speaker 1: wasn't a good test case for him. And in the

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Speaker 1: summer of eighteen fifty four, another collar outbreak happens. Seven

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Speaker 1: people are dead in two weeks, and this is when

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Speaker 1: he starts his experimentation and runs around testing water and

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Speaker 1: interviewing people and trying to figure out where this is

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Speaker 1: coming from so he can stop it. And he performed

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Speaker 1: two classic experiments during this eighteen fifty four outbreak UM.

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Speaker 1: The first was the Broad Street Pump outbreak experiment, which

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Speaker 1: is my favorite. He's like Sherlock Holmes of medicine and

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Speaker 1: it's pretty amazing. So UM, in the Soho district of London,

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Speaker 1: where he's actually based his medical offices are actually based,

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Speaker 1: there is a sudden case of cholera. Seventy fatalities within

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Speaker 1: a twenty four hour period, most of them within five

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Speaker 1: square blocks UM, and all of these fatalities are based

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Speaker 1: around the Broad Street Pump, which is a free water

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Speaker 1: pump for the poor. It draws the water from a

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Speaker 1: well underneath the Golden Square, which has some of London's porous,

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Speaker 1: most overcrowded people. So in the last week of August

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Speaker 1: eighteen fifty four, all the residents of Golden Square start dying.

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Speaker 1: And it starts with an upset stomach and then goes

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Speaker 1: to vomiting and severe cramps in the gut, and then

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Speaker 1: to diarrhea and thirst, and then, like we said, death

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Speaker 1: from dehydration, and it's fast to kill. Some people are

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Speaker 1: dying within twelve hours after it starts, and it's really

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Speaker 1: fast to spread. So the medical authorities are pretty quick

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Speaker 1: to identify this as cholera, and Snow moves in to

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Speaker 1: start studying what's happening, and he takes a really multidiscipline approach.

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Speaker 1: He looks at water samples and sees, you know, what

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Speaker 1: he can find in the water, but he also starts

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Speaker 1: looking at the maps of London dead or the weekly

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Speaker 1: statistics about who's dying of cholera in London, looking for

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Speaker 1: geographical patterns, and he draws a ghost map that showed

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Speaker 1: a correlation between cholera cases in this neighbor hood and

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Speaker 1: the Broad Street pump. Basically, if you lived within walking

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Speaker 1: distance of the Broad Street pump, if that was your

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Speaker 1: nearest water source, you were very likely to come down

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Speaker 1: with cholera. And it's really intense. You can find a

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Speaker 1: bunch of them online, of the ghost maps, but they're

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Speaker 1: just black lines everywhere showing people. They're very disturbing, little

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Speaker 1: stacks of black lines. And you'll see the pump location

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Speaker 1: in the houses immediately adjacent to the pump just have

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Speaker 1: these huge stacks of black lines coming from them. And

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Speaker 1: this is part of the reason he's called the father

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Speaker 1: of modern epidemiology and starts right here. Um So, after

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Speaker 1: about a week he goes to the local Board of

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Speaker 1: Guardians of St. James Parish with his findings with this

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Speaker 1: ghost map, and Um convinces them to shut down the

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Speaker 1: Broad Street pump, to take the literally take the handle

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Speaker 1: off the pump so people can't use it. And they're

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Speaker 1: not totally into it, though, are They know, they're still

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Speaker 1: thinking about the whole myasthma thing. So they're engaged in

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Speaker 1: this pursuit to spread lime all over the streets because

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Speaker 1: that'll kill the snows. That will kill it. But they decide, okay,

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Speaker 1: so let's go ahead and take the pump handle off,

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Speaker 1: and surprise, surprise, the outbreak ends. But what's so great

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Speaker 1: about Snow's experiment here is he doesn't just look at

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Speaker 1: the overwhelming evidence on the side of if you, you know,

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Speaker 1: drink this water, you very well might get sick. He

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Speaker 1: looks at kind of the statistical outliers. Yes, he's very thorough.

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Speaker 1: I love this. Yeah he um. There's some school children

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Speaker 1: who don't live near the pump who end up dying.

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Speaker 1: He reasons that they passed by the pump on their

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Speaker 1: way to school. And my favorite, there's a widow in

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Speaker 1: West End Hampstead and her niece in Isilington and they

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Speaker 1: got sick, but neither of them had been anywhere near

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Speaker 1: so how So he did some investigation, did some interviewing

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Speaker 1: and discovered that the widow had once lived on Broad

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Speaker 1: Street and liked the taste of the well water so

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Speaker 1: much that she had a servant go to Soho every

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Speaker 1: day and bring her back a bottle of it to drink.

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Speaker 1: It's like when you go to Florida, South Georgia and

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Speaker 1: you like, bring your Atlanta water. Um. So yeah, And

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Speaker 1: he actually finds the last bottle of water that the

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Speaker 1: widow had gotten was from August thirty one, which is

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Speaker 1: the start of the epidemics, So bad bad timing there.

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Speaker 1: There's also an army officer living in St. John's Woods,

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Speaker 1: who dies after dining in Water Street where he had

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Speaker 1: drunk in a glass of water from the Broad Street well.

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Speaker 1: And he also, in his thoroughness looks at the people

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Speaker 1: who didn't get sick. So the people at the Poland

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Speaker 1: Street workhouse are just around the corner from the Broad

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Speaker 1: Street pumps. So I mean, if you're thinking about it,

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Speaker 1: they should have been sick, but they weren't. And so

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Speaker 1: he went and looked into that. And that's because the

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Speaker 1: workhouse had its very own water source. They weren't using

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Speaker 1: a Broad Street pimp. And that's also a good case

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Speaker 1: against the maas a theory. These people are in the workhouse,

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Speaker 1: they're dirty, they're more likely to be morally corrupt, but

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Speaker 1: here they are, you know, safe from cholera. Also, the

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Speaker 1: Broad Street Brewery, which you know, right down the street

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Speaker 1: from the pump um no deaths because the workers are

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Speaker 1: given a daily beer allowance, so they don't need to

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Speaker 1: drink water. I feel like there's a lesson in there

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Speaker 1: somewhere for my bosses. He also has the help of

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Speaker 1: Reverend Henry Whitehead, who's the vicar of St. Luke's Church,

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Speaker 1: and Whitehead actually wasn't originally on his side. He thought

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Speaker 1: the outbreak was caused by God's intervention, and he started

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Speaker 1: a report to prove it, but it actually only ended

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Speaker 1: up confirming John Snow's study. But he was man enough

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Speaker 1: to come to a minute to Snow and admit, you know,

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Speaker 1: my research is the same as years, and he actually

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Speaker 1: helps Snow track down the source of the local outbreak

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Speaker 1: of sick child at number four the broad Street, right

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Speaker 1: near the pump um had had his diapers washed and

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Speaker 1: the water was dumped into a cesspool. It's only a

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Speaker 1: few feet away from the well, and after the child died,

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Speaker 1: no more diaper pail water had been dropped in that

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Speaker 1: cesspitse so people stopped getting sick. So later in the

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Speaker 1: year our Sherlock Holmes John Snow conducts a grand experiment

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Speaker 1: and he compares the London neighborhoods who are receiving water

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Speaker 1: from two different companies, and one company uses water that

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Speaker 1: comes from the Upper Thames and the other uses water

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Speaker 1: that comes from the heart of London. And interestingly, Parliament

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Speaker 1: had actually required the Metropolitan water companies to improve the

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Speaker 1: quality of their intake, but not all of them had complied.

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Speaker 1: And of course sewage is being dumped into the Thames.

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Speaker 1: The sanitation commissioner named Edwin Chadwick believed in the miasma thing,

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Speaker 1: and he thought that if you dumped sewage in the river,

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Speaker 1: you were keeping bat air away from people. So he

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Speaker 1: thought what he was doing was actually really good. But

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Speaker 1: of course he's dumping sewage into water that's then getting

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Speaker 1: turned into drinking water. But this dual water company thing

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Speaker 1: kind of presents the perfect opportunity for an experiment for

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Speaker 1: Snow because the companies were rivals and it had at

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Speaker 1: one point competed head to head. So some houses had

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Speaker 1: mans from one company while their next door neighbor had

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Speaker 1: a man from the other company. So essentially you had

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Speaker 1: this controlled experiment. Everything was the same in this neighborhood

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Speaker 1: except for the water where they got their water from.

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Speaker 1: And it turned out for people who got the London

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Speaker 1: sourced water, they had a much higher chance of contracting cholera.

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Speaker 1: And Snow is overjoyed because he thinks, wow, he's finally

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Speaker 1: proved it. The ratio of people who died from one

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Speaker 1: source of water versus the other was something ridiculous like

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Speaker 1: seventy five to five. I mean, if that's not proof,

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Speaker 1: you know, what is, and he suggests intervention strategies to

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Speaker 1: control epidemics extend. He's thinks that he's proven that contaminated

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Speaker 1: water is what gets people, but it didn't seem to stick. No,

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Speaker 1: people are still stuck on the miasma theory and it's

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Speaker 1: not sadly, it's not really until the eighteen eighties when

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Speaker 1: germ theory is, you know, golden people, people go with

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Speaker 1: that when the causative organism of cholera fabrio cholera is

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Speaker 1: actually finally understood. So when John Snow died in eighteen

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Speaker 1: fifty eight, people still thought it was my asthma, and

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Speaker 1: no one accepted all the things he'd worked out so hard.

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Speaker 1: Chadwick was still suggesting ridiculous things. At one point he

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Speaker 1: was quoted as saying, all smell is if it be intense,

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Speaker 1: immediate acute disease. And in the eighteen nineties he suggested

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Speaker 1: bringing down fresh air from places like the Eiffel Tower

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Speaker 1: and distributing it. We're discussing how that would actually be done,

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Speaker 1: Like how how do you get to the air and

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Speaker 1: then distribute it. I can't ask Mr Chadwick. The Great

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Speaker 1: Stink of eighteen fifty eight, which is my favorite name

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Speaker 1: of anything that has ever happened. Ever is what starts

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Speaker 1: to change things. Because this summer was incredibly hot and

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Speaker 1: sewage was everywhere in London. The flush toilets were overflowing

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Speaker 1: the basement cesspits which are going into the street drains,

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Speaker 1: and I mean it was so bad. No one wanted

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Speaker 1: to be in the city. It was so horrible. The

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Speaker 1: people in the House of Commons were draping their curtains

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Speaker 1: and soaking them in cloride of lime just so they

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Speaker 1: wouldn't be smelling the sewage. And so a committee was

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Speaker 1: set up to figure out how to fix the stink.

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Speaker 1: And this is where the modernization of the sewage system

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Speaker 1: in London started to happen. So even though sanitation is

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Speaker 1: much better in London today, it's still a problem in

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Speaker 1: a lot of places in the world, and cholera is

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Speaker 1: actually still causing a lot of deaths. Diarrhea is one

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Speaker 1: of the leading causes of death for kids in the

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Speaker 1: developing world. There's a treatment for it today, oral rehydration salts,

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Speaker 1: which you know, basically keep you from dying of dehydration

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Speaker 1: in twelve hours twenty four hours, and it's um it's

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Speaker 1: estimated that it's prevented forty million death since nineteen So

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Speaker 1: today we'd like to give thanks to John's Snow and

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Speaker 1: his amazing investigative work, and we recommend the book The

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Speaker 1: Ghost Map if you hadn't picked it up. And if

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Speaker 1: you'd like to learn more about infectious diseases and safe

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Speaker 1: water supply, come to how stuff Works and also check

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Speaker 1: out the blog on our homepage at www dot how

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Speaker 1: stuff works dot com. For more on this and thousands

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Speaker 1: of other topics, visit how stuff works dot com. Let

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Speaker 1: us know what you think. Send an email to podcast

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Speaker 1: and how stuff works dot com and be sure to

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Speaker 1: check out the stuff you missed in History Glass blog

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Speaker 1: on the how stuff works dot com home page