All Snow needed was a further breakdown: a record of deaths originating in houses that had been supplied with S&V water, and deaths in houses supplied by Lambeth. If Snow’s theory was right, there should be a disproportionate fatality rate in the S&V homes, despite the fact that they existed side by side with the Lambeth homes. Their elevation and air quality would all be the same—only the water would be different. Even economic status and upbringing would be taken out of the equation, since the rich and poor were just as likely to choose one water supply over the other. It would be the Thomas Street flats all over again: shared environment, different water. But this time the scale would be immense: thousands of lives, not dozens. As Snow would eventually describe it:
The experiment… was on the grandest scale. No fewer than three hundred thousand people of both sexes, of every age and occupation, and of every rank and station, from gentlefolks down to the very poor, were divided into two groups without their choice, and, in most cases, without their knowledge; one group being supplied with water containing the sewage of London, and, amongst it, whatever might have come from the cholera patients, the other group having water quite free from such impurity.
But the experimentum crucis would prove to be thornier than Snow anticipated. Farr’s original report had looked only at the level of entire districts, but Snow now divided the original data into subdistricts organized by water supplier. Twelve of them relied on water from S&V, while three drank Lambeth water exclusively. And indeed, the disparity between the two groups in terms of cholera deaths was pronounced: roughly 1 in 100 died in the S&V subdistricts, while not a single person had died of cholera among the 14,632 Lambeth drinkers. An unbiased observer might have been persuaded by those numbers, but Snow realized his audience required more, primarily because the subdistricts served by Lambeth alone were relatively well-to-do suburbs, in contrast to the smog-bound industrial zones that S&V serviced. Once the miasmatists had a look at the different neighborhoods, Snow knew his case would dissolve in a heartbeat.
And so the experiment would rise and fall on the sixteen remaining subdistricts that received both S&V and Lambeth water. If Snow could find a breakdown of cholera deaths within those districts along the lines of water supplier, he might well have conclusive proof of his theory, enough perhaps to turn the tide against the miasma model. But those numbers turned out to be elusive ones, because the pipes in those sixteen subdistricts were so promiscuously interlinked that it was impossible to tell from a given address which water company serviced it. If Snow wanted to disentangle the water supply of the sixteen, he would have to rely on old-fashioned shoe leather to do it. He would have to knock on every door mentioned in Farr’s account, and inquire where people procured their water.
It is worth pausing for a second to reflect on Snow’s willingness to pursue his investigation this far. Here we have a man who had reached the very pinnacle of Victorian medical practice—attending on the queen of England with a procedure that he himself had pioneered—who was nonetheless willing to spend every spare moment away from his practice knocking on hundreds of doors in some of London’s most dangerous neighborhoods, seeking out specifically those houses that had been attacked by the most dread disease of the age. But without that tenacity, without that fearlessness, without that readiness to leave behind the safety of professional success and royal patronage, and venture into the streets, his “grand experiment”—as Snow came to call it—would have gone nowhere. The miasma theory would have remained unchallenged.
Yet descending to the street-level scale of direct interviews ultimately proved unsatisfactory as well. Many residents had no idea where their water came from. Either the bills were paid by a distant landlord, or they had paid no notice to the company name when they last received an invoice and weren’t in the habit of keeping old paperwork around. The visible pipes were so jumbled that even direct inspection couldn’t reveal whether it was Lambeth or S&V water running into each house.
And so Snow’s inquiry had to venture down to an even smaller scale to track its quarry. The grand experiment that had begun with the bird’s-eye view of hundreds of thousands of lives would ultimately revolve around molecules invisible to the unaided human eye. In the course of his investigation, Snow had noticed that S&V water consistently contained about four times as much salt as Lambeth water. A simple test in his home lab could determine which company had supplied the water. From that point on, anytime Snow encountered a resident who had no idea who provided the water they were drinking, Snow would simply draw a small vial of water, mark it with the address, and analyze the contents when he returned home.
SO THIS IS WHERE JOHN SNOW FOUND HIMSELF PROFESSIONally when the cholera arrived at Golden Square: splitting his days between chloroform and shoe leather, leading a double life of celebrated anesthesiologist and South London investigator. By late August of 1854, the essential components of his grand experiment were in place, and the early returns were promising. All he needed was a few more weeks pounding the pavement of Kennington, Brixton, and Waterloo, and perhaps a few more weeks beyond that to tally up the numbers. When the cholera first struck a few blocks from his flat, the temptation to ignore the outbreak and continue with his grand experiment must have been tremendous. He had been chasing this thread for almost a year now, ever since Farr’s footnote had caught his eye. Another outbreak would be a distraction. But as word spread of the severity of the attack, Snow recognized that the Golden Square case might prove as revealing as his South London inquiry. By the end of Monday—with his water tests inconclusive, and the epidemic still raging around him—he was knocking on doors again, this time in his own neighborhood. All around him, the signs of devastation were inescapable. The Observer would later report: “In Broad-street, on Monday evening, when the hearses came round to remove the dead, the coffins were so numerous that they were put on top of the hearses as well as the inside. Such a spectacle has not been witnessed in London since the time of the plague.”
EDWIN CHADWICK
Tuesday, September 5
ALL SMELL IS DISEASE
THE FIRST SOLID CAUSE FOR HOPE BEGAN TO FILTER through the neighborhood Tuesday morning. For the first time in four days, Henry Whitehead let himself believe that this terrible visitation might finally be passing. The wife of Mr. G, the tailor, had died that morning, but for every new death, Whitehead could point to another dramatic recovery. The servant woman he had been tending to since Friday had risen from what she had assumed would be her deathbed, her pallor much improved. Two adolescents—a boy and girl—had also turned the corner, much to the delight of their remaining family. All three of them attributed their recovery to one thing: they had consumed large quantities of water from the Broad Street pump since falling ill. The speed and intensity of their recovery made an impression on Whitehead that would linger in his mind through the coming weeks.
In the late-morning hours, a small, formal parade of government officials, the members of the General Board of Health, arrived in Golden Square to tour the scene of the outbreak. The most notable thing about the procession was its leader: the Board’s new president, Sir Benjamin Hall, who had replaced the pioneering but controversial Edwin Chadwick a month earlier, prompting the Morning Chronicle to observe dryly that the incoming president was coming to the job “with one great advantage to his favor—his predecessors managed to accumulate upon themselves so much unpopularity that he has little to fear from invidious contrasts.”
As the officials walked through Dufours Place and Broad Street, small bands of surviving locals appeared on the sidewalk to express their gratitude for the Board’s appearance, their spirits also cheered by the sense that the outbreak was subsiding. The Board’s secretary released an account of the visit to the major papers, most of which obligingly reprinted it, including in their copy the self-congratulatory line: “The Guardians are acting most energetically, and every credit is due to them.” But it was harder to specify what those actions were exactly, however energetic they
might have been. The outbreak might have been diminishing, but it was still taking lives at a monstrous clip. More than five hundred residents of the Golden Square neighborhood had died in five days, and another seventy-six had fallen ill the day before. The Times itself was circumspect in describing what the Board was actually doing to battle the outbreak, beyond mentioning plans to form a committee to investigate it. The Board would eventually have a role to play in the Broad Street drama, but for the moment its actions were mostly theater.
The one intervention the Board of Health had made would have been immediately and viscerally evident to anyone walking through the neighborhood: the streets had been soaked with chloride of lime, and the smell of bleach was omnipresent, blocking out the usual stench of urban waste. In this one intervention, Edwin Chadwick’s influence on the Board lingered past his tenure as its head. The lime had been deployed to battle Chadwick’s lifelong nemesis, the sanitary curse he had built a career fulminating against, and the one he would go to his grave believing in: miasma.
IT IS NEARLY IMPOSSIBLE TO OVERSTATE THE IMPACT THAT Edwin Chadwick’s life had on the modern conception of government’s proper role. From 1832, when he was first appointed to the Poor Law Commission, through his landmark 1842 study of sanitation among the laboring classes, through his tenure as commissioner of the sewers in the late 1840s, to his final run at the helm of the General Board of Health, Chadwick helped solidify, if not outright invent, an ensemble of categories that we now take for granted: that the state should directly engage in protecting the health and well-being of its citizens, particularly the poorest among them; that a centralized bureaucracy of experts can solve societal problems that free markets either exacerbate or ignore; that public-health issues often require massive state investment in infrastructure or prevention. For better or worse, Chadwick’s career can be seen as the very point of origin for the whole concept of “big government” as we know it today.
Most of us today accept that the broad movements of Chadwick’s campaigns were ultimately positive ones. You have to be a committed libertarian or anarchist to think that the government shouldn’t be building sewers or funding the Centers for Disease Control or monitoring the public water supply. But if Chadwick’s long-term legacy was a progressive one, his short-term track record, as of 1854, was more complicated. No doubt he had done more than anyone alive to focus attention on the shameful condition of the industrial poor, and to mobilize forces to correct those problems. But some of the most significant programs he put in place ended up having catastrophic effects. Thousands upon thousands of cholera deaths in the 1850s can be directly attributed to decisions that Chadwick made in the decade before. This is the great irony of Chadwick’s life: in the process of inventing the whole idea of a social safety net, he unwittingly sent thousands of Londoners to an early grave.
How could such noble aspirations lead to such devastating results? In Chadwick’s case, there is a simple explanation: he insisted, to the point of obstinacy, on following his nose. The air of London was killing Londoners, he claimed, and thus the route to public health had to begin with removing noxious smells. He expressed this notion most famously—and most comically—in his 1846 testimony to a parliamentary committee investigating the problem of London’s sewage: “All smell is, if it be intense, immediate acute disease; and eventually we may say that, by depressing the system and rendering it susceptible to the action of other causes, all smell is disease.”
WITH FEW EXCEPTIONS, THE PROBLEMS THAT THE EARLY Victorians wrestled with are still relevant more than a century later. These are the standard social questions that you’ll encounter in any textbook account of the period: How can a society industrialize in a humane way? How can a government rein in the excesses of the free market? To what extent should working people be allowed to negotiate collectively?
But there was another debate that ran alongside those more austere themes, one that has not received as much attention in the seminar rooms or the biographies. It’s true enough that the Victorians were grappling with heady issues like utilitarianism and class consciousness. But the finest minds of the era were also devoted to an equally pressing question: What are we going to do with all of this shit?
The extent of London’s excrement problem was universally agreed upon. Chadwick’s influential 1842 study had laboriously recounted the repellent state of waste disposal in the city. Letter writers to the Times and other papers harped on the topic endlessly. A survey in 1849 examined 15,000 homes, and found that almost 3,000 had offensive smells from bad drainage, while a thousand had “privities [sic] and water-closets in a very offensive state.” One in twenty had human waste piling up in the cellar.
Many prominent reformers saw economic waste in all that fecal matter. Using human excrement as fertilizer in the greenlands around city centers was an ancient practice, but it had never been attempted with the waste of two million people. Hyperfertile soils would inevitably result if such a project were carried out, the evangelists claimed. One expert projected a fourfold increase in food production. A proposal in 1843 argued for the construction of cast-iron sewers that would transport waste all the way to Kent and Essex.
Few were as rhapsodic on the subject as Henry Mayhew, who saw in waste recycling an escape route from the Malthusian limits on population growth: “If what we excrete plants secrete—if what we exhale they inspire—if our refuse is their food—then it follows that to increase the population is to increase the quantity of manure, while to increase the manure is to augment the food of plants, and consequently the plants themselves. If the plants nourish us, we at least nourish them.”
As was typical of Mayhew, this circle-of-life philosophizing quickly gave way to a frenzy of numerical calculation:
According to the average of the returns, from 1841 to 1846, we are paying two millions every year for guano, bone-dust, and other foreign fertilizers of our soil. In 1845, we employed no fewer than 683 ships to bring home 220,000 tons of animal manure from Ichaboe alone; and yet we are every day emptying into the Thames 115,000 tons of a substance which has been proved to be possessed of even greater fertilizing powers. With 200 tons of the sewage that we are wont to regard as refuse, applied to the irrigation of one acre of meadow land, seven crops, we are told, have been produced in the year, each of them worth from 6l. [6 pounds sterling] to 7l.; so that, considering the produce to have been doubled by these means, we have an increase of upwards of 20l. per acre per annum effected by the application of that refuse to the surface of our fields. This return is at the rate of 10l. for every 100 tons of sewage; and, since the total amount of refuse discharged into the Thames from the sewers of the metropolis is, in round numbers, 40,000,000 tons per annum, it follows that, according to such estimate, we are positively wasting 4,000,000l. of money every year.
This sort of bookkeeping remained an essential subgenre in the political debate for decades to come. One scholar testified before Parliament in 1864 that the value of London’s sewage was “equal to the local taxation of England, Ireland, and Scotland.” The Victorians were literally flushing money down the toilet—or, worse, leaving it to decay in the cellar.
Edwin Chadwick, too, was a great believer in the economic bounty that lay trapped in London’s sewage. A document he helped produce in 1851 argued that fertilizing the countryside with London’s waste would cause land values to quadruple. He also entertained an aquatic version of the theory, arguing that delivering fresh feces in an expedient manner to England’s waterways would produce larger fish.
But for Chadwick and other social reformers of the period, the primary reason to deal with London’s rising tide of excrement had to do with health, not economics. Not everyone went as far as Chadwick’s conviction that all smell was disease, but most agreed that the vast quantities of waste decomposing in the cellars and the streets of the city were literally poisoning the air. If merely taking a stroll down the sidewalk could overwhelm you with the putrid stench of human waste, something clearly had to
be done.
The solution was straightforward enough, at least in theory. London needed a citywide sewage system that could remove waste products from houses in a reliable and sanitary fashion. It would require a massive engineering effort, but a country that had built a national rail network in a matter of decades and spearheaded the Industrial Revolution could handle a project on that scale. The problem was one of jurisdiction, not execution. The urban infrastructure of early Victorian London was governed by a byzantine assortment of local boards that had been assembled over the centuries by more than two hundred separate acts of Parliament. Paving or lighting the streets, building drains and sewers—these were all acts overseen by local commissioners with almost no citywide coordination. One three-quarter-mile stretch of the Strand was overseen by nine separate paving boards. To take on a project as epic as building an integrated metropolitan sewer system would require more than engineering genius and backbreaking labor. It would need a revolution in the power dynamics of city life. The bottom-up, improvised recycling of the scavengers would have to give way to the master planner.
In this, Edwin Chadwick was perfectly cast for the role. Brusque and strong-willed to the point of rudeness, Chadwick was in many ways a Victorian rendition of Robert Moses (that is, if Moses had lost his grip on New York City’s power structure halfway through his career and spent the last thirty years of his life editorializing from the sidelines). A devout Utilitarian and friend of Jeremy Bentham, Chadwick had spent the thirties helping to create—and then, partially, clean up—the national mess that was the Poor Law Acts of 1832–1834. But by the 1840s he had grown increasingly obsessed with sanitation issues, and his crusades ultimately culminated in the passing of the Public Health Act of 1848, which established the three-member General Board of Health, Chadwick at its helm. But the bill with the most dramatic short-term impact on London’s health would be the Nuisances Removal and Contagious Diseases Prevention Act, also passed in 1848, after years of Chadwick’s campaigning. “Nuisance” in this case meant, effectively, one thing: human waste. For a few years, new buildings had been required to drain into the existing sewer system, but the “cholera bill”—as it was conventionally referred to—was the first to require sewer connections from existing structures. For the first time, the law had something to say about people opting to fill their old cellars with “great heaps of turds,” as Samuel Pepys put it in a 1660 journal entry. Though of course the law didn’t quite express it that way—choosing a more delicate, if prolix, language to describe the problem:
The Ghost Map Page 11
