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April 7 - April 9, 2020
The population growth during the first half of the eighteenth century neatly coincided with the mass adoption of tea as the de facto national beverage. (Imports grew from six tons at the beginning of the century to eleven thousand at the end.) A luxury good at the start of the century, tea had become a staple even of working-class diets by the 1850s. One mechanic who provided an account of his weekly budget to the Penny Newsman spent almost fifteen percent of his earnings on tea and sugar.
Brewed tea possesses several crucial antibacterial properties that help ward off waterborne diseases: the tannic acid released in the steeping process kills off those bacteria that haven’t already perished during the boiling of the water.
The explosion of tea drinking in the late 1700s was, from the bacteria’s point of view, a microbial holocaust.
Do not mistake these multiple trends—the energy flows of metropolitan growth, the new taste for tea, the nascent, half-formed awareness of mass behavior—for mere historical background. The clash of microbe and man that played out on Broad Street for ten days in 1854 was itself partly a consequence of each of these trends, though the chains of cause and effect played out on different scales of experience, both temporal and spatial.
In a city like Victorian London, unchallenged by military threats and bursting with new forms of capital and energy, microbes were the primary force reigning in the city’s otherwise runaway growth, precisely because London had offered Vibrio cholerae (not to mention countless other species of bacterium) precisely what it had offered stockbrokers and coffeehouse proprietors and sewer-hunters: a whole new way of making a living.
The bird’s-eye view of the city, the sense of the urban universe as a system, as a mass phenomenon—this imaginative breakthrough is as crucial to the eventual outcome of the Broad Street epidemic as any other factor. To solve the riddle of cholera you had to zoom out, look for broader patterns in the disease’s itinerary through the city.
The basic technique of population statistics—measuring the incidence of a given phenomenon (disease, crime, poverty) as a percentage of overall population size—had entered the mainstream of scientific and medical thought only in the previous two decades. Epidemiology as a science was still in its infancy, and many of its basic principles had yet to be established.
Ironically, just a few days before Snow had unsuccessfully attempted to see any telltale signs of cholera in the water, an Italian scientist at the University of Florence had discovered a small, comma-shaped organism in the intestinal mucosa of a cholera victim. It was the first recorded sighting of Vibrio cholerae, and Filippo Pacini published a paper that year describing his findings, under the title “Microscopical Observations and Pathological Deductions on Cholera.”
John Snow would go to his grave never learning that the cholera agent he had spent so many years pursuing had been identified during his lifetime.
In this, Snow developed a strangely symbiotic relationship with V. cholerae: he needed the disease to flourish to have a shot at conquering it.
Farr recognized that these surveys could be far more valuable to science if they included additional variables. He waged a long campaign to persuade physicians and surgeons to report a cause of death wherever possible, drawing upon a list of twenty-seven fatal diseases. By the mid-1840s, his reports tallied deaths not only by disease, but also by parish, age, and occupation. For the first time, doctors and scientists and health authorities had a reliable vantage point from which to survey the broad patterns of disease in British society.
the communities at the higher elevations tended to be less densely settled than the crowded streets around the Thames, and their distance from the river made them less likely to drink its contaminated water. Higher elevations were safer, but not because they were free of miasma.
Yet despite his skepticism, Farr had been intrigued enough by Snow’s waterborne theory to add a new category to his Weekly Returns. In addition to tracking the age and sex and elevation of the cholera victims, Farr would now track one additional variable: where they got their water.
For much of human history, the solution to this chronic public-health issue was not purifying the water supply. The solution was to drink alcohol. In a community lacking pure-water supplies, the closest thing to “pure” fluid was alcohol.
Dying of cirrhosis of the liver in your forties was better than dying of dysentery in your twenties. Many genetically minded historians believe that the confluence of urban living and the discovery of alcohol created a massive selection pressure on the genes of all humans who abandoned the hunter-gatherer lifestyle.
Over generations, the gene pool of the first farmers became increasingly dominated by individuals who could drink beer on a regular basis. Most of the world’s population today is made up of descendants of those early beer drinkers, and we have largely inherited their genetic tolerance for alcohol.
The descendants of hunter-gatherers—like many Native Americans or Australian Aborigines—were never forced through this genetic bottleneck, and so today they show disproportionate rates of alcoholism.
Fermenting organisms, like the unicellular yeast fungus used in brewing beer, survive by converting sugars and carbohydrates into ATP, the energy currency of all life. But the process is not entirely clean. In breaking down the molecules, the yeast cells discharge two waste products—carbon dioxide and ethanol. One provides the fizz, the other the buzz.
They drank the waste discharged by yeasts so that they could drink their own waste without dying in mass numbers. They weren’t aware of it, of course, but in effect they had domesticated one microbial life-form in order to counter the threat posed by other microbes.
Starting in the mid-1700s, a growing patchwork of privately owned water pipes began snaking their way through the city, supplying the wealthiest Londoners with running water in their homes (or, in some cases, depositing the water in a cistern near their house). It is difficult to overestimate the revolutionary impact of this advance.
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.
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 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.
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.
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.
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
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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?
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.
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.
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.
Again...HURK
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.
London actually had an ancient drainage system that had evolved around a dozen creeks and small rivers that continue to flow beneath the city to this day. (The largest waterway, the Fleet River, runs beneath Farringdon Road, emptying into the Thames under Blackfriars Bridge.)
as the city’s population exploded, and as more and more houses discharged their waste into the existing sewers, the quality of the Thames water declined at an alarming rate. What’s more, the sewers themselves began to clog, leading to the occasional underground explosion of methane gas.
There was much squabbling and drafting of plans for expanding the city’s sewage system, but nothing practical was done for years, until a brilliant engineer named Joseph Bazalgette took charge of the project. In the meantime, the primary focus was on eliminating cesspools.
In the space of about thirty-five years, the Thames had been transformed from a fishing ground teeming with salmon to one of the most polluted waterways in the world—all in the name of public health. As the builder Thomas Cubbitt observed wryly: “The Thames is now made a great cesspool instead of each person having one of his own.”
Just as Snow was concocting his theory of cholera as a waterborne agent that had to be ingested to do harm, Chadwick was building an elaborate scheme that would deliver the cholera bacteria directly to the mouths of Londoners.
The first defining act of a modern, centralized public-health authority was to poison an entire urban population.
If all smell was disease, if London’s health crisis was entirely attributable to contaminated air, then any effort to rid the houses and streets of miasmatic vapors was worth the cost, even if it meant turning the Thames into a river of sewage.
a theory that blamed cholera on “putrescent yeast, emanations of sewers, graveyards, etc.”
Fucking yeast conspiracy theories
So often what is lacking in many of these explanations and prescriptions is some measure of humility, some sense that the theory being put forward is still unproven. It’s not just that the authorities of the day were wrong about miasma; it’s the tenacious, unquestioning way they went about being wrong.
The canary in the miasma coal mine should have been the sewer-hunters, who spent their waking hours exposed to the most noxious—sometimes even explosive—air imaginable. And yet, bizarrely, the canary seemed to be doing just fine,
Whenever smart people cling to an outlandishly incorrect idea despite substantial evidence to the contrary, something interesting is at work. In the case of miasma, that something involves a convergence of multiple forces, all coming together to prop up a theory that should have died out decades before.
Hippocrates was so obsessed with air-quality issues that his medical tracts sometimes sound like instructions for a novice meteorologist.
Miasma theories were eminently compatible with religious tradition as well. As one might expect from a man of the cloth, Henry Whitehead believed that the Golden Square outbreak was God’s will, but he supplemented his theological explanation with a miasmatic one; he believed that “the atmosphere, all over the world, is at this time favourable to the production of a most formidable plague.”
Again and again in the literature of miasma, the argument is inextricably linked to the author’s visceral disgust at the smells of the city. The
Modern brain-imaging technology has revealed the intimate physiological connection between the olfactory system and the brain’s emotional centers. In fact, the seat of many of those emotional centers—the limbic system—was once called the “rhinencephalon,” literally “nose-brain” or “smell-brain.”
In lay terms, the human brain appears to have evolved an alert system whereby a certain class of extreme smells triggers an involuntary disgust response that effectively short-circuits one’s ability to think clearly—and produces a powerful desire to avoid objects associated with the smell.
You can think of it as a form of evolutionary pattern recognition: over millions of years of evolution, natural selection hit upon the insight that the presence of hydrogen sulfide molecules in the air was a reasonably good predictor that microbial life-forms that could be dangerous if swallowed were nearby.
Nausea itself was a survival mechanism: it was better to void the contents of your stomach than run the risk that the smell was coming from the antelope you’d just finished eating.
If the smell had been ubiquitous—if, say, some common African flower had begun emitting hydrogen sulfide from its blooms—then the human brain might have evolved another way of anticipating the presence of decaying food.
