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For Snow, of course, the variable was water supply. But for the upstairs/downstairs rumor mill, the difference was class. A better sort of people lived on the ground floors—no wonder they were more likely to fight off the disease.
One study of mortality rates from 1842 had found that the average “gentleman” died at forty-five, while the average tradesman died in his mid-twenties.
The 1842 study found that 62 percent of all recorded deaths were of children under five. And yet despite this alarming mortality rate, the population was expanding at an extraordinary clip.
The hunter-gatherers or the early agriculturists couldn’t have formed a city of the size and density of 1850s London (much less today’s São Paulo) even if they had wanted to. To sustain a population of a million people—to keep them fed alone, much less power their SUVs or subways or refrigerators—you need a massive supply of stored energy to keep
all those bodies alive. Small bands of hunter-gatherers collected enough energy, if they were lucky, to sustain small bands of hunter-gatherers.
Cities were suddenly populated by a class of consumers, free to worry about other pressing matters: new technologies, new modes of commerce, politics, professional sports, celebrity gossip.
Industrial Revolution would have never happened if two distinct forms of energy had not been separated from the earth: coal and commoners.
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.
With the exception of the earth’s atmosphere, the city is life’s largest footprint. And microbes are its smallest. As you zoom in past the scale of the bacterium and the virus, you travel from the regime of biology to the regime of chemistry: from organisms with a pattern of growth and development, life and death, to mere molecules. It is a great testimony to the connectedness of life on earth that the fates of the largest and the tiniest life should be so closely dependent on each other.
Without the population densities and the global connectivity of industrialization, cholera might not have been as devastating in England, and thus might not have attracted Snow’s investigative skills in the first place. But in other places,
To solve the riddle of cholera you had to zoom out, look for broader patterns in the disease’s itinerary through the city. When health matters are at stake, we now call this wide view epidemiology, and we have entire university departments devoted to it.
seemed to show that higher ground was safer ground. This would prove to be a classic case of correlation being mistaken for causation: 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. They were safer because they tended to have cleaner water.
offset by alcohol’s antibacterial properties. 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.
“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’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,
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.
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?
The first defining act of a modern, centralized public-health authority was to poison an entire urban population. (There
Whenever smart people cling to an outlandishly incorrect idea despite substantial evidence to the contrary, something interesting is at work.
The weight of tradition, the evolutionary history of disgust, technological limitations in microscopy, social prejudice—all these factors colluded to make it almost impossible for the Victorians to see miasma for the red herring that it was, however much they prided themselves on their Gradgrindian rationality.
The respiratory system, on the other hand, was largely unaffected by cholera’s ravages. For Snow, that suggested an obvious etiology: cholera was ingested, not inhaled.
Among the forty-five houses extending in all directions from the intersection of Broad and Cambridge streets, only four managed to survive the epidemic without losing a single inhabitant. “Such a mortality in so short a time is almost unparalleled in this country,” the Observer noted.
But the pump handle stands for more than that local redemption. It marks a turning point in the battle
The decision to remove the handle was not based on meteorological charts or social prejudice or watered-down medieval humorology; it was based on a methodical survey of the actual social patterns of the epidemic, confirming predictions put forward by an underlying theory of the disease’s effect on the human body. It was based on information that the city’s own organization had made visible. For the first time, the V. cholerae’s growing dominion over the city would be challenged by reason, not superstition.
“Every limit is a beginning as well as an ending,” George Eliot would write a few years later in Middlemarch. So it is with the story of the pump handle’s removal. It was the end of the Broad Street well’s assault on Golden Square, and the beginning of a new era of public health. But it does not offer the easy closure of the detective story.
Within two hundred and fifty yards of the spot where Cambridge Street joins Broad Street, there were upwards of five hundred fatal attacks of cholera in ten days. The mortality in this limited area probably equals any that was ever caused in this country, even by the plague; and it was much more sudden, as the greater number of cases terminated in a few hours.
We will enter a new era: a planet whose human population is more than 50 percent urban. Some experts believe we are on a path that will take us all the way to 80 percent, before we reach a planetary stabilization point.
Less than two centuries later, the urbanites have become an absolute majority. No other development during that period—world wars, the spread of democracy, the use of electricity, the Internet—has had as transformative and widespread an impact on the lived experience of being human. The history books tend to orient themselves around nationalist story lines: overthrowing the king, electing the presidents, fighting the battles. But the history book of recent Homo sapiens as a species should begin and end with one narrative line: We became city dwellers.
For most of the world’s nations, living in a city now extends your life expectancy instead of shortening it. Thanks to the government interventions of the seventies and eighties, air quality in many cities is as good as it has been since the dawn of industrialization.
balance of our natural ecosystems, the best way to do it is to crowd as many of those humans into metropolitan spaces and return the rest of the planet to Mother Nature.
As urbanization continues worldwide, current estimates project that the earth’s human population will peak at around 8 billion in 2050. After that, it’s a population implosion that we’ll have to worry about.
“Cities were once the most helpless and devastated victims of disease, but they became great disease conquerors,”
revolved around density, capitalizing on the advantages of dense urban living while minimizing the dangers.
Ultimately, they live in these spaces for the same reason that the squatter classes of São Paulo do: because cities are where the action is. Cities are centers of opportunity, tolerance, wealth creation, social networking, health, population control, and creativity.
All the world needs is for a single strain of H5N1 to somehow mutate into a form that is transmissible between humans, and that virus could unleash a pandemic that could easily rival the 1918 influenza pandemic, which killed as many as 100 million people worldwide.
This is why we’re vaccinating poultry workers in Thailand, why the news of some errant bird migration in Turkey can cause shudders in Los Angeles. This is why the pattern recognition and local knowledge and disease mapping that helped make Broad Street understandable have never been more essential. This is why a continued commitment to public-health institutions remains one of the most vital roles of states and international bodies. If
There are thousands of scientists and billions of dollars spent every year exploring new ways to fight lethal epidemic diseases. But no one is working on a way to neutralize a nuclear explosion, presumably for the entirely rational reason that it is impossible to neutralize a nuclear explosion. We have made some advances in detection—all nuclear devices give off a radioactive signal that can be tracked by sensors—but detection is hardly a fail-safe option.
Our ability to render a virus harmless is growing at exponential rates, while our ability to undo the damage caused by the detonation of a nuclear device is, literally, nonexistent, with no sign that it will ever be technically possible.
The period from March 2020 to May 2020 almost certainly marked the most significant short-term change ever in worldwide human behavior. Vast sections of the planet effectively froze in place for a few months, and then adopted, en masse, a whole new set of routines to flatten the curve and slow the spread—a genuinely new trick for Homo sapiens. It was not obvious in advance that such a thing was even possible.
switch back into the “pandemic mode” they learned in 2020–2021. That change in behavior might save millions of lives the next time around.
