Get Well Soon

by Jennifer Wright

  Although diseases don’t stem from “bad smells,” some are carried by insects and other pests that are drawn to excrement and other creators of bad odors. So cleaning up your cesspools and removing fecal matter from the street are good ideas in general. Unless your solution is to dump the waste into the River Thames.

  Everyone drank from the Thames, and it was now filled with decades’ worth of fecal matter and urine from people’s basements. In 1850 Charles Dickens described the river, lamenting that it was “the black contents of common sewers and the refuse of gut, glue, soap and other nauseous manufactures, to say nothing of animal and vegetable offal of which the river is the sole receptacle.”7 In 1853 an article in the Builder declared: “The flood … is now, below London Bridge, bad as poetical descriptions of the Stygian Lake, while the London Dock is black as Acheron … where are ye, ye civil engineers? Ye can remove mountains, bridge seas and fill rivers … can ye not purify the Thames, and so render your own city habitable?”8 Drinking from such a river is a truly terrible plan if you do not wish to die.

  Especially if you’re dealing with a cholera outbreak. In fact, cholera was the main problem that the Nuisances Act was hoping to address. However, cholera isn’t spread through the smells in the air, as officials thought. It is spread through ingesting other people’s infected defecated matter. If you are thinking, I’m not into that. Even the idea of that is disgusting to me on a primal level, you are an evolved human being. The thought is so repulsive to most people that the whole horror movie trilogy The Human Centipede (2009–15) is based on the premise “What if people had to eat other people’s shit? That’d be a real bummer!” (Sorry I spoiled the movies, but you probably saw the best bits in the Academy Award recaps anyway.)

  While almost no one would contract it on purpose, cholera is very easy to acquire unintentionally if you are drinking water contaminated with fecal matter. Enough cholera bacteria to kill a person wouldn’t even cloud the water you were drinking. Once you have drunk it without even knowing it, the cholera bacterium settles in the small intestine. There, it begins reproducing and forms a toxin called CTX, which covers the walls of the small intestines. Now, the main purpose of the small intestine is to keep you hydrated; it absorbs water and then sends it on to other areas of the body. However, when its walls are coated with cholera bacteria, it instead begins expelling water. The result is a white-flaked, watery diarrhea that is referred to as “rice stool.” Cool fact: the “rice” flakes are actually cells from the small intestine. People would expel so much water that they could lose 30 percent of their body weight. Someone would drop from a healthy 120 pounds to a deadly 85 pounds within days. Without water, first nonessential organs begin to shut down, and then the essential organs like the heart and kidneys fail. The brain, perhaps especially tragically, was often the last organ to succumb, so people would remain conscious of their suffering until the end. The British newspaper the Times claimed that it gave people in the throes of death the appearance of “a spirit looking out in terror from a corpse.”9 Then the deceased’s cholera-contaminated rice stool would be dumped into the river or nearby water supply (or cesspool in the cases where people still insisted on having them, despite the Nuisances Act), and the process would be repeated.

  If the above paragraph was too long: People shat themselves to death. It was, and still is in countries where clean water is not readily available, a horrible way to die.

  But into this literally shitty quagmire stepped a hero. He was a physician named John Snow, and, like the Game of Thrones character Jon Snow, he was a real square. He was self-righteous in all his habits. He was a fervent teetotaler. Which is fine! The most accomplished people I know never drink and are always getting up early to run marathons. But Snow wrote very long, dry speeches on how you—you fool—should not drink alcohol. One that he wrote at the wise old age of twenty-three explains: “I feel it my duty to endeavour to convince you of the physical evils sustained to your health by using intoxicating liquors even in the greatest moderation; and I leave to my colleagues the task of painting drunkenness in all its hideousness, of describing the manifold miseries and crimes it produces, and of proving to you that total abstinence is the only remedy for those evils.”10 I am positive he would give that speech every time you had a glass of wine at dinner. He also claimed that people drank because of a level of curiosity “unpossessed of which we should remain as stationary as brutes; and which, if allowed to lie dormant, would cause us to remain for generations with as little improvement as the Chinese.”11 I thought he was going to say “as little improvement as animals,” but I was wrong! The fact that he hated the Chinese was not all that unusual by nineteenth-century British standards, but it doesn’t make me like him more. In any event, his fervent antialcoholism is ironic given that this was perhaps the only period in history when from a health standpoint you would have been better off consuming alcohol than water.

  I am not exaggerating or joking when I make that statement. In one instance, during the cholera epidemic of 1854 all eighty workers at a London brewery notably managed to avoid catching the disease. To be fair, the brewery had its own well, but the proprietor noted that most of the men just drank the liquor they produced.12

  Snow was also a vegan, though it “puzzled the housewives, shocked the cooks and astonished the children.”13 Again, being a vegan is cool—good for him—but I will bet you every penny I have that he never shut up about it. He was known to have a poor bedside manner and almost no social life. He wrote so many critical articles that at one point the editor of the Lancet journal wrote, “Mr. Snow might better employ himself in producing something, than in criticizing the production of others.”14 His acquaintance and later biographer Dr. Benjamin Ward Richardson noted: “He took no wine nor strong drink; he lived on anchorite’s fare, clothed plainly, kept no company, and found every amusement in his science books, his experiments and simple exercise.”15

  Sounds super fun.

  Okay. He may not be the hero we wanted, but he is the one we got. Let us fete him with a stick of celery and some seltzer.

  There were many times when being antisocial and extremely critical didn’t work in Snow’s favor. Having him as a guest for dinner sounds like a nightmare. (Playing “What three historical figures would you most hate to have dinner with?” is an amusing variation on the “Which people living or dead would you like to dine with?” game.) However, Snow’s cantankerous personality proved useful when going against everyone else, who had agreed upon a theory that was literally killing them. John Snow’s refusal to go merrily along with the rest of his profession’s assertion that cholera was spread either by the miasma theory or from person-to-person contagion proved very valuable.

  Snow had treated an outbreak of cholera in 1832, so he was well aware of its devastating effects.16 However, it was in 1848, during an outbreak that killed fifty thousand people in England and Wales, that Snow traced the first case in London to a sick sailor traveling from Hamburg. The sailor died in a room at a boardinghouse in London. That room was then occupied by another man, who also caught cholera and died. Now, I know what you are thinking, you nineteenth-century miasmist: This was truly a remarkable coincidence! Both Hamburg and London must smell terrible right now. How unfortunate. Everyone in the medical profession would have agreed with you. However, it seemed more likely to Snow that cholera had been transmitted in some way by the sailor from Hamburg, especially since he was coming from a city where the disease was killing people. Okay, that might indicate it could be passed from person to person. But the sailor was already dead (and gone) by the time the second inhabitant moved into the room. The doctor who had visited both these men never contracted cholera. Snow noticed that often doctors from different neighborhoods could visit with cholera patients but never get the disease themselves. Meanwhile, sometimes an entire neighborhood would be struck down.

  Snow determined that people were somehow ingesting the disease and were being made sick by “morbid matter,” alt
hough he wasn’t precisely sure how.

  By 1849 he was convinced cholera was spread by water. He had studied a group of twelve people who lived in a row of cottages and who had all contracted the disease. The people in the next row of cottages—who were surely exposed to the same smells in the air, and with whom the residents of the first cottages mingled—remained perfectly healthy. He found that the well for the first row of cottages was cracked; its water supply was being contaminated by a nearby sewer. The people in the second row of cottages pulled their water from a different well. Snow also noted that, while the East End of London smelled terrible, it didn’t have nearly the same number of cholera cases as South London, where people received much of their water from a particularly contaminated area of the Thames.17

  Our hero published a paper on these findings, which you and I would probably find wholly convincing as we already know that Snow was correct. However, people of that time did not believe his theory at all. According to the London Medical Gazette: “Other causes, irrespective of the water, may have been in operation especially as the persons were living in close proximity … The facts here mentioned raise only a probability, and furnish no proof whatsoever of the author’s views.”18 Proof, according to the journal, would depend on one source of water that, when conveyed to a community “where cholera had been hitherto unknown, produced the disease in all who used it, while those who did not use it escaped.”19

  So John Snow waited for an outbreak where such a case might be found. He practiced anesthesiology in the meantime, and he was great at it—he was present at the birth of two of Queen Victoria’s children. He was probably so proficient because he was a total snooze. (Why am I so mean to this good man who just wanted to save lives?)

  Faulty assumptions about the nature of cholera might have gone on forever if, on August 28, 1854, an infant known as Baby Lewis (her real name was Frances) had not contracted the disease. It’s not known how the baby got cholera. However, it is known that her family lived at 40 Broad Street, which had a cesspool in front that, unfortunately for everyone in London, bordered on the most popular water pump in Soho—the Broad Street pump. This pump was famous for the high quality of its water; it had such a good reputation that even people who didn’t live nearby would use it for their water supply. So it’s unfortunate that once her baby contracted cholera, Mrs. Lewis tossed Frances’s filthy excrement into that cesspool, where it began contaminating the pump’s water supply.

  Though the water from the pump was barely discolored, the cholera bacterium began its deadly work. Seventy-four people in the neighborhood died by September 3. Hundreds more were on the verge of death. Within a week, 10 percent of the neighborhood was dead,20 including Frances’s father. Although cholera often killed devastating numbers of people in a memorably agonizing way, it didn’t usually work so quickly. Typically, it took months to kill the hundreds of people who, in this instance, died within days.

  Snow lived only a few blocks away from the neighborhood. While other residents of Soho fled to stay with friends in different areas of town, he eagerly began his investigation. “As soon as I became acquainted with the situation and extent of this irruption of cholera,” he wrote, “I suspected some contamination of the water of the much-frequented street-pump in Broad Street.”21

  But how to go about proving his theory? Snow began going through the neighborhood and questioning the inhabitants about the habits of everyone who had acquired cholera. He constructed a map charting the outbreak, and in doing so noticed that the closer people were to the Broad Street pump, the more likely they were to be sick or dead. Those who did not get cholera had their own wells or, for whatever reason, chose not to use the Broad Street pump.

  Not all of the cases were obvious, of course. A few people didn’t recall drinking water from the pump; however, they had consumed sherbet, which was sold on the street and made from water from the pump. Another woman lived in Hampstead, absolutely nowhere near the Broad Street pump, and yet she had still contracted cholera. So had her niece who was staying with her. This would seem to contradict Snow’s theory, if not for the fact that the woman had formerly lived in Soho and believed the water from the Broad Street pump was the best. That is a charming bit of sentimental attachment to your former neighborhood. Her son explained to Snow that she loved the water so much that her children periodically bottled it and sent it to her in care packages. That lady’s inadvertently murderous family sounds so sweet and caring, and I feel very sad for them.

  But I’m guessing Snow was at least pleased on an intellectual level. Finally, here was the proof that the London Medical Gazette had claimed was necessary to prove that cholera was carried by water! In this case the water had quite literally been moved to a community “where cholera had been hitherto unknown, [and] produced the disease in all who used it.” The Hampstead cases could not simply be explained by the sickly smelling air around the Broad Street pump.

  On September 7, Snow shared his findings with town officials and implored them to remove the handle from the Broad Street pump. He explained the high rate of disease around the pump and how even people far removed from the pump who had drunk from the same water supply became sick. On September 8, the handle to the Broad Street pump was removed. Today, this breakthrough is the stuff of legend, so much so that when officials at the Centers for Disease Control and Prevention are looking for a solution to a medical mystery, they are known to joke, “Where’s the handle to the Broad Street pump?”22

  No sooner did the cases of cholera decline than people began to look for alternate reasons for the abatement. On September 15 the Times reported that around Soho there was

  a continual presence of [the strong smelling disinfect] lime in the roadways. The puddles are white and milky with it, the stones are smeared with it; great splashes of it lie about in the gutters, and the air is redolent with its strong and not very agreeable odor. The parish authorities have very wisely determined to wash all the streets of the tainted district with this powerful disinfectant; accordingly the purification takes place regularly every evening.23

  That had … nothing to do with why cholera was subsiding, although the fact that the streets were being made to smell of cleaning chemicals rather than more disagreeable odors would certainly satisfy those who believed in the miasma theory.

  The Globe, meanwhile, attributed the decline as “owing to the favourable change in the weather, the pestilence which has raged with such frightful severity in this district has abated, and it may be hoped that the inhabitants have seen the worst of the visitation.”24 No. Wrong again. But it was so much easier for people to think that bad odors—which they could smell and experience themselves—caused disease than to believe that it was due to something invisible in the water.

  In March 1855 Snow was called upon for testimony regarding an amendment to the Nuisances Act, which hoped to regulate industries like gas workers and bone boilers. Those industries emitted disgusting fumes into the air. So Snow was put in what must have been a peculiar position of defending the rights of industry to render bones, which, while gross, was not actually causing cholera. His testimony gave him the opportunity to strike down the miasma theory:

  I have paid a great deal of attention to epidemic diseases, more particularly to cholera, and in fact to the public health in general; and I have arrived at the conclusion with regard to what are called offensive trades, that many of them really do not assist in the propagation of epidemic diseases, and that in fact they are not injurious to the public health. I consider that if they were injurious to the public health they would be extremely so to the workmen engaged in those trades, and as far as I have been able to learn, that is not the case; and from the law of the diffusion of gases, it follows, that if they are not injurious to those actually upon the spot, where the trades are carried on, it is impossible they should be to persons further removed from the spot.25

  One interesting and weirdly specific aspect of the discussion was when Snow was asked wh
y, if smells can’t make you sick, do people vomit if they smell something extremely bad? Specifically, the chairman Benjamin Hall questioned, “I understand you to say that such effluvia, when highly concentrated, may produce vomiting, but that they are not injurious to health. How do you reconcile those two propositions?”

  If you have the same question, today it’s thought that noxious smells act on a receptor in the nose that warns your body of impending danger.26 A caveman in an area rife with bad smells is probably in an area where there are predators. The physical response tells his body to get out. Snow said only that he thought “it might be a kind of sympathy. Persons are often much influenced by the imagination,” but the important aspect was that smells do not make people permanently sick: “If the vomiting were repeatedly produced, it would certainly be injurious to health. If a person was constantly exposed to decomposing matter, so concentrated as to disturb the digestive organs, it must be admitted that that would be injurious to health; but I am not aware that, in following any useful trade or manufacture, the effects ever experienced.”27

  Basically, if something smells so bad it makes you vomit uncontrollably, you should probably leave the room. The fact that the people at this hearing harped on an irrelevant question reminds me of the days after 9/11 when, as I think Jon Stewart mentioned at the time, newscasters began postulating increasingly outlandish scenarios, like “What would happen if a terrorist had a smart bomb shaped exactly like a donut and the president ate it?” Well, it would be bad, but it was also not going to happen. Similarly, no one was going to remain in a room where bad smells made them vomit until they died. “Why do smells make people vomit then, huh, huh?” feels like the last desperate attempts of officials to hold on to their “known” world.