Responses to cholera

Driven entirely by the miasma theory, the national response to the 1848 outbreak included the Board ordering the flushing of sewers to remove foul odours. Tragically, this accidentally worsened the epidemic by pushing more raw sewage directly into the drinking water supply.

John Snow and the Broad Street Pump (1854)

• How do you stop a killer you cannot see? During the third epidemic in 1854, a localized outbreak in Soho killed over 600 people, prompting a doctor named John Snow to investigate using a scientific approach.
• Snow is considered the "Father of Epidemiology" because he used a "spot map" to plot deaths, identifying the Broad Street pump as the exact centre of the outbreak.
• He proved his theory by investigating anomalies. Workers at Huggins' Brewery survived because they drank free beer instead of water, while a woman in Hampstead (Susannah Eley) died because she specifically had Broad Street water delivered for its taste.
• Snow and Reverend Henry Whitehead traced the index case to a cesspit leaking into the pump's well. On September 8, 1854, Snow persuaded the local parish board to remove the pump handle, causing cases to drop immediately.
• Despite this evidence, the General Board of Health officially rejected Snow's findings in 1855. They remained committed to the miasma theory, meaning Snow's discovery had zero short-term impact on national public health policy.

The 1866 Epidemic and Bazalgette’s Sewers

• A smell so bad it literally stopped Parliament from working became the accidental saviour of London's water supply. The "Great Stink" of 1858 caused such extreme fear of miasma that the government funded a massive new sewer system.
• Engineered by Joseph Bazalgette, the system included 82 miles of main sewers and 1,100 miles of street sewers. Crucially, it separated human waste from drinking water.
• During the final 1866 epidemic (which killed 14,378 people overall), deaths in London were largely confined to East London—the only area not yet connected to Bazalgette's sewers.
• Statistician William Farr analyzed the 1866 data and found that 93% of London's deaths occurred in areas using contaminated water from the Old Ford Reservoir. This finally convinced the medical establishment that cholera was a water-borne disease.
• Other industrial cities suffered heavily in 1866 due to transient populations and a lack of infrastructure. Liverpool recorded a staggering cholera mortality rate of 54 per 10,000 people, compared to just 18 per 10,000 in London.
• Local responses in cities like Liverpool were largely improvised. Because permanent health infrastructure was lacking, parochial authorities were forced to set up temporary isolation hospitals, extra nursing care, and quarantine facilities to cope with the outbreak.
• Nationally, the government responded to the 1866 epidemic using emergency powers from the 1855 Diseases Prevention Act. The Privy Council issued regulations for affected cities, which included mandating house-to-house visitations by medical staff, ordering the speedy burial of the dead, and enforcing the disinfection of properties.

The 1875 Public Health Act

• Every time you turn on a tap to get clean drinking water, you are benefiting from the laws established in the late 19th century that finally ended the era of laissez-faire.
• The 1875 Public Health Act was a major turning point because it was completely compulsory. It consolidated 29 previous laws into one uniform code.
• This shift was politically driven by the 1867 Reform Act, which gave working-class men the vote, forcing politicians to improve living conditions to win elections. Scientifically, it was supported by Louis Pasteur's Germ Theory (1861), which finally disproved miasma.
• Under the Act, Sanitary Authorities were forced to provide clean water, collect rubbish, and appoint Medical Officers of Health and Sanitary Inspectors.

Comparing the Public Health Acts