London in 1854 was a Victorian metropolis trying to make do with an Elizabethan public infrastructure. The city was vast even by today's standards, with two and a half million people crammed inside a thirty-mile circumference. But most of the techniques for managing that kind of population density that we now take for granted—recycling centers, public-health departments, safe sewage removal—hadn't been invented yet.
This social topography would play a pivotal role in the events that unfolded in the late summer of 1854, when a terrible scourge struck Soho but left the surrounding neighborhoods utterly unharmed. That selective attack appeared to confirm every elitist cliché in the book: the plague attacking the debauched and the destitute, while passing over the better sort that lived only blocks away. Of course the plague had devastated the "meaner houses" and "bad streets"; anyone who had visited those squalid blocks would have seen it coming.
At the Lion Brewery on Broad Street, the seventy workers employed there went about their daily labor sipping on the malt liquor supplied as part of their wages.
For Londoners, the specific menace of cholera was a product of the Industrial Age and its global shipping networks: no known case of cholera on British soil exists before 1831.
One British doctor, Thomas Latta, hit upon this precise cure in 1832, months after the first outbreak, injecting salty water into the veins of the victims. Latta's approach differed from the modern treatment only in terms of quantity: liters of water are necessary to ensure a full recovery. Tragically, Latta's insight was lost in the swarming mass of cholera cures that emerged in the subsequent decades.
Snow was a truly consilient thinker […] Snow’s work was constantly building bridges between different disciplines, some of which barely existed as functional sciences in his day, using data on one scale of investigation to make predictions about behavior on other scales.
Snow also recognized the weakness of the contagionist argument. […] Clearly, the cholera was not communicated through sheer proximity. In fact, the most puzzling element of the disease was that it seemed capable of traveling across city blocks, skipping entire houses in the process.
Fear might not have been a contributing factor in the spread of disease, but it had long been a defining emotion of urban life. Cities often began as an attempt to ward off outside threats—fortified by walls, protected by guards—but as they grew in size, they developed their own, internal dangers: disease, crime, fire, along with the "soft" dangers of moral decline, as many believed. Death was omnipresent, particularly for the working class.
In a very practical sense, no one had ever tried to pack nearly three million people inside a thirty-mile circumference before. The metropolitan city, as a concept, was still unproven. It seemed entirely likely to many reasonable citizens of Victorian England—as well as to countless visitors from overseas—that a hundred years from now the whole project of maintaining cities of this scale would have proved a passing fancy. The monster would eat itself.
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.
Some of those forces were ideological in nature, matters of social prejudice and convention. Some revolved around conceptual limitations, failures of imagination and analysis. Some involve the basic wiring of the human brain itself. Each on its own might not have been strong enough to persuade an entire public-health system to empty raw sewage into the Thames. But together they created a kind of perfect storm of error.
Miasma became so powerful that it inspired a massive, state-sponsored intervention in the daily lives of millions of people, clearing the air by draining the cesspools. That intervention, miscalculated as it was, had the paradoxical effect of making the patterns of the epidemic more visible, at least to eyes that were capable of seeing them. And seeing the patterns more clearly means progress, in the long run at least.
In explaining Snow's battle against the miasma theory and the medical establishment, it's not sufficient to point to his brilliance or his tenacity alone, though no doubt those characteristics played a crucial role. If the dominance of the miasma model was itself shaped by multiple intersecting forces, so, too, was Snow’s ability to see it for the illusion that it was.
Whitehead thought the connection unlikely. He had personally seen so many residents recover from cholera after drinking Broad Street water. He himself had enjoyed a glass a few nights before, and had thus far resisted the plague. Perhaps Richardson had drunk too little.
Snow's argument was persuasive—and, besides, they had few other options. If Snow was wrong, the neighborhood might go thirsty for a few weeks. If he was right, who knew how many lives they might save? And so, after a quick internal consultation, the Board voted that the Broad Street well should be closed down.
Hall's list is a kind of straitjacket for an eventual document. You can tell from just scanning the instructions what kind of document they will ultimately produce: a rich and impossibly detailed inventory of the smells of Soho circa 1854.
Standing in front of his haggard parishioners in the half-empty church, he noted the disproportionate number of poor, elderly women in the pews. He congratulated them on their "remarkable immunity from the pestilence." But even as he spoke the words, he wondered: How can this be? What kind of pestilence spares the old and the destitute?
This is circular argumentation at its most devious. The committee begins with the assertion that cholera is transmitted via the atmosphere. When it discovers evidence that contradicts this initial assertion—a clear case that cholera has been transmitted by water—the counter-evidence is invoked as further proof of the original assertion: the atmosphere must be so poisoned that it has infected the water as well.
As for influence, it's pretty to think of John Snow unveiling the map before the Epidemiological Society to amazed and thunderous applause, and to glowing reviews in The Lancet the next week. But that's not how it happened. Its persuasiveness seems obvious to us now, living as we do outside the constraints of the miasma paradigm. But when it first began circulating in late 1854 and early 1855, its impact was far from dramatic. Snow himself seems to have thought that his South London Water Works study would ultimately be the centerpiece of his argument, the Broad Street map merely a piece of supporting evidence, a sideshow.
The construction of the new sewers was every bit as epic and enduring as the building of the Brooklyn Bridge or the Eiffel Tower. Its grandeur lies belowground, out of sight, and so it is not invoked as regularly as other, more iconic, achievements of the age.
Cities are invariably shaped by their master planners and their public officials; Chadwick and Farr had a tremendous impact on Victorian London—most of it positive, despite the miasma diversions. But in the last instance, the energy and vitality and innovation of cities comes from the Henry Whiteheads—the connectors and entrepreneurs and public characters who make the urban engine work at the street level.
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.
The great cities of the world would start to look like giant bull’s-eyes: millions of potential casualties conveniently stacked up in easily demolished high-rises.
Perhaps urban nuclear explosions will turn out to be like hundred-year storms: a bomb goes off once a century, millions die, the planet shudders in horror, and slowly goes about its business.
The global challenges that we face are not necessarily an apocalyptic crisis of capitalism or mankind’s hubris finally clashing with the balanced spirit of Gaia. We have confronted equally appalling crises before. The only question is whether we can steer around these crises without killing ten million people, or more. So let’s get on with it.