A Popular History of Unpopular Things
A podcast that makes history more fun and accessible - we love all things gory, gross, mysterious, and weird!
A Popular History of Unpopular Things
The London Cholera Epidemic
Join Kelli as she discusses the roots of the Cholera epidemic in London in the 1850s, and how a particularly smelly year in 1858 known as the "Great Stink" forced Parliament to fix London's sanitation infrastructure.
Intro and Outro music credit: Nedric
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Insta: @beardwrites
Welcome to A Popular History of Unpopular Things where we love all things weird, gross, and bloody disgusting. My name is Kelli Beard, and I don’t know why it’s taken me this long, but today we’re going to talk about DISEASE.
I love disease. It fascinates me. In the same way that true crime addicts can’t get enough of serial killers, I can’t get enough of disease… Tiny microbes that can change the course of human history… It’s incredible, right? I mean, the Black Death helped end the entire feudal period in Western Europe! Smallpox wiped out an entire continent of American civilization! Our entire lives changed when COVID-19 came around, and regardless of how you feel about everything that’s happened, there’s no denying that things are different now.
I’ve always been super interested in disease. When I taught high school, I spent way too long talking about it. I could tell that some students were on board and got excited by my passion, but most probably thought I was insane. But that’s ok, we all have that that *one thing* that we can talk about for hours. Disease is my “one thing.” I’m a disease nerd. It satisfies my dual interests in history and science. In case you haven’t listened to a bunch of my episodes yet, there is a bit more science in them than you might expect from a history podcast!
So for those of you who know me personally, you may know that the Black Death is my all-time favorite subject. I wrote my Master’s thesis on it - a comparative analysis of Britain’s political response to the plague in the 15th, 17th, and 19th centuries. But for my first podcast on disease, I don’t want to stick with the familiar. I want to introduce another deadly friend: cholera.
In today’s episode, I’m going to tell you all about cholera - what it is, how it functions, how it spreads, and how it intertwines with the Great Stink of London when in 1858, the smell of raw sewage in the River Thames was so strong that the politicians fled from Parliament in disgust. See, there was little information about the role of sewage and wastewater in disease transmission back then, and scientists had to fight for years to be taken seriously. It took a considerable amount of time for London to clean up and build infrastructure to remove the waste that was in the drinking water.
Today we are going to learn about the 19th-century cholera epidemic in London and how it was eventually cleaned up because of a particularly smelly year in 1858. But this isn’t just the story of disease - it’s also a story of class inequality, political inaction, and of a scientific community trying to persuade a whole population of people that you can in fact get sick from drinking poopy water. So get ready to be grossed out, and let’s get started!
First, let’s discuss cholera. You know I’m all about that historical context, but this time we need some scientific context. You won’t really get a sense of how bad it was in London in the 1850s without knowing more about cholera.
So, what is it? Cholera is a bacteria that lives in water. Bacteria, unlike viruses, are living organisms that do not require a host to survive. That doesn’t mean they can’t live inside us, and in fact there are trillions, yes trillions, of bacteria living in our bodies right now. But they’re not all bad! In fact, we need bacteria to help us digest food.
Now cholera bacteria spend most of their lives in bodies of water, swimming around with their flagellum, a little whiplike appendage that helps them move. Now normally, cholera bacteria are actually harmless! There are only two strains of cholera bacteria that are harmful to humans, and long story short and simplified, they are dangerous because they have been infected by a virus. We’ll only talk about the harmful strains, so I’m not going to differentiate any further.
So how does one come in contact with cholera bacteria? Well, since they live in water, you must ingest water that has cholera bacteria floating about in it, or water that has been tainted with contaminated fecal matter. So, poop water. From someone who has cholera.
Prepare yourselves, by the way, because there will be an uncomfortable amount of human waste in this episode. You’ve been warned.
Now if one ingests a small number of cholera bacteria, it’s likely that your stomach acid will just disintegrate them. No harm done. But if one consumes a lot of cholera bacteria, it's more likely that a handful will survive the gauntlet of stomach acid and make their way to the small intestines. From there, they attach to the lining and do their damage.
Cholera attacks the body in two main ways.
First, ir releases a toxin that prevents your body from being to absorb sodium and water. You know, things you need to survive. Sodium is needed to help move fluids into and out of your cells, among other things, so not being able to absorb it is very problematic.
Second, cholera triggers your cells to release sodium and potassium ions, which triggers your body to release excess water and fluid. Have you ever drank too much water or tea, and you find yourself going to the bathroom constantly? It’s because you’ve drank enough water, and the excess is flushed straight out of your system. Cholera will make you flush the water out of your system, but not just the excess - you’ll lose the water in your cells as well.
So you lose fluid and aren’t able to absorb more. That’s a pretty lethal combination.
Symptoms include diarrhea, vomiting, and cramps. Most people suffering from cholera die from dehydration, as their bodies can’t absorb enough to keep functioning. The skin will often turn a bluish color, the extremities will go cold, and the victim usually dies within a day. When those suffering from cholera pee, the fluid looks almost like rice water - that is, the cloudy color that rice gets when you wash it.
Short tangent - you should rinse rice before cooking it because it helps remove the excess starch that makes your rice “gluey.”
Anyway. Good news for people in the 21st century with access to basic resources - if you get cholera, you can treat it with an oral rehydration salt solution - one liter of water, one teaspoon of salt, and six teaspoons of sugar. It helps rehydrate your cells and overcome the symptoms of cholera until your body can fight it off properly.
The problem, of course, is that not everybody has access to clean water. That’s why we still see cholera epidemics in the 21st-century world. But that’s not why we’re here; we’re here to talk about how cholera absolutely crippled London in the 19th century.
So we know that cholera lives in water and that it’s deadly - but how did it get to London? How does cholera spread?
For this, we can look to the industrial revolution. Let’s transition from the scientific context to the historical context! My favorite!
With the industrial revolution in the late 18th century, steam engines became more commonplace. As a result, transportation improved. It became easier for nations like, I don’t know, Britain, to conquer other countries without the same level of technology, thus beginning the age of imperialism. Of the many countries that Britain took over, one was a place where cholera is endemic - India.
Endemic in this context means that cholera naturally lives in India. It’s nothing India necessarily did to make it so, cholera just lives there. Especially in the Ganges; cholera naturally lives in the estuaries and water systems of India’s most famous holy river.
As more and more British ships go to their Indian colony, they are coming into contact with people who are suffering from cholera; there was a particularly large outbreak in 1817 in Bengal, and it soon traveled across the country to a British port at Calcutta and Bombay, which today is called Mumbai. Not only would sailors and soldiers have come in contact with contaminated waste and people suffering from it, but their ships would have picked up cholera-laden water through the bilge pumps.
Now in his classic book Plagues and Peoples, my favorite disease historian William H. McNeill wrote the following:
[cholera in the 1817 epidemic] soon transgressed the boundaries that had previously confined it to the [Indian] subcontinent and immediately adjacent regions. What seems to have happened is that an old and well-established pattern for spreading cholera across the Indian landscape intersected new, British-imposed patterns of trade and military movement. The result was that cholera overleaped its familiar bounds and burst into new and unfamiliar territories, where human resistance and customary reaction to its presence were totally lacking… English ships and troops…, their presence and movement to and from the primary focus in and around Calcutta, carried the infection.
Ah, brilliant. McNeill is great. What, you don’t have a favorite disease historian? Psh. Weirdo.
So anyway. Where was cholera carried, you may ask? Back home to Britain, and more specifically, ports in London. We can trace its spread with the British ships to their colonies and trading partners. It even spread to New York in 1832!
But the most famous outbreak of cholera in the Western World was the epidemic that afflicted London in the mid-19th century. What we’re going to do now is take a look at how and why cholera became such an issue in London, why it was so prevalent, how a scientist tried to solve the issue and change people’s perceptions of how disease spreads, and how an engineer redesigned London’s sewage systems to prevent it from happening again.
Beginning in the 1850s, people who lived near Broad Street in London’s Soho District were dying of cholera. And I mean a lot of people were dying of cholera. Over 10,000 in this one outbreak! Curiously, a higher concentration of deaths was centered around the pump on Broad Street. A physician named John Snow was curious and went to check it out. His theory was that the water was contaminated, and by drinking this contaminated water, people were contracting cholera.
I know this doesn’t sound really monumental, but it was. To understand why this was such a big deal, we have to… you guessed it… look at the historical context!
Ok, so for much of world history, people believed in something known as the miasma theory. Miasma is such a cool word. Miasma is essentially bad, stinky air. Until we knew about things like germs and microbes, people believed that you got sick because of miasma. Basically, the bad smells were what made you sick. Miasma was also what people believed caused the Black Death, so when you look at ways they tried to prevent the spread of the plague, it involves making the air smell better. If you’re breathing in good, clean-smelling air, then you can’t possibly get sick from inhaling miasma, right?
By the way, another short tangent, this is why the plague doctor mask was created in such a distinctive shape. If you don’t know what I’m talking about, the “plague doctors” of the 14th century wore bird-like masks over their faces. The “beaks” of the masks were stuffed with flowers and herbs. This jives with the Miasma Theory; if the doctors were smelling “good” smells through their masks, they wouldn’t contract the plague from the patients they helped.
Now we modern folk know that this is ridiculous; coming in contact with the microbe will get you sick. The plague spread from person to person, first through physical contact and later through respiration, and no amount of pretty-smelling flowers can save you.
But cholera spread through the water… it was John Snow who helped prove it.
Now initially, people assumed that cholera, like the plague, was contracted because of miasma. If things smelled bad, then you could get sick. The people around Broad Street must be dealing with that, which explains why so many of them got sick, right?
Edwin Chadwick, a social reformer who helped create the Poor Laws to provide London’s most impoverished residents with jobs, homes, and food, was a staunch miasma theorist. Though misguided, he believed that he could help the poor by cleaning up their environment, removing the miasma through public sanitation efforts, and therefore improving their quality of life. In a speech to Parliament, he said that, quote, “all smell is, if it be intense, immediate acute disease… all smell is disease.”
Now in a weird way, this theory did actually help stop the spread of some illnesses. If you think about the miasma theory, it propagated the idea that bad smells cause sickness. By getting rid of the stench, it should cure the problem, right? And in a lot of cases, it worked. The premise was wrong, but the conclusion was the same - London officials would clean up the city in an attempt to remove the smell, but in cleaning up the city, there were fewer germs and microbes sitting around for people to contract.
Because the clean-ups associated with miasma theory did actually help, it explains why people were so keen on this theory explaining away disease.
However.
Miasma Theory also propagated social and class inequality.
You see, disease was associated with stench. The stench was associated with dirt and substandard living conditions. Dirt and substandard living conditions were associated with the poor, who often couldn’t afford anything better than the cramped, sweaty tenements that multiple families would share. By the transitive property, disease and miasma were therefore associated with the poor. Edwin Chadwick, the one who came up with the poor laws, clearly thought so. And he was one of the few actually trying to help!
Many of the early political decisions designed to remove the sewage had to do with managing the lower social and economic classes in London, and it led to a lot of classism. When John Snow finally did convince people that cholera was infecting the water supplies of poorer areas, little was done to fix the problem. But we’ll get to that later.
So we know that cholera can live on its own because it’s a bacteria and not a virus. We also know that cholera is typically found in water sources where there is a considerable amount of sewage - human waste in the water supply. So let’s be frank here - why was there so much poop in the water?!
Let’s talk about nightsoil.
Most of you probably don’t think about what happens when you flush the toilet. We do our business, flush, and assuming we don’t block the pipes and need to use the plunger, we never think about it again. Unless you’re one of those people that texts their best friends about their bathroom experiences. But do you honestly know where your waste goes once you flush?
Long story short and simplified, all wastewater flows into and through sewers to a wastewater treatment facility. The water is filtered, disinfected, and cleaned, then deposited back into a local body of water. This is pretty standard for much of the world that has sewage infrastructure.
But what about before sewer systems were put in place? Where did the poop go?!
So it was known as “nightsoil.” Human waste. People would do their business in rudimentary toilets that would send it all down into a cesspool, which would later be cleaned out by the nightsoil men, rakers who would physically remove the poo and take it somewhere else so it didn’t clog the streets. It was a well-paid job. Sometimes the cesspool would be in the basement of your house, or sometimes shoddy pipes would bring your waste to a community one that contained everyone’s shared excrement.
Here’s a fun and gross story for you - in 1326, a man named Richard the Raker was doing his business on the toilet, but the thing broke, and he fell through the floor into his own cesspool. It hadn’t been cleaned out in a long time, poor Richard the Raker drowned in his own filth. Yeesh.
But this still doesn’t fully answer the question - where does the poop go? I mean it can’t just sit in cesspools forever, right? Oh man, can you imagine how disgusting those things must have smelled? Talk about the bog of eternal stench! Yeesh!
Well, before chemical fertilizers were common, which is what we use nowadays, human waste was often used as fertilizer. Farmers would use the nutrients in the waste in their fields. Rakers would bring the waste outside city walls to where the farms were, and in this way, it was… recycled.
Sometimes, though, the waste would be dumped into the water, and I imagine people just assumed it flowed away somewhere. Out of sight, out of mind!
Now things changed a bit in the 19th century when guano became a common import. Once South American nations like Peru and Chile became independent in the 1820s, they contributed to the growing global economy through the sale of guano, or bird poo, which made an excellent fertilizer. It was also way cheaper to import guano from Peru instead of paying the pricey nightsoil men to bring human waste from the cities to the farms. Also, farms were becoming farther and farther away from the city centers, meaning it took a lot more transportation to bring nightsoil from A to B. Shipping guano was cheaper. And what good capitalist society wouldn’t go with the cheaper option?
So now that guano is a thing, and people are starting to experiment with chemical fertilizers, the same question remains: what do we do with all this poo?!
Well, let’s just dump it into the river.
In 19th-century London, there was a combination of cesspools and sewage pipes that led to the water. Sometimes, these cesspools would overflow, and waste would seep into the ground or even well water. Sometimes, the waste in the river would clog up, and the whole thing would be a polluted, poopy mess.
This worsened, of course, because of the population increase.
So as a result of a growing global market and imperialism, Britain saw economic prosperity. With the industrial revolution, life got easier for most people in Britain as well. More money and a better life led to …natural population increase. We also have to take into account migration into Britain from her colonies. As a result, London experienced a population boom. In 1810, the population of London was around 1 million people. By the 1850s, it was at nearly 3 million - it tripled in forty years! With all those extra people came a ton of extra waste, and it strained the already sub-par sewage system. Once steamships came back from India with the cholera bacteria, it didn’t take long for the microbe to find a home in London’s polluted water system.
Now. Initially, John Snow had to fight to prove that cholera was spread through the water. Remember, for hundreds of years by now people assumed cholera spread because of miasma, or perhaps in the impoverished communities often wracked by filth and disease. To prove he was right about the water, Snow mapped out the spread of cholera case-by-case. He was able to quickly determine that one pump in Soho, the one on Broad Street, was the main cause of cholera.
So let’s look at the River Thames. Side note - the river is spelled T-H-A-M-E-S, which looks like “Thames,” but is pronounced “Tems”. You’re welcome.
London’s sewage was being dumped into the River Thames in great quantities. Most people got their drinking water from the Thames. Those upstream were better off because they could use the less-polluted waters flowing from inland. But those living downstream, like the ones in Soho, were getting an entire city’s worth of wastewater drawn into its pumps. Those who pumped their water from downstream suffered from cholera nine times more than those who lived upstream. John Snow’s theory about the Broad Street pump was correct; he removed the pump handle, people stopped using it, and the cases dropped.
Despite John Snow’s work in determining that contaminated water was the cause of cholera during the 1854 outbreak, work to upgrade and rehaul the sanitation systems of London was slow. Essentially, the government didn’t want to spend the money to fix the infrastructure. Despite proving that it was microbes in the water supply, many still believed that miasma caused cholera. The rich members of parliament, or MPs, weren’t really affected; it was the poor living in the cramped streets that were suffering. The rich MPs also didn’t live downstream where water was drawn from the Thames, so they weren’t getting sick. Why deal with something that you don’t think will effect you, right? Ugh.
There was plenty of public outcry, though. This wasn’t a case of Parliament not knowing that there was an issue; they were just slow to act. Or didn’t want to spend the money. Or didn’t care.
Here’s a poem from 1848 called “Dirty Father Thames.” Accompanying it was a fun political cartoon of a man, all dirty and haggard-looking, fishing up debris from the river.
Filthy river, filthy river,
Foul from London to the Nore,
What art thou but one vast gutter,
One tremendous common shore?
All beside thy sludgy waters,
All beside thy reeking ooze,
Christian folks inhale mephitis,
Which thy bubbly bosom brews.
All her foul abominations
Into thee the City throws;
These pollutions, ever churning,
To and fro thy current flows.
And from thee is brewed our porter -
Thee, thou gully, puddle, sink!
Thou, vile cesspool, art the liquor
Whence is made the beer we drink!
Thou too hast a Conservator,
He who fills the civic chair;
Well does he conserve thee, truly,
Does he not, my good LORD MAYOR?
Another political cartoon from 1849 shows London residents looking into a barrel of Thames water with the caption: “Water! Water! Everywhere! And not a drop to drink!”
In 1855, scientist Michael Faraday wrote in a letter to the Times newspaper that, quote, “The smell was very bad, and common to the whole of the water. It was the same as that which now comes up from the gully holes in the streets. The whole river was for the time a real sewer. Having just returned from the country air, I was perhaps more affected by it than others… I have thought it a duty to record these facts, that they may be brought to the attention of those who exercise power, or have responsibility in relation to the condition of our river. If there be sufficient authority to remove a putrescent pond [cesspool] from the neighborhood of a few simple dwellings, surely the river which flows for so many miles through London ought not to be allowed to become a fermenting sewer.”
And perhaps my personal favorite is one presented to Parliament in July 1858, the same time as the Great Stink event which we’ll get to shortly, called “Father Thames introducing his offspring to the city of London.” This political cartoon shows an anthropomorphized river holding out his “children,” which were various diseases like cholera and typhus, to a clean and clearly disgusted woman who represented the city.
My point is - Parliament knew it was an issue. The people were quite vocal. The MPs just didn’t do anything about it, because miasma was a poor man’s problem.
Later, Germ Theory replaced Miasma Theory as the explanation for why people get diseases. It’s what we believe today - that tiny microorganisms and germs, whether they be bacteria, viruses, or fungi, cause diseases. We get plague because the Yersinia Pestis bacteria is transmitted to our body, usually by small mammals and their fleas, and it reproduces inside us, causing all kinds of nasty side effects. Cholera is the same - it’s a bacteria that we ingest through contaminated water, and if it survives our stomachs, it multiplies in our intestines.
Though Germ Theory was becoming more popular in the 19th century through the work of scientists like Louis Pasteur, who helped invent modern vaccinations alongside Robert Koch (COKE), it wasn’t until much later in the late 19th century and early 20th century that Germ Theory really took off.
So the miasma-fearing Parliament wasn’t too fussed about rushing to fix London’s sewage problem, despite John Snow’s work, until it directly affected them.
This, my friends, was an event in the summer of 1858 known as the “Great Stink.”
The summer of 1858 was unusually hot in London. The heat exacerbated the smell of the raw human waste clogging up the Thames, and it was reportedly so bad that Parliament had to flee the area. Suddenly, Parliament risked getting sick, too, because a majority of them still believed that bad smells, or miasma, would cause disease. The sewage problem in London was now so bad that they too were exposed. This was the impetus they needed to start solving the problem.
Though they got the premise wrong about where cholera came from, and how people were getting sick, it still led to the right conclusion: they needed to clean up the waste and make sure it wasn’t polluting the water.
One man, in particular, was charged with redesigning London’s sewage system to remove the excess waste from the River Thames, and his name was Joseph Bazalgette. It was only after the Great Stink did Parliament take seriously the human waste issue in London, and Bazalgette, chief engineer of the Metropolitan Board of Works, got to work. It was a colossal project that revolutionized London’s sewage system, which lasted by the way until the late 1990s before needing to be redone. That’s pretty impressive.
Bazalgette’s solution to the poop problem included over 80 miles of enclosed, underground brick sewers and over 1,100 miles of street sewers that would divert all sewage to treatment facilities, kind of like what we do today when we flush the toilet. These new sewers would prevent wastewater from overflowing into the streets, filling up leaky cesspools, or going directly into the Thames. At the treatment facilities, the sewage would be treated, disinfected, and then returned to the Thames downstream, at no risk to humans, animals, or the environment.
Though the plan was the remove the miasma by diverting it away to be treated at the processing plant, it did help solve the disease problem; instances of cholera, as well as others like typhus and typhoid, dropped once the sewage system was completed.
But today, cholera still affects people in areas where there is insufficient sewage infrastructure.
In 1991, cholera spread quickly around populations in shanty towns and cities with poor sanitation in South America, infecting 400,000 and killing 4,000. In Peru, cholera traveled 1,200 miles along the coast and infected more than 70,000 people in a month. It then spread north through Ecuador into Colombia, and also south down to Chile. Shortly after, it spread east to Brazil.
In 1994, towards the end of the Rwandan Genocide in Central Africa, cholera broke out in a refugee camp in Zaire (today’s Democratic Republic of Congo). The Rwandan Genocide lasted for one hundred days between April and August 1994 and claimed upwards of 800,000 lives in a conflict between the Hutu and Tutsi ethnic groups. As refugees fled west out of Rwanda and into neighboring Zaire, refugee camps popped up on the shores of Lake Kivu in the town of Goma. 200,000 refugees arrived in a single day; the prior population of Goma was only 80,000.
Growing refugee populations put pressure on Goma, and spaces were tight. The refugees slept in playgrounds, on the shores of the lake, and anywhere they could find shelter. Food and water were scarce. The only water available was described as a, quote, “thick, slimy brew already fouled by human waste.” Cholera soon appeared, and within twenty-four hours, 800 people died. In all, around one million people contracted cholera from Lake Kivu, and 50,000 died before preventative and curative measures, like antibiotics and those oral rehydration salts I told you about, were administered.
In 2010, Hurricane Matthew swept through and destroyed Haiti; cholera, already present on the island, spread rapidly in the stagnant pools of water. The dead were buried in graves without taking precautionary measures like wrapping them in plastic or wearing gloves, and soon, even more people were infected by cholera-laden waste and water. Unfortunately for the Haitians, cholera wasn’t endemic; it was brought there by UN peacekeeping troops from Nepal who were trying to help out after the hurricane. Roughly 10,000 Haitians died and nearly a million had been sickened since cholera arrived. Haiti still suffers from cholera outbreaks to this day. It’s November 2022 and I just read a news headline about the cholera situation worsening in Haiti.
But for 19th-century London, Bazalgette’s sewage system and the work of men like John Snow helped to clean up the city. Though many still erroneously believed that miasma caused disease, the issue was resolved by implementing city-wide sanitation infrastructure. The Great Stink was the culminating moment in a long history of dealing with London’s poo problem, and ultimately, the people were better off because of it. So think about all that the next time you flush.
Thanks for joining me for this episode of A Popular History of Unpopular Things. My name is Kelli Beard, and I hope you’ve enjoyed the story of the London Cholera Epidemic. Thank you for supporting my podcast, and if you haven’t already checked out my other episodes, go have a listen! Stay tuned for my next episode as we dive into the past to uncover the weirdest, grossest, most mysterious stories in history.
