AN OFFAL TALE – 1854 LONDON 21

Even if this is not an awful story it certainly is offal. American author Steven Johnson states in his 2006 book The Ghost Map, London, England in 1854 was a city of circa 2,500,000 inhabitants. There were no sewers, no municipal garbage pickup, and no reliable clean water supply. How on earth did the people in the city get by? They did manage after a fashion with human ingenuity and coping mechanisms, but not quite up to our standards - this being written as an understatement. This next part gets a bit dicey (again an understatement) so if you have a queasy stomach you may want to skip past it, but if you persist definitely make sure there is a decent interval between reading it and your next meal. On the other hand it may have a desired purgatorial weight loss effect.

Quite simply as the city grew, entrepreneurial opportunities developed. They were filled by lower echelon types and were not desirable jobs, but voluntary and necessary ones. According to Steven Johnson there were bone-pickers, rag-gatherers, pure-finders, dredger men, mud-larks, dustmen, bunters, toshers, shore men, and especially night-soil men to the tune collectively of 100,000 strong. Those people were the ultimate recyclers who would make modern day environmentalists green with both envy and revulsion. The toshers walked along the muddy banks of the Thames starting at daybreak looking for bits of scrape metal, especially copper. Along side were the mud-larks, often children (child labor laws were a little lax, not to say nonexistent at that time), scavenging for what the toshers deign to harvest: lumps of coal, old wood, scraps of rope, etc. The pure-finders name, as you might have surmised, is purely a euphemism. Those people collected dog manure from the streets to be used in leather tanning.

There was a niche for all of the recyclers and at the top of the heap, so to speak, were the night-soil men. Just so there is no misunderstanding I am referring to the products of not only the human alimentary system, but also that of cattle some people kept in the city. In describing those people’s work I will not be any more scatological than necessary, but we are talking about human waste from 2,500,000 people and cow dung are we not?

As I have already stated there was not a sewer system in London at that time. So what happened to the human refuse? Oddly the water closet (flush toilet) had been invented in the 16th century, but didn’t become popular until the late 18th century when a watchmaker, Alexander Cummings, and a cabinetmaker, Joseph Braham, came out with an improved version. Water closet installation increased 10 fold from 1824 to 1844. Popularity really increased when a further improved version was displayed in the Great Exhibition in London in 1851. According to one survey the average London household consumption of water increased from 160 gallons per day in 1850 to 244 gallons per day by 1856 due to the increased use of the WC. Yes, as you have foreseen, there was an ever increasing problem. Where did all this flushed egesta go? The same place it did when collected in slop jars and bed pans, but with increased volume, directly into the existing cesspools which were even more likely to overflow.

The night-soil men did their best trying to keep up. Theirs was a high paying job relative to the other recyclers, but hardly necessary to say, disgusting. Aggravating the health conditions was the expansion of the city which meant increased distances the night-soil men had to haul their loads to the outlying farms, thereby increasing the price they charged. Some people and especially landlords resisted paying these prices so they just let the waste material accumulate in the cesspits causing overflow into the basements of houses and flats.

Today there are in excess of 50 cities in the world with populations of 3,000,000 or more (the cities proper not the adjacent metropolitan areas). Mumbai (Bombay) is the largest with 13+ million and London has 7 ½ million. Try to imagine what conditions would be like with the same lack of refuse relieving infrastructure as London in 1854. You can try to imagine it if you wish. I will pass.

I believe this is enough detail of the underlying causes of the cholera outbreak in London in 1854. Around 10,700 people died of cholera which is a mere fraction of the deaths caused by the Black Death which scourged Europe in 1347-52. The real story here is that this was the first time a true scientific examination and solution were realized in a bacterial epidemic.

Cholera which is frequently called Asiatic cholera or epidemic cholera is a severe diarrheal disease caused by the bacterium Vibrio cholerae. Transmission to humans is usually by water and occasionally by food. Some evidence suggests that the natural environment of V. cholerae is aquatic. This characteristic makes it authochthonous to humans. We are aquatic creatures in our origin. Our blood is 84% water and contains some of the same minerals as seawater although not in the same amounts and embryos float in watery fluid in the womb. No wonder those little Vibrio cholerae like us.

V. cholerae produces cholera toxin whose action on the mucosal epithelium is responsible for the characteristic diarrhea of the disease. In its extreme manifestation, cholera is one of the most rapidly fatal illnesses known. It is possible, although not usual, that a healthy person would die within 2-3 hours of the onset of symptoms if no treatment is provided. More commonly death will occur in 18 hours to several days. Recent epidemiologic research suggests that an individual’s susceptibility to cholera and other diarrheal infections is affected by their blood type. Those with type O are the most susceptible; those with type AB are the most resistant.

In order for enough V. cholerae to survive the hostile acidic conditions of the human stomach something like 1,000,000 or more of these bacteria must be ingested to cause cholera in normal healthy adults. Cholera kills by causing rapid dehydration. As the volume of blood is reduced and becomes more concentrated, the heart beats faster to maintain normal blood pressure to keep the vital organs, the kidneys and brain, functional. Non vital organs such as the gallbladder and spleen begin to shut down. Eventually, as water is continuously expelled, the heart fails to maintain adequate blood pressure as hypotension sets in; within hours vital organs shut down resulting in death. The cure is mostly low-tech. Treatment consists of aggressive rehydration and replacement of electrolytes either intravenously or with commercial or hand mixed sugar-salt solutions. Tetracycline, ciprofloxacin, and azithromycin antibiotics are also given to reduce the duration and severity of cholera. Without treatment the death rate is as high as 50%; with treatment the death rate is below 1%.

Dr. John Snow was the single most important person in solving the cause of the 1854 cholera outbreak in the Soho district of London. A young Dr. Snow had previously established his reputation by deducing the proper amount of ether or chloroform to give surgical patients having figuring out the relationship of the concentration of gas and temperature. He then engineered a state-of-the-art medical devise to deliver it. Dr Snow became the most sought after anesthesiologist in the city.

The long prevailing contagion theory of getting cholera, as with almost all diseases, was miasma - that is breathing in foul air. The word miasma comes from the Greek word miasma meaning pollution. If the environment smelled bad it seemed natural to conclude that breathing in foul odors would give one disease. The name malaria is derived from the Italian word malaria (mala, bad and aria, air). In other words it was once thought that malaria was caused by breathing bad air rather than being caused by microscopic parasites introduced into the human bloodstream by the bite of female anopheles mosquitoes. It is interesting that in spite of evidence to the contrary there were and still are concepts and beliefs that are so strongly held that any attempt to challenge these ideas and beliefs are unfailingly repelled.

As I have previously written, in the 1920’s & 30’s German and other European chemists could not get past the firm belief that molecules from chemical dyes were the active ingredients in anti-bacterial drugs until a French lab, quite by chance, experimented with sulfanilamide alone and proved conclusively it was the anti-bacterial agent. In my opinion the modern miasma theorists are the people who insist that global warming is caused only by human pollution. This crowd will simply not entertain any suggestion that other mechanisms might be responsible for temperature variation on earth and they traduce anyone who questions their belief. As near as I can tell these people never address the incontrovertible fact that the earth has undergone even more temperature and weather extremes over millions of years as what might be happening now. If the earth’s temperature has been both hotter and colder, and wetter and dryer, and it has, when primitive humans were incapable of causing pollution, than anything experienced currently, then it is surely a paralogism to dismiss, without comprehensive investigation, those same causative factors now as occurred in the past. According to author Steven Johnson it is interesting that in the days before the cholera outbreak in Soho in August 1854, London was sweltering from a heat wave with the temperatures in the upper 80’s to lower 90’s degrees Fahrenheit for several days. Do you suppose that could have been due to Global Warming?

Even though Anton Van Leeuwenhoek of the Netherlands developed high resolution microscopes in the 4th quarter of the 18th century, microscopes were still not powerful enough for Dr. John Snow to see the V. cholerae in the Soho water supply in 1854. What was it then that alerted Dr. Snow to the cause of the cholera outbreak being contaminated drinking water? First Snow as a medical doctor was trained to observe physical symptoms and he understood that bodily effects of a disease were likely to offer important clues about the disease’s original cause. In the case of cholera, far and away the most pronounced change in the body lay in the small intestine. The disease invariably began with that terrible expulsion of fluids and fecal matter. Snow couldn’t say what kind of element was behind cholera’s catastrophic attack on the human body, but he knew from observation that it launched the attack from the gut. 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. Also he was a polymath scientist who spotted certain patterns and he was not constrained by orthodox medical beliefs. He noticed that the cases of cholera were not randomly distributed, but occurred in clusters and quickly realized that the area around one certain water pump (on Broad Street) had a higher density of cholera sickness and death than other municipal water pumps in Soho. There could have been other causes for this distribution, but after questioning the residents of Soho about where they and the ones who died got their drinking water, using statistical methods, Dr. Snow constricted a map of the area with the locations of people who died of cholera. For those cases which did not fit the pattern, the fact that Dr. Snow was a ten year resident of Soho and lived six blocks from the Broad Street pump gave him the opportunity to question people about their drinking water habits. It turned out that the people who lived close to the Broad Street pump and did not get sick, for various reasons got their water from other Soho pumps and most of those who lived farther away and got sick used the Broad Street pump water.

Another resident of Soho, Rev. Henry Whitehead, at first did not believe John Snow’s theory that water from the Broad Street pump was the source of the cholera epidemic. He was an intelligent and open minded man, who after examining all of the evidence, became a firm supporter of Dr. Snow. If you think the London city and Soho district officials and other medical men rejected miasma as the infecting agent and accepted Dr. Snow’s water bourn theory of cholera, then you have underestimated the tenacity which many beliefs are held. It was not until 1866 during another London cholera epidemic, eight tears after Dr. John Snow died, that there was wide acceptance that contaminated water was the source of cholera infections. I believe it would also be a mistake to condemn the narrow mindedness of many people of that time when there is ample evidence of people today clinging to beliefs which are unsupported by facts and could not stand up to careful exegesis.

Think of the millions of folks in this country and multiple that by an order of magnitude or two in the rest of the world for those who believe John F. Kennedy was the victim of a conspiracy by: (they can pick one or a combination that suits them) the anti-Castro Cubans, the pro-Castro Cubans, the CIA, the FBI, the KGB, Lyndon Johnson, the mob, or the big, bad wolf in the Little Red Riding Hood yarn. Then there are those who are firmly convinced that FDR knew the Japanese were going to attack Pearl Harbor and when. How about the chimerical people who just know aliens from outer space are living among us and their proof is given by the Roswell, New Mexico incident (you know, the remains of a crashed high altitude weather balloon which was hysterically interpreted by the logic challenged to be the remnants of an alien space ship)? Further there are the bedlamites who insist that strange and inexplicable disappearances have repeatedly occurred in the Bermuda Triangle caused by extra-terrestrial mischief. I don’t agree with some of what the late astronomer Carl Sagan has said, but when he stated that extraordinary events require extraordinary evidence to be believed he was right on.

The latest loonies are the corybantic true believers, headed by the sophist Al Gore, who are trying to convince us that man made Global Warming will wreak havoc on the entire world before this decade or the next expire. Reminds me of the 1960’s to 1980’s energumen and popular propagandist, Paul Ehrlich (see my essay Fools, Frauds, & Fakes), who predicted that “By 1985 enough millions will have died to reduce the earth’s population to some acceptable level, like 1.5 billion [there are currently about 6.5 billion].” He also wrote that by 1980 the United States would see its life expectancy drop to 42 years because of the use of pesticides, and by 1999 its population would drop to 22.6 million. There is nothing substantially different about the myrmidons of Paul Ehrlich then and Al Gore now. Spare me the doomsday scenarios be they caused by pesticides, pollution, or miasma. If you deduce that I am more than adumbrating the use of reason and rationality in examining current and historical phenomena you are correct.