Transcriber’s Note:

The cover image was created by the transcriber and is placed in the public domain.

CHOLERA
AND THE
WATER SUPPLY
IN THE
SOUTH DISTRICTS OF LONDON IN 1854.

BY
JOHN SNOW, M.D.
Reprinted from the Journal of Public Health for October 1856.
LONDON:
PRINTED BY T. RICHARDS, 37, GT. QUEEN STREET.

1In the summer of 1849, I published certain conclusions atwhich I have arrived with regard to Asiatic cholera, and thefacts and reasonings which had led to them. The followingis a very brief outline of these views. The cholera commencesas an affection of the alimentary canal, and not withgeneral illness; there is no evidence of poisoning of theblood in this disease, except in some cases where secondaryfever occurs; there is conclusive evidence that cholera maybe communicated from person to person, and it follows,therefore, that the morbid matter which produces the diseaseis applied to the interior of the alimentary canal, where itincreases and multiplies during the period of so-called incubation,and passes off, during the attack, to cause fresh caseswhen suitable opportunities occur. Various circumstancesconnected with the propagation of cholera seemed in accordancewith the above view of its pathology. Thus, it wasobserved to pass frequently from person to person in thecrowded habitations of the poor, who eat, drink, cook, andsleep in the same apartment, and pay little or no regard tocleanliness, who live, in fact, under circumstances where thesudden and copious evacuations of cholera, soiling the bedand body linen, would not fail to contaminate the hands ofthe patient and his attendants, and be thence transferredto any food they might touch. The absence of colour andodour in the evacuations could not help to favour this result.The social visitor who came to see the poor patient,or attend his funeral, frequently suffered, whilst the medicalman, and others who partook of no food in the apartment,and who washed their hands when requisite, escaped. Themining districts of this country have suffered excessively fromcholera in each epidemic, an event which might be explainedby the following circumstances when taken in connexionwith the above view of the cause of the disease. The minersstay eight or nine hours at a time in the pits, and take foodwith them, which they eat invariably with unwashed hands,and without knife and fork, whilst the pits are withoutprivies, and are generally extremely foul and dirty. Theentire absence of daylight must also cause the workmen totake much more dirt with their food than they are aware of. Itoccurred to me, as soon as I began to entertain the aboveopinions, that if the cholera excreta could reproduce the2disease in the way just mentioned, they might also do sowhen diffused in water taken as drink, and that unless thiswere the case, the whole of the phenomena of cholera, as anepidemic, could not be explained. I, therefore, soughtanxiously, and waited patiently, for some confirmation ofthis part of the subject before I should make my viewsknown. Two outbreaks of cholera occurred, however, aboutthe end of July 1849, one in Horsleydown, and the other inthe Wandsworth Road, which I investigated, and wh

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