The Great Sanitary Awakening
The nineteenth century witnessed ‘the great sanitary awakening’ in the
United Kingdom. It spread to other European countries and America. Filth
was recognized as both a source and a vehicle for the transmission of
infectious diseases. This recognition led to a social reform movement
that linked illness and disease to a lack of cleanliness. The movement
was grounded in an understanding of the close nexus between disease,
dirt, and destitution. Illness was considered a reflection of poor
social and environmental conditions, and cleanliness was regarded as the
path to physical and moral health. The social value attached to
sanitation changed the way society thought about health and its
responsibility for public health. Filth removal, clean water, sewerage,
drainage, river cleaning, waste management and other sanitary measures
became major social goals and public responsibilities for which new
public institutions and funding arrangements were created by
governments.
In 1854, Dr. John Snow applied statistical analysis and mapped
neighborhood mortality data in London to demonstrate that the spread of
cholera was correlated with contaminated water. Snow plotted the
geographical distribution of cases and the location of water pumps
serving the affected area. Observing that substantially more cases of
cholera pertained to households who consumed water served by the Broad
Street pump, he concluded that contaminated water in that pump was
behind the spread of cholera. He conducted another pioneering
investigation, studying the mortality rates due to cholera in the
districts of London that received water from one or both of two private
companies: Lambeth Company and Southwark and Vauxhall Company. The
former drew water from the Thames River through an intake point located
well upstream of London, while the latter supplied water from an intake
well situated downstream, susceptible to contamination by London’s
sewage. Based on recorded observations of deaths due to cholera over
seven weeks in 1854, Snow discovered that mortality rates were five
times higher in districts served by Southwark and Vauxhall Company
compared to districts supplied with water by Lambeth Company. Dr. Snow’s
finding that cholera resulted from the mixing of sewage and drinking
water led to its recognition as a water-borne disease.