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.