As John Snow stood on the streets of York and bid farewell to his father, the air swirled with traces of spring, the odor of horses, and the ever-present reminders of bad sanitation. He climbed aboard the waiting coach with the few items of clothing that his father’s meager income could provide, food that his mother had prepared earlier that day, and the improbable hopes of his parents.
The crack of the driver’s whip bisected the life of young John Snow. His childhood dissolved into memories as the carriage rattled off the cobblestones of York to the ringing beat of horses’ hooves. As he bounced north along the turnpike to Newcastle, his future began.
In time John Snow would reshape medical science, invent the fundamental tools of epidemiology, and redefine our relationship with drinking water. But in that moment, he was just a fourteen-year-old boy, alone in the shadows of the carriage. Through its window, he watched the landscape of the familiar disappear. The year 1827 offered no time for the indulgence of adolescence. He would not see his parents again for seven years.
Snow had come of age amid the poverty that hugged the banks of the River Ouse. As the son of a laborer, he might well have expected to spend his life in a hardscrabble neighborhood like the one into which he had been born. The river brought ships and barges and the opportunity for work, but it was grueling, physical labor that could grind a man to the bone with little chance for advancement. All manner of vermin, human as well as animal, scurried along the riverside. For a child, danger lurked in every darkened corner of the district.
One of the greatest hazards was the river itself. It routinely overflowed its banks, leaving behind dankness and rot. When it stayed within its course, many of the Snows’ neighbors along North Street routinely drank its water, oblivious to the hazards it carried.
John’s chances of escaping the filth and disease that clung to the working poor in Edwardian England were slim. If the daunting financial, physical, and social realities were not enough, Fanny Snow, the illegitimate daughter of a Yorkshire weaver, was heavy with her eighth child when she put her oldest son on that carriage to Newcastle. The simple demand of supporting such a large family would seem to extinguish any hope of escaping their place at the bottom of the economic ladder. The Snows, however, were not an average working class couple and John was far from a typical son.
The journey to Newcastle began when a six-year-old boy walked down Far Water Lane, turned down a narrow alley, and, for the first time, entered a remarkable world. There in the single room that comprised the Dodsworth School in St. Mary’s Parish, John Snow’s insatiable drive to understand took root. John Dodsworth, a York ironmonger, had founded three such schools to offer education to the city’s poor. The school Snow attended offered only twenty spots for boys between the ages of six and fourteen, selecting only the most talented and deserving children. With three parishes vying for just three or four openings each year, John may well have been the only child from the parish of All Saints Church chosen that year to attend. At Dodsworth School, he could learn to read and write free of charge. Arithmetic, his favorite subject, cost extra.
This was a fortuitous beginning for the bright young boy. For the eight years he attended, his parents not only made do without the assistance of their son, but also scraped together the extra money for his foray into math and science. Once he had completed those early years of schooling, he was ready to take a remarkable next step. John Snow would become a doctor.
The carriage rattled north across the English countryside for twenty-one bone-jarring hours before John Snow rolled through Gateshead, crossed the River Tyne, and rode into Newcastle. The view out the carriage window was unlike anything he had ever seen. The young man from York stared out at the grand metropolis. Great sailing ships lined the river, waiting to carry away the coal that powered the engines of the world and the booming economy of Newcastle. Ahead, on a hill, the castle keep stood watch over the bustling city as the spires of St. Nicholas and All Saints Church pierced the industrial sky.
The carriage left him in the heart of the city. From there John Snow walked up Westgate Street in the shadow of the thick stone tower of St. John’s church. There on the hillside, far from the filth and stink of the river’s edge, lived the city’s well-to-do. He had never seen such fine houses. Now he would live in one. For the next four years, he would stay in the home of William Hardcastle, just across from the church. A surgeon apothecary who had begun his practice in York before moving to Newcastle, Hardcastle was now among the most prominent doctors in the city. For a fee of one hundred guineas, he had agreed to take on Snow as an apprentice.
It seems likely that a hidden hand nudged open the door of opportunity to admit John Snow. The apprenticeship fee alone, roughly thirteen thousand in today’s dollars, would have dissuaded even the hardest-working laborer in 1827. Even with the fee in hand, it seems unlikely that an established surgeon would have taken on a poor boy from York as an apprentice. But more than five thousand miles away, in the jungles of South America, John Snow had a friend.
For three years Charles Empson had traveled deep into the Andean rain forest riding mules and small boats hundreds of miles into what would become Colombia. He had braved snakes, poisonous insects, and well-armed thieves and had dined on everything from roast armadillo to tortoise hash. He had come with the engineer Robert Stephenson to search the region’s abandoned gold and silver mines for business opportunities.
Empson was the brother of Fanny Snow. Although he would one day become a man of means, he was not yet wealthy. But he already had something far more valuable than mere money. Charles Empson had connections. He possessed a charisma that could unlock the doors of British society, which allowed him to create an ever-expanding social network. George Stephenson, the father of his traveling partner, was a visionary pioneer in the development of the British railroads. George and Robert Stephenson would go on to establish the first company to manufacture locomotives in England. The Stephensons lived just outside of Newcastle. Their family physician was another of Empson’s closest friends and John Snow’s mentor, William Hardcastle.
Empson and Snow would share a remarkable lifelong intimacy. Today the two men lie buried side-by-side in Brompton Cemetery. In 1827 Empson had connections to money, Newcastle, and Hardcastle, and he knew that his nephew, with his remarkable aptitude for math and natural science, was preparing to begin his career. It is not clear exactly which strings Empson pulled as he sat in Bogota and planned his return to England, but it is almost certain he pulled them.
If industry, ability, and a benevolent uncle launched John Snow on this mission, fate would define its course. A world away, in the ghettoes of Calcutta, another journey was beginning. An epidemic like none the world had seen before had begun to spread. As John Snow arrived to begin his medical training in Newcastle, cholera was in India, packing its bags.
In 1827 as William Hardcastle introduced his young apprentice to the vagaries of nineteenth-century surgery, cholera began to stretch its first fingers of death to the north and west of Calcutta. As John Snow learned the proper ways to slice into a patient’s veins and drain his blood, the disease climbed into the rugged mountains of central Asia.
Cholera strikes quickly. Within a day or two, its victims are writhing, immobilized in its terrifying grip. An obligate parasite, it must depend on its unfortunate host for survival. In that host, the bacteria finds food and an ideal environment to reproduce. The poor man or woman must also help cholera find a new victim.
Travel through the mountains of Afghanistan and southern Russia was arduous even under the best conditions. In the cold of winter, cholera’s messengers slowed to a crawl. The mountains were almost unpopulated. The carriers died or recovered before they could find new victims and cholera’s advance on Europe stalled.
Cholera, however, is a patient killer. By 1829 it had a second chance to spread. Improvements in the routes of transportation and the steady flow of British and Russian troops allowed cholera to reach Moscow. The great powers resorted to desperate measures to halt the disease. The Russians ordered their armies to surround any town where cholera appeared and shoot those who sought to escape. As the disease moved westward, the Germans massed troops at their border in hope of stopping the advance of the epidemic. Military might, however, was no match for cholera. By 1831, four years after John Snow began his apprenticeship, the British were under siege.
A creature that comes to life in the warmth of the human gut, the cholera bacterium thrives in hot, humid environments. Away from its home in India, it advanced in the summer and hid in the winter. During the summer of 1831, the pathogen took control of the ports of continental Europe. Britain’s vast armada of merchant ships flowed steadily into and out of those contaminated harbors. Each new load of returning cargo threatened to bring death to England.
Late in the summer, the Privy Council in London mandated that ships from Russia, Germany, or any Baltic port sit in quarantine for fifteen days. British warships patrolled the harbors of England, their cannons keeping watch over the invisible threat. As summer gave way to fall, the quarantine appeared to be working. By October the heat was fading and with it, the chances that a cholera epidemic would take hold. But Britain would not be spared. In the port city of Sunderland, at the mouth of the River Wear, the defenses of the realm were unraveling.
The River Wear was William Sproat’s life. The river ran just south of Newcastle and the region’s burgeoning coal industry had been good for business. The robust keelman spent most of the fall plying the river in heavily laden barges. Occasionally he would reach a thirsty hand into its dark water. It seems that one day in the fall of 1829, as he drew his hand back from the river that had, for so long, given him life, death clung to his fingers.
In the middle of October, something took hold of William Sproat. He fought his illness for more than a week. Disease was a constant companion in nineteenth-century England. Sproat had seen all the illnesses of the day, but none had proved a match for his sturdy frame. He had never felt anything like this.
During the dark, early hours of Sunday, October 23, the disease got the upper hand. After ten days of vomiting and violent diarrhea, excruciating cramps wracked William Sproat’s body. The family doctor had no remedy. Fearing the worst, Sproat’s wife rushed to the home of the one physician who might offer hope.
Dr. James Butler Kell, the only doctor in Sunderland who had ever seen a case of cholera, was surprised to find the desperate Mrs. Sproat at his doorstep. Kell, an army surgeon, had recently come to Sunderland after twenty-eight years of military service that had taken him to the far reaches of the British Empire and into cholera’s kingdom. When Mrs. Sproat pleaded for his help, he pointed out that she had a physician already and he did not want to intrude on the practice of a local doctor. As she continued to describe the state of her husband, Kell’s memory stirred. The more he learned, the more convinced he grew that he should examine Mr. Sproat. Nonetheless he did not want to do so on his own. He immediately sent an urgent message to Dr. Reid Clanny, the most respected physician in Sunderland and a member of the newly formed Sunderland Board of Health, requesting that he join him in visiting the afflicted boatman.
Within an hour, Dr. Kell and Dr. Clanny entered the home of the Sproats, a comfortable house on Fish Quay overlooking the harbor. Fearing the worst, William Sproat’s family, including his adult son and his eleven-year-old granddaughter, waited anxiously as the two doctors attended to their gravely ill patriarch.
When they saw his pale, shriveled face and his sunken eyes, Kell and Clanny immediately suspected the worst. Their fears grew as they heard the faint whispers of Sproat’s story. Then Kell lifted one of Sproat’s cold, pale hands. What had been the powerful hands of a boatman were limp and heavy. At the base of the thumb, Kell could feel the weak remnants of a pulse. As he knelt by the poor man’s side, Kell’s remaining doubts lifted and the horror of recognition took hold.
Kell had seen many strong, young British soldiers gripped by cholera. Just two years earlier he had been responsible for controlling an outbreak that struck a British regiment on the island outpost of Mauritius. Having seen cholera once, he could not forget it. Cholera had come to England.
More precisely, Asiatic cholera had arrived. The principles of British medicine that John Snow was dutifully learning just a few miles to the north painted a muddled picture of cholera. Hardcastle had taught his diligent pupil that good health required a proper balance of the four bodily humors: blood, phlegm, black bile, and yellow bile. The last of these, yellow bile, was also known as choler. Imbalance meant disease. Cholera, as noted in a medical book of the day, was “occasioned by a putrid acrimony of the bile.”
Because of this fundamental misunderstanding, cholera’s name was pasted across what we know today to be many different diseases, most of which involved severe vomiting and diarrhea. Snow had almost certainly seen cases of so-called common English cholera, a relatively nonspecific term for gastrointestinal diseases thought to be endemic to England. But as the epidemic approached from Calcutta, he quickly learned that this new sort of cholera was something entirely different. This new disease, according to the predominant medical thinking of the time, was a particular form of cholera known as either Asiatic cholera, to reflect its source, or cholera morbus, to reflect its severity. Today this is the only disease that we still refer to as cholera.
Most waterborne diseases cause diarrhea, vomiting, or both. They kill, ironically, by dehydrating their victims. Remarkably William Sproat hung on for several more days as cholera* sapped the life from his body. By Monday his blood began to grow thick and tarlike and his heart strained to pump the viscous fluid. Blood’s most important role is to feed the fires of metabolism and haul away the smoke and ashes. As Sproat’s blood slowed, those oxygen-starved fires dimmed. Slowly the color faded from his skin.
Kell had judiciously turned the care of Sproat over to Drs. Holmes and Clanny who did what they could, but medicine of the day had little to offer. The prevailing theories held that his body was trying to purge itself of some mysterious epidemic poison. Vomiting and diarrhea were to be encouraged. Recommended therapies routinely included emetics and enemas.
Three days later there was so little blood flowing to William Sproat’s brain that he fell into a coma. As death moved in, his fingers and legs turned dark blue. That night Sproat died the “blue death” of cholera.
For the Sproat family, the tragedy was not over. Within hours, the disease had the dead boatman’s granddaughter in its grip. By the next morning it had reached out to take the poor girl’s father.
As the week wore on, the number of cases rose steadily. The medical men of Sunderland held a meeting and concluded that cholera had undoubtedly arrived. They sent word on to London. In early November, health officers dispatched by the Privy Council in London had placed a quarantine of fifteen days on all ships originating from Sunderland. The epidemic was official and it had cut off Sunderland from the world.
But the fortunes of Sunderland, the fourth busiest port in England, rose and fell with the ships that filled her narrow harbor. A few weeks of unfavorable weather in the North Sea would send the local economy into a tailspin. An open-ended quarantine would cripple it.
Faced with this bleak reality, the medical men of Sunderland held a second meeting a week after the quarantine was announced. Kell and Clanny were not included. The assembled doctors, surgeons, and apothecaries declared that their earlier inference had been a misguided rush to judgment. They expressed their unanimous conclusion that the disease that had felled the Sproats (and several others in the days since) was not Asiatic cholera after all, but simply common English cholera. There was no epidemic.
The sloppiness of nineteenth-century diagnosis made this possible. Cholera, in 1831, was simply a set of symptoms. Today cholera is a specific disease and a definitive diagnosis is based exclusively on finding evidence that the Vibrio cholerae bacteria is responsible. In 1831 these doctors had no idea that such an agent existed. Microscopes were not a part of medical training and the notion that something undetectable to human senses might have the power to kill seemed ridiculous.
The ignorance of medical science made it possible to pretend that this was not Asiatic cholera. Overwhelming pressure from commercial interests made this sleight of hand expedient. Unfortunately renaming the disease failed to stop it. Over the next few days, the number of cases mounted and denial became untenable.
Just thirteen miles to the north, in the busy port of Newcastle-on-Tyne, an eighteen-year-old surgeon’s apprentice attended to his duties. For four years Snow had ground and mixed medicines for Dr. Hardcastle, taken his messages, managed his appointments, and written up the daily entries in Latin. He had assisted Hardcastle in everything from pulling teeth to delivering babies. As he gained experience, he had begun to see some of Hardcastle’s indigent patients on his own.
Snow followed the approach of cholera intently. He picked up information from any source available and tried to comprehend the convoluted web of primitive thinking as to its cause. Events in Sunderland also taught him about the capacity of the medical establishment to turn from the truth when economic and political forces make it desirable and ignorance makes it plausible, a process recapitulated in his own career many times over.
As November wore on, the medical community of Newcastle braced itself for the epidemic and John Snow attended to his duties. England was at war with cholera. Within a month, he would join the battle.
Cholera moved steadily north along muddy streets lined with human and animal waste. By late November it had reached the working class town of Tynemouth, just a mile downstream from Newcastle. It spread easily in this unsanitary world. The path upstream was short. On December 7, 1831, cholera arrived in Newcastle.
An unwashed hand, a dirty spoon, a bit of soiled linen. All innocent and harmless under normal circumstances. In the presence of cholera, however, they become the carriages in which death can ride. And so, in Newcastle, it did. Steadily from one person to the next. A touch, the sharing of a poisoned object, and the disease moved.
Epi-demos. Upon the people. An epidemic, by definition, afflicts large populations. Most epidemics, however, do not spread at a steady pace, but in fits and starts. Slow spread is punctuated by periodic, explosive outbreaks. In Newcastle cholera was picking off victims one by one. As Christmas approached, only a few dozen had died. Although the presence of the disease spread fear throughout the community, it had yet to show its potential for a sudden devastating outbreak. That was about to change.
As the residents of Gateshead sat to eat their Christmas dinners, Thomas Fife, a local apothecary, made his way through the narrow streets to a small, low-ceilinged room on Oakwellgate Lane. Like the other doctors of Gateshead, Fife had been following the news of the slowly growing outbreak in Newcastle, just across the river Tyne. As he walked through quiet streets of Christmas, Fife could hope that Gateshead, with only two deaths, might still be spared. A week earlier an impoverished ragpicker had died from cholera. The second case, a poor woman from Pipewellgate, had just fallen ill on Christmas Eve, but as Fife approached the tiny apartment of Margaret Taylor, he could still believe Gateshead would not feel the full wrath of cholera.
The air in the single room that Margaret Taylor shared with her sister, Isabella, was oppressive and still. The two women made a meager living as spinners at the twine yards. As he approached Margaret’s bed, her sunken eyes gazed up from a face that appeared far older than her forty-two years. The illness had taken its warmth and vigor leaving it shriveled and gray. Margaret Taylor had been fighting for her life since four in the morning and was now struggling to breathe. Fife sat next to her and laid his fingers across the cold skin of her wrist. He waited in silent concentration, but her feeble pulse eluded his touch.
Fife saw that she had entered the later stages of cholera in which the disease seems to asphyxiate its victims. Concluding that he needed to stimulate her and to excite her vascular system, he gave her a combination of ammonia, camphor, opium, and menthol. As the cold blue death crept in, he tried to warm her by rubbing her with heated flannel and administering warm water enemas. Fearing he was facing his first case of Asiatic cholera, Fife sent word to his colleagues, including Tom Brady, the man who had cared for the first two cases in Gateshead. Soon several doctors including Brady crowded into the room. Brady confirmed Fife’s conclusion that Margaret was in the final stages of the disease.
As Margaret Taylor lay dying, Fife was summoned to the bedside of a twelve-year-old girl, Mary Wheatley, who had been suddenly stricken with violent diarrhea and vomiting. Fife began to suspect that the epidemic had arrived in Gateshead as he rushed to examine the poor child. Relying on the confused concepts of disease and health that defined medicine in his day, Fife chose to purge her of the offending bile. He gave her ipecac to improve the effectiveness of her vomiting and an enema with turpentine in gruel.
Across town an apothecary by the name of Greenhow sat by the bed of Margaret Walker, the mother of nine children, who had been sick for three hours. When he had finished, he prepared several slices of toast, soaked them in vinegar, and coated them with black pepper. He then arranged them on her abdomen in hopes of improving her condition.
Throughout Gateshead, the story repeated itself over the course of Christmas Day as doctors, surgeons, and apothecaries rushed to offer useless remedies. With no real understanding of the disease, doctors selected their mode of treatment based on an amalgam of archaic beliefs interpreted according to the idiosyncrasies of their own particular misconceptions. As a result it is often impossible to discern the method in their madness. In treating the first two cases of cholera, Mr. Brady had spread a poultice of bran between two sheets and wrapped it around the legs of the victims. Another local doctor advocated the use of tobacco enemas during the course of the outbreak.
Fife’s efforts to help his two patients eliminate cholera’s poisons only hastened their death by dehydration. Margaret Taylor would not survive the night. Twelve-year-old Mary Wheatley died early the next morning. Greenhow’s warm toast was laudable only in its uselessness. It did no harm, but his patient fared no better than Fife’s. That same morning, the nine Walker children would lose their mother.
Fife did have one success. Just a few blocks from where the spinster, Margaret Taylor, lay dying, Joseph Laws, a twenty-four-year-old laborer, began to feel uneasy. Unsure of what to do to calm his queasy stomach, Laws sat down to a plate of cold mutton. He would soon discover that the stirring in his belly was not hunger, but cholera. When he called for Mr. Fife, the surgeon apothecary suggested he drink as much thin gruel as he wanted. By providing him with a mechanism to replace the fluids he was losing, Fife almost certainly saved Joseph Laws’s life. He failed, however, to recognize that he had stumbled on the only effective treatment for cholera.
Fife was too busy to think much about the mechanisms of cholera’s attack. At three in the morning of December 26, he was summoned back to Oakwellgate Lane to see Isabella Taylor, the sister of the spinster who had died the previous night. He found Isabella in a neighbor’s apartment. Death haunted the air. The cholera-ravaged corpse of her sister, Margaret, lay next door in the room where she had died. Now the disease had moved to Isabella. She would die by nightfall. Before the next day was over, cholera had attacked 119 people and 52 of them had fallen to the blue death.
The frail, the old, and the very young were most likely to die at the hands of cholera. A desperate mother with bowls of chicken broth might naively save her child’s life by staving off dehydration. In 1829 survival might have involved nothing more than avoiding medical care.
Like the other doctors in Newcastle, John Snow interpreted the outbreak in the context of the prevailing thinking about epidemic disease. The medical science of the day held that the spread of an epidemic disease such as cholera must involve a miasma, a foul-smelling airborne poison. An explosive outbreak such as occurred in Gateshead signaled the sudden presence of a particularly dense miasma in the afflicted community. Only the air could spread a disease this widely and rapidly. Snow would spend the rest of his career proving these theories wrong.
Although no one realized it at the time, Gateshead had just witnessed the tremendous capacity of water to spread cholera. In the months before the arrival of cholera, a severe water shortage had forced the local water company to pump water directly from the Tyne in order to ensure an adequate supply. Residents of Newcastle and the surrounding towns consumed bottles carefully filled with untreated river water. As the epidemic grew, the chance that cholera would crawl through the pumps and into those bottles increased. In the days before Christmas 1831, in the town of Gateshead, across the river from Newcastle, cholera had gotten into the water.
Cholera had established itself, but it was winter. In the cold, the disease slowed, hunkered down, and waited for better weather. With the arrival of spring, it began to travel again. As the summer warmed the coal-stained towns of northern England, the disease exploded all over the kingdom. The toll in Newcastle rose steadily.
In August 1832, with cholera raging, William Hardcastle called John Snow aside. Cholera, he told him, had spread to Killingworth, a coal town two miles to the north. In addition to his responsibilities in Newcastle, Hardcastle was Killingworth’s only physician. At the same time, the vestry of St. John in Newcastle had recently given Hardcastle responsibility for overseeing the care of the poor in the parish. Given the new assignment together with his existing clinical responsibilities in Newcastle, he simply could not take on this new outbreak. After five years of training, Hardcastle believed Snow was ready to work on his own. At the age of nineteen John Snow set out for Killingworth to take on cholera single-handed.
The Killingworth Colliery was one of dozens of shafts sunk into the vast coal seam that ran under the northeast corner of England. Snow knew that cholera loved nothing more than a mining town. In January the initial wave of the epidemic had struck at Newburn, a mining village of 550 people. Within a few weeks, cholera had attacked 330 of them, killing 65.
Rotting garbage, excrement, and poor ventilation were all presumed to contribute to miasmas and the spread of epidemics. Had miasmas existed, they would have found a warm welcome at the bottom of a mineshaft. The miners worked and ate in filth that was unparalleled, even in the gritty world of the working class in early nineteenth-century England. There were absolutely no regulations to protect the men, women, and children that worked in the mines. (It would be eleven years before Parliament passed a law prohibiting women, girls, and boys under ten from working in the mines.) Miners routinely worked shifts of twelve hours or more. Whatever food and drink they needed for those twelve hours, they would take with them into the mine. There, in a dark narrow cave with no privy or water, they would live, eat, and defecate.
For John Snow the weeks he spent in Killingworth left the most enduring memories of his entire apprenticeship as he watched the miners emerge from the coal pits stricken with the disease. Snow worked tirelessly throughout the outbreak. Day after day he visited the one-room houses that stood in rows around the mine. Night after night he cared for the sick and dying miners and their families.
Despite his best efforts, he watched again and again as cholera wreaked sudden and deadly havoc on its victims. Away from Hardcastle’s supervision, he had greater freedom to think for himself and to learn from his failures. He began to sense that there was something fundamentally wrong in the prevailing wisdom about cholera.
Later, as he reflected on the outbreak, he wondered why cholera had struck at Killingworth while sparing other mining towns. With Robert Stephenson, the famed designer of steam locomotives, as its engineer, this mine was at least as well designed and ventilated as other mines in the area. What sort of miasma would strike at this mine and not others?
In the humid tropics, cholera becomes endemic, simmering in the population, limited only by the immunity of those who have survived the disease and the caution of those never afflicted. In colder climates, a bitter winter can pull the disease up by its roots and in 1832 that is precisely what happened. After killing more than twenty thousand Britons, cholera left England, but the question would stay with John Snow. For the next sixteen years, in cholera’s absence, the question lingered as he moved on to other projects. He completed his apprenticeship with Hardcastle and then two more apprenticeships with surgeons in nearby towns. In 1836, after he had finished his final apprenticeship at the age of twenty-two, he walked home to York.
He had been gone for over seven years and much had changed in his long absence. The hard work of his parents had continued to pay off for his family. They now owned a farm on the outskirts of York and his older siblings were already on track to become teachers, clergymen, and businessmen. Two more Snows had been born in his absence. One of them, a brother, had died from an infection before John ever had a chance to see him.
The reunion did not last long. John, as always, was looking forward. The 120-mile walk from Newcastle to the family’s farm was merely a warm-up. After visiting York, John Snow planned to continue on to London where he would enroll in medical school.
Even if he had taken the most direct route, the trip to London would have required him to walk almost two hundred miles, heading southeast along the Great North Road. Young, full of energy, and eager for the challenge, John bid good-bye to his parents and his seven siblings on a September morning in 1836. He began to walk, not toward London and the rising sun, but toward Liverpool, a hundred miles to the west. This was to be a grand adventure.
Snow had planned a circuitous route to London that would not only expand his universe, but would also take him to see one of the most important people in his life, his uncle and mentor, Charles Empson. Charming, dapper, and worldly, Empson had come to Newcastle shortly after the arrival of his nephew from York. Through most of Snow’s apprenticeship, Empson owned a shop in Newcastle where he dealt in fine art, antiquities, and exotic shells and minerals, many of which he had collected during travels in South America. The shop was just a few blocks from Hardcastle’s surgery. It was a hub for the cultural elite of Newcastle and Snow was a frequent visitor.
But the shop in Newcastle had closed its doors long before John Snow finished his apprenticeship. Empson left under a cloud. A note in a local paper stated that he had been “the victim of a cruel, malicious, and slanderous report, fabricated and propagated by a vile wretch whom he had employed as a tradesman.” The precise nature of those accusations was never recorded, but they were sufficient to cause Empson to close his shop and move to Bath.
So after a stop in Liverpool, Snow turned south, toward Bath. Again he shunned the direct route, embarking on a tour through the Welsh countryside that added another hundred miles to his trip. He walked through beautiful mountains and past coal towns at least as dirty as those around Newcastle, coal towns that had been largely spared by the cholera epidemic. After walking almost four hundred miles, he arrived in Bath, found his way to an apartment above a small gallery at 9 Cleveland Place, and knocked.
When Charles Empson opened the door, John Snow had not seen him for two years. The two men spent their days together in Bath catching up on the events since their time together in Newcastle and discussing Snow’s future in London. Given the expenses that lay ahead for Snow, it is likely that he received financial support from his increasingly prosperous uncle. Then, after a warm farewell, John Snow began the final leg of his journey.
For ten days Snow walked past the fertile fields of southern England. The farms buzzed with the activity of the harvest. Carts laden with produce filled the roads. As he approached London, the traffic thickened. Coaches and carriages joined the farmers’ carts. Finally the countryside gave way to Kensington Gardens and Hyde Park. John Snow’s sense of exhilaration grew as he walked past Buckingham Palace and into the heart of the city that, perhaps more than any other, defined the nineteenth century. His trip ended on Great Windmill Street in Soho where he would continue his medical education as a student at the Hunterian School of Medicine. To get there he had walked almost five hundred miles.
As cholera faded from the consciousness of London, John Snow threw himself into his medical training. He did not forget cholera, although it would not return to England for twelve years. The disease would find him again, but it would also find that those years had made him a far more formidable adversary.