On the morning of 7 April 1853, Dr John Snow was summoned to Buckingham Palace to attend the birth of Queen Victoria’s eighth child Prince Leopold. Snow, a forty-year-old Yorkshireman, was one of the leading advocates of administering chloroform during labour (and during most other things too: in his lifetime he used the anaesthetic in 867 tooth extractions, 222 female breast tumour excisions, 7 male breast tumour excisions, 9 eyelid corrections, and 12 penis amputations).
The birth was a success, as was that of Princess Beatrice four years later, which Snow also attended. Snow had also used chloroform on the daughter of the Archbishop of Canterbury, and the combination of church/royal approval did much to popularise the use of anaesthesia in general. The procedures made Snow famous and rich, although these days he is largely remembered for something else: the use of a map to illustrate the infectious spread of cholera.
The map, which centred around London’s Soho, was not recognised as anything extraordinary at the time. It was not the first map to display this fatal disease, and the rigour of its science was found wanting. But it is now regarded as iconic, one of the most important maps of the Victorian age. And as a way of engaging young minds in the elementary detection of medical mysteries, it is a map yet to find its equal in either Sherlock Holmes or House.
John Snow – the map doc
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Asian cholera first came to Britain in 1831, claiming more than 50,000 lives. A second epidemic killed a similar amount in 1848, a devastating figure for a country being told by its government that the new Public Health Act, passed in the same year, would transform the nation’s sanitation. But cholera would prove a stubborn foe: by the time the third epidemic began to decimate Soho at the end of summer in 1854, there was still widespread disagreement about its cause. Most believed that cholera was miasmic (caused by airborne infection), a view supported by the two most prominent medical names of the day, Florence Nightingale and Sir John Simon, the Medical Officer of the City of London. But several leading epidemiologists had begun to suspect otherwise.
Snow’s study of the disease, in his 1849 pamphlet On the Mode of Communication of Cholera, dismissed the idea that there was just something in the air. He suggested cholera was caused either by the human consumption of contaminated food or water, or by ‘fomites’, which usually meant infested clothes or bed linen. He claimed that the 1848 outbreak had been caused by the arrival in London of an infected sailor and his bedclothes from Hamburg, though he found this difficult to prove. Snow suspected a cellular structure to the cholera organism, but as he had not been able to show it beneath a microscope he proceeded largely on instinct.
In late-August 1854 Snow was examining how the water supply routes from the Thames may have affected a serious cholera outbreak in south London when he learnt that new cases had been reported just a few hundred yards from where he lived in Sackville Street, Piccadilly. He used to live even nearer, in Frith Street, where there had already been several deaths, and he believed that his knowledge of the area, and contact with local residents, might yield the clues he needed to support his theory. He did what doctors still did in those days: he made house calls. It was a brave endeavour: in his efforts to match human illness to human behaviour he appeared to put himself at grave risk, for if cholera was airborne, the inquisitive Snow would surely be one of its victims.
Sniffing out the causes of cholera: Robert Seymour’s health inspectors on the trail in 1832.
In the first week of his investigations more than five hundred Soho residents would die. People began falling ill on 31st August, with a peak in fatalities occurring two days later. But by the third day, Snow believed he had found his cause: the public water pump where Broad Street met Cambridge Street. This was not only the main water supply for those living nearby, but also a common stop for passing traders and children. There were other fatally opportunist users too, including the local pubs who watered down their gin and whisky, and many coffee houses and restaurants. Snow noted subsequently that one keeper of a coffee house in the neighbourhood, popular with mechanics, ‘informed me that she was already aware of nine of her customers who were dead’. The water was also sold in small local shops, ‘with a teaspoonful of effervescing powder in it, under the name of sherbet.’
Snow tested the water from the Broad Street pump on 3rd September, but his results were inconclusive: he detected few impurities with the naked eye, although when he looked again the following day he saw an increase in ‘small white, flocculent particles.’ One resident also told him that the water had changed its taste. Seeing no other possible cause, and perhaps fearing that he was running out of time, he requested a list of the dead from the General Register Office. Eighty-nine people had died from cholera in the week ending 2nd September, and as Snow walked around with his list he immediately saw the pattern he had anticipated: ‘Nearly all the deaths had taken place within a short distance of the pump.’
As Snow continued walking he found further confirmation of his theory. Only ten deaths had occurred within the vicinity of another water pump, and five relatives of the deceased told him that they always drew water from Broad Street as they ‘preferred’ it – presumably either its taste or the fact they thought it cleaner. Two out of five of the remaining cases were children who went to school near Broad Street. Snow argued that the outbreak couldn’t be supported by the miasmic theories (which associated disease directly with poverty) when he found that a nearby workhouse containing hundreds of people was not affected by cholera; it turned out they drew their water from their own well. The evidence now seemed overwhelming. On the evening of 7th September Snow met the local board of guardians and presented them with his findings. ‘In consequence of what I said, the handle of the pump was removed on the following day.’
The ghost map: Snow’s plan of Soho with the cholera-infected Broad Street (modern Broadwick Street) water pump at its heart
Like the water itself, the cases slowed to a trickle. The number of fatal attacks on 9th September was only eleven, compared with 143 eight days earlier. By 12th September there was one case, and by the 14th none. But this could not be attributed directly to the closure of the pump, as the cases were already decreasing in the days before. And as Snow himself reported, evacuation played a significant role – hundreds of inhabitants had already left the area in fear.
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It was only now that Snow started putting together his famous map – an illustration of his findings rather than a cause of them. The base map itself was already available, printed by the nearby Holborn firm C.F. Cheffins, which also produced some of the earliest railway maps. The detailed scale was 30 inches to a mile, and the portion of the map Snow reproduced had Broad Street at its centre – the Jerusalem of Soho.
Snow added three key elements to the map. First were the locations of the water pumps – thirteen in all, the most northerly in Adam and Eve Court above Oxford Street, stretching down to Titchborne Street by Piccadilly Circus. Next, he placed a meandering dotted line over the area where the Broad Street pump would be closer for residents to visit than any other pump; this is now known as a Voronoi diagram, and Snow’s version is the most famous early example. And finally he added small black dashes denoting deaths, like gravestones in a very crowded burial yard.
There were several areas of clustering: St Ann’s Court off Dean Street had 24 bars; Bentinck Street off Berwick Street had 19; Pulteney Court by Peter Street had 10, with nine of them seemingly at one property. But the cluster around Broad Street is unmistakable: 82 deaths in the street alone, with many more marked close by.
Snow presented his findings – and his map – in a lecture to the London Epidemiological Society in December 1854. Soon afterwards, another report on the outbreak (conducted by local parishioners with Snow as their chief investigator) delivered an even more detailed breakdown of events, and another map. The findings were sickening, detailing not only extreme poverty and overcrowding but the sort of sanitation you wouldn’t expect on a farm, with cellars and basement rooms layered with human faeces.
It was the miasmatics’ claim that the fumes from these dungs would alone be enough to spread disease, and there was also a theory that the Soho area most affected by cholera in 1854 lay directly above a mass burial ground of thousands of casualties of the Great Plague of 1665. Despite the apparently glaring evidence displayed on Snow’s map, his water-borne theory was still not universally accepted, and for a while a great riddle remained: how did the pump’s water become contaminated in the first place?
The most convincing answer was provided by a local priest called Henry Whitehead, who, in the weeks that followed the Soho outbreak, had conducted a thorough investigation of his own. He began as a confirmed miasmatic, but began to have doubts as he did his rounds. At 40 Broad Street he met the police constable Thomas Lewis and his wife, and learnt that their daughter Sarah had died on 2nd September aged five months after a prolonged bout of diarrhoea. The mother spoke of the start of her illness on 28 August, and of emptying water containing the ‘dejections’ of the baby into the cesspool in the basement. When Whitehead examined this he found its faecal content leaking into the soil and evidently into the water supply. Snow was unaware of this first victim, and the baby is missing from his map, which shows the deaths at 40 Broad Street as four rather than five.
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Snow’s epidemiology wasn’t the first of its kind. The concept existed long before the word was coined in 1802, and there was significant mapping of London’s deaths following the Great Plague and Fire of 1665–66. And half a century before that, Bills of Mortality had identified the chief causes of death in London as dysentery and convulsion.
The first disease spot map: Valentine Seaman’s 1798 impression of the New York waterfront, identifying incidences of yellow fever.
In America, the title of first medical cartographer should go to a man named Valentine Seaman, the New York public health official who drew the first proper disease ‘spot’ map in 1798. An outbreak of yellow fever in the Manhattan docks near Wall Street had caused hundreds of deaths when he began examining what he believed to be the principal cluster of cases and plotting them on two maps that were published in an influential new medical journal. Unlike Snow, however, Seaman was a confirmed believer in miasma theory, finding that many of the deaths had occurred close to what he called ‘furry-fostering miasmata’ and an open public toilet. In the absence of a pump handle, the New York authorities would in time learn to control tropical diseases with quarantine.
Seaman’s maps remain both influential and timely. They amplified the emergence of a new trend, even a new science: medical geography. Its leading thinker was Leonhard Ludwig Finke, a German obstetrician who, in the 1780s, planned to construct an atlas based on disease. Heavily influenced by the writings of Hippocrates some 2,000 years earlier, he began to wonder about the overseas epidemics he had read about and wondered if they had a common thread. And then he found several, including the soil, vegetation, air, and methods of animal welfare. He believed that it was a particular district or country (rather than its people) that was diseased, and he constructed a scientifically rigorous three-volume explanation of his new geography – an early travellers’ advisory of where not to go. His ambition for a disease atlas was quashed by high costs at the time of the Napoleonic Wars, but he did produce a world map of disease in 1792.
Finke’s theories certainly endured. In 1847, Charlotte Brontë described Jane Eyre’s search for a dwelling place in the Empire that was free of the terrible diseases that filled the newspapers, but her choices were extremely limited. The new medical geography seemed to justify what would otherwise pass for xenophobia. In Jane Eyre the Tropics were largely a malaria-ridden disaster zone, while West Africa was ‘the plague-cursed Guinea coast swamp’. The West Indies, East Indies and much of the New World were similarly infested. But Bronte adopted a largely anti-imperialist stance, suggesting that the scarring of the physical landscape and the importation of pathogens were the definable and disastrous legacy of western colonialism.
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In London, the fact that water was the prime cause of cholera was finally acknowledged in the 1870s, when Sir John Simon, who had left his post as London’s chief medical officer to take on a similar role for the government, abandoned his miasma theory. It is impossible to estimate the number of lives saved by Snow’s instinct and persistence, nor the impact on urban sanitation. He didn’t do it all, of course: Henry Whitehead’s work was equally significant, and health officials were well aware by this time that public sanitation had to be checked and improved, not least the water supply from the Thames (ultimately it was cholera itself, rather than any report or map, that spoke the loudest). Within four years of the Broad Street epidemic the engineer Joseph Bazalgette would be appointed to rid London of the Great Stink; his intricate network of underground sewers, completed in 1875, did more to cleanse London of cholera than anything else.
But Snow’s work – and particularly his map – remains a thing of legend. The writer Steven Johnson has called it ‘The Ghost Map’, and it’s an apt title: despite the anonymity of those slim black dashes, they are more than just statistics. Perhaps because Snow lived in the area and would have known some of these individuals as neighbours if not patients, and perhaps because the descriptions of their lives and dwellings in the texts by Snow, Whitehead and others are so vivid, we feel we have a stake in their lives, even after death. Charles Dickens may have something to do with this too – not least his pungent descriptions of London squalor from the late 1830s that Snow would have witnessed on his daily rounds as a young doctor.
And then there is Snow’s map itself: its scale, the detail of the streets and alleys that many of us have walked down and enjoyed their noise and vibrancy. The map provides a degree of focus that was rare in public maps of the period, a focus not only on the streets but also the bustling and fetid activity they contained, something we are only now becoming familiar with again through the zoom of electronic mapping. But perhaps we remember Snow most of all because the story is so perfect: the map found the pump, and the removal of its handle stopped the epidemic. Neither is quite true, of course, but the map and its ghostly mortality has taken on an invincible life of its own.
In 1860, Australia was a place of barren mystery. The shape of the continent had been mapped reasonably well, the coastal cities of Adelaide, Melbourne, Sydney and Brisbane were expanding rapidly, and a gold rush in the early 1850s had caused a great boom in the population and economy of New South Wales. But the interior was a different story. Was it arable and potentially profitable? Would an inland waterway make it navigable? Could a telegraph line be laid down to link it with the rest of the shrinking Victorian world?
The aborigines had no need for these questions, but white explorers from the newly established Royal Society of Victoria wanted to advance not only scientific and geographic knowledge, but also play catch-up with the rest of the world. Detailed scientific cartography had transformed the look of Europe; the belts of India and Africa were being traversed; the Northwest Passage was being opened up in the Arctic. But in Australia the map remained a carpet of blank.
A few explorers had made tentative inroads in the first half of the century. In 1813 Gregory Blaxland and William Wentworth ventured from Sydney to cross the Blue Mountains. In the mid-1840s Charles Sturt made a bold northward trek from Adelaide, but was forced to retreat after desert heat proved unbearable. A Prussian adventurer called Ludwig Leichardt travelled for thousands of miles along the north-east coast, but his journey into the interior in 1848 ended in one of those great Bermuda Triangle-style conundrums of exploration: he and his team were simply never seen nor heard of again.
But in 1860, a grander – one may say grandly ludicrous – expedition was proposed by the Royal Society of Victoria. This was a journey across the entire continent, from Melbourne in the south to the Gulf of Carpentaria* in the north; and then back again, replete with maps and journals. It was a journey that would nowadays be classified as Extreme Sports, except that most extreme sports are rather better organised and carry less air of folly. For this was not a civilised expedition in the manner of the Ordnance Survey; it was an adventure closer in spirit to polar exploration. And like polar exploration, the quest would inevitably be led by men who were either too ambitious or too crazed to know their limits, and the voyage would be remembered for the sort of tragic heroism that made young boys sit up straight in class and vow to become explorers themselves. And then there was a map summing it all up – a map notorious for its depiction of death rather than glory, a precursor to something we would soon see in the Antarctic.
Several contemporaneous maps relate the exacting journey of Robert O’Hara Burke and William John Wills, but the most dramatic was produced at the end of 1861, a few months after the two men and others in their party had met a sorry, starving end. It was published, on a scale of 1:3 million, by De Gruchy & Leigh, a flourishing lithographic company that had made its reputation with city maps of Melbourne. It was a long millipede of a map, locationally unreliable, scientifically wanting, with little logic to its place names and observations, and a seemingly random start point, several months into the journey, halfway up the country by Cooper’s Creek. As such, it was utterly compelling.
The most dramatic section of De Gruchy & Leigh’s map of Burke and Wills’ route to the Gulf of Carpentaria. The rings show the doomed explorers’ final demise.
Burke and Wills’ expedition – a party of 19 men, 26 camels and 23 horses – set off from the Royal Park in Melbourne on 20 August 1860, with some 15,000 inhabitants cheering them away. It was an inauspicious start: their equipment included six wagons, but one collapsed before it had left the park and two others didn’t make it out of Melbourne. By 16 December, when the narrative on the maps starts at Cooper’s Creek, all but four of the nineteen men had either left the mission or been deployed on back-up and food storage tasks.
The biographical details of those who remained read like the start of a bad joke: Robert O’Hara Burke was an Irishman from County Galway who had once fought in the Austrian army; William John Wills was an Englishman from Devon, who had emigrated to South Australia and become a medical assistant and astronomer; John King, another Irishman, had gained some geographic experience in India; while Charles Gray’s background was more of a mystery, beyond the fact that he hailed from Scotland.
The second half of the outward journey, from Cooper’s Creek to the gulf, took a relatively uneventful two months. The scenic observations noted on the map are calm enough: Suitable for Pastoral Purposes; Stony Desert; Brackish; Rivulet of Pure Water; Large Anthills 2½ to 4ft High; Tea Tree Spring – Mineral Taste Probably Iron. Occasionally there is mention of the local inhabitants: by King’s Creek they noted Natives Inclined to be Troublesome. Near the summit, which reached Flinders River just below the Gulf of Carpentaria, a line declares: Burke & Wills proceed N on foot, leaving King & Gray in charge of camels. And then, at the top of the map, the happy legend: Burke & Wills, Feb 11 1861.
But the return journey is a very different concern. Wills, the main surveyor, made his own piecemeal maps every few weeks, but he was in no fit state to draw the full route. The De Gruchy & Leigh map was compiled retrospectively, largely from field notes recovered from the earth months after they were buried by the travellers, eager to lighten their loads. Their increasingly desperate narratives are reflected on the map with markings both shorter and sadder: Golah [a camel] Left Behind; April 16, Gray Died; Wills’ Body Found; Burke’s Body Found.
How did they die? Another map entry provides the source for the answer: King Found. John King was the only survivor of the quartet, discovered camping with natives by a search party led by Alfred Howitt several weeks after the others had perished. His diaries provide a vivid account of the final days of the expedition as they were destroyed by a combination of extreme heat, cold, hunger and exhaustion. They staggered through parched land and swampland. They encountered snakes with girths like tree trunks, shot about forty rats each night near their camps, and found the native Yandruwandha tribe to be both generous and thieving.
‘Is that Mount Hopeless up ahead?’ Burke, Wills and King crossing the desert in an engraving by Nicholas Chevalier in 1868.
They sacrificed their camels to cure and eat their flesh, and went back and forth over the same land for weeks with the increasingly delirious dream of being rescued. One landmark mentioned frequently in the field notes was called Mount Hopeless.
King’s account also revealed the tragi-comic circumstances of how the travellers just missed their support group (and the promise of rescue) on their return leg. Their back-up party had waited for the quartet to reappear at Cooper’s Creek for four months, assumed they had all died, and on 21 April turned back to Melbourne. Just eight hours later, Burke, Wills, Gray and King finally made it to their depot. It was their last chance. ‘From the time we halted, Mr Burke seemed to be getting worse,’ King wrote after his lonely return. ‘… He said he felt convinced he could not last many hours, and gave me his watch … He then said to me, “I hope you will remain with me here until I am quite dead – it is a comfort to know that some one is by”.’
The funeral of the pioneers was held in Melbourne in January 1863, and attracted about 100,000 mourners. Within a decade a telegraph line had been laid from Adelaide to Darwin, and in 1873 Ayers Rock, in the middle of the continent, was mapped by the English explorer William Gosse. A decade after that, much of the Australian interior had been traversed from many angles.
But it is Burke and Wills’ calamity that endures around the campfires. The voyage has become a movie – Burke and Wills – starring Jack Thompson as Burke, Nigel Havers as Wills and Greta Scacchi as the rather unlikely singing love interest; ‘Runs short of plot even before the explorers run short of water,’ said the New York Times. But more than that, the map and its narrative have etched themselves on the national consciousness and some distance beyond, so that they are now as much a part of the fantastical landscape as Ned Kelly, Dame Edna and Crocodile Dundee.
