Written by Anson Cheung
I spent the summer of 2017 interning in the Department of Health Services Research and Policy at the London School of Hygiene & Tropical Medicine (LSHTM). The main focus of my internship was mental health care for populations affected by humanitarian crises in low- and middle-income countries (please see my webinar below). But in addition to my formal work at LSHTM, I was also intrigued by London’s history and the implications of key events for the development of modern public health. I have never been much of a history geek and have not explored the subject much since Grade 10, but decided to seek out the history waiting to be discovered in the city. Pursuing this hobby was relatively easy: I began by following the historical “blue plaques” scattered throughout London by the English Heritage Trust. This is an example of a blue plaque outside the former residence of writer Charles Dickens.
My fascination with London’s history began during a tour of LSHTM’s main campus on Keppel Street. While making a stop in the library, my supervisor pointed out a bust of Richard Doll, who – along with Austin Bradford Hill and other colleagues – established the links between cigarette smoking and lung cancer, first through studies in London and then in other UK cities. The researchers were themselves stunned by the results and Doll ended his own smoking habit soon thereafter. Their results were an uncomfortable truth at a time when smoking was widespread and it took several years for the government to corroborate their findings. And the public health battle against smoking-induced cancers continues today, spurred on by Doll’s research published in the September 1950 edition of the British Medical Journal.
Throughout the rest of the summer I encountered many other historical figures – at the British Library, the British Museum, and the Wellcome Collection, among others. But one individual, John Snow, surfaced several times in the annals of public health history. Today, many recognize him as one of the founders of modern epidemiology, but in fact, it wasn’t until after his death that he garnered such acclaim. As a physician in 19th-century London, he was better known for his experiments with anaesthetics such as chloroform, which he famously administered to Queen Victoria during labour in 1853. Only later was he recognized for his work on cholera, a predominantly waterborne illness caused by the bacterium Vibrio cholerae.
During the nineteenth century, London was in the midst of the Industrial Revolution and many people headed to the city to take advantage of the manufacturing boom. But due to overcrowding and pollution, the city’s streets were grimy and perpetually riddled with waste. It was during this time that there were four outbreaks of cholera, which all occurred in the middle of the century between 1831 and 1866. After witnessing a cholera outbreak during an apprenticeship in Newcastle, Snow turned his attention to an 1854 outbreak occurring right outside his doorstep in the Parish of St. James. Working methodically, he plotted each case of cholera from his clinic on a map of Soho and demonstrated how cases appeared to be concentrated around the pump on Broad Street. He arrived at the unusual hypothesis that the water pump in the community was likely the source of the outbreak and convinced local leaders to remove the pump handle so that residents would not be able to drink the contaminated water. This act is now one of the best known interventions in early epidemiology and one that is frequently mentioned in introductory classes on the subject.
My own encounters with this piece of public health history began during a weekend excursion with fellow Queen Elizabeth Scholars. One afternoon, the three of us ended up in Soho after wandering from the bustle of Regent Street to the relative calm of Broadwick Street (formerly Broad Street). We had heard that a replica of the Broad Street pump was located nearby and were interested in finding it. But despite searching the entirety of Broadwick Street, we only managed to find the John Snow pub. The pump itself was nowhere to be seen.
Later that day, I looked online to see if anyone knew whether the pump had been relocated. A quick search returned results from the John Snow Society, which hosts an annual “Pumphandle Lecture” and devotes itself to commemorating Snow’s work. After searching further, I found that the pump had been removed several years ago during ongoing renovations on Broadwick Street, and, as of 2017, had yet to be replaced. It seemed as though I had reached the end of the line. But about a week later, I attended a talk at the John Snow Lecture Theatre – LSHTM’s newest and largest lecture hall. To my surprise, I noticed a glass curio right outside the entrance containing a replica of the pump accompanied by a brief description. After searching for so long, I had found this artifact of London’s public health history right under my nose, where I had least expected it. Perhaps Richard Doll had felt the same way after his discovery, as he gazed down at the cigarette between his lips and decided to stop at last. He too would have appreciated the irony.
Watch the video from Anson’s QE Scholar Insights webinar: