CHAPTER TWO

London, July 1854

On his rounds Dr. Snow heard stories that never made it into the newspapers. Buckingham Palace was said to be walled off, the Princess Royal dying. Queen Victoria's grim silence was undeniable. By the second week of the epidemic, rumors of cholera ranged from probable truth to the wildest speculation. Hundreds were reported to be dead by the East India docks where the Crimean ships unloaded.

The reports of armed troops blocking the roads out of London seemed dubious. Snow supposed no one else believed them either, for by night one could see a furtive exodus of families heading for greener homesteads. They carried little, afraid that cholera contamination might cling and follow them out of town.

The heat that summer was unlike anything southern England had felt for years. Hay workers in Surrey fainted with sunstroke, dropping from their high rick ladders like shot starlings. Produce sent into London rotted before it reached Covent Garden. Ladies furtively unbuttoned one or many buttons of their constricting dresses. Babies cried continually. And the cholera victims lucky enough to afford it were buried as quickly as a vicar could be found. Most were too poor for that luxury, so back streets held horrifying surprises.

Explanations for the scourge were varied and ingenious. Snow had a hard time with rational answers when people asked him, the expert, about everything they heard. Poisoned wells, poisoned Thames, vile smoke. Was it a foreign plot? An Irish plot? Or a Royal plot to suppress the working man?

Advice flourished. Don't leave your house or let anyone in. Don't eat plums, milk, cockles, hot pies; don't buy from the street stalls. Don't even look at a whore. Sure prevention was promised with rhubarb, opium, or pig urine. You could buy guaranteed charms to hang around your neck on a string. And was it true half of Paris was dead with it?

Despite the nearness of panic, London's main thoroughfares were as busy as ever. The undercurrent of cholera panic wasn't yet strong enough to slow the tenacious business of daily life. Dr. Snow threaded his way along Oxford Street through carts, horses, sheep, and thousands of afternoon pedestrians. All pushed their way east or west in a fume of coal smoke and river stink. Overhead the tops of rain clouds loomed darker than the sooty London buildings.

Snow fingered in his pocket a note he'd received just that morning, carefully packed in a basket with a dead gray squirrel under the packing straw: "Get back to your godless painkilling and stop working on cholera. They deserve to die."  The tufted-ear squirrel stank; it had been far gone. He had tossed it in the covered bucket he kept for dead laboratory hedgehogs and poked through the packing for a clue as to who could have sent it. All he came across was a gritty residue of fine red sand stuck to the shredded straw.

Religious zealots abounded in times like this, and Snow went through the gestures of paying no attention. Even so, he had kept the note.

If anything could make his exhaustion worse, it was brooding over God-crazed threats. His frame was stiff from recent hours in an unlit slum basement too low-ceilinged for him to stand upright. This last place had filled pages of his notebook with data on more than fifty cholera cases, all residents in a penny-a-night lodging. Unfortunately a third were dead by the time he got there, and had no answers for him. The alert ones had been willing enough to talk, and made for useful notes, but in the dark it was hard to write more than a few scratches. He was eager to get home and set things down more thoroughly.

Snow felt one more twinge in his gut, and waited for the first disastrous hints of sickness. He forced himself to slow his pace.

Don't want to put a strain on the body, he thought. Keep things easy. Keep it quiet. A small fear of his own vulnerability reared up, and he quelled it unthinkingly, out of habit.

The fear persisted, though, a familiar and almost comfortable part of his thoughts by now. It twisted through the fragments of a melody which had been stuck in his head for hours. Some street boys had been yawling it to each other earlier, their Cockney a mass of vowels and as foreign to Snow as Urdu.

Though he couldn't make out their words, the tune fingered some lullaby or nursery song from his childhood. Something about playing in the streets by moonlight? At first it had been pleasant, but by now its repetition in his brain had become a queer requiem for all the deaths he'd seen that day. He thought not of children playing and laughing, but of children dying in a cholera stupor. He felt closer to weeping with each new cycle of the tune. Sleep in any lullaby had always seemed to him an equivalent of death.

Without warning, the rain that had been threatening broke in a downpour. Water dripped from Snow's hat and dark beard before he could get his umbrella open. He was fumbling with the fastening, his elbows squeezed awkwardly against his ribs in the crowd, when a blunt-faced woman who barely reached his waist crooked her fingers around Snow's hand and tugged with surprising strength at his medicine bag.

Of course he thought she was trying to steal it. He struggled with both the bag and the half-raised umbrella, the woman hanging like a dead weight on his arm, refusing to let go. By now he was soaked through and trying hard not to poke out someone's eye with his umbrella tip. All this distracted him at first from hearing what she was saying.

"Business. Business for you." She tugged harder, never meeting his eye, her shaky voice hard to hear. "It's your job, ain't it?"

Even in the rain, tobacco smells rolled from her rusty black dress. It didn't seem to bother her that she was getting drenched. She barely blinked the drops from her eyes.

"Is it cholera?" demanded Snow. "Do you want me to see a cholera case?"  He dreaded seeing another one, and yet at the same time hoped that was what she had for him.

"God be praised, I hope not." But she must have seen his interest fade because before he could push on she said, "It may be, it may be. How should I know? That's for the doctor to say. Come along, won't you?"  She smiled now, showing blackened gums.

Already their blockade annoyed everyone around. A few who'd been close enough to hear the word "cholera" lowered their eyes and pushed at others, hoping to get as far away as they could. Snow saw them and thought of the recent riot caused when one cholera victim collapsed on a Piccadilly sidewalk. Dozens had been hurt. It would be easier to just go with this woman.

She led him through winding alleyways and rookeries, their walls still encrusted with tattered posters from the Grand 1851 Exhibition, now scrawled with obscenities. The two entered a tenement in Pulteney Court.  As they climbed up four flights of stairs, the heat increased at every step, as did a stench of sewage and burnt cheese.

Snow went through a door into a windowless attic lit only by a candle. He sensed in himself a rising excitement at the prospect of a room full of cholera cases waiting for help; more notes, more data, maybe an answer. A few inches from his head the roof tiles clattered with the rain.

It turned out to be only one patient after all: an old woman lying on what looked like a heap of straw, or bunched sacks. A disappointment which he knew to be petty made him dump his bag hard on the floor.

"You dragged me up here to see one case? Couldn't the Poor Hospital doctor come?" Snow jerked off his wet hat.

"Please, guvnor, she's terrible sick," she said, the words coming out with a pleading as false as a bad actor's lines. She pulled out a pipe and calmly filled it.

Snow lit his small brass lantern, hoping for a hook to hang it from, but there was none. They'd stripped the room bare, probably even pried the nails from the floorboards.

Now that the woman had settled into her smoke, her questions rushed out in irritating chatter. "Is it true about the cholera, Doctor, that it's the plague pits dug up, from old times, as causes it? And Manchester, is it really mostly gone now? That's what I heard, all of 'em dead. I had a sister tramped to Manchester once, in '32 . . . "Her voice wandered off but then found the thread again.

"I'm safe 'cause I had it myself back then. Can't get it twice, I know that. It's true, ain't it, that you cough and then your tongue goes black--"

The storm's first full peal of thunder ripped through her words and silenced her. Snow ignored both and knelt to examine the patient.

He pulled in his breath. She wasn't old at all; probably no more than sixteen. Just aged by cholera. One side of the girl's face stood out from the shadows, cradled in its nest of rags. Adolescent down still touched the curve of her collapsed cheek, but cholera had sunk the skin around her eyes into the skull cavities, the way the faces of the very old or the starved will sink in on themselves, as if in self-protection. Her view was fixed with resigned serenity on a dark corner of the room. If Snow hadn't caught the slight rise and fall of her chest, he would have thought she was dead.

Snow lifted her hand and checked the fingertips; blue under the fingernails, and wrinkled as dried winter apricots. He pinched the skin on the back of her hand between his finger and thumb. It stayed there, like biscuit dough, until he smoothed it back into place.

For some reason the street boys' tune drifted into his mind again, as clear as if someone had whistled it in the next room.  With it came once more a sense of loss and grief he couldn't explain. It wouldn't be for this girl; she was nothing to him. She could only be a prostitute, judging by the silky rags around her and the old woman's air of possession. Why should he care? Even so, the tears that had been threatening all afternoon rose up. Tears not just for cholera victims, but for the withered babies he'd delivered, for his dead mother, drowned sailors, and the hundreds of dead and dying he'd seen over the years in their dark chambers and sad beds.

He felt as if he could weep for hours. His lower lip quivered once and his vision blurred, but all it took was a quick wipe with his sleeve to fix it. Then his self-control took over and he turned his attention back to the girl.

With no warning other than a quiet belch, her slack mouth opened, and out poured a sluice of thin gray slime, saturating her and the rags beneath her with a quart of watery cholera vomit. "Damn her!" said the woman. She hustled over to grab the girl's limp foot and jerk it hard. "Damn her! I just finished changing everything. There's nothing clean left now."

The girl moaned once and shut her eyes. A wet gurgle came from beneath her thin skirt and the cholera stink of fish and shit billowed up. Even though he'd been smelling it all day, Snow fought a rush of nausea.

The old woman grunted in exasperation, and went back to her spot against the wall.

Snow took from his bag a square of soft linen, and pulled loose the shoulders of the girl's wet, patched chemise. He wiped off her mouth and the gray skin of her upper body, then tossed the cloth aside.

His eye caught something in the poor light. Lifting his lantern he took a closer look at her chest. The coppery lesions of secondary syphilis covered her torso, random as scattered pennies.

A sudden interest replaced Snow's sadness. He felt almost himself again. He had been wanting to study this aspect of syphilis but rarely saw it. Now was his chance to get all the information he wanted. Taking a notebook from his bag, he turned to a clean page and painstakingly made illustrations of the most prominent lesions and their patterns of distribution, with descriptions of the color variations as well.

The old woman rocked on her heels and smoked her pipe, oblivious to Snow's preoccupation, which was probably no stranger than most things she'd seen. It took Snow a while to get the drawings in the right detail, and the labor of it was the most relaxing thing he'd done in days.

"She probably won't live, you know," he said as he finished the drawing. "Not with this much fluid loss. Not with the pox weakening her."

"Oh, but she's such a beauty, sir. Just look at her. Good years left, plenty of 'em. Just fix her up a bit. I know you can do it." She came over and stroked the girl's cheek in a gesture Snow mistook for tenderness until the girl found enough strength to turn her head away.

Snow knew that if the girl died the woman could just go get another. Despite the rumors, business was brisk these days. There was nothing like fear to give men that need. And he wondered, if by some miracle the young whore survived, how old she'd be before she looked like her mistress. Thirty-five? Forty? He turned to his bag.

"Give her five drops of this, every few hours." It was a solution of opium and would stupefy the girl into a doze too deep for her to notice the woman's cruelty. If she survived, it couldn't hurt her. He pulled out a few shillings. "And if she's still alive tomorrow buy some boiled water. Make her drink."

The old woman's eyes darted under half-closed lids. Even the girl stirred at the clink of the metal. Snow replaced his tools in the bag, now fighting a dread of the room and aching for light and air. He took the lantern down the stairs, trying not to see the ruinous interiors he passed. In the outer doorway, his feet sloshed through an inch of thick toilet slops from a spilled bucket. He stumbled over the threshold and let the rain's benediction pour over his head and shoulders.

HISTORICAL REFERENCES

Cholera in London during 1854 was part of an epidemic wave that swept east and west from India.  To learn more about the Asiatic Cholera Pandemic of 1846-63, click here. 

Snow in his 1855 book wrote of the early cholera cases in London.  Click here for further information on London's first cholera case during the 1848-49 epidemic

Click here for additional information on the first cholera case in London's 1853-54 epidemic.