CHAPTER TWENTY-FIVE

1

The room was empty, the furniture gone. In daylight everything looked alien. To Snow, the only thing familiar was the dome of St. Paul's, jutting like a fat man's elbow above the landscape of rooftops. A bony woman in her forties scrubbed at the floorboards with a brush, and at bloodstains the size of farthings all over the wall behind where the bed had been.

"Where's Sophie?" asked Snow.

"You should ha' made some noise coming in. Startle a body like that. Sophie. Was that her name? Died yesterday." She resumed her scrubbing.

The woman looked up again, as if surprised he was still there. "It were and it weren't"

"She weren't taken so bad. It was the baby that did it. Losing the baby. All that blood."

Even through his shock Snow felt like a fool. He should have guessed it from the day he met her. Her breasts had grown over those few weeks. She had lost her appetite. And she had changed, internally, when they had sex. He flushed to remember it. Not his —  "I was here. I live downstairs." The woman held the scrub brush vertically and lightly tapped the floor. 

"Tell me." It was the cholera cramps. They squeezed that mite out before its time." 

"How much time?"

"Four months, I'd say. Maybe three. Yours?

He kept walking, blindly, his shoulder weighed down by the heavy wood kit box. His chloroform set hadn't done much good that day.

He'd been called out to a surgery early in the morning for an emergency appendectomy. The note had surprised him. No one had asked for him for weeks, and he assumed all the surgeons were using another man. He needed the money, so he went. The cholera work was at a standstill, anyway.

The surgery theater at Guy's hadn't changed since his student days. A day-old bucket of blood stood in a corner next to a basin of God knew what body parts. The light was no better, slanting from skylights glazed over by soot and pigeon droppings.

He'd seen from his first entrance that the patient was bad off. It looked like peritonitis to him, and surgery would be useless.

Sure enough, once the man was unconscious and they opened his abdomen, the sweet stink of sepsis filled the room. The entire gut around the appendix was suppurating, and the appendix itself, usually the size of a short earthworm, was as black and swollen as a blood pudding.

The surgeon gave Snow a long look and Snow knew his thoughts exactly. Let's give a stronger dose of chloroform, he seemed to say. Let's make sure he doesn't wake up.

But Snow had done nothing. He felt that his task in life was complicated enough without deciding who should live and who should die. He had ignored the surgeon's glance, and cleaned and packed his anesthesia equipment. He wrote up careful instructions for the man's care when he woke from the drug, as if he would be fine and would need only nausea drops for an hour or two, liquid meals for the first few days. And he had left, feeling ashamed, even though he hadn't done the shameful thing.

Sophie's death, no more his fault than the peritonitis, shamed him too. He hardly noticed where he was walking until he broke into a sudden fit of violent choking.

A wall of smoke rolled over him from the front of a burning house, and he had breathed in the fumes without thinking. Screams came from upper floors, and two men ran by with a cholera patient on a stretcher. Snow found himself trotting the other way, then running, downhill, the wood case bouncing and bruising his ribs.

He felt as if demons were after him and the square corners of the box could have been their pinchers reaching out. Finally he slowed but kept walking, close to the river now, past warehouses and dockyards. His failures rang in his head like church bells. Three months' work wasted, an entire practice of patients abandoned, an affair with a dead whore. He didn't know quite where in this litany to place his love for Lillian, but somehow it felt like another grievous error. He had seduced her, and he had nothing to offer her. Even if she married him, what life could she have with a failed, worthless doctor?

And then there was everything with Constable.

Snow had gone from the appendectomy at Guy's Hospital to see Sir Philip. Snow had waited two whole days after discovering Constable's name on the water company lists before talking to him, and all that time he had hoped to turn up something that would destroy the connection. He wanted so badly to believe in the man, and even now he didn't quite know why.

Constable kept him stewing in the airless corridor for almost an hour, with nothing to look at but the blank walls and the piles of water company notes he brought. When Snow finally went in, Constable had looked the quintessential politician behind an expanse of mahogany desk.

Snow stood nervously, feeling a ridiculous disappointment that Constable wasn't warmer to him. "If you have a few minutes, Sir Philip, there's a question or two I need to ask." To Snow his voice sounded hesitant and childish.

"By all means, Doctor. Feel free." Constable walked to the front of his desk and pulled a chair out for Snow.

"Perhaps if you could have a look at these figures." Snow spread the papers over the desk.

Constable bent, obedient, polite. "I'm afraid it doesn't make much sense to me," he said, still smiling.

"I'll explain, then."

And Snow told him all about the two water companies, the different houses, and carefully explained the salinity experiments. When he was finished, Snow looked up. "If you know anything about this, Sir Philip, it's your duty to speak up."

Constable laughed with a sound Snow thought was relief. "I'm afraid you're on the wrong track, Snow."

"What do you mean by that?"

"The Public Health folks have been after Southwark and Vauxhall since the company started. But there's nothing to prove. They analyzed every bit of information, trying to show that the water wasn't pure."

Snow's doubts, always near the surface, clouded his mind. But he was determined not to show it. "Perhaps you didn't understand the meaning of the salinity tests."

"Oh, no, I understand them well enough. What I can't see is why you think they prove anything."

"It's absolutely conclusive —"

"That some of the water has a high salt content. Or that some of your storage vials were contaminated with salt. But I don't see anywhere here a proof that salt causes cholera."

Constable rifled through the papers as if genuinely searching. "But it's a given — the water is salty because it comes from the Thames. The water was never filtered; it's polluted."

Constable gave a downward sweep with his hand, as if cutting off Snow's words. "Dr. Snow, if you want to amuse yourselves by this project, that's fine. But as I told you, the Board of Health has an inquiry going into the whole matter. Only Farr's official methods will be considered in the long run. There's no point in your pursuing it, especially if it results in accusations like this."

Snow looked closely at Sir Philip and saw that he was sweating and breathing heavily. He face had flushed darker since they arrived. He didn't look well.

"But that's absurd," said Snow. The Board of Health isn't investigating anything, they just threaten me, hire an insane dwarf —"

"And may I point out to you, Doctor," he went on, "the Board of Health would not look kindly on a doctor who frequents a whore in Seven Dials. Not good for the medical image."

Snow had been waiting for this, but dreading even more that somehow Constable would have found out about yesterday's secret hours with Lillian in the rainstorm. "You infernal bastard. I'd like to see what you might do in the same situation."

Sir Philip only looked away, still breathing heavily.

Snow bent over the desk and tried to gather all his papers with dignity. "Do what you like with the things you know about me. I can see we have nothing further to talk about. Thank you for your time, Sir Philip."

Then Snow had left without looking at the man again. His first thought had been that Constable would tell Lillian about Sophie and that would be the end of anything with her.

Going to see Sophie right then was probably the stupidest thing he could have done; but thinking of Lillian in the darkness yesterday, with the rain pouring down on the bushes outside, left him flooded with nervous desire. Lillian wasn't a woman he could have on a moment's whim; for all he knew he'd never see her again after what happened yesterday. Feeling vile every step of the way, he'd headed for Seven Dials. As it turned out, his sexual need disappeared instantly when he heard what had happened to Sophie.

Snow guessed she had finally broken down and given the details to Mango, who had somehow gotten them back to Constable. One letter from Constable to The Lancet would do it. Or The Times. Caleb wouldn't be much help on this one. Probably the letter was out already, being read at that moment by every doctor in the Royal Society. With the anesthesia practice washed up, and nothing to show for all the cholera work, he might as well go back to mixing headache pills at a pharmacy. If they'd let him do that much.

By now it had been dark for half an hour. Snow was walking east, meandering in and out of the narrow ways along the river. He finally reached the huge basin of St. Catherine's Docks and, blocked by water, could go no farther. He leaned against a wall and stared at the ships swaying in the moonlight. Not much ship traffic these days. Everything out of London was quarantined for so long in the docks that it wasn't worth sending it. The boats were stuck there, inert, useless. He watched them for an hour before turning around to go home.

2

It was a long walk back. His feet were burning and a headache pounded his skull before he realized he was famished. He stopped in a lawyers' chop house off Chancery Lane. The clinking glasses and low talk sounded like life noises of a distant tribe from a far place, not his fellow Londoners. He craved a slow, wandering conversation with a clergyman or a banker. Perhaps they could mull over the weather, or the value of the pound.

He sat at one end of a long table at whose opposite sat the very type he was looking for. Fiftyish, bald, new black and white clothes. The man was finishing dinner and a small decanter of sherry.

Suddenly he had it. With openmouthed delight Snow watched the idea unfold in his mind like a peacock's tail. The maps of London had been too big. The parishes had been too big. A map of one street was all he needed. And he knew which street it was.

That morning when he had left for Guy's Hospital and the surgery, he had passed through Golden Square, and then from Wardour Street through Broad Street. It had been the worst scene since the epidemic began. Bodies lay in rows in front of every door. He must have seen a hundred. Retching came from upper rooms where they had opened the windows to get a breeze. Nothing looked normal. The death count must have been atrocious.

He had kept on walking, too dazed to react, unable to think of anything useful to find out from this mess. And then, by the time he reached Little Windmill Street, things looked ordinary again. A maid leaned out of a window beating a carpet, and a canary cage hung from the front door. Granted, half the houses were empty, but the people who stayed on were not ill.

That was the street to map. Broad Street. Not populations, general figures, shaded-in areas. But each and every case on Broad Street and around it. Looking at all the deaths was easy, even counting them. But it proved nothing. Only a map would show it.

Snow was still standing by the empty grate in front of the mirror. He looked at his watch. It was eleven P.M. Lillian would be asleep, but he knew she wouldn't mind if he woke her. There was no one else he could trust.

The waiter appeared with the chops on a platter and Snow walked over and took one by the bone, reached into his pocket with the other hand, and laid a few coins on the table.

"Terribly sorry to rush off. I hope that will cover it."

With the chop in his hand, he ran out of the restaurant toward Lillian's house off Grosvenor Square, chewing the good, salty mutton.

3

On Brook Street the street lamps were all dark. Some failure in the gas lines, maybe. The row houses looked identical, with their spiked low fences and careful patches of front grass.

Luckily Snow remembered her address. Without hesitation he rang the bell. It was a long time before the door opened; it was Lillian. She was dressed but her hair was unpinned and hanging around her shoulders.

"The house staff has all gone to sleep. I thought it would be you," she said, smiling. But then she saw his tension. "What is it?"

"Can I ask for your help once more? I've figured something out; I'll explain it on the way.

"Yes. But I must put on some shoes. Come in; it will only be a moment."

"No. I'll wait here." He felt an impatient aversion to the warm lights of her house. He wanted to be off.

"All right." She went back inside and Snow ran down the steps to pace the sidewalk, too restless and excited to stand still. He couldn't believe he hadn't seen it before. The cause must be provable in the local, specific water; nothing as general as an entire city's water supply. He itched to get his hands on the records he could use to fill in the map, a map of Broad Street and the intersections around it. A scuffling sound came from the foot of the front steps.

"Good," Snow called out. "Let's be off, then."

There was no answer. Someone ran past Snow, pushing him in a sudden blow just behind the left knee. Snow fell into a squat, his hands smashing the pavement. His head was yanked back by his hair, so tightly that the skin around his eyes felt stretched.

A knife glinted past his face before resting on his throat and pressing painfully against the skin.

"It was you who killed her, you bastard. She was fine until she took up with you. Our Constable won't be too sorry to see you go, either." The knife pressed harder, and a sting like a bee's stab spread across his neck.

This is it, was all Snow thought. I am about to die. In a short second, the smell of Lillian's hair drifted through his mind, and then a moment from thirty-five years ago, of sitting in a sunny window with his mother, eating fresh bread and laughing.

Suddenly the door opened and light fanned across the stairs. Whoever held Snow gasped and loosened the knife. Snow jerked his head violently and his hair was released. He staggered to his feet while running footsteps faded off into the darkness.

Lillian's voice came to him. "My God, are you all right?"

"It was damned lucky you came just then."

"I heard something. Then when I came out I saw him." She shuddered. "A dwarf. And I thought you'd imagined him before."

Snow swiped at the skin under his collar. His hand came away black with blood. "I can't understand why he didn't kill me. Someone like him wouldn't care who saw it."

Lillian wiped at his bleeding neck.

The cut on his throat began to burn.

"You're bleeding badly. We should go in and have a look."

"There's no time," said Snow. He stared off toward where the steps had gone. "Go back inside and get a dozen candles." She obeyed without a word. When she returned and closed the door behind her, he grabbed her hand and headed for Fleet Street.

4

An hour later the two of them sat, with bruised knuckles, at the same back office of The Times where they'd checked the water records. They'd broken in; an exploration of an alley behind Fleet Street turned up a low window. Snow broke the glass with his fist, opened the casement, climbed in and pulled Lillian in after him.

His heart was still racing. If he was found out here, his career would be over. But there was no other way. He doubted Caleb would help him, and every hour of delay was costing more lives. He wiped every now and then at his neck, where the blood still seeped.

"We need to find the entire collection of London death reports for the past ten days. Caleb said it was kept back here." Snow started leafing through piles of papers, and came across orphanage records, rates of cabbage shipments into London, a book of weather reports from Edinburgh. But nothing that looked like death records.

"Here," said Lillian, "what's this?" The folio was huge. It contained every cholera death in London for the past two weeks. Next to it was a similar one of the reported cholera victims who had recovered.

"That's it," said Snow. "You sit here, and read them. I'll start the map." He ripped a huge piece of paper from the back of another volume (a listing of export rates for cotton cloth) and sketched out a rough map of Broad Street and the surrounding intersections. As he drew he felt a small yet growing fear that his idea would be wrong.

Lillian read off the name of each victim and his address. She had to go through deaths all over London, as the list wasn't separated by parish or in any way at all.

"Don't you think we should map them all?" Lillian asked.

"No, no. That's the whole point. By mapping them all we lose the focus, we get right back to where we were, looking at things in too large a view. I want you to read only the ones in the region bounded by Regent Street, Oxford Street, and Brewer Street.

Snow moved the sheet of paper to the floor. He marked every death in the neighborhood with a small dark stripe, a little wider at one end than the other. Like the boxes in the graveyard map. Like a coffin.

When they reached three hundred Snow was forced to change the scale and have a box represent ten deaths, not one. He had to go back and redo every mark, which took an hour. His fear of being wrong stayed with him, but lessened with each new mark on the map.

"Do you think this has anything to do with the water company?" She pointed to the growing stain of cases around the intersection on Snow's map, then went back to her lists.

"Probably, but it's impossible to tell. I can't know what water lines go through this area without seeing another map of them, a more detailed one than the one Caleb showed us. But it seems likely. Some source of contamination is causing these cases, that's a given."

"Then the Great Western Gravel Company would be implicated as well."

"I suppose, yes." Snow couldn't understand why she was interested in such a trivial detail"

"And what about Sir Philip?"

Snow tried to force himself to concentrate on the map, and not to wonder why she was worried about Constable's welfare. "As a member of their board, he would share the blame. But let's get on with the work."

Lillian resumed her reading. Her voice was less enthusiastic, though, and she had longer pauses between spotting the relevant addresses. She stopped again. "John — I — what will happen if this cholera isn't stopped?"

He began to feel impatient, but tried to answer her. "It will stop itself, eventually. All epidemics do, it's a law of nature." On a corner of the map he drew a small, bell-shaped curve. "If you think of the disease rate as following the shape of this curve, you can see that the rate falls, eventually." He drew a large "X" near the peak of the curve. "It may be that we've reached this point, and from here on the cases will slow down. There's no way to really know until it's all over."

He thought she was satisfied and would resume her search. But she went on. "Then why not just do nothing? If it will stop anyway?" Her voice sounded removed, as if she addressed a stranger. He couldn't understand what she was getting at.

"We could do nothing. But for every quarter-inch on this curve I've drawn, one or two hundred people will die. Don't you think it's worth trying to stop it earlier than nature might?

She was silent again, then finally began her reading.

At five in the morning, just as it was beginning to get light, they finished. Snow's knees were bruised from kneeling on the floor. The gash had stopped bleeding, but his neck ached terribly from both the attack and the strain of writing for so long. He gingerly lifted the map he had made and set it on the desk top.

There was no doubt. Black boxes scattered themselves over the neighborhood, clusters here and there, isolated cases on almost every street. But at the intersection of Broad and Cambridge the boxes stacked up, blotting out the street names, filling everything. The darkness in the center of the map was like the body of a spider, its legs stretching outward, made up of the occasional cases on the outer streets.

Lillian asked, "My God, what happened at that intersection?"

Snow was silent for a minute, then frowned and looked her. "And it's still happening, isn't it?" he said. "These lists are a day old. New ones will arrive when the office opens today. If we want to stop the curve, we haven't a moment to lose." He grabbed the map, rolled it and stuffed it in his pocket, then ran from the room. He used the front door this time. Lillian followed.

The Preface of this book states, the ..."majority of the events ...and all characters other than John Snow, are inventions of the author."  The author's intent was to weave an interesting story filled with drama, suspense and fascinating characters, rather than a factual view of John Snow's life.  With that said, here are several clarifications.

The was no Great Western Gravel Company.  For more on the history and ownership of the Southwark and Vauxhall Water Company, click here. 

John Snow did use a "salt test," but for the Grand Experiment of 1854.  His intent in using the test was to distinguish drinking water that came from two sources, the Southwark and Vauxhall Company's intake in the polluted region of the River Thames (in the tidal region of the river -- higher salt) and the Lambeth Company's intake in a cleaner upriver location (above the tides -- fresh water with little to no salt).  Both companies supplied households in a region south of the River Thames.  The salt test helped identified the source of the water and confirmed that those living in houses supplied by the Southwark and Vauxhall Company had much higher cholera rates than neighbors who received water from the Lambeth Company.  For more information on the two water companies click here.  For a description of the Grand Experiment of 1854, click here. 

With respect to the Broad Street Pump outbreak, John Snow suspected early on ..."some contamination of the water of the much frequented street-pump in Broad Street."  He visually examined the water for several days but came to no conclusions.  At the same time he obtained from the General Register Office (where William Farr worked) a list of cholera deaths during the prior week.  The information was "kindly granted" and did not require climbing through a broken window in the dead of night.  The location of these deaths helped Snow clarify his hypothesis.  For further information on the Broad Street outbreak in John Snow's own words, click here.

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