CHAPTER FOUR

London, July 1854

It wasn't a long walk back to Snow's house in Sackville Street.  Even though the rain slowed almost immediately, Snow avoided the busier streets leading to Piccadilly Circus, which would be awash in mud. He decided to take a chance that the sewer construction in Golden Square would have stopped for the day.  

The site was quiet and empty. He could go straight through the center path without getting jokingly cursed by drain diggers or having red clay spattered on his boots.

Halfway across, he saw his mistake. The square wasn't deserted after all; a dozen men hovered at the edge of one of the open trenches. As Snow approached he couldn't help edging in for a curious glance down, along with the rest of them. A slow drizzle still fell.

Pressing against a man who was probably one of the drain workers, judging by the mud caking his clothes, Snow peered over the heads in front of him. All he could see were two booted feet, lying in the trench. The rough leather looked fairly new, and the feet were bent inward at an angle, flattened, and limp. Ropes and the depth of the ditch obscured the rest of the body. A white splotch in the shadows marked the face. Snow's eyes went back to the dead man's boots; white stains around the toes reminded him of something he'd seen that day and couldn't quite place.

"What's happened?" Snow asked the worker next to him. He turned as he spoke, and found that the man was staring straight at him, studying him. Their faces were only inches apart. 

"Murdered," the fellow answered. His eyes were wide set and pale green, as pretty as a girl's. Mutton clouded his breath. "Can you believe it? They just found 'im. 'Ead bashed in."  The man kept his head averted from the body, either to avoid the sight or to keep scrutinizing Snow. The doctor couldn't tell.

"One of the workers?" 

"That's right, sir. 'E was diggin' 'ere just this afternoon." 

A waft of fresh earth smells came up from the red clay pit. 

"Was there no one to help him?" asked Snow. Even as he spoke a surprising self-pity and isolation engulfed him, as if the question were for himself. No help. Got to handle it alone. He suddenly felt abandoned and resentful that not one other doctor had offered to help him today.

For a long moment the feeling flooded him. Then, with a second breath of that clay odor from the pit, he knew where the self-pity came from. He could recall a similar earth smell of an uprooted pine tree felled by a summer storm and lying in a field, its black splayed roots groping, witchlike, into the sky. It was when he had begun his first village medical practice, twenty-two years ago. The tree had fallen in his third week. That same week, cholera broke out in nearby Kellingsworth coal mine, and he had passed the dying tree daily on his way to see the stricken miners in their cottages.

He had tried everything in his brand-new medical text to help them. Smoke inhalation, cold baths, rosemary ointment. Leeches, even, as a last resort, though he suspected they were useless.

After seven deaths Snow grew desperate and frightened. He had never felt so helpless before. As a last measure he sent for the district medical man from York, the nearest city. Nobody ever came, not even a reply. When it was all over, forty had died.

From the beginning he had tried to determine how they caught it from each other, and why the miners sickened and died while, paradoxically, the farm workers, exposed to animal wastes and the foul air from Yorkshire pig yards, stayed healthy.

He suspected the reason then, and now he was sure of it. Those miners helped form the earliest of his theories. Down in their pits for fourteen hours a day, the men lived, ate, and washed in their own excretions. They gave the cholera to each other with every bite of black bread and onions eaten with wet and filthy hands, with each jar of cold tea that they diluted with the water dipper and drank in the darkness. Cholera was in every sip they took.

But all those years ago, to prove anything about his ideas was impossible. It had been beyond him to do more than keep up with the useless treatments. Back then, a theory like his would have been laughed at. After all, the authorities were convinced that cholera was a moral disease, a disorder of air and poor life habits. More church was the answer.

He hadn't dared to even suggest his opinion. He'd only begged for help. Even now, staring into this ditch, Snow could find the resentment he still carried with him. Months afterwards, they'd sent him a letter; nothing but a series of questions on the spiritual fiber of the miners. "Did they go to services once on Sundays, or twice?"  "Were prayers said at each meal?"  "Were their children properly taught the catechism?"  On reading it, Snow had thought of the children he saw emerging daily from the coal shafts with coal dust tattooed into their cheeks and eyelids. He had crumpled the paper and burned it.

He swore to himself, back then, that one day he'd prove they were wrong about cholera.

"Nobody will care who did it," said the muddy man, bringing Snow back to Golden Square and the present.

The bitterness in his voice made Snow ask, "Did you know him?"

"I was 'is chief. I'm the foreman of these works. It'll fall on my 'ead, you'll see. 'E was a good man. Aside from the grief of it, I got to find a new one. Not so easy with this plague all around."  He gazed ahead, chewing on the inside of his cheek.

Just then there was a disturbance at the other end of the pit and a short, well-dressed man in a bowler pushed his way to the edge. He stared down at the body and then glared at the crowd.

"I'm the inspector for this case. You there!"  He jerked a forefinger at the man by Snow. "They say you're the foreman."

"That's right, guvnor. Matt Canty."

"Why was this man working so late today, Canty?"

"That's just it. 'E weren't. I sent 'em all home at six sharp. 'Im too."

The inspector narrowed his eyes at the foreman and said nothing. Then his glance fell on Snow's bag.  "You, sir, you're a medical man?"

Snow cleared his throat. "Well, yes, but I--"

"You two men, get this body out." The inspector grabbed the two gawkers closest to him. "And you, I want you to examine him."

"Now see here, Inspector..." Snow pulled out his watch and glanced at it. "I haven't time--"

"McGowan. Chief Inspector McGowan, Scotland Yard. Just step right over here, it won't take a moment." The crowd stirred and Snow found himself pushed to where the dead man had been hauled out onto the wet grass. Someone shoved a box forward and Snow sat next to the body.

The man had been killed with a single, powerful blow to the skull. His face was intact, but just above the eyebrows, where the forehead should have risen up, his skull was smashed into the same concave shape as the bent tin colander Snow's mother had used for shelling summer peas. There was surprisingly little blood.

"Well? Is it a clear-cut bludgeoning?" The inspector fidgeted at the edge of the ditch.

The dead man's eyes were open and Snow ran a hand down the face to shut them.

"There's no doubt this injury is what killed him," said Snow, without looking up. "As to what they used, I would guess the back of a shovel. The shape is right." He pulled at one stiff hand.

The long, ragged nails, as well as the cracks and calluses, were dark red with a mix of mud, sand, and blood. "It looks like he fought back," said Snow. Had the victim had any more chance than that dead squirrel in the basket? Snow looked up at McGowan, and saw that the foreman was near them now, and seemed to be about to speak to the inspector. Snow waited. But the man stayed silent.

"I really must get back to--"

"Of course, Mr.--"

"Doctor. Dr. John Snow." He was no apothecary; he was entitled to be called doctor. He had his medical degree from the University of London and he wouldn't let anyone forget it.

"Yes, Dr. Snow. I do appreciate your help."

Snow got to his feet and took one more look at the dead man below him. His eyes fell again on the boots and he knew where he'd seen those white stains today; salt stains on the boots of a dying workhouse man who'd tramped up from the salt flats of Epsom. But why should this London ditch digger have salt on his boots? Snow forgot the question almost as soon as it came to him. A better death than cholera, he thought. He headed again on his way.

HISTORICAL REFERENCES

After years of apprenticeship and study, Snow received his MD degree from the University of London when he was 31 years old. 

To learn more about his early medical apprenticeship starting at age 14, click here. 

To read about his formal medical education in London, click here.