CHAPTER EIGHT

London, July 1854

1

Snow stood at an attic window, his hand flat against one pane, with St. Paul's dome looming against the mauve summer twilight. The girl locked the door behind him. Water gurgled from a jug and a match scratched as she lit a candle. After the street din, it was so quiet he could hear the wick's gentle hiss when it caught.

The room was so hot that Snow couldn't think. His chief sensations were of the heat, his headache, and a throbbing erection.

The girl's dress fell to the floor in a shabby heap. She stooped for it and laid it over a chair. She stood in a dirty white petticoat and a corset too large for her. Her boots, scuffed blue ones with short heels, were still on.

"Do you want the petticoat off too?" She lifted her arms in a pantomime of pulling up the garment.

"What?"

"Some likes it on, some likes it off. What about you?"

Snow didn't answer. His eyes stayed on her bare white arms. Though she was so blond, the hair in her armpits was dark. He couldn't believe how much his head ached.

Her mouth lifted in a patient one-sided smile, tired, but still willing to please.

"Well then," she said, "if it's all the same to you I'd sooner take it off. Keeps the laundry bills down." This was in the tone of a casual housekeeping tip, something he might want to remember for future occasions.

Snow sat like a nervous suitor on the edge of the bed while she unlaced the corset and stripped off the petticoat. The triangle between her legs was as dark as her armpit hair. She sat on the bed next to him and started unbuttoning his trousers. The blue boots stayed on.

He remembered the dying girl in the house off Pulteney Court the other day. How many men had touched this pillow, the grubby counterpane? Visions of hell and his future as a syphilis-ridden idiot passed through his mind, but only fleetingly. As she leaned back and spread her legs, her adolescent breasts fell sideways, ever so slightly. She just looked at him and waited.

Even as he finished pulling off his trousers he wondered if it was too late for him to get out of it. He'd never intended to be in a situation like this; it was a complete accident.

He'd spent the day in cholera houses, collecting water samples and asking questions. Dazed and exhausted, lost in Eastcheap,  Snow had encountered the girl when she blocked his way in an alley off Drury Lane.

"Ey guvnor," she had asked, "kee' a lass comp'ny tonigh'?" Her cockney was so heavy he could hardly understand her.

Prostitutes rarely stirred Snow. Except for medical cases like that girl in the attic he'd never exchanged a word with one. But tonight his weariness led him to an indulgence. He slowed his pace and looked at her eyes. He stopped.

She had smiled and raised her brows in imitation of some arch look she must have thought was sophisticated. She was no more than fifteen. Adolescent baby fat still plumped her cheeks. Blond hair without a curl in it, pulled back tight behind her cheap bonnet. Her eyes, though small, were slanted and of an odd seawater blue, a blue he had seen somewhere. . . a smell of hay. A bowl, roses painted on it, holding a few peaches? Sun through a window.

And the first line of a tune came into his head, a silly baby's rhyme he hadn't thought of for years,

Oranges and lemons,

say the bells of St. Clement's.

He heard it as clearly as if the girl had sung him the song herself, She reached out and ran her finger lightly down the lapel of his coat. For the briefest moment her smile faded. She bit her lower lip, took a quick breath and turned on her heel to saunter down Dudley Street. Grime splotched the pink satin of her dress over her wide crinoline. She held her back straight, and below her waist she swayed like a sapling in a breeze.

Now it was too late to get out of it. His headache fit over his skull like a black cap. As the girl leaned back on the bed with such patience, a great urgency rushed him forward. It was hardly a feeling of passion, or even desire; just a sense that this was a procedure he must go through before he would be allowed to leave.

As he entered her he was filled with aversion at his own detachment. He climaxed in seconds. The aversion didn't fade for a moment.

After he caught his breath he felt her shaking and at first thought she was crying; but no, it was laughter. She was softly giggling to herself with her eyes shut.

The sound spun like a dart into some spot in his memory. Clover. A bowl with flowers. He hung onto the memory as long as he could but it faded in seconds to shame and caution returned. Was she ill? The pox? Clap? Nits?

He pulled himself out and staggered to the basin, wanting only to wash and be gone. She began to laugh again.

"I always love it with the clergy."

He turned, covering himself with his hand. "You're mistaken. I'm not a clergyman." It was then that he realized the headache was gone.

"No?" She frowned in disappointment, and laughed again, this time at herself. "Well, you sure looks like one, with your frowning mug. I could tell, when you saw us on Dudley Street. A messenger from Satan, that's what you thought. See where it got you!" She held out her palm, smiling. "Two shillings." It was as if they'd had a small joking bet, and he'd lost.

Snow paid and avoided her eyes. He quickly began to dress. God, what time was it? The window panes were black now. He pulled his shirt over his head, then pulled his watch out. Midnight. He groped for his jacket and couldn't remember where he'd put it.

The girl picked it off a coat rack, offered it to him, and then pulled it back playfully.

"No ‘urry, guvnor. Half a crown'll get you the whole night. It'll be light in a few hours. With this cholera everywhere like it is, yer safer in than out. Sit yourself."

She sat down again and patted the bed. "I'll send out for vittles. You got that pinched look. I know all about it. What do you like? Taters? Northern folks always does."

Snow decided it wouldn't hurt to wait a moment, "Can you hear it? My accent? Most people don't."

"Oh, enough to tell. Besides, me mum came from Yorkshire, afore she was like me."

"Like you? How?"

"On the street, I mean."

Snow couldn't think of any polite comment to make on this, so he stayed silent.

In the end, it was the thought of food which kept him there. They spent more time in the bed. The gray sheets seemed less foul. And it got cooler in the room, cool enough that the girl's warmth was good to lie against.

She fell asleep within a minute, but sleep was beyond him. He thought of sneaking out, but it was pleasant lying there, and for the first time in hours he could stop and think. It had been a long day.

That morning seemed as if it was a week ago. Still asleep on the sofa after his late-night hedgehog experiment, Snow had been awakened at ten by Mrs. Jarrett, saying there was a boy to see him.

Snow had followed the messenger through the hot, brick-shaded gloom of the alleys off Drury Lane.  The day before, the thermometer had stood at one hundred and two degrees according to The Times.

By now cholera was all over the poorer parts of London. The epidemic thrived on the heat. There were over three hundred cases, starting with that first baby Snow had seen four weeks ago.

Doubt had begun to erode at Snow's theories. What if Farr were right, and miasmatic fumes from the river could carry the disease? Or if it thrived in the gray street dust which coated his clothes and clung to his teeth?  It was easy enough in his cool library in Sackville Street to believe in his own ideas of water transmission. Out here any truth seemed likely.

He'd had little time to worry, though. Word had quickly got around that the doctor in Sackville Street would come to see cholera houses and maybe help.

The boy came for Snow saying his entire household was sick. Snow had seen four houses like that the day before, large families all sick and dying. The two reached their destination and Snow stepped up to the door of the building. It was then that the stone fell.

Just as they were about to enter a house, a dark object rushed past Snow faster than a lunging hawk and smashed against the pavement beside him. Chips of broken stone flew up. The boy jumped back, as startled as Snow. Snow's pulse raced. Both looked up to the roof above, ready to dodge again.

It was a crumbling roof cornice the size of Snow's medical bag. After they caught their breath both of them scrutinized the top of the four-storied row house. There was a snaggle-toothed gap in the broken masonry.

"Are you hurt, boy?" asked Snow. It was impossible for him not to think of the note, the dead squirrel. He made a physical effort not to go over to the stone and examine it for traces of red sand.

The boy shook his head while crouching over the fallen stone. He poked it with a grubby finger and turned his face once more to the roof.

Snow glanced at his watch. "Come on, let me in. I hope the rest of this place is more solid." His heartbeat slowed to normal in a few seconds. The collapse must have been an accident.

The boy didn't move. Scabbed knees showed through holes in his pants. He turned a finger in one ear and looked at Snow. "Don't you want to wait for the other, then?"

"What other?"

"That short fellow as was with you down the street."

"You're mistaken. No one is with me." Snow frowned and turned to glance down the street. He saw only intent pedestrians.

The boy gave a last look to the stone on the pavement and opened the door.

Snow entered the first room on the ground floor to the right of the stairs. The bodies of an older man and a young girl were laid out on the floor with crossed hands. This house had nothing like shrouds or sheets to spare for their dead. The wrinkled cadavers wore only the rags they'd died in. The room stank.

Snow stalked around the room once and turned to the boy, who eyed the corpses with mistrust, as though they might spring to dangerous life any moment. "You said there were cholera cases here. Is this all?"

"No, sir, these as was died last night. Come upstairs to see the rest." The boy averted his head from the corpses and preceded Snow up the stairs.

In the room at the top a woman in black, looking like a prison matron, stepped among moaning adults and children. She redistributed basins and chamber pots as each was filled. Her head down, she droned a string of words that Snow could barely make out.

"... pestilence that stalks in the darkness, and the plague that destroys at mid-day, for adulterers and sodomites and perjurers..." She trailed off into silence. "Boy, where's that doctor?" she shouted suddenly, before seeing Snow. "And get these emptied, outside." She gestured at the full pots.

Her eyes were big as a grouper's behind thick spectacles, her hair wild and bushy. She grabbed at a cross around her neck and ran her tongue along dry lips. With an arm full of dirty towels she waved at the bed and the floor.

"It's about time you're here. Too late for them sinners downstairs."

The woman went back to her distorted Bible quotes as Snow first picked his way over the people to try to open the window. It was so marked with years of soot and grime that the room was too dark to see more than the white faces of the victims. The heat felt as encompassing as a brick kiln.

The window was hopelessly stuck. His attempt to open it left him nauseated and even hotter, with a bleeding finger. The smell in the room was terrible. But blended with the sickly sweet cholera evacuations was another, less unpleasant odor which filled his mind with sadness. Apples.

With the apple smell came a clear memory of the last sight he had of his mother, heavily pregnant and sleepy, smiling at him the night before she went into labor. It had been early autumn, at the peak of the apple harvest, and apples were piled in the kitchen.

He must have been staring, sightless, at the thick window for a long moment before he turned and saw that under the bed and stacked up to the edge of the overflowing chamberpots were baskets and piles of apples. This was a house of fruit-selling costermongers. Time to get to work, he thought.

Snow checked the victims but none was coherent enough to answer his questions. He told the woman to give them as much boiled water as they would swallow.

"Where's the medicine for me to give ‘em, then? The Methodists what sent me here said you'd bring medicine."

"What medicine? There's no medicine for cholera." She stroked a mole on her cheek with shaking fingers before returning to her tasks. Snow couldn't tell if the shaking was palsy or anger.

It was unlikely that any of them would survive. "Where do they usually get their water?" he asked her.

She looked up as if in surprise that he was still there.

"Wine is a mocker and beer a brawler, whoever—"

"Water, I said, water."

"They buys it off Buckingham Palace, as they does their apples." She broke into a cackle, close to hysteria.

"No, please, it's important." He tossed her a shilling and was startled at how deftly her hand shot out. "Does it come from a well? Or a tap?"

"It's Bill there as fetches it. Some days from the river. Some from the ditch. There's no taps for them that lives in this hole."

"Can you spare him? Bill? I want him to show me the ditch."

"If you can catch him, take him where you likes." She limped to the head of the stairs. "Bill! You devil's imp! Where're you off to, then?" Bill appeared at the doorway below, scratching his head. He ran up the steps.

"Bill, take this gennmun round to the ditch. He wants a look. But here, take these too." She shoved more brimming pots at him, and he left the house. Once outside he dumped their contents in the gutter, then beckoned to Snow to follow.

"Is that lady a relation of yours?"

The boy mouthed his disgust. "I got no relations. But she's no relation of nobody. The Methodist Sisters sent her over for the sickness. I wish it'd take her and her preachin' with it."

Snow could smell the waterway before he could see it. It was an amplification of the room he'd just left. A handkerchief over his nose did nothing to stifle it. He and the boy reached an unsteady wood bridge spanning the ten-foot-wide channel. Rotting steps led down to the water. On the opposite side was the crazed back wall of a brick tenement, propped up by rotting timbers and ready to crash into the murk.

Snow descended the steps. The water lapped at the toes of his boots and washed the street dust away. A bloated dead cat floated past.

"Is it always like this?" he asked.

"Oh, no. When the tide's low it ain't nearly so nice as now. You can't swim then, nor drink. Too much mud. And the smell is awful. But now it's fine. This where I meet my mates to swim. Without warning Bill pinched his nose shut and jumped in the canal.

Snow grabbed with an instinct to stop him and then felt foolish.

Bill resurfaced. He filled his cheeks with water and almost spat it out at Snow, but remembered just in time the doctor's honored position. Instead he spouted it straight up in the air and back onto his own head.

"Come out of there, boy. You'll get ill."

"If it was beer I'd be well, I know that." The boy clambered out and dripped on the steps. He held out his wet hand palm up. "Give us a flatch, guvnor."

Snow put a halfpenny in his hand, then another. "Don't drink this water, boy. It's poison."

The boy's blue eyes narrowed at Snow. He opened his mouth to speak but his glance moved a fraction to the left and widened at something at the back of the alleyway.

Snow turned and caught a glimpse of someone scuttling around the corner. At the same time the boy pushed past him and darted down the alley.

"Hey! What was . . ." Snow's voice trailed off. He stared a moment at the trail of wet footprints. Then he took three glass vials from his pocket and stooped to fill them with water from the canal.

He was a few steps out of the alley when he heard the rapid approach from behind of a brisk clicking and panting. He didn't turn fast enough to see the dog before it had him, a snarling streak of white fur gnawing his leg.

"Hoi! Get off!" Snow tried to shake off the dirty bull dog but it seemed furious and wouldn't budge. Although it only had the skin of his leg in a pinching grip, at any moment it could bite deeper. Snow tried to lurch down the street with the animal clinging to him. It was impossible. A few street boys stopped to watch the show.

He finally had to beat the dog with the top of his medical bag so it would let go. It stayed on the pavement barking at him while he walked off with his trousers in shreds and blood dripping into his shoe.

Would Methodists have been so violent? That stone falling from the roof could have killed him, and the dog — it made no sense. Perhaps even this girl lying next to him was part of a plot. He laughed at the idea of that cross-clutching, fish-eyed nurse paying a whore to trail him.

The girl sighed in her sleep and muttered something about mangoes. Dreaming of tropical fruit, thought Snow. He raised himself on one elbow to study her face. In sleep the childish lines shone out. She smiled once, then her features were again blank. A sense of his own good luck at meeting up with her took him by surprise.

He found himself remembering her face earlier that evening, as her pale eyebrows had frowned in the childish concentration of unlacing the back of her dress, her hands in an awkward position behind her. A familiarity flooded over him. Singing games in a hay field came to his mind, and a puppy, a slice of bread. And more of the song.

Kettles and pans

Say the bells of St. Anne's

Sleepiness, like his sense of luck, took him by surprise.

When he woke the next morning she was gone, but she'd set out a teapot with a chipped spout and a small loaf on a cracked plate. There was a scrawled note beside the tray.

"you come back, an aks for Sofy. dudley strete. dont forgit to et yet taters."

Maybe it was the spelling that called him to his senses. This cholera work must be driving me mad, he thought. I could have caught anything from her. Pox. Clap, lice.

In daylight it wasn't hard to get his bearings and he made his way back to Soho with his head down, praying no one would remember him in the girl's neighborhood. It was clear he'd been working too hard. He needed a change. There were other subjects besides cholera.

He needed more work to develop his theory of stages of unconsciousness and pain; he suspected that the occasional deaths from chloroform and other agents used in surgery were due to overuse of the substance, or a descent into sleep which was far too rapid and deep.

The notebook was still where he had left it the night before. He had stopped at timed inhalations of three percent chloroform. Last night it had worked on one hedgehog, leaving the animal limp and compliant during a needle probe, yet perfectly healthy an hour later. But a week or two before, in an experiment with twice the dose, another animal had died in five minutes. It was smaller than the first, and female.

Rather than use an animal this time, Snow thought he'd try it on himself as he had many times before. Anything he found out with these animals was really not very useful until it had been demonstrated on humans. He checked his notes from his last try at this; half a dram of diluted chloroform had rendered him confused in twenty seconds. He knew he had lost weight since the last time he had used himself as a subject, so today it would have to be a little less.

He made sure everything was ready by the sofa, so the fall, if it came, would be short. No real danger threatened him; the lethal amount for a human was a hundred times that for an undersized hedgehog.

Even so, he felt nervous while he laid the marked needles on the tray, and arranged the clock with its large numbers, the mask and its attached tubes.

An absolute scale for pain was impossible. Snow had decided years ago to abandon all subjective measures and instead calibrate external things only. Externals were easy. The exact depth of the needle under the skin, the length of time, the ability to hold the arm still under repeated jabs.

His own will power was, of course, a large factor, and he calculated that as well, using a scale he'd invented of age, sex, and whether or not the patient had been through childbearing or unanesthetized surgery. The scale went from one to ten. Because he'd never had surgery, he rated a seven. He wished he had the nerve to ask Mrs. Jarrett to volunteer for an experiment. She'd had two children, so she would have rated a nine.

When everything was quite ready he began the deep breaths into the mask. A dreamy state floated over him. His hands felt disconnected from his body. Being careful not to breathe too deeply, he counted to twenty by the clock and began the slow jabs with the needle.

2

Two days later, Snow's mind felt clearer and ready again for some hard work. His moment of madness with the prostitute he tried to put out of his mind. Whatever had caused it, he had got it out of his system now. A good day for work lay ahead of him; Caleb had sent word to cancel their evening exchange of notes, so he had no deadline for his return.

He considered walking over the Vauxhall Bridge, but he decided to risk the traffic and get a cab on Oxford Street instead. If there really was someone after him, he'd be harder to follow that way. The hansom rattled west and then south to the Embankment, at a slower and slower pace as the street grew more jammed.

He felt more tired than he'd been for days. He'd ended up spending most of the previous night checking the case lists against his ordnance survey map of Lambeth. This time he arranged the cases by address instead of date. It was a terrible task, without any interest other than the one goal: to be able to walk down a street and up the next and knock on the door of every cholera case without skipping one.

Staying up all night was usually nothing to Snow. He couldn't figure out why he was so much more tired today. Perhaps, he thought, it was the weight of the lists themselves, the awesome power of death after death. The names and addresses receded from real souls into meaningless numbers and then back into people again, so that for each name on the list he had an image, a life, in mind.

Hamish McFarland, 38, wife Betsy, daughter Ann. He hadn't been able to go on reading; the couple was there before him in his study, with their smocks, their dusty boots, their stringy undernourished hair. Ann, age six, had circles under her eyes and a checkered apron. He would admonish himself and go on, but it happened again and again.

He hadn't been able to finish the work but he had enough streets catalogued to make the day worthwhile. He held the lists folded like a testament inside his old lab notebook and stared at its mottled cover. The design of these laboratory notebooks hadn't changed since he was a schoolboy.

The traffic on the bridge came to a standstill. Snow stayed in the cab, breathing the horse smells and feeling sleepy. There seemed no point in getting out; the houses would stay there. He fingered the frayed cardboard edge of his book.

He could remember holding just such a notebook, walking through the university courtyard with Caleb. What had been folded in it that day? Not data, that was for certain. Tracts. Thin tracts, poorly printed, and full of fundamentalist Christian bunk. He and Caleb had been on the way to the Methodist chapel to hear a new preacher. They had stopped briefly in Snow's rooms for Caleb's opium dose. That was when Snow was just beginning to try to get him down to ten drops a day.

They'd heard that the preacher was charismatic and profound, that just listening to him you could receive a literal vision of the plague of locusts and the burning bush flaming in desert heat. No figurative interpretations sufficed for this man.

At the University of London, variations on the Church of England formed a large part of the amusement for country boys like Snow and Beersdon. It gave them something to do if they weren't up to the alcoholic binges and betting sprees that were the other options for fun. It was like a social club where the main entertainer was God.

If they hadn't gone to this particular sermon Caleb might still be a single man. That was where he met Deborah. Her father was the preacher. She had latched on to Caleb instantly. Probably she sensed his vulnerability. Snow remembered the way she sat in her pew next to the young men, and looked up at the speaker with such filial devotion, but had still managed to look sideways at Caleb and sneak in a smile. They were introduced after the church service and from that time Snow and Beersdon were weekly sheep in the pastor's flock.

The cabby's voice from above jolted him back to the present. "Queen Street, sir. Two shillings."

Snow paid and stepped down, suddenly feeling a dizziness so powerful he had to grab onto the vehicle until it passed, and a sharp pain in his lower back. Not the gut, thank God.

When it was over he felt fine. He wondered if it was his kidneys again, or if it could be from the chloroform experiments. It was impossible to judge how harmful these things were when done more than once or twice in a lifetime. By now Snow had experimented on himself countless times. Maybe he would just use hedgehogs for a while, though he felt uncomfortable when they died. Even if the animals had no souls they surely would rather be running on a wheel in a cage than not existing at all. God must have made the animal for some purpose, though Snow doubted if Caleb and Deborah's God could have told any of them what the purpose was.

All these years later, and Caleb still couldn't escape frequent attendance at religious meetings. Snow knew what Caleb's congregation would have said about Snow's experiments in deadening sensation with chloroform.  To them pain was an act of God, and to escape from it was a sin as deadly as intemperance or adultery, punishable with unimaginable torments.

It was Deborah's vision of hell which finally scared Snow off the religious life in those old days. She knew the height of the blaze and even the temperature that God would use to incinerate workers drinking rum on a Sunday. Some exacting Methodist had figured the fire's dimensions out in cubits, using certain obscure texts in the Old Testament. Deborah had compared it to one of the pottery ovens at Stoke.

Surely none of those imagined pains could equal the real pain of the child last year whose entire right eye had to be removed without chloroform because of her parents' religious fervor. That they had hesitated to agree to the surgery, to save her life from the deadly tumor behind her eye socket, was amazing to Snow, but then when he understood that they were refusing chloroform he had been appalled. They said her pain would teach her the strength of God's power.

Though Snow didn't do the surgery himself he had stayed in the operating theater with his chloroform kit the entire time, in case the parents changed their minds. But the girl's moans didn't sway them. She had been a brave creature; the surgeon only needed two assistants to hold her down. The last Snow heard she was doing well, and had kept full sight out of the remaining eye. He doubted that she'd keep much in the way of religious enthusiasm.

And that was hardly Snow's first encounter with religious resistance to pain relief, and even resistance to saving a life. He remembered his summons to a recent childbirth that could have ended in an all too typical disaster. The woman's husband had sent a note begging Snow to come. By the time he arrived with his equipment, two other doctors had been there for some time, and the husband was weeping in a chair outside the room. One doctor glanced at Snow with resentment, and the other gave him a quick, sullen summing up.

"Been in hard labor for thirty hours. Fully dilated. It's obvious the head's too big to come down. The mother has reached the danger stage: low pulse, delirious, a fever raging. If we do a craniotomy right away there's a chance of saving her." The man picked up a long forceps with jagged teeth, tipped with points.

Snow had flinched. A craniotomy. He had seen enough of those to last him his entire life. When the fetus's head was too large the only way to save the mother was to reach in through the cervix and cut through the baby's skull, killing the baby of course, and withdraw the crushed head and dismembered body parts through the mother's tortured vagina. The physical pain the mother would undergo was unthinkable, aside from the chance of infection, which was enormous, as well as likely laceration from bone fragments. He'd seen a case last year of gangrene following a craniotomy delivery. It had resulted in the mother's vagina, bladder, and colon, putrefying and turning into one fused channel before she died.

"You're certain the child is dead?" asked Snow.

"No, in fact there was a distinct kick a moment ago. But the mother will surely die. You can't want to risk a cesarian."

Snow knew the recovery rate from a cesarian section was barely ten percent. Such surgery was only worth the risk when the mother was dying anyway, but the infant had a chance. "I'd like to try to chloroform her and bring down the child manually."

The other doctor shook the craniotomy forceps in impatience. "It's impossible. We already gave her opium, but the uterus is so clamped down we can't do a thing. And we can't hold the woman still, she won't tolerate it."

"But you didn't have chloroform then." As he spoke, Snow was rapidly opening his case and assembling his tubing apparatus, carefully measuring the minimal dose.

The third medical man finally spoke up. "I don't like this. It's unnatural. You'll kill her anyway, likely as not. Women were meant to suffer with childbirth. They have for thousands of years."

Snow ignored him and held the mask over the face of the wretched woman, who was beyond speech but seemed to agree, with her eyes, to his treatment. In ten seconds her eyes closed. In fifteen seconds she made no response to a pinprick.

Snow rolled up his sleeve and slowly inserted his hand into the woman's vagina, then attempted to pass the resisting cervix. A contraction came, and when it ended he was able to move his hand in and around the infant's skull. When he pressed against the carotid artery there pulsed a distinct, rapid heartbeat.

"The child's still alive," Snow called out. "I think we can bring it down. One of you, when the next contraction comes, push against her abdomen." The woman didn't stir.

"It'll never work," said the attending doctor. "The uterus is too spasmodic and rigid. You're wasting our chance to save her."

The other said, "The Church should put a stop to this sort of thing. The child obviously was not meant to live."

Another contraction came and Snow pulled gently at the base of the infant's skull, actually moving it down another half inch. The next contraction, and the next, kept sending the child further out. Because the chloroform had relaxed her involuntary muscles so thoroughly, the woman's uterus ceased the irregular spasm which seemed to be gripping it, and her now unconscious body worked with Snow's hand to release its burden.

Finally the first of the other doctors stepped over and began to push against her abdomen as Snow had instructed.

In ten contractions the child was delivered. A boy. It gasped, choked, arched its back, and did all the things an infant was supposed to. Snow handed it, still attached to the umbilical cord, to one of the other doctors, and bent to check the woman s face. Her eyelids fluttered open.

"Did you do it?" she murmured. "Did you have to destroy the child?" Snow could barely hear her.

"No, madam. You have a healthy son. Your pain is over."

As Snow left, the other doctor had been carefully packing away the unused craniotomy forceps, shaking his head in either disbelief, disgust, or stunned relief; Snow couldn't tell.

Heading down Queen Street with his cholera notes, Snow tried to bring his mind back to the present task, but couldn't. If the zealots had had their way that time, the child would be dead and the woman probably too mutilated to ever have another. How long could the world resist the relieving of such dreadful suffering?

He reached the first house on his list, and tried again to put religion, pain, and its relief out of his mind for a while.

A slum.

Eight deaths, ages two to sixty-three. He went through the questions, memorized and pat: where does the house get water? Was it treated before drinking it? Could he see the source? What company provided the pipe line? Snow filled yet another bottle and labeled it. His plan was to ask the questions for every house and collect specimens from one house out of ten.

At the next house on his list lived a laundress with one living child. Two weeks ago there had been four children, a husband, and a grandmother, but cholera had blasted them all. The laundress had lived and lay pale and weak, hardly understanding the disaster. A neighbor came in to watch the surviving baby who crawled through the dust and scraps on the floor.

Tomorrow was a Sunday, and Snow doubted that attending a morning and evening sermon was part of the household's plan. According to Deborah, missing church alone would condemn the woman, and the baby, to those Stoke pottery ovens.

He didn't think Deborah knew about the years of Caleb's opium addiction and Snow's fight to wrench him out of it. She only saw Snow as a bad influence on her husband. Even worse was his counsel to Caleb to pursue journalism instead of the church.

Snow's notebook was getting fat. By four o'clock he finished the street. He was crossing the opening of an alleyway when out of the corner of his eye a white shape moved. Suddenly he felt both his arms grabbed from behind. His papers scattered around him. Before he could shout, a hand clapped itself over his mouth. A strong smell of dog came up from the skin on the back of the hand.

They shoved him forward, into the alley, the grip behind him still strong. Once he was farther into the shadows, he was pushed roughly to his knees. The hand stayed over his mouth.

"Lay off, see?" A kick landed on his lower spine, bringing back the pains he had felt earlier, and the dizziness too.

"Do as you're told. This is just a gentle warning. We gets worse fast." The voice was generic. It could have been any poor man on the street.

Snow felt himself being pushed forward until his face pressed the packed dirt of the alley. The spat-out shell of a sunflower seed was under his eye.

He tensed his muscles to yank his arms free. But just as he was about to do it, he was kicked once more, harder, and suddenly released. Footsteps ran back toward the street.

He scrambled to his feet. Too slow. He saw no one. Cautiously he stepped into the sunlight at the edge of the alley. No one.

His papers and notebooks littered the pavement and he self-consciously stooped to gather them, looking on both sides at the pedestrians, who ignored him.

3

A day later he found himself checking a house on the street where he'd met Sophie. He never once consciously intended to try to see her again. Even so, he chose this house out of a list of fifteen, and he saved it for the end of the day, when dusk was falling.

She was there, talking to someone, perhaps a child.  It was too far to tell, with the street crowd in between. By the time Snow reached her she was alone again.

Confusion clouded her face, but lifted immediately.

Hey, it's the vicar, she cried, looking pleased to see him. Ready for another go?" she asked, pulling at his arm.

Once more there was a fleeting echo of eyebrow, and this time a turn of the head as well, a line of the nose. Oranges and lemons. Then it was gone, swallowed up in the present and forgotten. But the smell was real enough; not of hay this time. Of wet dog.

The suspicion rushed over him like a bad taste in his mouth. "Wait a moment. Who was that you were just talking to?"

Nobody. Just a friend."

You have children for friends? Are you the best person to be their friend?"

She gave him a hurt look and he immediately felt guilty for suspecting her.

What are you so worried about, anyway? No one would know you in this part of town."

Snow rubbed his leg, where the dog bites from three days ago were healing, and looked uncomfortably to either side, even though his chat with a whore was no more noticeable on this street than if he'd been buying turnips. The dog smell didn't fade, but no dog was in sight.

"I... I can't go with you, Sophie. I have my work.. ." The regret in his voice surprised him.

Her small eyes crinkled in amusement at the weakness of his excuse. "Look, guvnor, I know you're busy now, but I'll be here around ten. Come and see us.

She turned away and took off without waiting for a reply. Snow kept walking, as though she had merely asked him the time, or begged a coin. He knew he'd be there.

After that, every few nights he would turn up at her corner after eleven. They would go to her attic and make love, then she would cook him a supper over a spirit lamp.  Then they would do it again. Snow's quick way in bed soon changed, as Sophie persuaded him that there were better methods of doing it. She turned out to be surprisingly strong and resisted his impatience in creative and maddening positions.

His suspicions of Sophie faded along with his distaste for her gray sheets. As long as she didn't expect him to drink unboiled water, or eat raw foods, he was content.

When Sophie first suggested that they go out instead of staying in her hot attic, he had refused absolutely, out of fear of recognition, contagion, and just plain stubbornness. But her laughter and a guarantee of a disguise for him finally changed his mind.

They left one night after midnight, she almost drunk on rum and he intoxicated simply at the mild danger of what he was doing. She had never been able to persuade him to have a drink with her.

They stuck to the alleyways close to the river. Smells shifted from sewer stench to the mossy breeze a lily pond might have, and gave Snow no clue where they were. When they finally stopped he knew they'd reached the East India Docks [B5], judging by the ships' masts which swayed and clanked, making spears of dark against the lit London sky. The murmurs of shifting rope and chain mixed with squeaks of countless river rats scurrying over the cobblestones.

Snow and Sophie descended into a cellar. Snow had to stoop to pass under the low door and once inside, the ceiling brushed the top of his head. Rough men packed the room, a hollowed space under two or three of the old houses. In the poor light it was hard to see how big the place was. At least a hundred people were pressed together.

The crowd's anticipation was high. Everyone' s attention was fixed on a circular pit in the room's center, about two feet deep and ten in diameter. River damp glistened on the walls and shone in the clay floor of the pit.

Snow's height gave him a good view, but most had to jostle for priority, pushing and shifting against each other. If Sophie hadn't kept such a strong hold around his waist they would have been pulled apart.

Snow guessed a fight of some sort was ready, dogs or cocks, but even so, the crowd's fevered eagerness confused him. So did the shining eyes of the few women present, as if this place were forbidden and sexual. It reminded him of crowds outside the public hangings. He overheard a few remarks.

"I hear he's something powerful, this one. Done in two dogs last week. They're talking of setting him at rats next."

"Rats! Jesus! Not while I'm in the room. He'd be nothing but bones after. The dogs is bad enough."

"It's all one to me, so long as the man comes through on the bets. I got a shilling on him tonight."

The announcer came to the edge of the pit dressed in an old frock coat and top hat. His hair was dyed black and clung to his head in an oily glob. At first the crowd noise obscured his voice.

" -- and as was said before, all bets is now placed. Any ladies like to faint, better leave now before it starts."

No one stirred.

"Here we have the renowned beast Rumbler, prize rat killer and blue ribbon fighter." A small pit bull dog was carried in over the heads of the crowd. The dog's wide studded collar and two-foot chain were then bolted, with ceremony, to a ring in the wall of the pit. Those who had edged close now backed off as far as they could.

Gray splotched the dog's white coat and pink gums matched his pink rheumy eyes. His huge lower jaw displayed yellow teeth. He slavered and pulled at his chain. No barks or even growls came out; just the clank of the chain.

"And for your special entertainment tonight, ladies and gentlemen, against this brave beast, we have Monsyoor Mango, just back from his renowned tour on the continent. May the best win!"

At the name, a light flashed in Snow's mind and then faded. He tried to see what they were bringing in, and in his first shock he couldn't recognize it. Another dog? A pig? But no, it was a dwarf, a male dwarf, dressed only in short leather pants and a leather collar. Snow felt sick.

Sophie, why didn't you tell me what this was? I can't watch this. The man will be killed.

A tremor went through Sophie where Snow held her waist.

"Aw, don't be such a pansy. I told you this'd be good fun, and so it will. It ain't like he's human. It's all fixed, anyway. Besides, you can't leave. It's too crowded. They'd think you're a copper."

She was right. They were both pushed up to the edge of the pit and retreat was impossible. And he realized too that his accent had given him away. Mistrustful glances flicked in their direction.

"It's all right. He's straight. Just out for a lark." Snow's rough disguise hadn't succeeded.

"See? Shut up now. It makes ‘em nervous. Just watch."

So Snow watched. The dwarf was being chained, by a ring in his collar, opposite the dog, and two men held the dog back. Some ointment hateful to the dog must have been rubbed on the dwarf. The animal went wild. Snow thought it would pull loose from the restraining hands.

The dwarfs long square skull and bridgeless nose quivered once in and out of human vulnerability, and then set itself in a hard bestial fix. He raised his arms into a mock boxing position.

Snow thought about stopping the fight. A second too long. A bell clanged and the dog was released.

In half a second the dog had its teeth buried in the dwarfs right forearm. The dwarf used his left hand to partially strangle the animal, forcing it to release its jaws. This worked, and the dwarf began to pummel the dog's tender nose. It snapped and clawed, too busy for another attack, but held its ground. And it was clear that the dwarf's wounded right arm was already weakening. As he punched at the pink nose his blood spattered the walls of the pit and spotted the feet of the closest spectators.

The dog got a tooth grip again, this time on the dwarf's leg, and sent him sprawling in the mud. The dwarf was able to get his hands around the dog's neck. The veins in his muscular arms bulged in blue streaks under the muddy white skin. For three long seconds they struggled, equal in strength, without motion. The shouts of the bettors turned to a roar.

The dwarf quit his stranglehold on the dog and reached his unhurt arm around to grab the animal's hind leg. Bracing it against the mud floor, he wrenched it up at an angle and dislocated it at the hip joint.

Snow winced. He knew what it should have sounded like, that dislocation. The crowd was too loud to hear it.

The dog loosed his jaws for a moment to yelp in agony, and the dwarf lurched free. But a foot slipped in the mud, and the dog was instantly on top of him. His jaws were at the dwarf's throat. The dwarf thrashed from side to side, trying to throw off the beast, pulling at the animal's mauled leg and battering it around the eyes and nose with his good fist. His blood soaked the dog's hide. He was weakening fast.

Snow, unable to look away, began to calculate blood loss and system shock. The dwarf's jugular vein was half an inch from the dog's teeth.

Sophie, at Snow's side, began to breathe noisily. Does she know this man? Snow suddenly wondered. It was not, however, the time to ask questions.

Finally, in a last effort, the dwarf strained his thumbs up to the dog's eyes and in one spasmodic thrust dislodged both eyeballs. Dog blood gushed over the dirt, and although the canine jaws still held, they weakened for a second. The dwarf was able to prize them open, grab the beast around the throat, and pull himself to his feet. He snapped back the spine and the animal was dead.

The crowd roared with glee or chagrin, depending on their bets. Sophie looked shaken and relieved. Her words were obviously a lie. "I had sixpence on the dog. Ten to one, too."

The dwarf was carried out above the heads of the screaming audience, his face white as a cheese and his right arm dripping blood. He pushed past Snow and Sophie.

Snow met the man's glance. The shocking blue of the eyes held Snow's for a moment in a surprised recognition. The dwarf had time for one quick, questioning look at Sophie before he was borne away.

All of Snow's suspicions flooded back, much stronger this time. Then it flashed back in his mind; tropical fruits. In Sophie's sleep that first night together she had murmured ‘‘mango."  What a fool he had been.

He turned to Sophie. "That man knows you. He knew me. What are you up to here?"

Sophie tried to push ahead of Snow through the crowd, acting as if she hadn't heard.

Snow grabbed her arm from behind, jerking her around to face him. "Wait. Answer my question, I tell you."

A few men in the crowd looked at them hard. Sophie said, "Fine. I'll tell you when we get outside. Come on, then."

They stood in a dark doorway while the crowd filed past. Harbor smells enveloped them.

Sophie wouldn't look at him at first. He waited a long time for her to speak.

"All right, then. It's true. But it ain't like you think. I do know him." At Snow's gesture of impatience she changed this to, "He was my lover. He asked me to do you. Someone hired him."

"Do you mean to tell me that you approached me on purpose, that first night?"

She almost smiled. "Yup. He followed you, all the way, signaled me when to stop you."

For all Snow's suspicions, he was stunned. Why would anyone bother? It couldn't be Methodists, not this.

"I don't know why, but he was plannin' to catch you in the act, with another fellow along as witness. Make you look bad." Her expression was earnest now. "You got to believe somethin'. Except for those first few minutes before we talked, I weren't going to do it. I couldn't, not after I knew what you was like. And I didn't do it, neither. Since that first night Mango's been at me to come with him and tell all about you so they could catch you in the act, ruin your name. But I kept sayin' him the wrong times, the wrong day. He almost had us once or twice."

"Yet you kept seeing me."

"Yeah." She hung her head. "I got feelings for you. You were good to me. And you needed feeding."  Now she laughed, lightly, and raised her chin, looking almost defiant. "Besides, after I stopped doin' him, Mango cut me off. I needed your cash."

"But couldn't you get other business?"

"Don't you understand? He cut off all my business. He's got ways." She looked to one side now, nervous.

"There's more you're not telling me."

Her glance held his. "That's right, guvnor." She swallowed. "Mango wants you now. Himself."

Snow's head was reeling. "Wait a moment. Who hired him in the first place? Why? I don't understand you."

"I don't know who hired him, or why. You should know that better than me. But first all he was hired for is to ‘get you off the cholera,' he kept saying. Now he"s livid. Jealous. He wants you dead."

Snow laughed in a broken voice. It was all mad. "I don't believe a word of this. And why did you bring me here tonight if you thought he might see you?"

"I dunno. I thought you might like it. And maybe he wouldn't see us."

Snow suspected that she had been wanting to tell him and she had brought him half on purpose. He said nothing.

"You believe what you want, guvnor. But one thing I know, I ain't goin back with ‘im again." She shuddered, crossing her arms over her small chest.

She looked so vulnerable. Maybe she was telling the truth. That attack in the street was real enough. The bites on his leg were still raw.

They walked back to her place in Dudley Street without talking. When they reached her door, Snow said, "I can't come up, Sophie. I'll come by again soon."

"Sure."

He pressed a five-pound note into her hand. She must have known it was a final gift. To his surprise, she didn't try to refuse it.

In the days Snow had spent with Sophie, cholera increased all over London to thousands of cases and deaths. Soon after he stopped meeting her, Snow gave up hope of attempting to see patients in his office. Instead he spent his days going from house to house where the outbreaks had occurred. For a few days he had braced himself for other attacks or threats, but nothing happened. Her warning must have been a hoax, or a fanciful invention. Because he was so absorbed in his work, he soon forgot.

At the houses he asked the same question, over and over, repeating like a sedge-warbler's call: "Where do you get your water? Where do you get your water? Where do you get your water?" At first the incanted inquiry, with Snows s voice quick and sure, gave the same tactile pleasure as snapping the ends off fresh green beans. But after two mornings of it the tediousness of the work was beyond belief. The notebooks grew thick.

His bottles filled a wall of shelves in his library. He hadn't yet decided what to do with them, what tests he could possibly run in the little basement laboratory, and they waited in accusing, shining rows. His notes on the cases and conditions and locations were stacked in teetering piles. His desk, the sofa, armchairs, the little tables, every surface, all were buried under paper. Paper had spread itself over most of the floor, except for a narrow path from the door to the desk. Mrs. Jarrett stayed out.

He began missing his nights with Sophie.  Caleb, without explanation, had completely stopped coming by to get the cholera counts for The Times, so Snow's evenings were empty. To distract himself he would sit up almost until dawn, leafing through the sheets, reading all the data and coming to no conclusions at all.

It was such a contradictory mess. If water carried the organism causing cholera, then diseased water supplies should affect everyone and be easy to pinpoint. But no patterns existed. Sick households got their water from a paradoxical variety of sources; some obviously polluted, such as the Thames or that ditch, and others proven clean and pure, piping systems run by respected companies and repeatedly checked by the city.

There were neighborhoods where half the houses were sick and half as untouched as if they stood in some other city.

Some sick houses were near the river, others a mile or more inland. Some were low, others were at one or two hundred feet above sea level. And not all were poor; several houses on Grosvenor Square were hit. Lady Hardwick lost her three children, and she was famous enough to have her tragedy singled out in an article in The Times, along with the name of her "society physician," Dr. Phineas Greeley.  Greeley, Snow's old teacher from Westminster Hospital, held that cholera was caused by fumes and fogs. Snow wasn't surprised to see him mentioned. He tried to decide if he was jealous. He was.

Snow had a map of London over his desk. He spent hours at a time looking at it, thinking of the areas hardest hit and what they could have in common. The dotted black lines separating the parishes etched themselves into Snow's mind. The shapes of their borders spread across his vision like a badly done patchwork quilt.

One day it rained and he couldn't face another trek through the slums. With the map before him he sat once more at his desk, determined to come up with something, some solution to try to work on. His mind felt blank. Nothing made sense. And a sexual urge crept over him, along with memories he couldn't erase, of Sophie's white legs and her dark triangle. To annoy him even further, that song, stuck in his head ever since the first night he met her, wouldn't stop jingling away.

Brickbats and tiles

say the bells of St. Giles.

You owe me five farthings

Say the bells of St. Martin's.

He idly began drawing zigzag marks around the churches in the song. St. Martin's, St. Margaret's, St. Clement's, St. Mary-leBow. The distances looked so small from one parish to the next, though he knew how many hot exhausting minutes it had taken him that morning to walk from St. Ann's near his street, past St. Paul's, over to Drury Lane. His pencil point lightly traced his day's route.

Here comes a candle to light you to bed

And here comes a chopper to chop off your head.

Then it came to him. He couldn't believe how he had forgotten it, all these years. A smell of hay, and the song, were completely mingled with a sense of adoration for a little girl. What was her name? Her face came to him as clearly as a daguerreotype. Blond, with small sea-water blue eyes.

The memories came back in a rush. He was five or six, before his mother died, and it was a perfect day in June, around haying time. Out in the field between his house and Hazelhangar Farm, playing with the daughter of a hay worker. She'd been there with her mother every day that week, for the harvest, and would stay another ten days or more.

He and the girl were both too young to help with the haying, and to his child mind she seemed a permanent addition to his life. She knew games. Circle games, string games, riddles. And a game of London parishes with a head chopping ritual at the end of it. At the end she would catch him and his neck would be nipped gently by her grubby hands held out straight to simulate a giant scissors. That brief touch was thrilling to him and even now he remembered the shock it sent down his spine, like sparks from a carpet in winter.

She was from Haversham, a village over five miles away, and she seemed so exotic. He struggled once more for her name.

The following summer, he remembered, when haying time approached he waited every day for her and her mother to come. They never did. After his disappointment faded, he had forgotten her until this night.

On one of those endless June days she had explained the song to him.

"It's the parishes, you see. In London."

"There's more than one parish there?" he had asked. In his village, one church served every neighbor he knew.

"Like the fields here, with walls between. And a church for each one."

‘‘How do you know?"

"I know all about London. I asked me mum. I'm going there when I grow up."

And they had gone back to the game.

He gave up trying to remember her name. Now that her face was so clear, though, he knew that she looked nothing like Sophie. It was just the eyes. His thoughts moved to parishes. The parishes, the parishes . . . it could work.

A map of the case concentrations. Something one could actually see, rather than numbers to analyze.

He took the nearest pile of paper and began to scribble on the map with a red pencil. By dawn he had drawn in the total cases in each of the central parishes, grading the areas with different colors. Red was for the highest number, green the lowest, and five colors ranged in between. He hoped the colors would emerge in a pattern, something meaningful to make sense of all his collected details. It would be so exciting if something would finally be clear.

When he finished he scrutinized his work.

It proved nothing. It was still a crazy patchwork. He knew no more than before. Another night's work wasted.

George Cruikshank, the noted illustrator and political cartoonist, drew of dog fights during the Snow era.  To see his work, click here.