Below is a copy of the birth certificate of Frances Lewis, believed to be the first (or index) case of the Broad Street Pump outbreak. Frances was born in March 1854 to Police Constable Thomas Lewis and his wife Sarah Lewis. Nearly five months later on Monday morning, August 24th, Frances developed the intense diarrhea which would subsequently cause her death, and thereafter lead to the death of many others in her community.

BIRTH OF FRANCES LEWIS

Seen more clearly to the left, Frances was born on March 21, 1854 in a home at 40 Broad Street, directly adjacent to the Broad Street pump.

After baby Frances develped diarrhea on August 24th, her mother Sarah soaked the dirty diapers in a bucket of cold water. Before actually washing the diapers, she poured the dirty water into the cesspool (a tank where sewage is held) in the front area of the house. Crevices and breaks in the cesspool wall resulted in leaks into the adjacent Broad Street pump well.

During the same time, Dr. John Snow was unaware of baby Frances and the plight of the Lewis family. Instead, he was busy studying another epidemic of cholera, later termed the "Grand Experiment," in communities to the South of the River Thames. The Lewis family was tended by Dr. William Rogers, their local physician. Dr. Rogers did not suspect that baby Frances had cholera. Her condition worsened in the coming days and by Wednesday, she appeared listless and exhausted, but showed no signs of fever or cramps, and did not seem blue or cold. On Saturday, September 2nd, baby Frances died. Dr. Rogers filled out her death certificate, shown below.

DEATH OF FRANCES LEWIS

In the death certificate, as seen to the left, Dr. Rogers noted that baby Frances died of "exhaustion, after an attack of diarrhea four days previous to death." He also noted that mother Sarah Lewis was present at the death, which occurred at 40 Broad Street. Dr. Rogers did not believe that the death was due to cholera. Ten months following the death, Dr. Rogers attended a meeting of the London Epidemiological Society where Dr. John Snow was presenting a talk on the Broad Street Pump outbreak. Included in the talk, was the investigative work of Reverend Henry Whitehead which pointed the causative finger at baby Frances. Dr. Rogers objected, feeling that the evidence was insufficient that baby Frances had cholera and that even if she had, cholera could not have been transmitted from the Lewis home at 40 Broad Street to the Broad Street pump well. it is not clear if Dr. Rogers ever changed his mind.

Cholera continued to visit the Lewis household, but this time it was father Thomas Lewis who had the disease. Six days after the death of his daughter, Police Constable Lewis on September 8th developed the symptoms of cholera. Like his daughter, he had lain in the front kitchen of 40 Broad Street. Being at the front of the house, it was easier for wife Sarah to pour the water from the rinsing diapers and bedding into the front cesspool (which contaminated the Broad Street pump well), rather than the privey at the back of the house. On the same day, the Board of Guardians, at the urging of Dr. John Snow, had the pump handle removed from the Broad Street pump. As the days went by, Thomas Lewis remained sick and his wife Sarah continued to empty pails of water, used to soak his soiled bedclothes, into the front cesspool. After eleven days of illness, Thomas Lewis died of cholera on September 19, 1854. If the handle of the Broad Street pump had not been removed on September 8th, it is likely that the contamination of the pump well via the cesspool would have continued until September 19th when Thomas Lewis died.

DEATH OF THOMAS LEWIS

As seen at the left, Police Constable Lewis had fever for seven days, diarrhea for four days and diagnosed cholera for three days. His wife Sarah Lewis was present at his death, as she was at the death of baby Frances. On Tuesday, September 19, 1854 she became a widow with two children, 16-year old Thomas and 11-year old Anne. Her deceased baby daughter Frances was the likely index case for the Broad Street Pump outbreak. Her deceased husband Thomas would have continued the contamination of the pump water, if the pump handle had not been removed following the urging of Dr. John Snow.

Sources:

Boylan, D. Personal Communication, 2009.

Vinten-Johansen, P et al. Cholera, Chloroform, and the Science of Medicine. A life of John Snow, 2003.

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