The back of the medal focuses on 1849, the second of two years (1848-49) when cholera returned to London, following the earlier epidemic of 1831-1832. Persons in industrial London (symbolized by billowing smoke coming from a factory) became sick from consuming contaminated water, illustrated by the water flowing from the pump at right. A hand bell is being knelled at the top of the medal, following a cholera death. On the right side, a mother holds her infant, worrying that cholera will strike, while watching a man (perhaps her husband) cradle a sick or dead person.
While Belskie's medal does well in depicting the horrors of cholera, his intent was to honor Dr. John Snow. To this end, a more appropriate year for the top of the medal would have been 1854, when cholera returned a third time to London. It was in 1854 when John Snow conducted two epidemiological studies, both now considered historic classics in the field of epidemiology. The first was the Grand Experiment, in which Snow analyzed data on the distribution of household water in the same neighborhoods coming from two water companies; one company had moved up the River Thames to a fresh water site while the other remained in a cholera polluted site of the river. The second was the Broad Street Pump Outbreak, where John Snow had investigated an explosive cholera outbreak in the Soho neighborhood of London and found that the Broad Street pump was a factor common to most cases. He persuaded the parish authorities to remove the handle of the pump and the cholera outbreak subsided.