Lecture 19

The Snow series is an educational course. We hope you will recognise our efforts by donating to TTE or becoming a paying subscriber, as writing the series took a lot of time and effort.

We cannot end this cycle of Snow-centric lectures without mentioning the contribution of the Reverend Henry Whitehead to the recording and interpretation of the events around the Berwick Street cholera, as he called the outbreak.

Henry Whitehead (1825 - 1896)

First, let us remind ourselves that John Snow was fully occupied with his investigations in South London and his “natural experiment” (see Lecture 8). His time was limited and even more so when he went to investigate yet another outbreak in Deptford. 

However, Snow immediately recognised the importance of the Golden Square epidemic to test his theory.

Henry Whitehead, then aged 29, was the assistant curate of St Luke’s Church in the middle of the outbreak, so he was well placed to investigate amongst his parishioners as he was well known to them. He crisscrossed the area, relieving the sick and performing the last rites on those dying.

His 17-page pamphlet is a curious mixture of investigation and sermon. However, Whitehead carefully enumerated the dead, their addresses (and remarkably) on what floor they lived. Whitehead worked out the mortality density by the dwelling, something that would have been easier than for Snow as he knew most if not all, his parishioners. There is also a clue in his pamphlet to the “strange case of the workhouse in Poland Street”, another outlier. Here is his tally from page 6 of his pamphlet:

Whitehead missed nothing:

The workhouse had its deep well in the backyard, which is why only four or possibly five out of more than 500 inmates died (see Lecture 12).

To explain Whitehead’s investigation, we need to remember that the area around Broad Street had been genteel, with well-to-do people living in multi-storey homes. By the time of the outbreak, the houses had been split into flats, often with a communal kitchen, parlour and privy. Whitehead accurately reports the density of habitation and, as any good miasmatist, he was interested in the incidence (to use a modern term) of cholera by the height of the building. The higher people lived, the less likely they were to get cholera. However, that was not the case, as the reverend describes in his findings (like Julius Caesar, he writes in the third person):

So deaths were evenly distributed by altitude, probably for the reasons the Reverend described, but can any of our readers solve the other puzzle? What explanations can you think of to account for the increased incidence of deaths in the upper floors the further you were from Broad Street?

It is unclear when Snow and Whitehead first met, but it must have been around the beginning of September when the doctor was going about his enquiries and the reverend was looking after the sick.

As Parkes noted, Snow had yet to produce conclusive proof of his theory. The index case of the Broad Street outbreak had not been identified, and a cursory inspection of the pump and water had not revealed any obvious contamination, even after a microscopic examination by Hassal. Had Snow waited a few months before publishing MCC2, his theory would have been bolstered by Mr York’s excavations and Whitehead’s identification of Constable Thomas Lewis’s daughter’s agony and death at number 40. 

CONTEMPORARY THEMES

The folk living on the top floors were more likely to be mobile, which meant fetching water from the Broad Street pump. Henry Whitehead was intelligent and flexible enough to understand that the facts he had ascertained with such accuracy did not fit miasma theory.

Whitehead's masterstroke occurred when, on 3 April 1855, he interviewed the distraught widow of Constable Lewis, who had lost both husband and baby. Two details struck him. The baby's illness preceded the onset of the epidemic, and her diapers had been washed in cold water over the cesspool in front of number 40, which Mr York had ascertained communicated with the well.

The complicated interactions between the celebrity anaesthetist and the young curate are brilliantly summarised by Sidney Chave, one of Tom’s teachers, and also in the Vestry of St James’s report on pages 121 to 169.  By the end of the story, Whitehead had embraced Snow’s theory. 

We hope you have enjoyed this series. This is the last instalment.

References

Whitehead, Henry. The Cholera in Berwick Street. Hope, 1854. JSTOR, https://jstor.org/stable/60100462. Accessed 18 Sept. 2023. Available here.

Chave, S.P.W., HENRY WHITEHEAD AND CHOLERA IN BROAD STREET. Medical history, 1958. 2(2): p. 92-108. 10.1017/S0025727300023504. Available here.

Westminster St. James, Cholera Inquiry Comm. Report on the Cholera Outbreak in the Parish of St. James, Westminster, during the Autumn of 1854. Lond, 1855. Available here.

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