Dr McNab had asked this question with a smile. But the smile only irritated Dr Dunstaple and he bellowed: “Rubbish! Let Dr McNab give his reasons for saying that cholera is spread by the drinking of infected water!” He paused a moment to let his words sink in, and then added: “Perhaps he’ll explain away the case, reported officially to the Royal College of Physicians, of a dispenser who accidentally swallowed some of the so-called ‘rice-water’ matter voided by a patient in a state of collapse from cholera… but who suffered no ill-effects whatsoever!”
“No, I can’t explain that,” replied McNab, who had now recovered his composure and was speaking in his usual calm tone. “Any more than I can explain why cholera should have always attacked those of our soldiers who had recently arrived in the Crimea in preference to those who had been there for some time … Or why, as has been suggested, Jews should be immune to cholera, and many other things about this mysterious disease.”
Ah, it had been a mistake to mention Jews. The Magistrate could see people thinking: “Jews! Whatever next!”
“How d’you explain its high incidence in places known to be malodorous?”
“It should be obvious that in the crowded habitations of the poor, who live, cook, eat, and sleep in the same apartment and pay little regard to the washing of hands, the evacuations of cholera victims which are almost colourless and without odour can be passed from one person to another. It has often been noted that the disease is rarely contracted by medical, clerical or other visitors who don’t eat and drink in the sickroom. And consider how severely the mining districts were affected in each of the epidemics in Britain. The pits are without privies and the excrement of the workmen lies about everywhere so that the hands are liable to be soiled by it. The pitmen remain underground for eight or nine hours at a time and invariably take food down with them into the pits and eat it with unwashed hands and without a knife and fork. The result is that any case of cholera in the pits has an unusually favourable situation in which to spread.”
“Gentlemen,” interrupted the Collector, “it’s clear that the difference between you is a deeply felt and scientific one which none of us here are qualified for adjudicating … To an impartial observer it seems that there’s something to be said on either side …” The Collector hesitated. “Let us therefore be content, until the … er … march of science has freed us from doubt, to take precautions against either eventuality. Let us take care, on the advice of Dr Dunstaple, to ventilate our rooms, our clothes and our persons as best we can lest cholera be present in an invisible poisonous miasma. And at the same time let us take care with washing and cleanliness and other precautions to see that we don’t ingest the morbid agent in any liquid or solid form. As for the treatment of those unfortunate enough to contract the disease, let them choose whichever approach seems to them the most expressive of reason.”
The Collector fell silent, hoping that these words might bring the meeting to an end without leaving too great a schism between the two factions. But Dr Dunstaple’s bitterness was too great to be satisfied with this armistice.
“Dr McNab still hasn’t granted my request for evidence that cholera is spread by drinking water. Does he expect us to be convinced by his words about the prevalence of cholera in the pits? Ha! He’s forgotten to mention, by some slip of the memory, the one fact about the pits which is known to everyone … the impurity of the air breathed by the pitmen! Moreover, I should warn those present of the risks they expose themselves to under McNab’s treatment … which is, however, not a treatment at all, but a waste of time. Let him who is prepared, should McNab decide on another experiment, to have needles driven into his stomach, allow himself to be treated by this charlatan. I believe I’ve done my duty in making this plain.”
“I shall also give a warning to those present, to the effect that, in my view, nothing could be worse for the treatment of cholera than the warm baths, mustard-plasters and compresses recommended by Dr Dunstaple, which can only further reduce the water content of the blood … No medicine could be more dangerous in cholera collapse than opium, and calomel in the form of a pill is utterly useless.”
“Thank you, Dr McNab,” put in the Collector hurriedly, but McNab paid no attention to him.
“As for the evidence that cholera is spread in drinking-water, there is, as Dr Dunstaple should be well aware, a considerable amount of evidence to support this view. I’ll mention one small part of it only … evidence collected as a result of the epidemics of 1853 and 1854 by Dr Snow and which concerns the southern districts of London. These districts, with the exception of Greenwich and part of Lewisham and Rotherhithe, are supplied with water by two water companies, one called the Lambeth Company, and the other the Southwark and Vauxhall Company. Throughout the greater part of these districts the supply of water is intimately mixed, the pipes of both companies going down all the streets and into almost all the courts and alleys. At one time the two water companies were in active competition and any person paying the rates, whether landlord or tenant, could change his water company as easily as his butcher or baker … and although this state of things has long since ceased, and the companies have come to an arrangement so that the people cannot now change their supply, all the same, the result of their earlier competition remains. Here and there one may find a row of houses all having the same supply, but very often two adjacent houses are supplied differently. And there’s no difference in the circumstances of the people supplied by the two companies each company supplies rich and poor alike.
“Now in 1849 both companies supplied virtually the same water … the Lambeth Company got theirs from the Thames close to the Hungerford Bridge; the Southwark and Vauxhall Company got theirs at Battersea-fields. Each kind of water contained the sewage of London and was supplied with very little attempt at purification. In 1849 the cholera epidemic was almost equally severe in the districts supplied by each company.
“Between the epidemic of 1849 and that of 1853 the Lambeth Company removed their works from Hungerford Bridge to Thames Ditton, beyond the influence of the tide and out of reach of London’s sewage. During the epidemic of 1854 Dr Snow uncovered the following facts … out of 134 deaths from cholera during the first four weeks, 115 of the fatal cases occurred in houses supplied by the Southwark and Vauxhall Company, only 14 in that of the Lambeth Company’s houses, and the remainder in houses that got their water from pump wells or direct from the river. Remember, this was in districts where houses standing next to each other very often had a different water supply.”
“Pure reason!” ejaculated the Magistrate. “It will be too much for them. Ha! Ha!” If anything was destined to distract the assembly from an objective consideration of rival arguments it was this strange, almost mad, outburst from the Magistrate. Dr McNab continued, however: “During the epidemic as a whole which lasted ten weeks there were 2,443 deaths in houses supplied by Southwark and Vauxhall as against 313 in those supplied by the Lambeth Company. Admittedly the former supplied twice as many houses as the latter… but if the fatal cases of cholera during the entire epidemic are taken in proportion to the houses supplied, it will be seen that there were 610 deaths out of 10,000 houses supplied by the South wark and Vauxhall Company, whereas there were only 119 out of 10,000 supplied by the Lambeth Company. I challenge Dr Dunstaple to deny in the face of this evidence that cholera is not spread by drinking water!”