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Cleanliness . . . and an early application of medicine and medical skill . . . were supposed to be specifics against the contagion. And to a certain extent there is some truth in these views; and it is thus that God enforces on us, by his great and invariable laws of health, the necessity of attention to these sanitary measures. But, pushing that truth too far, men began to map out the geographical boundaries of the malady. . . . Then the selfishness of our nature, leaving the poor in their disease or in their danger to pay the penalty of their localities, was heard to congratulate itself on the comparative safety of its better situations. . . . And then it was . . . that the cholera at one leap passed from the squalid abodes of poverty into the houses which were rejoicing in their comforts, and the streets which were high and clean. —Rev. Henry Venn Elliott, “Two Sermons on the Hundred and First and Sixty-Second Psalms as Applicable to the Harvest, the Cholera, and the War” SNOW AND THE MEDICAL MODEL PHYSICIAN BENJAMIN WARD RICHARDSON, describing public reaction to the St. James epidemic, remarks, “[S]uch a panic possibly never existed in London since the days of the great plague. People fled from their homes as from instant death, leaving behind them, in their haste, all that they valued most” (xxvi). John Snow’s analysis of this epidemic and recommendation to remove 55 3 Invisible to the Naked Eye John Snow the Broad Street pump handle are always prominently featured in medical histories of the period. Histories of medical maps hold up Snow’s map of the Broad Street epidemic as the most important development in medical mapping of its era. Despite the dominant sanitary paradigm, Snow positioned himself against the sanitarians. In 1855, he gave evidence before the Select Committee, expressing his conviction that “he was no defender of nuisances, but . . . a bad smell cannot, simply because it is a bad smell, give rise to a specific disease” and that specific diseases were the result of specific disease agents (Richardson xxix). Snow’s famous second edition of On the Mode of Communication of Cholera begins with an argument for human transmission of the disease and a history of its movement across Asia and Europe from the Ganges. A substantial portion tracing epidemics in several other areas of London and the United Kingdom generally consists of verbal mapping, with place names and dates, but does not include cartographic representation. The first map is of the St. James outbreak (see fig. 3.1). This is of course the primary topic of the paper and the most impressive to the public not only because of the concentration of deaths there, but because of the fame of the parish as the location of court and metonym for aristocratic wealth of the metropolis, as we will see in chapter 4. Interestingly, it contains no dates, although using dates to show spread was a widespread practice in epidemic mapping. (Snow includes dates and numbers of deaths in a separate table.) Snow states that most deaths took place very close to the pump, but then mentions some which took place further away, in consequence of exposure to the pump water, or those deaths which resulted from exposure in Broad Street, but took place in the country as a result of householders fleeing the city. Snow does not choose to show a larger map with lines connecting such victims to Broad Street, which would provide more complete evidence but lessen the visual impact of the map. He defines the “cholera field” in the following way: The dotted line on the map surrounds the sub-districts of Golden Square, St. James’s, and Berwick Street, St James’s, together with the adjoining portion of the subdistrict of St. Anne, Soho, extending from Wardour Street to Dean St., and a small part of the sub-district of St James’s Square enclosed by Marylebone Street, Titchfield Street, Great Windmill Street and Brewer Street. All the deaths from cholera which were registered in the six weeks from 19th August to 30th September within this locality, as well as those persons removed into Middlesex Hospital, are shown in the map by a black line in the situation of the house in which it occurred or in which the fatal attack was contracted. (46) Additionally, Snow shows the locations of all pumps and adds explanations for why some pumps were less used than others, and why some deaths 56 Mapping Disease...

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