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Description

The Official Account of the Broad Street Cholera Outbreak, the Epidemic That Changed Epidemiology.

A complete copy of the General Board of Health's illustrated scientific report on the 1854 Broad Street Cholera Epidemic (also called the Golden Square outbreak), the most comprehensive contemporary account of the epidemic that resulted in John Snow launching a sea change in epidemiology and communicable disease theory.

The Board of Health's investigation of cholera outbreak at Broad Street was, according to historian Margaret Pelling, the first occasion in 19th-century England that a public health department financed scientific research. The investigation was very comprehensive, as related in Paneth, Vinten-Johansen, Brody, and Rip's "A Rivalry of Foulness: Official and Unofficial Investigations of the London Cholera Epidemic of 1854":

The Board's investigations included quantitative analyses of the relationship of cholera incidence to air and water temperature, rainfall, barometric pressure, humidity, wind pressure and direction, ozone level, cloud cover, crowding, and altitude. Microscopic and chemical analyses were performed of air in cholera wards, of water samples from all water companies and from many sites (including the Broad Street pump), and of sewage and fecal samples.

The BoH's was one of three concurrent investigations into the outbreak, with another undertaken by the local parish under the auspices of the Cholera Inquiry Committee, and the most famous the unofficial investigation by John Snow himself.

The present work was the product of the Committee for Scientific Inquiries (CSI), one of three constituent bodies of the Board of Health. The Committee included five physicians with ties to the sanitary reform movement, Neil Arnott, William Baly, William Farr, Richard Owen, and John Simon. Three scientists also worked for the CSI, James Glaisher, a meteorologist, Richard Dundas Thomson, a professor of chemistry, and Arthur Hill Hassall, an expert on microscopic anatomy and contamination.

Almost one-third of the 352-page report is taken up with Glaisher's meteorological analysis. Chemical and microscopic analysis is also part of the report; Thomson and Hassall oversaw inquiries into water and air quality. Like Snow, they correlated cholera mortality with water supplied by South London companies such as the Southwark and Vauxhall Company. To measure air quality, Thomson designed a 16-cubic-foot zinc-lined wooden tank, which suctioned air through a distilled water trap. All of these inquiries resulted in a plethora of illustrations, graphs, and tables. Some of them are particularly poignant, such as the plate illustrating the infamous Broad Street Pump water under a microscope (it is unusually bereft of obvious microscopic contaminants).

The diligence of the Board of Health in no small part contributed to Snow's discovery that the Broad Street pump was to blame for the outbreak; both Snow and Board of Health doctors were conducting independent house-to-house inspections in September of 1854, but, according to Snow, it was Doctor Fraser of the BoH who discovered that a Hampstead widow and visitor from Brighton had died of cholera after their only interaction with the neighborhood was drinking water from the pump. This information started Snow helped Snow arrive at his conclusion.

The Board of Health also recorded the details of 40 Broad Street, which the CIC would later determine included the index case for the outbreak, a 5-month-old who died of cholera and whose diapers were washed in a cesspool that interacted with the decayed foundation of the Broad Street pump.

The Map

The map seen here was a joint effort of the Board of Health and the parish Cholera Inquiry Committee. And while Snow's map is far better-known today, the present map includes all the information seen on Snow's map and quite a bit more. As "A Rivalry of Foulness" contrasts: 

Unlike Snow's better-known version, this map included all streets and mews, updated the number of cholera deaths in the area by tracing people who left the neighborhood for hospitalization, and tallied deaths of nonresidents who worked in or visited Golden Square. The Board of Health map also indicated the correct site of a burial pit used during the Great Plague of London in 1665. Many believed that the disturbance of the plague pit that allegedly occurred when sewer lines were dug in the 1840s was responsible for the severity of the Golden Square outbreak. But the jointly published map of the Board and the parish committee established that the true location of the plague pit corresponded neither with the sewer work nor with the epicenter of the cholera outbreak.

The potential locations of two historical plague pits or "pest fields" are labeled: "Erroneously supposed position of the ancient plague pit shewn in the map of the Commissioners of Sewers." and "Extent of the Craven Estate corresponding with site of pest-field 3 acres 2 chains"

In these divergent approaches to specificity, the two maps embody the rival theories of the BoH and John Snow; the BoH theory of cholera transmission (often called zymosis-miasma theory) took into account so many factors that it predicted too much and was difficult to falsify; Snow's map and theory, however, were very focused on the water-borne route to the exclusion of other possibilities, and intentionally lead the viewer to the same conclusion. As "A Rivalry of Foulness" notes:

[T]he strength of Snow's hypothesis lies in its exclusion of other alternatives; by insisting on a singular mode of transmission, Snow was able to imagine circumstances that would invalidate his hypothesis. The exemption of the Golden Square brewery workers from the cholera epidemic had no special meaning to the CSI but had a great deal of significance to Snow, as it led him immediately to a consideration of the brewery workers' distinctive water supply. Had they been drinkers of Broad Street pump water, Snow's theory would have suffered a heavy blow. As exceptions, the brewery workers were as significant a verification of Snow's hypothesis as were the cholera victims who used the Broad Street pump. 

Rarity

RareBookHub records no complete examples for sale since 1912, with one incomplete example selling in a group lot in 2012. We are aware of another copy having traded privately. Furthermore, the map has been offered separately for £15,000.

OCLC records 19 institutional copies of the Appendix, slightly more than the 10 recorded for Snow's On the Mode of Communication of Cholera (1855).

Snow's On the Mode of Communication of Cholera last sold at auction at Christie's in 2012 for £25,000, and has since sold for more privately.

Condition Description
Octavo. Original blue paper lettered wrappers (chipping and somewhat soiled). viii, 352 pages (i.e., complete, but largely disbound). 40 plates, some of which folding, including a large lithographed folding map of deaths around Broad Street, Soho, London. (Few plates chipped at edges or toned, the map with some unrepaired fold splits, short tears, and light foxing.) In general, this is a complete reading copy of the report, which could benefit from selected conservation.
Reference
Nigel Paneth, MD, MPH, Peter Vinten-Johansen, PhD, Howard Brody, MD, PhD, and Michael Rip, PhD, "A Rivalry of Foulness: Official and Unofficial Investigations of the London Cholera Epidemic of 1854", American Journal of Public Health, October 1998.