With the support of my tablet, I have found my way to the Nightingale Hospital to visit a friend. The directions warn me to “use caution – walking directions may not always reflect real-world conditions “.
Beneath the high pediment is proudly emblazoned the name of the eponymous Florence. She was appointed in late April 1853 to her first senior nursing position at the hospital when it was known as the Establishment for Gentlewomen during Temporary Illness. Florence was of her medical generation in holding throughout her life to a belief in the miasmatic explanation of the cause of disease. This theory held that epidemics of diseases such as cholera originated in a miasma of particles emanating from rotting organic matter. (Germ theory would not be proposed, by Louis Pasteur, until 1861.) Her legacy, however, is not in doubt, and is rooted in her aphorism: “…never lose an opportunity of urging a practical beginning, however small, for it is wonderful how often in such matters the mustard-seed germinates and roots itself.” She undertook seminal work during the Crimean War of 1854-56; amongst her pioneering work is counted her use of applied statistics.
In 1854 there was a severe outbreak of cholera near Broad Street in Soho. Two local men in particular made it their professional concern: Dr John Snow and the Rev Henry Whitehead. Dr Snow sensed that contaminated water from the public pump in Broad Street was the cause of the outbreak. He mapped the cases of cholera and proved to his own satisfaction that they were clustered around the pump. Snow appears to have cut through a Gordian knot of medical debate by persuading the Board of Guardians of St James’s Parish to remove the handle of the Broad Street pump on Friday 8th September.
With the death of John Snow in 1858, Whitehead was left as the main authority on the Broad Street outbreak when cholera returned to London in 1865. In a presentation of 1867, he stated: “I must not omit to mention that if the removal of the pump-handle had nothing to do with checking the outbreak which had already run its course, it had probably everything to do with preventing a new outbreak…”. Although Whitehead had been unconvinced by Snow’s 1855 work, “On the Mode of Communication of Cholera “, he was eventually able to give up his allegiance to miasma theory in a new understanding of waterborne disease.
Key to the sanitary reform of London was the work of Joseph Bazalgette, Chief Municipal Engineer to the Metropolitan Board of Works. He was primarily responsible for the creation of the extensive network of sewers under the streets of central London. His revolutionary proposals began to be implemented in 1858. In his planning, Bazalgette calculated the diameter required for the pipes, then doubled it, reasoning: “Well, we’re only going to do this once and there’s always the unforeseen.”
To quote Bertrand Russell: “Although this may seem a paradox, all exact science is dominated by the idea of approximation. When a man tells you that he knows the exact truth about anything, you are safe in inferring that he is an inexact man.”