European doctors were not familiar with the symptoms and prognosis for cholera. They had no idea how the disease spread and there was no cure. The rapid onset of symptoms such as diarrhoea, nausea and vomiting resulted in dehydration from fluid loss, lethargy, erratic heartbeat, sunken eyes and dry and shrivelled skin with a characteristic bluish tinge.

The combination of scary symptoms and fear of the unknown seized the public’s imagination and chlolera was characterised as a foreign epidemic (it was commonly known as Asiatic cholera), which was 'invading' the nation.

Science Museum Group Collection Image source Edwin Chadwick, c.1860

The first appearance of cholera in 1831 was followed in 1837 and 1838 by epidemics of influenza and typhoid, prompting the government to ask the lawyer and leading social reformer Edwin Chadwick to carry out an enquiry into sanitation.

In his publication The Sanitary Conditions of the Labouring Population (1842), Chadwick used quantitative methods to show that there was a direct link between poor living conditions, disease and life expectancy. This investigation inspired the Public Health Act of 1848 and the establishment of the general Board of Health, of which Chadwick was the first director.

In 1848, The Times described cholera as 'the best of all sanitary reformers', and Chadwick was appointed to the first Board of Health and became the Sanitary Commissioner of London.

In the course of his investigations into the living conditions of the poor, Chadwick became interested in the problem of sanitation. He was convinced that active measures such as cleaning, drainage and ventilation would improve the health of working people and therefore make them less dependent on welfare.

Chadwick supported the rapid removal of human waste, seeing it as a major source of the 'bad air' that caused disease. Unfortunately, his limited improvements to the chaotic sewage and drainage systems led to a greater flow of raw sewage into the River Thames—the main source of drinking water for London. By further contaminating London's water supply, the risk of cholera was greatly increased.

The measures that Chadwick introduced were based on the medical thinking of the day, which attributed the spread of infectious diseases to foul smelling air, called miasma.