Hektoen International

A Journal of Medical Humanities

Epidemic cholera and Joseph William Bazalgette

JMS Pearce
Hull, England, United Kingdom



Photo of Joseph Bazalgette
Fig 1. Joseph Bazalgette. Photo by Lock & Whitfield. 1877. National Portrait Gallery London. Via Wikimedia

Rampant epidemics of cholera took many lives in the Victorian era. These epidemics were finally overcome with the discovery that cholera was a waterborne infection and by massive reconstruction of the sewers. Sir Joseph William Bazalgette (1819-1891) (Fig 1), known as the “Sewer King,”1 was born in Enfield, London. His father was a retired Royal Navy officer of French descent; his mother was Theresa Philo Pilton. He saved thousands of lives by reconstructing London’s sewers. Why do so few remember his engineering struggles to help others at the cost of his health?



Cholera was known in ancient Greek and Roman times as a disease caused by bile (Latin, cholera morbus). In the wake of a pandemic in India—“Asiatic cholera”—in 1817 and 1829, a second pandemic reached Europe in 1831 and America in 1832. The first outbreak in Britain was in Sunderland in the autumn of 1831. From there it rapidly spread to Scotland and southern towns including London. These were dangerous times. Before it had run its course it claimed 52,000 lives.2 Four cholera epidemics struck England in the Victorian era (Fig 2). Typhoid, typhus, dysentery, and epidemic influenza were also common, taking many lives. When Queen Victoria was crowned, only half of London’s infants lived to their fifth birthday. Urban life expectancy was thirty-five when Bazalgette was born. Victorian understanding of infectious diseases was primitive, many infections being ascribed to foul miasmas in the air.

Most Victorian towns showed massive expansion of population, factories, and housing. From their windows, chamber pots were poured onto the cobbled streets below. Toilet effluvia joined overflowing cesspools. The outdated medieval sewage system was overloaded. Human waste ran through the streets, fouling the air and drinking water. Perfumed vinaigrettes were widely used to overcome the foul-smelling, putrid air of the streets.

Illustration of polluted river spreading cholera
Fig 2. The “SILENT HIGHWAY”–MAN. “Your MONEY or your LIFE!” 1858. Original cartoon from Punch Magazine, Volume 35 Page 137. Via Museum of London.

Cholera and typhoid were thought to spread through evil miasmas. But Sydney Smith, the famous Anglican cleric, presciently blamed drinking water: “He who drinks a tumbler of London Water has literally in his stomach more animated beings than there are Men, Women and Children on the face of the Globe.”

The anesthetist and epidemiologist John Snow (1813-1858) proved that cholera was a waterborne contagion, not a miasma.i On the Mode of Communication of Cholera (1849) described his theory, which at first was ignored.3 He then presented statistical evidence from the 1854 outbreak of cholera in London’s Broad Street that began on 31 August and claimed over 500 lives in ten days. Snow suspected contamination via the Broad Street pump, which extracted drinking water from a well that was contaminated by a cesspit (Fig 3).4 Despite medical opposition, the pump handle was removed. The incidence of cholera fell and Snow’s claims were in time vindicated.5



In 1836, Bazalgette left his native London for Northern Ireland, apprenticed to the renowned civil engineer John Benjamin MacNeill. His work included schemes for land drainage and reclamation. In 1842 he returned to London to start his own practice, much of it concerned with the expanding rail network. In 1847 he had a nervous breakdown attributed to excessive work, from which he slowly recovered.

In spite of Edwin Chadwick’s abolition of hundreds of cesspits, a cholera outbreak in 1848 killed 52,000 people in England and Wales. Typhoid and dysentery were also common. Bazalgette was appointed Assistant Surveyor to the Metropolitan Commission of Sewers in London, under the engineer Frank Forster. They found no unified system of sewage and drainage. The sewers were inadequately cleared by the Toshers and Mudlarks, who with little effect tried to unblock the smaller tributaries and tunnels that opened into the river Thames. (Fig 4)

The Broad Street Pump, a spreader of cholera
Fig 3. The Broad Street Pump. Photo by Justin Cormack. Via Wikimedia.

After Forster died in 1852, Bazalgette was appointed engineer to the Metropolitan Board of Works. Between 1853 and 1854 thousands of Londoners died from yet another cholera outbreak. He continued to search for an answer and in 1854, suggested his solution to his employers. They elected Joseph Bazalgette on a salary of £1,000 a year as chief engineer.

By the time his work began, thousands of Londoners had died of cholera, a pattern repeated in hundreds of other large towns. The hot summer of 1858 created the “Great Stink of London.”6 The smell of untreated human sewage overwhelmed anybody passing near the Thames. When it affected the Members of Parliament, unsurprisingly they quickly passed laws to support Bazalgette’s schemes.

He began to implement a radical improvement of roads, lighting, bridges, tunnels, and crucially, sewers over a hundred square miles of London. Strongly backed by Isambard Kingdom Brunel, over the next thirty years he transformed the sewers and health of London despite political, financial, and bureaucratic hurdles that temporarily thwarted him.

He unified separate drainage districts. His brick-walled sewer tunnels were shaped like an upside-down egg so that they could support the weight of the city above. Through the feeding tunnels, small volumes of rain could wash away putrid waste matter.

Driven by his exhausting work ethic, he rapidly devised an even better underground infrastructure that succeeded and has survived. To avoid digging up even larger areas of London, he created the huge Victoria, Albert, and Chelsea embankments that contained massive new main sewer pipes along the Thames. These lower level sewers were pumped by huge steam engines. The foul water was transported to treatment works sited eastwards, away from the city, and into the Thames, crucially at high tide. Bazalgette constructed eighty-two miles (132km) of main intercepting sewers, 1,100 miles of street sewers, four pumping stations, and two treatment works. These huge embankments also provided for an underground tube line.

The river Thames, a notorious source of cholera
Fig 4. The polluted river Thames 1832. Print by George Cruickshank. Via Science Museum Group Collection. CC BY-NC-SA 4.0

” . . . the most extensive and wonderful work of modern times”

The Observer, 14 April 1861

An obsessionally hard worker, both he and his expensive developments were under constant scrutiny and criticism. This affected his health. Joined by his son Edward, by 1866 most of London was connected to his newly devised sewer system along the Victoria, Albert, and Chelsea Embankments. It was extended in 1875 to 1,300 miles of sewers cleansing 1.8 billion liters of water, excreta, and waste. It was completed in 1885 and his sewage system then spread to towns throughout Britain, revolutionizing public health.

To counter the congestion of horse-drawn traffic, Bazalgette also designed the construction of new streets in London: Southwark Street, Queen Victoria Street, Northumberland Avenue, Shaftesbury Avenue, Charing Cross Road, and Battersea Park. He replaced three bridges—Putney, Hammersmith, and Battersea—with new structures of his own design.

He was described as “very slight and spare, and considerably under the average height; but his face, with its prominent aquiline nose, its keen grey eyes, and its grey whiskers and black eyebrows, gives you the impression of a man of exceptional power.” He was made a companion of The Order of the Bath (CB) in 1871 and was knighted in 1874. In 1888 he was elected President of the Institution of Civil Engineers, succeeding Thomas Telford and George Stephenson. He died in his Wimbledon home, aged seventy-one, and was buried at St Mary’s Church, Arthur Road, where he had been churchwarden.

Bust of Joseph Bazalgette
Fig 5. Bazalgette bust: Flumini vincula posvit. Photo by Prioryman. 2015. Via Wikimedia. CC BY-SA 4.0.

Joseph William Bazalgette probably made the biggest single contribution to the health of Victorian Londoners. The main monument to this remarkable man lies mainly hidden from sight. Above the Thames embankment his monument reads: “Flumini vincula posvit” (He placed the river in chains). (Fig 5)


End notes

  1. Filippo Pacini (1854) and later Robert Koch (1883) identified the comma-shaped bacterium Vibrio cholerae as the causative agent of cholera.



  1. Cook GC. Joseph William Bazalgette (1819–1891): A Major Figure in the Health Improvements of Victorian London. Journal of Medical Biography. 1999;7(1):17-24.
  2. Underwood EA. The History of Cholera in Great Britain. Proc Roy Soc med 1947;41:165-173.
  3. Snow J. On the Mode of Communication of Cholera. 1849 London. Ibid. 2nd edition, London. 1855.
  4. Hempel S. Medical Detective: John Snow and the Mystery of Cholera, London: Granta Books, 2014.
  5. Vachon D. Father of modern epidemiology: John Snow. University of California, Los Angeles (UCLA); Los Angeles, CA: 2005.
  6. Halliday S. The Great Stink of London: Sir Joseph Bazalgette and the Cleansing of the Victorian Metropolis. Stroud, Sutton Publishing 1999.



JMS PEARCE is a retired neurologist and author with a particular interest in the history of science and medicine.


Fall 2021  |  Sections  |  Infectious Diseases

Leave a Reply

Your email address will not be published. Required fields are marked *

This site uses Akismet to reduce spam. Learn how your comment data is processed.