Construction of London's Victorian sewers: the vital role of Joseph Bazalgette.

Until the early 19th century, London’s River Thames, contained relatively clean water. Some 200 years before this, Sir Christopher Wren (1632–1723) realised that drainage and sewage disposal would sooner or later prove a major problem in an expanding city. He designed a relevant system; however, this was not constructed and his subsequent work related to prestigious buildings (including St Paul’s Cathedral) rather than underground feats of architecture or engineering. In the early 19th century there was little or no consistency regarding sewage disposal in diVerent districts of the metropolis; cesspools were regarded as the proper receptacles for house drainage. 3 However, things were to change suddenly, and in the 1840s it became compulsory to drain houses into sewers (all of which ultimately ran into the Thames) ; within six years, >30 000 cesspits were systematically abolished, and “all house and street refuse [was] turned into the river”. 3 This inevitably meant that Thames water (from which domestic water supplies were derived) was heavily contaminated by sewerage; popular media of the day (that is, newspapers and journals) launched a campaign for cleansing Thames water (fig 1). Disease—before the enunciation of the germ theory—was considered by most authorities to arise from miasmas. The mid-19th century was a time when “sanitary reform” was at its height. Thomas Southwood Smith (1788–1861) became known as the “father of sanitary reform”. Cholera epidemics raged in London in 1831–32, 1848–49, and 1853–54; during the last of these John Snow (1813–58) was able, on epidemiological grounds, to demonstrate that this disease was most likely contracted from faecally contaminated drinking water. 12 This was several decades before the “germ theory” of disease was generally accepted. Also, Florence Nightingale (1820–1910) (herself a miasmatist) popularised the “sanitary concept” during her widely acclaimed activities at Scutari in the Crimean War (1854–56). By the late 1850s, Parliament was becoming increasingly unhappy that nothing was being done to alleviate a worsening situation. By July 1858, the smell from the Thames at Westminster proved too much for the Parliamentarians, who concluded that the premises were, at that time, unusable. 14 This “great stink” gave Benjamin Disraeli (1804–81), the future Prime Based on a paper delivered to a conference organised by the Section of Epidemiology and Public Health, the Royal Society of Medicine, to commemorate the 150th anniversary of the foundation of The Epidemiological Society of London, held on 30 October 2000.