London School of Hygiene & Tropical Medicine

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Charles Dickens Museum 

Although an unlikely pick for our list among epidemiologists and scientists, Dickens’ books illustrate the harsh reality of Britain’s poor and the disastrous attempts at a solution.  

Oliver Twist illustrates the life of children in a workhouse, which was an attempt at a solution to the homelessness epidemic in Britain. Workhouses were introduced in the Poor Law of 1834 championed by Secretary of the Poor Law Commission, Edwin Chadwick. Chadwick was a social reformer and believer in the miasma theory of disease, which suggests that disease is caused by foul air. Chadwick had two frameworks to base his sanitary reform on, the first was that poverty caused disease, disease was costly to society, and thus to prevent disease we must prevent poverty. The second was that disease (caused by miasma) led to poverty and thus political instability. He instituted workhouses to reduce unhygienic areas and shelter the homeless. However, the intention of these workhouses was formed on the principle of “less eligibility”, which meant the government sought to make conditions at the workhouse worse than the experience of the poorest employed people. The purpose of this was to discourage people from taking advantage of welfare. As Dickens illustrates in Oliver Twist, this system was harsh and punished the poor rather than offering support and nourishment. He went on to write essays criticizing the Poor Law and the conditions of workhouses. The work of Charles Dickens emphasizes the vital role of social reformers in public health. 

The Museum is situated on his home in Bloomsbury, but his inspiration likely came from growing up at what is now 22 Cleveland Street, down the street from the Cleveland Street Workhouse. The museum is open Wednesday to Sunday, 10 am to 5 pm.  

Charterhouse Square  

The Charterhouse has a rich history and is better known for its Tudor architecture. However, the land began as a plague pit for the Black Death. The land was donated by Walter Manny in 1348. The Black Death, caused by the bacteria Yersinia Pestis, first spread across England between 1348 and 1349. It is assumed that the epidemic killed between a third and a half of London’s population. The plague pit at the Charterhouse is considered the largest plague pit in London during the Black Death.  

Manny built a chapel to pray for the souls of those buried, and later built a monastery. Following Henry VIII’s separation from the Catholic Church, monasteries were dissolved. The building was confiscated by the King and given to Sir Edward North. North began the building of the Tudor mansion. In 1611, the mansion came under the ownership of Thomas Sutton who gave the mansion new life as a school and almshouse. The London Charterhouse was severely damaged in the Blitz but was restored.  

The museum and chapel were beautiful! The museum discusses the impact of the Black Death and the history of the priory. As we moved into the part of the museum about the Charterhouse’s time as a school. the museum staff told us to take care to see if we recognized any of the names.  

The museum is free and open 10:30 to 16:30.  

The Whitechapel Library 

The Whitechapel Library is home to the medical and dental textbooks for the Queen Mary University of London at the Church of St. Augustine with St. Philip. Take a look at the beautiful architecture and pay special attention to the windows.  The library hosts a collection of eight stained glass windows denoting the mortality trends for a variety of afflictions. Find the window with the purple tint, which denotes the morality trends of the 1918-1919 influenza outbreak. The 1918-1919 is also known as the Spanish Flu, despite likely originating in North America. Experts have estimated the virus killed 50 million people and infected 500 million people worldwide. This flu also had an unusually high mortality among young adults and was especially demoralizing as it came at the end of World War I.  

Mark Honigsbaum, a Wellcome Research Fellow and historian, caught up with a collaborator of the installation to learn more about the window. The blue window next to the central purple one is meant to symbolize healing, while the purple represents the suffering of those who gave their lives to help others. Therefore, the purple window reflects the victims of the pandemic that claimed citizens and healthcare workers alike.  

London Bridge & Joseph Bazalgette 

Standing on the London Bridge, you can look out onto The River Thames. The River Thames is considered one of the cleanest rivers among rivers that flow through major cities; however, that was not always the case. In Victorian England, the Thames was a massive sewer. Edwin Chadwick (yes the same one who implemented the Poor Law) was the champion of sanitary reform. He believed in the miasma theory of disease; thus, he theorized that the elimination of unhygienic living conditions through street cleaning and the removal of human waste would reduce disease and political instability. He also produced the Sanitary Report of 1842, which described mortality data before and after the introduction of drainage systems. He called for separate systems of fresh water and sewage. As we will learn, this didn’t quite work as water was not pumped from high enough upstream. 

The stink remained and the summer of 1858 (“The Great Stink”) resulted in Joseph Bazalgette being hired to fix the sewage issue. He created a massive underground system of that pumped the waste east of London. He had to calculate the flow of the Thames to determine the gradient of the drain and used bricks and cement to create the sewers. The type of cement he used was key as it hardened upon contact with water. He also used ovoid shaped pipes, which create better hydraulic performance. Some of these brick-lined tunnels are still in use today as Bazalgette made his tunnels quite large to account for an increase in population size. 

Guy’s Hospital, Mural celebrating African Health Workers 

On the side of Nuffield Suite at Guy’s Hospital is a mural created by Dr. Michele Curtis. The mural celebrates six women from Africa who worked in UK healthcare. The mural was supported by the Young Historians Project, a non-profit organization created by young people of African and Caribbean descent.  

• “Kofoworola Abeni "Ivy" Pratt – she was born in 1910 in Lagos, Nigeria. She trained as a nurse at the Nightingale School at St Thomas’ Hospital from 1946 to 1950. She has been dubbed "the Florence Nightingale of Nigeria" due to her influence shaping nursing there.
• Matilda Clerk – she was born in 1916 in Larteh, Gold Coast (present-day Ghana). She was the first Ghanaian woman in any field to be granted a scholarship abroad to study medicine, at Edinburgh University, which she attended from 1944 to 1949. She became the first Ghanaian woman to earn a postgraduate diploma.
• Dzagbele Matilda Asante – she was born in Ghana in 1927 and worked as a teacher before migrating to the UK. In 1947, she arrived in Dover and began training as a nurse at Barnet Hospital, Central Middlesex Hospital in Harlesden, and later studied health visiting at Battersea Polytechnic.
• Blanche La Guma (née Herman) – she was born in 1927 in Athlone, South Africa, and trained as a nurse and midwife in the 1950s. She was an activist against the Apartheid regime. While in London, she completed a refresher course in midwifery in the 1960s and conducted house calls.
• Dr Irene Elizabeth Beatrice Ighodaro (née Wellesley-Cole) – she was born in 1916 in Freetown, Sierra Leone. She studied medicine at the University of Durham from 1938 to 1944, becoming the first West African-born female doctor in Britain.” (BBC)
• Metian Parsanka – a current specialist occupational therapist in the accident and emergency department at St. Thomas’ Hospital. She was born in Kenya and moved to the UK when she wa    

Florence Nightingale Museum  

Within the St Thomas’ Hospital complex holds the Florence Nightingale Museum. Florence Nightingale was a statistician and reformer who revolutionized nursing and hospital sanitation. Nightingale trained as a nurse in Germany and later became superintendent at a women’s Hospital. However, she is better known for her work during the Crimean War. She was called to bring nurses to care for soldiers wounded during the battles. She arrived at a Barrack Hospital covered in waste. In response, Nightingale prioritized creating a clean hospital environment with proper food and clothing. In 1885, the British government’s sanitary commission found the drinking water was contaminated with sewer. She represented the mortality statistics in the famous rose diagram. Upon returning to England, Nightingale began a school of nursing which still exists today.  

Enjoy learning more about Nightingale’s work and her influence on Victorian England. 

The museum is open Tuesday to Sunday from 10 am until 5 pm. 

National Science Museum – Medicine & Communities 

The National Science Museum’s Medicine and Communities collection explores communicable diseases that impacted Britain. Explore infectious diseases from tuberculosis and cholera to HIV and COVID-19. Understand how the public learned about diseases through public health marketing materials and advertisements. There is also a display outlining the different vaccines and medicines we have developed to reduce the cases of infectious diseases. The gallery also celebrates advances in chronic illnesses, surgery, and mental health. 

This exhibit is on level one and is open daily from 10-18:00. Entry to the science museum is free.   

Edward Jenner & Kensington Garden 

Cruise through Hyde Parka and stop in the Italian Gardens to reflect on the work of Edward Jenner.  

Jenner was a physician who created the world’s first vaccine against smallpox. For centuries before Jenner, scientists in India and then later in China, the Middle East, and Africa, had used inoculation to reduce cases of smallpox. The process involved infecting a person with scabs from a smallpox infection. However, the process was not perfect and 1-3% of persons would die. The process was used in England at the insistence of Lady Mary Wortley Montague.  

There was some literature before Jenner that cowpox resulted in similar protection against smallpox as smallpox inoculation. Jenner began observing every case of cowpox and smallpox that he could find to understand the effect of both infections. In 1796, he inoculated a boy, James Phipps, with a cowpox sore taken from milkmaid Sarah Nelmes. After six weeks, Jenner inoculated Phipps with a sore from a smallpox patient. Phipps had no reaction to the smallpox. The Royal Society initially rejected his report, but Jenner successfully repeated the process with 23 individuals of varying ages and sexes. By 1853, the National Vaccination Program was enacted to make vaccines against smallpox compulsory up to age 13.  

Jenner created the term “vaccine” from the Latin vacca, which translates to cow. Smallpox was declared eradicated in 1980. 

John Snow Pump Handle (Broadwick Street (was Broad Street)) 

Celebrate the Father of Modern Epidemiology and toast to John Snow at the John Snow Pub on Broadwick Street in Soho.  

John Snow is notable as the father of modern epidemiology due to his investigations of the Broad Street cholera outbreak of 1854. Snow was a general practitioner and scientist. He was fascinated by William Morton’s use of ether to anesthetize patients for surgery Snow soon calculated the sufficient strength of ether and later chloroform, using himself as a subject. He skills as an anaesthetist were famously used for Queen Victoria in 1853. Cholera was an interest of Snow’s due to his early work on coal miners in Tyneside.  

A cholera outbreak in 1848 led scientists to determine an increased viscosity of cholera patient’s blood. This understanding led Snow to theorize that this was a result of fluid loss and the agent causing it must reside in the gut. Snow studied multiple cholera outbreaks, but the 1854 Broad Street outbreak remains the most famous. Broad Street, which was renowned for its clean water, was supplied by the Southwark and Vauxhall Company using their water from the Thames. However, unlike their Lambeth company competitor, S&V did not draw the water upstream of London.  

Snow went out and recorded where and when each case of cholera occurred, what water they used, and the water source. He then mapped these cases. Snow could determine the cholera death counts by water companies and households, which also allowed for controls – a key feature of modern epidemiological studies. This mapping of the distribution of cases convinced Snow that the Broad Street pump was causing the outbreak. 

Two exceptional cases helped convince Snow. The first was Mrs Eley of Hampstead, who died of cholera as she had water from the Broad Street pump delivered to her home. The second is that 70 workers at a brewery on Broad Street were unaffected as they drank beer instead of water. After convincing local officials, Snow removed the handle on the Broad Street pump on September 8th, 1854.  

Outside the John Snow pub is a replica of the pump, without the handle, celebrating Snow’s contribution to epidemiology. Ironically, John Snow swore off alcohol and was a vegetarian, so having a pub in his honour may not have aligned with his personal ethos. Nonetheless, the pub is a great learn more about Snow’s legacy. 

The John Snow pub is located at 39 Broadwick Street, London, W1F 9QJ. The pub is open Monday to Saturday 12 – 11pm and Sunday from 1 to 10 pm.  

Note: Much Information is from Eras in Epidemiology by Susser & Stein 

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