Kalle Kappner
Over the
last decade, the role of modern water supply and sewage disposal infrastructure
in the West’s 19th and early 20th century urban mortality
transition has attracted renewed attention among economic historians and
development economists (Harris and Helgertz, 2019). A robust conclusion of this
literature is that access to tap water and sanitary sewers was crucial in
turning cities from hotspots of infectious diseases to evermore healthy places.
However, the causal mechanisms linking patterns of declining mortality and
expanding access to modern water infrastructure are still poorly understood. In
particular, should the emergence of urban sanitation be seen as a rational,
indeed inevitable reaction to the 19th century’s recurrent epidemic
shocks and elevated urban mortality rates, an idea that Christopher Hamlin (2009) termed “cholera forcing”?
In a recent EHES working paper, I retrace Berlin’s long and bumpy
road to safe water conditions, challenging popular narratives that interpret modern
water infrastructure as an efficient, scientifically motivated answer to
Europe’s recurrent cholera epidemics since 1831. To the contrary, Berlin’s
experience suggests a highly complicated relationship between urban epidemics,
their statistical, proto-epidemiological examination, and water management
reform. Far from serving as “our old ally”, an attribute later assigned by urban
hygienist Robert Koch, cholera turned out not only a weak motivator, but in
fact an ambiguous one.
“The Great World Pestilence” in Berlin
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figure 1 a |
![]() |
figure 1 b |
Figure 1a and 1b: Cholera incidence and Crude Death Rates in Berlin, 1830-1880
In
hindsight, it is not hard to understand why cholera raged in a repeated, yet
seemingly erratic fashion. Berlin had experienced rapid population growth since
the 1850s, bringing about the typical problems of increasing density,
pollution, congestion and the consequent spread of infectious diseases.
Commercial travelers repeatedly carried vibrio
cholerae from the East and introduced the bacillus into the local
cesspools, which in turn contaminated the water of nearby wells, spreading the
diseases among the population. Berlin’s international connections, dense living
conditions and inadequate sanitary conditions rendered the city an ideal
transitional habitat.
On Unwanted Tap Water and Miasmatic Plague
Tubes
Roughly 25
years after its first acquaintance with cholera, Berlin began a lengthy path to
safe water conditions, substituting an essentially medieval infrastructure
based on pump wells, cesspits, open gutters and the river Spree’s natural
absorption capabilities by relatively clean tap water and sanitary sewers that
disposed waste in the rural hinterlands.
![]() |
figure 2a |
![]() |
figure 2b |
Initially,
recurrent epidemic shocks played hardly any motivating
role. By the 1850s, it
was aesthetic rather than sanitary concerns that brought the construction of a
modern tap water network on the municipal agenda. However, a combination of
misaligned economic incentives, low public demand, conflict over fiscal and
administrative responsibilities, and, crucially, a lack of understanding of
cholera’s fecal-oral transmission route ensured that the spatial expansion of the
network was slow, reaching full coverage only by the 1890s. Moreover, there is
evidence that failure to understand the adverse repercussions that an ample tap
water supply would have on an urban water cycle still lacking safe sewage
disposal contributed to the urban health crisis and cholera’s incidence in
particular, as suggested by the disease’s forceful comeback in 1866.
It took
another 25 years until the issue of complementary sewers would be tackled. Analysis
of contemporary discourse reveals that, while cholera’s continued appearance clearly
motivated some sanitary reform,
physicians, public health advocates, urban planners, and the general public for
a long time disagreed on the shape that such reforms should take on. Were
sewers preferable to manual disposal via containers and haulers? Was the strict
separation of liquid waste from excrement and other organic waste preferable to
mixed sewers that promised dilution of the contaminated material? Should waste
be left to the river’s natural cleaning capabilities or were sediments and the
soil’s microorganisms a more reliable disinfector? And what about dangerous,
disease-ridden “sewer gases” that could spread via underground plague tubes?
Far from suggesting a straight road to a unique sanitary solution, prevailing
miasmatic theories were vague enough to levy arguments for competing solutions
to the mounting urban health crises.
The Data Did Not Speak
In
hindsight, it is tempting to interpret this lengthy transition phase as a
result of technical, financial and political hurdles counteracting the
inevitable triumph of rational approaches to the problems of cholera and
infectious disease. However, a closer look at the epistemological struggles of contemporary
Berlin’s health officers and medical statisticians suggests that the
relationship between the extensive proto-epidemiological analysis of infectious
diseases and efficient sanitary reform was highly ambiguous.
Not only
did the collection of ever larger amounts of data fail to yield any compelling
reasons to rely on clean drinking water and sanitary sewers, as opposed to a
myriad of competing policy recommendation focussing on ventilation, cleansing
of the soil or quarantine. Moreover, the lack of adequate mathematical and
statistical tools proved fatal for the proto-epidemiological approach to
unraveling cholera’s complex properties. Well into the 1880s, Berlin’s health
statisticians were forced to retreat to the role of mere documenters as
prevailing miasma theories proved too blunt an instrument to cut through the
jungle of cholera’s complex spatiotemporal patterns. The “myth of John Snow” (McLeod, 2000) notwithstanding, Berlin’s
experience suggests that observational data and inductive logic did not suffice
to set the urban health community on the right track and induce crucial
investments into the urban water infrastructure. To the contrary, unable to
free itself from the vagueness of miasma theory, proto-epidemiology turned out
more an obstacle, rather than a driver of knowledge generation.
“Cholera Forcing”: Tales, Realities, and Implications
What lessons
does a careful reinterpretation of the Western urban sanitation transition
promise? Of course, there is no immediate danger of history repeating itself,
as comprehension of both cholera’s etiology and the importance of safe water
systems dramatically improved. Still, the absence of any automatisms in the
Western cholera-sanitation-nexus at the least suggests a cautious
interpretation of the disease’s potential to induce change.
Powerful
narratives of the West’s past struggle are highly consequential regarding the
attitudes, recommendation, and modes of assistance that today’s developing
world receives (Konteh, 2009). While it originates from a
misleading backward extrapolation of modern technocratic approaches and
scientific knowledge to the past, the real danger of the “cholera forcing”
narrative arises when extrapolation of an imagined Western past serves as the
basis for present policy recommendations.
References
Hamlin,
Christopher, 2009: “Cholera Forcing”. The Myth of the Good Epidemic and the
Coming of Good Water, American Journal of Public Health 99(11), 1946-1954, doi: 10.2105/AJPH.2009.165688
Harris, Bernard
& Jonas Helgertz, 2019: Urban Sanitation and the Decline of Mortality, The
History of the Family 24(2), 207-226, doi: 10.1080/1081602X.2019.1605923
Kappner,
Kalle, 2019: “Cholera Forcing” and the Urban Water Infrastructure: Lessons from
Historical Berlin, EHES Working Paper 167
Konteh,
Frederick Hassan, 2009: Urban Sanitation and Health in the Developing World:
Reminiscing the Nineteenth Century Industrial Nations, Health & Place
15(1), 69-78, doi: 10.1016/j.healthplace.2008.02.003
McLeod,
Kari S., 2000: Our Sense of Snow: The Myth of John Snow in Medical Geography,
Social Science & Medicine 50(7-8), 923-935, doi: 10.1016/S0277-9536(99)00345-7
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