Cure for cholera: a heavy dose of political will

The horror story that is cholera-wracked Zimbabwe begins with a hand-pump in a Soho street and a British doctor who came up with a very simple, very brilliant idea one and a half centuries ago.

Cholera is more than just a dreadful disease: it thrives on ignorance and the most abject poverty; it breaks out when a state breaks down; and it is ultimately curable not by medicine alone but by organising society itself on rational, scientific principles. The only antidote to cholera, in the end, is political action.

Today, Robert Mugabe's most powerful accuser is John Snow, the man who tracked down the cause of the bacterium Vibrio cholerae in Victorian Britain.

In September, 1854, cholera broke out in Soho, killing some 700 people, including entire families, in a matter of weeks. Conventional medical wisdom held that the disease was caused by some mysterious miasma in the air - “a wandering ferment” - a deathly smell lurking beneath the rank odours of the city.

Snow spotted that the brewery workers in Soho, who mostly drank ale, and the inhabitants of the workhouse, which was one of the smelliest places in the area but had its own water source, seemed to be immune. By plotting and mapping the spread of the disease, he traced the source to the water pump in Broad Street (now Broadwick Street): the water supply had been contaminated by an infected baby's nappy which had been washed in a bucket, and the water then sluiced into a cesspool from which it had seeped into the water supply.

Using methods that now seem almost tragically obvious, Snow established a direct correlation between death from cholera and walking distance to the pump. People living below the sewage outlets on the Thames, he worked out, were 14 times more likely to contract cholera than those obtaining their water upstream.

The clincher came when a former resident of Soho who had moved to Hampstead asked her son to bring her some of the distinctive-tasting water from her old neighbourhood: she died a few days later.

The young doctor was still widely disbelieved. For many, the idea that they were dying from drinking their neighbours' faeces was too disgusting to accept. But Snow was a brave man (he had, after all, administered anaesthetic chloroform to Queen Victoria during the birth of her eighth child, so he knew about taking risks). He removed the handle from the pump. The epidemic ceased.

Snow not only changed our understanding of cholera but helped to confirm the link between disease and living conditions, reinforcing the fledgeling concept of public health. Joseph Bazalgette's great enclosed sewage system, begun in 1858, would henceforth ensure that sewage did not run into London's drinking water.

A series of public health acts in the mid-19th century marked an acceptance of the State's role in maintaining minimal standards of public health, forging a movement that would culminate in the foundation of the National Health Service in 1948.

Vibrio cholerae was defeated, but not dead. Cholera returns, with grim predictability, when the most basic structure of a society is broken.

Outbreaks of cholera followed the Indian Ocean tsunami of 2004. The disease killed hundreds in Basra, after the city's sewage system was destroyed during the invasion of Iraq. One of the worst recent outbreaks afflicted Rwandan refugees fleeing the genocide.

The cholera bacterium - easily controlled, but horribly persistent - is the ultimate mark of a failing state. Snow's discovery, and the public health movement that it helped to create, was proof that only political action can eradicate the scourge.

This is undoubtedly true of Zimbabwe, where the cause of the disease lives in his own palace, surrounded by security guards, drinking bottled mineral water. Mugabe's spokesman has accused the West of using the cholera outbreak as a weapon to oust him; and so it should, for a state that allows its citizens to drink their own sewage has broken a basic compact and forfeited any residual legitimacy.

No one knows how many people have died from cholera in Zimbabwe because, like Victorian London, no one is accurately counting. The public health laboratory in Harare, where contaminated water could be tested, has closed down because of a lack of running water. The Zimbabwe National Water Authority is another front for corruption, pumping money into the pockets of Mugabe and his cronies, while the country's water, the essence of life, becomes a conduit of death. The Health Minister of Zimbabwe has advised citizens not to shake hands to prevent spreading the disease, advice that seems oddly reminiscent of the Victorian health expert who insisted that the disease was caused by eating too many plums.

My most vivid memory of Harare, from long before the country began to disintegrate, is the smell of the blossoming jacaranda trees. Those same streets now reek of raw sewage, in a country slowly being poisoned by its own effluvia.

In 1858, just four years after Snow's discovery, London suffered the “Great Stink”, when drains overflowed and bacteria thrived in the warm summer. The smell reached the House of Commons, and although the curtains were drenched in chloride of lime to try to keep out the appalling pong, the Honourable Members finally acted: the drains were fixed and cholera was eradicated.

The stink of corruption and death from Zimbabwe can no longer be ignored, but the cure, like that for cholera, may be surprisingly obvious: a matter of political willpower and concerted action.

One contemporary said of Snow: “The naked truth was what he sought and loved.” He simply removed the handle of the pump. The naked truth is that only way Zimbabwe can recover is to remove Robert Mugabe.

Ben Macintyre