How Oxford’s most famous character is helping to drag typhoid out of the rabbit-hole
Did you know that Oxford was once ‘basically the perfect breeding place for typhoid’? So say Dr Samantha Vanderslott and Dr Claas Kirchhelle, the curators behind the new Alice in Typhoidland display at the Weston Library and History of Science Museum.
Yes, back in the 19th century, Oxford’s poor sanitation, low-lying land, high town vs gown inequality, and lack of a public water system meant that almost every source of water was at risk of contamination. (Although Sam and Claas also tell me that Cambridge was worse … nice to see the old collegiate rivalry is alive and well.) This caused scandal in 1874, when three undergraduates died of typhoid fever in a lodging house in Jericho.
Meanwhile, over in Christ Church, Alice Liddell was being told stories in a rowboat by Lewis Carroll (also known as mathematician Charles Dodgson). Little did they know, there was another secret world beneath them besides Wonderland. Indeed, the river below them was part of a cycle of sewage, ideal for the spread of the tiny organism known as typhoid.
The display uses Carroll’s creation of Alice — perhaps Oxford’s most famous literary citizen — to explore a different kind of warren, that of underground sewers instead of a rabbit-hole! Sam and Claas are confident she will prove an entertaining and accessible guide to both the history and the surprising present of this disease.
This is part of the reason the pair have combined their skills for this venture. Sam is a sociologist, while Claas is a historian; between the two of them they are all too aware of how the western perception of typhoid as a ‘disease of the past’, as Claas puts it, is causing problems now. Thinking of typhoid as a product of a less enlightened age — ‘or of other countries’ as Sam saliently adds — belies its current resurgence across the globe. It also adds to an attitude where, historically, countries in the Global North have focused on eradicating typhoid at home and in their own traveling populations. In other countries, they too often turn a blind eye, which is risky for all of us when new and antibiotic-resistant strains begin to spread…
It’s something that the pair lay out very eloquently in an article called Decades neglecting an ancient disease has triggered a health emergency around the world. Speaking to them in person, this kind of international ‘I’m alright, Jack’ attitude comes up again, as we talk about the history of vaccines how they were often used primarily for British soldiers and travellers. It then took a lot longer for those same vaccines to trickle down for use in the countries they travelled to.
There are reasons for optimism, though, too. Alice in Typhoidland also features a ‘human challenge’ study that took place in Oxford in 2017. This study saw a reversal of the usual roles. Instead of being developed in the Global North and then tested in the Global South, this new vaccine was developed in India and then tested by volunteers in Oxford.
How did they test the vaccine, you ask? They drank live typhoid*.
It’s this close involvement with current work on the disease that makes for some of the most interesting items that are on display.
‘We’ve actually got some real artefacts that were used during the challenge study.’ Sam tells me. ‘So, that’s what is different from other exhibitions, we know the teams who carried out this research, so we can go into the lab and pick up some of the items they would have been using. For example, the bicarbonate of soda bottle that participants had to drink to neutralise their stomach.’
‘The vials of the typhoid shots they had to swallow, too,’ chimes in Claas. ‘Plus, we had access to the raw stories of this typhoid trial… we interviewed two of the people in the trial and asked them “why on earth did you swallow typhoid?” The answers were really interesting. We also asked them: how important was it to get payment? Would you have participated without payment? How did you tell your family, your parents that you were going to swallow typhoid bacteria? It turns out that one of our swallowers actually had a family history where three of her relatives, two generations back, had died of a typhoid fever outbreak.’
That history of vaccines will be over at the History of Science Museum (along with the present of vaccine research, showcasing those recent Oxford studies).
Meanwhile, over at the Weston Library, visitors can find out all about the history of sanitation. At that strand of the exhibition, you can find out all about the interventions made by the people connected to the story of Alice. It will also look at Oxford as an example of what works and ask what lessons we can export from the past to the present day.
It’s clear from talking to them that Sam and Claas are quite the team (they even finish each other’s sentences). It sounds like they’ve put together an exhibition that should be really unique.
To hear them tell it, it’s a collaboration that’s only possible thanks to the Oxford Martin School where they are both based.
‘We were both part of a wider programme called Collective Responsibility for Infectious Disease.’ Sam explains. ‘I think we just found we had a lot of overlap in interests — from me, working on vaccine attitudes, which seemed to go well with Claas’s work on anti-microbial resistance.’
Claas fills in a bit more of the background: ‘Andrew Pollard pushed us in the direction of typhoid [editor — not literally]. I was previously involved in an exhibition about antibiotics. At one of the events focusing on that exhibition, I got talking to Andy. He said: we should have something quite similar on typhoid where we’ve got similar problems. Typhoid resistance against antibiotics is rising rapidly. We’ve got the new hopes for vaccine development coming — this was actually in 2017, while the vaccine trial was ongoing in Oxford.
From that point onward, I found that Sam and I were working together. I really have to plug the Oxford Martin School here, because we were just allowed to sit together and develop ideas. The School has been incredibly supportive of that. It’s quite a rare story that institutions leave you to your own interdisciplinary devices, to give you the time to develop these stories too.’
And out of that time emerged Alice in Typhoidland. Not that the pair set out to make an Alice-themed exhibition, to shoehorn in the popular Oxford figure. Instead, says Sam, ‘When we looked back, Alice just kept popping up. Which we didn’t expect to see! We weren’t looking to find an Alice in Wonderland connection.’
Claas adds: ‘We first wanted to call the exhibition Typhoid in Oxford or we were thinking Typhoid: Past and Present. Then we went back and we found that it’s not just that Alice’s family is affected by typhoid — her mother nearly dies of it in 1848 in London — but it’s her father, Henry Liddell, who then plays an absolutely decisive role in typhoid control. Then we see that Lewis Carroll — or Charles Dodgson, to use his legal name — was writing the first Alice in Wonderland book right when Liddell was pushing through the first phases of sanitary reform. And really it is connected to Christ Church life; one of the first sewers that is put underground runs right through Christ Church. There are repeated outbreaks amongst Christ Church undergraduates.
‘After that, we just followed that story, and it made a lot of sense. We found that we were dealing with one of Oxford’s most well-known individuals, who is portrayed in a major work of fiction. And the book she features in starts with a tour on the river Thames, which is probably thoroughly polluted with sewage at this point. And we thought, well, instead of taking Alice down the rabbit hole, let’s take her down the sewer and highlight the really wonderful and important world of engineering that is still beneath our feet.’
So, at the centre of sanitary reform in Oxford, you find Henry Liddell: father of Alice, and one suggested inspiration for the King of Hearts. He worked closely on this with a doctor called Henry Acland, another friend of Dodgson/Carroll’s and a figure many suggest was the basis for the White Rabbit.
Several of Acland’s beautiful hand-drawn maps of Oxford are on show. As well as being wonderfully crafted, these would have been cutting edge research at the time that mapped the topography of Oxford against cholera and typhoid cases. They also mapped Oxford’s various sewage outlets. While Acland mistakenly believed that the sewage connection was due to bad smells or ‘miasma’ which spread disease, the reform he suggested was still very effective.
Together, Liddell and Acland (among other campaigners) made enough noise that the city began to take sewer and water development seriously. Oxford is fairly typical of UK cities in this way, as more outbreaks hit the news, more and more areas decided to do something about it. While national government did make resources available, a lot of this change was driven on a local level. Sam and Claas suggest that civic pride played a big role in this (hence their joking comment about Cambridge earlier). There was fierce competition about which cities were doing best in terms of sanitation and hygiene, which drove on reform.
It helped that this was at a time when, as Claas put it, ‘municipal socialism was a positive term’. There was plenty of will, on a local level, to make changes for the public good. This was reflected both in terms of the infrastructure that was built and in access to that infrastructure. This is something that Sam and Claas think is often overlooked. We think of the Victorians as great builders and engineers, but we forget that there were also strong social values at play.
For example, a fully connected sewer system was later followed by a public water supply. To pay for this, those with higher incomes (who lived on higher value land) were charged higher water rates, to make the lower, basic rate affordable. Think about it as the utilities version of the NHS, just on a much more local scale.
These changes paid dividends; as you can see from this digital mapping, deaths from typhoid began to drop following sewer reform. It then reduced almost to nothing following the introduction of a clean municipal water supply.
This is just one of the digital resources that form part of Alice in Typhoidland. You can see them all on the website — and they include a magical animated introduction, several fascinating videos, plus a few games too!
One of the most impressive aspects of these is the Sanitation and Typhoid in Oxford video, which includes a beautifully rendered 3D landscape of Oxford. This is no mere artist’s rendering; it is based on a composite of historical survey maps.
It also includes the aforementioned interviews with the famous ‘typhoid swallowers’. And then, yes, there are the games. Obviously, this piece wouldn’t be much of a guide to the exhibition if I didn’t try these out for you…
I have to admit, after playing through the ‘Typhoidland Mystery Game’, I feel like a proper detective. I’ve successfully put together the clues, identified the source of the infection, and saved Oxford from the ravages of a deadly disease. I’ve also, almost accidentally, learned some stuff. The character you play — Medical Officer of Health — was a real person. As, indeed, were all the typhoid cases the game has you investigate (as unlikely as one or two of them sound).
The games are all simple and well designed. The art style of Ben Leighton ties it all together into a consistent and evocative world. All the things I talked about with Sam and Claas are suddenly given form and feel that bit more real. That’s the power of this exhibition, so I’m now especially keen to experience it in person.
Also, having accidentally caused a riot in the streets of Oxford by placing a cesspool in the wrong place in the ‘Dean Liddell River Challenge’, I can confirm that it really does bring home the stakes of getting this infrastructure right!
This digital strand of the exhibition is especially important, as Alice in Typhoidland isn’t just a one-off exhibition. The physical exhibition will tour to Atlanta in the United States, then elements of it will become a permanent part of the new Museum of Oxford on St Aldates.
But perhaps most exciting is that the digital assets are available for everyone to use. Claas and Sam are keen for them to be used in schools, for example. And they’ll have a further life in the countries most affected by typhoid; videos, animations and games will be adapted to fit different contexts and cultures, and then be used in places like Nepal, Bangladesh and India. Claas calls it ‘a sustained wider project to raise awareness about typhoid globally, tying in research and public engagement’.
That’s another distinct aspect of this project: the way it ties in history with both existing and new research.
Remember ‘typhoid swallowers’ human challenge study? Part of the exhibition will be geared towards soliciting public perception and trying to answer questions like ‘should such studies be paid’? (In some countries, paying people for potentially risky studies is illegal, in case it encourages vulnerable people to put themselves at risk). As well as educating people about typhoid, the exhibition will then get people to use that new knowledge, and generate new data on a range of issues, such as public perception of vaccines.
Speaking of vaccines, they form a large part of the history section of the exhibition too. Did you know that Winston Churchill, back when he was a journalist, argued against early typhoid vaccine because of fear of side effects, which were unpleasant, from this early vaccine? Have you heard of the fascinating campaign during the First World War to promote vaccination, in which Sir William Osler (one of Acland’s successors in Oxford) wrote: ‘It is your patriotic duty to get vaccinated, because if you don’t, then you are helping the Germans’?
Claas and Sam picked out some of their favourite objects, so if you do make your way down to the exhibition, be sure to keep an eye out for:
- Personal correspondence between Henry Liddell and Henry Acland, showing real insight into a pair at the heart of both Alice in Wonderland and sanitation reform.
- Some of the original pipes of 19th century Victorian sewage and water systems and earlier, impressive (and huge) things made of both wood and cast iron.
- Plenty of supposed ‘remedies’ for typhoid, showing how ordinary desperate people tried to protect themselves. Marvel at the miracle elixirs and wonder at such ‘cures’ as rose dust!
- The typhoid vials, bicarbonate containers and other artefacts from the ‘typhoid swallowers’ study.
- The hand-drawn maps that map typhoid and cholera across Oxford — at once, both a work of art and a political statement.
- Historical vaccine technology, including the ingenious ‘opacity tubes’ used to get the correct dosage.
With all the resources of the Bodleian and University Archives behind them, it sounds like Sam and Claas have found some real gems.
Alice in Typhoidland opened on Tuesday 21 January. It is suitable for everyone aged 5+. The curators were inspired by how the Horrible Histories series took difficult events and presented them engagingly, but without trivialising. Visitors should expect to be entertained, to learn some fascinating things, and to come away with a new appreciation for the urgency of tackling this disease across the globe.
Claas sums up by saying: ‘I think our urgent message at the end is that typhoid is not a disease of the past, that’s what our exhibition clearly shows. And if we look back, then a city like Oxford holds many of the insights that could be used for typhoid control in the present. There is not only an urgent need for the global community to mobilise the resources that are necessary for further research and effective vaccines but also to invest in providing the basic infrastructures that we talked about earlier, water sanitation and hygiene that are not available to a large part of the world. Effective typhoid control depends on this interlayering of approaches. And this requires resources both at the national and local levels…like the cheap credits the Victorian authorities made available to cities like Oxford.’
