Mid-19th century.
The overall level of sanitation in Europe had not improved all that much compared to the Middle Ages.
Awareness that hygiene was important had spread, but the real problem was the rapid industrialization that drove people into the cities.
No matter how thoroughly the streets were cleaned, within a few days they would return to looking like pigsties. Maintaining clean streets was nearly impossible.
London, one of the largest cities in the world, was no exception.
Districts where wealthy people lived were incomparably cleaner than those of medieval Europe, but the neighborhoods where poor laborers lived were another matter entirely.
John Snow, who had been appointed by Killian as the head of the medical and nursing colleges, believed that this reality needed to be changed as quickly as possible. He emphasized the importance of hygiene in his education.
However, his theory ran completely counter to the doctrine that was regarded as truth in the British medical world at the time.
Naturally, the moment his lectures began, they caused enormous waves within the British medical community.
"Countless diseases spread through London every day, pushing people into suffering. The authorities and the health committee have made their preparations, but unfortunately, if we look only at the results so far, it is difficult to say they have achieved great success. Why do you think that is?"
John Snow asked the nursing students attending his class once again.
"I'm not asking for a perfect answer, so do not feel pressured. Speak freely."
Even so, no one responded.
John Snow let out a small sigh and pointed to a female student sitting in the front row.
"You there, student. What is your name?"
"Florence Nightingale, sir."
"Yes, Miss Nightingale. Why do you think epidemics continue to grow larger rather than being eradicated, despite the health committee's constant efforts?"
"I believe it is because the fundamental sanitation of the city has not improved. No matter how much attention is given to cleaning wealthy districts, diseases ultimately arise in filthy places. As long as such unsanitary districts remain in London, these epidemics will inevitably continue."
"A good observation. But we must consider what the essence of hygiene truly is. Valuing hygiene is good, but if the direction is wrong, no matter how much money or manpower is invested, the results will remain inadequate. Now, everyone, look here."
John Snow began writing a series of epidemic-prevention guidelines on the blackboard—rules published by the health committee and by The Lancet, the British Empire's most prestigious medical journal.
"The common argument here is obvious. Disease spreads through foul air and bad odors. This is the miasma theory. At present, this theory dominates the medical world almost like an absolute law."
Snow's slightly sarcastic tone made Florence Nightingale tilt her head.
As far as she knew, the miasma theory was already treated as unquestionable truth in medicine.
"But logically, this theory has too many flaws. The reason epidemics continue to spread through London is that the authorities invest money in the wrong places and fail to present a fundamental solution."
"Professor! But hasn't the miasma theory been proven correct in many cases? When I volunteered as a medical assistant, we always began by cleaning the patients' rooms thoroughly, and it always produced excellent results."
"Miss Nightingale, when you cleaned the patient's surroundings, did you do it to eliminate foul odors?"
"Yes. I believed that if foul air entered a patient's lungs it could cause illness, so I cleaned the surroundings to prevent any dirty air from spreading."
"Cleaning a patient's surroundings is always the correct choice. But we must ask ourselves whether the patient improved because the smell disappeared—or because something else disappeared when the environment was cleaned."
Florence Nightingale was not fully convinced, but since her own theoretical understanding was still developing, she decided to continue listening to her professor.
"Let me give an example. Gases that directly affect the human body tend to produce the same symptoms in everyone. Anesthetic gas is a good example. When it enters through the nose, people generally show the same reactions. The same applies to gases that suffocate people.
"But foul odors are different. If odors truly carried disease like anesthetic gases, why would illnesses manifest differently from person to person? And cholera—one of the representative diseases said to spread through miasma—why does it destroy the digestive system instead of the respiratory system?"
"..."
"And if foul smells are truly the root of disease, then why are London's street cleaners still alive and well? Doctors who believe in the miasma theory cannot provide a proper explanation for this. That is why I—"
Bang!
"You madman, John Snow! What in the world do you think you are doing in an educational institution touched by the Royal Family?!"
Before Snow could continue, the classroom door burst open and a group of middle-aged men stormed inside.
"Well, well. Quite a large delegation. But did you obtain permission before entering the school?"
"We can worry about that later! Stopping your madness comes first! Do you even realize what you're doing?"
"I'm more curious whether you gentlemen realize what you're doing. You've entered an educational institution founded by His Highness and are disrupting a class. If I call the police, who do you think they'll arrest?"
"Enough of this nonsense. Do you know who this gentleman is? This is Mr John Simon, the distinguished physician of King's College London and the newly appointed Chief Medical Officer of London! Disrupting a class? This is legitimate work carried out by the health committee responsible for the city!"
"So someone must have reported the lecture I gave to the medical students last time. But I already received permission from His Highness, the founder of this institution, to teach whatever I deem appropriate. If you have objections, take them up with him."
Looking around, Snow recognized the group.
John Simon, the head of London's public health administration.
Members of the health committee.
Even editors from the medical journal The Lancet.
Quite an impressive gathering of accusers.
In truth, Snow had anticipated something like this ever since Killian had asked him to become an educator.
At present, John Snow denying the miasma theory in Britain's medical world was no different from Galileo denying the geocentric theory.
"His Highness surely never imagined you would teach such madness! If you alone wish to believe such nonsense, we would not interfere. But if you inject these dangerous ideas into future doctors and nurses responsible for London's health, have you considered the harm this could cause to society?"
"Then society will gain a generation of young medical professionals equipped with a proper theory."
"You truly understand nothing, John Snow! That's not what will happen!"
"Enough. If you continue making noise, I'll call the police. Either leave now, get dragged out by the police, or go complain to His Highness and demand my dismissal. I still have a class to teach."
"You stubborn lunatic… very well! We will report this directly to His Highness and recommend that you be dismissed!"
Just as the uninvited guests turned to leave—
"If you have something to say, say it here."
A voice as cold as ice echoed through the corridor, followed by heavy footsteps.
"..."
"Who… could it be?"
No one had heard any notice that he would come today.
When they saw the figure who had suddenly appeared, everyone's eyes widened.
Members of the committee froze in place.
The nursing students hurriedly stood and bowed their heads.
Even John Simon.
Even John Snow.
Standing there—the founder of this institution and one of the figures representing the Royal Family of this nation—
Was Killian Gore Hanover, Prince Consort of the British Empire.
* * *
"Explain to me what this disturbance is, during sacred class hours."
At Killian's icy tone, the committee members flinched and looked toward their representative, John Simon.
Forced to speak, Simon awkwardly began.
"As the man responsible for London's public health, I received reports that John Snow was teaching material that could overturn London's entire medical system. I came urgently to verify the matter."
"Overturn London's medical system? How so?"
"He is denying the established miasma theory and spreading an unverified and bizarre theory instead…"
"I already heard John Snow's explanation beforehand and judged it reasonable. I gave permission myself. Are you blaming me?"
"Wh—what? No, Your Highness! That is not my intention. I only thought that John Snow might have misrepresented the facts to persuade you—"
"John Snow once served as physician to Her Majesty the Queen. Are you suggesting that the Royal Family is a group of fools deceived by a fraudulent doctor?"
The committee members' faces turned pale.
They quickly stepped away from Simon, shaking their heads frantically.
"Of course not! That is not what we meant…"
"And if you had disagreements, you could have submitted them after the lecture ended. Instead, you humiliated the man I appointed in front of countless students. That appears quite intentional."
Killian's irritation was obvious.
He had brought a guest here to show off the British Empire's advanced medical system, only for this farce to unfold.
"In another place I might overlook this. But to behave so arrogantly in a royal institution bearing both my name and Her Majesty's… I did not realize the British health authorities wielded such power. Must I seek your permission to run my own institution in the future?"
"N-No, Your Highness! That is not the case! The current situation is unstable, and we acted rashly in hopes of preventing greater disorder. We sincerely apologize!"
"Unstable situation? What do you mean?"
Simon glanced at the others, who nodded in agreement.
He took a deep breath and spoke quietly.
"It appears that cholera has broken out in London. It is not yet confirmed whether it will develop into a major outbreak. All available personnel are investigating. We intended to report it to the government tomorrow, but when we heard that John Snow was teaching material that completely rejects the official containment guidelines…"
"…Cholera?"
The great cholera epidemic of London was famous in modern history as an event of the 1850s, but outbreaks had appeared repeatedly since the 1840s.
Given the cause of cholera, it was entirely possible that London—whose industrialization had accelerated because of Killian's influence—would experience a major outbreak even sooner.
That was why Killian had asked Jacob Rothschild to fund a complete overhaul of London's sewer system.
He hadn't expected the epidemic to appear before construction even began.
Behind him, Otto von Bismarck muttered worriedly.
"I heard that in Russia a cholera outbreak killed hundreds of thousands…"
Hundreds of thousands in Russia?
If this crisis were stabilized quickly, it would prove that the British Empire's response capability was on an entirely different level.
After a moment of thought, Killian clicked his tongue lightly.
"The situation was urgent. Your judgment may have narrowed as a result. I will not hold you responsible."
"R-Really, Your Highness?"
"However, to prevent such matters from repeating, perhaps we should settle this dispute once and for all."
"Settle it…?"
Killian turned to John Snow, whose expression had already changed completely upon hearing the word cholera.
"Let us provide an opportunity to prove whether John Snow's theory is false or not. You may continue your own work without interference—I will not use your manpower or resources. When this cholera crisis ends, the correct theory will reveal itself naturally. John Snow, can you do it?"
"With your support, I will answer with results."
"Good. But you cannot do it alone. You will need an assistant."
Killian glanced around the classroom.
A suitable candidate was sitting in the front row.
"Miss Florence Nightingale, assist Professor John Snow so that his theory can be properly tested."
"M-Me…?"
"You only need to follow Professor Snow's instructions. Watching and experiencing this firsthand will help you become an excellent nurse."
The health committee clearly had many objections, but none dared voice them.
After all, Killian had already declared he would not use their personnel or budget.
So what could they possibly say?
Modern epidemiology's pioneer John Snow.
Modern nursing's founder Florence Nightingale.
Versus the London health authorities who still believed in the miasma theory.
The outcome of this contest was so obvious that Killian almost felt disappointed.
Still—
When this was over, the British Empire's medical system would leap forward once again.
Unlike Russia, which had lost hundreds of thousands to cholera, Britain would suppress the epidemic with minimal casualties.
And the reputation of Killian and his medical corps would rise even higher.
In the end, it would save the lives of countless British civilians and soldiers.
Quietly, Killian offered his thanks to the health committee—
For willingly laying themselves down as the stepping stone that would make it possible.