BOOK REVIEW : Science in a Time of Cholera : THE DRUMMER WAS THE FIRST TO DIE: A Victorian Novel, <i> by Liza Pennywitt Taylor,</i> St. Martin’s Press, $19.95; 309 pages

Eighteen hundred and fifty-four wasn’t a good year to be sick anywhere. But if you happened to have a complicated pregnancy, needed a tumor removed or were in the grip of the intense gastrointestinal spasms of cholera, you would have been better off in the hands of London’s Dr. John Snow than in those of almost any physician in the world.

A prominent surgeon, Snow was an early advocate of the use of anesthetics, particularly chloroform, during surgery and childbirth.

He was also interested in epidemic disease and, toward the end of his abbreviated life (Snow died at the age of 44 of a kidney disease said to have resulted from self-experimentation with anesthetics), he became obsessed with discovering the source of cholera.

Cholera swept England periodically in the 19th Century, always starting in India and moving slowly westward to Europe and then to the Americas. There had been a severe epidemic in 1832 and another reached England in July, 1854.

The disease was obviously contagious. The question was: How?

As the epidemic raged, Snow set himself two tasks: he tirelessly tended the sick and dying, and he meticulously marked the houses and hovels where each case occurred on a London street map.

Rejecting the wisdom of medical colleagues who attributed the disease to some vague “miasma” in the air, or to the lax morals of the afflicted, Snow looked for evidence that cholera was caused by a water-borne organism.

His map showed that cholera seemed to hop-skip houses on the same street. Seeking some common denominator, Snow discovered that different water companies had their own pipe lines in the same neighborhoods. He then filtered water samples from adjacent houses through silver nitrate.

Some of the samples showed large traces of salt--an indication of pollution with sea water. The salty samples all came from houses that contracted with a single supplier, the Vauxhall Water company. And these were the houses with cholera.

But cholera also raged where there was no piped water. On Broad Street, near Waterloo and Lambeth, Snow tracked down a single water pump as a locus of the dread disease. This pump was not drawing pure well water, but water contaminated by seepage from the Thames.

We know today that the cholera bacterium usually enters the human body through water, or food, contaminated by fecal matter from other cholera victims.

The installation of sewers and water treatment plants effectively ended epidemics in Western Europe and the United States by the end of the last century.

A marvel of epidemiological detective work, Snow’s contribution was ignored in his lifetime. But today he is medical legend.

Liza Pennywitt Taylor, a former AIDS researcher at UCLA, has skillfully fleshed out the historic Snow into a remarkable if somewhat unconventional hero in “The Drummer Was the First to Die,” a fictionalized romance.

The drummer of the title is an Indian musician who collapsed clutching his stomach while honoring the god Shiva in a fishing village off the coast of Malabar in January, 1854. Almost everyone else in the village also died by the end of the day.

Things weren’t much better down the road at the home of the British governor.

The only survivors there were Lillian Aynsworth, the governor’s not-so-young or -virginal daughter and her somewhat flighty stepmother. Lillian is the heroine of this novel.

Eager to leave India where she was doomed to spinsterhood, and suddenly an heiress, she sails for England. But she brings with her the baggage of more than one clandestine lover and a secret pregnancy--all of which will complicate her new life in a city where the cholera she thought she had left behind had gone ahead to greet her.

Miss Aynsworth soon meets John Snow. Of course they fall in love, and alone and together navigate the intricacies of London’s underworld (both figuratively in the persons of hired thugs, and literally in a chase through the tidal sewers).

Taylor has drawn a splendidly matched pair of eccentrics who pursue their separate quests for truth amid the familiar Victorian trappings of purloined letters, illegitimate offspring, visits to foul-smelling warrens of the poor and garish drawing-rooms of the rich.

Snow persists despite threats and scorn, while Lillian discovers that her fortune allows her to live and to love exactly as she chooses. Even in 1854, or perhaps especially in 1854, money bought respectability.

The story is filled with nuggets of scientifically accurate medical history.

Snow had administered chloroform to his queen at one of her “lyings-in,” and in so doing made the procedure acceptable despite the wrath of clergy who fought anesthesia as a kind of blasphemy, maintaining that the Bible decreed that women must labor in pain.

Taylor brings to life the sounds, sights and especially the smells (e.g., the tell-tale “cholera stink”) of a vanished era.

A timely book--for cholera is again at epidemic levels in parts of Latin America--”The Drummer Was the First To Die” makes a splendid read.