From 1807, the East End was supplied with water pumped from the River Lea at Bow by the East London Waterworks Company. This was not, however, the continuous flow of water we take for granted today. Dr John Simon wrote, in 1849, of the thousands who "wholly depend on their power of attending at some fixed hour of the day, pail in hand, beside the nearest standcock; where, with their neighbours, they wait their turn; sometimes not without a struggle, during the tedious dribbling of a single small pipe. Household rubbish was piled into heaps in the street and outdoor toilets drained into cesspits. The survey of sanitation in Bethnal Green made by Hector Gavin in 1848 paints a sorry picture. Knightly Court was typical of the streets he visited: "In it there are two privies in a beastly state, full, and the contents overflowing into the court. There is one dust reservoir. One stand-tap supplies the seven houses; two cases of severe typhus lately occurred here, one died."
This map of 1843 shows the distribution of sewers through the East End. They carried only surface water, contaminated with decayed rubbish from the streets and excrement from overflowing cesspits, and discharged it directly into the Thames - from which water companies pumped their drinking water.