"The Ghost Map" by Steven Johnson

"IT IS AUGUST 1854, AND LONDON IS A CITY OF SCAVENGERS."

Historian Steven Johnson  begins his study of the 1854 cholera epidemic, The Ghost Map, with a description of the many names and activities of the poor people who picked up the various waste products from 2,000,000 inhabitants of the growing city of London. The focus on these workers is important because cholera is a disease of filth, but the Londoners didn’t have a clue of how to clean up their city to defeat the disease, either by treating patients or by stopping the transmission to new victims.

The Ghost Map, published 2006.

What caused cholera, a terrible and often fatal disease, to infect large numbers of people suddenly and without warning? Johnson's history describes the dedicated quest of the now-famous Dr. John Snow to discover the cause, which turned out to be well water that was contaminated with cholera bacteria. In 1854, the scientific establishment had other theories, all of them wrong and likely to lead to missteps in public health measures. John Snow's insights and diligent research slowly over time became accepted wisdom, and cholera epidemics could thus become a horror of the past.

The specifics of Snow’s observations, as described in the book, led him to identify the most severely contaminated well from which the main number of victims had drunk. It led him to find the breach that caused a cesspool to seep its noxious contents into the well, to show that one cholera victim — the index case — had contaminated that particular cesspool. Snow’s scientific knowledge and reasoning led to his theory that victims would have ingested the infectious agent rather than having breathed foul air as most experts then believed.

Johnson describes Snow’s actions to find the victims and identify the source in great and fascinating detail. He also explains the struggle to convince the authorities of the correct explanation, and to take action to prevent further contamination — famously removing the pump handle from the poisoned well. Despite the outcome being known, the narrative is amazingly suspenseful.

Snow struggled for recognition, and in so doing he created a new scientific method and approach to public health and its response to epidemics. He wrote up his findings in particularly effective ways, particularly in creating a map showing the way cholera cases were distributed in London. (For a quick summary of the map, see this site: Maps of the 1854 Broad Street Pump Outbreak).

Obviously, reading the story of this quest for understanding and success at better public health inspires many thoughts of the current pandemic. Right now, we share the fear and desperation of the Londoners despite our better understanding of microorganisms that cause disease.

This book has been widely reviewed since its publication over a decade ago, so I am not going to do further reviewing. I found the following quotations especially interesting in connection with our current circumstances:

"Most world-historic events— great military battles, political revolutions— are self-consciously historic to the participants living through them. They act knowing that their decisions will be chronicled and dissected for decades or centuries to come. But epidemics create a kind of history from below: they can be world-changing, but the participants are almost inevitably ordinary folk, following their established routines, not thinking for a second about how their actions will be recorded for posterity. And of course, if they do recognize that they are living through a historical crisis, it’s often too late— because, like it or not, the primary way that ordinary people create this distinct genre of history is by dying." The Ghost Map (p. 32).

"You have to be a committed libertarian or anarchist to think that the government shouldn’t be building sewers or funding the Centers for Disease Control or monitoring the public water supply."  (p. 113).

"When the next great epidemic does come, maps will be as crucial as vaccines in our fight against the disease. But again, the scale of the observation will have broadened considerably: from a neighborhood to an entire planet." (p. 219).

In a way this is a very depressing book about the terrible suffering of the Londoners in the cholera epidemic, and about the difficulty Snow had of changing the minds of his fellow medical professionals. In a way, though, it’s also an upbeat book because it gives the reader a sense that humans can open their minds to new ideas that create better lives for people. I have hope that we might now take advantage of scientific understanding to get control of the pandemic that’s currently destroying so many lives. I’m not sure our rationality will triumph over the climate disaster that at the moment is causing vast wildfires in the west, hurricanes in the south, and impending problems throughout the globe. I fear that this book’s optimism will not be sustained.

blog post by mae sander © 2020.