Ghost Map

This book delves—in a pop-scientific way—into the 1850s cholera outbreak in London, England. This was at a time when cholera wasn't in the medical books and thoughts about miasma were flounced about by so-called medical professionals.

Johnson is very good at providing ample background information to whatever happens during this book, for example, the following two paragraphs:

Water closets were a tremendous breakthrough as far as quality of life was concerned, but they had a disastrous effect on the city’s sewage problem. Without a functioning sewer system to connect to, most WCs simply flushed their contents into existing cesspools, greatly increasing their tendency to overflow. According to one estimate, the average London household used 160 gallons of water a day in 1850. By 1856, thanks to the runaway success of the water closet, they were using 244 gallons.

But the single most important factor driving London’s waste-removal crisis was a matter of simple demography: the number of people generating waste had almost tripled in the space of fifty years. In the 1851 census, London had a population of 2.4 million people, making it the most populous city on the planet, up from around a million at the turn of the century. Even with a modern civic infrastructure, that kind of explosive growth is difficult to manage. But without infrastructure, two million people suddenly forced to share ninety square miles of space wasn’t just a disaster waiting to happen—it was a kind of permanent, rolling disaster, a vast organism destroying itself by laying waste to its habitat. Five hundred years after the fact, London was slowly re-creating the horrific demise of Richard the Raker: it was drowning in its own filth.

London's population exploded in size and nearly in crises; finding housing for everyone is one thing, but to try and keep sickness away proved impossible, especially when one considers that words from people who belonged to clerical professions carried the most heft where it came to matters medical (and scientific).

Descriptions of how cases of cholera broke out are detailed:

All that history would have weighed like a nightmare on Mr. G, as his condition worsened on Thursday. He may have begun vomiting during the night and most likely experienced muscle spasms and sharp abdominal pains. At a certain point, he would have been overtaken by a crushing thirst.

But the experience was largely dominated by one hideous process: vast quantities of water being evacuated from his bowels, strangely absent of smell and color, harboring only tiny white particles. Clinicians of the day dubbed this “rice-water stool.” Once you began emitting rice-water stools, odds were you’d be dead in a matter of hours. Mr. G would have been terribly aware of his fate, even as he battled the physical agony of the disease. One of cholera’s distinctive curses is that its sufferers remain mentally alert until the very last stages of the disease, fully conscious both of the pain that the disease has brought them and the sudden, shocking contraction of their life expectancy.

The Times had described this horrifying condition several years before in a long feature on the disease: “While the mechanism of life is suddenly arrested, the body emptied by a few rapid gushes of its serum, and reduced to a damp, dead…mass, the mind within remains untouched and clear,—shining strangely through the glazed eyes, with light unquenched and vivid,—a spirit, looking out in terror from a corpse.”

By Friday, Mr. G’s pulse would have been barely detectable, and a rough mask of blue, leathery skin would have covered his face. His condition would have matched this description of William Sproat from 1831: “countenance quite shrunk, eyes sunk, lips dark blue, as well as the skin of the lower extremities; the nails…livid.” Most of this is, to a certain extent, conjecture.

But one thing we know for certain: at one p.m. on Friday, as baby Lewis suffered quietly in the room next door, Mr. G’s heart stopped beating, barely twenty-four hours after showing the first symptoms of cholera. Within a few hours, another dozen Soho residents were dead.

This book almost turns into a complete hagiography where John Snow is concerned. He is the main character in this non-fiction book, which is nearly written in the way that a modern-day crime novel is: Snow's from a poor background, studied hard, worked his way up, and could have lived a relatively cozy existence as the man who started out modern-day anesthesiology. John Snow didn't do that.

Instead, he started looking into what was killing thousands of people and what the source of it could be, much like any modern-day forensic investigation could ramble along.

The idea of microscopic germs spreading disease would have been about as plausible as the existence of fairies to most practicing doctors of the day. And as Surgeon-in-Chief G. B. Childs’ letter-writing campaign to the Times suggested, laudanum was regularly prescribed for almost any ailment. The Victorian medical refrain was, essentially: Take a few hits of opium and call me in the morning.

This book is an easy read. I'm not one for pop-scientific books with oodles of fact, being nerdy in the extreme, but in spite of its monograph value, this book won me over, mainly through Johnson's style and well-written prose.

This is an analyst's book. It's divided into clear chapters and goes finely into details. There's not much flair over Johnson's writing, in a good way, which is apt, considering his near-dry British way of going over things; he walks the line between terse humour and in-depth medical detail in commendable ways.

This book delves—in a pop-scientific way—into the 1850s cholera outbreak in London, England. This was at a time when cholera wasn't in the medical books and thoughts about miasma were flounced about by so-called medical professionals.

Johnson is very good at providing ample background information to whatever happens during this book, for example, the following two paragraphs:

Water closets were a tremendous breakthrough as far as quality of life was concerned, but they had a disastrous effect on the city’s sewage problem. Without a functioning sewer system to connect to, most WCs simply flushed their contents into existing cesspools, greatly increasing their tendency to overflow. According to one estimate, the average London household used 160 gallons of water a day in 1850. By 1856, thanks to the runaway success of the water closet, they were using 244 gallons.

But the single most important factor driving London’s waste-removal crisis was a matter of simple demography: the number of people generating waste had almost tripled in the space of fifty years. In the 1851 census, London had a population of 2.4 million people, making it the most populous city on the planet, up from around a million at the turn of the century. Even with a modern civic infrastructure, that kind of explosive growth is difficult to manage. But without infrastructure, two million people suddenly forced to share ninety square miles of space wasn’t just a disaster waiting to happen—it was a kind of permanent, rolling disaster, a vast organism destroying itself by laying waste to its habitat. Five hundred years after the fact, London was slowly re-creating the horrific demise of Richard the Raker: it was drowning in its own filth.

London's population exploded in size and nearly in crises; finding housing for everyone is one thing, but to try and keep sickness away proved impossible, especially when one considers that words from people who belonged to clerical professions carried the most heft where it came to matters medical (and scientific).

Descriptions of how cases of cholera broke out are detailed:

All that history would have weighed like a nightmare on Mr. G, as his condition worsened on Thursday. He may have begun vomiting during the night and most likely experienced muscle spasms and sharp abdominal pains. At a certain point, he would have been overtaken by a crushing thirst.

But the experience was largely dominated by one hideous process: vast quantities of water being evacuated from his bowels, strangely absent of smell and color, harboring only tiny white particles. Clinicians of the day dubbed this “rice-water stool.” Once you began emitting rice-water stools, odds were you’d be dead in a matter of hours. Mr. G would have been terribly aware of his fate, even as he battled the physical agony of the disease. One of cholera’s distinctive curses is that its sufferers remain mentally alert until the very last stages of the disease, fully conscious both of the pain that the disease has brought them and the sudden, shocking contraction of their life expectancy.

The Times had described this horrifying condition several years before in a long feature on the disease: “While the mechanism of life is suddenly arrested, the body emptied by a few rapid gushes of its serum, and reduced to a damp, dead…mass, the mind within remains untouched and clear,—shining strangely through the glazed eyes, with light unquenched and vivid,—a spirit, looking out in terror from a corpse.”

By Friday, Mr. G’s pulse would have been barely detectable, and a rough mask of blue, leathery skin would have covered his face. His condition would have matched this description of William Sproat from 1831: “countenance quite shrunk, eyes sunk, lips dark blue, as well as the skin of the lower extremities; the nails…livid.” Most of this is, to a certain extent, conjecture.

But one thing we know for certain: at one p.m. on Friday, as baby Lewis suffered quietly in the room next door, Mr. G’s heart stopped beating, barely twenty-four hours after showing the first symptoms of cholera. Within a few hours, another dozen Soho residents were dead.

This book almost turns into a complete hagiography where John Snow is concerned. He is the main character in this non-fiction book, which is nearly written in the way that a modern-day crime novel is: Snow's from a poor background, studied hard, worked his way up, and could have lived a relatively cozy existence as the man who started out modern-day anesthesiology. John Snow didn't do that.

Instead, he started looking into what was killing thousands of people and what the source of it could be, much like any modern-day forensic investigation could ramble along.

The idea of microscopic germs spreading disease would have been about as plausible as the existence of fairies to most practicing doctors of the day. And as Surgeon-in-Chief G. B. Childs’ letter-writing campaign to the Times suggested, laudanum was regularly prescribed for almost any ailment. The Victorian medical refrain was, essentially: Take a few hits of opium and call me in the morning.

This book is an easy read. I'm not one for pop-scientific books with oodles of fact, being nerdy in the extreme, but in spite of its monograph value, this book won me over, mainly through Johnson's style and well-written prose.

This is an analyst's book. It's divided into clear chapters and goes finely into details. There's not much flair over Johnson's writing, in a good way, which is apt, considering his near-dry British way of going over things; he walks the line between terse humour and in-depth medical detail in commendable ways.

When I lived in London, we had an assessment to do any leisure activity that you would not have otherwise done. My class partner and I decided to go through her oddities of London book, which landed us in the Jon Snow pub. Ever since, I've been enamored by Jon Snow. His story is not just one of life-saving epidemiology, but also the triumph of good science (germ theory!) over bad (miasmists) and real science (...still germ theory) over social prejudice. Steven Johnson would also have you believe that this story is about urbanism and the way that population density results in vulnerability (I think. More on that later.) So, pretty much no matter what you're into, this is one of the coolest stories in Western history.

And Johnson just destroys it. I spent a lot of time thinking about how this went wrong. I read a lot of popular science, and there's some classical ways to mess it up: oversimplifying to the point of boredom, getting too bogged down in the details, getting attached to a pet theme, etc. Johnson does none of those. In fact, if I were to describe the content of the book, it would seem perfect. In addition to the science, Johnson explores how contemporary science and the politics therein reacted to this discovery and opposed it, how the friendship developed between the disparate Snow and Whitehead and how Whitehead's better social skills improved his ability to really test the hypothesis well. Those sorts of themes were key to my enjoyment of Johnson's the Invention of Air, which is one of the best history of science books I've ever read.

First, I thought there was something innately boring about the discussion of Victorian sewage. But I'm the sort of person who loves pedantic details and I have enough medical training that I am unimpressed by extensive discussion of unmentionable topics. I think there was just no organization to what was happening. And as a result, every 25 pages or so, for no clear reason, Johnson would start repeating one of his key themes, not really apropos of anything but because it had been a long enough time since a central thesis that I think he forgot what he'd already said.

The other problem was that the backend of the book was a mess. After an extremely in-depth exploration of very specifically the broad street pump outbreak of cholera, Johnson tries to expand to discussing urbanism in general and his thoughts are completely discombobulated. Included within this chapter are: But urbanism is good for the environment even though no one used to believe that, and Johnson and his family certainly will live in a city and he loves cities and this is the global city, but urbanism is bad if there is terrorism and terrorism is relevant because it could be bioterrorism, but vaccines will work against bioterrorism and they won't work against conventional terrorism, so it'll probably be a bomb and also, there's this idea of mutually assured destruction but what if a lone actor gets their hands on a nuclear bomb? With about that degree of organization between thoughts.

All of this disorganization happening at the end of a reasonable chapter about how Jon Snow made a physical map to prove his point, which Johnson used as an opening to discuss how critical graphics are in science and then did not include said map. And yes, it's 2017 and I had a smart phone handy to google it, but come on.

(This book is shockingly dry, given that its about a water pump.)

This book tells the story of an outbreak of cholera in London in 1854 which killed 616 people. At the time, the accepted theory was that bad air (miasma) caused disease. London stank to high heaven from the infrequently emptied cesspits, which keep this plausible. Physician John Snow thought cholera was spread by contaminated water, but wasn't convincing anyone. He investigated this outbreak, and became convinced that the Broad Street pump was the source of the infection. He managed to sway the local parish into removing the pump handle. The "Ghost Map" is the map of the area, showing the location of the pump and how the pattern of deaths (ghosts) clusters around the pump. I'd heard about this before, with the story that his persuasive map and clear data won the day. Johnson's book explains how it swayed the one parish's leaders, but actually didn't overturn the orthodoxy for some time. Lots of fascinating details about Victorian life. The last chapter is speculation about the future of cities, which struck me as a lot of blowing smoke.

Feb 9

The general consensus was that it was an interesting story and that we all learned a great deal, but that the book wasn't particularly well written, and ought to have been edited down quite a bit. There was quite a bit of repetition, and the final chapter seemed to have come from somewhere else entirely and been tacked on simply to make the book thicker. We psychoanalyzed the two main characters, deciding that Whitehead was the 19th century equivalent of a social worker, while Snow might have had Asperger's.

Feb 23

The book was better received than it was two weeks back. Nearly all of us were city dwellers, but a huge swath of us were also followers of Jane Jacobs. So the discussion tended to veer away from Victorian England and the use of scientific method to urban planning, and the health and environmental impact of country vs. city living. And is the new fad of hand sanitizers everywhere really helping?