The Ghost Map, by Steven Johnson

36086Some of the things we know now about medicine—hygiene prevents illness, the four humours are bunk, mercury doesn’t cure anything—seem so simple that medical history would be laughable if it hadn’t been so deadly. It’s easy to forget that it took us thousands of years to get to where we are*. Steven Johnson’s The Ghost Map: The Story of London’s Most Terrifying Epidemic is one chapter (a 320 page chapter) in the journey humanity has taken from curing insanity by drilling holes in people’s skulls to modern medicine.

Filippo Pacini was the first person to see the Vibrio cholerae bacillus in 1854. That same year, an epidemic broke out in London that claimed more than 600 hundred lives. Some Soho streets lost up to 12% of their population that fall. At the time, the predominant theory about how cholera and number of other diseases and ailments were spread was the miasmatic theory. “Bad air” would settle in a location and poison the people there. Dr. John Snow, a physician who pioneered the use of ether and chloroform, had another theory. He believed that the only explanation for the spread of cholera was contaminated water.

The Ghost Map tells the story of Snow’s attempts to trace the path of cholera during the 1854 Broad Street outbreak and change the minds of the entire British medical field. Johnson discusses Snow’s various strategies: interviews with survivors, reviewing mortality reports, and mapping sewer and water pipes. Snow’s case is overwhelmingly convincing to the modern reader. It’s stunning how his fellow physicians fought to vigorously to uphold the theory of miasmas in the face of so much patiently collected evidence.

Snow is not the only one pursuing the truth of cholera’s transmission. A curate who lived near Broad Street (the point of origin of the epidemic) named Henry Whitehead provided some crucial evidence by finding the “index case”—the first person known to have the disease at the start of an epidemic.

A memorial to John Snow a few blocks from
the site of the original Broad Street pump,
the point of origin for the 1854 outbreak.

Johnson’s account of the state of medicine in 1854 and the outbreak is painfully detailed. I wrote a post yesterday about how repetitive it is. This may have been because I listened to The Ghost Map instead of reading it. Hearing it aloud may have brought all the reiteration to my attention. At any rate, I can easily see readers’ eyes glazing over a various points in this book; it really could have used it’s own decimation. That said, however, I found it fascinating just how much Snow and Whitehead learned about how cholera spread from a single contaminated water pump throughout a neighborhood. Through their actions, the Broad Street pump was disabled and the immediate vector cut off. The 1854 outbreak took hundreds of lives, but it wasn’t unusual for Nineteenth century epidemics to kill thousands. Snow and Whitehead saved untold lives.

The Ghost Map absolutely captures the mood of the time. Before the disease was understood, cholera (and a number of other afflictions) seemed to come out of nowhere—or possibly from the next ominous looking cloud, depending on who one believed. Vibrio cholerae is a violent illness, capable of killing its victims within hours in a particularly gruesome manner. Shortly after I started listening to the book, as I heard Johnson describe how the disease kills people, I started to feel very, very thirsty. At the same time, I didn’t want to go get a drink of water because that’s where the cholera comes from. (Funny enough, as I sit here writing this post, I’m drinking a big glass of tap water. Filtered, of course.)

A note about the narration: Alan Sklar narrated the audiobook version of The Ghost Map I got from Sklar has a pleasingly deep voice and a good rhythm. Unfortunately, he’s also a very breathy reader. In the Audible edition, he can be heard sucking in breath before resuming his narration. He also mispronounces a few British place names, which I found jarring.

* If you’d like to learn more about the history of medicial, with special emphasis on the bizarre and misguided, I cannot recommend Sawbones highly enough. It is brilliant.

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