Johnson, Steven. The Ghost Map: The Story of London’s Most Terrifying Epidemic—And How It Changed Science, Cities, and the Modern World, 2006.
A popular science writer and former distinguished writer in residence in NYU’s school of journalism, Steven Johnson has produced a page-turner that tells the tale of London’s 1854 cholera outbreak. Johnson’s book has four protagonists: the city of London, the bacterium that caused the outbreak, and two men—the doctor John Snow and clergyman Henry Whitehead. In Johnson’s hands, this story encapsulates science’s victory over superstition and marks the point at which it became realistic to believe urban centers like London could survive and thrive, not just in spite of, but perhaps because of their size. If you can manage to get past Johnson’s occasional religious biases, you’ll get something out of the book.
Before modern infrastructure, big cities survived because of an impersonal division of labor.
London was already a miracle before Snow and Whitehead helped solve the 1854 cholera outbreak. It was a 19th Century city with a 16th Century infrastructure. Two and a half million people lived in a 30-mile radius, and all those people generated a lot of waste. Without anything close to an organized health department, the city’s indigent made do with doo-doo. People harvested bones, collected animal waste, and rescued metals and other treasures from sewage, contributing to an underground economy that kept the city functioning. The living conditions of these men and women were deplorable—it was proletariat workers like that that Friedrich Engels would have observed and written about in The Communist Manifesto—and it is of course the proximity of all that waste to London’s drinking water that hastened the cholera outbreak.
But these workers’ ingenuity and resourcefulness reveals something vital about the human spirit for these scavengers were not working alone. No single scavenger could have made the connections necessary to help build a market based on mining waste. Short of attributing this behavior to basic survival instincts, Johnson doesn’t really have an explanation as to why the London poor would work like this. The London living conditions described in the first chapter also predict this story’s really captivating heroes: Snow and Whitehead. Neither were part of an official governmental task force assigned to diagnose the outbreak’s causes. They worked as more or less independent agents and found each other not through governmental connection but through providence. Johnson admits that the modern city’s saving grace is that it allowed disconnected men like Snow and Whitehead to find one another. This kind of spontaneous cooperation was something London’s citizens exhibited even before the outbreak.
Past errors can be as instructive as past achievements.
If the book tells the victory of science over superstition, the book’s great villain is not religion but pseudo-science, particularly the miasma theory. This theory held that cholera was spread via the air and that the areas of the city most liable to contamination were the ones that smelled the worst. Germs were unknown to even the best doctors, and an 1854 microscope could not detect the tiny cholera bacteria in any way that would help a scientist definitively determine the truth that the disease was water-borne.
The outbreak detailed here of course afflicted the struggling denizens of Broad Street, a neighborhood that smelled particularly bad. From August 31 to September 10, 1854, over 500 people had died from cholera. Contaminated sewage from a cesspool infected drinking water, and when a little girl named Baby Lewis contracted the illness, her unsuspecting mother put the child’s lethal evacuations back into the drains which fed the water pump which then infected more people. Ironically, the cure for cholera is hydration. Death usually resulted from the infected patients losing their bodily fluids so rapidly that major organ shutdown was inevitable.
Johnson analyzes why miasma theory was both popular and hard to topple. Social prejudice, ideology, and biology all played a part in leading town officials to seek methods of treating the outbreak that only obscured the real cause. The problem was not that the miasma hypothesis could not be conclusively proven. John Snow’s case for cholera being something patients ingested lacked the concrete proof a 21st Century patient would demand. It was “the tenacious, unquestioning way” miasma advocates “went about being wrong” (125). Chief among these advocates was Edmund Chadwick, the man responsible for spearheading the Poor Laws of 1832 and the Public Health Act of 1848. On the one hand, Johnson approves of Chadwick for the part he played in establishing “the modern conception of government’s proper role” in public health and welfare (113). On the other, Chadwick demonstrated how poorly administered government authority, even when motivated by good intentions, can end up further endangering people’s lives.
While breakthroughs like the one achieved by Snow and Whitehead deserve examination, so too do the “perfect storm[s] of error” against which men like Snow and Whitehead triumphed (126).
Snow demonstrates that how information is presented is as important as the information itself.
By 1854, Snow was at the height of the London medical profession. The son of a working-class laborer, Snow had become one of the nation’s preeminent physicians on the basis of his research into and surgical use of ether and chloroform. In fact, he had in 1853 helped deliver the eighth baby of Queen Victoria, who was extremely grateful for chloroform’s effects. Yet, despite his reputation, Snow was rejected out of hand by his peers when he proposed that cholera was contracted not through something people breathed but through something they ingested, likely water. As a result, Snow was left on his own to martial evidence for his claims, spending time going door to door in the aftermath of cholera outbreaks to gain information. It was his research that located the Broad Street pump as the primary way the disease spread. He was able to trace the 500 victims back to one water source.
But two questions remained. If the pump could positively explain why certain people had gotten sick, what about the other people in the neighborhood who hadn’t gotten sick? That is, Snow had not yet accounted for the survivors It was only with the help of Henry Whitehead, a local clergyman, that Snow’s theory gained validity, for as Whitehead discovered, every single other person in the Broad Street area who had survived had a different source of drinking water. Now, the evidence not only led back positively to one water source, it also showed how a different water source could prevent contracting cholera.
The other more important question was how to communicate his discovery to his peers. Snow wrote frequent letters to The Observer and London Medical Gazette, but nothing he wrote made as much impact as the ghost map he constructed then presented to the Epidemiological Society in December 1854. The map showed the broad street pump and black bars representing the 500+ deaths radiating out from that pump like ripples in a pond. In Johnson’s words, the map was groundbreaking because it “wedded state-of-the-art information design to a scientifically valid theory” (194). It was so convincing that the local Vestry Committee to remove the Broad Street water pump to prevent others from drinking the contaminated water, the first time a government body had acted on the water-borne theory, and provided a bird’s eye view of the tragedy for future generations.
This story cannot be told in a religiously neutral way.
The character in this drama who Johnson has worked the hardest to rescue from the dustbin of history is Anglican minister Henry Whitehead. Snow couldn’t have succeeded without Whitehead’s local knowledge and ability to not just confirm Snow’s premise about the Broad Street pump but also chase down the water sources of the people who had managed to survive the outbreak. If Snow was an amateur in the sense that determining the cholera outbreak was not his official job, then Whitehead was a true amateur, someone who helped solve a mystery outside his . His own parish had lost the most lives in that deadly September. Henry Whitehead’s Christian devotion and pastoral care, then, motivated his contribution to uncovering the outbreak’s root cause. He grieved for those who died and cared for those who remained.
Whitehead is thus an awkward figure in the book. Johnson obviously thinks he’s important, but as a member of the clergy, Whitehead seems to test Johnson’s own theory that this story features science’s triumph over superstition. Now, religion and superstition are not necessarily the same thing, yet Johnson seems to equate them. To Johnson, they are both dogmatic, biased, and distracting. Thus, miasma theory was “compatible with religious tradition,” and he criticizes Henry Whitehead for believing that cholera outbreaks were God’s will. Johnson makes it seem like Whitehead’s theology hampered him, that his admirable scientific skills ran counter to his faith.
I would counter that Whitehead was not schizophrenic, that in his belief in service to the sick and in his commitment to an ordered, predictable universe subject to scientific testing, he was simply living out his faith.
Johnson’s clear writing helps give faces and names to the blank statistics of the 1854 outbreak, yet he fails to address the outbreak as a moral tragedy. Given Johnson’s evolutionary interests, it seems this story is merely interesting, a case where random mutation gave humanity a superior edge over bacteria. Even on Johnson’s own terms this superiority is illusory. Johnson labels Snow’s resistance to miasma theory as overdetermined in the same way that Chadwick and his followers were overdetermined to believe in miasma theory. This subtle commitment to fatalism makes the book’s epilogue tonally odd. Johnson shifts from analysis of a past event to a 25-page assessment of the threats currently afflicting the world’s largest cities. His assessment? We can solve potential pandemics like bird flu but are vulnerable to nuclear attacks.
But Johnson provides no explanation for thinking we have the creative freedom or moral burden to work for the progress Snow and Whitehead achieved. He assumes it is part of the necessary progression of the evolutionary progress. Johnson’s book is itself a ghost map, one on which God’s mercy and providence can be read, if only by their pronounced absence.