From Steven Johnson, the dynamic thinker routinely compared to James Gleick, Dava Sobel, and Malcolm Gladwell, The Ghost Map is a riveting page-turner about a real-life historical hero, Dr. John Snow. It's the summer of 1854, and London is just emerging as one of the first modern cities in the world. But lacking the infrastructure—garbage removal, clean water, sewers—necessary to support its rapidly expanding population, the city has become the perfect breeding ground for a terrifying disease no one knows how to cure. As the cholera outbreak takes hold, a physician and a local curate are spurred to action—and ultimately solve the most pressing medical riddle of their time. In a triumph of multidisciplinary thinking, Johnson illuminates the intertwined histories and inter-connectedness of the spread of disease, contagion theory, the rise of cities, and the nature of scientific inquiry, offering both a riveting history and a powerful explanation of how it has shaped the world we live in.
Steven Johnson is the bestselling author of twelve books, including Enemy of All Mankind, Farsighted, Wonderland, How We Got to Now, Where Good Ideas Come From, The Invention of Air, The Ghost Map, and Everything Bad Is Good for You. He's the host of the podcast American Innovations, and the host and co-creator of the PBS and BBC series How We Got to Now. Johnson lives in Marin County, California, and Brooklyn, New York, with his wife and three sons.
WARNING: Do not read this review if you are squeamish. Or eating.
This book is about cholera, and as a result, the author uses an impressive number of words for shit--including excrement, ordure, human waste, and the Victorian euphemism night soil. And shit, of course.
Johnson explains that a key question in the development of civilization has always been "What are we going to do with all this shit?" This book dramatically improved my vocabulary regarding topics related to 1850s London. For instance:
miasmatist: someone who believes that bad-smelling air rather than germs or bacteria cause disease (Florence Nightingale was a miasmatist)
pure-finder: someone who finds dogshit and sells it to tanners to use in the leathermaking processs
mudlarks: children who scavenge junk that toshers don't want
scavenger classes: pure-finders, toshers, mudlarks, and others in the recycling business
rice-water stool: don't ask
Johnson's previous books have been about how the mind works, so Ghost Map is really more about how people map information and adapt to innovations than it is a straightforward history of a particular epidemic. He writes that cholera is "a supremely dark chapter in the book of death" and points out how wrong it is that people are still dying of this preventable, treatable disease.
I learned that this is not a good audiobook to listen to when cooking dinner. However, it is a great audiobook to listen to when cleaning. My kitchen and bathrooms have never been more thoroughly disinfected.
By turns thought-provoking and irritating, The Ghost Map meanders from its central story -- how an unorthodox physician found the source of a cholera epidemic that swept through London in 1854 -- into a host of other issues. Expecting a more straightforward account of the unraveling of this medical mystery, I set this book aside twice in frustration, bored with the author's tendency to stretch out the narrative, and particularly his repeated examination of the hold the "miasma paradigm" had upon medical minds in the mid nineteenth century. He can't seem to get over the fact that all manner of educated and otherwise reasonable people believed that disease was caused by noxious smells. His lengthy discussion of the bureaucratic obstacles faced by John Snow, the physician who linked cholera with contamination of drinking water with sewage, begins to wear thin about half-way through the book.
The Ghost Map certainly starts promisingly enough, with a description of Victorian London's hitherto unheralded "recyclers" - the "night-soil men," "mudlarks," rag-gatherers, bone-pickers and others who made a living scavenging in London's streets, rivers, and sewers. This is fascinating stuff -- who knew, for example, that such a person as a "pure finder" (dealer in dog shit, or "pure, which was used by tanners) existed? In this Dickensian world, an astonishing diverse array of second- (or third-) class citizens eked out a living on the margins.
From an examination of this nether world, Johnson then moves on to the slums of London, doing a crack-up job describing the cramped, horrid living conditions. He zeros in on one street and one family; a harried mother is caring for a sick infant, who eventually dies. The child suffers from virulent diarrhea and is wasting away. The mother washes the soiled diapers and tosses the dirty water in the cesspool just outside her door. The cesspool, in turn, oozes into a local well. The stage is set for the beginning of an epidemic.
Johnson is best when he describes this world, with its reeking slums. But he is inclined, frequently, to hare after philosophical questions, not the least of which is mankind's inability to see beyond the dominant scientific paradigms of the time. This bogs the narrative down. While Johnson has many interesting ideas and speculations, it's tiring to be taken on so many unresolved side journeys. It's not quite so interesting, for example, to read (at length) of John Snow's battles with pig-headed authorities, who are blind to the obvious link that Snow establishes between one particular source of contaminated water and the cholera epidemic. Nor was I particularly enthralled to read the minutia of Snow's statistical analysis he built for his case. Johnson also seems inordinately fond of the idea of a "map" as a grand organizing theme, one which he stretches out well past the 19th century in the final chapter.
Actually, the final chapter leaves Snow's London altogether and is something of an eye opener. Johnson discusses the role of cities in the modern world, as well as the gravest threats that mankind faces today. This chapter could well be a stand-alone essay. It made me think, ultimately, that this book would have made two excellent books -- one the tale of the cholera epidemic and the other of the social consequences of the rise of cities. As it is, putting them into one book, weaving between factual account and philosophical premise, was over-reaching a bit.
Turns out, there are about seven books worth of topics in here, wrestling each other for space with brawny arms. Were all of them woven seamlessly together into one multifaceted, but logically coherent, narrative? Well no, actually, and I found myself in a constant whiplash between fascination and frustration throughout the book. Which left me with a lot to get off my chest, so if you want to move right along to the next review before the unloading begins, I totally understand.
1. What actually happened with Dr. Snow, the progress of the epidemic, the map and the pump handle = Fascinating. Enthrallingly, this turns out to be quite different than that story that was floating around my biology class. The way the structure follows the daily disease progress, the actions of Snow, and the previously underemphasized role played by local clergyman, Rev. Henry Whitehead -- all this was just great. If the whole book had been like this, plus a few more maps (see 5, below), I would have closed it a happy nerd, indeed.
2.The history of a classic scientific paradigm shift from the miasma (bad air) theory of cholera transmission to the waterborne theory, championed by Snow = EXTRA Fascinating. Analysis of social forces working in science? Why yes, please! This cholera epidemic struck before widespread acceptance of germ theory, so most people thought that it (and other diseases) was caused by smelly miasma interacting with poor people’s conveniently innate weakness and inferiority and stuff. Several years before the Broad Street epidemic, John Snow developed an alternate, water-borne theory of cholera transmission, and evidence provided by this epidemic started tipping the scales in its favor. Johnson covers the Kuhnian paradigm shift from miasma to water: the circumstances that gave miasma such legs, how, in the grip of the miasma paradigm, some folks designed a massive study of this epidemic that could only uncover evidence to support that paradigm and missed what was actually going on by like ten miles (and you know we’re totally doing this today, but about what??), who changed their minds (most people, eventually), who didn’t (some diehard folks who didn’t have even a nodding acquaintance with falsifiability), and why. See: a classic. (Did you know that Florence Nightingale was a committed miasmatist? I didn’t!) I wouldn’t have minded a small acknowledgement that some diseases are truly airborne, so the miasma crowd was not as off-the-deep-end as herein presented, but that’s a teeny quibble.
3. Report on waste disposal in Victorian London, with particular attention given to poop = Fascinating. ‘Nuff said.
4. Our modern understanding of the life history and evolution of the cholera bacterium = Frustrating, but maybe only to me. Host/pathogen evolution and interactions are like candy to me, because I’m weird like that, so I was quite looking forward to this bit. Well, the book and I got off on the wrong foot when he started with all that anthropomorphic language to describe the evolution of the cholera pathogen: the bacteria were “waiting patiently,” had “strategies” and “desires.” He did say, twice, that of course they’re not really hanging out and sentiently plotting our doom (for which, yay! Michael Pollan in Botany of Desire, please take note.), but then he kept right on using the misleading language. Dude! You’re a nonfiction writer! Taking complicated concepts and making them understandable is your job! Why would you tell us evolution is crucial to the story, tell us you’re explaining it wrong, then never actually explain natural selection exactly right? I didn’t get that at all.
5. Snow’s maps as visual displays of quantitative information = EXTRA Frustrating. The guy put “Ghost Map” before the colon, for Lord’s sake and dragged Tufte in, the least he could do is show us all the maps he discusses. The only Snow map in my book was not even his revolutionary Voronoi diagram. Plus, I was dying to compare Snow’s maps with the less useful Department of Sewers disease map that preceded them. Yes, you can find all the maps in the John Snow online archive, but of the seven pages of maps in here, why are they mostly copies of the same map, seemingly included for decorative purposes? Why? Why??
6. Treatise on historical urbanization and the emergent properties of city-as-organism = Fascinating for about half a page, quickly mutating into frustrating thereafter. Johnson has a clear parallel interest in these topics. Good on him: epidemiology and urbanization are intertwined in interesting ways. However, I feel like he could have dealt with it with a few swift paragraphs demonstrating the importance of urban conditions for disease emergence and why the scale of John Snow’s investigations mattered, and moved on already.
7. Rampant speculation about impact of the Broad Street epidemic on future urbanization patterns = FRUSTRATING. Now here’s where Johnson takes that parallel interest deep into crazy-train territory. The book closes with a 25-page epilogue of not-too-convincingly-supported hand-waving about suitcase bombs, bioterrorism, avian flu and urbanization that, even now, has my eyebrows in a pucker over what the heck so much of it was doing in there. If he really wanted to put an original stamp on the book (which, after 25 pages of this jive, I’m pretty convinced he did), perhaps axing 99% of the epilogue and generating some new maps would have been a far more relevant way to go. How awesome would it be to see maps showing deaths over time, maps with different variables, maps of Snow’s data made using modern epidemiological techniques, maps of other London cholera epidemics, etc.? Very awesome indeed.
In conclusion, more maps make everything better. Thank you.
Cholera is a nasty little bug. Once ingested, it forms colonies on the intestinal wall, begins to reproduce with ferocious speed, and proceeds to trick the cells into excreting water rather than absorb it. It doesn't really matter of the host dies soon, because millions of new little cholera bacteria rush out of the host with the excreta waiting for the next person to ingest some excrement. That is the key. The only was to get cholera is by ingesting the excrement of another person so infected. Now you might say, whoa, that's more than I really wanted to know and I have no intention of so doing anyway. Well, you're right, all homo sapiens have a predisposition NOT to do just that, but given the rise of cities, the closeness with which we live, the relative ease of transportation, and the total misunderstanding of basic sanitation that existed until the 20th century, it was inevitable that the little buggers would escape their original habitat along the Ganges River.
Johnson discusses the interrelationship of the rise of cities, alcohol tolerance as a genetic adaptation to increased agriculturalization. Drinking water could be quite hazardous, but drinking beer and other alcoholic drinks had survival value from a natural selection standpoint because the fermentation process and alcohol killed off many harmful bacteria. Since alcohol is a poison and ill-tolerated by many, the speculation is that as agriculture and cities began to predominate, those who could tolerate alcohol better than others survived to reproduction age.
In another of those little actions that are intended to benefit, but which have unintended consequences, the change in use of sewers in London, inadvertently laid the groundwork (pun intended) for the cholera epidemic. Sewers had been designed to channel away rain water to and help prevent flooding in the city. In fact, it was prohibited to dump anything in the sewers and the Thames had been teeming with fish and quite clean. As the population increased, waste accumulated, and the aroma of piles of excrement in basements and elsewhere gave the miasmatists (those who believed disease was transmitted in the air) food for thought (the puns just keep rolling along.) So they had the brilliant idea of using the sewer system to wash the excrement out of the city and into the river which soon became foul. As it had also been the source of drinking water, the transmission of the cholera bacteria was efficient and inevitable.
Snow's rational approach to discovering the cause of the disease is remarkable in other ways. It had been common (a mythos that still is often heard today) to blame disease on lack of moral fiber. Since most of the victims were poor, and we all know that the poor are morally unfit, the victims themselves were somehow responsible for the illness. Snow rejected that possibility, rationally looking at evidence and building his case for the water-bourne nature of the disease. Johnson turns a nice metaphor in describing Snow's discovery: "...how great breakthroughs usually happen in practice. It is rarely the isolated genius having a eureka moment alone in the lab. Nor is it merely a question of building on precedent, of standing on the shoulders of giants, in Newton's famous phrase.Great breakthroughs are closer to what happens in a flood plain, a dozen separate tributaries converge and the rising waters lift the genius high enough that he or she can see around the conceptual constructions of the age."
3.5 Had seen the PBS special on Snow and his discovery during the cholera epidemic a few months back and this added more detail to that show. Interesting theories abounded, the miasma theory which was a theory almost all favored. How they did so much with so little. Took hard work without all our modern scientific equipment. Snow dedicated his life to the sciences, what he accomplished was nothing short of astonishing. Loved all the extraneous information, how tea helped with the lessening of certain diseases, why the flow of the Chicago River was reversed, and info on why these diseases flourished in the first place and of how with current conditions in some third world country, it will happen again.
Quitman informative book, at times too much information, learned more than I wanted to know about how waste was handled in the past. The condition were nothing short of appalling. Didn't care for the last chapter but did hold my attention for most of the book.
This is an account of the 1854 cholera epidemic in London and of the work of John Snow who through his scientific investigations managed to establish that cholera was waterborne and that the source of this outbreak was the Broad Street pump. This was going against the scientific opinion of the time a miasmic theory which argued that air, small and conditions were responsible. The book covers a variety of areas: history, biography, detective work, epidemiology and scientific investigation. Johnson uses a Victorian novelist’s trick and takes a chapter to introduce each player. The first chapter introduces the city of London and then the main players, John Snow, Rev Henry Whitehead, Edwin Chadwick and William Farr. The account of Snow’s investigations is fascinating. The descriptions of the conditions in London before the sewer system was built was pretty stomach churning. I never realised that most basements/cellars were used as cesspits. Also the descriptions of the myriad citizens who in varying ways made a living out of the waste has its own fascination. It’s a great story and I knew a bit about Snow, but I was less aware of the role of Whitehead. He was working as a vicar in the area and knew and visited many of those who died. He did a good deal of the detective work that supported Snow’s thinking. Snow, of course, was already known for his work on chloroform and anaesthesia and would have had a place in the history of medicine just for that. Johnson’s introduction to the book is a good summation: “This is a story with four protagonists: a deadly bacterium, a vast city, and two gifted but very different men. One dark week a hundred fifty years ago, in the midst of great terror and human suffering, their lives collided on London’s Broad Street, on the western edge of Soho. This book is an attempt to tell the story in a way that does justice to the multiple scales of existence that helped bring it about: from the invisible kingdom of microscopic bacteria, to the tragedy and courage and camaraderie of individual lives, to the cultural realm of ideas and ideologies, all the way up to the sprawling metropolis of London itself. It’s the story of a map that lies at the intersection of all those different vectors, a map created to help make sense of an experience that defied human understanding.” The book is somewhat repetitive at times: and then there is the epilogue, which leaves the subject of the book and is much more speculative. Johnson looks at increasing urbanization, arguing we are becoming a city planet and looking at what might put this at risk. He focuses on various types of terrorism, individual with weapons and explosives, portable nukes, chemical and biological. Here Johnson is in a more reflective mode, but it is very speculative and not really on the mark with too much painting terrorists as pantomime villains and not enough analysis. Skip the last chapter.
who knew i'd find a nonfiction account of the epidemiological history of cholera more interesting than most YA fantasy??
this book was disgusting. it was also SO FUN. well, the first hundred or so pages were the funnest ever (five star level for real). then the next one hundred were like...eh. and the last fifty were "uhhh i think i'm just going to skip this i'm here for plagues and infectious disease not self-indulgent waxing romantic on the future of the city as a concept?????"
lot of question marks today, huh. even more than usual.
this is an impressive book and you should, at the very least, read the first hundred pages of this and then john snow's wikipedia page or something.
bottom line: i guess i like historical nonfiction sometimes?? who knew!!!!!
I enjoyed most of the book, but I hated the concluding chapter. I would have preferred it if he had stuck to his subject rather than stringing together a series of personal opinions. The discussion of the relative risks of a nuclear holocaust versus bio-terrorism via a genetically engineered virus seemed forced. Does it really matter? The author somehow managed to work in references to both the Iranian nuclear policy and intelligent design in a book about cholera in the nineteenth century. Was there an editor?
"Whenever smart people cling to an incorrect idea despite substantial evidence to the contrary...."
And so it was when a deadly cholera epidemic spread through London in 1854. The odor of the Thames, and London in general, was foul. Everyone knew it. Therefore, erroneous thinking assumed the disease must have arisen from "bad air". Seeing is believing. A bacterium in the drinking water? Not believable at that time. Before the investigative work of John Snow, a respected doctor and inventor of ether, and Henry Whitehead, a pastor deeply concerned about the mounting deaths among his parishioners, this miasma theory was prevalent. The outbreak of cholera was also blamed on the poor, the malnourished, the morally corrupt. Snow and Whitehead worked together, one from a scientific approach and the other from personal narratives, to find the source of this illness. The title of the book refers to the demographic maps they developed to pinpoint where the density of cases existed. Whole families were succumbing in tenements as well as in wealthier sections of the city. Their work was a victory for reason and science over misinformation, superstition, and long held biases.
Published in 2006, some of Johnson's conjectures about the treatment and progress of a modern pandemic are in need of reevaluation. Although Ghost Map is well-researched and fascinating, it did bog down in some sections. His ramblings on modern cities and current global issues were unnecessary to the story. This was an enjoyable read that might have been better with some serious editing.
This book tells the true story of the London cholera epidemic in the 1850s and how Dr. John Snow and Reverend Henry Whitehead eventually teamed up to solve the mystery of how the disease is transmitted. At the time, it was believed to be spread via “miasma” (bad air) and putrid smells. Snow believed in the water-born theory where vibrio cholerae bacteria is transmitted by drinking contaminated water.
Dr. Snow mapped the progress of the disease, tracing cases and deaths, to find the source of the outbreak. His methods were scientific, but at the time, superstitions and prevailing theories were ingrained, and it was difficult to overcome the rigid thinking. In fact, one of the most enlightening aspects is observing how unproven speculations garner so much traction that evidence to the contrary is dismissed.
I particularly liked Steven Johnson’s vivid portrayal of London. The smell of cesspools and overflows of human waste into cellars must have been atrocious, and it is easy to see how the miasma theory originated. The scavenging hierarchy is fascinating.
A lengthy epilogue covers the future of urbanization and threats to it. The author advocates bringing advancements in infrastructure to developing countries to improve sanitation and provide clean drinking water. He also covers global pandemics (a particularly relevant topic, obviously), genomic advancements as applied to microbiology, and bioterrorism.
This audio book sounds like a documentary and will appeal to people that want a deep dive into a single science-related topic. It is read by Alan Sklar. He narrates smoothly and his voice has a deep timbre, which works well for this subject matter.
Except for the feeling of nausea that accompanies the reading at times, this is a very interesting book about the cholera epidemic in 1854, before the existence of bacteriology/parasitology.
It is also the epic tale of John Snow who almost single handedly kept track of contamination pathways, fought against the miasma theory and the biased and unscientific approach of his peers, tried to locate and define the germ and still kept his hat on like a gentleman. Amazing true story, especially if you are interested in history of medicine. John Snow is known as the father of Public Health and Germ theory, (in addition to his many contributions to medicine).
A wonderful read. It's not perfect, but it' a very well-written piece; I would have preferred that we see the Ghost Map in its entirety at least once. After all, it's the title of the book! I can say, though, that this is my only complaint about the book. The two men whose lives are the driving forces in the narrative are each well-drawn.
I finally got my copy of this, but I also got an ebook copy & see that it has some maps. They're OK, but I didn't really miss them. He describes things well enough that an audio book is fine. In fact, his descriptions of life at the time are fantastic. The setup is a bit long, but it has to be. It's hard to imagine people living in those conditions (drinking out of open sewers!) with so little understanding of disease. It's incredible how far our common knowledge has come.
Well, in some cases, at any rate. I found the description of the newspaper ads & remedies incredibly sad because I see so many of them still promulgated today as pseudo-scientific cures. People are still buying supplements & using aroma therapy. A lot of this when I read "Bad Science" & it's just disheartening.
I got the ebook because wanted to go back over his explanation of how cholera mutated. I didn't really care for it because of the way he framed it as a 'desire'. That was OK at first, but later on he said something about a group intelligence that came across as pseudo science. Here's that offending paragraph.
It goes without saying that the bacteria are not in any way conscious of developing this strategy. The strategy evolves on its own, as the overall population balance of V. cholerae changes. In a low-transmission environment, lethal strains die out, and mild ones come to dominate the population. In high-transmission environments, the lethal strains quickly outnumber the mild ones. No single bacterium is aware of the cost-benefit analysis, but thanks to their amazing capacity for adaptation, they’re able to make the analysis as a group, each isolated life and death serving a kind of vote in a distributed microbial assembly. There is no consciousness in the lowly bacterium. But there is a kind of group intelligence nonetheless.
He could have used some statistical analysis (SA) to far better effect. That's what this book is about after all, the birth & use of SA to solve large scale problems. SA shows us what is really happening overall & not just what seems to be happening from what we can see in any one spot. That's his overall point, but I don't recall where he ever comes out & says that specifically.
Interestingly enough, the first epidemic council had just been formed a few years before this outbreak & that's what a lot of the book is about - figuring out how to analyze it. John Snow was the pioneer.
At the halfway point & a bit beyond it's been pretty boring, often a rehash & bunch of detail on what has already been covered in as much depth as I wanted to know. Far too much repetition as the author goes back to tie in the preacher's (Whitehead) observations & the public health commissions. I understand that it is a problem to outline general trends & then go back into the specifics that caused them. Some repetition is inevitable. There are also multiple players, causes, & trends to follow, but he's covering the same ground & facts each time. It's getting very old.
It was interesting the way he points out how the cure for the miasma theory wound up causing more problems based on ignorance, yet ultimately led to Snow being able to gather the necessary statistical data to narrow down the actual cause, still without knowledge of bacteria. That had been discovered, but was ignored by everyone. It also led to being able to solve the problem - eventually. The established theory prevailed far too long due to politics.
I took a break at 5/7 & skimmed through it & 6/7. It's hard to skim in an audio book, but the repetition was awful, so I supplemented with the ebook. It did get interesting at the end of 6/7 & into 7/7 with more about current techniques for statistically looking at cities, including the 311 service. A long stretch considering the title, but he was trying to show that Snow & Whitehead's techniques are still being used. Unfortunately, he's covered the basics already several times.
The epilogue is about doomsday scenarios in modern times from atomic bombs to 9/11 & the flu. I really dislike the way he discusses the latter. Again, he uses 'learn' as if viruses & bacteria could think. He also ignores the fact that deadly organisms are such a minority that they can actually be looked upon as poor mutations. It's not good to kill off your host, after all.
He also seems to think that a city-planet is a desirable goal. WTF?!!! We are becoming more urbanized, though. He does tie this nicely in with the Broad Street epidemic & show some of the dangers we face from all sorts of mass effects biological & mechanical. He reaches pretty far & it's not his area of expertise.
Overall, this would have been an excellent book if it had been about half as long. He tried to cover far too much territory & that led to a lot of repetition. It would probably have been better read as text where I could have skimmed more. As an audio book it was just painful toward the end.
When I was complaining about how bad Johnson’s The Invention of Air was I hadn’t realised that I had read and enjoyed his Mind Wide Open Your Brain and the Neuroscience of Everyday Life. Then David and Eric told me to try this one – and they are right, this is a far better book. The things that annoyed me in The Invention of Air (the asides on paradigms and Hegalian dialectics for instance) are both in part rehearsed here, but in a way that assumes either that the reader has heard of these ideas before or if not then that the reader only needs to know enough about these ideas to further the story. I didn’t ever feel spoken down to while reading this.
There is a necessity to the things that he tells us here (at least for the first three quarters or more of the book) that allows the story itself to build a momentum. In fact, the momentum of the story builds until it is difficult to put the book down. So that when he starts talking about the energy inputs that are necessary for a city to grow beyond 30,000 inhabitants toward one of millions, this is clearly information that has an important role to play in the story of London during the 1854 Soho cholera outbreak. These don’t feel like asides, they feel like important parts of the story itself.
While this book is centrally concerned with the story of this cholera outbreak and of Snow and Whitehead figuring out that cholera is not caused by smelly air, but by infected water, this is really a book set at a tipping point. That tipping point is really concerned with the question of whether cities can grow beyond a few hundred thousand inhabitants and still be liveable. Where diseases like cholera could wipe out one tenth of a suburban area’s population in a couple of weeks that was still very much an open question.
It would be hard to find a book that is better at presenting the relationship between facts and theories than this one is. There is a fascinating section of this book in which those looking for an explanation of why cholera struck Soho at this time had created a checklist of facts they needed to investigate – these included spotting all of the places in the area where bad smells could be found, creating endless tables of the temperature of the air and wind speed and direction over the period of the outbreak – that is, check all of the things that would generally go to confirm that cholera is an airborne disease. The blinkers our theories place on our eyes are so much easier to see in hindsight. Perhaps that is the only time we can see them at all.
The last part of this book almost, but never quite, looses its way. The discussion on the increasing urbanisation of our species and the benefits and potential risks associated with this are interesting, but not as well linked to the rest of the story as I think they ought to have been. Sometimes it felt like he was struggling to make these connections. For instance, one of the major ways that it became clear that cholera was waterborne rather than airborne was by way of a map prepared by Snow: the Ghost Map of the title. And while the discussion on this map – particularly the fact that reducing the amount of information on the map made the map more informative – was fascinating, I thought the later reference to mapping the genome stretching this metaphor to breaking point.
I don’t want to complain too much – as I do think that much of what is said at the end of the book is worthwhile, particularly around the threats of nuclear weapons, biological weapons and the possibility that we may be able to overcome the threats of biological hazards through our knowledge of DNA and predictive evolutionary biology. (And there is a nice aside on the dangers of Intelligent Design)
However, this book is at its best when it is explaining how this outbreak happened and what cities needed to do to make sure such outbreaks never happened again.
Learning that so few people thought to replace the water that patients were loosing, but rather seeking to ‘thin’ their blood by bleeding them – shows yet another way in which we blind ourselves with our theories. And this is perhaps the major theme of this book.
As I’ve said, a fascinating book and one that is told in a way that would makes me wonder how the writer could possibly also have written The Invention of Air.
London was a cesspool in the 1854.....raw sewage ran into the Thames or was just thrown into pits in the back yards of tenement buildings. In that year, London had an outbreak of cholera which killed its victims in less than 24 hours. This extremely violent strain captured the attention of a physician, Dr. John Snow and a local curate, Rev. Whitehead...how were people catching this deadly disease? The common belief in the medical community was that of miasma...in other words an air borne disease arising from the horrible stench that hung over certain areas of London. Medicos thought that the poor who lived in wretched conditions were the center of the outbreak and bore the blame for this disease. Dr. Snow was not a believer in the miasma theory and felt that the disease may be waterborne. He and the Rev. Whitehead began a study which for the time, was very complete and fact based. They traced the infected water supply to one public pump where the majority of the people in the affected area drew their water. The pump was closed and the epidemic ended. The pioneer work of these two men was the beginning of epidemiology....the reporting and tracing of disease patterns and the government's responsibility to protect the population. Although Dr.Snow and Rev. Whitehead did not find a cure for cholera, they created the engine that drove the discovery of treatment.
A very informative look at the biases and misinformation of the medical/scientific community in the Victorian age. Recommended.
This is one of the best nonfiction books I've read in awhile. It's about a cholera epidemic in London in 1854, and the author does a great job of explaining the various factors that helped cause the outbreak, including a population explosion and the lack of a proper sewage system. The book follows Dr. John Snow, who was the first person to identify that cholera was spread by contaminated drinking water.
I would recommend this book to history buffs, fans of epidemiology and also Anglophiles, because it brings Dickensian London to life.
Basically the first 70% was about poop and victorian era science trying to catch up on why sanitary water is good. Then the rest was about urban density, pandemics, and viral evolution, which was interesting given our current situation regarding covid quarantine. Overall, a great read. It made me sad Dr Snow never got to see his cholera work really excepted. Anyway, this book was a perfect blend of historical review and storytelling. It was informative, enjoyable, and makes me think twice about the fact that my well failed all our coliform testing, yet we still drink it every day.
This starts out so well, with descriptions of the guys who used to scavenge in the sewers of London. It then goes into the nitty gritty of where all those Londoners used to put their shit (basically a lot of them just piled it up in their cellars). I love this kind of thing -- looking at the forgotten underside of a period or place in history.
Unfortunately, Johnson runs out of steam pretty fast. He repeats the same points over and over again about how crazy people were for believing that smells made one sick. He attempts to make it a story about two men -- a clergyman and a doctor -- who together solved the mystery of the cholera epidemic, but he really doesn't have enough to string together a legitimate narrative. And finally, the last two chapters is essentially his own "master thesis" on how the ghost map of the title was the forerunner of Google Maps and such. Pretty weak stuff. Would've been much better if he stuck to the history.
“The establishment had its scientific head in the sand.” (p. 46).
Informative and deeply interesting, this book tracks John Snow’s efforts to discover the cause of London’s mid-1800s cholera epidemic, even while medical, scientific (e.g., The Lancet), and governmental authorities dismissed and/or impeded his work, often with shoddy science.
“How could so many intelligent people be so grievously wrong for such an extended period of time? How could they ignore so much overwhelming evidence that contradicted their most basic theories?” (p. 15)
The problem was that everyone else had already committed to miasma theory—the belief that cholera and other diseases spread via bad air—and thus were blinded to countervailing evidence and acted in ways that were detrimental to public health:
“Many doctors prescribed laxatives to combat a disease that was already expelling fluids from the body at a lethal rate.” (p. 50)
“The first defining act of a modern, centralized public-health authority was to poison an entire urban population … The madness that comes from being under the spell of a Theory.” (pp. 120-121)
But the book also deals with a whole host of other related topics, including the lives and activities of night-soil men (e.g., one drowned in poop in 1326), how overcrowding oppressed urban dwellers (“she then pointed to a chalk circle in the center of the room, defining the region that the ‘gentleman’ was allowed to occupy,” p. 28), how urban conditions differentially affected the rich and poor (“the average life expectancy for the working poor was sixteen years,” p. 84), how humans evolved to have increased tolerance to alcohol because it was our primary way of avoiding waterborne diseases (“they drank the waste discharged by yeasts so that they could drink their own waste without dying in mass number,” p. 104), and how the problem of dealing with excrement grew along with the exploding population size of cities in the 1800s:
“But the finest minds of the era were also devoted to an equally pressing question: What are we going to do with all this shit?” (p. 115)
John Snow is the hero in this story, not just for identifying that cholera spreads by water and for saving countless lives, but also for his willingness to stand up to scientific authorities, push back on orthodoxy, and call out bad research:
“He wrote in to The Lancet with so many critiques of sloppy science that the editor eventually scolded him gently in print, suggesting that ‘Mr. Snow might better employ himself in producing something, than in criticizing the production of others.’” (p. 61)
One of the things that is so cool about the book is that it is literally like a murder mystery, one that comes to an unusually definite conclusion, tracing the epidemic to a specific water pump that was infected via waste from a specific cesspool used by certain people living in a particular house. It is rare that such an aggregate level phenomenon (an epidemic) can become so individualized, in terms of both the investigator (John Snow) and the victims (the index case). In short, I highly recommend this book. It is awesome!
One more quote that I thought was memorable:
“That the advance of civilization produced barbarity as an unavoidable waste product, as essential to its metabolism as the gleaming spires and cultivated thought of polite society.” (p. 14).
I think I can pretty say that this book by Steven Johnson isn't going to be for everybody. It tells the story of how several men tried to cope with and understand a massive outbreak of cholera in London during 1854. Yeah, riveting, right?
Actually, it was. In addition to talking about the disease itself (which basically causes death by diarrhea), the book follows the quest of a London doctor named John Snow as he propels the nascent science of epidemiology into its own. Snow went door to door in what was largely considered a doomed neighborhood, gathering information about who died, what their habits were, and most importantly how they got their water. He was working on a theory (one that turned out to be quite solidly supported) that cholera was transmitted via drinking water, and one public water pump in particular: the now infamous Broad Street pump that was befouled because a cholera victim's septic tank was leaking into its water supply.
This was a time before the germ theory of disease was widely known or accepted, so Snow was more of an underdog and outsider than you might think. The prevailing wisdom of the time was the "miasma theory," which held that "all smell is disease," and that cholera and other maladies were literally carried on the wind in the form of smells and bad air. It was amazing how hard Snow and the other main protagonist of the tale, Reverend Henry Whitehead, had to fight against this theory, which was largely taken as fact despite its frequent lack of evidence. But the team's tenacity and creativity won the day, resulting in the closure of the Broad Street pump, the avoidance of another cholera outbreak, and the iconic map of cholera deaths from which the book takes its name.
In addition to this central story, Johnson talks about related subjects, such as the London underclasses, the sociology and civic engineering of large cities, and the new London sewer systems. (The latter were particularly interesting, since they were built as a means of cleaning up the filth of the city, but they basically just ended up flushing it all into the Thames river and making waterborne diseases like cholera worse.) About the only complaint I have about the book is that it goes off the edge towards the end in what is basically a thinly veiled plug for Johnson's Outside In project. But in general, the whole narrative proved to be both fascinating and educational. Plus I guess I just love this history of science when it's presented in a context and with interesting characters.
This review is so EXACTLY my take on this book I'm just going to link to it.
The spine of the book, and the best part of it, is the long detailed explanation of what Snow and Whitehead did to trace (not stop!) the cholera epidemic, ending with that famous pump handle. I loved them -- they're seriously like little scientist versions of Holmes and Watson. The history-of-science parts discussing the evolutionary shift in ideas about contagion are also quite good. But the book falls down badly in some wild rhetorical thrashing about with regard to urban planning, city planets (or maybe it was planets of cities), biological terrorism, nuclear bombs (what), and how wonderful the internet is, and unfortunately most of that is the conclusion and epilogue to the book so that knocks off a star for me. Johnson can write fairly well, and certainly engage the reader with a riveting narrative, but his own attempts at Grand Theorizing (which he actually warns against, repeatedly, in his own book) are sadly misguided.
I gave this book three stars purely for the degree of useful information accumulated in this work about the transmission of cholera in the nineteenth century. Sadly, that's the limit of which my review is positive.
For starts, Johnson isn't a great storyteller. The book is incredibly sterile and frequently unfocused. Johnson's narrative swerved manically between topics which he touched upon incredibly lightly, so lightly in fact that it was often confusing as to the relevancy of it.
He was also worrisomely unfamiliar with science. I found it disconcerting that an author who is writing 'science history' claimed, quite boldly, that the Black Death was "of course, transmitted via rats." No, my good Sir, the Black Death (formally known as the Great Mortality) was not transmitted via rats, but rather via fleas, and the majority of transmission occurred between humans rather than between rodents and humans.
However, despite his errors in a world where information is at his fingertips, he was heavily condescending to the intellectuals and academics of the nineteenth century for ascribing to the miasmic theories surrounding cholera. Johnson came across as someone ignorantly engulfed by his privilege. His narrative seemed to scoff at academics for believing that putrid smell could carry disease as if such a theory was as wildly idiotic as those who think 5G transmits COVID-19.
Johnson seems to forget that the academics and intellects of the nineteenth century weren't privy to the scientific advancements as we are today, or that they lacked the access to well-researched, peer-reviewed academic journals and the internet in general.
While this attitude may not have been Johnson's intent, his judgemental writing style (as opposed to a storytelling narrative) made it impossible for the reader to believe he thought otherwise. From the victims to the intellectuals, Johnson failed to display any genuine empathy for those affected by the outbreak in 1854, and this lack of heart left the book feeling lacklustre.
In a way, it's amazing it took me this long to get to this book. My husband and one of my best friends had both read and really enjoyed it. It's about cholera in England, and I have that weird sort of interest that comes from having played a roleplaying game in which my teenage vampire slayer and her cohorts in the Royal Magisterial Corps were tracking a vampire who had been possessed by a cholera spirit. Plus, it's history.
Note: The rest of this review has been withdrawn due to the changes in Goodreads policy and enforcement. You can read why I came to this decision here.
In the meantime, you can read the entire review at Smorgasbook
We've come a long way ... and yet ... have we really?
“How could so many intelligent people be so grievously wrong for such an extended period of time? How could they ignore so much overwhelming evidence that contradicted their most basic theories? These questions, too, deserve their own discipline: the sociology of error.”
This is a thorough detailing of the 1854 London Broad Street Cholera epidemic. The beginning was a bit too authoritarian and preachy, but the rest of the book was 5 star. The day by day progression of Whitehead, and John Snow in their respective fields working to tract an epidemiology was, to me, enthralling. The miasma theory being so completely embedded within worldview, Victorian science and culture- plus the speed of the bacterium equaled a nearly impossible task in overcoming the London and European mindset. Even within door to door mapping and the removal of the Broad Street Pump handle by Saturday- it took far past Snow's lifetime to have full acceptance of the water source evidence. The sections of the book about evolution of microbes and human city living are 6 star. And homo sapiens' memory and brainstem systems tied so closely to aroma and disease warning were 6 star, as well. This often obscures (and has throughout human history) with scentless and sightless materials which cause severe and deadly human outcomes.
Just from my own perspective, I have so often wondered that so many humans consistently embrace and exalt the glories and pleasures of urban density locations. This for both personal, work, and commute "green" reasons. When I cannot imagine living in such density when all waste has to be taken away and all food and drinking liquids shipped or piped in amidst so many other vectors. With 5 cities more than 20 million now, and at least 1/4th which are squatters- it is only a matter of time. Not just for bacteria crossing within human waste, but a mutated virus through an animal vector.
At one time it was a prerequisite for Chicago kids and college age classes to have some trip or class requirement tour into the Chicago Sewage plants on Lake Michigan, the reversal of the Chicago River lecture, the west of Chicago proper "poop ponds" for fertilizer products etc. And some even went into Deep Tunnel project. That's still ongoing. Our hunter gatherer ancestors would pall, and so do I- a BIG prejudice, at living anywhere with 400 people per acre.
London at that time was four times denser than Manhattan right now and with no skyscrapers- few buildings over 6 stories. Those poor people in those rooms dying in family groups. Johnson tries to give you some sense of what a small "stomach ache" pang might have done to your psyche at that time. I can't think of any situation in present day disease that leaves the mind so clear and the body so failing and horrific so quickly. It must have been emotional torture. Many dead in twelve hours, 100's more in 48.
Not only does this clearly draw the evidence for this particular high mark in perception needed at this specific time in history for water borne pathogens, but the book also completely demonstrates how the "truth" if it is a "whole piece" world view is often just not. This has applied to nearly every economic, scientific and logical "truth" outside of the hard sciences at one time or another. Often what everyone in majority "knows" or medicine or science accepts as empirically correct, just isn't, or is barely a sliver OR completely false within other context or vectors.
Cholera had been endemic in England for two decades when it hit the Golden Square neighbourhood of Soho, quite literally, like a bomb. The most virulent single outbreak of the disease in the country's history also provided the opportunity to understand the disease and apply preventative measures... if only medical science weren't so convinced that disease were a combination of class prejudice and smell. This is the story of one man's struggle to push his theory forward, aided by a degree of local knowledge, one or two fortuitous circumstances, dogged determination and, at the last, the help of one of his detractors. The filth and desperation of early Victorian London is laid bare in graphic terms, as is the prevailing medical knowledge (and how close it was to the breakthrough it needed is near heartbreaking), and the ultimate victory, symbolised by the simple removal of a pump handle, provides all the vindication necessary - even though for one of the heroes of the story it's posthumous. The wonderful story of how one medical breakthrough changed the world to the one we live in today, and how medial science took to its feet and defeated one of the scourges of the nineteenth century. While not true to say I couldn't put it down, I certainly couldn't wait to pick it back up. One everyone with an interest in history needs to read.
I just finished “The Ghost Map” by Steven Johnson this morning. It’s about the cholera epidemic that broke out in 1850 in London from the Broad St well. Although and very unfortunately so many people died from this occurrence, it significantly transformed London and science. I.e.: Germ theory as opposed to the miasma theory. The author also boldly claims that Big Ben is not London’s most magnificent marvel, but rather that which lies below the city – the London sewerage system. I found it to be a fascinating read from start to finish and it provides the eerie reminder that nuclear warfare should be far from our worries, especially when considering that an invisible monster actively lurks among us and for its best opportunity to attack. GERMS!
This 2006 book follows primarily 2 People: Dr. Snow and Henry Whitehead as they slowly (and initially separately) start to put the pieces together about the sudden outbreak of Cholera on and around Broad Street, realize it's due to water contamination, and ultimately start the wheels turning that collapse miasma theory and (eventually) bring about germ theory. It's a thorough and interesting book, that follows everything from Snow's history with using ether and chloroform and how that helped him follow the lead, to how Cholera itself works in the body, to the sewage system under London, to explain all the ways in which the outbreak was both inevitable and why Snow and Whitehead were the ones to uncover the cause.
There are some elements that feel breathlessly 2006 - many of the modern hypothetical equivalents focus on terrorist attacks, and there's a lot of speculation about what a future pandemic could look like that felt both somewhat naïve and prescient reading it in 2023. The most interesting part, honestly, was the afterword written for the 2023 edition in which the author discusses how living through this modern pandemic has impacted his view of this book, and how his previous authorship of this book affected his view of the current pandemic.