The Ghost Map: The Story of London's Most Terrifying Epidemic--and How It Changed Science, Cities, and the Modern World

by Steven Johnson

  In some cases, cows were lifted Picard, p. 2.

  defining the region that the “gentleman” Rawnsley, p. 34.

  forced to perform arduous labor Workhouses had existed in one form or another for centuries, but the Poor Law Amendment Act of 1834 had greatly increased their number, and the severity of the “punishment” they dealt out to the pauper classes of the day. “Under the new Act, the threat of the Union workhouse was intended…as a deterrent to the able-bodied pauper. This was a principle enshrined in the revival of the ‘workhouse test’—poor relief would only be granted to those desperate enough to face entering the repugnant conditions of the workhouse. If an able-bodied man entered the workhouse, his whole family had to enter with him. Life inside the workhouse was…to be as off-putting as possible. Men, women, children, the infirm, and the able-bodied were housed separately and given very basic and monotonous food such as gruel, or bread and cheese. All inmates had to wear the rough workhouse uniform and sleep in communal dormitories. Supervised baths were given once a week. The able-bodied were given hard work such as stone-breaking or picking apart old ropes…. The elderly and infirm sat around in the day-rooms or sick-wards with little opportunity for visitors. Parents were…allowed limited contact with their children—perhaps for an hour or so a week on Sunday afternoon.” See http://www.workhouses.org.uk/.

  “the noisy and the eager” Charles Dickens, Little Dorrit (London: Wordsworth, 1996), p. 778.

  “burst forth…with extraordinary malignity” London Times, September 12, 1849, p. 2.

  The epidemic of 1848–1849 Koch, p. 42.

  “While the mechanism of life” London Times, September 13, 1849, p. 6.

  “countenance quite shrunk” Shephard, p. 158.

  With the exception of a few unusual compounds “Louis Pasteur, who proved the microbial origin of such devastating diseases as foot and mouth disease, plague, and wine rot, set the tone of the relationship from the start. The context of the encounter between intellect and bacteria defined medicine as a battleground: bacteria were seen as ‘germs’ to be destroyed. Only today have we begun to appreciate the fact that bacteria are normal and necessary for the human body and that health is not so much a matter of destroying microorganisms as it is of restoring appropriate microbial communities.” Margulis, p. 95.

  A glass of water could easily contain Most of the information on the size, visibility, and replication rate of Vibrio cholerae comes from an interview with Harvard’s John Mekalanos. The Centers for Disease Control have an excellent overview of cholera, available online at http:www.cdc.gov/ncidod/dbmd/diseaseinfo/cholera_g.htm.

  “Those animal species that fully adapted” Margulis, p. 183.

  “We are living at a period” Quoted in Picard, p. 215. While the Great Exhibition is more famous than the Broad Street epidemic, in a strange sense the two events have a comparable, if inverted, symbolic value: the Exhibition marking the emergence of a truly global culture, with all the dynamism and diversity that suggests, and Broad Street marking the emergence of a metropolitan culture, with all the promise and peril that offered. The twentieth century would ultimately be the story of increasingly large cities increasingly connected to one another; the Great Exhibition and Broad Street each in their separate ways helped make that a reality.

  “All the world’s bacteria essentially” Margulis, p. 30.

  Thomas Latta, hit upon Shephard, p. 158.

  “among the first to recognize” Standage, p. 234. “The Elixir of Life sold by a Dr. Kidd, for example, claimed to cure ‘every known ailment…. The lame have thrown away crutches and walked after two or three trials of the remedy…. Rheumatism, neuralgia, stomach, heart, liver, kidney, blood and skin diseases disappear as by magic.’ The newspapers that printed such advertisements did not ask any questions. They welcomed the advertising revenues, which enabled the newspaper industry to expand enormously…. The makers of St. Jacob’s Oil, which was said to remedy ‘sore muscles,’ spent five hundred thousand dollars on advertising in 1881, and some advertisers were spending more than one million dollars a year by 1895.”

  “FEVER and CHOLERA” London Morning Chronicle, September 7, 1854.

  “Sir—I have observed” London Morning Chronicle, August 25, 1854. page 48 “Will you…kindly allow” London Times, August 18, 1854, p. 9.

  “Sir—Induced by” London Times, September 21, 1854, p. 7.

  “It really is nauseating” Punch, 27 (September 2, 1854), p. 86.

  “Having at length emerged” London Morning Chronicle, September 1, 1854, p. 4.

  Overnight, Henry Whitehead’s sociable rounds Henry Whitehead’s experiences and thoughts presented here are drawn almost entirely from four overlapping accounts of the epidemic authored by Whitehead himself: The Cholera in Berwick Street, his original pamphlet published shortly after the outbreak’s conclusion; his official report for the Cholera Inquiry Committee, published the following year; an essay recalling the outbreak published in Macmillan’s Magazine in 1865; and the transcript of an astonishingly long speech delivered at a farewell dinner on the eve of his departing London in 1873, published in H. D. Rawnsley’s biography in 1898.

  All but one would perish Whitehead 1854, p. 5.

  But one Soho resident The details of John Snow’s investigation of the Broad Street outbreak are drawn primarily from his account of the outbreak and its aftermath, in his report published in the Cholera Inquiry Committee report of 1855, and in his revised monograph, On the Mode and Communication of Cholera.

  He would largely avoid meat Details on Snow’s life up to his cholera investigations are drawn from four primary sources: Richardson’s hagiographic “Life of John Snow,” published shortly after Snow’s death; David Shephard’s biography John Snow: Anaesthetist to a Queen and Epidemiologist to a Nation; the superb Cholera, Chloroform, and the Science of Medicine; and Ralph Frerichs’ invaluable John Snow Web archive hosted by UCLA’s School of Public Health.

  A university degree opened “With a consulting practice and beds in one of the London teaching hospitals for his patients, a man of the right character and background could achieve fame of a sort treating high society. The lure of beds in a private hospital or a nursing home where they could treat wealthy feepaying patients tempted not a few physicians. For them a university degree—the M.A. as well as the M.D., perhaps, especially from Oxford or Cambridge—was important not so much for its academic kudos as for its social cachet, because if one wished to practise in fashionable circles it was as important to be seen as a gentleman as much as a well-trained doctor. A knowledge of Latin and Greek was as much an entree to this type of practice as a knowledge of medicine itself.” Shephard, p. 21.

  His first published paper “The arsenic candles investigations show Snow as a collateral scientist in keeping with the new scientific approaches to medicine that were part and parcel of his training. His approach to these investigations also reveals a model that would recur in his anesthesia and cholera research. At an early stage in his career he demonstrated an ability to set up a series of experiments that traced an agent as it circulated in a medical school dissection room, in rooms where arsenic candles were burned, and in the bodies of everyone who entered them. That is, he was already concerned with chemical analysis, employing animal experimentation, and asking questions about what he would later term modes of communication—the pathways by which a specific poison was introduced into a community and where and how it lodged in the body.” Vinten-Johansen et al., p. 73.

  “Mr. Snow might better employ himself” “[Lancet editor] Wakley’s statement can be read as a snub: Snow was an upstart trying to make a name for himself by finding fault with his elders. It can also be read as the reaction of a prickly editor who thought Snow was criticizing him for including flawed articles in his journal, and it can be read as a gentle, if ham-fisted, warning by a senior colleague that Snow should temper himself at so early a stage of his career. Whatever Wakley’s intent, his comment was patently unfair to Snow. H
is first letter to the editor had detailed arsenic experiments, and the Lancet had reported on Westminster Society meetings at which Snow had read several papers on his research activities. He appears to have taken offense, for he found a friendlier reception in [the London Medical Gazette].” Vinten-Johansen et al., p. 89.

  “When the dreadful steel was plunged” “Elective surgery was performed very infrequently prior to the advent of effective anesthesia. From 1821 to 1846, the annual reports of Massachusetts General Hospital recorded 333 surgeries, representing barely more than one case per month. Surgery was a last and desperate resort. Reminiscing in 1897 about preanesthesia surgery, one elderly Boston physician could only compare it to the Spanish Inquisition. He recalled ‘yells and screams, most horrible in my memory now, after an interval of so many years…. In one of these operations, performed by the hospital’s senior surgeon, John Collins Warren, M.D., the cancerous end of a young man’s tongue was cut off by a sudden, swift stroke of the knife, and then a red hot iron was placed on the wound to cauterize it. Driven frantic by the pain and the sizzle of searing flesh inside his mouth, the young man escaped his restraints in an explosive effort and had to be pursued until the cauterization was complete, with his lower lip burned in the process.” Sullivan 1996.

  He reaches for his pen Snow’s first biographer, Richardson, reported that Snow had investigated the following agents: “carnoic, acide, carbonic oxide, cyanogen, hydrocanic acid, Dutch liquid, ammonia, nitrogen, amylovinic ether, puff-ball smoke, allyle, cyanide of ethyle, chloride of amyle, a carbo-hydrogen coming over with amylene.” He went on to note: “If the agent seemed to promise favourably from these inquiries, he commenced to try it on man; and the first man was invariably his own self.” Richardson, p. xxviii.

  “Thursday 7 April” Snow and Ellis, p. 271.

  “The Consilience of Inductions,” Whewell wrote Quoted in Wilson, p. 8.

  His mind tripped happily Vinten-Johansen et al. make this point with typical eloquence: “Snow was a systems-network type of reasoner. He seldom dealt with linear chains of cause and effect but rather with interacting networks of causes and effects. He viewed the human organism, and the world it inhabits, as a complex system of interacting variables, any one of which, isolated temporarily for careful study, might provide a useful clue to the clinical-scientific problem—but only when seen in its proper context, and only when the variable, having once been isolated for study, was then put back into its place in the system and restudied in its natural environment. Vinten-Johansen et al., p. 95.

  “We can only suppose the existence” “History of the Rise, Progress, Ravages etc. of the Blue Cholera of India,” Lancet, 1831, pp. 241–84.

  By the time the epidemic wound down Nearly all the details of cholera outbreaks—and Snow’s investigations of them—leading up to the Broad Street affair are drawn from Snow’s own accounts, published in the various editions of “On the Mode and Communication of Cholera.”

  it didn’t include the false leads J. M. Eyler, “The Changing Assessments of John Snow’s and William Farr’s Cholera Studies,” Sozialund Präventivmedizin 46 (2001), pp. 225–32.

  “The experimentum crucis would be” London Medical Gazette 9 (1849), p. 466.

  The papers of the day were filled In the Central London area, postal deliveries could sometimes take only an hour to reach their destination. Each residence could expect twelve regular deliveries on a weekday. Picard, p. 68.

  “It is said that Friday night” Observer, September 3, 1854, p. 5.

  The 1842 study found Picard, p. 180.

  “Jo lives—that is to say” Dickens 1996, p. 475.

  “The roads, in all directions” Quoted in Rosenberg 1987, p. 28.

  “The infinite number of Fires” Quoted in Porter, p. 162.

  “the houses will become too numerous” Porter, p. 164.

  The unplanned…engineering of ant colonies For more on the connection between the bottom-up organization and intelligence of ant colonies and the collective development of cities, see my 2001 book Emergence. The extended Wordsworth quote reads: “Rise up, thou monstrous anthill on the plain / Of a too busy world! Before me flow / Thou endless stream of men and moving things! / Thy every-day appearance, as it strikes—/With wonder heightened, or sublimed by awe—/On strangers, of all ages; the quick dance / Of colours, lights, and forms…”

  “monster city…stretched not only” Quoted in Porter, p. 186.

  The Londoner enjoying a cup of tea For a thorough—and thoroughly entertaining—overview of the sociohistorical impact of tea (along with other beverages) see Standage’s A History of the World in Six Glasses.

  A collection of water molecules Iberall 1987, pp. 531–33.

  In a sense, the Industrial Revolution “If the steam-powered factory, producing for the world market, was the first factor that tended to increase the area of urban congestion, the new railroad transportation system, after 1830, greatly abetted it. Power was concentrated on the coal fields. Where coal could be mined or obtained by cheap means of transportation, industry could produce regularly throughout the year without stoppages through seasonal failure of power. In a business system based upon time-contracts and time-payments, this regularity was highly important. Coal and iron thus exercised a gravitational pull on many subsidiary and accessory industries: first by means of the canal, and after 1830, through the new railroads. A direct connection with the mining areas was a prime condition of urban concentration: until our own day the chief commodity carried by the railroads was coal for heat and power.” Mumford, p. 457.

  One mechanic who provided Picard, p. 82.

  Largely freed from waterborne disease Standage, p. 201.

  John Snow would go to his grave A comprehensive overview of the discovery of the cholera bacterium, including a biographical sketch of Pacini himself, is available online at the UCLA John Snow archive at http:www.ph.ucla.edu/EPI/snow/firstdiscoveredcholera.html.

  By the mid-1840s, his reports “He approached the Presidents of the Royal Colleges of Physicians and Surgeons and the Master of the Society of Apothecaries and persuaded them to write to their members throughout the kingdom, urging them ‘to give, in every instance which may fall under our care, an authentic name of the fatal disease,’ to be recorded in the local register books from which Farr compiled his statistics. At the same time, Farr compiled a ‘statistical nosology,’ which listed and defined 27 fatal disease categories to be used by local registrars when recording causes of death. Thus dysentery (‘bloody flux’) was distinguished from diarrhea (‘looseness, purging, bowel complaint’). Farr also gave the ‘synonymes’ (sic) and ‘provincial terms’ by which the diseases might be known locally. Letters were drafted in the name of the Registrar-General setting the qualifications which were necessary for local registrars, and instructions were also issued to ships’ captains concerning their responsibilities.” Halliday 2000, p. 223.

  “To measure the effects of good or bad” Quoted in Vinten-Johansen et al., p. 160. The authors offer this instructive commentary on the phrase itself: “Farr’s usage of the same Baconian term that Snow had employed in his first publication indicates the importance of the hypotheticodeductive method to some medical men of this generation. In the laboratory one can conduct a ‘crucial experiment’ in which two samples are treated in identical fashion except for the factor in dispute. The results of the experiment then tell one with certainty whether the underlying theory is correct, but London was not a laboratory.”

  To digest large quantities of it Ridley, p. 192.

  One provides the fizz, the other the buzz Margulis, p. 75.

  S&V chose to delay its move In many ways, Snow’s “grand experiment” with the metropolitan water supply stands as a more impressive—and, arguably, more convincing—example of medical sleuthing than the Broad Street case. For a detailed account, see Vinten-Johansen et al., pp. 254–82.

  “The experiment…was on the grandest” Snow, 1855a, p. 75.

  “In Broad-
Street, on Monday evening” Observer, September 3, 1854, p. 5.

  “The Guardians are acting” London Times, September 6, 1854, p. 5.

  This is the great irony of Chadwick’s life For more on the life of Chadwick, see Finer.

  “All smell is…disease” Quoted in Halliday 1999, p. 127.

  One in twenty had human waste Halliday 1999, p. 133.

  “According to the average of the returns” Mayhew could also wax philosophical on these issues, in language that was strikingly ahead of its time: “Now, in Nature everything moves in a circle—perpetually changing, and yet ever returning to the point whence it started. Our bodies are continually decomposing and recomposing—indeed, the very process of breathing is but one of decomposition. As animals live on vegetables, even so is the refuse of the animal the vegetable’s food. The carbonic acid which comes from our lungs, and which is poison for us to inhale, is not only the vital air of plants, but positively their nutriment. With the same wondrous economy that marks all creation, it has been ordained that what is unfitted for the support of the superior organisms, is of all substances the best adapted to give strength and vigour to the inferior. That which we excrete as pollution to our system, they secrete as nourishment to theirs. Plants are not only Nature’s scavengers but Nature’s purifiers. They remove the filth from the earth, as well as disinfect the atmosphere, and fit it to be breathed by a higher order of beings. Without the vegetable creation the animal could neither have been nor be. Plants not only fitted the earth originally for the residence of man and the brute, but to this day they continue to render it habitable to us. For this end their nature has been made the very antithesis to ours. The process by which we live is the process by which they are destroyed. That which supports respiration in us produces putrefaction in them. What our lungs throw off, their lungs absorb—what our bodies reject, their roots imbibe…. In every well-regulated State, therefore, an effective and rapid means for carrying off the ordure of the people to a locality where it may be fruitful instead of destructive, becomes a most important consideration. Both the health and the wealth of the nation depend upon it. If to make two blades of wheat grow where one grew before is to confer a benefit on the world, surely to remove that which will enable us at once to do this, and to purify the very air which we breathe, as well as the water which we drink, must be a still greater boon to society. It is, in fact, to give the community not only a double amount of food, but a double amount of health to enjoy it. We are now beginning to understand this. Up to the present time we have only thought of removing our refuse—the idea of using it never entered our minds. It was not until science taught us the dependence of one order of creation upon another, that we began to see that what appeared worse than worthless to us was Nature’s capital—wealth set aside for future production.” Mayhew, p. 160.