All smell is disease.

Library Updates, Medical History, New stock, Uncategorized

Ghost Map

By Steven Johnson

Paperback copy of The Ghost Map by Steven Johnson. Title and author in white, subheading in blue: "A street, a city, an epidemic and the hidden power of urban networks." Cover has an image of a water pump to represent the Broad Street pump. Copy has library markings and is on a brown desk against white walls.

Few of us likely stop to think about the subterranean world that keeps our country clean and gives us clean water on demand. Few of us recognise the sewers as a wonder of the modern age. Until that water stops, or the loo backs up, we are protected from the vile effluvia that lurk beneath our feet. We are unbelievably lucky and privileged in our sanitation system and take it too much for granted. This book is a salutary lesson on why this incredible civil engineering is so important to our modern lives. It serves up this lesson by reminding us how close we are to the diseased days of “night soil” piling in the city streets.

The book opens in London, 1854, only just over 150 years before this book was written. London (like all major cities) was drowning in its own waste. Even the army of recycling scavengers could not handle the quantity piling up. It piled up in the streets, it filled the water from which the poor drank, it accumulated below boarding houses, and clogged the ancient rivers of London.

The stench must have been unbearable, but it was not (as most assumed) dangerous. The smell of faeces would not poison people, but something else in there would. At this point, before Pasteur, before Lister, germ theory was not the dominant paradigm, miasmas were. Given the choice between invisible enemies and an omnipresent stink, Occam’s Razor showed the way. The obsession with smell – and thus the development of reforms that addressed the conditions of those smells, not the underlying issues – led to further disease.

For this book is about disease, and one disease in particular: the great terror and scourge that was cholera. At its core, this is the story of one outbreak in Soho and the two men who tried to track it and fight it. Two men began to wonder at the official rhetoric, the idea that insanitary conditions were the first cause of disease, that the moral failure of the poor led to their becoming sick. Their work would not change prevailing attitudes overnight, but it paved the way for acceptance of the waterborne nature of cholera, and from there, the end of the miasma.

Dr John Snow was a highly respected physician. He had standardised the field of anaesthesia and popularised it, after using chloroform to aid Queen Victoria during childbirth. He had a rigorous mind, a keen eye for detail, and a willingness to undertake field work to find the information he needed. Reverend Henry Whitehead also possessed an enquiring mind and dogged zeal, but instead of Snow’s medical experience, he knew the ground. Soho was his turf, and his name and position opened doors Snow could not even have found.

Whitehead, in fact, thought the water theory preposterous, and initially tried to disprove it. The more he looked though, the more he realised it must be the truth. Across the course of the investigation, he would become Snow’s most valuable ally and a close friend. When 1866 brought another cholera outbreak, he was asked to assist the investigation and was able to posthumously vindicate his friend’s theory.

The Ghost Map of the title refers to Snow’s great act of visualisation, one which has been elevated to the information design canon. Snow drew on the work of Edmund Cooper (an engineer plotting the outbreak) to produce a map marking each death in relation to the pumps of Soho. He then tracked an area bordered by time, not distance: which houses were closest walking distance to the Broad Street pump?

In the midst of death, there was life (the local brewery staff drank malt liquor); and in life, death (a widow in Hampstead whose sons brought her contaminated water), solve this dichotomy and you could prove it was the water. This book is a detective story, shot through with the history and mechanisms of cholera, and looking onwards to the development of the city (and the modern world) from Bazalgette’s sewers.

Little changes, epidemiology may be backed by computer networks and massive global horizon-scanning programmes, but in the end the same qualities that Snow and Whitehead embodied win the day. Personal local knowledge supported by expert medical knowledge; patient dogged detective work; open-mindness; rigorous scientific testing of samples; and perseverance will uncover the truth.

Equally though, as recent events have shown us, the same barriers to action remain: entrenched political opposition; dangerous competing theories; misguided efforts to help; lack of funds; stigma towards or “irrelevance” of those affected. Snow and Whitehead may only have won a symbolic victory when the Broad Street pump handle was removed, but it was a victory, nonetheless. Against powerful opposition from established medical opinion, a public health decision was made based on expert testimony, even if only for a moment. Victories in public health are always worth celebrating.

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