Even émigrés from Golden Square retained their taste for the Broad Street well. Susannah Eley, whose husband had founded the percussion-cap factory on Broad Street, moved to Hampstead after being widowed. But her sons would regularly fill a jug with Broad Street water and deliver it to her via cart. The Eley brothers also maintained two large tubs of well water for their employees to enjoy during the workday. With temperatures reaching the mid-eighties in the shade on those late-August days, and no wind to freshen the air, the collective thirst for cool well water must have been intense.
We know a remarkable amount about the quotidian drinking habits of the Golden Square neighborhood on those oppressive days of August 1854. We know that the Eley brothers dispatched a bottle to their mother on Monday, and that she shared it with her visiting niece later that week. We know that a young man visiting his chemist father enjoyed a glass of pump water with his pudding at a restaurant on Wardour Street. We know of an army officer who visited a friend on Wardour Street for dinner and drank a glass of Broad Street water with his meal. We know that the tailor Mr. G sent his wife several times to grab a pitcher of water from the pump outside his workplace.
We also know of the holdouts who did not drink water from the pump that week, for a variety of reasons: the laborers at the Lion Brewery who had their malt liquor supplemented by water supplied by the popular New River Company; a family who normally relied on their ten-year-old girl to fetch water from the pump went dry for a few days as the little girl recovered in bed from a cold. A regular pump-water drinker—and noted ornithologist—named John Gould had declined a glass on that Saturday, complaining that it had a repulsive smell. Despite living a few feet from the pump, Thomas Lewis had never favored its water.
There is something remarkable about the minutiae of all these ordinary lives in a seemingly ordinary week persisting in the human record for almost two centuries. When that chemist’s son spooned out his sweet pudding, he couldn’t possibly have imagined that the details of his meal would be a matter of interest to anyone else in Victorian London, much less citizens of the twenty-first century. This is one of the ways that disease, and particularly epidemic disease, plays havoc with traditional histories. Most world-historic events—great military battles, political revolutions—are self-consciously historic to the participants living through them. They act knowing that their decisions will be chronicled and dissected for decades or centuries to come. But epidemics create a kind of history from below: they can be world-changing, but the participants are almost inevitably ordinary folk, following their established routines, not thinking for a second about how their actions will be recorded for posterity. And of course, if they do recognize that they are living through a historical crisis, it’s often too late—because, like it or not, the primary way that ordinary people create this distinct genre of history is by dying.
Yet something has been lost in the record as well, something more intimate and experiential than stories of pudding and malt liquor—namely, what it felt like to contract cholera in that teeming, fraught city, at a time when so little was understood about the disease. We have remarkably detailed accounts of the movements of dozens of individuals during that late-summer week; we have charts and tables of lives and deaths. But if we want to re-create the inner experience of the outbreak—the physical and emotional torment involved—the historical record comes up wanting. We have to use our imaginations.
Sometime on Wednesday, it’s likely that the tailor at 40 Broad, Mr. G, began to feel an odd sense of unease, accompanied by a slightly upset stomach. The initial symptoms themselves would be entirely indistinguishable from a mild case of food poisoning. But layered over those physical symptoms would be a deeper sense of foreboding. Imagine if every time you experienced a slight upset stomach you knew that there was an entirely reasonable chance you’d be dead in forty-eight hours. Remember, too, that the diet and sanitary conditions of the day—no refrigeration; impure water supplies; excessive consumption of beer, spirits, and coffee—created a breeding ground for digestive ailments, even when they didn’t lead to cholera. Imagine living with that sword of Damocles hovering above your head—every stomach pain or watery stool a potential harbinger of imminent doom.
City dwellers had lived with fear before, and London, of course, had not forgotten its Great Plague and its Great Fire. But for Londoners, the specific menace of cholera was a product of the Industrial Age and its global shipping networks: no known case of cholera on British soil exists before 1831. Yet the disease itself was an ancient one. Sanskrit writings from around 500 B.C. describe a lethal illness that kills by draining water from its victims. Hippocrates prescribed white hellebore blooms as a treatment. But the disease remained largely within the confines of India and the Asian Subcontinent for at least two thousand years. Londoners first took notice of cholera when an outbreak among British soldiers stationed in Ganjam, India, sickened more than five hundred men in 1781. Two years later, word appeared in the British papers of a terrible outbreak that had killed 20,000 pilgrims at Haridwar. In 1817, the cholera “burst forth… with extraordinary malignity,” as the Times reported, tracking through Turkey and Persia all the way to Singapore and Japan, even spreading as far as the Americas until largely dissipating in 1820. England itself was spared, which led the pundits of the day to trot out an entire military parade of racist clichés about the superiority of the British way of life.
But this was merely cholera’s shot across the bow. In 1829, the disease began to spread in earnest, sweeping through Asia, Russia, even the United States. In the summer of 1831, an outbreak tore through a handful of ships harbored in the river Medway, about thirty miles from London. Cases inland didn’t appear until October of that year, in the northeast town of Sunderland, beginning with a William Sproat, the first Englishman to perish of cholera on his home soil. On February 8 of the following year, a Londoner named John James became the first to die in the city. By outbreak’s end, in 1833, the dead in England and Wales would number above 20,000. After that first explosion, the disease flared up every few years, dispatching a few hundred souls to an early grave, and then going underground again. But the long-term trend was not an encouraging one. The epidemic of 1848–1849 would consume 50,000 lives in England and Wales.
All that history would have weighed like a nightmare on Mr. G, as his condition worsened on Thursday. He may have begun vomiting during the night and most likely experienced muscle spasms and sharp abdominal pains. At a certain point, he would have been overtaken by a crushing thirst. But the experience was largely dominated by one hideous process: vast quantities of water being evacuated from his bowels, strangely absent of smell and color, harboring only tiny white particles. Clinicians of the day dubbed this “rice-water stool.” Once you began emitting rice-water stools, odds were you’d be dead in a matter of hours.
Mr. G would have been terribly aware of his fate, even as he battled the physical agony of the disease. One of cholera’s distinctive curses is that its sufferers remain mentally alert until the very last stages of the disease, fully conscious both of the pain that the disease has brought them and the sudden, shocking contraction of their life expectancy. The Times had described this horrifying condition several years before in a long feature on the disease: “While the mechanism of life is suddenly arrested, the body emptied by a few rapid gushes of its serum, and reduced to a damp, dead… mass, the mind within remains untouched and clear,—shining strangely through the glazed eyes, with light unquenched and vivid,—a spirit, looking out in terror from a corpse.”
By Friday, Mr. G’s pulse would have been barely detectable, and a rough mask of blue, leathery skin would have covered his face. His condition would have matched this description of William Sproat from 1831: “countenance quite shrunk, eyes sunk, lips dark blue, as well as the skin of the lower extremities; the nails… livid.”
Most of this is, to a certain extent, conjecture. But one thing we know for certain: at one p.m. on Friday, as baby Lewis suf
fered quietly in the room next door, Mr. G’s heart stopped beating, barely twenty-four hours after showing the first symptoms of cholera. Within a few hours, another dozen Soho residents were dead.
THERE IS NO DIRECT MEDICAL ACCOUNT OF IT, BUT WITH the hindsight of a century and a half of scientific research, we can describe with precision the cellular events that transformed Mr. G from a healthy, functioning human being to a shrunken, blue-skinned cadaver in a matter of days. Cholera is a species of bacterium, a microscopic organism that consists of a single cell harboring strands of DNA. Lacking the organelles and cell nuclei of the eukaryotic cells of plants and animals, bacteria are, nevertheless, more complex than viruses, which are essentially naked strands of genetic code, incapable of surviving and replicating without having host organisms to infect. In terms of sheer numbers, bacteria are by far the most successful organisms on the planet. A square centimeter of your skin contains most likely around 100,000 separate bacterial cells; a bucket of topsoil would contain billions and billions. Some experts believe that despite their minuscule size (roughly one-millionth of a meter long), the domain of bacteria may be the largest form of life in terms of biomass.
More impressive than their sheer number, though, is the diversity of bacterial lifestyles. All organisms based on the complex eukaryotic cell (plants, animals, fungi) survive thanks to one of two basic metabolic strategies: photosynthesis and aerobic respiration. There may be astonishing diversity in the world of multicellular life—whales and black widows and giant redwoods—but beneath all that diversity lie two fundamental options for staying alive: breathing air and capturing sunlight. The bacteria, on the other hand, make a living for themselves in a dazzling variety of ways: they consume nitrogen right out of the air, extract energy from sulfur, thrive in the boiling water of deep-sea volcanoes, live by the millions in a single human colon (as Escherichia coli do). Without the metabolic innovations pioneered by bacteria, we would literally have no air to breathe. With the exception of a few unusual compounds (among them snake venom), bacteria can process all the molecules of life, making bacteria both an essential energy provider for the planet and its primary recycler. As Stephen Jay Gould argued in his book Full House, it makes for good museum copy to talk about an Age of Dinosaurs or an Age of Man, but in reality it’s been one long Age of Bacteria on this planet since the days of the primordial soup. The rest of us are mere afterthoughts.
THE TECHNICAL NAME FOR THE CHOLERA BACTERIUM IS Vibrio cholerae. Viewed through an electron microscope, the bacterium looks somewhat like a swimming peanut—a curved rod with a thin, rotating tail called the flagellum that propels the organism, not unlike the outboard motor of a speedboat. On its own, a single V. cholerae bacterium is harmless to humans. You need somewhere between 1 million and 100 million organisms, depending on the acidity of your stomach, to contract the disease. Because our minds have a difficult time grasping the scale of life in the microcosmos of bacterial existence, 100 million microbes sounds, intuitively, like a quantity that would be difficult to ingest accidentally. But it takes about 10 million bacteria per milliliter of water for the organism’s presence to be at all detectable to the human eye. (A milliliter is roughly 0.4 percent—four thousandths—of 1 cup.) A glass of water could easily contain 200 million V. cholerae without the slightest hint of cloudiness.
For those bacteria to pose any threat, you need to ingest the little creatures: simple physical contact can’t get you sick. V. cholerae needs to find its way into your small intestine. At that point, it launches a two-pronged attack. First, a protein called TCP pili helps the bacteria reproduce at an astonishing clip, cementing the organisms into a dense mat, made up of hundreds of layers, that covers the surface of the intestine. In this rapid population explosion, the bacteria inject a toxin into the intestinal cells. The cholera toxin ultimately disrupts one of the small intestine’s primary metabolic roles, which is to maintain the body’s overall water balance. The walls of the small intestine are lined with two types of cells: cells that absorb water and pass it on to the rest of the body, and cells that secrete water that ultimately gets flushed out as waste. In a healthy, hydrated body, the small intestine absorbs more water than it secretes, but an invasion of V. cholerae reverses that balance: the cholera toxin tricks the cells into expelling water at a prodigious rate, so much so that in extreme cases people have been known to lose up to thirty percent of body weight in a matter of hours. (Some say that the name cholera itself derives from the Greek word for “roof gutter,” invoking the torrents of water that flow out after a rainstorm.) The expelled fluids contain flakes from the epithelial cells of the small intestine (the white particles that inspired the “rice water” description). They also contain a massive quantity of V. cholerae. An attack of cholera can result in the expulsion of up to twenty liters of fluid, with a per milliliter concentration of V. cholerae of about a hundred million.
In other words, an accidental ingestion of a million Vibrio cholerae can produce a trillion new bacteria over the course of three or four days. The organism effectively converts the human body into a factory for multiplying itself a millionfold. And if the factory doesn’t survive longer than a few days, so be it. There’s usually another one nearby to colonize.
THE ACTUAL CAUSE OF DEATH WITH CHOLERA IS DIFFICULT to pinpoint; the human body’s dependence on water is so profound that almost all the major systems begin to fail when so much fluid is evacuated in such a short period of time. Dying of dehydration is, in a sense, an abomination against the very origins of life on earth. Our ancestors evolved first in the oceans of the young planet, and while some organisms managed to adapt to life on the land, our bodies retain a genetic memory of their watery origin. Fertilization for all animals takes place in some form of water; embryos float in the womb; human blood has almost the same concentration of salts as seawater. “Those animal species that fully adapted to the land did so through the trick of taking their former environment with them,” the evolutionary biologist Lynn Margulis writes. “No animal has ever really completely left the watery microcosm.… No matter how high and dry the mountain top, no matter how secluded and modern the retreat, we sweat and cry what is basically seawater.”
The first significant effect of serious dehydration is a reduction in the volume of blood circulating through the body, the blood growing increasingly concentrated as it is deprived of water. The lowered volume causes the heart to pump faster to maintain blood pressure and keep vital organs—the brain and the kidneys—functional. In this internal triage, nonvital organs such as the gallbladder and spleen begin to shut down. Blood vessels in the extremities constrict, creating a persistent tingling sensation. Because the brain continues to receive a sufficient supply of blood in this early stage, the cholera victim retains a sharp awareness of the attack that V. cholerae has launched against his body.
Eventually, the heart fails in its ability to maintain adequate blood pressure, and hypotension sets in. The heart pumps at a frenetic rate, while the kidneys struggle to conserve as much fluid as possible. The mind grows hazy; some sufferers become lightheaded or even pass out. The terrible evacuations of rice-water stools continue. By now, the cholera victim may have lost more than ten percent of his body weight in a matter of twenty-four hours. As the kidneys finally start to fail, the bloodstream re-creates on a much smaller scale the crisis of waste management that helped cholera thrive in so many large cities: waste products accumulate in the blood, fostering a condition called uremia. The victim slips into unconsciousness, or even a coma; the vital organs start to shut down. Within a matter of hours, the victim is dead.
But all around him, in his soaked sheets, in the buckets of rice water at his bedside, in the cesspools and sewers, are new forms of life—trillions of them, waiting patiently for another host to infect.
WE SOMETIMES TALK ABOUT ORGANISMS “DESIRING” CERTAIN environments, even though the organism itself surely has no self-awareness, no feeling of desire in the human sense of the word. Desire in this case
is a matter of ends, not means: the organisms wants a certain environment because the setting allows it to reproduce more effectively than other environments: a brine shrimp desires salty water, a termite desires rotting wood. Put the organism in its desired environment, and the world will have more of that particular creature; take it out, and the world will have less.
In this sense, what the Vibrio cholerae bacterium desires, more than anything, is an environment in which human beings have a regular habit of eating other people’s excrement. V. cholerae cannot be transmitted through the air or even through the exchange of most bodily fluids. The ultimate route of transmission is almost invariably the same: an infected person emits the bacteria during one of the violent bouts of diarrhea that are the disease’s trademark, and another person somehow ingests some of the bacteria, usually through drinking contaminated water. Drop it into a setting where excrement eating is a common practice, and cholera will thrive—hijacking intestine after intestine to manufacture more bacteria.
For most of the history of Homo sapiens, this dependence on excrement eating meant that the cholera bacterium didn’t travel well. Since the dawn of civilization, human culture has demonstrated a remarkable knack for diversity, but eating other humans’ waste is as close to a universal taboo as any in the book. And so, without a widespread practice of consuming other people’s waste, cholera stayed close to its original home in the brackish waters of the Ganges delta, surviving on a diet of plankton.
The Ghost Map Page 4
