The Ghost Map

by Steven Johnson

  page 29 “the noisy and the eager” Charles Dickens, Little Dorrit (London: Wordsworth, 1996), p. 778.

  page 33 “burst forth… with extraordinary malignity” London Times, September 12, 1849, p. 2.

  page 34 The epidemic of 1848–1849 Koch, p. 42.

  pages 34–35 “While the mechanism of life” London Times, September 13, 1849, p. 6.

  page 35 “countenance quite shrunk” Shephard, p. 158.

  page 36 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.

  page 37 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.

  page 38 “Those animal species that fully adapted” Margulis, p. 183.

  page 41 “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.

  page 43 “All the world’s bacteria essentially” Margulis, p. 30.

  page 45 Thomas Latta, hit upon Shephard, p. 158.

  page 46 “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.”

  page 47 “FEVER and CHOLERA” London Morning Chronicle, September 7, 1854.

  page 47 “Sir—I have observed” London Morning Chronicle, August 25, 1854.

  page 48 “Will you… kindly allow” London Times, August 18, 1854, p. 9.

  page 49 “Sir—Induced by” London Times, September 21, 1854, p. 7.

  page 50 “It really is nauseating” Punch, 27 (September 2, 1854), p. 86.

  page 51 “Having at length emerged” London Morning Chronicle, September 1, 1854, p. 4.

  page 52 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.

  page 54 All but one would perish Whitehead 1854, p. 5.

  page 58 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.

  page 59 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.

  page 60 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.

  page 61 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.

  page 61 “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. His 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.

  page 63 “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 a
n explosive effort and had to be pursued until the cauterization was complete, with his lower lip burned in the process.” Sullivan 1996.

  page 65 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.

  page 66 “Thursday 7 April” Snow and Ellis, p. 271.

  page 67 “The Consilience of Inductions,” Whewell wrote Quoted in Wilson, p. 8.

  page 68 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.

  page 69 “We can only suppose the existence” “History of the Rise, Progress, Ravages etc. of the Blue Cholera of India,” Lancet, 1831, pp. 241–84.

  page 70 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.”

  page 74 it didn’t include the false leads J. M. Eyler, “The Changing Assessments of John Snow’s and William Farr’s Cholera Studies,” Sozial- und Präventivmedizin 46 (2001), pp. 225–32.

  page 75 “The experimentum crucis would be” London Medical Gazette 9 (1849), p. 466.

  page 83 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.

  page 83 “It is said that Friday night” Observer, September 3, 1854, p. 5.

  page 84 The 1842 study found Picard, p. 180.

  page 85 “Jo lives—that is to say” Dickens 1996, p. 475.

  page 86 “The roads, in all directions” Quoted in Rosenberg 1987, p. 28.

  page 88 “The infinite number of Fires” Quoted in Porter, p. 162.

  page 89 “the houses will become too numerous” Porter, p. 164.

  page 91 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…”

  page 91 “monster city… stretched not only” Quoted in Porter, p. 186.

  page 93 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.

  page 93 A collection of water molecules Iberall 1987, pp. 531–33.

  page 94 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.

  page 95 One mechanic who provided Picard, p. 82.

  page 95 Largely freed from waterborne disease Standage, p. 201.

  page 99 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.

  page 101 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.

  page 102 “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.”

  page 103 To digest large quantities of it Ridley, p. 192.

  page 104 One provides the fizz, the other the buzz Margulis, p. 75.

  page 105 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.

  page 106 “The experiment… was on the grandest” Snow, 1855a, p. 75.

  page 109 “In Broad-Street, on Monday evening” Observer, September 3, 1854, p. 5.

  page 112 “The Guardians are acting” London Times, September 6, 1854, p. 5.

  page 114 This is the great irony of Chadwick’s life For more on the life of Chadwick, see Finer.

  page 114 “All smell is… disease” Quoted in Halliday 1999, p. 127.

  page 115 One in twenty had human waste Halliday 1999, p. 133.

  page 116 “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.