page 116 He also entertained an aquatic version Another visionary named William Hope thought that these new sewage farms might attract visitors as a kind of excrement-themed spa: “London beauties might come out to recruit their wasted energies at the close of the season, and… would perhaps at times listen to a lecture on agriculture from the farmer himself, while drinking his cream and luxuriating in the health-restoring breeze.” Halliday 1999, p. 133.
page 118 “[Any] Dwelling House or Building” Nuisances Act, September 4, 1848, p. 1.
page 119 the sewers themselves began to clog Halliday 1999, pp. 30–34.
page 120 “The Thames is now made” Halliday 1999, p. 35.
page 121 “On entering the precincts” “A Visit to the Cholera Districts of Bermondsey,” London Morning Chronicle, September 24, 1849.
page 122 “How is the cholera generated?” London Times, September 13, 1854, p. 6.
pages 122–23 “telluric theory”… “failed to include all the observed phenomena” London Times, September 13, 1849, p. 6.
page 123 “The very first canon of nursing” Florence Nightingale, Notes on Nursing (New York: Dover, 1969), p. 12.
page 124 “If the tell-tale air test” Nightingale, p. 17.
page 125 “It might be supposed” Mayhew, p. 152.
page 127 “Whoever wishes to investigate” Hippocrates, p. 4.
page 127 “the atmosphere, all over the world” Whitehead 1854, p. 13.
page 128 The brain scans in the 2003 study Royet et al., pp. 724–26.
page 132 For every sewer-hunter living happily Tom Koch offers a precise and articulate survey of some of the statistical and cartographic studies offered in defense of the miasma theory during this period, including work on elevation authored by Farr. In most cases, Koch observes, the studies were thorough and internally consistent, even if they were ultimately supporting an incorrect hypothesis. “While the miasmatic, contagionist conclusion was wrong, the inverse relationship that was used to argue it was accurate. That Acland and Farr missed the meaning of the relation is a fault neither of the researchers nor the mapping they did. In contention were different theories of disease, different perceptions of the city, and different assumptions about the data required for a disease study. One cannot blame a scientist for being limited by the science and knowledge of his time.” Koch, p. 126.
page 133 “The probability of an outburst” Quoted in Vinten-Johansen et al., p. 174.
page 142 Snow noticed another telling absence There is some ambiguity about the timing of these investigations in the historical record. Snow’s investigation of Broad Street unfolded in two primary phases: a rapid survey of the neighborhood as the outbreak was still raging, and then a longer study that commenced a few weeks after the outbreak subsided, based partly on secondhand accounts from other surgeons and physicians in the area. Snow may in fact have uncovered information about the brewery and the workhouse in his later investigation, though the prominence of both operations, in terms of number of employees and proximity to the pump, makes it more likely that Snow paid them both a visit during the outbreak itself. In his published account Snow merely reports: “There is a Brewery in Broad Street, near to the pump, and on perceiving that no brewer’s men were registered as having died of cholera, I called on Mr. Huggins, the proprietor.” This appears several paragraphs after his description of requesting the Weekly Returns from the Registrar-General’s Office shortly after September 2.
page 145 Snow was naturally inclined to view the theory “Perhaps his research into the nature and mechanisms of anesthesia by inhaled gases made him certain that gaseous vapors alone, whether general or local, could not cause specific epidemic diseases, as miasmatic theory posited. Moreover, his investigation of arsenical candles had suggested that when a body inhaled a specific poison, it showed the specific effects of that poison, not the generalized fevers typically claimed for miasmatic and local effluvial poisoning. Contrary to the older generation of medical men who dismissed the law of the diffusion of gases as armchair theorizing, Snow’s training and daily experience administering anesthesia made him believe that careful attention to the chemistry and physics of gases could have practical benefits. It was precisely that which permitted him to use otherwise dangerous medicinal agents with safety and with exact application to the peculiar needs of each patient and each surgical operation.” Vinten-Johansen et al., p. 202.
page 145 “I have arrived at the conclusion” Lilienfeld, p. 5.
page 146 For Snow… an obvious etiology “A consideration of the pathology of cholera is capable of indicating to us the manner in which the disease is communicated. If it were ushered in by fever, or any other general constitutional disorder, then we should be furnished with no clue to the way in which the morbid poison enters the system; whether, for instance, by the alimentary canal, by the lungs, or in some other manner, but should be left to determine this point by circumstances unconnected with the pathology of the disease. But from all that I have been able to learn of cholera, both from my own observations and the descriptions of others, I conclude that cholera invariably commences with the affection of the alimentary canal. The disease often proceeds with so little feeling of general illness, that the patient does not consider himself in danger, or even apply for advice, till the malady is far advanced. In a few cases, indeed, there are dizziness, faintness, and a feeling of sinking, before discharges from the stomach or bowels actually take place; but there can be no doubt that these symptoms depend on the exudation from the mucous membrane, which is soon afterwards copiously evacuated.” Snow 1855a, pp. 6–9.
page 149 He delivered chloroform to two patients Snow’s casebooks report the full range of his professional activity for the week: “Saturday 2 Administered Chloroform at Mr Duffins to a little girl three years old from the neighbourhood of Blackheath whilst Mr D. performed amputation of the great toe together with its metatarsal bone. Monday 4 Administered Chloroform at Mr Cartwright’s to a lady whilst he extracted two [?] teeth. Wednesday 6 Administered Chloroform to Mr Jenner, Linen draper, Edgware Road whilst Mr Salmon operated by ligatures on some haemorrhoids. The patient was extremely blanched from loss of blood from the past and had a bounding haemorrhagic pulse. No faintness or depression from the chloroform. Administered Chloroform at 16 Hanover Square whilst Mr A. Rogers extracted 2 teeth. Thursday 7 Administered Chloroform to a gentleman on King Street Covent garden patient of Mr Edwards whilst Mr Partridge operated for haemorrhoid. No sickness &c. Friday 8 Administered Chloroform at 46 Wigmore Street whilst Mr Salmon operated for fistula in ano. No sickness.” Snow and Ellis, pp. 342–43.
page 152 But the most likely scenario I am grateful to Harvard’s John Mekalanos for suggesting this scenario.
page 154 “No one but those who knew him” Richardson, p. xix.
page 154 St. Bartholomew’s Hospital had received Lancet, September 16, 1854, p. 244.
page 160 And so… the Board voted Snow’s own description of the exchange is taciturn: “I had an interview with the Board of Guardians of St. James’s parish, on the evening of Thursday, 7th September, and represented the above circumstances to them. In consequence of what I said, the handle of the pump was removed on the following day.” This last sentence is now memorialized on a pin worn by members of the John Snow Society. Snow 1855a.
page 160 “Owing to the favourable change in the weather” Globe, September 8, 1854, p. 3.
page 161 “We regret to announce” Globe, September 9, 1854, p. 3.
page 162 These were real achievements Richardson probably did more than anyone to build the story that the pump handle’s removal had single-handedly brought the outbreak to an end. “The pump handle was removed,” he triumphantly announced, “and the plague was stayed.” The popular version of the Broad Street story conventionally follows this appealing narrative line. Snow identifies the perpetrator, and brings its reign of terror to an immediate end. In my research, nearly half of the shorthand accounts of the outbreak tel
l the story along these lines.
Snow did not demonstrate the link between the pump and the cholera by removing the handle; he demonstrated the link through statistical analysis of data accumulated via door-to-door interviews. And of course, the pump was not the neighborhood’s only water source, merely the most popular. In fact, the existence of the other water sources was crucial to Snow’s case. But the biggest—and most common—distortion is the notion that closing down the pump single-handedly brought the outbreak to an end. Removing the pump, in all likelihood, had little impact on the course of the outbreak. New attacks were already on the wane before Snow had the handle removed, and it’s entirely possible that the water had ceased to be dangerous by the time the authorities did anything about it.
The final statistics for the Broad Street outbreak suggest that the removal of the pump handle likely played a minor role in the ultimate trajectory of the outbreak. The most dramatic decline in deaths falls between the 4th and 5th of September, while the second-most dramatic drop occurs between the 10th and the 12th. The timeline of attacks, not deaths, has a more dramatic spike at the beginning of the week, followed by a steady leveling-off. The number of new attacks reaches the statistical norm for the neighborhood only by the 12th. If you assume a twenty-four-to-forty-eight-hour incubation period between ingesting V. cholerae and the first onset of symptoms, it would appear that the closing of the Broad Street pump well may have extinguished what was left of the outbreak, like a fire department arriving to snuff out the last embers of a building that has already burned to the ground. The plague may well have been stayed by Snow’s intervention, but it was already on its last legs. However, as we will see at the end of this chapter, there might well have been a renewed epidemic after John Lewis contracted the disease had Snow not convinced the authorities to shut down the pump.
page 163 “Structural peculiarities of the Streets” Committee for Scientific Inquiries, pp. 138–64.
page 169 “Dufour’s Place… Five houses escaped” Whitehead 1854, p. 4.
page 170 “There were no less than 21 instances” Whitehead 1854, p. 6.
page 170 “God’s ways are equal” Whitehead 1854, p. 14.
page 172 “principally on the ground” Cholera Inquiry Committee, p. v.
page 175 As much as he had resisted Whitehead described his response to Snow’s theory in his 1865 memoir: “When I first heard of it, I stated to a medical friend my belief that a careful investigation would refute it, alleging as one proof of its inaccuracy the fact of several recoveries from collapse having taken place, at least in spite of, if not actually by reason of, the constant use of the Broad Street water. I added that I knew the inhabitants of Broad Street so well, and had occasion almost daily to spend so much time among them, that I should have no great difficulty in making the necessary inquiries. Accordingly I began an inquiry, which ultimately became very elaborate; at an early stage of which, however, one day meeting the same friend, and being asked by him what way I had made towards clearing the character of the pump, I was obliged to confess that my opinion on that matter was less confident than when we had last talked about it.” Whitehead 1865, p. 116.
page 176 Whatever agent had caused the cholera Whitehead 1865, p. 116.
page 179 “abominations, unmolested by water” Whitehead 1865, p. 121.
page 181 “You and I may not live” Rawnsley, p. 206.
page 182 “The weight of both positive and negative” Cholera Inquiry Committee, p. 55.
page 183 “In explanation of the remarkable intensity” Committee for Scientific Inquiries, p. 51.
page 184 “That such local uncleanliness” Committee for Scientific Inquiries, p. 52.
page 185 “Atmospheric Pressure” Committee for Scientific Inquiries, p. iv.
page 186 “The water was undeniably impure” Committee for Scientific Inquiries, p. 52.
page 192 If some noxious effluvium Koch, pp. 106–8.
page 194 It was not the mapmaking technique Koch, pp. 75–101. Vinten-Johansen et al. also have a superb chapter on Snow’s cartographic legacy that addresses many of these topics.
page 196 it measured how long it took Koch, p. 100.
page 198 copies of copies began appearing in textbooks The original redrawing appears in Sedgewick’s public-health textbook from 1911. For a meticulous investigation of the Broad Street map’s convoluted history, see Koch, pp. 129–53.
page 204 Snow responded to these papers “SIR,—I did not until to-day, read the important and interesting Address of Sir J. K. Shuttleworth, Bart., in The Lancet of the 2nd instant. I find that he alludes in complimentary terms to my conclusions regarding the propagation of cholera, as modified by a suggestion of Drs. Theirsch and Pettenkofer, but he erroneously attributes these views, so modified, to Dr. W. Budd.… A few weeks after the first edition of my essay on Cholera appeared in 1849, Dr. W. Budd published a pamphlet on the subject, in which he adopted my views, and made a full and handsome acknowledgement of my priority.” Lancet, February 16, 1856, p. 184.
page 205 “Why is it, then, that Dr. Snow” Lancet, June 23, 1855, p. 635.
page 205 “What a pity” Quoted in Halliday 1999, p. 82.
page 206 “DR. JOHN SNOW—This well-known physician” Lancet, June 26, 1858, p. 635.
page 208 “It was certainly a very troublesome job” Quoted in Halliday 1999, p. 183.
page 211 Ninety-three percent of the dead This account of the East London outbreak is drawn largely from Halliday 1999, pp. 137–43.
page 212 “The final report of the scientific committee” Parliamentary Papers, 1867–1868, vol. 37, pp. 79–82.
page 215 to reverse the flow of the Chicago River http:www.sewerhistory.org/chronos/new_amer_roots.htm.
page 216 The main road in… Sultaneyli Neuwirth, pp. 1–11.
page 218 A service called GeoSentinel http:www.istm.org/geosentinel/main.html.
page 221 “Towns and suburbs… are natural homes” Jacobs 1969, pp. 146–47. The current buzzword for this trend is “long tail” economics; instead of concentrating exclusively on big mass hits, online businesses can target the “long tail” of quirkier fare. In the old model, the economics dictated that it was always better to sell a million copies of one album. But in the digital age, it can be just as profitable to sell a hundred copies each of a thousand different albums. Urban information mapping systems offer an intriguing corollary to the long-tail theory. As technology increasingly allows us to satisfy more eclectic needs, anytime those needs require physical presence, the logic of the long tail will favor urban environments over less densely populated ones. If you’re downloading the latest album from an obscure Scandinavian doo-wop group, geography doesn’t matter: it’s just as easy to get the bits delivered to you in the middle of Wyoming as it is in the middle of Manhattan. But if you’re trying to meet up with other fans of Scandinavian doo-wop, you’ll have more luck in Manhattan or London. The long tail may well lead us away from the dominance of mass hits and pop superstars toward quirkier tastes and smaller artists. But it may also lead us to bigger cities.
page 225 The public spaces and coffeehouses “‘The coffee-house was the Londoner’s home, and those who wished to find a gentleman commonly asked, not whether he lived in Fleet Street or Chancery Lane, but whether he frequented the Grecian or the Rainbow.’ Some people frequented multiple coffeehouses, the choice of which depended on their interests. A merchant, for example, might oscillate between a financial coffeehouse and one specializing in Baltic, West Indian, or East Indian shipping. The wide-ranging interests of the English scientist Robert Hooke were reflected in his visits to around sixty London coffeehouses during the 1670s, recorded in his diary. Rumors, news, and gossip were carried between coffeehouses by their patrons, and on occasion runners would flit from one coffeehouse to another to report major events such as the outbreak of war or the death of a head of state.” Standage, p. 155.
page 226 “In the Broad Street outbreak” Quoted in Rawnsley, p. 76.
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page 227 “that in any profession the highest order” Rawnsley, p. 206.
page 232 Two-thirds of the women living in rural areas Statistics from “State of World Population 1996.” See http://www.unfpa.org/swp/1996/.
page 233 “Virtually any service system” Toby Hemenway, “Cities, Peak Oil, and Sustainability.” Published at http://www.patternliteracy.com/urban2.html.
page 234 If we’re going to survive as a planet Much has been made of the staggering size of the environmental footprint of today’s modern city, the area of land required to support sustainably the energy intakes of the city’s population. London’s environmental footprint, for instance, is practically as large as the entire United Kingdom. The sheer magnitude of such a footprint has been invoked as part of antiurban environmental arguments, but the primary objection is in fact industrialization not urbanization. However large London’s footprint might be today, it would be many times larger if the city’s population were scattered at suburban or exurban densities. Unless we renounce our postindustrial lifestyle altogether, cities are environmentally preferable to other, lower-density forms of living. The United Nations’ Global Environmental Outlook describes it this way: “The relatively disproportionate urban environmental footprint is acceptable to a certain extent because, for some issues, the per capita environmental impact of cities is smaller than would be made by a similar number of people in a rural setting. Cities concentrate populations in a way that reduces land pressure and provides economies of scale and proximity of infrastructure and services.… Urban areas therefore hold promise for sustainable development because of their ability to support a large number of people while limiting their per capita impact on the natural environment.”
page 235 “All the apparatus of surgery” Jacobs 1969, pp. 447–48.
page 238 “The most devastating damage” Owen, p. 47. Owen describes the environmental impact of his family’s move from Manhattan to rural northwest Connecticut: “Yet our move was an ecological catastrophe. Our consumption of electricity went from roughly four thousand kilowatt-hours a year, toward the end of our time in New York, to almost thirty thousand kilowatt-hours in 2003—and our house doesn’t even have central air-conditioning. We bought a car shortly before we moved, and another one soon after we arrived, and a third one ten years later. (If you live in the country and don’t have a second car, you can’t retrieve your first car from the mechanic after it’s been repaired; the third car was the product of a mild midlife crisis, but soon evolved into a necessity.) My wife and I both work at home, but we manage to drive thirty thousand miles a year between us, mostly doing ordinary errands. Nearly everything we do away from our house requires a car trip. Renting a movie and later returning it, for example, consumes almost two gallons of gasoline, since the nearest Blockbuster is ten miles away and each transaction involves two round trips. When we lived in New York, heat escaping from our apartment helped to heat the apartment above ours; nowadays, many of the BTUs produced by our brand-new, extremely efficient oil-burning furnace leak through our two-hundred-year-old roof and into the dazzling star-filled winter sky above.”
The Ghost Map Page 26
