“The probability of an outburst or increase during [calm, mild] weather, I believed to be heightened on holidays, Saturdays, Sundays, and any other occasions where opportunities were afforded the lower classes for dissipation and debauchery” – unattributed quote by ‘expert’ regarding how cholera disproportionally attacks the poor and other social underclasses, in Victorian London.

As strange as this seems to modern eyes, this statement was backed up by scientific evidence, or at least what passed for such in England of the mid-19th century. During this time, the predominant theory for the spread of contagion and sickness was miasma (Greek for “pollution”), that is bad smells and foul air were the causes of disease.

The Ghost Map: the Story of London’s Most Terrifying Epidemic – and How it Changed Science, Cities, and the Modern World, by Steven Johnson (Riverhead Books) is the story of Dr. John Snow and Rev. Henry Whitehead’s discovery of the water-born transmission of cholera, a disease which struck with terrifying regularity in London and other large cities. The popular folklore is that Dr. Snow plotted cases of cholera deaths on a map, and deduced that the outbreak’s source was a particular well in a poor section of London, and removed the handle to the pump, thereby halting the epidemic, and was hailed as a hero.

The true story is not nearly so neatly packaged. Dr. Snow noticed, in earlier epidemics, a pattern of isolated groups either contracting cholera in isolation, or seeing groups that were spared contagion in the middle of a raging epidemic. Using his skills and experience, he correctly deduced that water somehow carried the source of the disease (although he had no idea about germ theory), and managed to track the common source to the water well located on Broad Street, in the area now known as Soho. Although he was unable to find anything in the water that could be the source of the disease (in fact, other wells had cloudy or smelly water, but no pattern of contagion). Over a period of months, however, he was unable to convince the health boards and community groups of his findings, because it was commonly known that bad smells were the source of disease, and indeed this had been known for centuries. This belief was continually reinforced because the most stricken areas, such as Broad Street, also happened to be the dirtiest and most fetid location in London. The scientists of the day could confirm their views by taking an (admittedly short) stroll through the impacted areas.

London grew from a city of a few hundred thousand to over 2 million in a matter of decades. Before the growth, most human waste was collected and carried to the surrounding farmland for fertilizer. However, with the rapid grow and expansion of the city limits, the feasibility and cost to remove ‘night soil’ became too expensive for the poor, and so the waste collected in the cesspools under the houses and in open pits in the alleys and yards. What few sewage systems existed dumped the untreated water directly into the Thames. The invention of the water closet increased the problem, since the additional water used for flushing ended up in the same overflowing pits. London was drowning in human waste, and it was commonly believed that the city would eventually perish under its mountain of refuse. And, common ‘scientific’ belief was that since the worst situation, and the worst smells, existed in the poorest neighborhoods, as did the greatest incidences of disease, crime, and death, the poor somehow brought it upon themselves, hence the quotation at the beginning of this article.

Dr. Snow eventually persuaded the local council to remove the pump handle, but by this time, new cases of cholera (and the original index source of the outbreak) had moved on. The councils were not, however, persuaded of the validity of their belief in miasma. In fact, Dr. Snow’s views were openly mocked on the pages of The Lancet and the newspapers of the day. How did they explain that in some cases, some members of a family died while other survived, while supposedly breathing the same foul air? Or that one household might entirely succumb while their immediate neighbors, who shared a yard, might all survive? The Victorians concluded, based on their understanding of the evidence, was that a person’s inherent constitution and moral character could be protective. Reverend Whitehead, who served as the local vicar and knew nearly all of the people of the Broad Street area on a first-name basis, initially scoffed at Dr. Snow’s hypothesis, as well, but became intrigued and finally assisted Dr. Snow’s data collection efforts when he realized that the ‘constitution and moral character’ of the individuals succumbing to cholera did not necessarily jive with the mortality cases. He also helped Dr. Snow track down and tabulated cases of cholera among ‘the better sort’ of people who no longer lived in the Broad Street area but may have partaken of the well’s water during a visit. He was also impressed that the entire population of a workhouse (the Victorians’ favorite scapegoat) survived the outbreak, as did all of the workers at a particular brewery, who were paid in product and never drank water.

In the end, it was not an epiphany that led Dr. Snow to his breakthrough, but years of plodding, shoe leather, tedious tabulation of victims, and his now-famous map, that convinced the skeptics of his claim. It was nearly 10 years after the outbreak before Dr. Snow’s discovery was finally accepted by mainstream scientists and politicians, and it was shortly after that that London finally embarked on the ambitious plan to install both sewer collection systems and to supply filtered water to the population of London. The last cholera outbreak was in 1866, shortly before the completion of the system. London’s example served as a model for the other great cities of the world.

Dr. Snow and Rev. Whitehead’s true legacies are not that they stopped cholera epidemics, but that they introduced a multidisciplinary approach in thinking about medical and scientific problems, and moderized the methods of scientific inquiry. ( )

Excellent. This is my second Steven Johnson book. Now I will have to read all of his stuff. This is much more than pop-science history. Strong sociology of science elements.

Johnson does a great job of weaving the 1854 Cholera crisis into a larger tale about the positive and potentially dreadful issues that exist in our rapidly urbanized “city-planet” a century and a half after the fact. Most of the book is indeed dedicated to the London epidemic and is mainly structured from the perspective of John Snow’s emergence as a dedicated, fastidious medical professional that must develop his water-born disease theory in the face of long-held embrace of the miasma theory (fetid air as the communication device of the disease) among other more absurd theories. Ultimately the story has two heroes, Snow and the Reverend Henry Whitehead who originally denounced Snow’s idea and ridiculed the removal of the pump handle. But all of this is likely found within the book description above, so there’s no need for me to subject this to my dubious contortions.

I’ll simply say that this is not a linear narrative as Johnson is all over the place chronologically and thematically, despite the day-to-day account/chapter heads that only somewhat structures the story. It works well, in my opinion, and warrants my bestowment of the title “page-turner” to his effort. He necessarily delves into the more scientific aspects – rendering the information in a clear way for us laypeeps. Of course he’s also a layperson so I’d be curious to read the opinion of a real scientist or medical professional. Occasionally I did have this odd sensation that he was writing and repeating /reiterating statements in such a simplistic, almost preachy prose as if directed towards a slow eleven year old. And this wasn’t even so much with the scientific explanations but with statements dealing with Victorian era morality. I also – having read one of his previous books, and seeing his lecture – found myself thinking “aha!” as I was about mid-way through the concluding chapter. Here he suddenly confronts us with a dissertation about how communication devices and potentialities of the 21st century enables new and uncharted forms of urban interrelations – essentially his main agenda as evidenced by his other writings. I was initially bothered as I really just wanted the London story, but it all comes together – mostly in the Epilogue – as a resolved and interesting series of correlations and statements about scientific inquiry, issues relating to dense urban settlement and how the idea of an informational/projective “map” has transformed (the proof of which I see immediately to the right where, as I type, some digital add for something called the ATT "LOOPT" maps a conversation between two women in New York who realize they had purchased the same "cute dress" from that same "cute boutique." Tragedy is averted as the instantaneous LOOPT conversation allows one to return her dress immediately, thus avoiding an attire faux pas later that evening. Thank goodness...). ( )

Rarely do I read nonfiction, but this one was great! It was ecommended to me by a friend when I told him I loved novels on the theme of epidemics and deadly diseases.

In 1854 a neighborhood in London suffered an astonishing outbreak of cholera which descimated the population... but only of one area. The book focuses on the investigations of John Snow and Henry Whitehead. Snow, the doctor who discovered how cholera was transmitted, and Whitehead, a clergyman who provided key pieces of the puzzle and became a champion for Dr. Snow.

Far from stoppin at the disease, the book goes into the concepts and technologies that allowed Snow to solve the problem, and how these ideas have developed up to the present day, and how they are likely to develop in the future. The lengthy epilogue discusses the positives and negatives of city dwelling today, and how an epidemic disease today would be spread and how it would be conquered. ( )

An engaging account of Dr. John Snow and the medical detective work that kept London’s plumbing from killing again. A book you can't put down and a story you won't forget. ( )