I still consider myself very much an amateur at reviewing works of nonfiction, even though I have been reading nonfiction relatively consistently for the last three years or so. But Steven Johnson’s chronicle of London’s 1854 cholera epidemic, titled The Ghost Map: The Story of London’s Most Terrifying Epidemic – and How it Changed Science, Cities, and the Modern World is a good text for me to practice on, since I experienced two very different – and strong – reactions to it. So expect subjectivity here, folks. That’s all I’ve got.
My favorite works of nonfiction are those that blend a variety of genres, and this book is an excellent example of that approach. The obvious place to shelf this book is under history, but it could also reasonably be considered science or sociology, and Johnson makes frequent references to Victorian literature, especially to the novels of Dickens. He also makes a surprising turn toward the political in his epilogue, but I will get to that a bit later.
The first 90% of this book is absolutely excellent. Moving methodically through the week of August 28, 1854, Johnson tracks the spread of cholera from its index case, a five month-old girl whose mother emptied the water in which she washed the baby’s soiled diapers into a cesspool whose brick walls were crumbling, allowing the bacteria in the dirty water to corrupt the water from the Broad Street pump, which was known to have the best-tasting water in London’s Soho neighborhood.
Note: If you are eating right now, and/or if you are sensitive to reading about doo-doo corrupting the water supply, doo-doo being piled up in people’s backyards and cellars, and the various factors that can lead to accidental human consumption of doo-doo, you might not want to read much further in this review, and you DEFINITELY don’t want to read Johnson’s book. But hey – he’s describing Victorian London, and there was a lot of doo-doo in Victorian London. There is a lot of doo-doo today too, but thanks to many of the events chronicled in this book, we usually do a better job of getting rid of it. But I digress.
The second and third chapters of the book focus on two individuals who took a specific interest – for very different reasons – in this cholera outbreak. John Snow was a London doctor who lived in the Golden Square neighborhood of Soho, close to the outbreak. Snow had already made a name for himself as a pioneer in the field of anesthesiology – specifically, in the regulation of gas density to increase patient safety while using ether and chloroform. Before the cholera outbreak, Snow had achieved such renown in this field that he was hired to administer chloroform to Queen Victoria when she delivered her eighth child. Earlier in his career, Snow had studied the spread of cholera and took an interest in this one above and beyond his work as an anesthesiologist. He was skeptical about the miasma theory that was almost universally believed to be responsible for the spread of disease, and he hoped to prove – and eventually did prove – that cholera is a waterborne illness. Henry Whitehead was a local clergyman who knew the lower-middle class residents of Soho intimately, and his duties included visiting the sick. However, like Snow, he took a personal interest of solving the puzzle of how cholera was spreading through the neighborhood.
Johnson spends a good while working through the complexities of the miasma theory of disease transmission, which states that most diseases are caused by bad smells. Of course, many things that smell bad – corpses, doo-doo, stagnant water – also carry disease, but the agents that cause disease are not transmitted directly by the smell. In most cases, the smell is a warning sign prompting humans to stay away from the source of the smell. Johnson ventures into evolution and natural selection, explaining the likely reasons that we evolved this tendency to fear things that smell bad when we abandoned the hunter-gatherer lifestyle in favor of a more settled life – in which the problems of how to deal with corpses, doo-doo, and other forms of waste suddenly became monumental. So while the miasma theory is consistent with the human instinct to stay away from things that smell bad, it also confirms a variety of typical human prejudices: namely those against the poor. While wealthy people can often afford whatever strategies their societies have pioneered to avoid bad smells (and in 1854 many wealthy people had already equipped themselves with flush toilets), poor people don’t always have that luxury – and in some cases, the trades that are available to poor people bring them into contact with unpleasant smells. (Johnson provides quite a catalog of these trades early in his book – again, these are not for the squeamish.)
The miasma theory is not the only misconception that kept Snow from making progress in his work. In Victorian London, the idea that the dispensing of medical advice should be the sole task of those with a medical education was not yet widespread – after all, for centuries, most medicine was practiced by ordinary people in the form of herbs and other home remedies. He quotes from a variety of letters to the editor from London newspapers of the era offering various remedies for cholera. My favorite: heroin. This particular remedy was recommended by London’s chief of police. In his letter, he rhapsodized about the benefits of laudanum and other opiates to cure any gastrointestinal complaints from mild nausea all the way up to the spasmodic cholera, and then he goes on to say that if any of his readers don’t believe him, they are invited to visit their nearest police precinct and ask the officers on duty for their opinion. All police stations, wrote the chief, are stocked with a supply of laudanum just in case any of the officers are caught short with an attack of diarrhea.
Johnson unifies his book with a truly brilliant conceit. Cholera epidemics are the result of human mismanagement of their waste products (although Johnson also makes clear that the scourge of cholera in London was also a side effect of globalization, as empire-builders slowly brought the disease northward from India and elsewhere in Asia). Any time humans settle down in one place, the disposal of waste becomes a huge problem, from the burial or burning of corpses (I grew up, for example, in a city where cemeteries are forbidden within city limits. Instead, there is an entire suburb – the town of Colma, CA – devoted almost exclusively to cemeteries. Its website proclaims prominently that its population includes over 1,600 residents and 1.5 million “souls,” and the motto of the town – also prominently displayed on the website – is “it’s great to be alive in Colma.”) to the struggles we have in our own century with the recycling of glass, plastic, aluminum, and other materials and the safe disposal of nuclear, industrial, and medical waste. Johnson takes the idea of human waste products to a new level and looks at it philosophically: “the advance of civilization produced barbarity as an unavoidable waste product, as essential to its metabolism as the gleaming spires and cultivated thought of polite society” (14). In other words, a massive city like London becomes a likely breeding ground for diseases like cholera and other biological and social ills specifically because of its size, immense population, and capacity for great art and other works of advanced “civilization.” Hunter-gatherers don’t get cholera, but they don’t build Big Ben or write Bleak House either.
There is very little that this book is not “about.” It’s about biology on both the prokaryotic and human levels. It’s about human history and sociology and anthropology and epidemiology. I learned a great deal about civic engineering in general and about London in general. In its final chapter, however, the book takes a turn that I didn’t expect and didn’t like. My first clue that Johnson was taking on a political, polemical tone was the frequent appearance of the first person plural pronoun. All of a sudden, Johnson felt compelled to begin to speak on behalf of humanity as a group: “A hundred and fifty years after Broad Street, we see [population] density as a positive force: an engine of wealth creation, population reduction, environmental sustainability. We are now, as a species, dependent on dense urban living as a survival strategy” (236).
My response: Who are you calling ‘we,’ dude?
Now, Johnson remains the responsible, thorough journalist in this final chapter, and he does provide some compelling arguments for the advantages of city living, including the fact that if New York City were made a state, it would rank twelfth in terms of population but dead last in terms of energy consumption – and that’s great. I take environmental concerns seriously, and energy conservation is important. But I am not willing to make the leap from appreciating this particular statistic to accepting that I am a part of some abstract “we” that believes that city life is safer, saner, and more responsible than life in the country or in a small town. I don’t think I will ever believe that.
Then Johnson begins a coda on a series of fashionable sources of fear – namely terrorism and killer viruses. My cynical side suggested that this tacked-on epilogue seemed like the sort of thing an editor would request in order to sell books, but I realize that if this were the case these topics would be featured more prominently in the marketing materials on the book’s front and back covers – and they’re not. Johnson proposes all kinds of nightmare scenarios – the Ebola virus attacking New York, the avian flu virus merging with a less virulent strain to make itself more readily transmissible, radiation poisoning from dirty bombs, improvised explosive devices – a whole laundry list of CNN headlines that are all designed to do one thing: to make us afraid.
I distrust any authority figure that tells me what to feel – and, almost all the time, authority figures who play to the public’s emotions are working with one of three emotions: pride, euphoria, or fear. For 228 pages, Johnson is a voice of historical and journalistic integrity, chronicling the 1854 cholera epidemic with a tone of serious inquiry, wry humor, and detached wonder at the complexity of creation. And then in his epilogue everything changes, and he becomes one of those voices that want me to be afraid of the world.
And I resent the hell out of that.
Of course I believe that all communities should maintain departments of public health and safety. Of course we should understand the routes that epidemics take and fight these epidemics the best we can. Of course we should never stop tinkering to make our world better and safer. But no water filtration system, no metal detector, no evacuation plan, no program of genetic engineering – no matter how brilliant and Nobel Prize-winning – will change the fact that human beings die, and every study of the interconnected disciplines of human life must be written in a spirit of humility that recognizes that we are being counterproductive when we encourage people to fear death. If we can eliminate a threat like cholera or polio or smallpox, then certainly should, but we should not believe that in doing so we have made the world safer. Another threat will come along to take the place of the one we have conquered. That’s how it’s always been – the human death rate, over time, is always 100%.
I have a feeling that many of my readers will see this review – or the second half of it, anyway, after I stopped using the word “doo-doo” – as bleak and naysaying and pessimistic. I disagree, but I doubt if I will make much headway in persuading others. I don’t have much use for an intellectual approach that is teleological – or oriented toward end results – in nature. I appreciate the fact that there are people in the world who love to solve problems, but I am glad that I don’t have to spend a lot of time inside their brains, and I don’t think that those people eventually do much to explain the world. And when an author like Johnson starts ranting at me about the many ways that I can die, sooner or later I stop listening. My model of intellectual inquiry is the one that Johnson models for the first 90% of his book, the one that analyzes and studies problems but recognizes the infinite complexity of everything that human beings do – not to mention everything that happens in the biological world. Absolutely we should solve problems, but we have to recognize that our solutions will only create or reveal other problems – and that this complexity in itself is something to inspire wonder.
Bring me an authority that wants to inspire me to wonder. That is the authority figure I want to listen to.
I found the “miasma” theory quite interesting. History of science is something I never really learned much about, even though I majored in Biology in college. I was too busy learning all the pathways the cholera bacteria use to learn much about where it came from and what people used to think caused it. It’s unfortunate. This was a great review! But I think that if I read it, I’ll skip the epilogue. Because I, too, hate fear-mongering.
I only took two science classes in college (the minimum required), and they were both history oriented: one was an interdisciplinary course on epidemic diseases team-taught by a medical doctor, an anthropologist, and a historian/comp lit professor – in that class we spent a LOT of time on the miasma theory, since from an anthropological perspective it’s very interesting and complex – and one was the history of cosmology – how people throughout history have viewed the universe. Both were awesome!
Absolutely we should solve problems, but we have to recognize that our solutions will only create or reveal other problems – and that this complexity in itself is something to inspire wonder.