The Ghost Map: The Story of London's Most Terrifying Epidemic—and How It Changed Science, Cities, and the Modern World

Kirsti

Rating: really liked it
WARNING: Do not read this review if you are squeamish. Or eating.

This book is about cholera, and as a result, the author uses an impressive number of words for shit--including excrement, ordure, human waste, and the Victorian euphemism night soil. And shit, of course.

Johnson explains that a key question in the development of civilization has always been "What are we going to do with all this shit?" This book dramatically improved my vocabulary regarding topics related to 1850s London. For instance:

miasmatist: someone who believes that bad-smelling air rather than germs or bacteria cause disease (Florence Nightingale was a miasmatist)

pure-finder: someone who finds dogshit and sells it to tanners to use in the leathermaking processs

toshers: trash-pickers

mudlarks: children who scavenge junk that toshers don't want

scavenger classes: pure-finders, toshers, mudlarks, and others in the recycling business

rice-water stool: don't ask

Johnson's previous books have been about how the mind works, so Ghost Map is really more about how people map information and adapt to innovations than it is a straightforward history of a particular epidemic. He writes that cholera is "a supremely dark chapter in the book of death" and points out how wrong it is that people are still dying of this preventable, treatable disease.

I learned that this is not a good audiobook to listen to when cooking dinner. However, it is a great audiobook to listen to when cleaning. My kitchen and bathrooms have never been more thoroughly disinfected.

Kay

Rating: really liked it
By turns thought-provoking and irritating, The Ghost Map meanders from its central story -- how an unorthodox physician found the source of a cholera epidemic that swept through London in 1854 -- into a host of other issues. Expecting a more straightforward account of the unraveling of this medical mystery, I set this book aside twice in frustration, bored with the author's tendency to stretch out the narrative, and particularly his repeated examination of the hold the "miasma paradigm" had upon medical minds in the mid nineteenth century. He can't seem to get over the fact that all manner of educated and otherwise reasonable people believed that disease was caused by noxious smells. His lengthy discussion of the bureaucratic obstacles faced by John Snow, the physician who linked cholera with contamination of drinking water with sewage, begins to wear thin about half-way through the book.

The Ghost Map certainly starts promisingly enough, with a description of Victorian London's hitherto unheralded "recyclers" - the "night-soil men," "mudlarks," rag-gatherers, bone-pickers and others who made a living scavenging in London's streets, rivers, and sewers. This is fascinating stuff -- who knew, for example, that such a person as a "pure finder" (dealer in dog shit, or "pure, which was used by tanners) existed? In this Dickensian world, an astonishing diverse array of second- (or third-) class citizens eked out a living on the margins.

From an examination of this nether world, Johnson then moves on to the slums of London, doing a crack-up job describing the cramped, horrid living conditions. He zeros in on one street and one family; a harried mother is caring for a sick infant, who eventually dies. The child suffers from virulent diarrhea and is wasting away. The mother washes the soiled diapers and tosses the dirty water in the cesspool just outside her door. The cesspool, in turn, oozes into a local well. The stage is set for the beginning of an epidemic.

Johnson is best when he describes this world, with its reeking slums. But he is inclined, frequently, to hare after philosophical questions, not the least of which is mankind's inability to see beyond the dominant scientific paradigms of the time. This bogs the narrative down. While Johnson has many interesting ideas and speculations, it's tiring to be taken on so many unresolved side journeys. It's not quite so interesting, for example, to read (at length) of John Snow's battles with pig-headed authorities, who are blind to the obvious link that Snow establishes between one particular source of contaminated water and the cholera epidemic. Nor was I particularly enthralled to read the minutia of Snow's statistical analysis he built for his case. Johnson also seems inordinately fond of the idea of a "map" as a grand organizing theme, one which he stretches out well past the 19th century in the final chapter.

Actually, the final chapter leaves Snow's London altogether and is something of an eye opener. Johnson discusses the role of cities in the modern world, as well as the gravest threats that mankind faces today. This chapter could well be a stand-alone essay. It made me think, ultimately, that this book would have made two excellent books -- one the tale of the cholera epidemic and the other of the social consequences of the rise of cities. As it is, putting them into one book, weaving between factual account and philosophical premise, was over-reaching a bit.

Rachel

Rating: really liked it
I read The Ghost Map: The Story of London's Most Terrifying Epidemic--and How It Changed Science, Cities, and the Modern World because I wanted to learn more about a story I thought I knew. The story I learned goes like this: during a terrible cholera outbreak in Victorian London, Dr. John Snow made a revolutionary map of the mortality, was like, “Holy crap! The deaths all radiate out from this one pump!” and removed the pump handle, thus halting the epidemic dead in its tracks.

Turns out, there are about seven books worth of topics in here, wrestling each other for space with brawny arms. Were all of them woven seamlessly together into one multifaceted, but logically coherent, narrative? Well no, actually, and I found myself in a constant whiplash between fascination and frustration throughout the book. Which left me with a lot to get off my chest, so if you want to move right along to the next review before the unloading begins, I totally understand.

The Contenders

1. What actually happened with Dr. Snow, the progress of the epidemic, the map and the pump handle = Fascinating. Enthrallingly, this turns out to be quite different than that story that was floating around my biology class. The way the structure follows the daily disease progress, the actions of Snow, and the previously underemphasized role played by local clergyman, Rev. Henry Whitehead -- all this was just great. If the whole book had been like this, plus a few more maps (see 5, below), I would have closed it a happy nerd, indeed.

2.The history of a classic scientific paradigm shift from the miasma (bad air) theory of cholera transmission to the waterborne theory, championed by Snow = EXTRA Fascinating. Analysis of social forces working in science? Why yes, please! This cholera epidemic struck before widespread acceptance of germ theory, so most people thought that it (and other diseases) was caused by smelly miasma interacting with poor people’s conveniently innate weakness and inferiority and stuff. Several years before the Broad Street epidemic, John Snow developed an alternate, water-borne theory of cholera transmission, and evidence provided by this epidemic started tipping the scales in its favor. Johnson covers the Kuhnian paradigm shift from miasma to water: the circumstances that gave miasma such legs, how, in the grip of the miasma paradigm, some folks designed a massive study of this epidemic that could only uncover evidence to support that paradigm and missed what was actually going on by like ten miles (and you know we’re totally doing this today, but about what??), who changed their minds (most people, eventually), who didn’t (some diehard folks who didn’t have even a nodding acquaintance with falsifiability), and why. See: a classic. (Did you know that Florence Nightingale was a committed miasmatist? I didn’t!) I wouldn’t have minded a small acknowledgement that some diseases are truly airborne, so the miasma crowd was not as off-the-deep-end as herein presented, but that’s a teeny quibble.

3. Report on waste disposal in Victorian London, with particular attention given to poop = Fascinating. ‘Nuff said.

4. Our modern understanding of the life history and evolution of the cholera bacterium = Frustrating, but maybe only to me. Host/pathogen evolution and interactions are like candy to me, because I’m weird like that, so I was quite looking forward to this bit. Well, the book and I got off on the wrong foot when he started with all that anthropomorphic language to describe the evolution of the cholera pathogen: the bacteria were “waiting patiently,” had “strategies” and “desires.” He did say, twice, that of course they’re not really hanging out and sentiently plotting our doom (for which, yay! Michael Pollan in Botany of Desire, please take note.), but then he kept right on using the misleading language. Dude! You’re a nonfiction writer! Taking complicated concepts and making them understandable is your job! Why would you tell us evolution is crucial to the story, tell us you’re explaining it wrong, then never actually explain natural selection exactly right? I didn’t get that at all.

5. Snow’s maps as visual displays of quantitative information = EXTRA Frustrating. The guy put “Ghost Map” before the colon, for Lord’s sake and dragged Tufte in, the least he could do is show us all the maps he discusses. The only Snow map in my book was not even his revolutionary Voronoi diagram. Plus, I was dying to compare Snow’s maps with the less useful Department of Sewers disease map that preceded them. Yes, you can find all the maps in the John Snow online archive, but of the seven pages of maps in here, why are they mostly copies of the same map, seemingly included for decorative purposes? Why? Why??

6. Treatise on historical urbanization and the emergent properties of city-as-organism = Fascinating for about half a page, quickly mutating into frustrating thereafter. Johnson has a clear parallel interest in these topics. Good on him: epidemiology and urbanization are intertwined in interesting ways. However, I feel like he could have dealt with it with a few swift paragraphs demonstrating the importance of urban conditions for disease emergence and why the scale of John Snow’s investigations mattered, and moved on already.

7. Rampant speculation about impact of the Broad Street epidemic on future urbanization patterns = FRUSTRATING. Now here’s where Johnson takes that parallel interest deep into crazy-train territory. The book closes with a 25-page epilogue of not-too-convincingly-supported hand-waving about suitcase bombs, bioterrorism, avian flu and urbanization that, even now, has my eyebrows in a pucker over what the heck so much of it was doing in there. If he really wanted to put an original stamp on the book (which, after 25 pages of this jive, I’m pretty convinced he did), perhaps axing 99% of the epilogue and generating some new maps would have been a far more relevant way to go. How awesome would it be to see maps showing deaths over time, maps with different variables, maps of Snow’s data made using modern epidemiological techniques, maps of other London cholera epidemics, etc.? Very awesome indeed.

In conclusion, more maps make everything better. Thank you.

Eric_W

Rating: really liked it
Cholera is a nasty little bug. Once ingested, it forms colonies on the intestinal wall, begins to reproduce with ferocious speed, and proceeds to trick the cells into excreting water rather than absorb it. It doesn't really matter of the host dies soon, because millions of new little cholera bacteria rush out of the host with the excreta waiting for the next person to ingest some excrement. That is the key. The only was to get cholera is by ingesting the excrement of another person so infected. Now you might say, whoa, that's more than I really wanted to know and I have no intention of so doing anyway. Well, you're right, all homo sapiens have a predisposition NOT to do just that, but given the rise of cities, the closeness with which we live, the relative ease of transportation, and the total misunderstanding of basic sanitation that existed until the 20th century, it was inevitable that the little buggers would escape their original habitat along the Ganges River.

Johnson discusses the interrelationship of the rise of cities, alcohol tolerance as a genetic adaptation to increased agriculturalization. Drinking water could be quite hazardous, but drinking beer and other alcoholic drinks had survival value from a natural selection standpoint because the fermentation process and alcohol killed off many harmful bacteria. Since alcohol is a poison and ill-tolerated by many, the speculation is that as agriculture and cities began to predominate, those who could tolerate alcohol better than others survived to reproduction age.

In another of those little actions that are intended to benefit, but which have unintended consequences, the change in use of sewers in London, inadvertently laid the groundwork (pun intended) for the cholera epidemic. Sewers had been designed to channel away rain water to and help prevent flooding in the city. In fact, it was prohibited to dump anything in the sewers and the Thames had been teeming with fish and quite clean. As the population increased, waste accumulated, and the aroma of piles of excrement in basements and elsewhere gave the miasmatists (those who believed disease was transmitted in the air) food for thought (the puns just keep rolling along.) So they had the brilliant idea of using the sewer system to wash the excrement out of the city and into the river which soon became foul. As it had also been the source of drinking water, the transmission of the cholera bacteria was efficient and inevitable.

Snow's rational approach to discovering the cause of the disease is remarkable in other ways. It had been common (a mythos that still is often heard today) to blame disease on lack of moral fiber. Since most of the victims were poor, and we all know that the poor are morally unfit, the victims themselves were somehow responsible for the illness. Snow rejected that possibility, rationally looking at evidence and building his case for the water-bourne nature of the disease. Johnson turns a nice metaphor in describing Snow's discovery: "...how great breakthroughs usually happen in practice. It is rarely the isolated genius having a eureka moment alone in the lab. Nor is it merely a question of building on precedent, of standing on the shoulders of giants, in Newton's famous phrase.Great breakthroughs are closer to what happens in a flood plain, a dozen separate tributaries converge and the rising waters lift the genius high enough that he or she can see around the conceptual constructions of the age."

How the source of cholera epidemics in London in 1854 was identified and explained is the subject of this engrossing work. A very good companion book to read with this one is Yellow Fever, Black Goddess: The Coevolution of People and Plagues which has an excellent section on modern cholera treatments.

Diane S ☔

Rating: really liked it
3.5 Had seen the PBS special on Snow and his discovery during the cholera epidemic a few months back and this added more detail to that show. Interesting theories abounded, the miasma theory which was a theory almost all favored. How they did so much with so little. Took hard work without all our modern scientific equipment. Snow dedicated his life to the sciences, what he accomplished was nothing short of astonishing. Loved all the extraneous information, how tea helped with the lessening of certain diseases, why the flow of the Chicago River was reversed, and info on why these diseases flourished in the first place and of how with current conditions in some third world country, it will happen again.

Quitman informative book, at times too much information, learned more than I wanted to know about how waste was handled in the past. The condition were nothing short of appalling. Didn't care for the last chapter but did hold my attention for most of the book.

Paul

Rating: really liked it
This is an account of the 1854 cholera epidemic in London and of the work of John Snow who through his scientific investigations managed to establish that cholera was waterborne and that the source of this outbreak was the Broad Street pump. This was going against the scientific opinion of the time a miasmic theory which argued that air, small and conditions were responsible. The book covers a variety of areas: history, biography, detective work, epidemiology and scientific investigation. Johnson uses a Victorian novelist’s trick and takes a chapter to introduce each player. The first chapter introduces the city of London and then the main players, John Snow, Rev Henry Whitehead, Edwin Chadwick and William Farr. The account of Snow’s investigations is fascinating. The descriptions of the conditions in London before the sewer system was built was pretty stomach churning. I never realised that most basements/cellars were used as cesspits. Also the descriptions of the myriad citizens who in varying ways made a living out of the waste has its own fascination.
It’s a great story and I knew a bit about Snow, but I was less aware of the role of Whitehead. He was working as a vicar in the area and knew and visited many of those who died. He did a good deal of the detective work that supported Snow’s thinking. Snow, of course, was already known for his work on chloroform and anaesthesia and would have had a place in the history of medicine just for that. Johnson’s introduction to the book is a good summation:
“This is a story with four protagonists: a deadly bacterium, a vast city, and two gifted but very different men. One dark week a hundred fifty years ago, in the midst of great terror and human suffering, their lives collided on London’s Broad Street, on the western edge of Soho.
This book is an attempt to tell the story in a way that does justice to the multiple scales of existence that helped bring it about: from the invisible kingdom of microscopic bacteria, to the tragedy and courage and camaraderie of individual lives, to the cultural realm of ideas and ideologies, all the way up to the sprawling metropolis of London itself. It’s the story of a map that lies at the intersection of all those different vectors, a map created to help make sense of an experience that defied human understanding.”
The book is somewhat repetitive at times: and then there is the epilogue, which leaves the subject of the book and is much more speculative. Johnson looks at increasing urbanization, arguing we are becoming a city planet and looking at what might put this at risk. He focuses on various types of terrorism, individual with weapons and explosives, portable nukes, chemical and biological. Here Johnson is in a more reflective mode, but it is very speculative and not really on the mark with too much painting terrorists as pantomime villains and not enough analysis. Skip the last chapter.

Lynne

Rating: really liked it
I enjoyed most of the book, but I hated the concluding chapter. I would have preferred it if he had stuck to his subject rather than stringing together a series of personal opinions. The discussion of the relative risks of a nuclear holocaust versus bio-terrorism via a genetically engineered virus seemed forced. Does it really matter? The author somehow managed to work in references to both the Iranian nuclear policy and intelligent design in a book about cholera in the nineteenth century. Was there an editor?

emma

Rating: really liked it
who knew i'd find a nonfiction account of the epidemiological history of cholera more interesting than most YA fantasy??

this book was disgusting. it was also SO FUN. well, the first hundred or so pages were the funnest ever (five star level for real). then the next one hundred were like...eh. and the last fifty were "uhhh i think i'm just going to skip this i'm here for plagues and infectious disease not self-indulgent waxing romantic on the future of the city as a concept?????"

but still.

lot of question marks today, huh. even more than usual.

this is an impressive book and you should, at the very least, read the first hundred pages of this and then john snow's wikipedia page or something.

bottom line: i guess i like historical nonfiction sometimes?? who knew!!!!!

Barbara

Rating: really liked it
"Whenever smart people cling to an incorrect idea despite substantial evidence to the contrary...."

And so it was when a deadly cholera epidemic spread through London in 1854. The odor of the Thames, and London in general, was foul. Everyone knew it. Therefore, erroneous thinking assumed the disease must have arisen from "bad air". Seeing is believing. A bacterium in the drinking water? Not believable at that time. Before the investigative work of John Snow, a respected doctor and inventor of ether, and Henry Whitehead, a pastor deeply concerned about the mounting deaths among his parishioners, this miasma theory was prevalent. The outbreak of cholera was also blamed on the poor, the malnourished, the morally corrupt. Snow and Whitehead worked together, one from a scientific approach and the other from personal narratives, to find the source of this illness. The title of the book refers to the demographic maps they developed to pinpoint where the density of cases existed. Whole families were succumbing in tenements as well as in wealthier sections of the city. Their work was a victory for reason and science over misinformation, superstition, and long held biases.

Published in 2006, some of Johnson's conjectures about the treatment and progress of a modern pandemic are in need of reevaluation. Although Ghost Map is well-researched and fascinating, it did bog down in some sections. His ramblings on modern cities and current global issues were unnecessary to the story. This was an enjoyable read that might have been better with some serious editing.

Joy D

Rating: really liked it
This book tells the true story of the London cholera epidemic in the 1850s and how Dr. John Snow and Reverend Henry Whitehead eventually teamed up to solve the mystery of how the disease is transmitted. At the time, it was believed to be spread via “miasma” (bad air) and putrid smells. Snow believed in the water-born theory where vibrio cholerae bacteria is transmitted by drinking contaminated water.

Dr. Snow mapped the progress of the disease, tracing cases and deaths, to find the source of the outbreak. His methods were scientific, but at the time, superstitions and prevailing theories were ingrained, and it was difficult to overcome the rigid thinking. In fact, one of the most enlightening aspects is observing how unproven speculations garner so much traction that evidence to the contrary is dismissed.

I particularly liked Steven Johnson’s vivid portrayal of London. The smell of cesspools and overflows of human waste into cellars must have been atrocious, and it is easy to see how the miasma theory originated. The scavenging hierarchy is fascinating.

A lengthy epilogue covers the future of urbanization and threats to it. The author advocates bringing advancements in infrastructure to developing countries to improve sanitation and provide clean drinking water. He also covers global pandemics (a particularly relevant topic, obviously), genomic advancements as applied to microbiology, and bioterrorism.

This audio book sounds like a documentary and will appeal to people that want a deep dive into a single science-related topic. It is read by Alan Sklar. He narrates smoothly and his voice has a deep timbre, which works well for this subject matter.

Ayse_

Rating: really liked it
Except for the feeling of nausea that accompanies the reading at times, this is a very interesting book about the cholera epidemic in 1854, before the existence of bacteriology/parasitology.

It is also the epic tale of John Snow who almost single handedly kept track of contamination pathways, fought against the miasma theory and the biased and unscientific approach of his peers, tried to locate and define the germ and still kept his hat on like a gentleman. Amazing true story, especially if you are interested in history of medicine. John Snow is known as the father of Public Health and Germ theory, (in addition to his many contributions to medicine).

Richard Derus

Rating: really liked it
A wonderful read. It's not perfect, but it' a very well-written piece; I would have preferred that we see the Ghost Map in its entirety at least once. After all, it's the title of the book! I can say, though, that this is my only complaint about the book. The two men whose lives are the driving forces in the narrative are each well-drawn.

And it's only $1.99 on your Kindle here.

Jim

Rating: really liked it
I finally got my copy of this, but I also got an ebook copy & see that it has some maps. They're OK, but I didn't really miss them. He describes things well enough that an audio book is fine. In fact, his descriptions of life at the time are fantastic. The setup is a bit long, but it has to be. It's hard to imagine people living in those conditions (drinking out of open sewers!) with so little understanding of disease. It's incredible how far our common knowledge has come.

Well, in some cases, at any rate. I found the description of the newspaper ads & remedies incredibly sad because I see so many of them still promulgated today as pseudo-scientific cures. People are still buying supplements & using aroma therapy. A lot of this when I read "Bad Science" & it's just disheartening.

I got the ebook because wanted to go back over his explanation of how cholera mutated. I didn't really care for it because of the way he framed it as a 'desire'. That was OK at first, but later on he said something about a group intelligence that came across as pseudo science. Here's that offending paragraph.

It goes without saying that the bacteria are not in any way conscious of developing this strategy. The strategy evolves on its own, as the overall population balance of V. cholerae changes. In a low-transmission environment, lethal strains die out, and mild ones come to dominate the population. In high-transmission environments, the lethal strains quickly outnumber the mild ones. No single bacterium is aware of the cost-benefit analysis, but thanks to their amazing capacity for adaptation, they’re able to make the analysis as a group, each isolated life and death serving a kind of vote in a distributed microbial assembly. There is no consciousness in the lowly bacterium. But there is a kind of group intelligence nonetheless.

He could have used some statistical analysis (SA) to far better effect. That's what this book is about after all, the birth & use of SA to solve large scale problems. SA shows us what is really happening overall & not just what seems to be happening from what we can see in any one spot. That's his overall point, but I don't recall where he ever comes out & says that specifically.

Interestingly enough, the first epidemic council had just been formed a few years before this outbreak & that's what a lot of the book is about - figuring out how to analyze it. John Snow was the pioneer.

At the halfway point & a bit beyond it's been pretty boring, often a rehash & bunch of detail on what has already been covered in as much depth as I wanted to know. Far too much repetition as the author goes back to tie in the preacher's (Whitehead) observations & the public health commissions. I understand that it is a problem to outline general trends & then go back into the specifics that caused them. Some repetition is inevitable. There are also multiple players, causes, & trends to follow, but he's covering the same ground & facts each time. It's getting very old.

It was interesting the way he points out how the cure for the miasma theory wound up causing more problems based on ignorance, yet ultimately led to Snow being able to gather the necessary statistical data to narrow down the actual cause, still without knowledge of bacteria. That had been discovered, but was ignored by everyone. It also led to being able to solve the problem - eventually. The established theory prevailed far too long due to politics.

I took a break at 5/7 & skimmed through it & 6/7. It's hard to skim in an audio book, but the repetition was awful, so I supplemented with the ebook. It did get interesting at the end of 6/7 & into 7/7 with more about current techniques for statistically looking at cities, including the 311 service. A long stretch considering the title, but he was trying to show that Snow & Whitehead's techniques are still being used. Unfortunately, he's covered the basics already several times.

The epilogue is about doomsday scenarios in modern times from atomic bombs to 9/11 & the flu. I really dislike the way he discusses the latter. Again, he uses 'learn' as if viruses & bacteria could think. He also ignores the fact that deadly organisms are such a minority that they can actually be looked upon as poor mutations. It's not good to kill off your host, after all.

He also seems to think that a city-planet is a desirable goal. WTF?!!! We are becoming more urbanized, though. He does tie this nicely in with the Broad Street epidemic & show some of the dangers we face from all sorts of mass effects biological & mechanical. He reaches pretty far & it's not his area of expertise.

Overall, this would have been an excellent book if it had been about half as long. He tried to cover far too much territory & that led to a lot of repetition. It would probably have been better read as text where I could have skimmed more. As an audio book it was just painful toward the end.

Jill Hutchinson

Rating: really liked it
London was a cesspool in the 1854.....raw sewage ran into the Thames or was just thrown into pits in the back yards of tenement buildings. In that year, London had an outbreak of cholera which killed its victims in less than 24 hours. This extremely violent strain captured the attention of a physician, Dr. John Snow and a local curate, Rev. Whitehead...how were people catching this deadly disease? The common belief in the medical community was that of miasma...in other words an air borne disease arising from the horrible stench that hung over certain areas of London. Medicos thought that the poor who lived in wretched conditions were the center of the outbreak and bore the blame for this disease. Dr. Snow was not a believer in the miasma theory and felt that the disease may be waterborne. He and the Rev. Whitehead began a study which for the time, was very complete and fact based. They traced the infected water supply to one public pump where the majority of the people in the affected area drew their water. The pump was closed and the epidemic ended. The pioneer work of these two men was the beginning of epidemiology....the reporting and tracing of disease patterns and the government's responsibility to protect the population. Although Dr.Snow and Rev. Whitehead did not find a cure for cholera, they created the engine that drove the discovery of treatment.

A very informative look at the biases and misinformation of the medical/scientific community in the Victorian age. Recommended.

Bettie

Rating: really liked it
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