Tuesday, February 05, 2008

The Angel of History

In The Ghost Map, Steven Johnson describes how seventy residents of London's Golden Square neighborhood were dispatched by disease in a single twenty-four hour period during the cholera epidemic of London in 1854. So rapid and sudden was their demise that their bodies were wheeled out of the neighborhood by the barrowful. Common wisdom of the era suggested that cholera, like all human disease, was caused by a foul smell. This "miasma theory," would have seemed credible, even likely, to a resident of Victorian London, which was plagued as it were, by innumerable foul odors. But a physician named John Snow had trouble believing it himself -- the evidence just didn't add up. It seemed unlikely to him that smell would transfer disease in such a manner, and he knew a thing or two about inhaling: he was one of the first to practice and perfect the art of administering inhaled anesthetics like chloroform.
(Before this, the administration of anesthetics had been spotty at best, with some patients waking up halfway through surgery, some not at all. Check out the description of Fanny Burney's mastectomy sans anesthetic on page 62, if you revel in the gruesome.)

But despite the fact that he was a celebrated doctor who had administered deadly gases to the Queen, people had a hard time buying this theory that cholera didn't come from the air, but rather, from the water. The city fathers clucked their tongues, stroked their beards and said, "What's to be done with this John Snow?"

So the good doctor had to build an irrefutable case to convince them. To this end, he had an unlikely ally: clergyman and Golden Square resident Henry Whitehead. Henry had read about Dr. Snow's waterbourne theory and thought it nonsense. He set about trying to disprove it by gathering his own evidence, but began to notice that the disease did seem to trace its origins to one locale: 40 Broad Street, precisely the area Snow had theorized was the source of the outbreak. Once he realized Snow was probably right, he became a staunch supporter and foot-soldier in Snow's one-man army.

Together, the two drew the "ghost-map" of the title, marking black lines on top of certain houses, one for each person who had died.


The map showed the thickest, darkest masses of lines all located near 40 Broad Street, radiating out from the pump located there. Whitehead was even able to locate the index case (an epidemiology term for the first person to fall ill in an outbreak): a baby belonging to a woman named Sarah Lewis, who lived at 40 Broad Street, and disposed of her sick infant's dirty diaper in the cesspool there.

Eventually, they managed to convince the board of health to remove the handle of the Broad Street pump, though they had a hard time convincing people of the validity of their new waterbourne theory. (Amazingly, an Italian scientist Filippo Pacini isolated the cholera germ in water at the same time as Snow's discoveries in London, but his work was ignored by the academy for thirty years. ) Miasma theory must be hard to shrug off in a stinky city.

I really loved this book, and not just because I'm fascinated by disease. Although Johnson's descriptions of the events that transformed these cholera-stricken Londoners from "healthy, functioning humans being to a shrunken, blue-skinned cadavers in a matter of days" are fantastic. Johnson doesn't hold back with the gory physical details of the disease. The early symptoms are indistinguishable from "a mild case of food poisoning." An upset stomach. Next comes vomiting, muscle spasms and sharp abdominal pains, and a "crushing thirst." "But the experience was largely dominated by one hideous process: vast quantities of water being evacuated from [the] bowels."

Those small white particles? That's your small intestine.

Once this loss of fluid started, you'd be be dead in a matter of hours. Well, first you'd swell up and turn blue. Then you'd die. But you wouldn't be a state of febrile unreality, no, you'd be lucid up till nearly the end, when you'd pass out just around the moment massive organ failure set in. Writes Johnson, "The actual cause of death with cholera is difficult to pinpoint; the human body's dependence on water is so profound that almost all the major systems begin to fail when so much fluid is evacuated in such a short period of time."

In a city emblematic of modernity's triumphs, inequality allowed an underclass to live intimately with filth, disease and death. And yet it was precisely this condition, the overcrowding of large cities, that would eventually lead to the knowledge and skill base that would allow humans to cure disease. Quoting Jane Jacobs, Johnson writes, "All the apparatus of surgery, hygiene, microbiology, chemistry ... are fundamentally products of big cities and would be inconceivable without big cities."

Which leads me to the other reason I love this book. I love reading the history of modernity, of big cities and their attendant technological and social developments. When does modernity begin? Is it after the French Revolution? The Industrial Revolution? The Arcades Project? Post-colonialism? What marks it? The eradication of fatal diseases? Solid things suddenly melting for some reason? Reading this book made me feel like Steven J. is really into this stuff too, and maybe my masters degree in "interdisciplinary humanities" ain't so stupid and worthless after all.

1 comment:

Greg said...

Great review/essay ... thank you