I appreciated Johnson’s opening to the chapter, with his focus on recycling. London at that time, a city of two million people, had none of the public infrastructure, services, or works we today take for granted. Instead there arose a whole class of different gatherers, scavengers, and waste collectors, operating out of necessity, who scooped up items that alone represented little value but when collected and sold by the pound could return enough for someone to live on. The entrepreneurial spirit (or spirit of desperation) of these unemployed and desperately poor Londoners kept the city cleaner and more efficient then had economic conditions not forced people to eek out a dirty, grueling, dangerous existence collecting and retailing society’s garbage. I though Johnson’s segway from waste recycling at a societal level to recycling at a biological or chemical level a fairly clever way of highlighting the importance of utilizing waste: to do so is a basic function of most successful organisms.

“All nucleated organisms generate calcium as an excess waste product. Since at least the Cambrian times, organisms have accumulated these calcium reserves, and put them to good use: building shells, teeth, skeletons. Your ability to walk upright is due to evolution’s knack for recycling its toxic waste (16).”

Johnson then goes on to note that regardless of the reasons for a population’s density, (London’s population explosion can be attributed to the industrial revolution, whereas humanity’s first confrontation with population explosion, waste management, and disease came during transitions from hunter gatherer to agricultural based societies) without efficient forms of recycling, these forms of life cannot survive long (18).

Johnson also provided an example of how economic realities affected disease control and general cleanliness in the city. Despite the actions of the various waste collectors in London, the city was still filthy. However cesspools and latrines, those cleaned by “night soilers” were somewhat maintained given that the pay was high enough (night soilers would sell the human excrement to farmers outside the city) for many people to engage in the profession. However Johnson notes that as the city expanded, it became increasingly expensive to transport the waste outside the city walls to farms, meaning that the cost for cleaning each cesspit became unaffordable for many families. This is an economic reality, given that the factors of production (transport) had become more expensive, however it had the disastrous effect of allowing disgusting amounts of waste to accumulate, and disease causing bacterial populations to flourish.

The discussion of cholera, and the terror and devastation it caused, is relevant because despite the fact that today with have a significant amount of knowledge about the mechanics and operations of pathogens in our environment, there are massive frontiers of knowledge we have yet to discover. Reading about the dangerous beliefs in London at that time, such as that if water looked clean to the eye it had to be pure, or that disease is the result of moral failings, it prompts one to question how much of our knowledge is truly as factual as we would like it to be.

One thing that bothered me in the reading however, was this little gem of a quote, “to this day, the Netherlands has the highest population density of any country in the world” (16). I immediately questioned the validity of this assertion. How could a country like the Netherlands, a wealthy, highly stable, European country, with an aging population and declining birth rate, rival the population density of say, Bangladesh? When I looked up population density by country, not a single website had Netherlands in even the top ten. Although this doesn’t discredit Steven Johnson’s work, it does to an extent draw doubt to the validity of some of the data he raises, and leads one to believe that he may embellish generously so as to prove a point.

-Jesse Geisler

Victorian medicine was severely limited by the lack of basic empirical method or scientific knowledge. Germ theory, which we take for granted today, would have saved countless lives and allowed for progress in the field of bacteriology which would ultimately have revealed V. cholerae to be the perpetrator of cholera. Scientists and physicians of the era seemed to be largely concerned with promoting their own quack cures which superficially eliminated or obscured the symptoms of the disease. John Snow was able to overcome the conventional thinking of the era and laid the road for modern medicine and public health by examining the trends and analyzing what might be the underlying causes rather than acting entirely upon superficial observations.

Miasma theory had gained a strong foothold in the medical community, and supporters of the theory had remained steadfast even with John Snow’s discovery that V.cholerae was waterborne. Why was miasma theory so popular? Was it entirely because of ignorance and stubborn public opinion or could there have been an economic drive as well?

I found the beginning of the books with it’s description to how London was amazing. I could picture how disgusting it must have looked, how crowded the streets were, the sweat rolling off people’s face. It got me to me every time they talked about the waste and how it piled on the cesspool. Just by picturing it, I can see how disgusting everything must have been, how suffocating it must have been to live there, I can’t imagine how these people continued to live there with those conditions, especially after Cholera broke out. People were definitely not rich but was it not possible at all to evacuate the area because there was clearly something wrong with the area. If it was up to me, I would give up all my money to live somewhere else as long as it meant that my family and I wouldn’t die. I wouldn’t want to take the risk of catching the disease and the area was filthy anyway. It makes me cherish what I have now, when I see how we try to keep our streets clean to an extent and most definitely our homes. I cannot imagine facing waste everyday or even being within vicinity of that much waste. It also makes me glad how much we’ve advanced as a society especially when they had their doctors in London coming out with a different cure everyday without actual evidence. Now we actually go through experiments to make sure a cure works. I cannot imagine our daily newspapers covered with ads of doctors to try their cure for a disease.

As a pre-med student, I’ve taken Biology and am in the middle now of MicroBiology. In that class, we actually touched upon Snow’s remarkable accomplishment of figuring out cholera’s dastardly ways. We also talked about the symptoms and just how deadly it was. But none of the classes that I’ve taken so far come close to demonstrating just how gruesome and terrible it actually was. It is, and will always be, something imaginary, something that unless we actually contract, we can only sympathize, not empathize. But trying to put yourself in their collective perspective is, in my opinion, probably one of the few skills needed to effectively run public health initiatives. Understanding the disease is only one of the skills. Understanding the effect it has on the public is an entirely different and more powerful one, one that is absolutely necessary in order to effectively combat the panics of the public. As we see with Thomas Latta and his cure, which actually worked, his insights were buried under the public’s clamor for a cure, any cure at all, even ones that were most probably hoaxes.

My question then is: How do public health officials get this skill? Reading books is definitely not enough. How is it possible to obtain this very powerful skill of not just sympathizing, but empathizing?

– Joseph Kabariti

As I read the first three chapters of The Ghost Map by Steven Johnson, I was pleased with Johnson’s narrative, but disappointed to see how the novel did not relate to the “modern world.” That being said, it was only the first three chapters so it is too early to go into the implications of what Dr. John Snow accomplished. I am amazed at how Johnson was able to convey the cholera outbreak in an engaging narrative. He also touched upon the social class and the society of 1854 London through his use of anecdotes. Specifically, in pages 36-39, he explains the effects of cholera in laypeople’s terms. Instead of giving data, Johnson would merely use anecdotes get his point across. He brought up the topic of disinformation where the London Times would have advertisements for the “cures” for chorea from fraudsters.

Something that I wondered as I read this was how strangely it felt reading someone’s documentation of a disease outbreak from the 19^th century in the 21^st century. It is akin to reading Rachel Carson’s Silent Spring in the present day. If The Ghost Map were written in the late 19^th century, it would be a very powerful narrative that speaks about the importance of clean water, similar to Carson’s message about how reliance on pesticides is a bad thing, but without the backlash from Silent Spring. The actions of Dr. Snow and how he would record the households that had cholera and the sampling of the water pumps from different locations can be compared to Carson’s findings about the hazards of DDT and other chemicals. The part that makes this awkward was that these events took place a while ago and because the reader is looking at the events in hindsight, it can make the readers wonder why such simple truths were so hard to find out. A few people in this class expressed disbelief that it was so hard to figure out the cure to cholera was clean water and I think it is because we are reading this in hindsight and with that, I will end on this note: Do you think reading about something new to us such as the discovery and invention of smartphones and cloud storage right now would be as interesting to our future generations a few hundred years from now where such technology will probably be extremely taken for granted or obsolete as it is to us?

While reading these chapters, I was more interested in why it took so long to find a real cure for cholera than I was in the process of determining the cause of its spread.  Yes, as a Pre-Med student, I was intrigued by how the disease gave seemingly contradictory facts about how it is contracted.  How can an entire area be affected save a few random houses?  However, I was wondering why no one thought of giving water to someone who is clearly dehydrated.  Was it because there was cholera in the water supply, therefore it didn’t help?  Or was it because people believed that if there was “bad blood” it should be removed, and the same idea translated into “removing diarrhea”?  How did the “Waterstones” daughter recover from cholera when the rest of her family did not?

Time and again we take for granted the development and progression of society, and modern science. From the opening lines of the novel, “ It is August 1854, and London is a city of Scavengers. Just the names alone read now like some kind of exotic zoological catalogue: bone pickers, rag-gatherers, pure-finders, dredgermen, mud larks, sewer hunters, dustmen, night-soil men, bunters, toshers, shoremen.”, it is clear that London has a deeply rooted social class system. The author continues to clearly delineate the horrendous “jobs” the aforementioned people perform. These hapless members of society were not only exposed to terrible “working” conditions, but also experienced an entrenched aversion during the nascence of the cholera outbreak. Many people believed that the upper class was immune to cholera, and that the “mean and bad” people were being attacked selectively. This false belief, along with many others, served as thorn in the road to discovering the true cause of the outbreak of cholera.

One of the factors that was presented by the author which had a major role in this epidemic was the gullibility of society. There were countless times in which charlatans posed quick and easy methods as the cure for cholera. Many of these “solutions,” however, proved to do more harm than good. We take for granted how far we have progressed in the medical field. As shown by the author, people didn’t know anything about medicine and were swayed by any quack. It is interesting to note that not many people were convinced at first by John Snow’s, a well known figure in the medical field, observations. It was his keen eye, along with Whitehead’s history with Soho, which helped crack the cholera epidemic. So I ask, how does it feel to live in a time period in which a gripping epidemic makes the continuation of life so uncertain?

I guess !’ll go first!

“Most world historic events-great military battles, political revolutions-are self-consciously historic to the participants living through them. They act knowing that their decisions will be chronicled and dissected for decades of centuries to come. But epidemics create a kind of history from below; they can be world changing, but the participants are almost inevitably ordinary folk, following their established routines not thinking for a second about how their actions will be recorded for posterity. And of course, if they do recognize that they are living through a historical crisis, it’s often too late because, like it or not, the primary way that ordinary people create this distinct genre of history is by dying.” (Johnson, 55)

This breathtaking paragraph from chapter 2 page 55 (your page number may be different, Im reading this as an eBook) stopped me in my tracks. This claim is bold, but after a few hours of thought it seems undoubtably true. Which leads me to my question.

Does the fact that the “common person” living through an epidemic is unaware or uncaring of their historical implications show that acts of heroism or innovation were truly for the benefit of humanity as opposed to the development of an individual’s success or legacy?

-John

P.S. Every time the term “rice water” is used I gag a little bit.

I’m looking forward to hearing what you all think about the first few chapters. i know it starts with a detailed discussion of the social organization of sewage, but given how cholera spreads that’s actually important.