History, Medicine, and Science: Nonfiction and Fiction discussion

I hope y'all are enjoying The Ghost Map: The Story of London's Most Terrifying Epidemic--and How It Changed Science, Cities, and the Modern World as much as I am. The writing is more than just beautiful, it is packed with information. Johnson takes things I already knew, and gives them new context. Then he adds things I didn't know. Wow!

One thing that I think is worth paying special attention to is the way he weaves big picture history (the sweep of cholera from east to west) with the very specific history of individual lives and deaths.

Here are some other questions that I plan to spend time on as I continue to read:
1. Johnson starts the book by describing both cholera and London as major characters in the story. Is that just a rhetorical flourish, or does he actually treat them as characters? (In my mind, major characters change over the course of the narrative arc of the story.)
2. Johnson suggests that cholera became more deadly as a result of changes that are normally considered progress. Are there parallel problems today?
3. The young clergyman, Henry Whitehead, is obviously going to play an important role in discovering the source of the cholera. During the mid-nineteenth century, the relationship between religion and science was under new strains. (Darwin's Origin of Species was first published in 1859.) What role does Whitehead's faith play in the narrative, if any?

That's enough from me. I can't wait to hear what you have to say.

I have just finished up Ghost Map and have to admit that it was very enlightening as well as educating.

I think you bring up a good point about Johnson making both Cholera and London major characters, because as I read along I felt as though both had personalities just as Dr. Snow and Henry Whitehead. It was very interesting for me to see how Johnson changes their personalities though out the story to create a life within each one.

The Cholera he treats like a person affecting people, which helped me to get more personal with the disease itself. This entire book is a very socially adept look into disease, civil engineering, as well as technological trends, and socialism in South London.

You said that in your mind the major characters change over the course of the narrative arc of the story, and I think that is exactly what Johnson has done for both London and Cholera.

In all good stories the protagonist/antagonist usually go though some sort of transition allowing the reader to follow with them as the conquer hurdles and get pulled down by detours. That is exactly what Johnson has done in this story. To me London and Cholera are cast more of main characters and Dr. Snow and Whitehead as the supporting rolls.

Tiffany wrote: "To me London and Cholera are cast more of main characters and Dr. Snow and Whitehead as the supporting rolls. ."

This is a really interesting idea. I'm eager to see how it unfolds. (You're further along in the book than I am.)

I agree that London and cholera are developed as major characters in the story. The weaving of some of Dicken's writings within the context of London's development and the outbreak bring the time alive for me.

Cholera is also given a personality as when he discusses cholera "desiring an environment" (pg40). his explanation of bacteria's ability to morph into something more lethal also provides some sense of character development.
Supporting this is evidence of a change in both characters when Whitehead notices that the neighborhood seems calm and quiet. While he initially takes this as a sign that the worst is over, the truth is it is the calm before the storm. Within hours many die. What can not be seen from the street is the agony behind the doors and windows

I really enjoyed The Ghost Map. But, as impressive as Dr. John Snow's achievements were, he owed a huge debt to James Farr, who published a periodical that stastically analyzed the diseases then occurring in London. (Sort of like the MMWR, though it was a personal effort, not governmental.)

Kathleen: Do you mean William Farr? Here's a quick link to a brief bio: http://www.enotes.com/public-health-e... Obviously one of the founders of modern medicala statistics.

I started the book on Sunday and have enjoyed it immensely so far.

1. I have seen that the author does treat cholera and London as characters in the books, especially with cholera. The way Johnson describes the way cholera traveled from Asia to Europe it could easily be replaced by a human character's movements. The descriptions of the infection and what it does to the human body are fascinating and very well-written.

2. There are several parallel problems where progress has led to health problems. With advances in medicine that allow people to live longer, we are seeing increases in old-age diseases like Alzheimer's disease and cancer. Also, our exposure to chemicals in today's world has upped the illnesses we suffer from. We live in a world where food is plentiful, at least in the first world, so we are also seeing obesity-related diseases such as diabetes and heart disease. Though these aren't infections like cholera there are many parallels.

3. I haven't really seen how Henry Whitehead's faith plays into the story, but I do think that his position as a minister gave him a lot of access to the people in Soho and so he saw a lot of epidemic up close. At the end of the 3rd chapter, it appears that he is starting to try to put what he has observed together to try to find the causes of the epidemic. I'm interested to see what other people have to say.

I'm enjoying the book so far. In response to Pamela's item 2, I think there's a modern parallel in the rise of antibiotic-resistant bacteria resulting from changes ('progress') in livestock production.

Also in response to 2. Not to give take anything from the author or give away the ending but an idea that Johnson re-emphasizes near the end of the book is the Urbanization of the world.

In denser populated areas pandemics as well as tragedy will have a high death toll for the simple fact that it has more opportunity than in less densely populated areas. Tragedy can only survive as long as it has a victim. If there are no more victims it has nothing to feed off of and dies out as well.

I'm about a third of the way through "Ghost Maps" and am fascinated with bacteria's ability to change and modify far faster than we as a specie. It almost seems like an unfair advantage for bacteria. Can anybody recommend a layman book on bacteria? If I were a betting man -- bacteria would get my money to eventually win the battle with man. Is this too dystopian?

I know that Johnson is painting a big picture of city and urban development. I find myself feeling uncomfortable with present day references -- which are certainly intentional. Is anybody else uncomfortable with present day references? My first instinct was to ignore them -- but that misses the big picture, doesn't it?

Sound off, my friends.

Joe wrote: "I'm about a third of the way through "Ghost Maps" and am fascinated with bacteria's ability to change and modify far faster than we as a specie. It almost seems like an unfair advantage for bacteri..."

A layman's book on bacteria that I enjoyed is:
Good Germs, Bad Germs: Health and Survival in a Bacterial World. I just got Ghost Map, so I can't comment on that.

Joe wrote: "If I were a betting man - bacteria would get my money to eventually win the battle with man. Is this too dystopian?"

This (or, more precisely, that a virus will ultimately win) is the premise for much of the recent Zombie craze. One book from 2006, World War Z, is particularly chilling because it's written as an Oral History from the aftermath of Zombies as pandemic. It's realistic enough that the notion of bacteria or a virus being mankind's ultimate downfall doesn't seem much of a stretch at all. (And yes, I just uncovered my dirty little secret - I like Zombie books, movies, and TV shows). :)

From what I've read so far of Ghost Map, the personal experience of the cholera epidemic must have been much like what is portrayed in fictional accounts of pandemics that seem to be popular today. The horror of watching family, friends, and neighbors die; seeing the symptoms in yourself and knowing what's going to happen next; and the communal fear and confusion from not knowing what's causing this is pretty palpable in the book.

I would think that Avian flu, mad cow disease, and similar illnesses related to how we grow and manage food might be parallels to cholera although we haven't (yet?) experienced them to the same scale.

I think I've read a little beyond the scheduled pages for the week so I'm not going to say anything about Henry Whitehead beyond that I'll be interested to see how he and Snow's storylines come together.

Joe wrote: "I'm about a third of the way through "Ghost Maps" and am fascinated with bacteria's ability to change and modify far faster than we as a specie. It almost seems like an unfair advantage for bacteri..."

joe,

go to any good college book store and get a book on microbiology--true it's not a laymans book on the subject but the subject is not a layman's area of interest usually, so you have to study the real thing. what about the present day references bother you? yes bacteria have it over us--survival of the fittest remember?

So I just finished Ghost Map. I like how Johnson describes London as an organism, and the cholera as a smaller microorganism breeding within the overused arteries of the city. It's also interesting that well-intentioned public health efforts worsened the spread of cholera. It makes you wonder how many other public health measures that may not actually be beneficial.
This book might be good to read with The Death and Life of Great American Cities, by Jane Jacobs. It's not a science book per se, but it does a lot to describe a city as a self-sustaining, growing organism.

Also, I often had to put the book down because the descriptions of the filth and waste of London just got to be too much. It's hard to believe that just a century and a half ago, in one of the most "advanced" cities in the world, so much of daily existence involved close encounters with human waste.

Joe wrote: "I'm about a third of the way through "Ghost Maps" and am fascinated with bacteria's ability to change and modify far faster than we as a specie."

We can't evolve as fast as bacteria. However, we can change our behavior radically in response to the lethality and transmission rate of different diseases (staying indoors, disposing of waste differently, wearing masks, etc.). That can happen fairly quickly. So we do have a few tricks up our sleeves. OF course, once we change our tactics, so do the bacteria. And on and on.

Just checking in to tell you all how much I'm enjoying the conversation. I fell into the American Civil War (speaking of cholera) and have just now found my way back out. I should have my head back in Ghost Map tomorrow.

The map created by John Snow is mentioned in the book a few times. Here's an online resource that provides a PDF of the map (and other interesting information) for those that are curious:
http://www.theghostmap.com/

red,
thanks i will look at it.

red,

i just looked at the tape -it's wonderful--everyone should watch it.thanks again.

Amanda wrote: "Joe wrote: "If I were a betting man - bacteria would get my money to eventually win the battle with man. Is this too dystopian?"

This (or, more precisely, that a virus will ultimately win) is th..."

Amanda -- Thanks for the zombie insight -- zombie vs virus. I'd love to hear your thoughts on the current comic book super hero craze. What do you attribute this? Are they our new hero's?

Pamela wrote: "Just checking in to tell you all how much I'm enjoying the conversation. I fell into the American Civil War (speaking of cholera) and have just now found my way back out. I should have my head ba..."

Just visited Gettsburg -- which civil war book were you reading. This topic is addicting.

Red wrote: "The map created by John Snow is mentioned in the book a few times. Here's an online resource that provides a PDF of the map (and other interesting information) for those that are curious:
http://ww..."

Thanks for the map online -- my kindle was limited on what I could see. This was much improved.

Joe: I've been writing essays for a book on the Literature of War. First up,Stephen Crane's The Red Badge of Courage and Ambrose Bierce's Tales of Soldiers and Civilians & Other Stories. Beautiful, grim, and, in the case of Bierce, very, very weird.

Ghost Map was amazing. I loved it!

To comment on the thread of comments about the war between man and bacteria... Well, the question isn't a matter of "if" the bacteria are going to win, it's a question of "when." Bacteria swap genes like businessmen at a conference swapping business cards. I've heard it said from someone on the front lines that anywhere you sample in the Ganges you find a whole host of known anti-bacterial resistant genes. I was advised, "Those genes are already making the rounds." I nearly gasped when I heard this...

But I always ask myself what the relevance of this story has for today. As the epilogue stated, there have recently been cholera outbreaks. We obviously haven't learned all there is to learn from this disease. Especially how it relates to sanitation and human waste recycling.

I think the most pressing modern day cholera-like outbreak would be a respiratory disease like influenza (H1N1, etc). With more and more cities worldwide of incredible densities compounded with international travel the potential for a widespread calamity is daunting to comprehend.

I just finished the chapter on Tuesday, September 5th. It reminded me a lot of the book The Big Necessity by Rose George with the talk of waste disposal in big cities and the development of sewer systems. We look back on the times of this 1854 outbreak and think we are so ahead of them now, but as Travis pointed out we have cholera outbreaks still today. The Big Necessity also shows that we have a long way to go when it comes to waste disposal. It was interesting to read this chapter so soon after reading Rose George's book.

Not that this is news, but cholera is on this Online Nursing Degree list of "10 Diseases that Totally Changed the World" - http://www.nursingdegree.net/blog/917...

I thought Johnson's account of just how cholera kills was fascinating. It reminded me of Sherwin B. Nuland's excellent 1994 book, How We Die, in the matter-of-fact way he describes the successive shutting down of systems. Like Nuland, Johnson separates the emotion from the biology, but he balances the science by profiling real characters--a most effective approach for a lay reader.

Something I also find fascinating is how The Ghost Map also illustrates the rise of cleanliness as a moral obligation, changing the mores regarding dirt and filth in Victorian society. Culminating in the almost missionary zeal of personalities from Colonel Waring to Dr. Kellog (and his insistence on clinical circumcision as a veritable panacea), the medicalization of filth has generated consequences that continue to form our behavior even today.

marigny777--i see the rise of cleanliness as a result of finding the cause of death, in this case contaminated water.once the cause has been shown and changes made that work, the people will make the changes necessary.what do you mean by the medicalization of filth?explain tht to me please.

The question that continued to fascinate me as I read the book was the issue of paradigm change, and how the culture we are part of shapes what questions we are able to ask.

One point that struck me is that both the Board of Health and John Snow asked questions predicated on their beginning assumptions. The major figure in the book to actual experience a paradigm shift is Henry Whitehead, who sets out to disprove Snow and is converted to Snow's point of view.

Hello Bunnie-
What I am talking about is basically a form of the medicalization of deviance. We see behavior that is socially deviant (pauperism, destitution, moral turpitude), and we treat it as a medical disorder. Edwin Chadwick in his 1842 "Report on the Sanitary Condition of the Laboring Population of Great Britain" stated that the central cause of and suffering and moral decline is filth. So we see an undesirable behavior being imbued with a medical solution, namely, the sanitation movement that developed during this period. Attitudes towards dirt and filth forged in the era of Victorian sensibility permeate our western culture even today. For example, the pronounced taboo associated with geophagy in all but the poorest segments of western society.

I personally found the author's treatment of cholera and London as characters to be distracting and a bit annoying. I kept thinking "But cholera doesn't 'desire' anything," for instance.

Marigny777, I think of taboos as carrying a strong social penalty. When I moved from a sizeable city to a smaller one, I met people who practiced geophagy, and others who knew of the practice but had no reaction to it. Are you using the word taboo differently, or do you see people reacting to the practice more strongly?

phylwil--explain the term geophagy to me please-i have never heard the word before and looked in the dictionary but could not find it. so yes taboo does carry a strong social penalty-i agree with that.what do you mean the authors treatment of cholera being distracting and anoying_it would be anoying to have cholera i would think.how can cholera desire anything? it is a disease that does not think!

Marigny777 wrote: "Hello Bunnie-
What I am talking about is basically a form of the medicalization of deviance. We see behavior that is socially deviant (pauperism, destitution, moral turpitude), and we treat it as..."

marigny777- ok here is another term that i do not understand--medicalization of deviance-what do you mean by that?are you refering to mental illness and the treatment of? why are pauperism and destitution considered socially deviant?can one always help that condition or do anything about it--moral turpitude i agree is socially deviant although again some people have no control over that candition. how does this relate to cholera and other diseases that people have no control or knowledge of at the time.

Tiffany wrote: "I have just finished up Ghost Map and have to admit that it was very enlightening as well as educating.

I think you bring up a good point about Johnson making both Cholera and London major charact..."

Hello phylwil--
I am using the term taboo in the sense that it is an act that carries with it a form of social prohibition. In the case of geophagy, this would be shame, embarrassment, and stigmatization. I am citing an article from the peer reviewed journal Deviant Behavior (the abstract of which can be found here: http://www.ingentaconnect.com/content...
publication homepage here: http://www.tandf.co.uk/journals/tf/01...)

Hello Bunny-
Pauperism and destitution were socially deviant in that they were behaviors that violated enforced norms of the times in question. For that matter, they still are. One's ability to control one's own behavior is irrelevant in the context of whether or not that behavior is deviant. Whether pauper by choice or by circumstance, it was still deviant.

Here is the textbook definition for Medicalization of Deviance: http://www.sociologyencyclopedia.com/...

It has been used to justify everything from primitive psychosurgery to the modern child birth.

This does not specifically relate so much directly to Cholera but to the changing attitudes and perceptions surrounding dirt/filth/disease that I think The Ghost Map exposes . I appreciate that the book in addition to being a narrative of medical detective work, also points out these changes in the social fabric.

tiffany-seems to me that all of you are treating this story like a play or an essay--i look at the two protagonists as the heros of the story--having the curiosity,the ability to observe and the brains to reason out the cause of all the deaths and to effect a cure for it.after the germ theory of Pasteur measures were taken to eliminate the major causes. construction of sewers and provision of clean water were some of the major ones. It takes far seeing leaders to get these changes made for the people are generally uneducated as they are today about health topics.how many of us today throw our toilet waste into our basements and do we have clean and germ free water to drink?

Bunnie wrote: "phylwil--explain the term geophagy to me please-i have never heard the word before and looked in the dictionary but could not find it. so yes taboo does carry a strong social penalty-i agree with t..."

phylwil-ok i found out what geophagy is-but what does that have to do with cholera and the water contamination? i don't remember it in the book anywhere -let me know where it is please so i can reread it.

marigny777--ok i read the article and i see what you mean-

Thanks to everyone who joined in on the discussion of The Ghost Map: The Story of London's Most Terrifying Epidemic--and How It Changed Science, Cities, and the Modern World.

I hope you'll hop over and pick up the discussion of Blood Work: A Tale of Medicine and Murder in the Scientific Revolution I'm four chapters in and already seeing some familiar topics: miasma, paradigm shifts, urban planning....

pamela--HELP WAIT--i'm still reading stiff--will finish soon. i must be the slowest reader of all--

Bunnie wrote: "pamela--HELP WAIT--i'm still reading stiff--will finish soon. i must be the slowest reader of all--"

Take your time, Bunnie. I'm trying to read ahead so I can moderate the discussion. (Hope that works out better than it did last month. :D) We're reading both Stiff and Blood Work this month.

pamela--ok thanks--

Bunnie--don't know if you are still reading these posts, but I'll respond regardless. I have been away from computer connections. Marigny777 used geophagy as an example of a taboo--it's not in the book anywhere.

phylwil--yes i am reading the posts still--thnks for the definition.

I did my thesis on the interaction between religion and science in Victorian England, specifically focusing on the Broad Street pump case (even my graduation cake was a replica of the pump--complete with buildings and coblestone).

The Ghost Map is an interesting and enjoyable read. However, Whitehead did not start investigating to prove Snow wrong. In fact, he had already published a work (including a map) before he and Snow ever were assigned to the Inquiry Committee. On a side note, Whitehead was not the only cleric involved in the case.