The Ghost Map discussion

So baby Lewis kicked off the London cholera epidemic of 1854. The Ghost Map traces the events following her illness and everything that occurred thereafter, and mystery solved.

Except, where did SHE pick up the cholera? I don't remember the book addressing that question, even in passing. She had to have gotten it from someone else, right? The fact that she was an infant makes it more puzzling. I'm assuming that she wasn't out in the world too much. So how did she come down with it?

IIRC Cholera itself can be developed from natural causes in the dirt/soil etc - sorta like anthrax...I don't know if they every managed to isolate what caused it

Ohhhh. Thanks for that info. Was that in the book somewhere and I missed it?

Maybe that explains my disconnect with the beginning of the book. With the descriptions of bone pickers and the mudlarks or whatever they were called. Did the author try to draw a connection there that I didn't see?

I completely failed to understand what they had to do with the rest of the story (except to maybe more clearly illustrate the nastiness of 19th century London).

i think most of it was focused on the idea that for so long, germ theory was attributed to the nastiness of certain places..polio research started out that way - a better read (at least to me) was Polio: An American Story - it tells the story behind the development of the polio vaccine, but looks at how it was spread/contracted a bit as well

Thanks Dee. Maybe I'll look into it.

Cholera is a waterborne disease. The baby got it from the water drawn from the pump.

Stephanie is right. It's a waterborne disease, and the baby was one of the first people to drink water from that pump after the human waste leaked into the source. I also agree with Dee--the author spent a lot of time discussing the popular theory of the time that diseases like cholera and plague were airborne, so John Snow had to work extra hard prove that it was the water and not contaminated air that was infecting people in London.

Or at least in that neighborhood of London.

Stephanie wrote: "Cholera is a waterborne disease. The baby got it from the water drawn from the pump."

Well, hence my confusion, because Baby Lewis was presented as the primary cause of the epidemic. Her illness, and the actions of her mother (and improper sewage and sanitation barriers), caused its spread at the pump. What I think you're saying is that her waste WASN'T the first to have contaminated the pump.

Maybe it's not that big a deal - it's not supposed to be the main point of the book. Or maybe they couldn't trace the disease any further back than her, if what you're saying is correct. If that's the case, I just thought the author would've noted that she was not the first to have become ill with the disease during that epidemic. There was someone before her. Another "patient zero".

so out of curiosity, I just googled cholera and this is what it said:

A bacterium called Vibrio cholerae causes cholera infection. However, the deadly effects of the disease are the result of a potent toxin, called CTX, that the bacteria produce in the small intestine. CTX binds to the intestinal walls, where it interferes with the normal flow of sodium and chloride. This causes the body to secrete enormous amounts of water, leading to diarrhea and a rapid loss of fluids and salts (electrolytes).

Cholera bacteria in the environment
Cholera bacteria occur naturally in coastal waters, where they attach to tiny crustaceans called copepods. The cholera bacteria travel with their hosts, spreading worldwide as the crustaceans follow their food source — certain types of algae and plankton that grow explosively when water temperatures rise. Algae growth is further fueled by the urea found in sewage and in agricultural runoff.

Surface or well water. Cholera bacteria can lie dormant in water for long periods, and contaminated public wells are frequent sources of large-scale cholera outbreaks. People living in crowded conditions without adequate sanitation are especially at risk of cholera.

so from this, I would say that maybe the bacteria that caused the baby to get sick was in the water that they drank and it affected the baby - which got the diahrrea; and got sick, which then infected the water all the more

Sheila wrote: "Stephanie wrote: "Cholera is a waterborne disease. The baby got it from the water drawn from the pump."

Well, hence my confusion, because Baby Lewis was presented as the primary cause of the epide..."

No, the baby was not presented as the main source of the epidemic (based on how I read the book). The author proved the baby picked up the illness from drinking water out of one source: the pump that supposedly had the best water of London. That particular pump was being exposed to leaking sewage over a long period of time. The waste from the baby went into another pump source, which started to spread cholera to people who did not go to the same pump the parents of the baby did. They also used the baby to demonstrate why some of the pump areas had temporary exposure to waste and why the cholera epidemic did not last long around other pump sources like it did for the main pump the author focused on.

When Sarah Lewis tip-toed downstairs to toss the water in which she had rinsed her daughter’s soiled diapers, she was unaware that she was setting off one of London’s most terrifying epidemics. It would, within in a space of weeks, kill her husband, along with hundreds of her neighbors. She probably never realized that the episode that left her widowed and childless could be traced right to her own doorstep; “Baby Lewis” was the index case for England’s great cholera outbreak of 1854.

Nursing Book Club: The Ghost Map

http://www.workingnurse.com/articles/...

Index case (according to Wikipedia)The index case or primary case is the initial patient in the population of an epidemiological investigation.[1][2] The index case may indicate the source of the disease, the possible spread, and which reservoir holds the disease in between outbreaks.

The baby got it from somewhere. If you're right and she contracted it from another pump, somehow that pump managed to infect her and only her (and didn't result in widespread illness at that point)? It was her mother's subsequent actions in proximity to the Broad Street pump that turned it into an epidemic?

I was intrigued about this book when I saw the Book TV interview of the author, Stephen Johnson. I really did like the book. The beginning was not pleasant to read, but necessary information. If people in that time could live through it, I could certainly read about it. I think it's important to learn what health advancements we have made and how important it is that people practice good hygiene.

I remember from my ServSafe training that Vibrio bacteria (and cholera is part of that family) can be present in shellfish. And oysters, cockles, winkles, and mussels were all cheap food often eaten by the poor of London. And a baby's immune system is often not as robust as an adult's, plus, the bacteria can be destroyed by cooking. Suppose her mother prepared oysters for dinner, but some of the bacteria remained on her hands, and the baby was exposed and ingested it that way. Result: one sick baby, lots of dirty diapers, one contaminated pump.