Tuesday, December 9, 2008

Cholera: London, 1854

It's curious how these things happen. My mention yesterday of the cholera epidemic in Zimbabwe set me off on a journey that led all the way back to mid-nineteenth century London. After making my blog entry, Ellie and I joined our neighbor for the morning's exercise walk around the hill and it turned out that she had just finished reading this book... I asked if I could borrow it, and I'm already a third into the fascinating story that it tells.

"The Ghost Map," by the journalist and popular science author Steven Johnson, is a scary and totally gripping ride into the past--and one that makes you glad to have been born into a place and time where flush toilets and good sewer systems make life infinitely more livable, in the quite literal sense of that word. I spent the afternoon yesterday wandering the streets of a London whose stench and squalor is barely imaginable today, though Johnson does almost too good a job in helping us imagine it. It's, um, vivid. The descriptions of the biological waste of two and a half million human beings jammed into a small space--and of the primitive methods then available for its disposal or recycling--leave the reader holding his nose and gasping for a breath of clean air. Drawing liberally on the resource of work by Dickens and other contemporaneous writers, Johnson takes us on a tour of the riverbanks and the overflowing cesspools that were the primitive and ineffectual sewage system in those bad old days, and introduces us to the "night-soil men" whose (relatively well-paid) task it was to collect the human waste and transport it out to the countryside to be recycled by farmers in the form of manure. These descriptions, while offered with great zest for the telling detail and a wry sense of humor, are certainly a challenge for the squeamish.

They're also a lesson for the contemporary world, since Johnson usefully wanders off to explore their meaning in the broader, continuing contexts of ecological science and urban planning. I've just arrived at the point where he begins to discuss the relationship between sanitation and health. By today's standards, the paucity of medical and pharmaceutical knowledge at the time of Johnson's story is nothing short of astounding, with opiates being the favorite means of treating all kinds of ailments and disease. Letters from newspapers of the day suggest that home remedies, folklore, and simple quackery vied for medical credibility, along with academically trained physicians and workman "surgeons"---who operated until well into the 19th century without the benefit of anesthesia. One particularly hair-raising passage narrates the performance of a mastectomy in agonizing detail.

This being a story about a cholera epidemic, Johnson is at pains to prepare the reader for its onslaught with a brief and pithy introduction to the microscopic life of bacteria and their skillful work of survival in biological environments, drawing the parallel between the action in this infinitesimal micro-world and that in the macro-world of human beings and their crawling cities. (The effect of the cholera bacterium, as I understand it, is to deprive the intestine of its normal functioning to preserve water and thus to drain the body of its liquids, leading to a rather swift and nasty death from dehydration.) Nothing of this is understood by the scientists and medical professionals of the time, leaving them defenseless in the face of imminent disaster.

Thus far in my reading, Johnson has introduced the reader to what I take to be his two main protagonists, a doctor and a clergyman, whose observational powers and devotion to empirical method will--I presume--pave the way for an eventual understanding of the disease. I have to say, despite the intestinal discomfort as I read, that this is a totally compelling story, a page-turner, rich in historical, social, and scientific information and in evocative description. Its subtext is as relevant today as it was some one hundred and fifty years ago: the interdependence of all living things--including those sneaky bacteria--and the absolute necessity of vigilance when it comes to the survival of our species in a world of infinite and often dangerous complexity.

There, more than you ever needed to know about nineteenth century London. Now, back to my book...

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