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on 21 May 2016
So, who caused the 1858 "great stink"? Who fixed it? How did a Policeman's very small baby manage to kill many hundreds of people? Where exactly in Broad Street Soho ( now Broadwick Street, go and have a look . . . ) was the infamous sweet water and Cholera well pump which helped lead to the study epidemiology ( instead of blaming grumpy God for everything )? How can one person make a difference and how much work do you have to do to match a victorian? This book probably provides most people with enough of a set of answers ( me included ) . . .
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on 23 January 2007
This book combines a detective story with a slice of Victorian social history. Outbreaks of cholora were not infrequent in 19th. cent. London but Steven Johnson is concerned with one particular case in Soho in 1854, centered round the pump in Broad Street. In an England bustling with the great inventions of the Industrial Revolutions the ever present danger of vast quantities of crap - in the streets and the water - appears to have been overlooked. The awful smells convinced everyone that epidemics were spread by air but two people contested this assumption. I found this book strangely un-putdownable, possibly because I lost four members of my own family to cholora in the same year, in Whitechapel, London, but also because you want to know what happens next. You also learn a fat slice of our recent history.
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on 28 May 2007
I loved this book. It is very informative and at the same very readable. As a reader who usually reads fiction, I found this a 'step up' and felt that I learnt a lot about Victorian London, the jobs the people did, the way they lived and what there lives were about. the characters come to life and you live there lives. I will definitely be reading more books on this subject - but feel I have been spoilt reading this first. I would definitely recommend.
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on 13 September 2011
The Ghost Map tells the story of the 1854 outbreak of cholera in Broad Street, London. More than six hundred people died, but the episode marked a turning point in the understanding of how the disease was transmitted. Dogged investigation by Dr John Snow and Rev Henry Whitehead suggested that, contrary to the accepted view that transmission was airborne ('miasmatic'), victims had been infected by drinking water from a well contaminated with faeces. A striking map of the location of the victims (the 'Ghost Map') helped to win converts to the water-borne theory, which is now universally accepted.

Apart from the importance of the discovery about the nature of cholera, Snow and Whitehead's work was one of the earliest examples of scientific epidemiolgy and is revered by historians of that discipline. It also provides an illustration of the often glacial pace at which scientific revolutions occur: the miasmatic theory clung on for decades and was only gradually and quietly dropped.

The story is engagingly told by Johnson in a similar vein to Dava Sobel's Longitude. The Victorian sewage system is not at first sight a promising theme, but it proves surprisingly rewarding. We learn of the army of waste recyclers and the almost unbearable smelliness of London in the 1850s.

There are irritations. First, the overheated subtitle describing 1854 as 'London's Most Terrifying Epidemic'. No doubt the episode was locally alarming, but the death toll was tiny, both in absolute and proportional terms, compared to the plague epidemics which struck the city in previous centuries. Indeed, as Johnson himself notes in the main text in some ways what is surprising is how little newspaper coverage was generated by the cholera outbreaks of the mid 19th century.

Second, the epilogue. This consists of a rambling account of the various threats facing modern cities: nuclear attack, bio-terrorism, bird flu, global warming and so on. His general line is that if these problems are addressed with the same Victorian can-do with which Snow and Whitehead tackled the 1854 cholera epidemic then the 'forces of reason will win out'. So, he concludes, 'Let's get on with it'. It is all rather naff.

Third, Johnson's condescension towards those who believed the miasmatic theory. Certainly from a distance of 150 years the theory appears incorrect and indeed counter-productive, but in another 150 years time won't the current theories also look absurd? There is little sense here of the relative nature of scientific progress, with each generation looking back on the preceding generation's theories in horror (a process particularly noticeable in the medical field).

Still, as other reviewers have said, if you can ignore the epilogue it's a lively read.
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on 3 May 2008
Interesting book although somewhat lacking in depth. It does give the reader a sense of London's public health history and changes that were initiated as a result of the 19th century cholera epidemic. The descriptions of life in London during that time, the population density of the city and the poor sanitation (or lack of sanitation) are thought provoking and I found those to be the most interesting part of the book. Many people of the time (as well as scientists) thought that diseases were spread by smell and went through pains to try and cover up the bad odors. There is a detective nature to the book as the means by which the spread of cholera are investigated, and a specific outbreak is linked to a water pump. This is an easily readable book and is recommended for those who want to know something about cholera and its impact on public health.
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on 3 January 2010
The story of how Dr John Snow and the Rev Henry Whitehead pieced together that cholera was waterborne against the very strong conventional wisdom that it was airborne. They did this , working at first hand among the thousands of people suffering a miserable death in Soho in London.

In the mid 19th century, London, which was urbanising very rapidly, really did not have the sewers and public health infrastructure to cope with the dense populations. When cholera hit, the conventional wisdom was that it was due to the "miasma" (foul air). Overcoming this miasma theory held by the medical establishment took painstaking detective work in tying the disease back to the Broad Street Pump. It took a long time (30 years) to effect a change of policy. In the meantime, disastrous decisions were taken with the London sewage system that led to widespread drinking water pollution. Eventually when the importance of clean water was grasped, London undertook building an immense sewage system that became the envy of the world.

But the book is not just about cholera and clean water. It is also about the development of epidemiology and the way discoveries are made. Discoveries are not just the result of some brilliant individual mind, although both Snow and Whitehead clear thinking, diligent, exceptional people. John Snow, from humble beginnings, had already established himself as an early adopter and innovator in the use of ether and chloroform as anaesthetics and become a leading anaesthetist. But the book acknowledges the input of a range of people and circumstances - from William Farr, London's Registrar General, to the Vestry Committee who removed the Broad Street Pump handle against intense opposition.

The experience in overcoming cholera and the success of London in creating the conditions that allows dense populations to live together provides the blue print for the development of city living round the world. A wide ranging discussion on the development of cities and the threats for the future is stimulating.

A carefully researched, readable book by a powerful intellect.

It also provides a useful reading list! Snap again!
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on 7 December 2008
This book deals with a cholera outbreak in London in 1854 and environmental and hygeine conditions that existed at that tima.
In 1854 itwas commonly believed that cholera was spread by foetid air but it was Dr.John Snow who conclusively prooved that it was waterborne.This result was achieved by careful investigation,mapping,case histories,surveillance,collection of data and statistics.All these factors are woven into a thrilling detective story by the author.
Equally fascinating is the social comentary of the times with its filth,sewage, horrendous housing and poverty.
The principles of disease investigation used by Snow are the basis of epidemiology which is practised today.
The maps ,diagrams and illustrations are good but I do not like the title of the book "The Ghost Map"which hs no relevance to the investigation of the outbreak.
The notes and bibliography are good but it is surprising Snows book "The Broad Street Pump"is not listed.
110 years later in 1964 a virtually identical incident occured in Hong Kong known as "The Temple Street Well".
Abook to be recommended.
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on 2 March 2016
Very interesting book about John Snow and the cholera out brake on 1854. Comprehensive and detailed, written like a detective novel. Catchy. Didn't like the conclusions, thought. Too vague.

Overall, recommended.
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on 6 January 2007
Johnson's book reads as a detective story, with the two heroes seeking to find how Cholera is spread and how to stop an epidemic. However, he also "parks" on other interrealated themes of how "ideas" spread, some of the implications for city life, our lives in the "city planet" we now inhabit and the way we will live in the future. Great read. Fascinating history. Great use of various interrelated disciplines from someone who is passionate about life in the city, science, breakthroughs in ideas and history.
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It seems like I am not alone in these sentiments, at least among the critical reviewers of this book. Much of the Conclusion, and certainly all the Epilogue is such a non-sequester in style, content, but primarily in the quality of thought from what preceded it. The last 50 pages seem like a rambling "cut and paste" add-on.

Johnson is a polymath in his own right, and has mastered the diverse aspects of the outbreak of cholera in the Soho section of London, in 1954, and has written a compelling story. It is the London of the time of Charles Dickens, whom Johnson has read and routinely quotes. His descriptions of the significant part of the population that dealt in "recycling" and human wastes (and these people would have formed one of the larger cities in England at the time) were most memorable; Dickeneque in their own right. He provides an excellent clinical description of the action of cholera on the human body. The "drama" of the story centers around the action of two very different men, the scientist Dr. John Snow, and the social worker pastor Henry Whitehead, who combined their different outlooks and skills, to prove that the vector that carried cholera was water; which was totally contradictory to the received ideas of the time. Establishment thought considered it to be the "miasma," the fetid air, the bad smells that transmitted the disease. Johnson gives an impressive biological explanation why human reactions to smells would cloud their judgment; much contradictory evidence, such as the fact that the laborers who worked in the fetid atmosphere of the sewers all day were not particularly susceptible to the disease, was simply ignored. Johnson laces his account with some droll humor, for example, praising the advantage of cities so that it gave consumers an opportunity to concern themselves with "new technologies.... and celebrity gossip"(!) Considerable emphasis is given to the impact of "the Ghost Map," which is a graphical representation of where the deaths occurred, and how this helped "sell" the theory that the water from the one well, at 40 Broad Street, which had been contaminated with cholera from the diapers of Victim #1, or as they say in epidemiology, the "index case," was the source of the disease. And yes, despite some reviewer comments, the Ghost Map is in the book, in several places, even with a "ghost" shading.

But even with the first 200 pages I had some problems. The gas/liquid/solid energy metaphor of the three states of water compared to the three developmental states of human society: hunter-gather/farmer/city dweller is completely muddled, and the energy levels are actually the reverse of what is indicated (p 94). The Ghost Map was in the book, but it certainly would have been useful to have a Voronoi diagram also. And when he cites Marcel Proust and his Madeleine-inspired reveries (p 128) he missed a marvelous opportunity to compare Dr. Snow's work with Marcel's father, Dr. Achille Adrien Proust, who was an epidemiologist who devoted much of his life to fighting cholera, and is largely responsible for developing the "cordon sanitaire" technique. There is also the problem, particularly prominent at the publisher, Penguin, Love and Consequences: A Memoir of Hope and Survival of not taking the time to run the manuscript through spell-check. The editing, particularly towards the end was shoddy - saying the same thing about the 1918 flu epidemic, thrice, in three pages. Despite these shortcomings, I would have given the book 5-stars if he had stopped around page 200.

The last 50 pages should have been prefaced with that classic cover from the "New Yorker," that shows the world in wildly distorted proportion, with Manhattan consuming about 80% of it, Jersey as a distant shore, San Francisco a remote dot, and all of China a smaller and more remote one still. Johnson is an unabashed New Yorker, (and yes, as the cliché has it, it is a great place to visit, but...) and he apparently believes that the world would be a better place if we all lived like they do in the Big Apple. "We are now, as a species, dependent on dense urban living as a survival strategy" (p 236). Pleeeze. Some of us in the "fly-over zone" would demur. Johnson asserts with the aplomb and certainty of Edwin Chadwick, one of the chief miasmaists who propounded the "All Smell is Disease" dogma.

As a few other reviewers have commented, it is rather ironic that there are large dollops of miasma-theory supporter thought processes behind Johnson's statements made in the final pages. All the contradictory evidence is set aside when "I (heart) NYC." Is New York really the greenest city in the United States, aside from an article in - no surprise here- "The New Yorker"? Density as an engine of wealth creation? How many trillion did Wall Street just vaporize? Density leads to population reduction? Or is it increased income levels that makes the "human" Social Security of many children no longer necessary? And then the long ramble about terrorist threats was sophomoric, at best, with nary a thought as to how to reduce or eliminate these threats. It is not that terrorism, fossil fuel depletion, or the threat of a new epidemic are not real issues to be considered in rationale discourse, but how could you NOT mention America's, and even New York's massive reliance on foreign capital, and foreigners to supply us the necessities of life, while so many able Americans are unemployed as being the central issue that must be resolved: an equitable distribution of the wealth of society. I just finished reading Thoreau's Walden, and what a stunning contrast.

Overall, the last section should be dropped, or re-worked, with much more critical thought, including some input from beyond the Hudson River, and perhaps made into its own stand-alone book. Combining the excellent portions of the book, with a shoddy ending: 3-stars.

(Note: Review first published at Amazon, USA, on June 30, 2010)
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