World Toilet Day, Cholera, and the Great Stink

I've just recently finished Clare Clark's novel The Great Stink and Steven Johnson's nonfiction work The Ghost Map, and just as I was preparing to write about them, I found out that Wednesday was World Toilet Day.

Knowing when to get off the pot, I decided it was a sign that I should start writing.

I picked up The Great Stink because I heard about it on MPR's "Midmorning" when the topic was Good Books for Hard Times. Basically, they said it was a murder mystery set in Victorian London, and much of it took place in the sewers, which were under construction at the time. That was enough to set me off.

But the book is much more than it sounds like. It portrays a very real slice of life for characters from both the bottom of London and the struggling lower middle in the late 1850s, and does a particularly great job of portraying the post-traumatic stress of a returned Crimean War soldier, making the reader appreciate how far our world has progressed when it comes to attitudes about mental illness. (Not far enough, of course, but it used to be a lot worse.) The main character is a low-level engineer working on planning London's new sewers, the largest public works project in the world at the time.

While I was reading Stink, I saw a discounted copy of Johnson's The Ghost Map (subtitled The Story of London's Most Terrifying Epidemic -- and How It Changed Science, Cities and the Modern World), which takes place just a few years before the fictional events of The Great Stink. While the novel had focused on the brilliant engineering of Joseph Bazalgette, Johnson's book focused on two men -- Dr. John Snow and Rev. Henry Whitehead -- who worked together to prove that cholera is caused by contaminated water, rather than bad air, as had been believed up until that time.

Johnson's book is a great read, despite all the details of cholera's symptoms (which I read during lunch one day... yum). It's books like this that should be used in high school history classes, rather than textbooks that attempt to summarize everything that ever happened and wind up turning it all to dust. It brings history to life (or death, I guess).

The book is also great for explaining how bacteria work (both for ill and good), envisioning what life in Soho was like in 1854, and, for most of the book, delving into what Johnson calls "the sociology of error" -- the error being the belief that disease was caused by bad air and dirty living habits, rather than contaminated water. This belief led London's public health officials to clean up the city's cesspools by draining them to the Thames, which was the source of the city's drinking water. Over 35 years, the process changed the Thames from a clean river to the source of "the Great Stink," and a major cause of cholera.

Some favorite quotes:

Without the bacteria-driven process of decomposition, the earth would have been overrun by offal and carcasses eons ago, and the life-sustaining envelope of the earth's atmosphere would be closer to the uninhabitable, acidic surface of Venus. If some rogue virus wiped out every single mammal on the planet, life on earth would proceed, largely unaffected by the loss. But if the bacteria disappeared overnight, all life on the planet would be extinguished in a matter of years (page 7).

The initial symptoms [of cholera] would be entirely indistinguishable from a mild case of food poisoning. But layered over those physical symptoms would be a deeper sense of foreboding. Imagine if every time you experienced a slight upset stomach you knew that there was an entirely reasonable chance you'd be dead in forty-eight hours (pages 32-33).

From our vantage point... it is hard to tell how heavily that fear weighed upon the minds of the individual Victorians. As a matter of practical reality, the threat of sudden devastation -- your entire extended family wiped out in a matter of days -- was far more immediate than the terror threats of today.... Living amid cholera in 1854 was like living in a world where urban tragedies on [the scale of 9/11] happened week after week, year after year (page 84).

Even with its higher crime rate, New York City in its debauched nadir of the 1970s was a vastly safer place to live than Victorian London (page 87).

I learned from Johnson that our reaction to rotten and fecal smells is based in the part of our brains called the amygdala, one of the most ancient parts of the brain, the seat of our "instinctual responses to threats" (page 128), as well as the ventra insula, which is home to our phobias. "Both regions can be thought of as alarm centers of the brain; in humans, they possess the capacity to override the neocortical systems where language-based reasoning occurs" (page 128). Johnson's argument is that this irrational, "gut level" response prevented the Victorian establishment from seeing the real cause of the contamination, and he makes a good case. Going a bit off-topic when I read this, I couldn't help wondering if some of our other irrational attitudes (like maybe bigotry) can't be explained by some type of conditioning connected to smells.

In the final chapters of the book, Johnson expounds on what the cholera outbreak and its aftermath have to tell us about our present situation. We need urban density, he says, to make our level of population sustainable on the planet (because city dwellers use substantially fewer resources than rural inhabitants), but at the same time urban density makes us vulnerable both to purposeful attack (nuclear or biological) and unintended pandemics. If density comes to be seen as deadly, people will flee the cities. And then where will we be on a global sustainability level?


By the way, I haven't said why the book is called The Ghost Map. Dr. John Snow created a map, now famous in the fields of both epidemiology and information display, of all the deaths from the Soho cholera outbreak of 1854. For each death at a particular address, Snow drew a short, horizontal black bar. The bars stack up at the addresses where multiple people died (people who had drunk water from the Broad Street pump) and thin out or disappear where the people had not drunk the water. If a house was closer to the pump as the crow flies, but farther as the streets ran, people were less likely to die.

The map doesn't look like much to someone of our time, accustomed to colorful information graphics that rub our faces in their meaning lest we overlook it. The map's brilliance is especially hard to detect at web resolution, I fear. But over time, this map of the dead came to be accepted as the ultimate proof that cholera reached its victims from the well, and that if we are going to live in cities, we have to spend money on infrastructure to make the city sustainable.