Nursing Book Club: The Ghost Map

Nursing Book Club

Nursing Book Club: The Ghost Map

The story of London's most terrifying epidemic — and how it changed science, cities and the modern world

By Steven Johnson; Riverhead Books, 2006
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Reviewed By Elizabeth Hanink, RN, BSN

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.

Fortunately for us, someone did eventually figure out what was happening: Dr. John Snow. His life and contributions feature prominently in this account of a true medical mystery. In his practice, Dr. Snow specialized in research on gases and administering anesthesia, and it is that role for which we most remember him. During her eighth confinement, none other than Queen Victoria herself received chloroform from Dr. Snow. His medical research, of course, was relevant on that occasion. It proved to be even more so in what was to come.

Book ReviewJohn Snow knew the properties of gases, and he understood the human respiratory system. Who better to ask whether inhalation was really the cause of the violent dysentery that, within hours of onset, claimed the lives of his neighbors? Even though he practiced in the era before Pasteur and Koch, Dr. Snow was able to assimilate the necessary information to hypothesize that contaminated water, not air, transmitted vibrio cholerae.

He proved his theory by devising a mapping format critical to investigating future outbreaks. The originality of his design, now iconic, together with his unique knowledge of his own Soho neighborhood, proved pivotal; unlike previous efforts, the ghost map plotted the intersection of both the living and the dead. The information had been available all along, but only Dr. Snow, together with a local cleric, Henry Whitehead, waded through the muck and saw the pattern. If you drank water from the Broad Street pump, you got cholera.

Not everyone agreed with Dr. Snow. Victorian England at that time had an entrenched medical hierarchy that firmly believed in a “miasma theory.” Contaminated air caused illness, air befouled by tanners, bone-boilers and dye-makers. Even Florence Nightingale thought polluted vapors were the source of disease. Sewage cesspools adjacent to fresh water supplies caused no concern. When he insisted that the handle to the Broad Street water pump be removed, Snow showed the medical establishment that it was wrong, and he stopped the terror in its tracks.

Stephen Johnson is a gifted writer who weaves a good story out of mountains of detail. His descriptions of Victorian London awash in its own garbage are compelling, but there is more. Mr. Johnson also draws parallels to modern scourges like Ebola and avian influenza. Without being able to deal with the byproducts of our human lives, cities the size of Los Angeles, Paris or Beijing would not be possible.

Written By Elizabeth Hanink, RN, PHN, BSN, is a freelance writer in Los Angeles. She has 30 years of nursing experience.

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