For two days after the Lewis child began vomiting, life carried on normally. Not too far away, there was a clergyman named Henry Whitehead. Whitehead had attended Oxford University, and he was known for his gregariousness. He was a devotee of tavern life—he loved to spend his night talking politics or philosophy with friends. Since 1851, he’d been a priest for St. Luke’s church, where he specialized in helping the slum dwellers of Soho. At the time, the area around St. Luke’s was filthy even by London standards: there was a slaughterhouse up the street, and the streets were always full of horse manure.
Henry Whitehead is one of the book’s two main characters (the other is John Snow, not yet introduced). Whitehead was a likeable, talkative man, and he was clearly devoted to helping other people. In an era when many people were understandably consumed with fear of losing their lives to disease, Whitehead devoted his own existence to selflessness and good will.
On the morning of Saturday, September 2, 1854, Whitehead walked to a nearby coffeehouse and may have paid a visit to a military factory run by the Eley Brothers. Whitehead stopped to say hello to many people—he was a friendly man, and he knew the area’s residents well. At this time, Charles Dickens’ latest novel, Hard Times, about the misery of working-class city life, was being serialized; Whitehead may have mentioned Dickens to someone at the coffeehouse. But not one of Whitehead’s conversations broached the topic of cholera.
Johnson alludes to the novelist Charles Dickens many times in The Ghost Map; Dickens was one of Victorian England’s greatest critics of social injustice and urban squalor. Whitehead and his friend do not discuss cholera: not only because nobody knew what caused it, but also because it was a taboo topic in Victorian society, reflecting people’s deep fear of contracting the disease. (This is also the first time in the book that Johnson has used the word “cholera.”)
Seen from above, the area around Broad Street (one of the biggest streets in Soho) would have looked utterly chaotic, with people moving in all directions all day long. The most heavily trafficked part of the street, however, was the Broad Street water pump, long regarded as a good source of clean water. The pump connected to a well underground, and it was so popular that people would go out of their way to get Broad Street water, which was generally colder than the water from other pumps. In August 1854 alone, tens of thousands of people must have used the pump, including the Eley Brothers and Mr. G., the community’s tailor, who lived above the Lewis family. Some locals didn’t drink water from the pump, however—the laborers at the nearby Lion Brewery, for example, were paid in alcohol, meaning that they rarely drank water.
Without talking about cholera explicitly, Johnson creates a strong sense of foreboding, relying upon his readers’ knowledge of how diseases are spread. Thus, the passage strongly implies that the Broad Street water pump spread cholera to thousands of people. More generally, though, the passage illustrates some of the perils of urban life: in dense, highly crowded areas such as Soho, deadly diseases spread easily from one host to another (whereas in earlier, less dense societies, the disease might have stopped short of an epidemic due to a lack of available hosts).
The history of epidemics is a challenging subject, because it requires historians to pore over banal details of people’s lives. Amazingly, cholera historians have been able to determine what many people were doing on the morning of September 2. On Wednesday, for example, Mr. G. the tailor began to feel sick to his stomach, and he wondered if he had food poisoning (which, at the time, could be lethal).
For now, Johnson doesn’t go into detail about how epidemiologists obtained so much information about Mr. G. and his peers—however, he later explains that much of modern epidemiologists’ information about the 1854 outbreak was gathered by John Snow and Henry Whitehead.
London has a long history of epidemics, stretching back to the Great Plague. Furthermore, cholera is an ancient disease—it’s been suggested that there were cholera outbreaks in the Middle East in 500 B.C. However, until the 1800s and the rise of globalization, cholera was mostly limited to Asia. In 1829, cholera spread from India, then under the control of the British Empire, back to England. In the 1830s, there were cholera outbreaks in England and Wales, which claimed tens of thousands of lives.
One of Johnson’s most provocative points is that civilization is a victim of its own success. For example, the age of imperialism brought tremendous wealth and power to England—but, as we see here, it also brought deadly diseases back to England from around the world (and vice versa).
On Wednesday, Mr. G. began to grow frightened. He vomited through the night and had muscle spasms; he also began excreting odorless, watery stool, full of tiny white particles (later dubbed “rice-water stool”). By Friday, he was feeling cold, his skin was pale, and his heart was barely pumping. Within a few more hours, he and a dozen other Soho residents had died.
Cholera has evolved to the point where it causes its human hosts to excrete watery diarrhea (rice-water stool) that can spread the cholera bacterium to other human hosts.
Cholera is a bacterium—i.e., a microscopic organism consisting of single cells containing DNA. Bacteria are diverse and abundant. They can survive on nitrogen and sulfur, live in extreme temperatures, and process most organic molecules. Bacteria are essential energy providers, and they’re responsible for recycling waste. The history of life on Earth, it’s been suggested, is just one long “Age of Bacteria.” In small quantities, the cholera bacterium, or Vibrio cholera, is harmless for human beings; only when millions of cholera bacteria group together do they become lethal. Humans can touch cholera bacteria safely, but when they ingest cholera, they become horribly sick.
We might be predisposed to think of ourselves as the strongest, most important creatures on the Earth—but in fact, we have some stiff competition from bacteria. If longevity and propagation are signs of a “successful” life form, then bacteria are, far and away, the most successful creatures on the planet—far more so than human beings. The Age of Humans is relatively recent, but the Age of Bacteria is still going strong after millions of years.
Cholera bacteria inject a toxin into the small intestine, causing the body’s cells to expel water (hence rice-water diarrhea). Over time, cholera dehydrates the human body; as a result, it causes the heart to pump faster, resulting in muscle spasms and a tingling sensation. The kidneys begin to fail, and the heart slowly weakens and shuts down. Because cholera victims excrete and vomit, they expel cholera bacteria from their body, sending them to potential victims.
From a human being’s perspective, cholera bacteria are terrifying creatures who cause pain and suffering. Seen objectively, however, this pain and suffering is just a means to an end for cholera bacteria—the “end” of replicating themselves and passing into another human host.
When discussing cholera, it’s important to resist the temptation to personify the bacterium—i.e., to think about what cholera “wants” and “tries” to do. While cholera bacteria aren’t conscious, one could say that cholera “desires” to move into a certain environment, which allows the bacteria to reproduce more efficiently. In a sense, cholera “desires” to be in a moist environment, where it can reproduce quickly and spread to other hosts (i.e., living bodies). For most of human history, cholera spread slowly, because humans didn’t ingest other humans’ excrement—but cholera survived in rivers and puddles. On the occasions when prehistoric humans did contract cholera, the disease didn’t spread rapidly, since the population density of early human society was low. But with the growth of civilization—and especially the growth of cities—cholera could spread from human to human more quickly.
In this passage, Johnson at first criticizes the tendency to speak of bacteria as if they’re conscious beings (in literature this is called personification or the pathetic fallacy), but then falls into that same tendency himself. Even if cholera bacteria aren’t conscious beings, they could be said to “desire” a human host in the sense that they’ve evolved to seek out human hosts. Charles Darwin’s theory of natural selection can be used to show how, over millennia, cholera bacteria evolved to infect human beings: cholera bacteria that could do so survived and thrived, while cholera bacteria that could not simply died out.
As cholera bacteria spread through human hosts, it became increasingly lethal. Bacteria evolve faster than humans because their lives are shorter and because they produce millions of offspring. Furthermore, bacteria produce offspring whose DNA is arranged in far more diverse combinations than in the case of human reproduction. The result is that cholera bacteria can adapt to their environment very quickly. The most successful bacteria survive and reproduce, passing on useful traits to their offspring, while the least successful bacteria die out. In the case of London in the 1850s, the most “successful” cholera was the most lethal: it reproduced quickly (depriving its hosts of water) and induced vomiting and diarrhea (spreading to other hosts). To be clear, cholera didn’t consciously develop a strategy for survival—rather, natural selection caused cholera to become deadlier.
In Darwin’s theory of natural selection, the “fittest” species survives and reproduces, passing on useful genetic traits to the next generation, and so on. In bacteria, this process occurs thousands of times a year, because bacteria reproduce at a tremendous rate. Even if cholera bacteria themselves are unconscious of being successful or unsuccessful (or anything else, for that matter), they’ve evolved to become some of the most “successful” living creatures on the planet—at least in the sense that they’ve colonized every corner of the Earth.
The tragic irony of the cholera epidemic of the 1850s is that it could have been prevented with one thing: water. When cholera victims are treated with clean drinking water and electrolytes, they usually survive with nothing more than bad diarrhea. As early as the 1830s, a British doctor named Thomas Latta had determined that water could be used to cure cholera patients; however, his findings never seriously influenced the British medical community, and there were too many other, dubious “cholera cures.” At the time, untrained quack doctors sold their “miracle cures” for various diseases—and many people, unable to access good medical care, bought them. Some salesmen sold absurdly overpriced castor oil to cholera victims, making huge profits in doing so.
It’s remarkable that British doctors (or at least one British doctor) were aware of a cure for cholera twenty years before the cholera epidemic of the 1850s. In the 21st century, it seems obvious that a cure for a deadly disease would quickly be offered to the public, as so many people would have a strong incentive for the cure to be made available. But in the 19th century, there wasn’t a strong system of peer review (and there were too many quack doctors selling “miracle cures”), meaning that some important medical findings, such as Latta’s, could go unnoticed for a long time.
While quack doctors peddled their cures on the streets and in newspapers, “serious doctors” couldn’t agree on how to treat cholera, either. Some argued that the cure for cholera was to drain the patient of blood; others prescribed purgatives, such as rhubarb. Many doctors’ treatments worsened their patients’ conditions instead of curing them. Few realized that hydration was the most effective cure for cholera.
Doctors proposed complicated cures that, in retrospect, seem almost funny (except that they hastened the deaths of many patients). Perhaps it was the very simplicity of the cure for cholera that made it so hard to find—doctors were used to overthinking things, and thus never recognized the importance of clean water.
Johnson returns to the specifics of the 1854 epidemic. By Friday, hundreds people were dying throughout Soho, and “the fear was inescapable.” Whole families lay ill together, slowly dying in agony. When Whitehead traveled to Peter Street, he found that half the people living there were seriously ill. Perplexingly, however, Whitehead realized that there were very few ill people living in the dirtiest, smallest homes on Green’s Court. It appeared that the cleanliness of the household had no bearing on the residents’ chances of avoiding the disease.
London was a center of politics, finance, and intellectual life in the 19th century (and today)—but it was also a hotbed of disease and fear. In the midst of so much chaos and uncertainty, few people could keep a clear head—but one of those few was Henry Whitehead. Instead of listening to the conventional wisdom, he recognized the truth: some “dirty” people got cholera, but others didn’t.
Around the same time that Whitehead was exploring the street, a medical officer named John Rogers was visiting patients who’d fallen ill in the last day. Rogers realized that the Soho neighborhood was in the grips of a cholera epidemic. As he visited houses on Berwick Street, he inhaled the sickening stench of vomit and excrement. He came to the Lewises’ home, where he found that their baby daughter had died.
John Snow and Henry Whitehead were far from the only people going door-to-door in Soho to study the cholera epidemic. Notice that John Rogers “inhaled” the stench of cholera—which, according to most doctors at the time, should have proved fatal.
In the afternoon, Whitehead visited a family of six (for the purposes of the book, Johnson calls them the Waterstones—no record of their real names exists). Whitehead found that the Waterstones’ young daughter was barely conscious. Outside, someone placed a yellow flag in the middle of the Street, signaling that there was a cholera outbreak. The flag was superfluous, however—the streets were already full of dead bodies.
The passage conveys Whitehead’s dedication to his mission—providing comfort and relief for the sick and miserable. It also emphasizes the chaos and ineffectuality of the authorities in Victorian London—they couldn’t do anything more for their own people than plant a useless flag in the middle of the street.