A friend at the curling club recommended this documentary about the epidemiology of the cholera outbreak in London in 1864, and I am glad he did. I vaguely recalled this story from epidemiology classes more than fifty years ago, but this book is a well-written refresher course that goes into far more detail and background and puts the story into the context of its enabling of the subsequent development of cities worldwide. Dr. John Snow, the first British physician to use ether and chloroform, almost singlehandedly deduced that cholera was waterborne, not transmitted through the air, and proved his theory by mapping the outbreak to a single well on Broad Street in SoHo, before the existence of the Vibrio cholera bacteria was known. Ironically, in the same year, an Italian physician, Philippe Pancini, described the microscopic appearance of the culprit bacteria, but this discovery was ignored for thirty years by a medical establishment convinced that contagious diseases were always transmitted through foul air, ignoring the earlier proof of the waterborne transmission of typhoid fever by Dr. William Budd.
But like most medical discoveries, this was not ultimately the work of a single genius working alone, and the curious clergyman, Henry Whitehead, who contributed greatly to the proof has not been yet been given due credit for his part in the discovery, nor has the the work of the Registrar General who complied ‘Weekly Returns’ reporting on the distribution of the cholera deaths in the city, that allowed Snow to map the lethal epidemic.
John Snow is rightly feted as a hero of eighteenth century medicine, doubly so because he sought no fame or recognition. But like most important scientific discoveries, his breakthrough would probably soon have been made by some contemporary of his, perhaps by Dr Budd, if not by him, given the convergence of the different pieces of evidence. A little later a fierce race was on between Charles Darwin and Alfred Russel Wallace to be the first to establish credit for the description of evolution. Watson and Crick, and Banting and Best raced with competing researchers to establish credit for their discoveries. It is sad that more often than not, modern medical research is driven by big egos, anxious to be recognized, but I’ll admit to being caught up in that competition in my past life. Even in my less-than-stellar, stunted, part time career as a medical researcher, I and collaborators were twice preparing to publish our observations about two new diseases, one genetic and one acquired, only to read in a journal that someone else had made the same discoveries, and beat us to publication of a first description.
The Epilogue provides a very speculative assessment of the future of urbanization. Like Edward Glaeser in Triumph of the City, Johnson details the economic, social and environmental benefits of packing hordes of people into dense cities, but also assesses the risks- the ability to kill thousands or millions of people with a new altered microbe, a nuclear bomb, or a disruption of complex and crucial infrastructural interconnections.
I have a couple of quibbles about this well-written informative book. Throughout Johnson uses ‘statistics’ to describe what is really ‘data’ and they are very different by definition. And a minor dispute that I can’t resolve – Johnson describes bacteria as the largest biomass on earth, but during a trip to Antarctica, researchers on The Ushuaia told us that that honour belonged to saltwater krill. Who is right about that? Does it matter?
The Passionate Reader 