London, 1854
In the year of cholera epidemic in Soho, there are enough people of the lowest classes of existence to form by themselves the fifth largest city in England. Many of them make their living—such as it is—from picking over the effluence of the city’s sewage and selling what’s of value. The word that should be coming to mind right now is Dickensian, but the author expands upon that to lend the situation a metaphorical depth worth of the Dickens himself:
“London is a city of scavengers. Just the names alone read now like some kind of exotic zoological catalogue: bone-pickers, rag- gatherers, pure-finders, dredgermen, mud-larks, sewer-hunters, dustmen, night- soil men, bunters, toshers, shoremen.”
Not Quite Eureka!
John Snow is the hero of the tale; a renowned anesthesiologist before the outbreak who was officially conferred with genius status afterward. The author points out that brilliance was not in short supply at the time, even among those who were staunch opponents to Snow’s theories. The eureka moment of one individual who sees everything clearly in an epiphany is not the way these things work:
“Great breakthroughs are closer to what happens in a flood plain: a dozen separate tributaries converge, and the rising waters lift the genius high enough that he or she can see around the conceptual obstructions of the age.”
The Metropolis
London in the mid-1800’s was already a larger metropolis than some of the world’s major cities today. Imagine living in Denver today with no indoor plumbing, electricity or even the most basic understanding of how diseases are transmitted. Got the picture? Okay, now add three more Denvers and you are almost to the:
“dark reality of urban poverty: to live in such a world was to live with the shadow of death hovering over your shoulder at every moment.”
The Miasma Theory
The miasma theory explaining the spread of disease is quite simple and utterly complicated. It is simple to explain as metaphor, but too complicated to rationally and logically address with a solution:
“If all smell was disease, if London’s health crisis was entirely attributable to contaminated air, then any effort to rid the houses and streets of miasmatic vapors was worth the cost, even if it meant turning the Thames into a river of sewage.”
Elementary, My Dear Whitehead
John Snow’s great breakthrough involved tracing a path backwards from the effect of observable organ failure of cholera patients to the collective social behavior which could have been the cause. It was this logical force reasoning that transformed Henry Whitehead from avid miasma proponent into Snow disciple:
“Snow’s theory was like a ladder; each individual rung was impressive enough, but the power of it lay in ascending from bottom to top, from the membrane of the small intestine all the way up to the city itself.”
