Episode 27: Summer Book Club - The Ghost Map, Part 2

As part of the podcast series Solutions for Higher Education, SUU President Scott L Wyatt will lead a "Summer Reading Club" focusing on a new book each month. Readers who join the podcast will be given an introduction to the book by Scott Wyatt and podcast host Steve Meredith near the beginning of each month, and then near the end of the month, an expert guest will join the conversation to give additional insight and context to the completed reading.

The Ghost Map: The Story of London's Most Terrifying Epidemic - and How it Changed Science, Cities and the Modern World by Steven Johnson
In the middle 1800s London was emerging as a modern city, but it lacked most of the sanitation that we take for granted. In 1854, the city was in the grip of its second outbreak of cholera in less than 10 years. With a combined death toll nearing 100,000, the citizens turned to modern science for answers. Unfortunately, the science of the day dictated that the outbreak be treated as though the disease were airborne, and any efforts to seek other explanations were met with reactions ranging from skepticism to anger. Undaunted, early epidemiologist, Dr. John Snow and local priest, Henry Whitehead began interviewing residents of the SoHo area to see if they could discover the cause of infection and the way in which the contagion spread. The Ghost Map is an intriguing, historical detective novel, and serves as an example that history's greatest discoveries have often been made by those who refused to accept the conventional wisdom of their day.

Full Transcript

Steve Meredith: Hi again everyone, and welcome to Solutions for Higher Education, a podcast featuring Scott L Wyatt, the president of Southern Utah. I'm your host, Steve Meredith, and with me in-studio today, as he always is, is President Wyatt. Good morning, Scott.

Scott Wyatt: Well thank you very much, Steve.

Meredith: It's a pleasure to be here today, as it always is with you, and we have an exceptionally interesting guest and an exceptionally interesting topic of conversation. This is actually our last book of our summer book list, The Ghost Map by Steven Johnson, and we had our guest in for a little teaser at the beginning of the month, but now we're going to get to go further into it with him. Will you go ahead and introduce him?

Wyatt: So Dr. Blodgett, welcome this morning.

Dr. Dave Blodgett: Thank you, it's great to be here.

Wyatt: We're so glad to have you here. Your business is public health?

Blodgett: That's correct, that's correct.

Wyatt: Preventative medicine and a myriad of other things. But it's public health. [Laughs]

Blodgett: Right. So the science that developed, probably starting in large measure with the events that are described in this book, now almost every county in America has a health officer and a local health department designed to prevent disease and keep people healthy instead of waiting for them to get sick.

Wyatt: So you, in many ways, owe your career to the story that's told in this book.

Blodgett: Absolutely. It was certainly the genesis of the concepts that are put into place every day in the modern practice of public health. They all started—at least got a big jump up—with the activities that John Snow was engaged in in The Ghost Map. Right.

Wyatt: Yeah. So that's one of the reasons why this book is so relevant. It's a great story, but it's so relevant to us because we all have a better life because of the story told in this book.

Blodgett: Absolutely. Just yesterday in our health department, we were discussing…we're engaged in a project to build a well in Malawi.

Meredith: Oh, wow.

Blodgett: And the tagline is always "The difference between a first world country and a third world country is public health." The things that you put in place and the structural things that are available to people in order to help them not get sick just by being the environment they're in. So, you take somebody in Malawi, the rate of children getting diarrhea is in the 25%-30% range before they're two years of age. And so the average age at death is in the 40s because so many children die. That's what this science brings into the modern world is we don't even hear about that now, right? It's not even in the top 10 causes of death—diarrhea in children—but in a place where you don't have a clean water supply, that's what you face.

Wyatt: Yeah, and that gets me thinking of hospitals that I have visited in third world countries. But that's another topic, I don't want to get us too far distracted.

Blodgett: Yes, I apologize.

Wyatt: No, no. You just reminded me and when we travel, we don't really see all of this. We visit other countries and we don't see what the hospitals look like and we don't really get a sense of the fact that they don't have public health. When I'm in some countries…it does now because of what I've been learning, but now I do think, "I'm so happy that we have food handlers permits and training and somebody watching out for us." And that is only touching the tip.

Blodgett: It's largely a thankless job is part of the problem. I just read an article entitled, "In Praise of Maintenance" and how in our society, nobody wants to thank the guy that keeps it where it's at, but it really is…that's something that when you look around, it's the maintainers of the world that help keep society the way it is.

Meredith: Well and some…a lot of this is discussion about stuff that, at least in previous years, was not really part of polite company. We're talking about waste disposal and management, and there's a sentence in the book where he talks about London and what, at the time, all the modern miracles that it was beginning to see. But the biggest miracle of all was that they finally built this sewer system. It was underground and not seen but it saved countless lives and made the world in London certainly a better place.

Blodgett: Probably around the world because it became a model for everybody else. They'd say, "Wow, we all need to do this."

Meredith: Yeah.

Wyatt: Well, let's start this discussion out there because the book is a story of the cholera outbreak in London in 1854. And so let's start out with London in 1854, and what really grabbed me in reading this story was thinking about the comparison when I travel to large cities today what I find and what kind of repulses me a little bit in a lot of garbage that might be laying on the side of the street or things that are dilapidated, and I think, "Well, we should keep these cities prettier." But in fact, they're beautiful compared to what cities were like 150 years ago. We have no concept of how clean even our most unclean cities are.

Blodgett: Yeah, absolutely. And I think the book does a wonderful job of highlighting just what that must have been like. The description of the average home—they have a cesspool in their basement…

Wyatt: A cesspool in the basement.

Blodgett: Yeah, in the home. Things like they'd take a cow into the home and hoist it up and feed it until it died and they'd have to try to figure out a way to get it back out…but the cesspool fills up and it overflows and so coming out of the basement, you have raw sewage, often flowing over most of their yard, and then sometimes they'd put stepping stones so they could make it through the sewage without actually walking through the sewage, but…[Laughs] I don't think that's a scene that would fly very well in modern America.

Wyatt: No, but it was normal life. It was normal life for them. And the whole industry that built up in London and other cities like London with the dredgermen and the night soil men, the pure finders, the rag gatherers…wasn't it in Oliver that we've got these people wandering around at night picking pockets of dead people on the streets?

Meredith: Yes, absolutely. This is positively the Dickens description of London and everything you see there.

Blodgett: Yeah, Dickens was alive at this time, right?

Meredith: Yeah.

Wyatt: And when it comes right down to it, all of those people were providing a very valuable service. And they were among the first recyclers in civilization.

Blodgett: [Laughs] An important role. And so the job you want in that one is the appraiser, right? They have expert appraisers of the trash to tell you what it's worth. I'm not sure how you get that job, but…[All laugh]

Meredith: As they have the argument about miasma versus waterborne illness, the author here, Mr. Johnson, keeps coming back to the idea that these people who were up to their knees in filth every day would have been dying at a much higher rate had miasma actually been the cause of this. Because surely they worked in the foulest smelling, worst place in the city, and yet, they weren't dying at a higher rate than anyone else.

Wyatt: And we had over 100,000 people in London in the 1850s who made their living taking clothes off of dead people, collecting human waste, dog waste, bones, recycling this, selling it, cleaning cesspools…that's really interesting to think of more than 100,000 who are making their livings off of scavenging in the cities.

Blodgett: [Laughs]

Wyatt: And the night soil men who are cleaning the cesspools are getting paid I think a schilling a cesspool, which is considerably higher wages than the average skilled worker, and that becomes part of the problem, doesn't it? That the cost to clean out a cesspool is so expensive that people just let it go?

Blodgett: Yeah, let it stay. I don't know if this is an appropriate point of the moment, but I was fascinated of the discussion that this was the beginnings of fertilizer though. That they took all that waste, they took it out to the country and put it on farmland and started figuring out, "Hey, that's a way to make the farmland much more productive." And so even in these worst of circumstances, you start to see the thought process that leads to improvement.

Wyatt: Yeah.

Blodgett: Necessity, I guess. The mother of invention.

Wyatt: The night soil men had this figured out, didn't they? They got paid pretty good to clean a cesspool, and then they found a farmer that would buy the product of the cesspool, if I can use that description [All laugh] for fertilizer.

Blodgett: That's right. But even that spread the disease too.

Meredith: Right.

Wyatt: Spread the disease.

Blodgett: So the context here, if you want to have that, is from '51 or '52 when this outbreak of cholera started, roughly 30,000 people died of cholera in London. That, in contrast…there's 700 that died directly as a result of the Broad Street pump, but in the bigger context, this is a catastrophe. 30,000 people that's…you have to go pretty far up in the list of leading causes of death today to find something that kills 30,000 people.

Wyatt: Well, and we're in the 1850s, and until about 1831, there was no cholera in England.

Blodgett: Right.

Wyatt: Cholera came on the ships as part of the Industrial Age and being able to transport goods from one country to another, and so cholera came. So it's interesting so how this advancement that we made brought problems, and people became more and more densely populated, which spread the problems. And now we have to figure out how to solve it.

Blodgett: Absolutely. So each wave of progress brings with it its own issues that have to be solved, right?

Meredith: Yeah.

Blodgett: So now we worry about an airplane. Somebody getting on an airplane and taking a disease that would have taken a millennia to move 20 years ago now goes around the world in weeks—days. So the capacity to travel has magnified itself in the modern age.

Wyatt: Making this business of public health dramatically more important.

Blodgett: Yeah. And putting a surveillance system, we call it—"surveillance" means "to watch over"—in place is part of the piece that is necessary to make sure that we have something ready to go when a new disease hits. And they do.

Wyatt: Yeah. Diseases that we're not prepared for because they're not in our communities, but they all of the sudden appear from travel.

Blodgett: Well, you don't have an immune memory to it to help you fight it off, you don't have medical infrastructure—immunizations, medications, things like that—in place. So…

Wyatt: Part of the story that I think is so interesting is part of the detail that came out as a result of the investigation of these people that were trying to desperately to end the cause of cholera. And the story of Thomas and Sarah Lewis moving into this house on Broad Street and the details are pretty accurate right down to the day, the time, the person…we don't know the name of the baby, but what we know is that this little child is sick—diarrhea—and Sarah Lewis is trying to take care of her child, her husband is a police officer in London, and on a particular day, she is cleaning up the mess that her daughter had left, washes it out in a bowl, and then takes that, and throws it into the cesspool. And that event is what started this whole thing. But of course, the baby got it from somewhere, but it was thrown into this cesspool that then leaks into, we later discover, the Broad Street well that caused all of these deaths and the spread of this illness. I think it's really just so interesting that they know who it was and where it was.

Blodgett: Yeah, and the description of the Broad Street pump I found fascinating as well. It was known to be cleaner, cooler, purer water than the other wells. [All laugh] So people would come from all over to get the water there because it had this reputation for being some of the best water around.

Wyatt: But everybody's cesspool is leaking into it. [All laugh] And nobody is concerned about that.

Blodgett: [Laughs] Well, when you don't know what bacteria are, I guess you don't have to worry about things like that.

Wyatt: "If it's too small for this court to see…"

Blodgett: That was in the teaser, right?

Wyatt: That' right. You're going to have to go back and listen to the other one to get that. [All laugh] Well let's…why don't we do on with this investigation work, which leads us in a few minutes to the title of the book, The Ghost Map. Why don't you walk us through that?

Blodgett: Well, so as people started to fall ill, people…they started to recognize…actually, it's interesting. The book is actually…once you hit chapter three, each chapter is a day in the outbreak. And so you realize how compressed time becomes when people start to die so rapidly, so it takes you one to two days to die from cholera. Generally not a very pleasant way to die. Generally removing all of the fluids from your body, not a very pleasant experience. Most of the time, people would end up…

Wyatt: I didn't want to interrupt your flow, but I did, because I…part of this story, when you said that back in those days, if you got a stomach ache, you know there's a very real possibility that you will be dead in a couple days. We don't have that fear today.

Blodgett: Yeah. We don't even recognize that that was a problem.

Wyatt: "I've got a stomach ache, oh well, I'll just work through it." Anyways, sorry about the interruption.

Blodgett: No worries.

Wyatt: It's just that that's the world that we have never known. "I have a stomach ache, I might be dead in two days."

Blodgett: It's so foreign to the way we think now. We think, "Well, I'll go to the doctor and I'll get fixed." And so when it doesn't work out, that's the exception, not the, "Wow, it wasn't just a stomach ache, it was that 30% fatal stomach ache." So, ironically enough, or non-ironically enough, I don't know, because people didn't really…this is the birth of many kind of renaissance moments. Lots of learning going on, lots of changing going on, and you could have people that could be kind of cross-disciplinarian and really kind of geniuses in multiple areas…that's kind of the hallmark of the era and it's really pretty remarkable. So this John Snow, he is that guy. He developed anesthesia almost single-handedly, he had three or four other areas where he really excelled, but he was interested in cholera, largely because as he had studied the cholera outbreaks and the epidemics, he came to believe that they miasma theory—which is kind of the antagonist in this story if you want to call it that—wasn't the reality. And he wasn't to prove that it wasn't in order to better public health and things like that. So as he enters into the scene, he's interested because he notices that these people are getting sick rapidly and they're in a fairly focused area in the city. And then it became much more study-able than these general kinds of outbreaks of cholera where it had been broad based throughout the whole city. So the fact that he began to notice that people were concentrated in a small area really led him to believe that this might be a small chance for him to really study cholera and how it was spread. So in modern days, we know that rehydrating is the way to treat cholera. In those days, they thought that stopping fluids was the way to treat cholera. So they made the problem much worse by, well once you were sick, they said, "OK, no more water." When it was exactly the opposite that was necessary, you start tanking up. And so it's kind of a testament to the helter-skelter nature of medicine at the time that 20 years before, somebody had figured out that, "Hey, if you inject somebody with a little bit of salt water, they do much better" but in all of the publishing that was going on about cholera, it got lost for another 40 years before somebody figured out, "Hey, IV fluids might have a rule here." So…

Wyatt: Yeah. So he puts himself at great risk, John Snow. The prevailing opinion of all of medicine and science is that cholera is spread through miasma, poison air, and he thinks there might be another cause and so he goes into "poison air."

Blodgett: Absolutely, directly confronting the issue.

Wyatt: If he's right, he's going to save the world. If he's wrong, he's going to die.

Blodgett: And sometimes they do, these researchers that are a little bit crazy. For example, the guy that wanted to prove that yellow fever was spread by mosquitoes allowed himself to be bit by infected mosquitoes and died. So it takes a certain amount of extra devotion to the cause to prove some of these things I guess. It's interesting that the other protagonist in this adventure, Henry Whitehead, was also there for different reasons. He was in the clergy and was out seeing people and interested in helping them. And he at one point drinks the water, but the difference was he put a little shot of alcohol—I can't remember what it was, brandy or something—in the water which sterilized the water, right? And so he had a hard time coming around to the idea that it was the water because he was drinking the water at the time this was going on. So you have these two…one, Whitehead, starts up being a miasma theorist who eventually, because of the events and John Snow, swings over…his story becomes the story of the science as you progress through the book. It's kind of interesting in that way.

Wyatt: Yeah, and part of this investigation work led them to people like that were working at a brewery.

Blodgett: Yes.

Wyatt: And they weren't getting sick. And other…anyway, it's so interesting all the leads that they pursued and the confusion at times and finally come to some conclusions. Anyway, I interrupted your flow of the story.

Blodgett: Well, so one part of this story that I think is remarkable is that John Snow realized that the secret to making this work was details and compiling in a scientific matter all of the data that was available to him. So as he and Henry Whitehead started to write down the stories and to quantify what was going on, that's what led to the map, number one, but it also led to a good understanding of what was going on and who was doing what. And often times in an investigation like this, it's the outliers that become your most telling indicator, right? So you find a couple of people that are a long ways away from the pump that die, but when you do the work to talk to them and they say, "Well, you know what? I had them bring the water to me because it was this great water and I drank the water too." That's when you start to say, "Yeah, I think we've got the right thing." So he does this incredibly detailed work of figuring out where all of the deaths are and plotting them on the map, which gives you a visual representation, along with the work of identifying all of the risk factors that these people are involved in and then being able to narrow it down to, "Yeah, they all had contact with the water."

Wyatt: Yeah, the Ghost Map.

Blodgett: The Ghost Map. That's the Ghost Map.

Wyatt: This map of…and it took Whitehead's research, didn't it?

Blodgett: Yeah, between the two of them.

Wyatt: Because he was in every home, he knew who was sick, they were able to write this down, create a map…normally, you would just kind of—under the theories of the day of miasma—you would just say, "Well, where is everybody congregated that's getting sick?" But they said, "That's not the point. The point is where did everybody get their water that's getting sick?" And so you get this map that's got all these tentacles that reach all over and once you've got the Ghost Map put together, it's pretty clear, isn't it?

Blodgett: Yeah. Well, and there was a second map too which I think is also instructive in the process. And the second map was where the two competing water companies fed their water into the city. And so you could show…so the question was, "If it's miasma, how come the people that are in the brewery aren't getting sick or the other people that are living there?" And yet you could show that the homes that were serviced by one of those water companies had a much different cholera rate than the other one. And so those kinds of maps helped dispel the fact that this isn't smell, this is related to something exterior to that. It's related to the water.

Meredith: In fact, it was the fact that the water was being delivered by different companies that helped separate that out. Isn't that right? They gave him the cleaner study. And that and the combination of, as you suggested earlier, that the Broad Street pump was renowned for its clean, cool water, so people would come…so he was able to…that map extended to places where miasma wouldn't have really factored into it because people would send their grandchildren or whatever long distances just to get the water from that pump.

Blodgett: Yeah, absolutely. Some wealthy people out in the country.

Meredith: Yeah.

Blodgett: And those cases really strengthened the hypothesis because then you say, "Well, it can't be miasma because this was miles away." But it did prove that it was in the water because they had the water and they drank the water. It was pretty elegant science for 1854. [Laughs]

Wyatt: And then how long did it take that theory to be recognized, accepted?

Blodgett: Well that's the disheartening thing, is even after that…in London, they started to do some things more related to that. They focused on getting the sewers up and running, but really, the initial report that came out from Chadwick and others that were ahead of the sanitation department basically stacked the data in a way that didn't allow the conclusion that it was water. And so it was still decades before finally, mainstream science started to swing around and say, "You know what? This is not about miasma. It's about waterborne pathogens. And in a lot of cases, it took the microscope and being able to see the bacteria…those kinds of things that brought the science around. But it was an evolution, it wasn't a revolution of the moment. [Laughs]

Meredith: In our discussion before we started, you had said this kind of represents both the best and worst of government.

Blodgett: Yeah.

Meredith: So this is the first time maybe that there really is a city sanitation committee that's looking at this important and problematic issue?

Blodgett: Yeah, right. [Laughs]

But they come to the wrong conclusion and stick to it as hard as they possibly can for decades until finally, their idea is turned.

Blodgett: So they were out pouring gallons of bleach on the issue when that wasn't the problem.

Wyatt: Yeah, and it's…part of this story that's so interesting too is that when they thought that miasma, poisonous air, was the cause of cholera, then the city went about cleaning up the air. And the way they cleaned up the air was they drained all the cesspools into the river.

Blodgett: Yeah. That's right.

Wyatt: Which spread it. And that made it worse, far worse.

Blodgett: Yeah, because they were pulling their drinking water out of the Thames river, which was now being…it had all the sewage in it.

Wyatt: The book talks about other examples of this where our assumptions lead us to very bad places, like spreading cholera. But the other one was this plague outbreak of 1665-66 that is described in this book where popular lore was that the plague was being caused by cats and dogs so they went out and killed them all.

Meredith: And left the rats. [All laugh]

Wyatt: Which gave the rats free play and they were spreading it.

Blodgett: Yeah. There's an equally tragic story in the plague saga where in Venice, they actually thought, "You know, I think this is related to the rats." And so the Doge, the main guy, said, "I'll give money for whoever brings in a rat tail." So all the sudden, all of these rat tails came in and they thought, "This is great, it's going to wipe out rat population." He went for a walk one day and he saw three or four tailless rats heading down the thing and he realized what was happening. [Laughter] That poor people were catching the rats, cutting off their tails so they could continue to reproduce and be an income source for them, right? [All laugh] So instead of having the intended effect, it gave people some food to eat and so they were not willing to dispose of the rats.

Wyatt: "If the rodents are gone, my job is gone!" [All laugh]

Blodgett: That's exactly right. And so they had a tailless rat population instead of a dead rat population.

Wyatt: I ask myself this question all the time. I think I see a problem, and I think I know the solution and I'm going to go after the solution, and sometimes I find that the solution isn't the solution. It's making it worse.

Blodgett: Was worse than the problem. Well and medicine I think tends to highlight those issues a lot better than some other areas in our lives because the effects are so immediate, so it allows us to do kind of an assessment of the situation almost in real-time. But it serves as a great analogy for the rest of life because I think that's exactly true. Sometimes our perceptions and the data we have available to us lead us to a conclusion that isn't exactly right.

Wyatt: Yeah. Here's a line from the book, and I'll say this in a room where two of the three of us are very smart. [All laugh]

Meredith: Hey! [All laugh] I know who that leaves out. [All laugh] I'm smart enough to figure that out.

Wyatt: I'm leaving out myself. But here's this interesting line: "Whenever smart people cling to an outlandishly incorrect idea, despite substantial evidence to the contrary, something interesting is at work. In the case of miasma, that something involves a convergence of multiple forces all coming together to prop up a theory that should have died out decades before." And we just get into these assumptions, and when smart people buy them, it's so hard to get rid of them. [Laughs]

Blodgett: Yeah, it is. Well, it's even harder when people's livelihoods are at stake, or they perceive their livelihoods are at stake. So that's part of the problem there. You've got this commission now that's based itself on cleansing the streets of odors, and they can't see that there might be a role for them if this other theory works. And so they have additional incentive—and maybe they're not cognizant of it, it's not a conscious decision—but subconsciously, or at least on some level, they realize, "Wow, if I pursue this course, my job becomes much different or non-existent."

Wyatt: That's why sometimes, the only real way to find a solution is to have somebody outside of the culture come in. Somebody who has no stake in the game. But you're right. I'm convinced as well that for the most part, we're not subconsciously trying to protect ourselves…we're not intentionally trying to protect ourselves, but subconsciously, we frequently end up going that.

Blodgett: Yeah.

Meredith: I also wonder how much of this was just the strength of our sense of smell. You know, as I was reading it and looking at the miasma apologists and they're painted as being, as we've discussed here, just sort of stubbornly clinging to an obviously false doctrine, but it seems like to me that if the city—as the description unfolds of London—if it stunk as bad as it has to have stunk, I can…I have some pity on the miasma people. [All laugh] If you walk down the street of a place where people were dying of diarrhea and their homes were cesspools essentially, I can see where you'd think that…I mean, our sense of smell is so immediate and so strong and that smell particularly is so revulsive to us, you can see where people would jump to the conclusion of, "Well, for heaven's sake, the air is sick in here."

Blodgett: Well you've got to remember this theory goes along with all of Galen and Hippocrates…all of the ancient physicians. Things that had been there all through the Middle Ages, so the humors where you bleed people and all of those kinds of things, they were all still widely current in medical practice. And trying to break free of those after four, five, six, seven hundred years of currency in medical practice was very difficult. Was and is, it still can be.

Wyatt: There's so many little pieces in this story that, when we read it today, we just think, "Why couldn't they see that?" And I'm sure that someday, someone will ask us the same questions about just, why can't we see something?

Meredith: Are there current things today, Doctor, that are…I mean, is the anti-vaccination crowd an example of this? I'm not trying to pick a fight with anybody…that's a movement that had some traction within the last four or five years maybe.

Blodgett: Yeah. You know, I think that's a pretty good example of it. Part of the problem with the anti-vaccine movement is most of the people now haven't seen what diphtheria looks like or something like that. So it's easy to believe that a disease isn't a threat when you haven't seen it, right? And so I think that's part of the problem we've faced with them. But it isn't…but it is also true that almost universally, you can find ways…once science has taken care of an issue, to say, "Well, that never happened before. It just wasn't reality." I tell you what, it's easiest to get people vaccinated that come from a place where these diseases are widely spread still and hardest in places where they're most insulated from it. And so if you have to pick an epicenter for the anti-vaccine movement, it's Malibu, Hollywood, California because they are so insulated from this stuff and they just don't…

Meredith: They've never seen smallpox…

Blodgett: They don't see what these diseases are like and what it does to kids and things like that and things like that and I tell you, the fastest conversion you'll see from an anti-vaccine to vaccine is when a kid from one of these families gets sick and they realize, "Wow, I'm not just playing with something here." I had a mother call me the other day who said, "This is…my kid is really sick. He's been coughing for three months and he's as sick as he's ever been." And I said, "Yeah, that's why they call it 'pertussis' because they cough until they throw up and they also call it the 'hundred day cough' for a reason." And it used to kill four, five, six thousand kids every year in the United States and so…most people don't realize what they're dealing with in that sense.

Wyatt: There's…yeah. They don't know what they're dealing with or don't know certain things that can't be seen or aren't apparent to us or obvious. One of the little stories that is told in this book as these investigators are working—and I think it's a really interesting little insight—is that Henry Whitehead is preaching one Sunday morning and all of these people have been dying and one of the ideas was is that if you had a stronger constitution, you were less likely to become sick. And as he's preaching to his congregation and congratulating them, it dawns on him that he's talking to a group of old, infirm, the least healthy segment…

Blodgett: Of the population.

Wyatt: He describes it, "Standing in front of his haggard parishioners in the half empty church." And that in and of itself must be quite an experience to watch people dying all around you and getting sick and being scared about it and you show up Sunday to preach and your building is half full. But he noticed the unproportionate number of poor, elderly women in the pews and asked himself the question, "What kind of pestilence spares the old and the destitute rather than the young and strong?" And that was one of those really big clues that something is going on there that isn't so obvious.

Blodgett: A bigger difference than we thought. Well, so there's this element of miasma and I think the fact that some diseases spread through the air led to that as well, but there's also this element of…that I think was not uncommon in their thought process and probably might be more of our thought process in the modern world than we would like to admit of social Darwinism. That people that got sick got sick because they deserved it or they lived in places that deserved it, they aren't doing the right things that they should be doing and so that's why they got sick, and that I think was not absent from the thought process of some of those that were charged with dealing with disease and things like that.

Meredith: Yeah, the regular theme of the book is that this did not spare the wealthy. It didn't spare those that were born into a higher life in London. It seemed to be cut across all of the socioeconomic statuses of the time and that that was…that that bore, as you suggest, something of a blow to the miasma theory, was that people that can afford to breathe purer air but they were still getting sick.

Blodgett: Yeah, absolutely.

Meredith: And the people who, as I suggested earlier, the people who were actually working in it every day were not getting sick at a rate any higher than anyone else unless they were drinking water from the infected wells.

Blodgett: And one of the bad guys, if you want to call him that, was Edmund Chadwick, and he was the guy that ran the municipal government because he was still an advocate of the miasma theory, but in a lot of ways, he was a pioneer himself. He'd advanced the idea that municipal government should play a role in helping citizens survive which was kind of in opposite to the, "We'll just let it go and see what happens" kind of theory. Today, we think that sounds really kind of strange, but that was why the current of the day, "Let people survive who are going to survive. If you don't survive, it's because you weren't supposed to survive." So even though he got it wrong with the miasma theory, and least his heart was in place where he wanted to do good.

Wyatt: So, we get to the end of this story, and go through all this process of figuring out the cause of cholera, trying to sell the cause, getting government permission to remove the handle of the Broad Street well pump, and I'm struck by the very end of the book, that we wrap this story around to its beginning. Because at the beginning, we have Thomas and Sarah Lewis moving to this spot on Broad Street and a daughter is dying and it's her…all of the mess that she's created that gets thrown into the cesspool that starts this great outbreak from the Broad Street well. But then, when we get to the end of the story after the handle has finally been removed, and Sarah's husband, Thomas, dies and she innocently cleans up all of his excrement and throws it right back into the exact same cesspool. Which, had the handle not been removed, would have restarted the whole story all over again. It's kind of a chilling end of the book, isn't it?

Blodgett: It is. It has all of the makings of a great movie. [All laugh]

Wyatt: It does have all the great makings.

Blodgett: The music at the end and the…[Laughs]

Wyatt: But for these guys that put in so much effort risking their lives going into so-called "poison air" environments, figuring this out, battling the politics, battling conventional wisdom, and finally getting that handle removed…but for all of that, there would have been, what do you think? Thousands more deaths.

Blodgett: Yeah, thousands more. Absolutely.

Wyatt: And it would have continued over and over and over.

Blodgett: Yeah, and who knows how much longer it would have been before the science started to take off. I mean, I think it probably would have developed eventually. But who knows? 30, 40, 20, 100 years later? I don't know.

Meredith: Yeah. Another thing that struck me was that Snow doesn't really live to see the fruits of this labor. He dies as a fairly young man and in his obituary, they note that he invented ether or that he pioneered anesthesia, and that's it.

Blodgett: Yeah.

Meredith: I mean, he doesn't really get credit for saving the world. [Laughs]

Blodgett: He doesn't live long enough to see the theory that cholera is from a bacteria really take hold. The book mentions that some scientists in Italy had isolated the vibrio cholera bacteria 20 years earlier, but it was another 20 or 30 years before somebody finally identified it again and it was recognized and became part of the germ theory of disease.

Wyatt: And malaria. Isn't the root of the word "malaria" "poison air?"

Blodgett: Yeah, from…yeah. Very good.

Wyatt: Well, the lessons that we learn from this book…I think that the first lesson to learn from this book is that we live in a great time. No matter where we live in the world, we're living in a better time, better place than in the past. And progress keeps going forward happily. Our lives are so much more full, we live to longer ages, we live at better health longer ages. Despite the pollution that cars cause in big cities, it's better that than…I mean, I read some accounts of how messy New York City was before cars.

Blodgett: Yeah. Truckloads of horse manure. [Laughs]

Wyatt: Everywhere you go. I mean, you can't keep it off your shoes, no matter where you go. Anyway, we live in a great time. And the second thing that I take from the book is we need to keep our eyes wide open and not allow assumptions to just stay with us forever but to really be willing to examine our thinking.

Blodgett: Absolutely. I also, from my standpoint as a practitioner in this field, I think there's something powerful in becoming acquainted with how a science and how a way of thought evolved and became current. It's still modern in its application that we can, using scientific principles, get to the bottom of an issue and help make life better for people if we're willing to apply the principles correctly and if we're willing to put in the work to do it. So, that's what I do every day and it's a wonderful line of work. I'm grateful to be engaged in it.

Wyatt: And I'm glad you're doing it, because when I drink water and when I stop and buy food in a restaurant, when I move around town, I know that our lives are so much better.

Meredith: Dr. Dave is looking out for us.

Blodgett: [Laughs]

Wyatt: Well, it's absolutely true.

Blodgett: It's always under the radar, and few people come up to you and say, "You know, I didn't get sick eating in that restaurant yesterday, so thank you." [All laugh]

Wyatt: Well, let me be the first. [All laugh] I ate in a restaurant yesterday, thank you for being there. Thank you for being on the wall. Somebody's got to be there.

Meredith: Yep.

Blodgett: And maybe it's the praise of those that maintain, I guess.

Wyatt: Well, we all have to find a way to be self-validating and not necessarily rely on everybody else. Because if we were that why, then Snow and Whitehead would have given up a long time before they got to their conclusions.

Blodgett: Yeah, absolutely.

Meredith: You've been listening to Solutions for Higher Education, a podcast featuring Scott Wyatt, the president of Southern Utah University. We've had as our guest in-studio today Dr. David Blodgett and we've been discussing The Ghost Map by Steven Johnson. Thanks so much for listening, we'll be back to our regular schedule of weekly podcasts pretty soon, I think. As soon as…

Wyatt: School starts Monday.

Meredith: Yeah, that's right. School starts very quickly here. Anyway, we're looking forward to that and we appreciate you listening. Thanks so much.