Thursday, July 23, 2009

The Power of Prayer

What an unexpectedly riveting read. Steven Johnson's 2006 book The Ghost Map tells of an outbreak of cholera in London in 1854, a fearsome local epidemic that decimated a densely-populated part of Soho in the space of a couple days. It's a really gripping story, brilliantly organized and masterfully told--Johnson has a stunning grasp of the myriad consilient things that bear on the subject. He writes so well that he makes me ashamed to even pretend to write myself.

The book fascinates in numerous ways. Though it's only 150 years ago, the world of 1854 is very different in ways that come to bear directly on the story. London was the world's largest city, at a time when the very existence of large cities was an uncontrolled experiment. There was serious doubt about whether masses of people could live collected in this fashion, and many expected the whole enterprise to collapse in on itself in a kind of organic meltdown. And not without reason: the living conditions of London's urban poor are surprising and appalling, and it is especially shocking to modern sensibilities (well, mine anyway) to glimpse a world without much awareness--certainly without understanding--of sanitation, without the germ theory of disease, a world devoid of science. This is a mass population under the sway of quacks and preachers and charlatans, people preying and living well on the fears and ignorance of the--literally--unwashed masses. The newspapers are full of home-brewed cholera remedies and editorials blaming the disease on immorality or "sin." So it feels like a different world (well, unless you listen to Rush Limbaugh), but historically speaking it's just yesterday.

Johnson also gives us a close-up view of cholera, a killer now extinct from all but the poorest places, but one responsible for so many deaths in history. It's a disease that thrives in exactly the crowded, unclean conditions that prevailed in 1854 London, as Johnson explains in some detail. Cholera is a central character in the book, not just for the number of deaths wrought, but for the manner in which it killed. It's a terrifying way to die, particularly when, as with the emergence of any new epidemic, we have little sense of what causes it and no reliable means of stopping its spread. The disease could run its entire course--from first inkling to death--in less than a single day. In the dense crowding we find in this part of London at the time--a population density, Johnson says, four times what we find in contemporary Manhattan!--death is suddenly everywhere, taking rich and poor, old and young, whole families (he paints a harrowing picture of young children helpless in the family flat with their parents dead in their beds). Imagine a world where a minor bout of diarrhea or even the slightest hint of a stomach ache could well signal the beginning of one's quickly-impending end. What a way t0 live.

But most striking of all to me--the one ray of light in a dark, dark story--is the emergence and application of an early scientific methodology. The work done by the physician John Snow and others marks the emergence and slow triumph of systematic rationality in the face of terror, and in this setting it's quite thrilling. It's yet another thing we take absolutely for granted today, but the story shows us we're maybe not as far out of the murk as we'd like to think. We could hardly have a better example of the stark contrast between the wild grip of fear and ignorance on one hand, and John Snow's dogged and relentless tread of rationality in tracking down the actual source of the disease, going where facts lead him and blocking out the noise. His suspicion that the disease might stem from a polluted water source was opposed by many powerful people, and in the teeth of opposition ranging from disinterest to condemnation, Snow simply keeps his head down and goes where the statistics lead him. Author Johnson shows us just how new this approach was. He juxtaposes vivid and erudite historical and factual detail with the terrifying life-and-death nature of the episode; it makes for an awesome gray cloud which gains its silver lining by way of the halting and difficult birthing of a scientific approach to epidemiology, something for which we are all daily beneficiaries.

Very highly recommended.


Addendum: I just can't help seeing religion everywhere in this book. It has no bearing on the book being so brilliant, so I'll put this observation in a postscript. Johnson himself doesn't make much of an issue of religion, and indeed one of the story's central characters, Henry Whitehead, is a clergyman at St. Luke's, which is located in Soho, in the midst of the outbreak area. Of course, Whitehead's contribution is not in having materialized his imaginary spiritual friend to eradicate the suffering (odd how that never happens), but as a man who knows the area's people and their habits, which knowledge very much assisted John Snow as he tried to piece together the facts of those who died and those who did not. A good argument could be made for the story exposing not religion, but the vein in the human psyche on which religion feeds: the pretending to knowledge we don't have; the willingness to profit from people's fear and ignorance; the desire to control others; these things aren't specifically religious, even if the church reliably demonstrates them.

This story reminds me of the terrible explosion of AIDS in the early 1980s. Just like in 1854 London, plenty of people were happy to write letters to their local newspapers declaring, with smug schadenfreude, that AIDS was a punishment from their god--always with a ready list of transgressions against their particular code. I specifically remember a teapot tempest from a Dear Abby column where the writer called AIDS "God's will," and Abby countered that it was a medical issue and not an act of God. And she was inundated with responses: "HOW DO YOU KNOW?!" An awful lot of people believed that disease is a form of divine retribution (well, a lot of Dear Abby readers; with her death, they've all had to switch to Faux News). Likewise, many Londoners in 1854 concocted all manner of "moral" or behavioral explanations for cholera deaths, always finding a way to twist and amend their thinking to keep their hatreds and prejudices alive in the face of contradictory evidence (of which there was a very great deal). It's a perfect expose of religion in action: superstition codified and governed and spread among the poor and the ignorant by a self-appointed power structure insulated in its actions by "divine" right.

With that thinking we would still be in the midst of cholera today (to cite one of a zillion examples), and this story is tangentially about the removal of one of religion's keystones on the road to civilization.


Dzesika said...

Edward Tufte did some work examining the cholera map as one of the earliest examples of effective information graphics. Can't remember off the top of my head which of his books this is in ... but check him out regardless - he's kind of like a god. :)

Jeffy said...

The story of John Snow's handling of the cholera outbreak is well known by epidemiologists (it is taught in the introductory epidemiology courses). Snow is considered one of the fathers of Epidemiology, and his detective work on this cholera outbreak is used to illustrate one of the first and best examples of how to determine the cause of an outbreak. It really is an amazing feat of logical reasoning when you consider that almost nothing was known about the cause of disease at the time.

As Dzesika mentioned, Tufte considers Snow's outbreak map to be a great example of how graphical representation of data can lead to insights that are almost impossible to get otherwise. As she also mentioned, Tufte is highly regarded as an expert in the graphical presentation of information. Many of the epidemiologists and statisticians I work with see him as the definitive voice on how to convey information graphically, and I'd say I have to agree - given how Tufte rails against PowerPoint these days.

You may be interested in Tufte's books (I can't give them a personal endorsement - I've only read a few of his shorter papers). One of the other graphics that he holds up as one of the best examples ever of a graphical representation of statistical data is a chart made by Charles Minard depicting the dwindling troops in Napoleon's 1812 foray to Moscow. Several of the faculty in our dept. have a poster of this chart, Tufte sells copies on his web site, and you can see it on the Wikipedia page for Minard.

wunelle said...

Yes, in the crush I rather forgot to mention the importance of his map, though author Johnson does not neglect it. It was one of the key elements he used to convince the miasmists that deaths were centered around the pump.

As an aside, I bought a book a couple weeks back that made me think of Dzesika: it's called Urban Railway Maps of the World (or some such; I'm in Germany and don't have it in front of me just now). I initially though the book was a description of various cities' subways and passenger rail systems, but it's really an exploration of the design of railway MAPS (London's famous tube map being the most famous). There's a post in here somewhere, but it's a race against the information percolating on the one hand, and disappearing from memory on the other!