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July 3, 2008

Eat Shit and Die
Posted by Jim Macdonald at 12:07 AM * 156 comments

I don’t often read books twice in rapid succession. I just did that with The Ghost Map: The Story of London’s Most Terrifying Epidemic—and How It Changed Science, Cities, and the Modern World by Steven Johnson.

The epidemic, of course, is the cholera outbreak around Golden Square in Soho, 28 August— 6 September 1854. We’re talking about 700 dead in a five-block area over about a week’s time. Famously, this is the case where the board of governors removed the handle from the Broad Street Pump.

What makes that a turning point is that this is the first time an official body gave credence to the germ theory of disease. The accepted theory of disease at the time was miasma — that bad air caused disease, and the form in which the disease appeared depended on the moral quality and inner constitution of the victim.

The person who made the connection was a doctor named John Snow, one of the pioneers of early anesthesia, who lived in the neighborhood. He had been following cholera for some time, and had formulated an idea that it had something to do with the water rather than the air.

This is a discursive book. It starts with a description of the toshers, mud-larks, rag pickers, bone pickers, sewer hunters, pure finders, and nightsoil men who made up the garbage collection and recycling system of Victorian London. From there we go to a history of Soho, then the biology of cholera (a bacterium that in its normal course feeds on algae in the Ganges). We have touching and horrid scenes in this book: a man eating a cup of pudding and washing it down with a glass of water, not knowing that that simple act would feature in books over a century hence. Children dying alone in dark rooms beside the corpses of their parents. The streets blocked with hearses.

Cholera is a nasty disease. It’s roughly 50% fatal if untreated. The incubation period ranges from one to five days. Then the cholera patient can die in as little as two hours after the onset of symptoms, as up to 30% of the patient’s body mass is evacuated in the form of watery diarrhea. It’s transmitted by the fecal/oral route: you have to ingest an infected person’s shit, and London in the 1850s seemed to have been designed to get as much shit into as many mouths as possible.

The cure for cholera was within the reach of Victorian medicine, and had been described in a journal as early as 1832. But that cure had been drowned out by the claims of the patent medicines and the advice of theorists recommending anything from castor oil to opium to bleeding.

The cure for cholera is simply rehydration. The patient needs to drink water in sufficient quantity to stay alive long enough for his body’s immune system to get up to speed. Oral rehydration salts are good (the field-expedient mix is one teaspoon of salt plus eight teaspoons of sugar in one quart of water), but failing that, plain water works fine.

Back to the book: We meet eminent Victorians like William Farr who published the Weekly Returns, a list by parish and cause of all the deaths in London. Farr (like all other scientific men) was a miasmatist — he recorded atmospheric conditions and smells district by district)— but he provided the raw material for a statistical study of what was killing people and where. Statistics as a science had finally reached the point where it could reveal hidden truths.

Another eminent Victorian: Edwin Chadwick—

It is nearly impossible to overstate the impact that Edwin Chadwick’s life had on the modern conception of government’s proper role. From 1832, when he was first appointed to the Poor Law Commission, through his landmark 1842 study of sanitation among the laboring classes, through his tenure as commissioner of the sewers in the late 1840s, to his final run at the helm of the General Board of Health, Chadwick helped solidify, if not outright invent, and ensemble of categories that we now take for granted: that the state should directly engage in protecting the health and well-being of its citizens, particularly the poorest among them; that a centralized bureaucracy of experts can solve societal problems that free markets either exacerbate or ignore; that public-health issues often require massive state investment in infrastructure or prevention. For better or worse, Chadwick’s career can be seen as the very point of origin for the whole concept of “big government” as we know it today.

Alas, Chadwick was an ardent miasmatist (as were all learned men); he went to his grave (in 1890) still believing in miasma. And what he did to alleviate bad smells involved dumping London’s human waste upstream of London’s water supply.

When the Board of Health investigated the Golden Square cholera outbreak they examined in astounding detail:

Atmospheric pressure
Temperature of the Air
Temperature of the Thames Water
Humidity of the Air
Direction of the Wind
Force of the Wind
Velocity of the Air
Comparison of the Meteorology of London, Worcester, Liverpool, Dunino, and Arbroath
Ozone [again]
Progress of the Cholera in the Metropolitan Districts in the Year 1853
Atmospheric Phenomena of the Year 1853
Atmospheric Phenomena in relation to Cholera in the Metropolitan Districts in the Year 1854

The data were all genuine, the math of the analysis was exhaustive and correct, and the results were utterly useless.

Snow presented his conclusions, that an unseen quality of the water from a single source caused the disease, and was dismissed. The earlier removal of the pump handle was the desperate act of a group that had run out of options — and indeed, had no effect. The number of new infections was already declining before the handle was removed, and the curve didn’t change afterward.

The Ghost Map of the title was a street map of the area around Golden Square that Snow created, showing where the deaths occurred, and bounded by a line showing where the Broad Street pump was closer by walking time than other pumps. The deaths occurred inside of that line, with odd lacunae, like the Lion Brewery (only a few yards from the pump) with no deaths at all. The men of the Lion Brewery, however, were partly paid in beer and no one could recall ever seeing any of them drink water.

Which is pretty much where things might have stayed, if not for Henry Whitehead, a young curate in St. Luke’s parish, where the outbreak had taken place. He set out to examine and disprove all of the theories on what caused cholera. One that he tried to disprove was Snow’s waterborne theory. On its face it seemed ridiculous: the water from the Broad Street pump was well-known locally to be good; cold and sweet-tasting. Whitehead himself had drunk water from the pump during the height of the outbreak. And he was aware of people who had survived the disease who had drunk literally gallons of Broad Street water in the course of their recovery.

(Johnson hypothesizes that the reason this worked was because the bacteria had already vanished from the water — cholera doesn’t last long in cold pure water lacking algae to feed on. I think that it doesn’t matter whether the cholera bacteria were present or not—what was going to happen to those folks if they drank contaminated water? They’d catch cholera?)

Try as Whitehead will, he cannot disprove the waterborne hypothesis. He disproves the others, one by one, until he has nothing else. And when you have eliminated the impossible, as Sherlock Holmes would later say, whatever remains, however improbable, must be the truth. He champions the waterborne theory, and lives to see it become the accepted wisdom.

But that was long after Snow’s death in 1858. Four years after the outbreak at Golden Square the waterborne theory of cholera transmission still had not been accepted. Then, all at once, it was. And London got new sewers, and a new system of running water, and … there’s never again an outbreak of cholera in London.

Robert Koch would eventually find the cholera bacterium (thirty years later).

The last fifty pages of the book is an extrapolation to the Cities of the Future, and the earth as a world of cities. The author points out that the richest people on earth, who have the means to live anywhere they want, choose to live in cities. He points out that cities use less energy per capita than rural living, so in a future of limited energy, cities make sense. (For example, if New York City became a state, it would rank twelfth in population, but fifty-first in energy consumption.)

I’m not convinced by the conclusions in the last fifty pages, but the trip up to that point (jumping from microbiology to chemistry to city planning, all illustrated with quotes from Victorian novels) is great fun.

Okay, to finish this post up (aside from saying, go read this book, folks):

If you’re in an area where you aren’t sure of the water, boil your water (one minute at a rolling boil minimum) before you drink it. Either that or stick to booze, tea, and coffee. Wash your hands (in known good water) after using the toilet and before preparing food. Avoid shellfish. Stick to food that is completely cooked and served hot, or things that come in thick rinds.

And if you do get cholera (the symptoms are unmistakable), drink a lot of water.

Signs and symptoms of cholera (from the Mayo Clinic website):

  • Severe, watery diarrhea. The incubation time for cholera is brief — usually one to five days after infection. Diarrhea comes on suddenly. Cholera diarrhea often is voluminous, flecked with mucus and dead cells, and has a pale, milky appearance that resembles water in which rice has been rinsed (rice-water stool). What makes cholera diarrhea so deadly is the loss of large amounts of fluids in a short time — as much as a quart an hour.
  • Nausea and vomiting. Occurring in both the early and later stages of cholera, vomiting may persist for hours at a time.
  • Muscle cramps. These result from the rapid loss of salts such as sodium, chloride and potassium.
  • Dehydration. This can develop within hours after the onset of cholera symptoms — far more quickly than in other diarrheal diseases. Depending on how much body fluids have been lost, dehydration can range from mild to severe. A loss of 10 percent or more of total body weight indicates severe dehydration. Signs and symptoms of cholera dehydration include irritability, lethargy, sunken eyes, a dry mouth, extreme thirst, dry, shriveled skin that’s slow to bounce back when pinched into a fold, little or no urine output, low blood pressure, and an irregular heartbeat (arrhythmia).
  • Shock. Hypovolemic shock is one of the most serious complications of cholera dehydration. It occurs when low blood volume causes a drop in blood pressure and a corresponding reduction in the amount of oxygen reaching your tissues. If untreated, severe hypovolemic shock can cause death in a matter of minutes.

Index to Medical Posts


Comments on Eat Shit and Die:
#1 ::: Edward Oleander ::: (view all by) ::: July 03, 2008, 12:40 AM:

John Snow.... anesthesia... Is this where we get the term "snowed"?



#2 ::: James D. Macdonald ::: (view all by) ::: July 03, 2008, 12:49 AM:

No. According to Cassel's Dictionary of Slang, the term "snowed" dates to the 1920s and meant under the influence of cocaine.

#3 ::: Edward Oleander ::: (view all by) ::: July 03, 2008, 12:49 AM:

Jim, you've probably read "Plagues and Peoples" by William H. McNeil (isbn: 0-385-12122-9). If you haven't, it's an oldie (1976) but still goodie about the relationship between various plagues over the centuries and the development of human civilization...

#4 ::: Michael Roberts ::: (view all by) ::: July 03, 2008, 12:56 AM:

Freaky! I've just been rereading "Plagues and Peoples" myself! I had to read it for Humanities back at Earlham. That was a long time ago, so it's like reading an entirely new book.

Fantastic post!

#5 ::: Lee ::: (view all by) ::: July 03, 2008, 01:09 AM:

Okay, an obvious question: if you're vomiting, how do you manage to drink enough water for it to do any good?

#6 ::: G D Townshende ::: (view all by) ::: July 03, 2008, 01:17 AM:

My wishlist at Amazon has been growing like crazy lately, and now James has made it grow by another title. I've already got Cassell's Dictionary of Superstitions (plus a couple of other books James has recommended), and I can now foresee another purchase in my future, along with the book reviewed in this post.

#7 ::: Tania ::: (view all by) ::: July 03, 2008, 01:32 AM:

Oddly enough, that's my next non-fiction book in the TBR stack. Right now I'm reading about pirates. After The Ghost Map, I have Bonked in the queueueueueue.

#8 ::: JimR ::: (view all by) ::: July 03, 2008, 01:42 AM:

Reading your advice there at the end, I feel very unsure about this whole Japan thing.
"Raw" is the preferred way of eating pretty much everything here, and if it's got a thick rind, the rind will probably be eaten, too.
Also, myths notwithstanding, Japan has a bit of a problem with waste management and cleanliness. They dump a lot of it into the sea, then eat the fish and shellfish from the same sea. Also, there is a tendency not to wash hands, or only give a quick rinse, after using the toilet.
There was an outbreak of cholera last April. Probably an isolated non-handwashing episode, but still.

#9 ::: Wakboth ::: (view all by) ::: July 03, 2008, 01:53 AM:

Pardon the pun, but cholera sounds like a really sh*tty way to die.

#10 ::: elise ::: (view all by) ::: July 03, 2008, 02:18 AM:

OK, that's another book for the list. Sounds pretty good, too.

Speaking as somebody who was taken to the ER because of dehydration (following the norovirus in Madison this past Memorial Day, aka the WisCholera), I can testify to the extreme ungoodness of dehydration. (Mind, I probably wouldn't have gotten so sick if the norovirus hadn't heterodyned with the Crohn's disease. Oy.) They're absolutely right about the irritability and lethargy, plus disorientation, though that might have been the 102.9 fever. The ER intake people took one look at me, said, "Riiight," and pretty much got us in there right away and started pushing fluids and potassium. (The potassium stuff is connected to the arrythmia stuff, right, Jim? Us recovering anorexic types need to steer clear of that kind of nonsense.) They gave me two big cups of that orange stuff that does not taste at all like it looks like it should, and two bags o' fluids, and stuff started getting better pretty darned fast.

Only took me a little over 24 hours from onset of the norovirus to get that sick, though.

In case I didn't say it before, thank you, Patrick, for poking people to check in on me. And Katie is a Hero of the Revolution for hauling my butt in to the ER.

If it had been cholera, I probably wouldn't be here. Scary stuff, cholera.

#11 ::: T.W ::: (view all by) ::: July 03, 2008, 02:20 AM:


Having done the food poisoning non stop purge you just keep taking water in. If anything it dilutes the pain of the acids and bile but some will still find it's way into the system in the first few seconds. Sipping slowly tepid water with a little salt in it helps. Just have a really large bucket next to you or sit next to the tub.

#12 ::: Linkmeister ::: (view all by) ::: July 03, 2008, 02:22 AM:

Jim R @ #8, I remember taking a train north from Yokosuka to Tokyo to see the sights but also to get a real McDonalds hamburger (I'd been stationed in Japan for about three months by then, and the base mess hall burgers just didn't taste right). Other than that, I ate a fair bit of Japanese food (even the yakitori street food!) and never got cholera. It can be done!

#13 ::: Farah ::: (view all by) ::: July 03, 2008, 02:31 AM:

The book is brilliant. As I remember one of the crucial bits of evidence was the elderly woman some distance away from the pump who, it turned out, came from the area and whose loving son delivered her a small barrel of the pump's water every day because she liked its taste.

#14 ::: Edward Oleander ::: (view all by) ::: July 03, 2008, 03:03 AM:

#5 - Lee - "Okay, an obvious question: if you're vomiting, how do you manage to drink enough water for it to do any good?"

It can be done... but it might take a fair amount of anti-nausea meds like pepto-bismol (comes in generic tabs yucky taste). You can also help by not drinking cold liquids... makes the stomach clench... and by drinking electrolytic drinks instead of plain water. Even sugared drinks like kool-aid are often easier on the stomach than plain water.

Even if it's just water, you just keep trying... the line between staying functional and having dehydration take you down can be quite fine, so keeping up the effort helps...

Case in point: My Red Cross EMS team works 1st Aid for the Taste of Minnesota... a few years back it was deadly hot and humid. At the end of day 1, the event caught us giving out free water (undermining their profits from FOUR dollars for a bottle) and made us stop. On day 2 we had almost ten times as many heat related cases that required treatment...

#15 ::: abi ::: (view all by) ::: July 03, 2008, 03:39 AM:

Dehydration to the point of vomiting: the times I have been in that state, I've sucked on and crunched through ice cubes.

And Henry Whitehead sounds like he was a proto-Mythbuster.

"So Henry, you've tested all of the myths about cholera. How did it come out? Evil spirits?"
"Busted. There was no difference between church-going people and non-church-going people."
"Bad food?"
"Busted. People ate food from many sources and still got sick."
"Surprisingly, this one was busted too. I was sure miasma was the cause, but the data just didn't support it."
"Something invisible in the water?"
"Since it's invisible, I can't find whatever it might be that's causing the cholera, but this is the only explanation that makes any sense at all. I can't confirm it, but this one is definitely plausible."
"Well, how about that? Myth plausible."
"Yes. Now let's go blow something up."
"Sounds good to me."

#16 ::: Bacchus ::: (view all by) ::: July 03, 2008, 04:52 AM:

It is a mark of the rough-and-tumble nature of the internet threads I've been participating the last few days, that when first I saw this thread title, I felt a fight-or-flight feeling of dread, and wondered which of the valued people within my radius of treasured linkages would be either the source or the target of the sentiments in the thread title.

Words cannot describe my relief when I realized that I was reading one of Jim Macdonald's treasured (and too few) medical-details posts, this one with juicy history. I sank gratefully into the five minutes of pure reading pleasure that followed.

Thanks, Jim!

#17 ::: ajay ::: (view all by) ::: July 03, 2008, 05:07 AM:

Before the 20th century, most serving soldiers during wartime died from disease rather than wounds.


We've got the cholerer in camp -- it's worse than forty fights;
We're dyin' in the wilderness the same as Isrulites;
It's before us, an' be'ind us, an' we cannot get away,
An' the doctor's just reported we've ten more to-day!

Since August, when it started, it's been stickin' to our tail,
Though they've 'ad us out by marches an' they've 'ad us back by rail;
But it runs as fast as troop-trains, and we cannot get away;
An' the sick-list to the Colonel makes ten more to-day.

There ain't no fun in women nor there ain't no bite to drink;
It's much too wet for shootin', we can only march and think;
An' at evenin', down the nullahs, we can 'ear the jackals say,
"Get up, you rotten beggars, you've ten more to-day!"

'Twould make a monkey cough to see our way o' doin' things --
Lieutenants takin' companies an' captains takin' wings,
An' Lances actin' Sergeants -- eight file to obey --
For we've lots o' quick promotion on ten deaths a day!

Our Colonel's white an' twitterly -- 'e gets no sleep nor food,
But mucks about in 'orspital where nothing does no good.
'E sends us 'eaps o' comforts, all bought from 'is pay --
But there aren't much comfort 'andy on ten deaths a day.

Our Chaplain's got a banjo, an' a skinny mule 'e rides,
An' the stuff 'e says an' sings us, Lord, it makes us split our sides!
With 'is black coat-tails a-bobbin' to Ta-ra-ra Boom-der-ay!
'E's the proper kind o' padre for ten deaths a day.

An' Father Victor 'elps 'im with our Roman Catholicks --
He knows an 'eap of Irish songs an' rummy conjurin' tricks;
An' the two they works together when it comes to play or pray;
So we keep the ball a-rollin' on ten deaths a day.

We've got the cholerer in camp -- we've got it 'ot an' sweet;
It ain't no Christmas dinner, but it's 'elped an' we must eat.
We've gone beyond the funkin', 'cause we've found it doesn't pay,
An' we're rockin' round the Districk on ten deaths a day!

#18 ::: Francis ::: (view all by) ::: July 03, 2008, 05:21 AM:

Off the top of my head (I don't have the source material for this anywhere near so take at your own risk), there's some mythologising in the above post. John Snow was in fact the second person to draw a map like that and trace a cholera outbreak and trace it back to the water supply. (I forget who the first was - and he wasn't half as good a politician as John Snow).

I also seem to recall something about the official investigation being funded by the water companies, but I could be getting the wrong investigation.

And it's one of life's minor ironies that the Victorian temperence movement actually encouraged people to drink beer.

Finally it's a pet rant of many people in Public Health that not only are the maps no easier to draw, they are actually illegal to draw in Britain under current law.

#19 ::: Fragano Ledgister ::: (view all by) ::: July 03, 2008, 06:37 AM:

My own introduction to the history of the germ theory of disease was Hans Zinsser's eminently readable Rats, Lice, and History, the story of typhus.

I can recall my surprise when I was doing research into nineteenth century writing on the Caribbean, to discover the miasma theory being asserted by Froude in 1887 (to explain malaria and yellow fever).

#20 ::: Fragano Ledgister ::: (view all by) ::: July 03, 2008, 06:39 AM:

Jim: In view of the means by which cholera is transmitted should not the header read 'Drink, shit, and die'?

#21 ::: Alex ::: (view all by) ::: July 03, 2008, 07:04 AM:

The men of the Lion Brewery, however, were partly paid in beer and no one could recall ever seeing any of them drink water.

Not quite as good for the story, but like most breweries, it had its own borehole because the quality of the water is important for the quality of the beer.

There is an excellent account of Snow and Whitehead in Bad Medicine: Doctors Doing Harm since Hippocrates. Hilariously, the official inquiry plotted cholera deaths against altitude above sea level on a graph in order to support the miasma theory - unfortunately, they got the result that near sea level everyone would already be dead, and several cities fell under this.

Farr decided that this was because people slept in buildings, and therefore the average altitude at sea level was actually 14ft. The real reason for the apparent relationship was of course that most British cities are close to the sea.

What worries me is how many neo-Farrs there are on the Internet - David Kane, Tim Blair et al...

The site of the Broad Street Pump is now a pub called the John Snow.

#22 ::: Emily ::: (view all by) ::: July 03, 2008, 07:24 AM:

Okay, an obvious question: if you're vomiting, how do you manage to drink enough water for it to do any good?

From experience with the Wonderful Joys of theophylline overdose... In a genuinely severe case, you can't. But in the vast majority of nausea and vomiting, the patient can take a sip of water, let it absorb via the mouth lining and then have another. (in a theophylline overdose, even that can trigger the next round of vomiting, which is one of the many reasons why you tend to end up in the hospital if you overdose on it)

Once you're at the point where your mouth lining isn't absorbing water fast enough, you can start swallowing. I'd suggest sticking with things like warmish orange juice, tepid boullion, tepid tea, warm gatorade and the like. No solid food, or even slightly solid. Medical professionals tend to use "water" as "things that you drink that contain no solids", rather than a normal person's H2O. And from experience... make sure you're drinking a doctor's notion of water, not actual water. Electrolytes and calories are good, and you can't eat solid food to get them yet. For a lot of people, milk counts as solid food when they're ill. Too much fat. If you're one of the lucky souls who can drink it, do. (maybe in cocoa?)

Your body can absorb a bit less than a quart per hour via the stomach. So if you start pushing fluids upon first suspicion of trouble, odds are you can keep up even with cholera.

Our bodies are mostly fluid, and they can tolerate rather a lot of variation in the fluid levels. That's why cholera (and all the other similar diseases) have an easier time killing off children. A small child just doesn't have as large a tolerance range as an adult, and they can't process fluid fast enough to compensate.

#23 ::: Julia Rios ::: (view all by) ::: July 03, 2008, 07:26 AM:

I had cholera when I was 14 and visiting my Mexican relatives. It is nasty stuff, but Jim's right: one can live to tell the tale given plenty of rehydration. I spent days drinking water and Pedialyte, and while most of the fluid left my body nearly as soon as I'd ingested it, persistence did pay off. One thing I'll say that wasn't mentioned here is the sweat. Water will leave your body by whatever means possible, and your sheets definitely do not smell good even if you make it to the bathroom every time you need to. Boil water, wash hands, and be very careful buying food that isn't pre-packaged or thoroughly boiled/fried when you are in a cholera zone. We're pretty sure what got me was a shrimp cocktail. Take heed.

#24 ::: Alan Braggins ::: (view all by) ::: July 03, 2008, 07:56 AM:

> if New York City became a state, it would rank twelfth in population, but fifty-first in energy consumption

Though unless you adopt something like vertical farming, I think you have to include a correction for that part of rural energy use that is growing food to be shipped into cities for a fair comparison.

(That's still not going to make putting lots of people close to services less efficient than spreading them out.)

#25 ::: Laura ::: (view all by) ::: July 03, 2008, 08:15 AM:

Here's a photo of the John Snow Pub
The location of the famous pump is designated by a
light pink granite curbstone about where the high school girls are standing. The replica pump (no handle) is diagonally across the street.

#26 ::: fidelio ::: (view all by) ::: July 03, 2008, 08:38 AM:

I read this one a year or two ago, and it's an excellent book--I found it interesting that a hundred and fifty years ago, recycling was done far more thoroughly than it is now.

Without Whitehead's efforts, Snow's theory might have been lost by the side of the road. He did an immense amount of work locally, knocking on doors and asking people questions in his efforts to get to the bottom of things. Because he was the local clergyman and had made a point of getting to know absolutely everyone in the neighborhood, church-goer or not, they all felt comfortable talking to him, and so he was able to get a lot more useful information than outsiders might have. His efforts are part of what epidemiologists do today on the ground when they try to identify the origins of an epidemic--work they often do with the assistance of local help, because, like Henry Whitehead, the local workers will know the people there and be able to get more information. The pump was Snow's inspiration, but Whitehead gets a share of the credit for making it a viable theory and not just a contrarian hypothesis--although Whitehead always insisted on giving all the credit to Snow.

Also, the story of the Broad Street Pump, like the other outbreaks of cholera and the outbreaks of typhoid that kept reoccuring in the nineteenth century, as Europe and America moved more and more into urban settings, is a strong argument for good water systems with public control--accountability is vital to ensure safe water supply and sewage treatment. This is not an area where you want management placing the shareowners' interests over the customers'.
Enron was starting to take an interest in water utilities...

#27 ::: Lila ::: (view all by) ::: July 03, 2008, 08:40 AM:

I too enjoyed The Ghost Map; I read a lot of nonfiction, but seldom run across a nonfiction book I can't put down. This was one.

Re prevention: my husband got a (thankfully mild) case of diarrhea on an overseas trip because he used tapwater instead of boiled water to rinse his toothbrush. Habit is strong.

#28 ::: James D. Macdonald ::: (view all by) ::: July 03, 2008, 09:19 AM:

John Snow was in fact the second person to draw a map like that and trace a cholera outbreak and trace it back to the water supply.

Steven Johnson is careful to point that out (the first person to draw a dot-map of the deaths in the Broad Street outbreak was an engineer named Edmund Cooper, employed by the Metropolitan Commission of Sewers). Snow didn't even draw his map until months later. But Snow's map was important and influential, not least by forming part of the evidence that Henry Whitehead found convincing.

Johnson then goes discursively off after information theory, other maps and mapping techniques, and the graphic display of information.

Snow was a prominent physician. He had supplied the anesthesia to Queen Victoria for two of her confinements, and he could not easily be ignored, even if his theory was rejected.

One of the great things about this book is the large number of lengthy quotes from primary sources. For example, there is this editorial that appeared in The Lancet in 1855:

Why is it, then, that Dr. Snow is so singular in his opinion? Has he any facts to show in proof? No! ... But Dr. Snow claims to have discovered that the law of propagation of cholera is the drinking of the sewage-water. His theory, of course, displaces all other theories. Other theories attribute great efficacy in the spread of cholera to bad drainage and atmospheric impurities. Therefore, says Dr. Snow, gases from animal and vegetable decomposition are innocuous! If this logic does not satisfy reason, it satisfies a theory; and we all know that theory is often more despotic than reason. The fact is, that the well whence Dr. Snow draws all sanitary truth is the main sewer. His specus, or den, is a drain. In riding his hobby very hard, he has fallen down through a gully-hole and has never since been able to get out again.

Which sounds ever so much like so many editorials I've read recently on the global-warming question.

#29 ::: Carol ::: (view all by) ::: July 03, 2008, 09:35 AM:

There's a theory that the "staked vampire shrivels up before your eyes and expires" was taken from people's horrified observation of cholera deaths.

#30 ::: Emma ::: (view all by) ::: July 03, 2008, 09:42 AM:

Fidelio @25: the privatization of the water supply has been a hobbyhorse of mine for years; it has had some horrific results when it has been tried, especially in Latin America and Africa. The Pacific Institute has some good research on this, as has Public Citizen, and I encourage everybody who is interested in improving the world's lot to take a SERIOUS interest in the matter.

If you ever want to choke on the stupidity and greed that precede and follow privatization, look up "Aguas Argentinas".

#31 ::: Teri ::: (view all by) ::: July 03, 2008, 10:22 AM:

Either that or stick to booze, tea, and coffee.

Really..? I would think you'd want to avoid both coffee and tea, unless you were sure that the water they were prepared with was also boiled first. You can make both without boiling the water during the preparation.

#32 ::: James D. Macdonald ::: (view all by) ::: July 03, 2008, 10:29 AM:

Tea and coffee contain enough acids to kill off a bunch of bacteria. Even if they aren't boiled. (Though boiling is better.)

#33 ::: Doctor Science ::: (view all by) ::: July 03, 2008, 10:35 AM:

I have never been able to even *look* at the title Love in the Time of Cholera without thinking, Love in the Time of Explosive Diarrhea -- The True Test. And the movie trailer looked so *pretty*, I had to just laugh.

#34 ::: Tlönista ::: (view all by) ::: July 03, 2008, 11:01 AM:

Hah! Doctor Science, that's what I always thought too. Nothing says romance like diarrhea.

I work in Marylebone and have some time to kill after work...maybe I'll pop down to Soho and have a drink in the John Snow while I get started on The Ghost Map.

#35 ::: veejane ::: (view all by) ::: July 03, 2008, 11:46 AM:

Cholera happened to strike several cities in the spring of 1849, including St. Louis. As a result, several of the wagon-trains heading westward over the Plains -- and thanks to the California gold rush there were massive numbers that year -- carried cholera with them, and buried people one by one along the trails.

George Bent, who was about ten at the time, later wrote in detail about how cholera came to the Cheyenne, and scared the everliving crap out of them (so to speak) because it was such a fast-moving disease with such violent symptoms. Families fled in all directions, bands broke up, a lot of traditions got shorted in all the mess and terror. The contemporary estimates were that when the epidemic was over the southern Cheyenne had lost half their population -- not just due to disease, but the dispersal afterwards, vulnerability to enemies, starvation when parties couldn't be organized to hunt.

If not for cholera, the 1849 exodus might have been very different: the southern Plains "Indian wars" of the 1860s might have happened a decade earlier, and one of the parties to that war might have been a lot more robust.

#36 ::: James D. Macdonald ::: (view all by) ::: July 03, 2008, 11:49 AM:

Louis Pasteur wouldn't get started on his experiments with fermentation (proving that fermentation was a biological rather than purely chemical process) until 1856.

#37 ::: Andrew Willett ::: (view all by) ::: July 03, 2008, 12:04 PM:

Bacchus @ 16: You weren't the only one who jumped to that conclusion. I saw this post's headline at the top of the main page, and my first thought was "Wow, Jim has really lost his patience with all the folks who showed up here to argue about the V**l*t Bl** thing."

#38 ::: judyt ::: (view all by) ::: July 03, 2008, 12:23 PM:

Delurking with a question:

I have vague memories of learning as part of a history course at University (this was 20 years ago so I'm afraid I can't trace the reference) that there were riots in some British cities during the 19th-century cholera outbreaks because rumours got around that the authorities were burying people alive.

The book explained the rumours as being due to a peculiarity of cholera - that when a person dies of it, their body cools in the normal way but then, due to continuing bacterial action, becomes warm again. However this wouldn't be the first piece of medical misinformation I've seen in a history book, and the rumour sounds like the sort of thing that might arise in any fear-inducing epidemic. Does anyone here know if the warming-up-again is true?

Sorry to break silence with such a morbid question, but you were already talking about morbidity! Also, it occurs to me that if it is true, it might also have some bearing on the vampire theory Carol mentions at #29.

#39 ::: joann ::: (view all by) ::: July 03, 2008, 12:38 PM:

Tlonista #34:

If you do hit the John Snow, give a report. I was somewhere between fascinated, gobsmacked and squicked out to discover just now that the ground zero for this whole affair was literally around two corners from the flat we borrowed for two weeks a couple of decades ago.

#40 ::: Chris J. ::: (view all by) ::: July 03, 2008, 12:41 PM:

Charles Rosenberg's The Cholera Years is a bit old (first published in 1962, revised in 1987), but still excellent. It describes what happened when cholera hit New York City.

#41 ::: Kristi Wachter ::: (view all by) ::: July 03, 2008, 01:53 PM:

Francis @ 18:

not only are the maps no easier to draw, they are actually illegal to draw in Britain under current law.

Seriously? Why are they illegal?

#42 ::: Clifton Royston ::: (view all by) ::: July 03, 2008, 02:41 PM:

(Hmm, thought I posted here last night but guess either I failed to confirm or tripped a spam test?)

Thanks for posting this; it moves it up my long "get and read" list.

Edward Tufte devotes a page to showing and discussing Snow's map, as an example of graphical excellence, in his The Visual Display of Quantitative Information.

#43 ::: Ginger ::: (view all by) ::: July 03, 2008, 03:02 PM:

Lee@ 5: Others have mentioned ways to keep hydrated in a time of nausea and vomiting. Speaking from personal experience (severe mono with constant nausea and vomiting for three days, plus a fever), sometimes you can't consume enough oral fluids, and that's when you need the IV stuff*. There are lovely drugs for stopping emesis (Phenergan is my personal friend for life), and then the IV helps with the rest. Once nausea is under control, then slow oral consumption is possible. For cholera, the primary loss of hydration is through diarrhea. The combination of vomiting and diarrhea is more rapidly lethal, as you lose not just water but also electrolytes. Loss of potassium leads to cardiac irregularities; loss of sodium leads to brain swelling.

*I needed 6 liters, the first 4 L in the first 6 hours of hospitalization, and the rest over the next twelve hours. I didn't start urinating until the fifth liter was finished. Although it was not painful (except for the fever headache), I don't ever want to feel like that again. However, I gained an appreciation of what my patients feel when we put in a catheter for IV hydration.

#44 ::: Francis ::: (view all by) ::: July 03, 2008, 03:17 PM:

Seriously? Why are they illegal?

Privacy concerns IIRC. When using publically available data your output must be aggregated to a point where you can't identify individual cases of just about anything without 'disproportionate effort' or direct consent. And in the case of causes of death direct consent is impossible...

#45 ::: Leva Cygnet ::: (view all by) ::: July 03, 2008, 03:21 PM:

Veteran backpacker here.

Couple of things to keep in mind for water:

1) At very, very high altitudes, boiling does not kill bacteria because the water doesn't get hot enough. The exact altitude you become concerned is dependent on the bug you're dealing with. Most of the time, this isn't a concern, but it is something to keep in the back of your mind ...

2) Iodine works better than bleach, if you're not allergic to it. It also tastes arguably better and is easier to transport (in tablet form) than bleach.

3) Sterilize the water FIRST, then add flavorings/electrolytes after you've let it set for a few hours.

4) If using water bottles with threaded caps, make sure you soak or boil the caps and the threads of the bottles. What you don't want to do is submerge a bottle in a contaminated body of water, drop your iodine tablets in, and then cap the bottle without treating the threads. I'm pretty sure not treating the wet threads of a bottle is how I got a memorable case of the trots on a solo trip in the middle of nowhere, Arizona.

5) Water purification pumps don't work well with hard water and are only 100% reliable when used under absolutely perfect conditions. In the field, they're somewhat less than optimal.

I always end up going back to iodine tablets, myself. (In my bug-out bag, there's also a bottle of iodine tablets. They weigh nothing, are relatively cheap, and are reasonably idiot proof as long as you're careful about not contaminating the threads of the bottles.)

Oh, someone mentioned milk up-thread. If you're in the developing world, boil the hell out of any milk you get unless you're certain it's been boiled before you drank it. You really don't want to get bovine tuberculosis or brucellosis while you're trying to keep hydrated due to the cholera.

-- Leva

#46 ::: James D. Macdonald ::: (view all by) ::: July 03, 2008, 03:55 PM:

Rumors of people being buried alive were way common in the 19th century, and it's entirely possible that some people were.

If you want to learn a great deal about the history of the medical search for death, the book Buried Alive: The Terrifying History of Our Most Primal Fear by Jan Bondeson is absolutely first-rate. You'll learn a great deal about what happens to human bodies during the decomposition process, including temperature variations, stiffness, and movement.

During the early-to-mid 19th c. the only absolutely sure test was observed decomposition, so there were "dead hospitals" where the dead were laid out (amid flowers, to kill the smell) with a watchman to watch for signs of life, until they started to rot. (Wilkie Collins set a novel in just such a place; Mark Twain describes visiting one.)

Other tests for death included such things as sticking a long needle into the heart and watching to see if it moved. Or more obnoxious things than that.

Eventually, a gentleman won a substantial monetary prize for coming up with a reliable test for death: listen to the heart with that new invention the stethoscope for five minutes. If you don't hear a heartbeat in that time, the person is dead. (Stethoscopes at the time were made of wood, BTW.)

Really good book. Highly recommended to anyone who's interested in the history of medicine. It's another of the couldn't-put-it-down non-fiction books. (Oh, and there are notes about vampire legends and their possible physiological origins, too.)

#47 ::: judyt ::: (view all by) ::: July 03, 2008, 04:33 PM:

Thank you! Relurking, with booklist. (Just what I needed. Another booklist)

#48 ::: Clifton Royston ::: (view all by) ::: July 03, 2008, 04:56 PM:

JimR @ #8: My personal less-pleasant analog of Proust's madeleine is that the smell of raw sewage instantly brings back my childhood in Tokyo. In the '60s at least, even in Tokyo there were still a lot of open ditches carrying untreated sewage. I don't know why there wasn't/isn't more epidemic disease in Japan.

#49 ::: KB ::: (view all by) ::: July 03, 2008, 05:09 PM:

I listened to the Audio version of The Ghost Map downloaded from It should be required reading for all microbiology and health profession students. The story of John Snow often turns up in the health curriculum, but seldom in such detail, and seldom with the kind of drama that surrounded the events of 1854.

The reason proposed in the book that the well sometimes had cholera and sometimes didn't wasn't just the water temperature -- it was also the flow of groundwater that fed the well. The mother who rinsed her choleric baby's diaper in the little-used cesspool in her basement tainted the groundwater that flowed into the well. When that tainted stream of water had gone by, the well was clean again. When she cleaned up after her husband, who also contracted cholera, the well was poisoned again. At least that's what the data from the time suggest. Whitehead never did tell her that she was the probable source. Can you imagine what she would have felt? What the neighbors would have done?

Miasma theory actually led to an increase in cholera, as well-meaning people, in an effort to reduce odors in London, piped sewage out of the city and into the Thames.

In a reverse of that theme, social reformers in the U.S. were reluctant to embrace germ theory, since miasma theory spurred cities into doing city-wide cleanups, establishing sanitary services, and improving sewer and water service. These clean-up efforts reduced disease and infant deaths, and reformers were afraid that an acceptance of germ theory would lead people to believe that cleaning up cities was unnecessary.

And no, neither the heat nor tannins in brewing tea and coffee will necessarily kill the cholera bacteria. One of the victims of the 1854 outbreak was an elderly woman whose sons brought her water from the Broadstreet pump for making her tea, because she preferred the Broadstreet water over water available closer to her house. Had she boiled the water for a good 30 minutes she could have killed the bacterium, but of course no one knew that in her time. And what tea lover would want to boil the water to death, anyway?

#50 ::: Linkmeister ::: (view all by) ::: July 03, 2008, 05:09 PM:

Clifton @ #48, I have vivid memories of being stuck in traffic in Japan behind "honey trucks." That was in 1973-1974.

#51 ::: Leva Cygnet ::: (view all by) ::: July 03, 2008, 05:15 PM:

Clifton -- If memory serves, one of the last really big mass outbreaks of cholera was in Japan. I don't remember the cause, and it may or may not have been sewage.

That said, the Japanese are fanatically clean and were historically pretty well educated and motivated about public health issues.

The Japanese are the people who invented multi-function remote control toilets with bidets with warmed water and warmed seats and music. Somehow, I suspect that they had the concept of "hand washing" down pretty early in the game.

#52 ::: B. Durbin ::: (view all by) ::: July 03, 2008, 06:00 PM:

Chinese miners in the California Gold Rush tended to be healthier, on the whole, than the general run of miners, and the theory is that it was because they drank tea instead of water.

And Sacramento raised the city in the 1860s to deal with flooding— and stopped having malaria and cholera outbreaks. Changing your city from a swamp will do that.

#53 ::: Teresa Nielsen Hayden ::: (view all by) ::: July 03, 2008, 06:05 PM:

Fidelio, Emma: The idea of a privatized water supply horrifies me right down to my toes. Water systems are the original public works projects. They're why highly organized early civilizations all grow up around irrigation systems: no individual can build his own dams, qanats, irrigation canals, aqueducts, or water mains, but a water system built by everyone will serve everyone.

Not many people own their own top-to-bottom watersheds. It's useful to imagine what would happen if individuals could build large water delivery systems themselves: crisscrossing aqueducts, Winchestering clusters of private reservoir dams to catch the spring runoff, and such massive accumulations of individual house pipes under the streets that a cross-section of them would look like a closeup photo of the vessels in a freshly-sawn piece of hardwood. You quickly arrive at the obvious conclusion that water systems are inherently cooperative.

#54 ::: colin roald ::: (view all by) ::: July 03, 2008, 06:05 PM:

Let me second Fragano@19's recommendation of Rats, Lice, and History. Zinsser's parentheticals are awesome -- for instance, "it is to Kepler's credit, however, that - although one of the most eminent physicists of all time - he never wrote a book on God and the Universe."

#55 ::: Madeline F ::: (view all by) ::: July 03, 2008, 06:10 PM:

Reminds me of Kipling's "The Young British Soldier" published I believe in 1889:

When the cholera comes -- as it will past a doubt --
Keep out of the wet and don't go on the shout,
For the sickness gets in as the liquor dies out,
A' it crumples the young British soldier.
"Go on the shout" is something like "buy rounds of drinks"; so at that time there still wasn't the complete knowledge that alcohol was protective against cholera.

In searching for that bit of poetry I came across a blog post from September 12, 2007, at Obsidian Wings, about cholera outbreaks in Iraq.

I was also just recently looking into the fellow who decided that the reason one wing of the Vienna maternity hospital had a 2% death rate and the other had a, what, 35% death rate? was that the bad wing was served by doctors who did autopsies on putrescent corpses and then went to deliver babies: basically, something on their hands transferred over. He demanded that the doctors sterilize their hands by dipping them in a harsh solution, and the death rate dropped. However, due to racial and other politics (he was a Czech, there were wars, he couldn't suggest a mechanism for how a tiny smudge of stuff would kill a woman, "Doctors are gentlemen and gentlemen have clean hands") he was considered a kook, and no one listened. He got angrier and angrier, writing other doctors letters about how they were murdering women by not washing their hands, until he was packed away to a mental hospital and there, beaten to death.

#56 ::: Jenny Islander ::: (view all by) ::: July 03, 2008, 07:21 PM:

Victim of the family curse of sinus headaches checking in. My variation goes like this: sinuses clog, pressure builds, pain becomes blinding and horrific, something opens up in there, impacted mucus drains, it usually goes down my throat and then I throw up until I can't throw up no mo'. It's very important to start sipping tepid water as soon as the thought of doing so doesn't bring on the gag reflex. The first two or three sips will probably come back up, but they do cut the bile and stomach acid. Also, rehydration helps to ease the last lingering symptoms of the headache.

Luckily, my headaches only last half a day or so and I have learned that keeping hydrated and never letting my forehead get cold will keep them under half a dozen a year. I even wear a hat when I go down into the basement to do laundry on a cold day. If we have to keep the heat as low this winter as I suspect, I may buy a nightcap.

#57 ::: Jenny Islander ::: (view all by) ::: July 03, 2008, 07:29 PM:

Madeleine @#55:

The mortality rate for hospital births was well known then and there. Unfortunately, the "midwives are dirty, midwives are ignorant, midwives are a bunch of batty old ladies" meme was taking hold, so some women from well-to-do families faced enormous pressure to go have the nice doctors deliver them of their burdens. The best some of them could do was arrange it so that they went into labor somewhere the city doctors couldn't reach. IIRC, the trip to the country to see Cousin Jane, interrupted at an inn along the way by the premature birth of a bouncing nine-pounder, was not uncommon.

#58 ::: Raphael ::: (view all by) ::: July 03, 2008, 08:02 PM:

"This is a discursive book. It starts with a description of the toshers, mud-larks, rag pickers, bone pickers, sewer hunters, pure finders, and nightsoil men who made up the garbage collection and recycling system of Victorian London. From there we go to a history of Soho, then the biology of cholera (a bacterium that in its normal course feeds on algae in the Ganges). We have touching and horrid scenes in this book: a man eating a cup of pudding and washing it down with a glass of water. Children dying alone in dark rooms beside the corpses of their parents. The streets blocked with hearses."

These days, in the blogs and elsewhere, you'll find a lot of people who get into contact with many poor people in their jobs, often see things that shock them, and then blame that on the welfare state. When I read their rants, I usually wonder what they think they would have seen among the poor back before the modern welfare state existed. Perhaps they should be given that book?

"(he was a Czech"

Hungarian, actually.

#59 ::: Chris Quinones ::: (view all by) ::: July 03, 2008, 09:53 PM:

Madeline, #55: You're thinking of Semmelweis. Hungarian rather than Czech, plus he was suspected of sympathy to Hungarian independence, which obviously didn't sit well in the capital of what did not become even the Dual Monarchy till after he died.

#60 ::: James D. Macdonald ::: (view all by) ::: July 03, 2008, 10:17 PM:

Perhaps they should be given that book?

Or the complete works of Charles Dickens....

#61 ::: ethan ::: (view all by) ::: July 04, 2008, 12:00 AM:

TNH #53: The idea of a privatized water supply horrifies me right down to my toes.

That, even more than the ludicrous waste involved, is why the popularity and ubiquity of bottled water terrifies me and pisses me off.

#62 ::: Don Fitch ::: (view all by) ::: July 04, 2008, 12:12 AM:

I don't know the year, but my mother was about 16 when her mother died of typhus or typhoid as the result of drinking water from a public well in semi-urban Louisville, KY, which would put it early in the first decade of the 20th Century. It seems curious, as well as interesting, that increasing areas in the U.S. have water supplies that are rated as various degrees of Unsafe For Drinking... and that there appears to be little or no official control over the safety of commercially-vended water.

#63 ::: Don Fitch ::: (view all by) ::: July 04, 2008, 12:28 AM:

JimR @ #8:

There's no certain safety anywhere (Salmonella, anyone?) but in Japan c. 1952, as a member of the Army of Occupation, I was an enthusiastic member of that sub-set of my Outfit that ate Japanese food at every possible opportunity -- often from little stands or dodgy-looking restaurants in areas that got their water from local open wells. The only food/water-related problems I encountered as a Medic resulted from two episodes of (non-serious) mass food-poisoning in the Army mess-halls.

#64 ::: Michael Roberts ::: (view all by) ::: July 04, 2008, 12:54 AM:

Yeah, Semmelweis was Hungarian. My wife's Hungarian. I can so recognize the whole be-right-and-badger-people-until-you're-locked-up-as-a-madman syndrome. It's so very Hungarian. There's nobody as romantic as a Hungarian.

#65 ::: Paula Helm Murray ::: (view all by) ::: July 04, 2008, 01:00 AM:

Teresa, thanks for that descriptive word, "Winchestering." For the circumstance presented it is very appropriate.

The one visit I've made the the Winchester house was only valuable in two ways. 1) I learned pretty much what MY house walls are made from and 2) just how large a person can fit though that rat maze without getting stuck. Jim and I took the tour at ConJose, and there was an Extremely Large Fan with the group.

We kept laying odds on where he would get stuck like a cork, but he apparently made it all the way through.

#66 ::: Lee ::: (view all by) ::: July 04, 2008, 01:29 AM:

ethan, #61: Take heart, things are changing for the better. For the times when you really need a bottle to carry with you, we save plastic bottles and refill them from our filtered tap. You can't tell the difference.

#67 ::: ethan ::: (view all by) ::: July 04, 2008, 01:30 AM:

Lee, that's great news.

#68 ::: colin roald ::: (view all by) ::: July 04, 2008, 01:31 AM:

fidelio@26 wrote: I found it interesting that a hundred and fifty years ago, recycling was done far more thoroughly than it is now.

It's a lot more workable when rags are valuable because workers can barely afford one new pair of pants a year, and when unskilled wages are so low that "freelance rag-picker" sounds like a good plan. It seems to me not enough people appreciate that (I don't mean to pick on fidelio here -- I mean in general).

What I mean is, the fact that we now have a world where human labour is valuable while mere things are cheap, and therefore can afford to regard recycling as a luxury -- it's all a sign of enormous progress. And not just contemptible bourgeous "progress": I think it's a pretty fundamental measure of the success of a society if it regards people as more valuable than things.

There are lots of places in the world where people are still disposable.

#69 ::: Tlönista ::: (view all by) ::: July 04, 2008, 01:53 AM:

Oh wow! Done reading. It didn't remind me of Mythbusters so much as the best House episode ever. (Where House insists that cholera is waterborne, of course, and the rest of the team think it's miasma. Halfway through the episode, they consider the possibility it could be a kind of cancer, so Wilson can get a few lines.)

Odds and ends:

- The John Snow is a hop skip and a jump away from Carnaby Street, population 80% suits, 10% hipsters, and 10% tourists. (I was going to take a picture of the pump but a businessman was leaning against it typing on his BlackBerry.) It's a Sam Smith pub -- that is, serves only a particularly cheap brand of alcohol and has a lovely ambiance. Very cozy, if you can find a place to sit down! There's a framed article on John Snow up on the wall on the first [second] floor.

The streets have changed very little from Victorian times. One difference from the map is that Broadwick Street now connects directly to Carnaby Street, having been extended a little. For those following along at home, a few streets have been renamed: Cambridge Street and Little Windmill Street are now called Lexington Street, for example.

- Johnson's comment that London then was a Victorian city with an Elizabethan infrastructure reminds me that today London is a twenty-first-century city with a Victorian infrastructure. The sewers are still that old. And denizens are notoriously chary of tap water. (Politicians have been drinking tap water during press conferences to promote it, but that assumes one trusts the politicians...)

- An aside: Johnson suggests that the development of alcohol tolerance can be chalked up to urban living (it's in the fourth chapter). And yet about half of all Asian people (who presumably have had cities for a while) are total lightweights. I happen to have inherited this from the Asian side of the family, and that half of cider I had in the Snow left me quite flushed and fuzzy-headed. Although I do my best to mitigate the effects, the fact is that I just can't tolerate alcohol. (This goes over great in Britain as you can imagine.) Explain?

- Clifton Royston #48: The smell of manure reminds me of the small town I grew up in -- a place American tourists passed through on their way to their Lake Huron cottages. The odour of pig shit regularly wafted in from the farms. After a heavy rain, the manure would get washed into the lake. It was advisable not to swim immediately afterwards. Eventually, around when Walkerton hit the news, authorities in charge of beaches started posting warning signs when the E. coli levels were high. Moral of the story: don't let raw sewage get into water that's going to get anywhere near your mouth.

- Re: Snow, Whitehead, Semmelweis and Lister all struggling against received wisdom in the scientific establishment: the Howlers' party line in was that scientific revolutionaries who overturned current orthodoxies were in for long fame, and the idea of a scientist withholding or keeping secret their disproof of evolutionary theory (as creationists assert happens) was ridiculous. Of course, keeping the side up blah blah blah, but in fact it was a terrible uphill climb and the establishment did not, in fact, welcome paradigm shifts with open arms.

The creationists are wrong in that the people who challenged received wisdom did not air their views so subtly that you could only tease them out via quote-mining. These guys were all vociferous and passionate in defending their views that the contemporary medical practices -- and the scientific assumptions they were based on -- were killing people.


#70 ::: T.W ::: (view all by) ::: July 04, 2008, 02:57 AM:


I can't remember the exact name of it but the alcohol intolerance is a genetic thing; it is most common in Asian populations but dose occur in all groups. As I understand it one of the byproducts of your liver processing alcohol out is the culprit and while that compound is in the bloodstream it causes the reaction and the bodies tolerance level for it can be high or super sensitive; some people are even allergic to it.
Many Asian populations have not had the type of food supplies that lead to plentiful supplies of booze until more recent history. It takes a lot of generations for a population to evolve the biology to handle some substances as many First Nations groups demonstrate.

#71 ::: Marilee ::: (view all by) ::: July 04, 2008, 03:40 AM:

Lee, #66, the date that's on the water bottle? That's the date the plastic starts leaching into the water. It's better to buy a water bottle of a non-leaching plastic (mine are Rubbermaid) and use that, over and over again.

#72 ::: ajay ::: (view all by) ::: July 04, 2008, 04:55 AM:

Unfortunately, the "midwives are dirty, midwives are ignorant, midwives are a bunch of batty old ladies" meme was taking hold, so some women from well-to-do families faced enormous pressure to go have the nice doctors deliver them of their burdens. The best some of them could do was arrange it so that they went into labor somewhere the city doctors couldn't reach.

As in, for example, "Tristram Shandy" (which I am reading right now; it's really rather good).

Johnson's comment that London then was a Victorian city with an Elizabethan infrastructure reminds me that today London is a twenty-first-century city with a Victorian infrastructure. The sewers are still that old. And denizens are notoriously chary of tap water. (Politicians have been drinking tap water during press conferences to promote it, but that assumes one trusts the politicians...)

All true - but as a Londoner, I'm chary of the tap water because it just doesn't taste very nice. There aren't many people who would argue that it's actually unsafe - in fact it's safer than bottled water.

#73 ::: SeanH ::: (view all by) ::: July 04, 2008, 05:10 AM:

My own experience of the city (longest cathedral in Europe!) has not given me the information to work out what's meant by "Winchestering" - can someone help?

#74 ::: Paul A. ::: (view all by) ::: July 04, 2008, 06:06 AM:


It's not Winchester as in the city, it's Winchester as in the rifle. More specifically, as in Sarah Winchester, daughter-in-law of the Winchester and heir to the family fortune, and the house she built in San Jose. (Paula Helm Murray mentions it at #65.)

Construction on the house continued non-stop for 38 years, and would have continued longer if Mrs Winchester hadn't died at that point. She insisted on the work continuing around the clock, and whenever the house seemed to be in danger of being completed, she'd add a few more rooms to the plans. The popular story is that she believed she was under the hostile gaze of the ghosts of those slain by the Winchester rifle, and would die if construction was ever halted.

The resulting edifice covers several acres and is full of unusual features like doors that open onto blank walls or ten-foot drops, stairways that lead to solid ceilings, and so forth. Some people say she was trying to confuse the ghosts; some people say that the ghosts were dictating the form of the house to some otherworldly design. There is of course also the theory that Mrs Winchester just wasn't a very good architect (or, at least, had other priorities that outweighed any concern for conventional building design).

#75 ::: Raphael ::: (view all by) ::: July 04, 2008, 06:41 AM:

Tlönista @69:

"- An aside: Johnson suggests that the development of alcohol tolerance can be chalked up to urban living (it's in the fourth chapter). And yet about half of all Asian people (who presumably have had cities for a while) are total lightweights. I happen to have inherited this from the Asian side of the family, and that half of cider I had in the Snow left me quite flushed and fuzzy-headed. Although I do my best to mitigate the effects, the fact is that I just can't tolerate alcohol. (This goes over great in Britain as you can imagine.) Explain?"

A point that has already been brought up in other contexts in this thread: Tea.

#76 ::: Tlönista ::: (view all by) ::: July 04, 2008, 07:31 AM:

*facepalm* I feel like an idiot.

I chalk it up to writing posts at 6am local.

#77 ::: BuffySquirrel ::: (view all by) ::: July 04, 2008, 08:38 AM:

Was the cholera epidemic really more terrifying than the Black Death? Just askin'.

#78 ::: James D. Macdonald ::: (view all by) ::: July 04, 2008, 08:42 AM:

More terrifying than the Black Death?

Probably not.

#79 ::: A.J.Hall ::: (view all by) ::: July 04, 2008, 11:13 AM:


There were definitely riots in the 1832 cholera epidemic in Manchester though these seem to have been provoked by surreptitious use of the cholera victims' bodies by anatomists: the cholera epidemic at that date was predominantly in the "Little Ireland" area of Chorlton-on-Medlock (the River Medlock was notoriously an open sewer and probably the groundwater was thoroughly contaminated) and when an infant was returned in a casket from the Swan Street Infirmary and the parents, on opening the casket, discovered the child to be headless, the riot began, mostly on the basis that the cholera epidemic was a genocidal plot aimed at the Irish, with a side order in the profitable re-selling of corpses to the anatomical schools.

#80 ::: joann ::: (view all by) ::: July 04, 2008, 11:14 AM:

Tlonista #69:

Thanks for the John Snow report.

#81 ::: joann ::: (view all by) ::: July 04, 2008, 11:16 AM:

Paul A. #74:

Michaela Roessner's Vanishing Point is set in the Winchester Mystery House, in a sort of alternate reality.

#82 ::: fidelio ::: (view all by) ::: July 04, 2008, 12:52 PM:

Teresa @53--What I'm talking about (and, I suspect, Emma is as well) is not the individualization of water supplies and sewers (you have to be pretty non-urban to talk about doing that without sounding like a moonbat), but the process (already being tried outside of Europe and North America) of turning these utilities over to private (whether closely-held or publicly traded, as Enron was) companies, anwserable first to the ownership, and lastly, if at all, to the municipalities and customers involved. There were those at Enron who regarded this as the next great chance to make a pile, and while Enron is gone, like-minded souls are forging ahead.
You're right, though, that water supply is best served by group effort and support, rather than individual effort, as soon as you're in a built-up environment. There are only so many wells and septic tanks you can pack into a piece of territory before Bad Things happen--things like the outbreak of cholera that set John Snow to thinking about how such things happened.

colin roald @68---you're right that things are now cheaper, while we (mostly) now see people as more valuable than we once did (for the "our society" value of "we"), but you might want to take a closer look at the things our ancestors did with their garbage. While there was a thriving second-hand clothes trade (as there is now--as several of us here can attest, including our hostess), rags also had industrial value (papermaking, for cotton and linen rags, as one example), as did such things as dog turds (tanning, of all things). Part of this is because modern chemical processes make it easier for industry to work up useful substitutes from other materials more cheaply than from the materials used two hundred or a hundred and fifty years ago. Try pricing rag-content paper versus a comparable weight of wood pulp paper for one example. Even now, when we have been working on modern recycling issues since the early 1970s (at least), the economic factors of finding ways to reuse/reprocess materials, and to ship them to where they can be reprocessed at a reasonable price have been stumbling blocks. Aluminum is easily recycled, and it's cheaper to melt old aluminum cans than it is to smelt alumina ores. Even now, glass is a more challenging prospect. People will pay you for your cans after the party where you and your guests go through several cases of beer and asoft drinks, while glass recycling general doesn't pay the consumer for recycling directly.

My great-great-grandparents (and even my great-grandparents) found it entirely reasonable to save all their fats for things like making soap and candles, and to do things like greasing the wagon axle; fats were in short supply in their world, and they had no substitutes like silicone for lubrication; petroleum was either not yet exploited in useful quantities, or else refining efforts had not progressed far enough to produce the range of products we get today. Today, I do not save fats so I can lubricate my truck or make soap and candles; once the bones from last night's chicken are used for stock, they go into the trash, and so on. This is not the result of valuing human life more, but of changes in manufacturing and the processing of raw materials.

You are, however, all too right when you say there are plenty of places left on earth where human life doesn't have much value--and there are too many people in places or power in the US who see that as a good thing, and want us to be more like that.

Tlönista @69--thanks for taking that side-trip to the John Snow, and for sharing it with us!

#83 ::: Constance Ash ::: (view all by) ::: July 04, 2008, 01:24 PM:

Our Mutual Friend has quite a lot to say about why those who owned 'dust' heaps were able to become so wealthy. The BBC version shows in graphic period detail the people sifting by hand those mountains of 'dust' to separate into their various categories what could be sold to tanners, etc.

As for the privatization of water supplies, it's been going apace for decades now. Most of the potable fresh water on the globe is now owned by two or three European-based transnationals. They own most of the open water in Africa and have been buying up our municipal water systems here too.

What do they do with that water? They are the ones putting it into plastic bottles and re-selling it, while propagandizing that the water out of your tap isn't as healthy -- and certainly not stylish. Talk about manufactured want! The Mad Men of the late 50's, early '60's were nothing to these transnationals.

Love, C.

#84 ::: John A Arkansawyer ::: (view all by) ::: July 04, 2008, 01:30 PM:

fidelio in #82 may be thinking of T. Boone Pickens, who is buying up water rights in Texas.

#85 ::: Clifton Royston ::: (view all by) ::: July 04, 2008, 02:08 PM:

Tlonista/T.W. -

To expand a little more, some sociologists think that the key reason people of European and Middle-Eastern descent tolerate alcohol well and Asians and Native Americans don't, is that from Sumeria on to the west, brewing beer (and later wine) became the chief public health discovery which made living in cities practical. To the east of their (India, China, and Japan) it was boiling water for tea. In European cities, from what I've read, everyone down to small children used to regularly drink beer because - unhealthy though it may be to consume lots of alcohol - it was healthier than water. (Cultural acceptance that children should not drink seems to be a very 20th century phenomenon.)

Several millenia of that was enough time to establish strong selective pressure and spread the genes for alcohol tolerance through the entire population. Thus I have heard.

#86 ::: dcb ::: (view all by) ::: July 04, 2008, 03:40 PM:

ajay @ 72

I'm not a Londoner - I just live here now. Originally I'm Mancunian - nice soft water straight from the Lake District. I hated the taste of London water when I got here. Now I have a nice glass bottle, fill it with water from the tap and keep it in the fridge. When I want water, I drink that, sometimes with a bit of lemon juice in (more often, I make tea - lots of different types of tea) or I drink beer - lots of different types of beer *grin*.

#87 ::: Chris ::: (view all by) ::: July 04, 2008, 06:53 PM:

Slightly off topic, but speaking of dying, Jesse Helms did.

"Natural causes" would include cholera, I guess, but however full of shit Helms was, that probably wasn't the cause of death (because we in industrialized countries have high-tech, sophisticated water purification systems and, by sheer coincidence I'm sure, very low rates of cholera). Helms benefited a lot from the Enlightenment values he fought against; there's very little chance he would have lived to 86 without the secular science he despised.

The article on his death (linked above) quotes him as saying "I had sought election in 1972 to try to derail the freight train of liberalism". I was born too late to know - *was* there ever a freight train of liberalism? That would be cool to see. I'm kinda tired of the Exxon Valdez of conservatism finding every iceberg in the strait.

#88 ::: Diatryma ::: (view all by) ::: July 04, 2008, 07:04 PM:

I don't drink my tap water immediately-- it goes into a filter pitcher. The pipes in my apartment are old, and I don't trust the first splash of brown that comes out.
Still, I feel weird having even that. What, my tap water's not clean enough?

#89 ::: joann ::: (view all by) ::: July 04, 2008, 07:19 PM:

Diatryma #88:

After the umpteenth invasion this spring/summer by teeny tiny ants (yes, we're in a bit of a drought here, damn things will head for any available source of water) we have to keep ours in the fridge. I've gone back to drinking the tap water--although I still use the filtered stuff in the espresso machine. I'm not sure I want to investigate its tank to see if it's got critters, and I'm not sure I could tell them from coffee grounds without a magnifying glass anyway.

#90 ::: joann ::: (view all by) ::: July 04, 2008, 07:24 PM:

Oh, and I still drink peach-flavored bottled water--no sugar, just a touch of flavor--because I really don't like straight water either with lunch or right after exercise. I'm only a sipper, so I use up about a 20-oz bottle ($1.25) or two a week; this is not a major investment in anything.

#91 ::: pericat ::: (view all by) ::: July 04, 2008, 08:06 PM:

In European cities, from what I've read, everyone down to small children used to regularly drink beer because - unhealthy though it may be to consume lots of alcohol - it was healthier than water.

The alcoholic content of beer or wine need not be very high, and may well not have been, in order to satisfy the body's need for so much water per day. Reading Dickens or Austen gives me the impression that drinking beer in the morning (and throughout the day) was normal for workers; if what they were writing about was a kind of small beer, there's not much there that would hurt you. I can't see hoards of workers consuming several pints of 5.x ale daily and still continuing to get stuff done, let alone avoid killing or maiming each other by the dozens, but that could well be my limited imagination.

At the same time, accounts of the amount of rum owed to a sailor per day astonish me, especially when I consider that sailors were still expected to do better than a full day's work. So I think we're talking some truly high alcohol tolerance levels as being common, and you don't get that way without years of practice.

#92 ::: sara ::: (view all by) ::: July 04, 2008, 09:49 PM:

Living for a year in a mainly Latino neighborhood in central Los Angeles, I saw my neighbors frequently buying large bottles (the office cooler size) of water. I learned that recent immigrants, coming from Mexico or other countries where tap water's purity is unreliable, don't trust drinking U.S. tap water, even though Los Angeles municipal water is fine, barring apocalypse or its privatization by libertarian right-wingers.

Of course, the water in these bottles may have come from the tap, and the people buying them are getting fleeced even more than middle-class white people buying small Evian bottles.

#93 ::: Dave A. ::: (view all by) ::: July 05, 2008, 12:06 PM:

This historical incident is featured in one of the episodes ("What the Doctor Ordered") of the fabulous series "The Day the Universe Changed" by James Burke. I think the series may now be on YouTube.

#94 ::: James D. Macdonald ::: (view all by) ::: July 05, 2008, 12:48 PM:

That's The Day the Universe Changed, episode 7.

#95 ::: James D. Macdonald ::: (view all by) ::: July 05, 2008, 01:48 PM:

In The A.B.C. Murders by Agatha Christie, published (and set) in 1935, we have mention of a character, a working-poor woman age about 65, who was one of ten children, of whom three lived to adulthood.

That would have put her birth around 1870. And that would have put the infant mortality rate in that family at 70%. This was a minor bit, passed without remark and unremarkable. (Of the other two children, one died in the trenches in WWI, and the other went to South America and was never heard from since.)

Back around 1840 or so, in London, the life expectancy among the gentry was 45. Among tradesmen, 26. And among the working poor, 16.

That didn't mean you could expect to die at 16 -- it means that, when you averaged the numbers, for every person who lived to be eighty another five died at one.

#96 ::: Mez ::: (view all by) ::: July 05, 2008, 02:51 PM:

I'm pretty sure infant mortality was higher in cities and later ages, but of all the things that I didn't like in the The Lord of the Rings films, the one that threw me out & irritated me most was where an older man — Theoden? — was mourning the death of his son, saying that very modern line about "parents shouldn't have to bury their children". Had whoever put that line in ever been in an old cemetery?

There would be dozens, scores, of things to say about the death of a strong young promising man from that period (and up to a century and somewhat ago) — even ones remarking on the sadness/unfairness of an old person seeing their child die in his prime — but that particular version seems so very anachronistic that I'm puzzled as well as annoyed by its use.

#97 ::: Julie L. ::: (view all by) ::: July 05, 2008, 03:51 PM:

Leva Cygnet @51: The Japanese are the people who invented multi-function remote control toilets with bidets with warmed water and warmed seats and music. Somehow, I suspect that they had the concept of "hand washing" down pretty early in the game.

Handwashing, yes. Soap, not so much.

Soapmaking requires a substrate of fats/oils, neither of which was in large supply during the long periods when everyone had a near-exclusive vegetarian diet. Some oils were commonly produced and used in smallish quantities-- camellia oil for hairdressing, fish oil for lamps-- but there wasn't enough steady production of (otherwise) waste animal fats for saponification.

Traditionally, bathers scrubbed themselves with a small bag of rice bran; I think garments were washed with some sort of foamy root, and one of my cookbooks says that foodware was just rinsed with plain water (most cooking wasn't oily enough to require suds). Even now, at least based on a ~1.5-wk visit earlier this year, it's relatively uncommon for most Japanese toilets to have soap at their sinks-- unless you bring your own, all you can do is rinse your hands in water and wipe them dry (if you also remembered to bring a hand-drying cloth, since paper-towel dispensers are also rare-- otherwise, you're stuck letting your hands drip/air-dry or surreptitiously wiping them on your clothing).

Which also indirectly reminds me of fictional menus that make me cringe-- anytime during the pre-modern era when crops were routinely fertilized with untreated animal/human waste, eating most raw salad veggies would've been well-nigh suicidal.

#98 ::: James D. Macdonald ::: (view all by) ::: July 05, 2008, 04:10 PM:

During the 19th c., in one of the McGuffy Readers, children were told that they should be kind to their younger siblings because they would not be with them long.

And there was another tradition of not naming children until their first birthday because ... why bother?


I had known that "workhouses" existed in Victorian England (see, for example, Scrooge asking "are there no workhouses?") but until I read this book I'd been unaware of exactly what workhouses were. Boy howdy am I glad that we don't have 'em any more.

#99 ::: James D. Macdonald ::: (view all by) ::: July 05, 2008, 04:38 PM:

A Chartist Song (from

You working men of England one moment pray attend
While I unfold the treatment of the poor upon this land
For now-a-days the factory lords have laid the label low
And daily are contriving plans to prove our overthrow

What will become of England if things go on this way
There's many an honest working man starving here today
They cannot find employment for bread their children crave
And hundreds of those children they're lying in their grave

So arise you sons of freedom the world is upside down
They treat the poor man as a thief in country and in town

Now some have money plenty but still they crave for more
They will not lend a hand to help the starving poor
They'll treat you like a dog and on you cast a frown
That is the way old England the working man casts down

How altered are the times rich men despise the poor
Stand them off without remorse quite scornful at the door
And when a man is out of work his Parish pay is small
Enough to starve himself and wife his children and all

So arise you sons of freedom the world is upside down
They treat the poor man as a thief in country and in town

In former days when Christmas came we had a good fat loaf
We had beef and mutton plenty and we enjoyed them both
But now-a-days such altered ways and different are the times
For if a man should seek relief he's sent to the Whig Bastille

So to conclude and finish these few verses I have made
I hope to see before long men for their labour paid
Then we'll rejoice with heart and voice and banish all our woes
But before we do old England must pay us what she owes

So arise you sons of freedom the world is upside down
They treat the poor man as a thief in country and in town

And as sung by Chumbawamba (on English Rebel Songs).

#100 ::: Clifton Royston ::: (view all by) ::: July 05, 2008, 05:04 PM:

There is a Japanese Buddhist story (probably a Zen story) about a meditation and calligraphy master who is called by the local daimyo (feudal lord) to write an scroll with some auspicious saying for display at the castle. The master arrives, prepares his paper and ink, and in one fluid stroke of the brush writes "Grandfather dies, father dies, son dies." The lord's men seize him at once, and the lord demands to know what the master means by writing a phrase which invites such misfortune. He answers, "All men die. It would be misfortune indeed if a man were to die before his own father, or if his son were to die before him. If instead a man outlives his father, and he in turn is outlived by his son, this is the natural order of things. What could be more fortunate than this?" The master is sent on his way with honors.

#101 ::: Tim Walters ::: (view all by) ::: July 05, 2008, 08:03 PM:

Lindsay Cooper's 1980 album Rags sets many texts and broadsides of the period, including a couple of Chartist anthems, plus a song called "Cholera":

All you that does in England dwell
I will endeavour to please you well
If you listen I will tell
About the cholera morbus

CHORUS: They tell me now it's all my eye
No more you'll hear the people cry
"Have mercy on me, I shall die
I've got the cholera morbus."

In every street as you pass by
"Take care" they say "or you will die"
While others cry "it's all my eye
There is no cholera morbus."

You must acknowledge what I say;
When thousands go from day to day
With scarcely food and clothing, they
May have the cholera morbus

#102 ::: sara ::: (view all by) ::: July 05, 2008, 08:55 PM:

What happens when you leave control of a municipal water supply to the local authorities (review of the episode)

Apologies to Canadian readers who are probably over-familiar with the Walkerton story, but many American readers may not be.

#103 ::: Emma ::: (view all by) ::: July 05, 2008, 10:12 PM:

Teresa, Fidelio @ 82 is right. Here's the brief:
on Aguas Argentinas
. Utter nightmare. And it's happening here in the States, too, although at a slower pace. Oil, schmoil, the last great battle for resources is going to be over water and it'll be bloody.

#104 ::: Adrian ::: (view all by) ::: July 05, 2008, 10:42 PM:

Julie (#97), old-fashioned washing technology is commercially available again (or perhaps still.) I found dried Chinese Soapberries being sold as "Soap Nuts," and advertised as environmentally benign and hypoallergenic. They contain quite a lot of saponin, which they release in hot water. I bought a small box and have been using them for laundry. I find them reasonably effective, when dissolved in hot water. They're a nuisance to use for clothes I wash in cold water, though. And probably not worth the expense, for me. My point is that the fat+alkali reaction is not the only source of saponin on the planet.

I agree with you about the problems of sewage contaminating vegetables, or trace contamination of drinking water. (More than trace contamination makes the water smell and taste bad, but if it tastes ok, and it's always been a good seems sensible to drink.)

#105 ::: Doug Burbidge ::: (view all by) ::: July 06, 2008, 03:28 AM:

Brackets in a place other than the place that would make sense in the following sentence:

The deaths occurred inside of that line, with odd lacunae, like the Lion Brewery (only a few yards from the pump) but with no deaths at all.

As always from you, Mr Macdonald, a detailed and interesting post.

#106 ::: David Goldfarb ::: (view all by) ::: July 06, 2008, 04:29 AM:

Tim Walters@101: Some here may not know that "morbus" is Latin for "disease". (And yes, that's where we get the word "morbid".)

#107 ::: Bruce E. Durocher II ::: (view all by) ::: July 06, 2008, 10:34 AM:

Was the cholera epidemic really more terrifying than the Black Death? Just askin'.

More terrifying than the Black Death?

Probably not.

Is it time for Part Six of Beat The Reaper already? Can't we just go "Back to the Shadows Again"' instead?

#108 ::: B. Durbin ::: (view all by) ::: July 06, 2008, 02:13 PM:

In regards to #98: I was re-reading the Betsy-Tacy books (books about some small girls) and several things struck me: The five-year-olds were allowed to run off and play by themselves, and Tacy's little sibling dies and Betsy, in her five-year-old wisdom, gives Tacy sympathy along with the concept of "it just happens."

Of course, my father had two siblings die, one as a crib death and the other from measles.* Any time somebody rants about the dangers of vaccinations I think of the mortality rates from childhood diseases. (And seriously, even IF there were any connection to autism, which there isn't, which is worse— an autistic child, or a dead child? Some people have no sense of perspective...)

*And my mother got polio. And rubella when she was pregnant with my oldest sister. Who is perfectly healthy, one of the minority.

#109 ::: CHip ::: (view all by) ::: July 06, 2008, 02:53 PM:

Tlönista@69: when did Sam Smith become cheap? When I last looked (1-2 months ago), most English beers were $8-9 per 6x12oz here in Boston; Sam Smith was $9-10 per 4x12oz -- good beer, but not cheap. Some years ago I had a pint at a Sam Smith house just off Trafalgar Square; the session beer ("Library Ale") was reasonably but IIRC not noticeably cheap.

#69/70: IIRC, the missing link is acetaldehyde dehydrogenase, which handles one of the steps in

    ethanol -> <steps> ethanal (aka acetaldehyde) -> <steps> acetyl

, which is then ]burned[ (add oxygen, make carbon dioxide and energy) in tricarboxylic-acid cycle. This is offered as \another/ piece of evidence that western-hemisphere aborigines came across from Asia, although it's unclear how much of their ]traditional[ reaction to alcohol was lack of experience, deliberate encouragement of drunkenness by whites, etc.

JMD@95: London poor were an extreme case, but not very extreme; the grandfather I'm named after was one of 11 in an educated family (his father was a 2nd-generation Yale PBK), of whom 4 died in childhood (and one in the Civil War -- my line seems to go for \late/ decisions).

Mez@96: the line you object to might have come from Tolkien himself; the books make it obvious he had a grossly romanticized idea of how the masses lived. To be fair, it also reflects a less-common situation; IIRC, childhood deaths were much more common than the prior death of adult offspring.

#110 ::: dcb ::: (view all by) ::: July 06, 2008, 03:04 PM:

"Try as Whitehead will, he cannot disprove the waterborne hypothesis. He disproves the others, one by one, until he has nothing else. And when you have eliminated the impossible, as Sherlock Holmes would later say, whatever remains, however improbable, must be the truth. He champions the waterborne theory, and lives to see it become the accepted wisdom."

This reminds me of the statistician, whose name I cannot remember (mea culpa) who discovered the link between smoking and lung cancer. It's not what he expected to find - he was expecting a link with laying of tar on roads (people working on the roads, or people living along the roads). What he found was the link to smoking.

#111 ::: Clifton Royston ::: (view all by) ::: July 06, 2008, 05:01 PM:

Oh, one more factoid on the alcohol intolerance thing.

I can't remember where I learned this - maybe in college biology? - but a tiny minority of people have the gene for methanol tolerance. In other words, their genes specifically code for an enzyme which breaks down formaldehyde into the next step in the reaction chain, so they can drink methanol and suffer no ill effects, whereas most people get poisoned. The thing is, there's no selective pressure for it, so the gene hasn't spread.

Perhaps if a world-spanning civilization banned alcohol for thousands of years, resulting in thousands of years of people drinking bad bootleg vodka containing methanol, this gene might become broadly established. Until then, it remains a curiosity, much as the ethanol tolerance gene did in Asia and the New World.

#112 ::: abi ::: (view all by) ::: July 06, 2008, 05:18 PM:

B Durbin @108:
The five-year-olds were allowed to run off and play by themselves

I don't know the full context, but my four year old is allowed to go to the play park five doors down by herself. Her classmate across the way does it as well, with appropriate care crossing the (dead quiet) street.

The Dutch village that I am in can be easily mapped to 1950's America in terms of social cohesion, and my kids' degree of freedom is entirely unremarkable. Indeed, having just come here from the UK, we are probably a little paranoid for local convention.

Sorry for the off-topic comment, but you reminded me of how different things are here.

#113 ::: Mary Aileen ::: (view all by) ::: July 06, 2008, 06:03 PM:

My grandfather lost a little brother at age two. But the other seven children all lived to grow up. And the four boys who fought in WWI all, remarkably, survived, although one was badly injured and another spent most of the war as a POW.

A great-grandfather on the other side lost his five younger siblings to tuberculosis.

#114 ::: Joe McMahon ::: (view all by) ::: July 06, 2008, 08:34 PM:

In a cemetery in a small settlement near where I grew up in West Virginia, there is a set of three small tombstones; one for each of the three children from the same family who died of diphtheria in less than a week - this was sometime in the late 1800's, as I recall.

#115 ::: Graydon ::: (view all by) ::: July 06, 2008, 09:08 PM:

CHip @109, Mez at 96 --

That line, given to Théoden, was an addition by some combination of the actor playing Théoden and the script-writing troika. It made me cringe, too.

The textual Theoden doesn't manage to say much about the death of his only son and heir, being modeled on rather stoic Mercians.

The film made rather a botch of Theoden, which is a great pity.

#116 ::: Julie L. ::: (view all by) ::: July 06, 2008, 09:19 PM:

Graydon @115: The film made rather a botch of Theoden, which is a great pity.

True, but at least Theoden was able to retain some sense of dignity and strength. Denethor was reduced to a mad caricature.

#117 ::: ajay ::: (view all by) ::: July 07, 2008, 06:30 AM:

115: at least they kept his dying words, which are the best line in the whole trilogy.

#118 ::: clew ::: (view all by) ::: July 07, 2008, 02:48 PM:

Susan Strasser's Waste and Want is detailed and entertaining on the history of garbage and recycling in pre-to-early-industrial US. Some of it, IIRC, was done because there was no easy source for a material; some was profitable because immiserated labor was so cheap; some was useful because the citizenry and economy weren't entirely in the *market* economy yet. Rural people and rather more households-containing-women were more autarkic than now, because there weren't alternative markets for their specialized labor, or there were social burdens to taking wages. It's a good read if you like Braudel, or if you like long-Victorian-period novels but can't figure out what the background chores are about.

On the other hand, today's cheap stuff that we-including-me can so easily use isn't produced with much regard for universal human worth, either at site of manufacture, or site of disposal. Or transport; Oakland breathes more than its share of shipping fumes.

I assume that a legal structure that made costs explicit would inspire some better tack on most of this -- design-for-reuse is the usual name -- don't know how we get there, though.

#119 ::: CHip ::: (view all by) ::: July 07, 2008, 11:03 PM:

Joe@114: crowding is always a special case, even in hamlets. In the great cemetery on the backside of Montreal's eponymous hill there are two small forests of 1/3-size stones, with no visible writing beyond two overseers saying "Aveugle" and "Sourd"; my guess from context was that a home for the young handicapped was ~slaughtered by the "Spanish Flu" -- they would have lived in very crowded conditions.

#120 ::: Paula Lieberman ::: (view all by) ::: July 08, 2008, 12:16 AM:

#97 Julie L.
#104 Adrian

Soapwort, aka "Bouncing Bet. It gets used by restoration experts to wash delicate antique textiles, for example.

It's a very enthusiastic weed in my yard.

#121 ::: Rikibeth ::: (view all by) ::: July 08, 2008, 12:32 AM:

#120 Paula

I'm going to have to look around for that! I recently picked up an antique white pique skirt -- maybe a summer walking skirt, maybe it started life as a sturdy petticoat -- the tag said 1880s and I could see that back pleat being cut to accommodate a bustle, maybe.

Anyway I love it and it's sturdy enough to be a wearable, but I want to treat it as gently as I can in order to prolong its life.

#122 ::: B. Durbin ::: (view all by) ::: July 09, 2008, 08:17 PM:

abi @ #112: The Betsy-Tacy books are, IIRC, set sometime around 1900 in Minnesota. Or Wisconsin. Basically somewhere in between a town and a city, but one that had only been around for a few decades, so no entrenched slums. And "run around and play" means up the hill, down the hill, as far as they wanted to go, and nobody supervising.

And "Tacy" is short for Anastasia, of all things.

#123 ::: Emily ::: (view all by) ::: July 11, 2008, 01:13 PM:

Oh, someone mentioned milk up-thread. If you're in the developing world, boil the hell out of any milk you get unless you're certain it's been boiled before you drank it. You really don't want to get bovine tuberculosis or brucellosis while you're trying to keep hydrated due to the cholera.

Listeria too iirc. Raw milk is nasty nasty stuff if the dairy is not kept immaculately clean. And while a dairy can be kept that clean, pasteurization is easier, cheaper and faster. I'm a huge fan. I have had safely produced raw milk before, and... I'd rather have pasteurized. I was raised in dairy country, so I just assume that no one is crazy enough to drink raw milk.

US doctors often assume in their hydration rules that you're in the US. Reasonable assumption.

(and since it counts as solid food, I don't think anyone *should* try it for a dehydration with nausea illness til the patient is past the nausea point. Calories are good, increased vomiting is NOT.)

This does bring a question to mind tho... has anyone *checked* whether cholera and other virulent illnesses pass through breast milk? I know all kinds of unpleasant stuff does, and it would be useful to know whether to pasteurize breast milk in an epidemic...

#124 ::: P J Evans ::: (view all by) ::: July 11, 2008, 01:46 PM:

Emily @ 123
My father, who spent part of his childhood on a dairy, said that he wouldn't drink unpasteurized milk unless he knew the cow.

#125 ::: Ginger ::: (view all by) ::: July 11, 2008, 03:46 PM:

Emily @ 123: Cholera is fecal-oral transmission, so not likely to be in the breast milk as produced -- however, should the outside of the person producing the milk be contaminated, or any part of the handling of said milk be contaminated, then yes, milk can carry anything.

But yes, we do have some idea of which things can be passed through milk, and which cannot.

#126 ::: Rob Rusick ::: (view all by) ::: July 11, 2008, 05:25 PM:

Emily @123: Raw milk is nasty nasty stuff if the dairy is not kept immaculately clean. And while a dairy can be kept that clean, pasteurization is easier, cheaper and faster. I'm a huge fan. I have had safely produced raw milk before, and... I'd rather have pasteurized. I was raised in dairy country, so I just assume that no one is crazy enough to drink raw milk.

Years ago I spent a couple of weeks on an uncle's farm. First day there I watched my uncle milk the cows. After he milked the cows, he brought the milk into a small shed where they kept the separator. That room was thick with flies and the smell of sour milk. There was a useless flystrip hanging from the ceiling; useless because it was black with flies and there was no more room left to catch any.

The family drank the milk from their own cows. I asked if they pasteurized the milk; the answer was 'no'. I avoided drinking any milk for the rest of my stay.

#127 ::: Naomi Kritzer ::: (view all by) ::: July 13, 2008, 03:23 PM:

Wash your hands (in known good water) after using the toilet and before preparing food.

The "known good water" part strikes me as impractical in many places where the water is likely to be unsafe. As a college student, I spent a semester in Nepal, where all the water can be safely assumed to be fecally contaminated. (Unless you are standing on top of Mount Everest, you are downstream from other people.) I did not drink anything that hadn't been boiled or treated with iodine, but I didn't have the luxury of treating my wash-water, especially as boiling water required firewood in most parts of the country, and deforestation was a huge problem already. The UV water treatment gadgets they make for hikers may have improved the situation, but honestly, worrying about wash-water has always struck me as a recipe for driving yourself nuts while traveling in a developing country. Do you also worry about the water that falls on your face while you're showering? About the water your dishes were washed in? I would go ahead and embrace paranoia if I were in an area that was experiencing a cholera epidemic, but while traveling in South Asia as a student I stuck with normal precautions (don't drink or brush teeth with untreated water, cook vegetables or choose fruits and veggies with a nice thick peel, tea is your friend) and beyond that, trusted in the protection of (a) my knowledge of how to orally rehydrate myself if I got sick and (b) my well-nourished privileged first-world immune system.

#128 ::: 'stina ::: (view all by) ::: July 16, 2008, 06:08 PM:

When I was in grad school for public health, my epidemology prof used to call John Snow the Father of Epidemology.

#129 ::: James D. Macdonald ::: (view all by) ::: December 04, 2008, 05:31 PM:

Zimbabwe declares cholera national emergency

HARARE, Zimbabwe (CNN) -- The Zimbabwean government has declared a national emergency in the face of a cholera outbreak that has killed more than 560 people, the state-owned newspaper The Herald said Thursday.

Harare also appealed for help for its hospitals, which Health Minister David Parirenyatwa said "are literally not functioning."

Reportedly, cholera is on the increase in nine of Zimbabwe's ten provinces.

Boil your water, and if you show signs and symptoms ... drink water. By the gallon.

#130 ::: Fragano Ledgister ::: (view all by) ::: December 06, 2008, 12:07 PM:

Jim Macdonald #129: Robert Mugabe needs to drink some untreated water.

#131 ::: Ginger ::: (view all by) ::: December 06, 2008, 01:06 PM:

Fragano @ 130: Pretty soon, all the water in Zim will be untreated. Open sewage lines in the capital? Eventually someone in his entourage will drink unboiled water, and then the clock will be ticking.

Let's see: they've had War, and Famine -- now it's the turn of Pestilence.

#132 ::: Fragano Ledgister ::: (view all by) ::: December 06, 2008, 03:39 PM:

Ginger #131: The way in which Mugabe has changed from liberator to leech is terrifying. He needed to go years ago.

#133 ::: Xopher ::: (view all by) ::: December 06, 2008, 04:01 PM:

Fragano 130: Robert Mugabe needs to drink some untreated water.

Robert Mugabe needs to drink some Flavor-Aid®.

#134 ::: Fragano Ledgister ::: (view all by) ::: December 06, 2008, 07:27 PM:

Xopher #133: You are too kind to the old bastard.

#135 ::: Xopher ::: (view all by) ::: December 06, 2008, 08:20 PM:

I am practical. Might be able to slip it to him. I suppose if everyone but Mugabe and his minions fled the capital, it could be bombed flat, but even that's risky.

#136 ::: Ginger ::: (view all by) ::: December 06, 2008, 10:26 PM:

Fragano @ 132: Apparently, Mugabe was a master of deceit and murder before he got into office, and -- not surprisingly -- got worse once in power. I've got South African friends who reported that there'd been suppressed information leaking out way back when, and it was too little/too late at the time.

#137 ::: Fragano Ledgister ::: (view all by) ::: December 08, 2008, 08:19 AM:

Ginger #136: That wasn't clear to the rest of the world at the time, of course. It wasn't even clear to Joshua Nkomo.

#138 ::: Elliott Mason ::: (view all by) ::: January 01, 2009, 02:08 PM:

Fragano Ledgister @ #130 Robert Mugabe needs to drink some untreated water.

He's convinced, by the way, that it's a US bioterror attack on his nation.

Because if the US was honestly going to use biological agents on a country deemed 'enemy,' we'd use CHOLERA. Riiiiiight.

#139 ::: Epacris ::: (view all by) ::: January 01, 2009, 07:14 PM:

Elliot @138, his government has mostly been blaming the UK, rather than USA:

“This was a calculated warfare. There are forces who are continuing to plant anthrax and cholera disease.

“Cholera is a calculated, racist attack on Zimbabwe by the unrepentant former colonial power, which has enlisted support from its American and Western allies so that they can invade the country.” (Mugabe claims cholera was released by the British Telegraph (UK) 13-Dec-2008)
Squid ink.

#140 ::: Fragano Ledgister ::: (view all by) ::: January 02, 2009, 02:53 PM:

Epacris #139: I'm waiting for Mugabe to start blaming the Martians. They're just as likely to be responsible as the British, after all.

#141 ::: Elliott Mason ::: (view all by) ::: January 06, 2009, 01:14 PM:

Epacris #139: Still holds true. Any disease that can be cured by unlimited access to safe drinking water isn't a credible bioterror threat ... unless your country is falling to shards around you in the first place.

#142 ::: James D. Macdonald ::: (view all by) ::: February 24, 2009, 12:30 AM:
"Then, in 1883, Koch achieved the first great triumph of science over disease. Earlier in the nineteenth century, two cholera epidemics had devastated Europe and the United States. As a new epidemic in Egypt threatened the borders of Europe, France dispatched investigators in this new field of bacteriology to track down the cause of the disease. Germany dispatched Koch.

"Before this, medicine's greatest successes had come about almost serendipitously, beginning with an observation. With smallpox Jenner started out by taking seriously the experiences of country folk inoculating themselves. But not here. In this case the target had been fixed in advance. But the French and Koch rationally designed an approach, then turned the general tools of the laboratory and bacteriology to a particular target.

"The French failed. Louis Thuillier, the youngest member of the expedition, died of cholera. Despite the bitter and nationalistic rivalry between Pasteur and Koch, Koch returned with the body to France and served as pallbearer at Thuiller's funeral, dropping into the grave a laurel wreath 'such as are given to the brave.'

"Koch then returned to Egypt, isolated the cholera bacillus, and followed it to India to explore his findings in greater depth. John Snow's earlier epidemiological study in London had proved only to some that contaminated water caused the disease. Now, in conjunction with Koch's evidence, the germ theory seemed proven in cholera--and by implication the germ theory itself seemed proven.

"Most leading physicians around the world, including in the United States, agreed with a prominent American public health expert who declared in 1885: 'What was theory has become fact.'

"But a minority, both in the United States and Europe, still resisted the germ theory, believing that Pasteur, Koch, and others had proven that germs existed but not that germs caused disease--or at least that they were the sole cause of disease.

"The most notable critic was Max von Pettenkofer, who had made real and major scientific contributions. He insisted that Koch's bacteria were only one of many factors in the causation of cholera. His dispute with Koch became increasingly bitter and passionate. With a touch of both Barnum and a tightrope walker about him, Pettenkofer, determined to prove himself right, prepared test tubes thick with lethal cholera bacteria. Then he and several of his students drank them down. Amazingly, although two students developed minor cases of cholera, all survived. Pettenkofer claimed victory, and vindication.

"It was a costly claim. In 1892 cholera contaminated the water supply of Hamburg and Altona, a smaller adjacent city. Altona filtered the water, and its citizens escaped the disease; Hamburg did not filter the water, and there 8,606 people died of cholera. Pettenkofer became not only a mocked but a reviled figure. He later committed suicide."

--The Great Influenza: The Story of the Deadliest Pandemic in History by John M. Barry, pages 52-53.

#143 ::: Jon Meltzer ::: (view all by) ::: May 02, 2010, 01:08 PM:

Reopening this thread because of current Boston water situation.

#144 ::: Thena ::: (view all by) ::: May 02, 2010, 02:01 PM:

RE: Jim Macdonald @ The Happy Wanderer #71/72 -

Is there a Jim Macdonald emergency water post?

Not yet.

Your four basic choices are boiling, distillation (which you might think of as boiling with fancy additions), filtration, and chemical purification (usually iodine or chlorine; choose your poison).

Individually or in combination, depending on the nature of the contamination:

boiling will kill microbes and parasites but doesn't do much for chemicals or debris;
same for chlorine / iodine treatment, both of which leave their own residue;
filtration's effectiveness depends on how fine your filter is but it works for macrocontaminants such as mud;
distillation takes the water out of the everything else and puts it into another container, but it requires a heat or vacuum source to vaporize the dirty water, and a clean container to collect the distillate in.)

#145 ::: David Harmon ::: (view all by) ::: May 02, 2010, 02:10 PM:

News links: on the initial story and "boil-water order"

MSNBC on early response -- the fix is going faster than expected.

#146 ::: Mary Aileen ::: (view all by) ::: May 02, 2010, 02:11 PM:

Depending on how serious the contamination is, you may also have to be careful when showering/bathing. Getting contaminated water in open wounds (cuts, abrasions), your mouth, and maybe your eyes could be a bad thing.

#147 ::: Mary ::: (view all by) ::: May 02, 2010, 02:20 PM:

From David Harmon's second link in #145: "safe for showering." That makes things easier.

About fifteen years ago, there was a bad water main break in the town I lived in; similar precautions were in place for a day and a half. They feared cross-contamination from the sewer lines, but fortunately that didn't happen. (Very fortunately: the kids at the schools had been drinking out the water fountains all morning before the break was discovered. That could have been bad.)

#148 ::: Mary Aileen ::: (view all by) ::: May 02, 2010, 02:22 PM:

(#147 was me. Not sure how that happened.)

#149 ::: Thena ::: (view all by) ::: May 02, 2010, 02:34 PM:

@144 I fubar'd the html somehow, and the first the paragraphs of that are Jim.

My own blathering starts at "Individually or in combination...."

#150 ::: Seth Gordon ::: (view all by) ::: May 02, 2010, 04:13 PM:

Good news: we have plastic gallon jugs of spring water stashed in our basement against just this kind of eventuality.

Bad news: the jugs are over two years past their sell-by dates.

I’m not sure how bad this bad news really is; it’s not like the containers have been exposed to direct sunlight for any of this time.

#151 ::: Kathryn from Sunnyvale ::: (view all by) ::: May 02, 2010, 04:23 PM:

If you know what's in the water to contaminate it, UV purification is an option. However, you have to know that the organism is vulnerable to UV, and the water has to be clear enough for the UV to get to the organism.

#153 ::: Jim Macdonald ::: (view all by) ::: May 02, 2010, 07:48 PM:

And, for our friends in Tennessee: if you're in a flood zone, boil your water even if there isn't an official announcement.

Just sayin'.

#154 ::: James D. Macdonald ::: (view all by) ::: October 22, 2010, 03:00 PM:

Cholera kills 138 in 48 hours

(CNN) -- Chaos reigned north of Haiti's capital Friday as hospitals overflowed with people rushing to get help from a fast-moving cholera outbreak that has killed at least 138 people.

Eric Lotz, Haiti's national director for the nonprofit Operation Blessing, described a "horrific" scene outside St. Nicolas hospital, the main medical facility in the city of St. Marc, as patients and their family members fought to get care.

"There was bedlam outside the gate," said Lotz. "Inside (the hospital), every square inch is covered with people."


#155 ::: Lee ::: (view all by) ::: October 28, 2010, 08:43 PM:

Sidebar on cholera epidemic in Haiti from BoingBoing. Pretty much summarizes the top-post, minus the historical data; it's a good overview for people who don't know anything about cholera.

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