Death by the Numbers


During the nineteenth century, Britain was struck by four epidemics of cholera, an often fatal disease characterized by attacks of diarrhea so intense that the body may lose gallons of water in just a few hours. The horrifying symptoms—dehydration so severe that the flesh shrinks back against the skull and the blood turns to jelly—appeared suddenly, and death could follow in the same day. It felt “like being hit with a club,” reported one survivor.1

Doctors, desperate to conceal their powerlessness, prescribed the following as “cures”: boiling water applied to the belly, electric shocks, enemas of turpentine and mutton stew, and gunpowder fired into the air in the vicinity of the patient. The public variously attributed the disease to ozone, ionic fields and other disturbances of the atmosphere, fumes produced by rotting sewage and putrescent yeast, and poison administered by doctors: at the time there was strong demand in medical schools for cadavers for dissection purposes, and this led to a spate of much-publicized murders, some of which were rumored to be linked to the cholera epidemics.2

Steven Johnson’s The Ghost Map tells the story of how the mystery of cholera transmission was solved by an ingenious physician named John Snow and how his discovery helped eliminate cholera from Britain and eventually from the Western world. But it also tells a parallel story about how a modern state bureaucracy emerged to confront one of the many novel challenges posed by urbanization. Nineteenth-century London was characterized by great civic turmoil. Never before had three million people lived together in so limited a space, and as Johnson points out, some doubted whether such a dense settlement was sustainable at all. Writer and publisher Sir Richard Phillips, whom Johnson quotes, even suggested there was something dangerous in the idea of the city itself:

The houses will become too numerous for the inhabitants, and certain districts will be occupied by beggary and vice or become depopulated. The disease will spread like an atrophy in the human body, and ruin will follow ruin, till the entire city is disgusting to the remnant of the inhabitants…. Such have been the causes of decay of all overgrown cities. Nineveh, Babylon, Antioch, and Thebes are become heaps of ruins….

The growth of cities and towns set off by the industrial revolution would forever transform the economy and culture of the West, but it also caused unprecedented upheavals, including vast inequalities in wealth, class tensions, the weakening of social ties, and overcrowding and squalor of an order previously unknown. These last conditions provided new niches for deadly diseases like cholera that could not spread through scattered rural populations.

Public coordination was required to manage a sprawling urban organism like London, and various government offices emerged to oversee the paving and lighting of streets, the collection of taxes, the construction and management of sewers, drains, prisons, and workhouses, and to respond to crises such as epidemics. Like the compartments of some giant developing brain, these…

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