BPL Book Discussion: The Ghost Map

Monday we met and had an engaging, interesting, and I would even venture to say a bit raucous, discussion of Steven Johnson's 2006 bestseller and award winning The Ghost Map.  Here is the official summary from the publisher:

"This is a story with four protagonists: a deadly bacterium, a vast city, and two gifted but very different men.” So begins Steven Johnson’s multi-layered account of the 1854 London cholera epidemic. London was just emerging as one of the first modern cities in the world, but it lacked the public health infrastructure to support its exploding population. As a result, the city became the perfect breeding ground for a deadly disease. Rising up against the dogma of the scientific community, two men, Dr. John Snow and Reverend Henry Whitehead, attempted to put a stop to the epidemic, and in doing so revolutionized the way we think of the spread of disease, the nature of scientific inquiry, and the rise of the modern city.

So yes, we had a great discussion about sewage and poop.  I was a bit worried before we started, so I made a conscious effort to get the uncomfortable stuff out of the way from the start.  I began by saying, "I know we usually start by asking who liked, disliked, and was so-so on the book, but I realize no one is going to admit to liking a book about poop, so I will change the question to who found the book interesting, not interesting enough to get over that it is about poop, or so-so."

This did a lot to alleviate the discomfort a few people had when they came in.  I diffused the situation with humor and a direct acknowledgement of the subject matter.  If you discuss this book, even of you are okay with talking about poop in public (I'm all good, my hubby is a doctor; poop is tame for our house), don't underestimate how uncomfortable others may be.  Cut it off at the pass.

Now on to the discussion:

• We had 9 Interestings and 5 so-so, but not a single person raised their hand for not interesting.  People had different parts that they enjoyed more than others.  Many cited how much they enjoyed the history of science angle.  One person got specific and said she really liked following the discovery process.  Another group of people said what most intrigued them was how Johnson probed into why people hang on to a wrong idea for so long, and how John Snow worked tirelessly to change their minds.
• One of my favorite comments of the entire discussion came from the participant who said that this book reminded her that "clean water is a gift."
• We talked at length about how Johnson structured the book. This will come up frequently as I recount our discussion.  The first issue that came up about this was that there were a few people who disliked the opening chapter.  This chapter was all about the way the sanitation was handled by different people who worked in the underclasses in Victorian England.  There was a lot of detail about how poop was scooped and recycled/disposed of (to put it succinctly).  Those who really enjoyed the epidemiology part of the book, said they just needed to get past this part.
• In general John structures the book in a narrative style. He is telling us the story of as I quoted above, "...a deadly bacterium, a vast city, and two gifted but very different men.”  This is not a linear story. As a result, they are a lot of "side stories" or tangents that Johnson goes off on for longer periods of time before eventually making his way back to Snow and Rev Whitehead (the two gifted men).  Some people were turned off by this wandering style, but a few others loved it. One participant said, "the way he told the story was exactly how my brain works; moving around and following the different leads and questions before going back to the main point."
• The cholera bacteria itself is also a character here.  One woman summed it up perfectly. She started talking about how it attacked the body.  As she was going into some of the graphic details, she cringed a bit.  I asked her if it bothered her.  She straightened up and said, "Oh no.  It was gross, but it was great!."  We all liked learning how bacteria alone are nothing, but how when they come together, they get a group intelligence. We know all know how they use us to live, but when the cholera bacteria kills us, they too die, unless they can get back in the water supply to find a new intestine.
• We talked about John Snow.  Below, I have a link to a large online archive of his work, and there I learned how he is not known in the normal world, but among doctors and medical workers, he is considered the best doctor ever.  We talked about why Snow was the man to finally convince the world that things we could not see in the water were causing cholera, not a bad smell.  Here are some things that were said:
• he was curious
• the ultimate researcher
• cared about people
• very skilled and studied every kind of medicine
• lower class origins so was willing to go into the homes of the poor
• was willing to look elsewhere for answers
• He was more than a doctor: he was a physician, one of the first anesthesiologists, a statistician, an anthropologists, a sociologist, an epidemiologist, a map maker, a public health worker.
• While Farr made a map of the deaths from cholera, Snow used the data and his work on the street level to make that death map into a ghost map.  It was about the people and how they lived rather than just statistics about where and when they died.  This was key to finding the index case and proving how the cholrea got from one baby's dirty diaper into the entire water supply for one neighborhood.
• He was courageous: it takes courage to fight those with all the money and power, but Snow did it
• We decided Snow was like a third party candidate would be today; this led us on a side tangent (Johnson would have been proud) on how much we need a third party candidate with Snow's qualities today. Someone who would allow us to look at the whole picture from a bird's eye view, just as he did with this cholera outbreak.
• We decided that Bill Gates is like Snow.  He has the time, money, brains, and influence to tackle similar issues.  Right now, Gates is working on clean water issues in Africa.
• This book is an emotional roller coaster ride, noted one person. We know Snow will win out and people will conquer cholera, making it safe to live in cities as a species for the first time in history, but the trip to get there was emotional.  Many of us were extremely touched by the discussions of entire families suffering and dying together behind closed doors.  But we also decided that the 8 days chronicled in this book really did change the world forever.  At least the suffering was all worth it.  But as a counter point, you could not relax while reading this book.  That comment really struck a chord with a majority of the group.  While everyone found the book interesting and are very glad they read it, very few enjoyed the reading experience in the traditional sit back and read a good book way. 
• Back to the style for a second.  Not only are there a lot of side stories here, but a few people commented on how there is a lot of repetition.  Johnson hammers the same points over and over again.  One person said, "It was like my husband talking to me." I refocused the group and asked them to consider that maybe Johnson was repetitive for a reason.  In general I find that when something about the style bothers the group, if I ask them to consider why the author made this style choice and get them to stop thinking about whether they liked it or not, I can squeeze some discussion out of them beyond, "I didn't like that part." It was suggested that maybe he used repetition to underscore how meticulously Snow had to build his case against the miasma theory.  Johnson wore us down to show how hard it was to knock the prevailing theory down.
• The last 2 sections (conclusion and epilogue) brought out a lot of negativity.  Multiple people asked where the editor was here.  The problem is that the tone changes.  The book proper ends with summing up the work of Snow and then a comment about how there is a still a pub on the same spot from that fateful summer, only it has been renamed The John Snow.  But then the conclusion and epilogue are, as one person put it, Johnson up on a soapbox. We liked how he made the case for living in cities as the best way for people to live: it is cheaper, greener, and safer.  We loved learning about how NYC's 311 helps them to collect data about how New Yorker's live. But then he gets into terrorism.  The best way someone put it was that the narrative shift was very jarring.  The book went from carefully constructed narrative to soapbox preaching.  Even when we agreed with him, we did not appreciate the style. We understood that he wanted to make the connection to today, but we felt he had already done that.
• Instead, we decided we would have liked more about how people still hang on to ideas that are wrong and how we can convince people to change their minds.  Snow was an information manager.  Someone mentioned how today we are only at the beginning of "The Information Age" and we would have liked to see Johnson talk about that more. He only grazed the surface of that issue.
• By the way, we wanted more detailed examples of Snow's maps.  You can see them online here, but in the book would have been good.  The one map we get is fuzzy and has very little detail.

At the end of the book, Johnson points the reader to a webiste hosted by UCLA's school of public health that is deidcated to John Snow's life and times.  Click here to access it.

Readalikes:  NoveList suggests some good readalikes for The Ghost Map in its book discussion guide.  They include but are not limited to:

• London: The Biography by Peter Ackroyd
• The American Plague: The Untold Story of Yellow Fever, the Epidemic That Shaped Our History by Molly Caldwell Crosby
• The Hot Zone by Richard Preston
• Cholera, Chloroform, and the Science of Medicine: A Life of John Snow by Peter Vinten-Johansen, Howard Brody, Nigel Paneth, Stephen Rachman, and Michael Russell Rip
• The Map That Changed the World by Simon Winchester

You can access the "why" each of these books works by going to NoveList through your local public library.

I think these books represent a nice range of readalike option.  To these I wanted to add some other nonfiction that shares no subjects in common, but all are authors who combine science and history and write their books with an engaging style:

• Walter Isaacson
• Michael Pollan
• Dava Sobel

I have also read a few historical novels which are engaging but also teach you something interesting and different:

• The historical mysteries of Matthew Pearl
• Ghostwalk by Rebecca Stott
• Brookland by Emily Barton

Finally, the last section of The Ghost Map has a lot about today's squatter cities with their similar structure to Victorian England.  One of this year's consensus best books addresses this issue directly, Behind the Beautiful Forevers: Life, Death and Hope in a Mumbai Undercity by Katherine Boo.  It makes a great 21st Century companion read to Johnson's Victorian set work.