Fluid Lives

Malaria, dengue and health in contemporary South Asia


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Mapping Life and Death in Victorian Soho

Friday 15th March was the 200th anniversary of physician John Snow‘s birth (1831-1858). Although better known in his day for his work on ether and chloroform as anaesthesia (including administering them to Queen Victoria during the birth of her last two children), he is best known today as one of the fathers of modern epidemiology, tracing and mapping a cholera outbreak in 1854 to a pump on Broad(wick) Street in Soho. So there has been a flurry of internet excitement in urban and epidemiological circles around the 200th anniversary of John Snow’s birth – The Guardian even describing him as a ‘data journalist‘ (although given his fight to get his work recognised as science I’m not sure he’d have found that title useful!). Two weeks later, I have finally got around to seeing the London School of Hygiene and Tropical Medicine‘s exhibition ‘Cartographies of Life and Death: John Snow & Disease Mapping‘.

For the most part, the exhibition places the power of mapping and cartography as an innovation central to thinking about the recording of death and disease. 1854 was also the year that the Crimean War broke out, where Florence Nightingale was to assiduously collect and record of data on cleanliness and sanitation in hospitals using ‘coxcomb’ diagrams. The combination of detective work and powerful visual narratives in the shape of maps and mapping means the topic fits well with contemporary interests in data visualisation, the potential of health and medical records as datasets and in particular for ‘big data’ in drawing out correlations between types of ill health and other factors, recording disease incidence and modelling its progression.

Just as contemporary developments in computing power are allowing new manipulations of very large data sets, mid-19th century developments in printing and map making had allowed Snow to plot, record and then publish his work in map, rather than simply tabular form as ‘On the Mode of Communication of Cholera‘ the following year in 1855. In 2013 both printed and mobile (phone) maps now allow one to walk around the streets of Soho itself, and get a sense of the visual clarity that maps provide, but also as one crosses roads and dodges boisterous late Saturday afternoon pedestrians, to get a sense of the everyday melee that the data was distilled out of. The exhibition brought these kinds of data visualisations up to date with a screen showing Google Earth updated with postings to the Pro-MED  (Program for Monitoring Emerging Diseases) email list.

It’s hard to disagree with Beth Skwarecki list on the PLOS Public Health Perspectives blog of the top three things she things she thinks we’re still learning from John Snow’s work:

  1. That data visualisations can make powerful arguments for change,
  2. that microbes have been under our noses all the time
  3. and that sanitation and clean water are still (no brackets needed!) really important.

But other striking things emerged from the exhibition and maps too. On the handbill version of the exhibition map, sites in contemporary Soho are marked with quotes from Snow’s ‘On the Mode of Communication of Cholera‘. We learn that residents of Soho themselves had their suspicions about different water sources:

“37 Broad Street. Mr Eley, the percussion-cap manufacturer of 37 Broad Street informed me that he had long noticed that the water became offensive, both to smell and taste, after it had been kept about two days. This as I noticed before, is a character of water contaminated with sewage. Another person had noticed for months that a film formed on the surface of the water when it had been kept a few hours.”

Elsewhere

“Brewery on Broad Street. There is a brewery on Broad Street, near to the pump, an on perceiving that no brewer’s men were registered as having died of cholera, I called on Mr Hugguns, the proprietor […] the men were allowed a certain quantity of malt liquor, and Mr Hugguns believed they do not drink water at all; and he is quite certain that the workmen never obtained the water from the pump in the street. There is a deep well in the brewery, in addition to the New River Water.”

Similarly, there was a Workhouse on Poland Street, which with its large number of (by definition) poor residents living in close conditions might be expected to have had a large number of deaths, saw only 5 deaths out of 535 inmates. But the workhouse had its own pump on the premises, and received piped water from the Grand Junction Water work, not the Broad Street pump. The dept of the pump in both of these cases is significant, placing it below the level of a shallow bore pump that drew in water contaminated by cesspits and drains. Faecal contamination, even of piped water remains a significant problem in rapidly urbanising cities where functioning sewerage systems may be hard to come by or entangled with water distribution pipes owing to the order in which they are laid.

Nonetheless, the Broad Street pump water had its own attractions, particularly its taste and coolness at the end of a long hot summer.

“The pump-water was also sold in various little shops, with a teaspoonful of effervescing powder in it, under the name of sherbert; and it may have been distributed in other ways which I am unacquainted with.”

Although the shorthand that a map provides as a visualisation of data is powerful enough a technical and rhetorical form to eventually challenge and displace the miasma explanation for cholera (no surprise that Edward Tufte is a fan of Snow’s work) to that of germ theory, it is also clear that many of these insights would not have been available to Snow without spending consdierable time walking the streets and talking to people. It was not only proximity to the Broad Street pump that lead people to drink from it. The sensual dimensions of water, it’s taste, coolness and slight carbonation also shaped people’s preferences for one pump or another. In Steven Johnson’s book The Ghost Map, an entertaining account of Snow’s work and battle to get it recognised (and excellent TED talk), further details of the Eley family, whose percussion-cap business was based at 37 Broad Street (above) also appear.

“Even emigres from Golden Square retained their taste for the Broad Street well. Susannah Eley, whose husband had founded the percussion-cap factory on Broad Street, moved to Hampstead after being widowed. But her sons would regularly fill a jug with Broad Street water and deliver it to her by cart. The Eley brothers also maintained two large tubs of well water for their employees during the work day. With temperatures reaching the mid-eighties in the shade on those late-August days and no wind to freshen the air, the collective thirst for cool well water must have been intense.” (No page number)

While the addresses of those who appear on the parish burial records provide would have provided Snow with points that could have been plotted on a map, without his work walking the streets and talking to people, recognising the significance of the social and economic relations of those who lived in the streets around the Broad Street pump, cases would have been missed. Furthermore, vital counter examples such as the lack of deaths of those associated with the Brewery and relatively few at the Workhouse on Poland Street with their independent source of water would not have emerged. Yet Snow’s struggle to get his interpretation of the data recognised, against a miasmatic framing of disease and the handle of the contaminated Broad Street pump permanently removed, is also indicative of contemporary struggles with government bodies to provide adequate infrastructures.

In his recent book ‘Urbanising Cholera: The Social Determinants of Its Re-emergenceRajib Dasgupta argues for a return to a more holistic approach to epidemiology, understanding how biological, environmental and behavioural factors are located within wider structures, in contemporary rapidly growing cities, like Delhi. He argues that diseases like cholera need to be approached as a complex phenomenon at the interface between biomedical, environmental, social and political domains. Water infrastructures too are at this interface, winding their way through present day cities, linking neighbours in unexpected ways, and fractures and disjunctions, as well as distrust between others. All of these factors need carefully tracing and understanding how they come together as a complex assemblage of relations, or in the case of disease as medical anthropologist Merill Singer might better put it, a syndemic.

More on the John Snow Bicentennary: http://vimeo.com/channels/johnsnow

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Casting off – Fluid lives in a South Asian megacity

At some point in most summers, water-shortages and an unpredictable supply make the headlines in Delhi. Soaring temperatures and often a late monsoon fray already shortened tempers, aggravating relationships between North Indian federal states and boosting the profits of private water tanker operators, as the struggle to access water preoccupies residents across the city. As the level of the River Yamuna fell, water pressure across the distribution network may drop. At the same time, power outages frequently prevent the use of booster pumps to suck water from the pipes or from illicit boreholes in informal, ‘unauthorised’ neighbourhoods on the rapidly urbanising margins of the network. One summer recently, after several days of receiving little to no water at all protests in one such neighbourhood turned violent, as residents vented their frustration at their lack of formal recognition and incorporation into the state’s distribution network by stoning government buses. Yet the struggle for water in Delhi is far from exceptional and shapes the everyday lives of the city’s 17million residents. Waiting for water disrupts the patterns of daily life and requires local politicians to be petitioned for a greater, cleaner or timelier allocation of water. Meanwhile, buying in supplementary water supplies is a substantial drain on often insubstantial household incomes.

[Updated 2014] This blog began to provide an informal research notebook for my new research project which at that point was to explore how people in Delhi negotiate the slippery issue of water in their everyday lives. Can attention to the history and development of water infrastructure shed light on contemporary issues? How do different narratives and discourses about shape understandings of water, wellbeing and the city and illustrate the social and political relations within which water is embedded at different scales? In particular what can attention to water tell us about the pressing wider questions of health in a ‘global city’ under conditions of rapid urbanisation?

While this research has come to focus on dengue fever as a complex, multiscalar entry point to undersand the interrelationships between disease, health and the socio-enviornment of the city, many of my concerns discussed here persist. Understanding Delhi’s water network as an assemblage of different kinds of relations, be they social, political, historical, technical, structural etc (in a more Ong & Collier sense, than a D&G or specifically Latourian sense – you can interview humans after all), this project will explore some of these issues through a number of strategic spatial and temporal locations. Some of these explorations I plan to discuss here. This work builds on my earlier research exploring the spatial dimensions of the politics of development in Delhi through the lives of resettlement neighbourhood residents; people who survived the demolition of their houses by the state nearly 40 years ago, rebuilding their lives on what was once the periphery of the city. Here too questions of water, access to it, entitlement to it, played out against a wider backdrop of debates about the place of the urban poor in the city.

Posts may take the form of reflections on debates in the literature, contemporary concerns in development circles, observations on Delhi happenings, and other interesting things. Crucially all these thoughts and posts are provisional. As Teo Ballvé eloquently puts it: ‘This blog is my motley space for commentary, summary, research notes, study, and whatever else I might want to do.