Krankheit im Labor: Robert Koch und die medizinische Bakteriologie (review)

This book contains four almost-separate studies, based on the author's Heidelberg Habilitationsschrift. The first section is on the early nineteenth-century discussions of infectious disease in relation to the "lower fungi," as they were called, and the genesis of laboratory bacteriology; the next, on the tuberculosis-tuberculin problem; the third, on experimental therapy; and the last, on Robert Koch's bacteriological travels. Together, they link up to form a detailed and lifelike account of a man, his science, and his politics. There are plenty of historical works on Robert Koch, on the history of bacteriology, and on the introduction of laboratory medicine, in French, German, and English. As the historiography of medicine has veered away from its origins in the classics and medieval medicine, the history of the late nineteenth-century laboratory has become a favorite trope, a mirror in which the twentieth century found a recognizable scene, not too far removed from its own experience. But Christoph Gradmann manages to make it strange: an enclosed world—a Denkstil, as Fleck famously called it¹ —embodied in the life of one man.

Gradmann's Koch works through two separate disciplines: botany and medicine. The tensions between them are the tensions between the laboratory and the clinic. As a botanist, Koch's bent is ontological—toward the identification of the causal organism. His animal model allows him to control the world in which his creation, the tubercle bacillus, lives. But the point of bacteriology is its application in the clinic, and the patients are not virgin guinea pigs. Their disease is chronic and uncontrolled—no one knows how long they have had it. Even the healthy negative controls react furiously to Koch's tuberculin, unlike the guinea pigs who are otherwise so sensitive to infection. The bridge from laboratory to clinic is not easy to cross, for one whose principles include the stability of bacterial species with constant pathological effect. There is no room in this for healing or resistance—the patient is nothing more than a passive recipient of infection: we look at things from the point of view of the bacteria, rather than the disease or the sufferer (pp. 130–31). The bacteria advance in an irresistible, quasi-military formation, and colonize the body; but Gradmann makes the interesting remark that the popular conception of them as a conquering army came first from a more general worldview that historically included such military stuff, a preconception rather than a result of the work of the bacteriologists (p. 343).

Koch's most glorious successes come when he can allow himself to live up to those clear principles: the anthrax bacillus and its sprouting spores are a single, stable species; the normal body, like the new guinea pig, is free of germs; the causal organism of tuberculosis can be seen and stained in the sputum; and the organism of cholera can be found in the gut of the dead and in the water of the Calcutta tanks where the people wash their linen and dip out their drinking water. The patient is either a postmortem subject or a culture medium. There are several instances when patients do actually play the role of guinea pigs: in spite of legislation against it, new treatments continued to be tried out on more or less passive patients—some of whom, as in the case of the Africans with sleeping sickness, were held by force while treatment was carried out.

If this sounds like a very harsh attitude toward Koch and his work (we think of Geison on Pasteur here),² Gradmann softens it by his sympathetic reading of the archival material: publications, notes, letters (some personal), and reports, published and unpublished, of Koch himself and his fellows in science and government—the "fine structure" of a scientific life, as Holmes called it.³ "Fine structure" generates an intimacy, so that you cannot be too harsh; there has to be a...