-
Introduction
- Johns Hopkins University Press
- Chapter
- Additional Information
Introduction T his story begins and ends with a wave of foul odors in Paris. In 1880, a pervasive and disgusting stench a=licted the city for most of the summer, provoking a popular outcry and a minor political crisis. According to the consensus of medical experts and ordinary Parisians, the odors either could cause or did cause disease. In 1895, a similar stink arose in the city, again sparking anger and indignation among the population. This time, however, scarcely anyone claimed that the odors spread disease. This book tells the story of how public health knowledge and practice changed—and didn’t change—during the fifteen years separating the two unpleasant episodes. The germ theory of disease was a critical ingredient in the shift but cannot alone explain it. The years at the heart of this story coincide with the apex of Louis Pasteur ’s career. In 1880, Pasteur was already well known for his work on silkworms , wine, and beer, but he had only recently begun to turn his attention to the role of microorganisms in human disease. Because of his reputation for scientific innovation and problem solving, Pasteur was appointed to the national commission formed to study the Great Stink of 1880. The commission concluded that foul odors could indeed spread disease—not as generalized miasmas but as vehicles of specific pathogenic microbes. Pasteur cited a recent study at a farm north of Paris in which he claimed to have found sheep that became infected with anthrax simply by sni;ng the ground beneath which sheep that had died of anthrax years earlier were buried. In e=ect, the centuries-old doctrine of miasmatism seemed to have gained validation from the new science of germs.1 In 1895, less than two months after the end of the second Great Stink, Louis Pasteur died in St. Cloud outside Paris. So great was his fame that his elaborate state funeral drew thousands of mourners into the streets of the capital as the mile-long procession led by the Republican Guard carried the co;n from the Pasteur Institute to Notre Dame Cathedral.2 The scientist had become a symbol not just of the power of laboratory science in the modern world but also of French glory and achievement in an era marked by widespread fear of national decline. The landscape of health and disease that Pasteur left behind in 1895 would have been almost unrecognizable to a visitor from 1880: thanks in part to his development of vaccines for anthrax and rabies—and to the unprecedented publicity that work received—germs and disease had become all but synonymous by the mid-1890s, and the future of treatment and prevention clearly lay in the bacteriological laboratory . The odors of 1895 and Pasteur’s state funeral did not mark the end of an era; rather, they brought further confirmation (if any was needed) that a new era of health and disease was already well under way. The germ theory of disease changed everything and nothing at all. Seen from a bird’s-eye view, the landscape of disease causation in France was reshaped dramatically—as if by an earthquake—in the span of less than twenty years. In the late 1870s, nearly all medical observers agreed on the fundamental causes of disease: heredity, climate, miasmas, immoderate lifestyles. Some diseases were considered to be contagious in some circumstances —smallpox and syphilis, for example—but even those could usually be traced to these fundamental causes. By the mid-1890s, all but a few holdouts considered living microorganisms the only true cause of infectious disease. The causal microbes for some diseases had not yet been uncovered, but that was only a matter of time. The practical strategies recommended for preventing disease, however, had changed little. Moderation , conformity with behavioral norms, avoidance of overcrowded living conditions, public and domestic cleanliness, containment and disposal of bodily excretions, and even the neutralization of contaminating odors with disinfectants figured as prominently among precautionary injunctions in 1900 as they did in 1875, or in 1840 for that matter. The connection between filth and microbes that seems obvious today— disgusting things spread germs, germs are found in disgusting places and substances—came to be obvious through a series of developments that in a relatively short period of time left its mark indelibly on medicine and society. The chapters that follow trace the response to infectious disease at the local level in France, paying special attention to shifting...