The Great Stink of Paris and the Nineteenth-Century Struggle against Filth and Germs

4 Putting Germ Theory into Practice

4 Putting Germ Theory into Practice evolutionary etiological breakthroughs and the assimilation of time-honored sanitarian knowledge into the new language and new scientific paradigm of bacteriology were only the first steps intheestablishmentofanewpublichealthregimeinFrance.The new knowledge would prove barren if it did not produce practical strategies and policies to combat disease. Pasteur’s 1881 anthrax vaccine demonstration at Pouilly-le-Fort (and his rabies vaccine four years later) promised miracle cures and vaccines for many other diseases, but promise was not enough. Epidemic doctors and others confronting devastating outbreaks and lamentable sanitary conditions on a daily basis needed new weapons immediately. Their options were limited, but they seized them with remarkable zeal and conviction. By century’s end, a guiding template for responding to infectious disease outbreaks at the local level had firmly taken hold. It rested on the twin pillars of isolation and disinfection, and joined to these immediate material interventions a long-term auxiliary strategy of popular education in the principles of the sanitary-bacteriological synthesis. Among scores of examples, the report on a 1900 scarlet fever outbreak in the Burgundy wine-making towns of Chassagne-Montrachet and Santenay (Côte-d’Or) demonstrates the extent to which short-term responses became formulaic, even automatic. The local epidemic doctor’s investigation and report consisted of the following observations: the origin and cause of the outbreak were “unknown”; the sanitary condition of the towns was “good.” Chassagne-Montrachet: Measures taken: isolation of the patients Measures proposed: disinfection of linens, clothing, bedding, rooms. Santenay: Measures taken: isolation of the patient Measures proposed: disinfection.1 Laconic in the extreme, this report represents the default option for busy epidemic doctors: when in doubt, recommend isolation and disinfection. By 1900, this strategy had become routinized to such an extent that an actual visit to the site of the outbreak was scarcely necessary. Along the way, however, the policy of isolation and disinfection in the short term accompanied by popular hygienic education in the long term, encountered resistance and contestation from various quarters before eventually achieving an uneasy and incomplete success. The Pedigree and Theory of Disinfection From setting fires in the streets to burning incense or sulfur indoors, communities have attempted to neutralize disease-causing influences by chemical and other means since ancient times.2 By the mid-nineteenth century, the favored forms of disinfection—defined by the Larousse dictionary in 1870 as the destruction of “certain gases or certain exhalations produced by living matter, and called miasmas”—included the application of liquid chemicals, the burning of materials such as sulfur, and mechanical devices producing artificial ventilation through the forced circulation of air. Larousse’s definition also complained about the popularity of so-called disinfections that “left much to be desired,” merely masking unpleasant odors with stronger odors rather than truly “removing the harmful and stinking substances from the air.” Such a definition both undermined and reinforced the equation of foul odors with disease, cautioning against superficial deodorization while at the same time suggesting that harmful substances did in fact stink and that genuine disinfection rendered dangerous substances “odorless and trouble-free,” as if the two naturally went hand in hand.3 Meanwhile, beginning in the late 1860s, Joseph Lister began publishing accounts of his new “antiseptic” surgical practice, in which carbolic acid sprays seemed to drastically reduce the incidence of sepsis. Initially controversial among surgeons, Listerian antisepsis eventually gained converts in Britain and abroad. (Lister claimed Pasteur as a chief influence and inspiration , and maintained warm relations with the Frenchman.)4 The benefits claimed for surgical patients both enhanced the status of chemical disinfecPutting Germ Theory into Practice 141 142 The Great Stink of Paris tion and accelerated the process by which it became linked with the germ theory of disease. An age-old practice was about to be reborn. It took a combination of technical potential, scientific justification, and the mobilization of local authorities, however, in order for disinfection to become a central element of public health practice. For many years, disinfection meant little more than deodorization—literally, “dis-infection,” when “infection” meant any foul stench. In 1877, for example, the district public health council in the Breton town of Montfort (Ille-et-Vilaine) responded to complaints of “ammoniac odors” produced by the town’s newly installed public urinals by recommending their “disinfection” with a solution of chloride...