Spreading Germs: Disease Theories and Medical Practice in Britain, 1865-1900 (review)

Well known for his studies on the history of tropical medicine, Michael Worboys now offers readers a study of the relationship between medical practice and changing disease theory in his recent book, Spreading Germs. In essence, Worboys provides an intellectual history of the germ theory of disease. Throughout this volume, existing interpretations of the development of germ theory are expanded and revised.

Two essential themes pervade this work: the use of the metaphor of "seed and soil" in medical discussions of germs, and how infections in individuals and populations were managed by public health officers in Britain in the late nineteenth century. Worboys demonstrates throughout that there were many germ theories of disease during this time and that these disease theories were evolving and used in a variety of ways, in a variety of medical fields (veterinary medicine, surgery, public health, and general medicine).

Featuring seven chapters that negotiate "the constructions, meaning and uses of germ theories and practices", Worboys is striving to "place [his] early work on tropical medicine and parasitology in the wider context of the development of microbiology and new theories of disease" (xv). In so doing, he clearly demonstrates the range of germ theories of disease that were prevalent between 1865 and 1900. But Worboys goes beyond a mere discussion of germ theories, as he considers germ practices as well—that is, how germs were viewed, killed, cultured, altered, and represented in medical practice.

Chapter one begins a discussion of the medical profession and disease theory context of the mid-1860s. As he introduces the main medical ideas on the nature of disease and key principles of zymotic theory of disease and its relevance to surgery and public health, Worboys also "concentrates on the areas in which major developments in germ theories and practices originated or gained the greatest currency" (p. 20) namely, surgery, state medicine, and laboratory medicine. It is here that he points to the ideas that "informed both disease management with individual patients and disease prevention in populations" (p. 20) to reveal the relationship between theory and practice.

The following chapter takes into account the influence and relevance of veterinary medicine during this same period, with particular interest in the cattle plague of 1866. The understanding of contagious animal diseases and their relation to disease control practices is a primary focus of this discussion. Moreover, Worboys extends a greater attention to the many aspects of the relationship between animal and human medicine than what it has previously been given.

Antiseptic surgery is the main topic of the third chapter, attempting to place the ideas and work of Joseph Lister into the wider technical and ideological development of the larger field of surgery and germ theories. In particular, the developing innovations and ideas on wound management are discussed.

The fourth chapter discusses the diverse policies and ideas found in public health in the late nineteenth century, and the use of living germ theories and practices into the public health arena are placed at an earlier date than is suggested in other recent studies. This chapter strongly supports Worboys's main assertion that "the spread of germ ideas and practices in medicine [was] additive and adaptive, rather than a series of conflicts between competing, incommensurable paradigms" (p. 109). The two main issues in public health in the late 1860s and 1870s were understanding the sources of epidemics and understanding how to prevent the spread of zymotic diseases once they were found in a population—it is within this context that germ theories of disease were often debated. Thus Worboys explores the changing understanding of diseases such as smallpox, cholera, and typhoid fever, with their local, national, and even imperial importance.

Chapter five looks at the ways surgeons increasingly used bacterial germ theories, namely how to avoid germs and how to...