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Perspectives in Biology and Medicine 45.4 (2002) 620-622
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Diseases, Theories, and Medical Practice in Britain, 1865-1900
Spreading Germs: Diseases, Theories, and Medical Practice in Britain, 1865-1900. By Michael Worboys. Cambridge: Cambridge Univ. Press, 2000. Pp. xvi + 327. $59.65.
Practicing scientists well know the conditional and often contested ground in which they work, and so they should not be surprised by the ways in which Michael Worboys's Spreading Germs: Diseases, Theories, and Medical Practice in Britain, 1865-1900 thoroughly and convincingly revises a number of historical beliefs. Chief among those beliefs is that the enunciation of the germ theory in the 1870s and 1880s marked a sudden and decisive shift in theories of disease causation. On the basis of careful reading of the medical and biological opinion of the time, Worboys argues, rather, that many different germ theories could be found in Britain in the 1860s and 1870s, that the notion of disease specificity connected with bacteria made only gradual headway, and that holistic theories of disease held surprising ground against ontological conceptions down to the end of the 19th century or later.
Worboys thus joins other historians who have modified earlier, oversimplified views of the real achievements of Louis Pasteur, Robert Koch, and Joseph Lister. But he also argues that germ theories had a perhaps greater and earlier impact on medical practice than we have realized. He therefore intends to shift some of our attention from the theoretical impact of Pasteur and Koch to the practical and clinical consequences of their work. [End Page 620]
"Germs" were not particularly unusual in British thinking by the 1860s, but little agreement existed about what they were: chemical poisons, fungi, degraded or morbid cells, poisons from dead tissues, or invasive organisms? Could they appear spontaneously in nature, "de novo"? And, perhaps more important, were they necessary causes for a disease and, if so, were they sufficient causes? Some of the different views of "germs" entered into the widely accepted seed-and-soil metaphor that dominated British thought about disease causation for much the second half of the 19th century: "seed" (the germ) needed favorable "soil" (whether in the general environment or in the individual), a view that persisted (for example) well after Koch announced his identification of the tubercle bacillus (1882) or the similar claims made by Klebs and Loeffler about diphtheria (1883-84). Worboys shows that this "contingent contagionist" view, most often associated with the Munich sanitationist Max von Pettenkofer, enjoyed particular currency in Britain (as indeed it did in the United States, as Georgina Feldberg's Disease and Class  illustrates).
The variety of germ theories also informed the continuing British tension between "exclusive" and "inclusive" approaches to disease prevention and control. Worboys argues that British responses fell along a continuum between the strictly exclusive (quarantines, isolation, notification) and the strictly inclusive (broad environmental amelioration), whether the disease at stake was smallpox, cholera, typhoid fever, or tuberculosis. If germs were an insufficient explanation of disease (or if germs might appear de novo and hence untraceably), the door to more multicausal explanations remained open, and with it a continuing interest in environmental approaches.
Worboys is sensitive to the political factors that contributed to these features of the British medical scene. Xenophobic reactions partially explain British hesitancy to hail Koch and Pasteur, for different segments of medical opinion regarded British sanitation with complacency and believed in the superiority of clinical experience to laboratory-based theorizing. British medical experimentation faced unusually strong opposition from anti-vivisectionists, especially relevant to Worboys's interesting emphasis on veterinary ideas and practices. More important still, imperial issues intruded, for Anglo-Indian medical opinion (fearing international trade restrictions and quarantines) held to anti-contagionist views about cholera as an article of faith.
Under the political issues and examples raised by Worboys lay a more general British political dilemma. Economy in government was an article of 19th-century liberal faith; so, too, was respect for the autonomy and liberty of the individual. The "exclusive" approach...