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

Michael Worboys. Spreading Germs: Disease Theories and Medical Practice in Britain, 1865–1900. New York, Cambridge University Press, 2000. xvi, 327 pp., illus. $59.95.

Well known as a historian of tropical medicine, Michael Worboys has taken a somewhat new tack in his latest book. Spreading Germs adds several innovative dimensions to recent work that reconsiders the history of germ theories and their influence in medicine. This intensively researched, dense, and thoughtful analysis traces the intricate interactions between germ ideas and germ practices at the local level, situating them “in the field, in operating theatres, clinics, and [in the management of] infectious diseases” (p. xv). Focusing on these uses of germ ideas, Worboys transcends tired debates about who supported or opposed germ theories and demonstrates that the rhetorical and practical value of germ ideas was much broader than the identification of specific germs with specific diseases. Worboys shows that debates over the particulars of germ ideas played a positive role in shaping germ practices and vice versa; the two developed inseparably. He also revises historians’ understanding of the role of British medical groups in establishing certain germ practices within a transnational context.

These accomplishments derive from the successful way in which Worboys has met the goals he set for Spreading Germs. First, he aimed to underscore that there were many germ theories, taken up and used in different ways by different branches of medicine. Chapters, both thematic and roughly chronological, highlight the activities of veterinarians, surgeons, Medical Officers of Health (MOsH, physicians functioning as local public health authorities), and general practice physicians. Each group used the tools available to them differently: Veterinarians supported contagionism but favored quarantines and other administrative controls over germ practices such as vaccination; surgeons adopted germ practices but in early years eschewed germ theories. Groups had to be persuaded of the value of germ practices for their own needs, Worboys argues; thus, MOsH who had to manage public opinion as well as public health focused on contingent contagionism as a way to encourage public cooperation. In the end, germ-related ideas and procedures redefined the role and meaning of scientific practice in medicine by transforming the daily work of practitioners within its many branches.

Worboys also successfully demonstrates that germ practitioners influenced the disposition of germ ideas. He explores a wide spectrum of disease-causation ideas by following the metaphor of the “seed and soil.” Infectious organisms could “seed” a disease into a body; and notions of constitutional susceptibility became refashioned into immunology through an understanding of the body as “soil” vulnerable to seeding. Listerians, for example, changed the theories on which they justified their practices between 1877 and 1900 in light of new understandings about seed and soil interactions. Worboys’ discussion of investigations on tuberculosis focuses not on Koch’s identification of the tubercle bacillus but on the ways that this discovery launched a series of debates about why infected people could remain healthy and why diseased people sometimes had no bacilli in their sputum. The varying arguments of veterinarians, MOsH, pathologists, and clinicians could be reconciled under the umbrella of seed and soil; thus useful, this concept also became an important precursor to bacteriology and immunology.

Spreading Germs makes other contributions. It emphasizes continuity in ideas over time along with the importance of localized professional and intellectual debates; it places the consolidation of the laboratory sciences later than some other historians have. The book’s strengths may invite challenges, however. The author’s determination to expose complexities might concern some scholars whose views of Lister’s or Koch’s contributions stand to be revised. Others may find Worboys’ attempt to characterize whole groups of individual actors as problematic or decry the absence of farmers, housewives, and other laypeople concerned with health and disease. Yet these concerns only point to the importance...