Prof: Well good morning.
 
I think we should get started.
 
And what we'll be talking about
this morning is the germ theory
of disease.
 
In a sense, it's taken us half
a course to reach a period when
we begin to see the development
of what you would probably
recognize as a scientific modern
medicine.
To appreciate the enormity of
what happened with the germ
theory of disease,
I think it's worth casting our
eye back to a point we had
already reached.
Let's say we compared the year
1789 with 1900.
Before 1789,
and the developments with the
Paris School of Medicine,
you'll remember the conceptual
framework was dominated,
still, by that of Hippocrates,
Galen and humoral medicine.
 
Humoralism was in retreat,
as doctors were absorbing ideas
about the circulatory system,
and the nervous system.
But the medical philosophy,
the vocabulary,
therapeutics and medical
education,
were still cast in the old
framework,
supplemented by other
developments--
astrology, for example--and
epidemic diseases were thought
to be explained by the doctrine
of miasma--
that is, the corruption or
poisoning of the air--
or malaria, as it was called at
the time.
By 1900, I think it's clear
that more change had occurred
than in all of the centuries
since Hippocrates combined,
and that medical science,
whose basic principles were
recognizably similar to our own
today,
had emerged.
 
Furthermore,
the speed of change was
gathering momentum as the
nineteenth century progressed.
The closing decades of the
century witnessed a wholesale
revolution, with the germ theory
of disease as its central
feature.
 
This theory,
I'm going to argue,
was as important a revolution
in medicine as for,
example, Galileo's theory of
the rotation of the earth was to
astronomy;
or perhaps Darwin's theory of
natural selection was to
biology;
or gravitation to physics.
 
So, what I would like to begin
with then is looking at what is
the germ theory?
 
What were its preconditions?
 
Who were the decisive figures?
 
What were the decisive events
associated with that famous trio
of Louis Pasteur,
Joseph Lister,
Robert Koch?
 
What were the implications?
 
Let's avoid the idea of a
single genius coming up with a
great idea.
 
Let's question the vision
behind the idea of the Nobel
Prize.
 
I'm going to be arguing that
these discoveries,
that culminate in the germ
theory, had a long gestation
period,
and were a collective process
that required a long train of
preconditions.
Let's look at the preconditions
first.
I'll argue that they're
conceptual, technological and
institutional.
 
Let's look at conceptual
preconditions.
The germ theory of disease
didn't arise directly out of
hospital medicine and the Paris
School,
but I think it's inconceivable
without the background of that
development.
 
It was crucial to have a
nosology--that is,
disease classification--the
idea of disease specificity--
that they were specific
entities--and without the idea
of localism;
that is, lesions.
And also essential was the new
development of pathological
anatomy, derived from the
post-mortem in the Paris
hospitals.
 
The idea of specificity was
critical.
Any further progress to the
idea of a microbial disease
depended on the view that
diseases didn't transform from
one into another.
 
Before the Paris School,
it was common to believe,
for example,
that cholera--to take one
disease--
was simply a heightened form of
endemic summer diarrhea.
 
It wasn't a specific disease,
and it grew out of another
preexisting condition.
 
The germ theory depended
instead on the conviction that
there are stable,
unchanging disease entities,
that each one is specific and
has a specific microbial cause.
But the followers of
Louis--Pierre Louis,
that is--in Paris,
while carefully distinguishing
one disease from another,
and classifying them,
didn't advance much towards the
idea of the causative pathogens
behind them.
 
Now, when we've talked about
the Paris School,
I don't want to give you the
idea that all of the crucial
figures in disease specificity,
and nosology, were French.
There were other crucial
figures as well.
William Gerhard,
who distinguished typhus from
typhoid.
 
He had studied in Paris with
Louis for a couple of years,
and then returned to his native
Philadelphia.
During an epidemic of typhus,
he dissected hundreds of
cadavers and discovered that
their lesions had no resemblance
whatsoever to typhoid.
 
There was William Budd,
who wrote an important book
called Typhoid Fever:
Its Nature, Mode of Spreading
and Prevention,
in 1873.
And he referred to the
unchanging, specific nature of
the disease.
 
Let's listen to what he said.
 
He said this:
"To propagate itself and
no other,
and that on a series of
indefinite progressions,
constitutes the very essence of
the relation on which the idea
of species is founded.
How much this applies in the
animal and plant world we all
know.
 
It is strange that what it
implies, in the case of
diseases, should be so seldom
recognized until now."
Or there was Pierre Bretonneau,
who believed that there were
morbid seeds that caused special
diseases,
just as every seed--in the
natural history,
that is--gives rise to a
determined species.
And he applied that idea to
diphtheria.
Just so as apples don't turn
into wheat--apples seeds into
wheat--so too endemic diarrhea
doesn't transform itself into
Asiatic cholera.
 
There was an important
transitional figure too.
Claude Bernard,
of the Paris School,
one of its stars,
who lived from 1813 to 1878,
and in 1865 wrote an important
book called An Introduction
to the Study of Experimental
Medicine,
where he presented a critique
of the Paris School.
He argued that diseases were
dynamic processes.
They weren't static in the way
that the Paris idea of nosology
seemed to suggest.
 
And he argued that they,
hospitals, displayed the end
stages of diseases,
not their beginnings.
And he argued that hospitals
and clinics had an excess of
variables that wasn't helpful
for the further development of
medical science.
 
So, he proposed an alternative,
that was embodied in his title;
that is, experimental medicine.
 
And by that,
he meant laboratory medicine.
He's one of the people who
suggest a new epistemology for
medicine,
which isn't the hospital ward
but the lab,
where you could have the
experimental testing of single
variables in controlled
settings.
 
Here was a new source of
medical knowledge.
If that provides conceptual
preconditions,
there were also institutional
ones.
And here I'm thinking of the
rise of the laboratory,
of the university;
that is, full-time professional
scientists, research
institutions,
and Germany leading the way,
rather than France,
in this development.
 
There were also technological
foundations.
It's impossible to think of the
rise of the germ theory of
disease without microscopy.
 
And so it was indebted to Anton
van Leeuwenhoek,
who lived from 1632 to 1723,
and developed the simple
microscope.
 
And then in the 1820s,
and thereafter,
there were major improvements:
the development of the compound
microscope and higher
magnification,
the work of the Zeiss Company
and the development of lenses.
There was also,
for a fourth precondition,
a lonely, neglected pioneer,
and that was a Hungarian
gynecologist,
who lived in Vienna,
called Ignaz Phillip
Semmelweis,
whose crucial idea,
which dates from the 1840s--
Semmelweis noted that the
infection rate in childbirth was
much lower on obstetrical wards
where women were delivered by
midwives,
rather than on wards where they
were delivered by physicians.
 
The reason had nothing to do
with their training or relative
degree of benevolence and
malevolence.
The point was that the
physicians were just returning
from post-mortem examinations,
from autopsies,
after which,
at that time,
they didn't wash their hands,
and so they were transmitting
disease to their patients,
from autopsies they were
performing in an adjacent
building.
So, Semmelweis,
suspecting--although he didn't
know the mechanism--
that this was the case,
established elaborate
hand-washing rituals,
using a chlorinated lime
solution--a little bit the first
hand sanitizer,
we might say--and he noted that
mortality plummeted from twenty
percent to one percent.
Unfortunately,
his own career was not a happy
one.
 
He was mocked by his colleagues
as a charlatan,
and was actually demoted in his
own hospital.
Well, then, there's a fifth
precondition,
and that's the development of
the basic sciences.
And it's hard to imagine,
as we'll see in a minute,
the rival of the germ theory
without chemistry in particular.
The specific issue that gave
rise to the germ theory of
disease was fermentation.
 
And Pasteur,
after all, was originally a
chemist, who in the 1860s became
a biologist, and we should note
that he wasn't a physician.
 
This is to introduce you to
Louis Pasteur.
The immediate background to the
germ theory of disease involved
the dominant theory of the day,
which was called the zymotic
theory of disease;
that is, that it was a form of
ferment--a little bit like
Pettenkofer had asserted--caused
by some fermentation of decaying
organic material.
Under the right conditions of
soil, temperature and moisture,
this fermentation would give
off a poison into the
environment.
 
Also quite widespread was the
idea of spontaneous generation,
that diseases arose somehow
spontaneously in a particular
locality,
weren't brought in or imported
from the outside.
 
There was a famous experiment
about this, from the seventeenth
century.
 
It was Redi's maggot experiment.
 
The idea was that if you could
have rotting meat,
and you could cover it,
you wouldn't develop maggots.
But if you didn't cover it,
then you would find that it was
full of maggots.
 
So, the maggots didn't appear
in the rotting meat by some
internal mechanism of
spontaneous generation,
but were imported from outside.
 
And Pasteur,
as we'll see in a minute,
takes up this very idea,
to the idea that germs too,
like the maggots,
are imported from outside.
The immediate issue for Pasteur
was in fact fermentation.
He began by studying the
fermentation of wine and beer,
and in particular their
spoilage.
At the time,
this was thought,
when he took up his work,
to be a chemical process.
And remember that Pasteur was
not a physician but a chemist
originally.
 
Well, what he did was to
discover that the fermentation
was caused instead by living
microorganisms,
bacteria that he identified
through the microscope.
Now, this was a high-profile
investigation in the 1860s,
for the simple reason that the
production of wine and beer
involved two of France's major
economic activities.
Pasteur--and this was part of
his genius--immediately made a
far-reaching connection.
 
In his estimate,
the fermentation that he saw in
wine and beer,
now caused by bacteria,
was analogous to putrefaction
and infection in wounds,
for example.
 
So, he began to regard disease
as a process involving
microorganisms,
living things.
This was work that Pasteur
conducted in the late 1850s and
1860s,
and it marked the first
transformation in his career
from that of a chemist into a
biologist,
or we might say today a
microbiologist.
 
He examined not only wine and
beer,
he then turned his attention to
milk and its souring,
and he wrote a book on that,
and then a study on wine and a
study on beer.
 
Now, of great importance was
the fact that Pasteur's
discovery that abnormal
fermentation leads to spoilage,
along with that went another
discovery he made,
which was that this process
could be controlled by heat.
Here was a major public health
discovery, and that led to the
process we now know as
pasteurization.
So, already in the 1860s,
Pasteur was busily transforming
biology.
 
Even if had he stopped then,
his discoveries were already
those of a fully productive
life's work.
But then in the 1860s came a
turn in Pasteur's interests from
biology, more specifically to
medicine and public health.
And he began to study
spontaneous generation.
Now, followers of Pasteur
believed instead in biogenesis.
With regard to cholera,
that we already examined,
about which there was a debate,
the idea was that cholera was
imported from outside.
 
It didn't arise spontaneously.
 
It wasn't the transformation of
some other disease that already
existed into cholera.
 
Rather it was a specific
disease that could not arise as
a heightened form of a
pre-existing condition.
Pasteur also devised--well,
Koch didn't think this was so
elegant,
but it certainly convinced
Pasteur and his followers--
a famous swan neck flask
experiment.
 
That is, he sterilized a flask
with a swan's neck,
and found that if the culture
is boiled,
and the flask prevents air from
gaining access to it,
then there was no development
inside of organisms that we
would call bacteria.
 
A culture of them could grow in
the flask, only if germs were
allowed to enter it.
 
But if the neck of the flask is
broken and air is emitted--you
can see the neck broken at the
bottom--then you get a luxurious
development of life.
 
And this had enormous
implications for diseases and
wounds.
 
Pasteur wrote simply,
"There is no known
circumstance in which it can be
confirmed that microscopic
beings came into the world
without germs,
without parents similar to
themselves."
Now, Pasteur's success was
partly based on the fact that he
was aware of the full range of
the scientific implications of
his work,
and he selected carefully
topics with high profile,
philosophical and biological
interest.
 
He was an expert at cultivating
the media.
That was one reason that
spontaneous generation had led
to so much excitement.
 
But most decisive in Pasteur's
work was what he did in the
1870s,
as he turned to diseases,
demonstrating the full
implications of his ideas on
fermentation in the previous
decade.
This new phase of discovery
occurred,
despite the fact that in 1868
he suffered a major cerebral
hemorrhage,
that left him paralyzed on his
left side.
 
What did Pasteur do in the
1870s that was so crucial?
Well, first of all,
I'll look at two major things
that he did.
 
One is work with silkworms,
and the other is work with
chicken cholera and anthrax.
 
The first thing was a major
contribution to the germ theory
of disease, accomplished by the
work with an unexpected
experimental animal;
that is, the silkworm.
And again let's look at the
fact that Pasteur's success,
his influence and his genius,
was in part the fact that he
took on really high-profile
research topics;
that is to say,
disease of silkworms,
where these diseases were
decimating one of France's
leading industries,
that is, silk.
Through meticulous and
painstaking research,
Pasteur demonstrated that there
were two major diseases at work
affecting France's silkworms.
 
He called them pebrine and
flacherie--you needn't remember
them for our purposes--and
asserted that both were specific
diseases caused by bacteria.
 
And he immediately realized
that there were enormous
implications,
not only for silkworms,
but for human beings as well.
 
He isolated then two germs
affecting silkworms,
and demonstrated that they were
responsible for specific
contagious diseases.
 
Pasteur isolated a germ and
convincingly linked it with a
specific disease,
and the concept of specificity
was at the basis then of the
whole idea of the germ theory of
disease.
 
Now you know Pasteur didn't
invent the idea of contagion.
You've seen it with Fracastoro.
 
You've seen it in John Snow,
who talked about the
possibility of animalcules.
 
And there were other
scientists--Casimir Devaine in
France,
the English physician John
Sanderson--
who were also advancing a
hypothesis that they were
finding microbes with their
microscopes,
and hypothesizing that they
might be the agents of disease.
 
But Pasteur was the first to
provide a demonstration in a
specific case,
proving that microbes were the
causative agents of specific
diseases,
and he provided a methodology
for further experimentation and
discovery.
 
Pasteur then turned from
silkworms to diseases,
the diseases of chicken cholera
and anthrax.
Neither is responsible for
extensive human disease,
as both are causes of diseases
of animals.
But what was critical was the
process.
His work on anthrax helped to
establish a model for
investigating infectious
diseases,
and establishing the claims for
the germ theory of disease,
and putting that on solid
foundation.
At the same time,
he made another major
development.
 
His vision went beyond simply
demonstrating the germ theory,
although he did that.
 
In addition,
he developed a public health
practice--
that is, vaccination,
which had been pioneered a
hundred years before--
and he helped now to found the
discipline of experimental
immunology.
 
Now, let's--we've seen
vaccination and the work of
Edward Jenner.
 
Let's define.
 
Vaccination is the introduction
into the body of either the
whole,
or part, of a disease-causing
microorganism,
in order to teach the immune
system to attack that same
organism,
should it reappear in the body
through natural processes.
The mechanism is that the
vaccine primes the immune system
to produce antibodies,
or teaches immune cells to
recognize and attack the
organism,
that we now know perhaps to be
a virus,
a bacterium,
or a parasite of a different
kind.
 
The problem,
of course, was how to stimulate
immunity without causing
disease.
Jenner benefited from the
cross-over immunity from cowpox
to smallpox.
 
Pasteur did something else.
 
He used the concept of
attenuation.
Jenner is the father of
immunology, in a sense,
Pasteur the founder of
experimental immunology.
The idea he had was that live
pathogens could be introduced in
the body,
but only after being treated in
some way--
heat, for example,
or passage through a different
host first was another--
in such a way then that their
virulence is diminished.
Then they'll stimulate the
immune response,
without causing disease at all,
or only a mild disease.
This discovery was made during
his work with the bacterium that
causes chicken cholera,
made sort of by
chance--serendipity played a
role.
He left a batch of bacteria
untouched for a week or so while
he went on vacation during the
hot summer months.
On returning,
he found initially,
to his frustration,
that the culture no longer
produced the disease when he
attempted to infect other
chickens.
 
So, he got a fresh batch of
bacterium, and injected the same
chickens with it,
as well as a lot of new
chickens, and made a surprising
discovery.
That the original chickens,
injected with the old vaccine,
remained healthy--in our terms,
they were immune--
while the new and previously
untreated chickens sickened and
died.
 
He repeated the experiment
several times,
with the same results,
and concluded that the summer
heat had changed or attenuated
the culture of the bacterium.
Later techniques expanded the
repertoire, demonstrating that
heat could kill vaccines of
chicken cholera but still induce
immunity.
 
There were other vaccines that
could employ live but attenuated
bacteria or viruses.
 
Some used killed microorganisms.
 
Some used sub-unit vaccines.
 
And the processes of
attenuation are not only heat,
but let's say for polio,
could be the passage through
formaldehyde and various--
there are other means.
Attenuation though was critical
to the development of vaccine as
a public health strategy.
 
But let's return to Pasteur.
 
Having discovered attenuation
with chicken cholera,
Pasteur applied the same
principle to the different
disease of anthrax.
 
The pathogen responsible was
the Bacillus anthracis
that had recently been isolated
by Robert Koch.
And if you see the film,
The Story of Louis
Pasteur, you'll see what he
did in 1881 with the bacterium.
In a famous experiment,
he vaccinated twenty-four sheep
with an attenuated--
that is, heated--bacterium,
after which he challenged the
original twenty-four sheep with
live unattenuated anthrax
injections,
as well as twenty-four control
sheep that had not been
vaccinated.
 
The vaccinated sheep remained
healthy.
The non-vaccinated all died.
 
Then came the 1880s,
and Pasteur turned to another
high profile disease,
and that is rabies.
Having discovered attenuation
by heat, with chicken cholera
and anthrax, Pasteur extended
the principle of attenuation by
other means.
 
This involved further famous
experiments.
Rabies, as it turns out,
was not another bacterial
disease, but a disease caused by
what we now know to be a virus.
In this case,
he attenuated the virus by
isolating it from foxes,
and then passing it through an
unnatural host of a different
species;
in this case, the rabbit.
 
So, passing the virus through a
series of rabbit bodies,
he succeeded in producing a
variant that would no longer
cause the infection in foxes,
but would serve to protect
against the natural occurring
rabies.
Rabies was not a high impact
disease,
in terms of numbers of people
it affected,
but it was a disease of high
drama,
and one that was then,
and still is,
universally fatal.
 
So, it was ideal for attracting
media attention.
The great human trial occurred
in July 1885,
with a famous case of a
nine-year-old boy,
Joseph Meister,
who had been severely bitten by
a rabid dog and was thought to
be certain to die an agonizing
death.
 
But taking advantage of the
incubation period for rabies,
Pasteur vaccinated the boy with
his attenuated rabies virus.
Joseph Meister survived,
and became a celebrity patient,
the first person ever known to
have survived after being
severely bitten by a rabid
animal.
And Meister remained loyal for
the rest of his life,
to Pasteur.
 
He returned,
as an adult,
to Paris, to work as a
gatekeeper at the Pasteur
Institute, where Pasteur himself
was buried in the crypt.
The apocryphal story--I won't
assert its truth--
the story is that he was killed
in 1940,
as an elderly man,
when he tried to prevent
occupying German troops from
desecrating Pasteur's grave,
the grave of a national icon of
an enemy power.
A slightly less poignant but
better documented narrative is
that he committed suicide in
despair of the German
occupation.
 
Well, the Pasteur
Institute--that's the
vaccination of Joseph Meister.
 
It's not Pasteur doing the
actual vaccination,
because, as I said,
he wasn't a physician.
And this is the Pasteur
Institute,
founded in 1887,
with Louis Pasteur himself as
its first director,
committed to biomedical
research in Paris,
and to a series of satellite
institutes elsewhere in the
world.
It followed the public health
strategy of vaccination,
pioneered by Jenner,
and now consolidated by
Pasteur.
 
The founding of this
institute--you'll note its size
and imposing nature--
gives us the opportunity to
note in passing another aspect
of nineteenth and twentieth
century science.
 
The way in which it became a
focal point for competing
nationalisms,
in a way familiar to us from
the Cold War competition between
the U.S.
and the USSR.
 
In any case,
there's a clear case in the
nineteenth century with the
rivalry between Louis Pasteur
and Robert Koch,
the embodiments and icons of
French and German medical
science,
of two hostile national powers.
 
The Pasteur Institute in Paris
rivaled the Koch Institute in
Berlin.
 
And that brings us--we'll also
note the crypt where Pasteur is
buried.
 
There's a kind of--what shall I
say?--worship of Pasteur almost,
and of French medical science.
 
But let's move on to Robert
Koch, who lived from 1843 to
1910,
the second great figure in the
establishment of the germ theory
of disease,
the German scientist who was
twenty years younger than
Pasteur.
 
Now, if Pasteur's hallmark was
the imaginative breadth of his
scientific vision,
Koch's distinctive feature was
his scientific rigor,
his more rigorous techniques of
microbiology.
 
He had a critique,
a famous critique,
of the whole swan neck flask
experiment.
He argued that Pasteur had been
lucky--contamination was
possible.
 
He developed the plate
technique, using the Petri dish
and solid culture,
and he developed staining
techniques for microscopy.
 
What I'd particularly like you
to note is his methodology,
which he embodied in what are
called "Koch's
Postulates."
 
This was the methodology for
determining that a suspected
microbe is the causative agent
of a particular disease.
He said you could know this
under four conditions.
First, the organism suspected
as a pathogen must be found in
all animals suffering from the
disease.
In other words,
it has to be universally
present where the disease is
present.
And then the organism must be
isolated from a diseased animal,
and grown in culture.
 
Third, the cultured organism
must cause the disease,
when introduced into a healthy
animal.
And lastly, the organism must
be re-isolated from the
experimentally infected animal.
 
These postulates are some of
the most famous in medical
science, and were the model for
establishing germs as pathogens
for other diseases.
 
Koch's microscopy had a number
of immediate implications.
His staining raised the idea
that if you could stain,
you could also have an idea of
magic bullets,
what later became antibiotics.
 
But Koch didn't pursue that
particular interest.
The other was this led to
reliable differential diagnosis,
and therefore a more properly
based nosology.
It could lead also to major
public health measures,
and ultimately to developments
in therapeutics.
It furthered the sanitary idea,
and gave it a firm,
scientific basis,
and irrefutably proved the
truth of contagionism rather
than anticontagionism,
as Pettenkofer learned,
to his cost.
But immediately there
wasn't--it didn't imply,
and I think we should note
this--the understanding of
disease did not immediately lead
to therapeutic advances.
Remember what happened in
Naples during the cholera of
1884.
 
Koch's idea was used for a very
negative therapeutic method;
that is, acid enemas that were
administered to patients.
Well Koch also moved forward on
other diseases,
applying the methods he had
developed,
that Pasteur had developed in
the 1870s,
and applying his own rigorous
postulates.
In 1882, the most famous of
all, he isolated the bacterium
that causes tuberculosis,
the most prevalent disease of
the time.
 
The paper that Koch presented
in 1882 was one of the most
dramatic and important moments
in the history of medicine.
Tuberculosis was not feared in
the same way cholera was,
but it was unquestionably the
greatest killer of the
nineteenth century,
and until 1882,
it was shrouded in mystery.
 
Suddenly Koch cast a new shaft
of life, revealing to the world
that he had unraveled the entire
mystery of its etiology.
Then, in 1883,
he followed up this discovery
with another that was almost
equally influential.
In 1883, he isolated the
Vibrio cholerae.
Koch then had discovered and
demonstrated the role of
pathogens,
the ones responsible for two of
the most prevalent and feared
nineteenth century diseases.
This marked,
as I said, the definitive
triumph of contagionism.
 
And the 1880s and '90s were a
golden age of microbiology,
with the pathogens being
discovered for a whole range of
other diseases.
 
This was an extraordinary
period in medical science.
The pathogens were discovered
for gonorrhea,
bubonic plague,
dysentery, tetanus,
the common bacteria of wound
infections, staph infections and
others.
 
The paradox,
of course, there were still few
benefits for patients,
until the turn of the new
century.
 
The quip was made that the main
beneficiaries,
at first, of the germ theory of
disease, were physicians rather
than patients.
 
But there was a major
exception, and that was not in
medicine but in surgery.
 
And this introduces the third
major figure of our trio,
establishing the germ theory of
disease,
and that's Joseph Lister,
who lived from 1827 to 1912,
and made his major
contributions in Scotland.
He was professor of surgery at
Edinburgh University,
where he was appalled by the
numbers of patients who died
after otherwise successful
operations.
You know the old joke about the
operation being successful,
just too bad the patient died.
 
Well, Pasteur's idea
immediately struck him for its
lifesaving, practical
implications.
That is, he made practical use
of Pasteur's discovery about the
role of airborne germs in
causing wound infections in
surgery.
 
Now, surgery,
before Lister,
had a number of major limits.
 
There was pain itself,
and the need for speed.
There was blood loss,
and there was septicemia.
The result was that the major
body cavities remained off
limits: the abdominal cavity,
the thoracic cavity,
the cranial cavity.
 
And there was a high rate of
death from infection.
The idea was thought by
physicians at the time that the
infection arose through
spontaneous generation.
As tissue died,
they gave off toxins that
caused infection,
and so infection was simply
accepted as an inevitable,
normal part of surgery.
Lister's surgical revolution
occurred with the work he
published,
"On the Antiseptic
Principle in the Practice of
Surgery,"
in 1864.
 
The implications of Pasteur's
work on fermentation were
that--you could have an analogy.
 
If Pasteur was right,
there was no spontaneous
generation.
 
An airborne microorganism
penetrated the wound and caused
infection or septicemia.
 
The remedy was to prevent the
penetration of the
microorganism,
the idea of antisepsis.
So, Lister accepted Pasteur's
insight that infections were not
a chemical reaction,
caused by oxidation when air
touched a wound.
 
Instead, infection was the
result of contamination,
from the outside,
of the wound by microorganisms.
His solution first was this,
the carbolic spray device that
he invented.
 
What you did was to spray the
air around the patient,
applying carbolic acid also
directly to the wound.
And Lister also washed his
hands before operating,
and sterilized his instruments.
 
There's a stylized idea of a
Lister-type surgical technique
at work.
 
Well, until Lister's
revolutionary innovation,
surgery had been an emergency,
a treatment of last resort,
because of the wound infection.
 
After 1866, it became a normal
procedure.
There were other innovations as
well, that went with it.
His contemporaries improved on
Lister.
You'll see that here they
aren't wearing masks,
for example,
or gowns.
Those are introduced--and
gloves made from vulcanized
rubber--
were introduced in the 1890s,
but really became a part of
best practice only from about
the time of the First World War.
 
This also revolutionalized
obstetrics,
with the conquest of puerperal
fever,
with--hospital and clinical
procedures then were transformed
by the antiseptic idea.
 
So, by the 1890s,
you have the consolidation of
the germ theory of disease,
revolutionalizing medicine and
become accepted throughout the
international medical
profession.
 
I'd like to mention the impact
also on culture.
And this particular book,
which is by Bram Stoker,
which is Dracula,
published in 1897,
that gives us,
I would argue,
expression in a really dramatic
and--
I just read it again--a really
scary--
I assure you--idea of anxieties
about infection.
Now, Dracula is really,
for its time,
a high-tech novel.
 
In it you see all about the
latest scientific and medical
inventions and ideas.
 
It contains the phonograph,
the telephone,
stenography,
railroads, the two-wheeled
bicycle.
 
And in medicine it deals with
the latest inventions in
psychiatry, in blood
transfusion, infectious
diseases.
 
And indeed, I would argue,
it also involves what was the
cutting edge scientific idea in
medicine at the time,
the possibility of vector borne
diseases like malaria and
filarial.
 
Then it's just at the time when
we're going to see tropical
medicine--
we'll look at next
time--becomes the cutting edge
of late nineteenth-century,
early twentieth-century medical
science.
Now, you know the drill about
Dracula,
how Count Dracula--the word
Dracula comes from the
Romanian word dracul,
which means a devil,
a little devil.
 
And you know how he lived,
the Count--the evil Count--in
Transylvania,
in Romania, in the Carpathian
Mountains.
 
And the important point is he
travels by ship from the Black
Sea port,
aboard a Russian vehicle,
through the Mediterranean,
and up along the coast of Spain
and France,
where he lands by ship in
Britain at the port of Whitby.
 
Then he travels by train,
and is transported by railroad
from Whitby to London,
where his plan is to ravage the
huge population of London.
 
Now, what does that remind you
of?
Doesn't that--it reminds
me--I'm going to argue that
Dracula is many things.
 
In literature,
you'll see that Dracula
is a metaphor--and this is often
said--for repressed sexuality,
in the Victorian Era.
 
You'll find interpretations of
it as expressing also a
repressed homoeroticism.
 
In it, we also find expression
of the battle of good and evil.
That's our friend Dracula.
 
And you'll see--love never
dies--the idea of--the sexual
idea is clearly--some 200 films
have been made of
Dracula.
 
And you can see clearly
possible sexual ideas in films
such as this.
 
And they're clearly also here.
 
But what I want to argue is
what's been neglected so often--
and I think it's really
important--is I want to argue
that Dracula is also an
allegory of infectious disease;
not a specific disease,
but diseases like plague and
cholera,
that originated in Eastern
Europe and traveled,
just as Dracula did,
by ship and by railroad;
that they had Count Dracula's
goal of ravaging industrial
cities, huge population centers
like London.
 
And it's interesting that the
vampire hunters in the novel are
doctors, physicians,
whose mission is to destroy the
invading vampire.
 
Also involved,
we see, is the seasonality.
It's not by chance that Count
Dracula arrives in late
August/September,
just as cholera would have,
or bubonic plague.
 
And we see miasmatism in the
novel: the flowers,
the garlic, the mists
surrounding Dracula.
And I would argue that Dracula
is a composite of many
infections.
 
Here's the handsome count again.
 
And I'd like to show you one
more handsome picture of him;
and that's that one.
 
And I would argue that this
clearly makes me think also of
vector-borne disease,
and possibly this is a million
miles removed from malaria and
filarial,
which we'll be talking about
next week.
So, I urge you also to read
Dracula.
I'm sure you'll enjoy it as
much as I did.
 
 
