The history of medicine is full of horror stories. I found a fun medical chart from the middle ages listing procedures contraindicated by birth sign. Listen to this:
Taurus: Avoid incisions in the neck and throat and cut no veins there.
Holy crap, I'm telling the doctor I'm a Taurus!
Scorpio: Avoid cutting the testicles and anus.
Aaah! No! Scorpio! I'm a Scorpio!
I refuse to believe that the medical profession used to be entirely populated by morons. So how does dumb stuff like bleeding and purging become standard practice for hundreds of years? It's been argued that it isn't fair to judge previous generations for their silly beliefs; they did the best they could with the limited knowledge they had. To an extent, I agree. It can be an easy way to feel an unearned sense of superiority over people who had the same human brains that we do, no better or worse. But since they were as human as us, I think it's instructive to look at some of those silly beliefs, especially the matter of their persistence, with a critical eye. After all, you don't really expect future generations not to be critical of some of the stupid shit we've been doing, right? Join me below the fold for the story of the 230-year-long fumble that is the history of germ theory.
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Consider this story, recounted by Dr. Lewis Thomas in his book The Youngest Science: Notes of a Medicine-Watcher. It was told to him by his father, who, as an intern, was privileged to observe a highly respected elderly doctor at work. Typhus was a big problem at the time and this respected elderly doctor was a master of diagnosing typhus before any indications were apparent to anyone else. His chief method was tongue palpitation. His rounds consisted of going up and down the ward inspecting tongues, manually, and diagnosing a hell of a lot of early stage typhus. (Maybe you can see where this is going.) Within a week or two he would be proven right as those unfortunate people developed typhoid fever. Wow! Of course, one thing he didn't do was waste his time with that new-fangled, hoity-toity nonsense of washing your hands, which makes his diagnostic skills somewhat less impressive to you and me. Let's just file that little story away for a bit. We'll come back to it.
The germ theory of disease is something we all grew up with, which I suppose makes it difficult to imagine what made such a simple concept so dificult to imagine. Antonie van Leeuwenhoek discovered the existence of single-celled organisms in 1676. From that day forward, humanity had the crucial bit of information that would have allowed for sterile surgery, sanitary hospitals, the search for antibiotics, and, with a couple more pieces of the puzzle, vaccines. Leeuwenhoek's "animalcules" (I love his name for them) caused quite a stir, but their medical implications were almost entirely overlooked. How did everybody miss that?
It was an answer lacking a question, that's how. It was already well known what causes disease, you see. Well known by elderly, respected doctors with all the weight of tradition, doctrine, and a ton of literature to topple on the head of any impertinent student who would dare question their elderly, respected knowledge. Disease is caused by Imbalance of the four Bodily Humours. It may be spread by tiny particles of stink in the air called "miasma". Oh, and you'd better believe that every illness is a direct punishment from God. Seriously, a pope hath declared it, so you'd better believe it. So certain microbes are present where certain diseases are present? That's interesting. The ancient Greeks have passed us the knowledge that rotting meat causes the spontaneous generation of maggots, and mud is the source of worms. As we can now see, diseased Humours cause microbes. And that's that.
Edward Jenner developed the smallpox vaccine in 1796. Germ theory, folks? No, thanks, we're good. Edwin Chadwick's fight for improved sanitation in the U.K. resulted in a reduced incidence of communicable disease. That was a good clue, right? Wrong, silly, remember miasma theory? The less stink particles in the air, the less people get sick. Duh!
Here's a man who rejected the miasma theory. From http://www.sciencemuseum.org.uk/:
"Ignaz Semmelweis was a Hungarian physician whose work demonstrated that hand-washing could drastically reduce the number of women dying after childbirth. This work took place in the 1840s, while he was Director of the maternity clinic at the Vienna General Hospital in Austria...
Doctors and medical students routinely moved from dissecting corpses to examining new mothers without first washing their hands, causing death by puerperal or ‘childbed’ fever as a consequence. As dissection became more important to medical practice in the 1800s, this only increased.
Through vigorous statistical analysis, Semmelweis figured out where the problem lay and introduced rigorous hand-washing rules in the maternity ward. Deaths were drastically reduced and Semmelweis became known as the ‘saviour of the mothers’."
That's all factually true, but it's a bit of a whitewash. There were two maternity wards in that hospital. Ward 2 was attended by midwives. Doctors didn't go in there. Women waiting for a bed in Ward 2 would literally give birth in the street rather than take a bed in Ward 1, where the doctors brought death from the dissection room directly to the new mothers. Dr. Semmelweis' handwashing stricture was met with hostility and derision everywhere in the medical community, even as death rates on his ward plummeted. He was removed from his position after a few short years, his handwashing idea tossed out, and previously healthy women once again resumed dropping like flies in Maternity Ward 1 of Vienna General Hospital.
The good doctor was understandably pissed. And he wouldn't shut up about it, which pissed off his colleagues. In 1865 Dr. Semmelweis was tricked into visiting an insane asylum, where they promptly clapped him into a straight jacket. He was injured in the struggle and died two weeks later from, of all things, infection. Yes, he has a statue. It went up thirty years after he died.
It's not hard to find, looking through articles about medical history, the words "so and so's ideas were met with resistance" but it's much more uncommon to come across examples of what that resistance actually sounded like. That's why I was so pleased to find a couple of quotes directed against Louis Pasteur at this useful history site. Here's the first.
"I am afraid that the experiments you quote, M. Pasteur, will turn against you. The world into which you wish to take us is really too fantastic."
La Presse, 1860
This bit of concern trolling was directed at Pasteur's early work. What he was doing, what La Presse was attacking, was showing through rigorous experiments that spoilage of milk, beer, and wine was caused by microbes. I don't think anyone still believed in the spontaneous generation of life forms by then, but germs were clearly seen as an effect, not a cause.
In 1864, Pasteur presented his findings at a conference at the University of Paris, conclusively demonstrating the truth. I'm sure a lot of people were stoked about the implications, but not the old guard. Look at the date. This was the year before Dr. Semmelweis was involuntarily committed and involuntarily manslaughtered. Just sayin'.
Pasteur soon moved on to identifying and culturing pathogens, with the express purpose of developing vaccines. Not to denigrate Jenner's work, but the whole cowpox/smallpox thing was a huge stroke of luck. Pasteur knew he would need a way to isolate weakened versions of the disease pathogens in order to confer immunity (however the hell that worked). It was a tough row to hoe. He succeeded first in developing a vaccine against a strain of cholera that affects chickens. Then, in 1881, he hit the jackpot with an anthrax vaccine. This was the reaction of some snarkmeister named Rossignol:
"Will you have some microbe? There is some everywhere. Microbiolatry is the fashion, it reigns undisputed; it is a doctrine which must not even be discussed, especially when its Pontiff, the learned Monsieur Pasteur, has pronounced the sacramental words, "I have spoken". The microbe alone is and shall be the characteristic of a disease; that is understood and settled;…..the Microbe alone is true, and Pasteur is its prophet."
Rossignol, written in 1881.
Jeez dude, project much? I love that I found this particular use of the word "doctrine" after I'd already titled the diary. It was doctrine, of course, that was crumbling in the face of careful observation. And some people just frickin'
hate that.
It's time to return to Dr. Lewis Thomas' anecdote about the respected elderly diagnostician. (Dr. Thomas' books, by the way, are very insightful and entertaining, and I can't recommend them highly enough.) Up until now, every event I've chronicled has had a date attached, but I don't have one for this. That's okay, we can figure it out. The elder Dr. Thomas, Joseph Thomas, witnessed this typhoid-spreading practice at New York's Roosevelt Memorial Hospital as an intern. He also married when he was an intern, and that was in 1906. Forty two years after Pasteur's findings were presented to the scientific community.
In 1907, Mary Mallon, a.k.a. Typhoid Mary, was forcibly taken from her home (also in New York City) and quarantined on North Brother Island (in the East River near the Bronx). The evidence used to justify this was the presence of the typhoid bacillum in her bodily fluids.
Are you seeing what I'm seeing? As Dr. Respected was spreading typhus through sheer stubborn denial of established fact, he was surrounded by people who fucking knew better! And nobody stopped him.
Looking back over all this, it seems to me that the single biggest factor inhibiting the development of germ theory was the original one: it was an answer lacking a question. Yes, there were often unpleasant consequences for those who finally asked the questions, but without them humanity was held back by a fossilized, worse-than-useless paradigm.
We KosAbility members are in a unique position. We tend to have a lot of exposure to the medical field without, in most cases, a whole lot of medical training. (Still new around here, but those are pretty safe guesses, right?) We're outsiders who've had a pretty good look at the inside.
What do you think they might be overlooking or getting wrong right now? What paradigms do you think are in need of a good shifting?
What would you question?
Edit: I used the terms "typhus" and "typhoid fever" interchangeably in this diary. That was rather goofy of me, as the suffix "oid" means "resembling, but not the same thing". As was pointed out by astute DK member cai in the comments, that holds true in this case as well. They're not the same thing.