The bacteriologist and historian Charles-Edward Amory Winslow once posed the question: why had no serious thinker by the year 1700 arrived at the modern germ theory of disease? Given the advances in microscopy, generations of attacks on Galenic orthodoxy, and the experience of smallpox, plague, and syphilis, did no one wonder if specific diseases might be caused by specific types of minute, living organisms? In returning to the decades around 1700, Margaret DeLacy’s The Germ of an Idea arrives at several conclusions: first, that some writers did argue that certain diseases are contagious, speculating that worms, insects, or animalcule are the true agents of disease; second, that the proponents of contagion and of the idea of a living agent of contagion remained marginal figures, never able to mount an effective challenge to the dominant Galenists and neo-Galenists of the Royal College of Physicians; and third, that the experiences of smallpox inoculation and the terror sparked by the 1720 plague of Marseilles did at least confer an enduring credibility on the notion of contagion. Very large conceptual gaps separate modern germ theory from the standard views of the Restoration medical establishment. We know that many diseases are caused by specific microorganisms which can spread from person to person or via animal vectors and that they cause predictable sets of symptoms. This is the ontological view of disease. The Galenists and neo-Galenists who dominated Oxford, Cambridge, and the Royal College of Physicians subscribed to a rival paradigm according to which sickness occurs as a result of the interaction between an individual and his or her environment. Advocates of this physiological approach usually insisted that the particular constitution of the patient determines the kind of sickness that he or she develops when exposed to disruptive influences. DeLacy shows how a small number of British medical writers, between the 1660s and 1730, deviated from this standard model. Several authors, including long-remembered figures like Hans Sloane and Richard Mead, argued for the contagiousness of major killers like consumption, plague, smallpox, syphilis, and leprosy. Others alleged that tiny organisms – insects, worms, or animalcule – cause sicknesses. Writers tended to adopt, at most, one or two elements of germ theory. For instance, they could (like Marchamont Nedham) blame disease on living organisms but claim that they are so omnipresent in the air that there is no place for direct person-to-person transmission. Or, they might accept (like Robert Hooke) that people can infect others but deny that the infective material is living. Only a few, like the obscure London physician Benjamin Marten, put the pieces together to create something akin to modern germ theory. The Germ of an Idea does an excellent job of conveying the diversity of ideas about both contagion and the nature of the hypothesized sickness-inducing agent. In the course of describing the speculations of the few writers who anticipated germ theory, DeLacy also usefully describes the insuperable obstacles to it becoming a new orthodoxy. Some of these reasons had to do with the quality of the evidence. These included: a complex epidemiological picture that did not always appear to lend support to contagionism, the failure of contemporary microscopists to identify tiny organisms that were associated with specific diseases, and the difficulty physicians had in agreeing that outbreaks of disease in different locations were actually the same disorder. But The Germ of an Idea makes clear that social, religious, and political factors bulked every bit as large. Most members of the Royal College of Physicians upheld the notion that medical wisdom is to be found in books rather than derived from empirical inquiry and they were accordingly skeptical of ideas about which the ancients had been relatively quiet. Those who did embrace an ontological theory of disease, in contrast, were socially and politically disposed to challenge authority. Some were Dissenters who had been obliged to study medicine overseas and were frozen out of the Royal College. They were more likely to have encountered the ideas of earlier, continental writers, like Girolamo Fracastoro and Jan Baptist van Helmont, who had subscribed to elements of the ontological theory. They were also incentivized to reject Galenic orthodoxies in part because publishing innovative ideas was a way to enhance one’s reputation. Nevertheless, these theorists fell short of creating the kind of scholarly network that could put an ontological theory on the map. Indeed, many of the speculations which DeLacy has recovered, appeared in private letters rather than in the form of published prose. After the 1730s, in fact, fewer radical physicians devoted themselves to contagionism: many a Dissenter who wished to practice medicine studied under Herman Boerhaave in Leyden and adopted his physiological approach to disease. Even so, DeLacy argues, the concept of contagion did not fade away. The success of the introduction of smallpox inoculation after the 1720s lent it a new plausibility. So too did the success of the French cordon sanitaire imposed around Marseilles in 1720. The fact that the British government upheld a strict quarantine policy for the remainder of the century ensured that both contagionism and the ontological model of disease retained credibility, in spite of inspiring plenty of outrage and opposition. Many a physician, patient, and politician could accept that a few diseases, most notably smallpox and plague, are specific diseases which can be conveyed from one person to another. The Germ of an Idea provides a useful account, based on exhaustive research, of a fascinating moment in British medical history. Most striking is DeLaey’s demonstration of how social and political factors underwrote both the articulation of contagionist theories and the opposition to them. The overall result is a persuasive answer to Winslow’s question: germ theory could not establish itself as a new orthodoxy where the empirical case remained so incomplete and the traditionally-trained members of the Royal College of Physicians had no incentive to abandon physiological explanations of disease. © The Author 2017. Published by Oxford University Press. All rights reserved. For permissions, please e-mail: email@example.com This article is published and distributed under the terms of the Oxford University Press, Standard Journals Publication Model (https://academic.oup.com/journals/pages/about_us/legal/notices)
Journal of the History of Medicine and Allied Sciences – Oxford University Press
Published: Oct 16, 2017
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