Bacteriological Revolution Research Articles

Russian Public Health during the First World War

ABSTRACT Public healthcare came late to Russia, and it developed along two paths: a state system and a community medicine system. The state system developed first with a small number of hospitals in Russia’s capitals (Moscow and St. Petersburg) and some army hospitals, leaving healthcare in rural areas mostly to the individual. When, from the 1860s, zemstvos as institutions of local self-government were introduced, a public healthcare system (“community medicine”) started to be developed. It coincided with the bacteriological revolution and functioned during the great epidemics of, for example, cholera, typhus, and plague. Infectious diseases affected Russia and were often linked to famines, a social affliction with which the government tried to cope. In the late nineteenth century, epidemics led to the foundation of research institutes and laboratories. Shortly before the outbreak of the First World War, the establishment of a ministry for public health was discussed but was postponed. However, it was the Great War that gave impetus to the modernizing process, although initially there was no centralization. Both the state system and the zemstvo systems expanded—for the army as well as for the civilian population. The state and zemstvo systems continued to rival one other, but an outstanding coordinating role was played by a member of the royal family. Leaving the First World War after the October Revolution, Russia immediately plunged into the Civil War, which resulted in the complete dissolution of non-governmental healthcare bodies, which had been so significant during the war. In Bolshevik-controlled Russia, all healthcare institutions were subordinated to a centralized ministry of health, thus abolishing the Unions and the Pirogov Society. This article describes the conflict between the pre-First World War state and zemstvo healthcare systems, the efforts for improvement during the war, and the centralization after the war.

Mythological Endings: John Snow (1813–1858) and the History of American Epidemiology

During the COVID-19 epidemic, the name of the 19th-century English physician John Snow (1813-1858) has cropped up to a surprising extent, notably in connection with the severe cholera epidemic of 1854 in the district of Golden Square, London. It is repeatedly stated that Snow brought this epidemic of waterborne disease to an end by removing the handle of the Broad Street pump. It is also widely known that this story is a myth. Nonetheless, the Broad Street pump story as told by Snow's close friend Benjamin Ward Richardson remains embedded, partly, it is argued, because of its appeal to areas of the cultural consciousness. In America, Snow and his work on the epidemiology of cholera, including the Broad Street pump story, achieved a serious status which has endured, in one form or another, to the present day. In contrast to Britain, the heroic age of public health in America coincided with the optimism of the bacteriological revolution and higher hopes for medical science. However, this rapidly changing environment exacerbated differences of opinion as to what the small and emergent specialty of epidemiology should look like, what its project was, and where it should be based. Different versions of Snow's persona came to represent basic and often conflicting conceptions of epidemiology and the status (or lack of it) of its practitioners. For many, consciously or otherwise, the removal of the Broad Street pump handle remained an individualistic triumph, a single human intervention which resembled modern medicine in providing a “cure.”

Sulphuric Utopias: A History of Maritime Fumigation

Sulphuric Utopias: A History of Maritime Fumigation

Epidemics in Nineteenth-Century British Towns: How Important was Cholera?

Abstract One major legacy of the bacteriological revolution of the later nineteenth century is a simplified model of cause and effect. Looking back, this model seems entirely appropriate for a century dominated by infectious diseases. In this widely accepted picture of the nineteenth-century mortality experience the leading role is taken by the cholera epidemics which invaded Britain between 1831 and 1866. Historians have followed this lead by making cholera an exciting cause of political and social change, including the first Reform Bill. This essay suggests that the sporadic incursions of cholera were less a spur to reform than a distraction from the perpetual, or endemic, causes of death, which are inevitably those with the closest connections with the social, economic and political contexts of Victorian Britain. The Benthamite sanitarians built their case primarily on what they called continued fever, which we now identify as typhus and, increasingly, typhoid. The endemic diseases, year upon year, caused more deaths than cholera, and it is they which provided the quantitative definition of excess mortality which came to justify government intervention. Similarly, a further phase of public health reform was necessary after cholera was no longer a factor. These later reformers deplored the degeneration and mortality associated with extreme urbanization, and attributed them to respiratory conditions, fluxes, and what we might now call the pneumonia-diarrhoea complex among children. Cholera was an important phenomenon, but its effects on society need to be defined with some precision. Note: this is a revised version of the 12th Henry Cohen History of Medicine Lecture, given in 1983, and republished by kind permission of the Liverpool Medical Institution.

Sulphuric Utopias: A History of Maritime Fumigation by Lukas Engelmann and Christos Lynteris

Reviewed by: Sulphuric Utopias: A History of Maritime Fumigation by Lukas Engelmann and Christos Lynteris Brad Bolman (bio) Sulphuric Utopias: A History of Maritime Fumigation By Lukas Engelmann and Christos Lynteris. Cambridge, MA: MIT Press, 2020. Pp. 320. Sulphuric Utopias: A History of Maritime Fumigation By Lukas Engelmann and Christos Lynteris. Cambridge, MA: MIT Press, 2020. Pp. 320. In the early months of the COVID-19 pandemic, transport ships became objects of added suspicion, with governments recommending masks and handwashing for crews, as well as routine disinfection and increased air circulation. In extreme cases, quarantine was required, threatening the transit of goods across the globe. Although written before the outbreak, Lukas Engelmann and Christos Lynteris's Sulphuric Utopias feels like urgent reading. Maritime fumigation is no one's first choice for a good time, but Engelmann and Lynteris's ambitious study, which knits together histories of technology, medicine, and science, offers a timely account of how the expansion of international commerce relied on relatively unheralded technologies, namely fumigation. Focused, in particular, on the sulfereous Clayton machine—its New Orleans genesis and distribution across the world's major trading ports—the authors reveal how quarantine and commercial mobility became reconciled, making the Clayton machine, they argue, "a forgotten pillar of globalization" (p. 5). The book opens with a history of the medical and scientific underpinnings of fumigation, as well as an abbreviated history of quarantine (ch. 1). From J. C. Galès's "fumigatory box" to the earliest international sanitary conferences, fumigation supported an expanding system of maritime sanitation and a view of the absolutely central chemical battle against infectious disease. Next, the authors introduce the "Clayton" (ch. 2). The device, Engelmann and Lynteris argue, was neither a result of the broader bacteriological revolution nor of particular breakthroughs regarding disinfection. Rather, besieged as New Orleans was by yellow fever and a host of other ailments, the need to slow or eliminate the spread of illness without imposing longer, "barbarous" detentions spurred development of the Clayton and related devices (p. 68). The authors then turn from New Orleans to explore carbon-based fumigation in Ottoman and German contexts around the turn of the twentieth century, showing how rats became the prime target of maritime fumigation (ch. 3). Readers witness the Clayton's introduction to England and France, where the attraction of destroying rat populations helped ensure the device's utilization (ch. 4). In this account, it was the ship itself, rather than ports, that became the key object of disinfection during the first decades of the twentieth century, with Claytonization a relatively economic as well as politically palatable method for maintaining inter-imperial trade. The authors then reveal how international conferences acted to "stabilize" [End Page 616] the Clayton machine as a preferred fumigation device—even amid concerns about its effectiveness—due to its adaptability for larger and smaller spaces (ch. 5 and 6). By 1903, whether one believed in the Clayton, fumigation itself was undeniably attractive, and a French alternative appeared: the Aparato Marot, known as the "Sulfurozador" in Argentina, where it left ships to support a city-wide fumigation strategy. Engelmann and Lynteris call this and other programs "sulphuric utopias": visions of a future commerce uninhibited by the "stasis" of quarantine. Yet in the final chapter, we see sulferic utopias already reaching their demise around the third decade of the twentieth century. After World War I, maritime fumigation abandoned its focus on germicide. Alongside this shift in strategy came a chemical transformation, with cyanides gradually replacing sulfer-based technologies such as the Clayton. Where sulfer had sunk to ship hulls, allowing rats to flee to higher ground, hydrocyanic acid (HCN) was devastating at all levels. "With the disjuncture of disinfection and disinfestation in the practice of fumigation, efficiency in terms of the rapid destruction of pests and vermin became more important than the capacity to kill pathogens" (p. 191). New air-jet sprays that could direct HCN directly into rat nests were sulferization's death knell. Sulphuric Utopias is laudable for its sweeping geographical scope and multidisciplinarity. Its slight chapters, indeed, leave much room for additional scholarship. The book suggests that the Clayton machines and the wider experimental system surrounding...

Brève histoire des épidémies au Québec: Du choléra à la COVID-19 by Denis Goulet

Reviewed by: Brève histoire des épidémies au Québec: Du choléra à la COVID-19 by Denis Goulet David Wright Goulet, Denis –Brève histoire des épidémies au Québec: Du choléra à la COVID-19. Québec: Septentrion, 2020. Pp. 172. In 1847, amid an emerging typhus epidemic, the public health authorities of Montréal frantically built fever sheds along the Saint Lawrence River to care for and contain infected Irish immigrants debarking from dozens of ships. Sanitary police were called in to act as a barrier to prevent the potentially contagious from escaping the scenes of misery under cover of darkness. Amid the palpable tensions, the Grey Nuns and the newly formed Sisters of Providence selflessly tended to the sick crammed into makeshift barracks, hundreds of whom would succumb in short order to what was known as "ship's fever." The Bishop of Montréal descended upon the dying to deliver last rites to his coreligionists before they were buried hastily in mass graves. Ultimately, several thousand died in the scorching heat of July and August of that year, including, as the epidemic inevitably spread throughout the city, the Mayor himself. The great typhus disaster is but one of the principal epidemics showcased in this informative "brief history" of epidemics in Quebec. The book is divided into two principal parts: the first covers the period from the cholera pandemic of 1831–1832 to the smallpox epidemic of 1885; the second begins with the Spanish flu of 1918 and concludes with the arrival of AIDS in the 1980s. The echoes of past responses to epidemics will no doubt resonate with readers living through the current COVID-19 crisis. Cholera prompted the installation and formalization of quarantine protocols; the typhus epidemic encouraged the establishment of municipal health boards; the smallpox riots of 1885 reflected the longstanding suspicion of, and resistance to, compulsory vaccination. Despite the implementation of sanitary reform and discoveries associated with "scientific medicine," the remedies of mainstream medicine were often insufficient. The 1918 Spanish flu revealed the limitations of the bacteriological revolution; the decennial polio outbreaks highlighted our growing preoccupation with technological solutions (such as the iron lung); and AIDS demonstrated how effective therapeutics and vaccines sometimes take years, indeed decades, to develop. Brève histoire des épidémies provides an accessible compendium of many of the prominent infectious disease outbreaks in the history of Quebec after the conquest. It will be of particular value to a general public eager to dip into medical history and to peruse the captivating stories of sacrifice, suffering, and scapegoating in the past. Readers, for example, might be surprised to learn that more residents of Quebec city died of cholera in 1832 than COVID-19 in 2020, despite the fact that the city's population was, in 1832, one-tenth of what it is today. The book's strongest contribution may lie in its careful analysis of the construction of Quebec's public health infrastructure over the last two centuries. Who knew that the Rockefeller Foundation, so active in Latin America, also played a pivotal role in funding unites sanitaires across the province during the interwar period? For academic historians, there are, of course, some downsides to emphasizing only the major epidemic outbreaks of the past two centuries. It is easy to forget that the biggest infectious disease killer of the 1800s was actually tuberculosis, which was so widespread as to [End Page 200] be considered endemic. What is more, the very high death rates from nonepidemic diseases of urban capitalism—"summer diarrhoea," measles, and "enteric fevers"—merit relatively little attention, even though Montréal had the dubious reputation of boasting the highest rates of infant mortality in the Western world in the decade leading up to the First World War. Nevertheless, this is a readable and accessible book that conveys technical aspects of disease transmission very clearly while maintaining a sensitivity to the diverse cultural and social aspects of epidemic outbreaks. Goulet demonstrates vividly how societal responses were often pluralistic, with some people placing faith in medical science and the power of government to do good, whilst others were more skeptical of the motives of medical men and...

Medical Bacteriology and Medical Genetics, 1880–1940: A Call for Synthesis

Between 1880 and 1920 the medical quest to unearth the causes of disease saw two pathbreaking discoveries. One was the bacteriological revolution – the identification of specific germs as causal agents of specific diseases (anthrax, tuberculosis, diphtheria, cholera and so on), and the simultaneous effort to develop disinfection techniques and immunisation measures to combat these diseases. The other was the rediscovery of Mendel’s laws of heredity and the resulting emergence of medical genetics, where an entire set of medical maladies (deafness, blindness, bodily deformities, haemophilia, Huntington’s chorea, feeble-mindedness and many mental diseases) were identified – rightly or wrongly – as genetically determined. The ‘germ theory of disease’ and the ‘gene theory of disease’ shared striking, all-too-often overlooked similarities. Both theories built on shared epistemological assumptions that influenced their explanatory mechanisms and their overall conceptual frameworks; both mobilised similar visual and linguistic vocabulary; both appropriated – and enforced – prevailing cultural and gender norms; and both enshrined broadly parallel hygienic practices. Reflecting similar social concerns, medical bacteriology and medical genetics acquired kindred scientific and societal configurations, which this paper highlights and scrutinises.

Strangling Angel: Diphtheria and Childhood Immunisation in Ireland by Michael Dwyer

Reviewed by: Strangling Angel: Diphtheria and Childhood Immunisation in Ireland by Michael Dwyer Mary Hatfield Strangling Angel: Diphtheria and Childhood Immunisation in Ireland By Michael Dwyer Liverpool: Liverpool University Press, 2018. x + 212 pp. Hardback £85.00. Michael Dwyer's debut monograph documents the history of diphtheria and the campaign to implement anti-diphtheria vaccination in the Irish Free State. Offering a new analysis of the Ring College disaster and the role of the British pharmaceutical company Burroughs Wellcome in Ireland's immunization initiatives, this book is an innovative and insightful study into the history of vaccination and public health policy. As the question of compulsory vaccination once again looms high on the public agenda, Dwyer's work casts a historical light on the challenges of pursuing innovation in public health policy while also ensuring protection of the vulnerable and individual rights. The volume is the first to focus on diphtheria in Ireland and the development of a vaccination. Given the extent of the disease and its fatality rate, this is a welcome addition to the literature on vaccination and childhood health in Ireland. The study utilizes Irish newspapers, government reports, and public health records to trace efforts taken to mitigate this childhood disease and the challenges and failures of early immunization campaigns. The book is not a social history of the disease, and therefore limited attention is paid to how parents and children experienced diphtheria or thought about the risks and rewards of vaccination. This study focuses on public health officials, on the medical community, and the scientific development of an antitoxin. [End Page 471] Dwyer makes a strong case for the prevalence of diphtheria as one of the deadliest childhood diseases, though it was often misclassified and underreported during the late nineteenth and early twentieth centuries. The book argues that Irish health policies were radically progressive, influenced by American and specifically New York's public health schemes. The Irish were one of the earliest European nations to adopt and implement childhood immunization. However, their progressive stance masks a darker history of vaccine experimentation carried out on children in Irish industrial schools, as well as the administration of experimental vaccines to children with limited parental consent. The vision of a diphtheria-free Ireland meant that some physicians took risks that were likely unacceptable to wider Irish society but were considered necessary among British and Irish medical communities. Dwyer focuses on the aggressive schemes launched in Cork and Dublin to bring about a bacteriological revolution. The vigor of such health policies was largely connected to the personality of the acting medical officer. Jack Saunders's energetic and extended appointment in Cork from 1929 to 1957 enabled a long-term commitment to childhood immunization schemes. The early successes of anti-diphtheria immunization were brought to a halt with the Ring College disaster in 1936–37. After a routine anti-diphtheria immunization by a local Waterford doctor, twenty-four children reportedly contracted tuberculosis and one 12-year-old girl died. The existing historiography relating to the Ring incident has insisted that Burroughs Wellcome mistakenly supplied a bottle of live tuberculosis in lieu of a bottle of the anti-diphtheria serum. Dwyer suggests that the local doctor and his advisors conspired to cover up initial negligence in administering the immunization and subsequently failed to provide medical treatment to the affected children in order to avoid blame. Perhaps the most striking element of the episode was the collusion of medical and school authorities to prevent parents from knowing that their children had been diagnosed as tubercular. Legal action against the prestigious Wellcome company produced an inconclusive verdict, and the real effect of the Ring College disaster was an 80 percent decline in children presented for immunization the following year. Dwyer's concluding chapter follows the development of vaccination schemes in Ireland until the 1960s, providing insight into the gradual acceptance of diphtheria immunization and the decline of the disease. There is a noticeable lack of tables and charts throughout the volume. These would have been very useful to contextualize and compare incidences of disease and immunization rates. There are several long sections in chapters [End Page 472] 3 and 4, drawn from yearly reports...

“FOR THE CULTURE, TOWARDS THE HYGIENE”: PUBLIC HEALTH AND “THE EXHIBITIONARY COMPLEX” IN LVIV IN THE LATE XIXTH – EARLY XXTH CENTURY

The long XIX century became «the golden age» in the history of exhibitions. During that period of time, understanding of their meaning, organizational approaches and thematical content changed, thus they received new functions. Quite often these processes are considered and explained within the framework of the concept of «the exhibitionary complex». The development of public health, its inclusion into the list of the indices of «civilization»and «progress», high prestige of the hygiene and hygienists, and «bacteriological revolution» contributed to the emergence of separate international, national and regional exhibitions that focused on public health and hygiene in the second half of the XIXth century.Two exhibitions, dedicated to medicine and natural science, that was held in Lviv in 1888 and 1907, echoed and followed the international trends. Although they did not focus exclusively on hygiene and public health, separate departments and sections were devoted to these issues. Both Lviv exhibitions were organized by professionals within the scope of the congresses of Polish physicians and naturalists, and thus they had both local and national character.The separation of hygiene as an autonomous part of these exhibitions should be considered in connection with two phenomena. The first was the development of the hygiene movement in Galicia during that time. Hygienists, among other purposes, sought to spread «hygienic education» among broad strata of society. The second was the shaping of public discourse on public health in the province of Galicia. Additionally, exhibitions became a site of cooperation between authorities, activists and professionals, and also they spread the idea of progress in Galicia.

From ‘Vilest Beverage’ to ‘Universal Medicine’: Drinking Water in Printed Regimens and Health Guides, 1450–1750

Abstract Historians tend to assume that in pre-modern Europe people avoided the water, as too unsafe, risky and generally unhealthy to drink. This assumption is clearly flawed: early modern Europeans knew, through experience, which waters were ‘best’ and to take certain precautions when it came to the consumption of water. Town councils enacted legislation to ensure water quality as well as more pro-active measures to keep water sources clean. Extensive and expensive water works in many larger towns and the presence of water-carriers suggests a demand for drinking water. And yet the history of both water control measures and drinking practices before the onslaught of Asian cholera and the bacteriological revolution in the nineteenth century have yet to be written. As a contribution towards filling this gap, this study seeks to understand the radically changing nature of medical advice on water consumption between 1450 and 1750, and what it can tell us about the place of water in early modern society. To do this, we consider printed dietary regimens and guides to good health and long life, a successful, varied and changing genre. They offer privileged access to the circulation of knowledge regarding water, in the context of the everyday regulation of food and drink in the maintenance of health. We explain why water went from being considered ‘the vilest of beverages’ in the mid-fifteenth century, the consumption of which, though necessary, had to be carefully regulated, to a ‘universal medicine’ three hundred years later, able to prevent and cure disease. In the process, wine gave way to water as the preferred healthy drink—at least, for medical authors. We relate the medical advice to the different local conditions (such as river water quality), practices (use of cisterns, boiling or filtering) and fashions (cold-drinking) discussed in the medical literature. If water’s very banality means that it is often invisible in the written evidence, the regimens provide ample evidence of the importance of drinking water and of changing attitudes and practices over the course of the early modern period.

Syphilization and Its Discontents: Experimental Inoculation against Syphilis at the London Lock Hospital.

In 1867 James Lane and George Gascoyen, surgeons to the London Lock Hospital, compiled a report on their experiments with a new and controversial treatment. The procedure, known as "syphilization," saw patients be inoculated with infective matter taken from a primary syphilitic ulcer or the artificial sores produced in another patient. Each patient received between 102 and 468 inoculations to determine whether syphilization could cure syphilis and produce immunity against reinfection. This article examines the theory and practice of this experimental treatment. Conducted against the backdrop of the Contagious Diseases Acts, the English syphilization experiments have been largely forgotten. Yet they constitute an important case study of how doctors thought about the etiology and pathology of syphilis, as well as their responsibilities to their patients, at a crucial moment before the advent of the bacteriological revolution.

Portuguese Experiences of Artificial Infant Feeding in the Late Eighteenth Century

Infant feeding is an explanatory factor of infant mortality levels in historical populations. The bacteriological revolution in the early 1870s changed medical science and technologies in terms of food production and ways in which infant populations were fed. Even before that change, however, connections between food and child health were being discussed in both the medical literature and political institutions. How foundlings were fed was a crucial issue in pre-industrial Europe. At that time, increasing foundling numbers and difficulties in providing wet nursing, due to the shortage of suitable women and financial constraints, forced the authorities to take action to keep infant mortality levels under control. This article shows evidence of dry nursing strategies and practices in Portugal in the late eighteenth century. It explores the relationship between political and healthcare institutions, medical knowledge and the living conditions of the infant population and, more specifically, discusses the use of artificial feeding in Portugal and the intervention of authorities such as the Intendant-General of Police, Diogo Inácio de Pina Manique, and his experiments with animal milk.

“Until Cleansed and Purified”: Landscapes of Health in the Interpermeable World

The Lazaretto quarantine station on the Delaware River was built beginning in 1799, in the aftermath of four devastating yellow fever epidemics, to protect Philadelphia from imported disease. Although historians of quarantine have focused on debates over the contagiousness of various diseases, far more important than the danger of contagion in the Lazaretto’s operations was “infection” in the ships themselves and in their cargo. This paper explores the elusive and misunderstood concept of “infection” in the nineteenth century through an examination of detention criteria and disinfection—or “purification”—procedures at the Lazaretto, as well as the rationale for the location of the quarantine station itself. I suggest that the critical elements of disinfection were not chemicals, but time and air—ideally, a particular kind of air in a particular kind of place. I also sketch the outlines of the “interpermeable world” prior to the Bacteriological Revolution, in which air, earth, water, and bodies were perceived as mutually permeable and always potentially health-promoting and pathogenic to varying degrees.

Performing State Medicine During its 'Frustrating' Years: Epidemiology and Bacteriology at the Local Government Board, 1870-1900

This article is about the performance—referring to the projection and reception—of state medicine in late Victorian Britain. Moving away from the lens of the ideas and policies historians have previously explored, I focus on epidemiological and bacteriological investigations of typhoid fever as they were conducted through the Medical Department of the Local Government Board, during the period historian Roy MacLeod characterised as a ‘frustrating’ one in the history of state medicine. The article focuses on two late Victorian epidemiological investigations, Richard Thorne Thorne's 1879 study of an outbreak of typhoid fever at Caterham, and H. Timbrell Bulstrode's 1896 study of an outbreak of typhoid fever at Chichester, to demonstrate the complex ways that epidemiology was constructed and defended vis-à-vis the emergence of laboratory science during the so-called Bacteriological Revolution.

'So Far as I Can Define without a Microscopical Examination': Venereal Disease Diagnosis in English Courts, 1850-1914

The absence of a ‘bacteriological revolution’ in venereal disease (VD) diagnosis in late nineteenth-century Britain has most commonly been demonstrated through medical texts and hospital practice. The following article contributes a broader perspective to the subject of knowledge transmission about VD diagnosis, by using evidence from English criminal cases and general practice. It demonstrates that general practitioners were limited by slow knowledge transfer processes ‘from above’, by a lack of resources and by the reinforcement of traditional methods ‘from below’. The article also pays attention to how and why the medical diagnosis of venereal diseases altered according to the age of female complainants. It shows that, as doctors had to visually interpret vaginal discharges rather than use ‘objective’ bacteriological diagnosis, claims to diagnostic uncertainty could be shaped by wider frameworks of legal, moral, social and professional thought.

Cultures de bactériologie en France, 1880–1900: la paillasse et la politique

Iconic accounts of the “bacteriological revolution” presented it as a radical change in the understanding of the natural world. Scientist had discovered that human being shared their environment with billions of invisible living beings which shape life phenomena, health and disease. They also learned to cultivate and manipulate these invisible creatures. The domestication of microorganisms in the laboratory disarmed them as enemies and occasionally transformed them into allies. This analysis of the development in French bacteriology displays a more nuanced and complex picture, with continuities as well as ruptures, and multiple levels of change. Between 1880 and 1900, the rise of “pasteurian science” did produce important changes in French society, but these changes were obtained through a variety of approaches: introduction of new experimental techniques, administrative and legal methods, training of professionals, education of the general public, and a direct political intervention.

‘More Like Cooking Than Science: Narrating the Inside of the British Medical Laboratory, 1880-1914′

This blending of the domestic and the laboratory sits uneasily with historians‟ representations of late-Victorian medical laboratories as modern and professional spaces. They might dismiss Conan Doyle‟s image as an example of the crime genre; suggest that it is somehow quaint or idiosyncratic, or show how it conforms more to the spaces occupied by the amateur scientist than with a style of modern scientific medicine associated with the laboratory. Certainly, Holmes‟ encounters with the laboratory and his own experimentation throughout the Holmes‟ canon do not match the professionalising account associated with the „laboratory revolution‟ in medicine. According to this narrative, the development of new laboratory practices after 1850 through physiology, bacteriology and pathology not only represented the establishment of new medical specialisms, but also involved rapid and dramatic changes in medical education, research, and the understanding of disease. The result was a series of remarkable advances in medicine and a transfer in medical authority from the clinic to the laboratory that saw a paradigm shift that left little room for traditional practitioners or the amateur. But should Conan Doyle‟s image of a laboratory space be dismissed so easily? Was it just in the realms of the scientificallyminded detective or the gentleman scientist that the laboratory inhabited such domestic and apparently incidental spaces? In the historical literature, the day-to-day work of the laboratory and the spaces in which medical science was performed has often been marginalised. In part this has been a consequence of the assumptions made about questions of professionalisation, institutionalisation, and the growing importance of a series of laboratory disciplines to medicine. Our conceptual image of the laboratory as a site for discoveries owes far more to the institutional structures developed in Germany and France around physiology and bacteriology than they do to British endeavours, which are often represented as dominated by empirical, bedside medicine (Lawrence, “Incommunicable Knowledge”). However, just as historians have come to question the boundaries of the “laboratory revolution” to reveal how the laboratory initially served a more subordinate role in medicine, the location and nature of laboratory practice also need to be re-examined (Brunton; Worboys, “Was there a Bacteriological Revolution?”). Encouraged by the anthropological work of Bruno

Public health measures against neonatal tetanus on the island of Vestmannaeyjar (Iceland) during the 19th century

The article presents a study of neonatal tetanus on the tiny island of Vestmannaeyjar (Iceland) during the 18th and 19th centuries. At an early date, Vestmannaeyjar was known for its high levels of mortality from neonatal tetanus. This appalling mortality is analysed, inter alia, on the basis of parish registers at the individual family level. During the late 18th and early 19th centuries, more than three out of four newborns on the island died during the first 2 weeks of life. At the beginning of the 19th century, Icelandic and Danish authorities had already showed great interest in improving infant survival on Vestmannaeyjar. In 1827 a physician was appointed to the island and by the late 1840s the disease was successfully fought on the island. The achievement on Vestmannaeyjar is a good example of how the sanitary movement was able to bring about important improvements in infant survival long before the breakthrough of the bacteriological revolution.

Contagious: Cultures, Carriers, and the Outbreak Narrative (review)

Reviewed by: Contagious: Cultures, Carriers, and the Outbreak Narrative Alan M. Kraut Contagious: Cultures, Carriers, and the Outbreak Narrative. By Priscilla Wald. Durham: Duke University Press. 2008. As culture critic Roger Rosenblatt reminds us, "story-telling is what the human animal does, to progress, to learn to live with one another." English professor Priscilla Wald analyzes a particular genre of recurring story, the account of the communicable disease outbreak, the history of which is especially compelling in light of contemporary concerns about HIV/AIDS, SARS, Avian Flu, and drug-resistant strains of tuberculosis. [End Page 129] She intends her interdisciplinary analysis of outbreak narratives to aid scholars in their understanding of disease's impact upon society. Such understanding might then lead to "more effective, just, and compassionate responses both to a changing world and to the problems of global health and human welfare." (3) Outbreak narratives share a "formulaic plot," according to Wald. Each narrative, whether in fact or fiction, begins with "the identification of an emerging infection, includes discussion of the global networks throughout which it travels, and chronicles the epidemiological work that ends with its containment." (2) Wald begins in the midst of the bacteriological revolution which began in the late nineteenth century. In the treatment of Mary Mallon (a.k.a. Typhoid Mary) in the early twentieth century, Wald locates an early and culturally powerful factual outbreak narrative. George Soper, a clever epidemiologist traced typhoid deaths at a summer house to a female Irish immigrant cook, a healthy carrier, who is unwittingly spreading infection to those who ate food she prepared. It was an era before such phenomena were widely understood, and Mary's insistence of innocence, her pursuit, and her detention in isolation arouses sympathy for both the dead and for Mary, who emerges as a victim of her own body and a fearful society. Wald looks to similar historical narratives in the Cold War era and, more recently, in exchanges about the HIV/AIDS pandemic. In literature, Wald locates the outbreak theme in Michael Crichton's Andromeda Strain (1969) and Richard Preston's Hot Zone (1994). On the screen, there is Invasion of the Body-Snatchers (1956 and 1978 versions). These stories include a patient zero (the first to contract the disease), superspreaders, hot zones, and persistent pathogens, or invaders. Wald prods readers to consider how humans respond to the biological invasions of their bodies, especially by microorganisms. Her examples remind us that increasing human connectedness with its gift of shared information, also imperils us by the speed with which disease is spread. Citing journalist Laurie Garrett's The Coming Plague (1994), Wald suggest the possibility of a counter-narrative in which the world, with some humility, reconceptualizes humanity's place in the Earth's ecology and acts locally and globally to ensure every person's right to the highest possible level of health through reform in the distribution of medical care and banishing the extreme poverty that triggers outbreaks of disease. Wald also sensitizes readers to how contagion spreads and whom it affects. She cautions against confusing disease and victim, hoping to diminish medicalized prejudice and stigma often assigned to sufferers. Contagious is too rich in detail and cultural reference for most undergraduates, but scholars of American culture will applaud it. It is unlikely that Wald's cultural critique with its plethora of examples from novels and films offers the kind of data that can alter America's medical landscape, but thoughtful physicians, nurses, and public health workers who do encounter her book will never battle an "outbreak" without pondering how it might give rise to yet new cultural expressions, symbols, and social relationships. Alan M. Kraut American University Copyright © 2010 Mid-America American Studies Association

Missionary Medicine and Akan Therapeutics: Illness, Health and Healing in Southern Ghana's Basel Mission, 1828-1918

AbstractThe Basel missionaries in southern Ghana came from a strong religious healing tradition in southwest Germany that, within some circles, had reservations about the morality and efficacy of biomedicine in the nineteenth century. Along with Akan Christians, these missionaries in Ghana followed local Akan healing practices before the colonial period was formalized, contrary to a pervasive discourse condemning local religion and healing as un-Christian. Around 1885, however, a radical shift in healing practices occurred within the mission and in Germany that corresponded to both the Bacteriological Revolution and the formal colonial period. In 1885 the first medical missionary from Basel arrived in Ghana, while at the same time missionaries began supporting biomedicine exclusively. This posed a great problem for Akan Christians, who began to seek Akan healers covertly. Akan Christians argued with their European coreligionists that Akan healing was a form of culturally relative therapy, not a rival theology.