Much of the recent literature on the late nineteenth century “germ revolution” and its aftereffects on the practice of modern sanitation and public health tend to emphasize one major point; continuity- rather than dramatic conflict and divergence- typifies the historical development of medical theory and its implications for the public health. The bacteriological revolution was rapidly insinuated into existing paradigms for both the intellectual construction and practical control of disease; dirt and filth were in many ways united with germs as a limited scourge to be eliminated from the public by a responsive (and technocratic) state. Yet a number of important questions remain if we are to accept the idea of continuity and gradual (or cyclical) change in modern medicine and public health:
1. How is difference constructed and articulated across space, time and the emerging professions?
2. What historiographical and sociological techniques are most useful in tracing real and constructed changes amongst both medical/administrative and more popular approaches to public health?
As Olga Amsterdamska argues (“Demarcating Epidemiology,” 2005), sociology of science and an analysis of top-down processes of professional demarcation contribute much to understanding dynamics of continuity and change during the late nineteenth and early twentieth century. Amsterdamska points out that those epidemiologists most invested in maintaining their position as founders and scientific auxiliaries to the sanitation revolution of the nineteenth century were not immediately threatened by the implications of the bacteriological revolution on the conceptualization of public health and the epidemiological perspective within emerging professional public health institutions. 1
The bifurcation between epidemiological and bacteriological ‘sciences’, statistical and laboratory-based experimental approaches, inductive and deductive methodologies and holistic and reductionist philosophy toward public health emerged during the twentieth century interwar period and gained intensity after the second World War. For the most part, these twentieth-century demarcations of scientific authority were not the result of a real threat to the institutional foundations of the epidemiological profession. Rather the methodological battles between bacteriology and epidemiology were constructed by anxious epidemiologists insecure about their position in the increasingly complex scientific hierarchy and seeking to create stronger intellectual foundations for the multi-factorial approach to public health. 2
But the intellectual construction of “revolution” and concomitant professional demarcations says very little about the ways in which perceptions of health and disease did change and the ways in which people (including the lay population) incorporated germ theory into existing paradigms. It is the cultural turn that best captures the construction of difference across both time and social class. According to D. Barnes, (The Great Stink of Paris: The Nineteenth Century Struggle against Filth and Germs, 2006) “the germ theory of disease changed everything and nothing at all.” Situating his study between the two “Great Stinks” of Paris in 1880-and 1895, Barnes argues that a new population of invisible microbes certainly came into existence for the majority of the Parisians during this interval, but the practice of public health and the conceptualization of disease changed very little. Disease was still associated with filth, immorality, poverty and the contamination from suspect persons; illness remained the province of socially stigmatized groups. A Sanitary Bacteriological Synthesis (SBS) was reached in which germs were peacefully incorporated into existing sanitary ideas and public health practice even as popular conceptualizations of the agent of illness underwent substantial revision. Clearly, although various authors were crying for monotheoretical approaches and “specificity” (see Koch and Hill respectively), the ways in which expanding national bureaucracies in Europe and the United States approached the public health solution changed very little.
- In fact, and as the American public health leader WH Frost points out (“Epidemiology” in Papers of
Wade Hampton Frost, 1941), epidemiology acted as a catalyst to the bacteriological revolution using a methodology quite different from that of experimental or laboratory science. See discussion on John Snow’s inductive method pp. 532-540. ↩ - That problems of professionalization and scientific legitimation also contributed much to the practice of public health is emphasized by Paul Starr (“The Boundaries of Public Health,” in The Social Transformation of American Medicine, 1982). Emerging from a situation of weak professional and institutional organization during the nineteenth century, the American medical profession has played an exceptionally strong role in limiting the scope of public health intervention on professional prerogatives and autonomy during the last century. ↩
