saline is performed, and a palpable optimism flickers to life in our
operating room.
Mr. Louis, although bizarrely disfigured with no arm and no shoulder,
will live.
Mr. Louis’s life was saved by surgery and by penicillin. I have posed the
question many times to friends and patients: How many years ago was the
first dose of penicillin given? In ancient times, or five hundred years ago,
or during the Revolutionary War, or after the First World War? Few people
realize that the first clinical administration of penicillin in a small English
hospital was only seventy-five years ago.
The pioneering work of Pasteur, Lister, and Koch convinced scientists
and physicians that germs were real. As Robert Koch microscopically
elucidated their life cycles and interactions with humans, the dark veil of
ignorance regarding infectious diseases was lifted. Semmelweis and
Lister, among others, were able to show the advantages of handwashing
and sterilization, and it is not surprising that public health institutions
were created in the years after John Snow helped create epidemiology and
Florence Nightingale influenced hospital design. Although improved
sanitation and cleanliness dramatically decreased epidemics, there was
still no answer for acute or chronic infections in individual patients.
The advent of modern chemistry coincided with the triumph of germ
theory during the 1880s, in no small part because manufacturing dyes
provided contrast and color to an otherwise drab and blurry microscopic
world. The bourgeoning German industrial chemical companies began as
dye manufacturers, only later turning to fertilizers, perfumes, photography,
and pharmaceuticals. Paul Ehrlich (1854–1915), a Prussian-Jewish
physician-scientist continued the proud German tradition of perfecting the
art of histological staining, eventually gaining fame for differentiating the
component cells in peripheral blood.^1 A contemporary of Robert Koch,
Ehrlich had a breakthrough insight when he considered the chemical
processes that were occurring during the staining of tissues and bacteria.
There was a primitive understanding that certain dyes had a special
affinity for certain cells (and their constitutive parts); further trial-and-
error testing with dyes by the Danish physician Hans Christian Gram
(1853–1938) yielded the most important finding in the history of
bacteriological microscopic analysis—that bacteria could be grouped into