440Chapter 23diseases. These microorganisms (a term coined in 1880)
might be spread by air (as was smallpox), by water or
food (as was cholera), or by sexual intercourse (as was
syphilis). The germ theory had been proposed by a Ro-
man physician in the first century B.C., but physicians
repeatedly rejected it in favor of other theories, such as
the humoral theory (humors in the body were unbal-
anced) of the ancient world. The microscope revealed
the existence of microorganisms in the seventeenth
century, but scientists still favored the miasmal theory
of diseases, which stressed vapors arising from the
ground. The medical establishment remained so reluc-
tant to accept the germ theory that in 1892 a German
physician drank a beaker full of cholera bacteria to
prove that microorganisms did not cause the disease.
He did not die, but his theories did.
The germ theory was important for several reasons.
First, it led to greater cleanliness, thereby reducing dis-
ease transmission. Without the knowledge that invisible
organisms transmitted disease, no need existed for anti-
septic conditions. Without antisepsis, doctors’ offices,
hospitals, and surgeries were deadly places. Hospitals
packed fifty or sixty people into shared wards, where
they also shared diseases. Surgeries had walls and floors
impregnated with the waste of recent operations, the
floors typically sprinkled with sawdust to soak up the
mess. Surgeons wore frock coats, spattered with the
blood of their patients; they tied whipcord, used to sew
incisions shut, to their buttonholes, where it dangled in
the blood of other patients. Doctors treated one patient
after another often without washing their hands, and
surgeons operated without washing their implements.
Not surprisingly, survival rates were low. Even mater-
nity wards were deadly, often having a 25 to 30 percent
death rate for new mothers from puerperal fever, spread
by physicians who performed examinations with un-
washed fingers. General infections were so common
that they were simply called “hospital disease.” As Flo-
rence Nightingale later lamented, “The very first re-
quirement in a hospital is that it should do the sick no
harm.”
The research of French chemist Louis Pasteur and
German physician Robert Koch convinced the med-
ical world to accept the germ theory of disease trans-
mission. Pasteur’s early work proved that
microorganisms in the environment caused fermenta-
tion in beverages and the decay of organic matter.
This knowledge led Pasteur, Koch, and others to the
identification of the bacilli causing various diseases
and then to the creation of vaccines against them.
Pasteur’s research showed how to keep dairy products
and beer fresh by eliminating microorganisms
(through “pasteurization”) and led to a vaccination
against rabies. Koch conducted similar work on tuber-
culosis, and in 1882 he isolated the bacillus of the dis-
ease that had killed an encyclopedia full of the
creative artists of the nineteenth century, including
the English romantic poet John Keats (at twenty-five),
the Polish pianist Frederic Chopin, the French painter
Paul Gaugin, and the Italian violinist Nicolo Paganini.
Even before Pasteur’s proof of the germ theory, a
few physicians had called for antiseptic medicine with-
out being able to prove their case. The greatest early
champion of antisepsis was Dr. Ignaz Semmelweiss,
whose ideas earned him the nickname “the savior of
mothers” and the scorn of his colleagues. Semmelweiss
was an assistant in Vienna’s maternity clinic in the
1840s. He observed high rates of puerperal fever
among women whose doctors treated patients in other
parts of the hospital, and this convinced him that sim-
ple cleanliness could reduce the death rate. Semmel-
weiss asked that doctors wash their hands in a chloride
of lime solution before delivering a baby. He required
such antisepsis in the Viennese delivery ward in 1847,
and within a few weeks the death rate from puerperal
fever fell from 18 percent to 2 percent. Semmelweiss
could not demonstrate why antisepsis succeeded, how-
ever, and the medical profession rejected his conclu-
sion; the savior of mothers was branded a charlatan and
driven from his job after he also supported the revolu-
tion of 1848. The Medical Association of Vienna pro-
claimed it “time to stop all this nonsense about chlorine
handwash” and abandoned his innovation. Semmel-
weiss died in a straitjacket during the same year that a
British surgeon became famous for demonstrating the
success of antisepsis.
Joseph Lister became the father of antisepsis in-
stead of Semmelweiss. Lister had been studying wounds
when he read Pasteur’s work and concluded that mi-
croorganisms caused the infections he saw. He tested
carbolic acid as a cleansing agent to kill such organisms
in a successful experiment in 1865. His essay “On the
Antiseptic System of Treatment in Surgery” (1867)
quickly led to a decline in operating room deaths from
45 percent to 15 percent. Clean rooms, the storage of
surgical threads in antiseptics, and a pump to spray a
carbolic acid mist across the surgery (see illustration
23.3) won rapid acceptance, though simpler forms of
antisepsis took a surprisingly long time to arrive. An
American surgeon introduced rubber gloves (originally
intended to protect his hands from the carbolic acid) in
1889; a Polish doctor began to use gauze facemasks and