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Germ Theory: Medical Pioneers in Infectious Diseases

Author: Robert P. Gaynes1
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Affiliations: 1: Emory University School of Medicine, Atlanta, Georgia;
Content Type: Trade
Publication Year: 2011

Category: General Interest; History of Science

Named as Choice Outstanding Academic Title 2012

From Hippocrates to Lillian Wald-the stories of scientists whose work changed the way we think about and treat infection.

  • Describes the genesis of the germ theory of disease by a dozen seminal thinkers such as Jenner, Lister, and Ehrlich.
  • Presents the “inside stories” of these pioneers’ struggles to have their work accepted, which can inform strategies for tackling current crises in infectious diseases and motivate and support today’s scientists.
  • Relevant to anyone interested in microbiology, infectious disease, or how medical discoveries shape our modern understanding

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Microbe Magazine

02 August 2013

The idea of telling the history of medicine through a series of biographies is hardly new. The use of this model goes back at least to Henry Sigerist's Great Doctors, which was fırst published in German in 1932. A more recent example is Sherwin Neuland's Doctors: The Biography of Medicine (1988). One might also seek the antecedents of this book in Paul DeKruif's romanticized telling of the history of medical microbiology, The Microbe Hunters (1926).

The appeal of this biographical approach is easy to understand. It permits the reader, and the author as well, to focus on a series of famous individuals rather than on the more complex dynamics of a research or professional community. In the present case Robert Gaynes gives us a series of chapters on famous and influential fıgures in the history of medicine, among them Edward Jenner, Ignaz Semmelweis, Louis Pasteur, Robert Koch, Paul Ehrlich, and Alexander Fleming. A pleasant surprise is to fınd a fınal chapter on Lillian Wald, a woman, a nurse, an American, and a founder of public health nursing. In general the chapters are written in a lively style, and they clearly set before the reader the achievements for which the chapter's subject is remembered today. The book is a pleasant read that tells a familiar story. Unfortunately it has several substantial weaknesses.

Since this is such a broad synthesis, the author can be forgiven for relying exclusively on translations of European scientifıc works and on English-language histories. He can be expected, however, to have incorporated the results of recent English-language historical scholarship. Unfortunately, the author ignores the most relevant historical scholarship of the past 40 years. This is a great pity, because the research of Codell Carter, Margaret Pe ling, Michael Worboys, Gerald Geison, Bruno Latour, and others has a great deal to tell us about both the content and the context of the research that constructed the modern germ theory of disease. By studying the publications of a broader segment of the scientifıc and medical communities and by using manuscript sources previously unconsulted, these scholars have helped us understand how the concepts and research problems of the 19th century were understood and framed at the time, keeping us from reading our modern understandings back onto the past. This modern scholarship also throws much light on how the research of the most famous fıgures was conducted by broadening our focus from the single individual researcher to a research community populated by nowforgotten scientists who made crucial, sometimes unacknowledged, contributions, where rival germ theories of disease existed, and where the results of research were not always interpreted initially the way they would be subsequently understood. The failure to come to terms with this research and to incorporate it into this synthesis is a great opportunity missed.

Some readers will legitimately wonder what chapters on Hippocrates, Avicenna, or Fracastoro are doing in a book on the history of the germ theory. A critical reader will object to the author's anachronistic use of "humoral theory" in discussing the 18th and 19th centuries. The unwary reader may infer that the concept of contagion had its origin in a minor 16th-century literary work by the Girolamo Fracastoro from which it evolved steadily to gain acceptance in the 19th century. Scholarship since the 1940s, on the other hand, has shown its more probable origins in the practices of quarantine fırst for leprosy and later bubonic plague. Moreover, far from steadily gaining scientifıc credibility, the theory of contagion reached its scientifıc nadir in the early 19th century among some of the age's most prominent scientists, including the pathologists and physiologists who we remember today for their roles in making medicine modern.

In short, we have here a pleasantly written book that tells a familiar story. Unfortunately, it could have been a better, more informative synthesis.

Microbe Magazine

Reviewer: John M. Eyler, University of Minnesota

Review Date: July 2012

The Quarterly Review of Biology

14 July 2013

HUMAN BIOLOGY AND HEALTH

In this volume, the author recounts the circuitous paths by which germs have become recognized as pervasive causes of disease, and the effects of this enlightenment on human health. The book focuses on the contributions of about 15 historic figures from Hippocrates to Alexander Fleming. For each, Gaynes masterfully weaves together key discoveries and insights with personal histories, philosophical clashes, and the tone of the times.

The author follows the threads of the three great practical applications of the germ theory: vaccination, therapeutics, and improved hygiene. His extension of hygienic applications beyond the hospital environment is, however, a bit rickety. When he discusses waterborne disease, for example, he invests more text on Koch’s secondary study of cholera transmission than the more powerful, pioneering studies conducted decades earlier in London by John Snow; moreover, he fails to mention the most critical part of Snow’s work, namely the comparison of cholera among residents provisioned by two water companies before and after one of them began providing safe water. In one swoop, Snow showed how cholera could be transmitted and controlled, launched the discipline of epidemiology and, as Snow himself recognized, provided strong evidence that the disease was caused by an invisible, living agent.

Gaynes’s historical tour peters out by the middle of the 20th century. This truncation is unfortunate because one of most exciting developments of the germ theory has been unfolding since then: the recognition that germs cause a broad spectrum of chronic diseases and do so by recently clarified mechanisms of pathogenesis. The author devotes some attention to AIDS, but the recent development of the germ theory spans much more broadly; it now incorporates peptic ulcers, numerous cancers, gingivitis, periodontitis, and type 1 diabetes, and may eventually include diseases such as atherosclerosis, stroke, Alzheimer’s disease, multiple sclerosis, and schizophrenia. It is ironic that Gaynes paid so little attention to this great new phase of the germ theory. It appears that he, like critics of the germ theory he brings to life in his book, has been constrained by tradition.

The Quarterly Review of Biology

Vol. 88, No. 2, p. 151

Reviewer: Paul W. Ewald, Biology, University of Louisville, Louisville, Kentucky

Review Date: June 2013

Key Reporter

23 June 2013

Robert P. Gaynes succeeds in depicting in large brushes the history of infectious diseases, placed into the context of concepts and ideas as they evolved from the time of Hippocrates in ancient Greece 2,500 years ago to the present. He does so by presenting lively biographies of twelve pioneers selected for changing the prevailing view of the time and for contributing major advances in the understanding, diagnosis, prevention, and treatment of infectious diseases. One appealing aspect of the book lies on the personal background of each individual, providing insight on how upbringing and world affairs affected the way discoveries were made and progress achieved. A portrait of the twelve scholars and their character helps the reader understand what it took to overcome preconceived ideas and why some important innovations failed to enter current practice until much later. The book’s captivation also stems from Gaynes’ description of contemporaneous innovations in other fields such as the appearance of medical schools and hospitals, advances in anatomy (Vesalius’ dissection of cadavers), and the broader dissemination of information with the advent of the printing press.

I found the story of Avicenna particularly fascinating. This brilliant scholar who lived a tumultuous life was way ahead of his time when he postulated the contagious nature of tuberculosis in his Canon of Medicine. But prejudice tragically prevented Western medicine from embracing this innovation that countered the then prevailing Galenic view that disease was internal to the human body. The concept of contagion would resurface only during the Renaissance with Girolamo Fracastoro who witnessed the beginning of a syphilis outbreak and its terrifying effect on the population.

While most biographies are from physicians, there are exceptions. Antony van Leeuwenhook was a draper with great skills for making microscopes of great magnification power to which he added light to illuminate carefully prepared specimens, allowing for the first time the observation of bacteria and other single-celled organisms. Louis Pasteur was a chemist and Lillian Wald a nurse whose contributions served as the underlying foundation of the public health infrastructure.

A large part of the book is devoted to advances achieved between the second half of the eighteenth century and the beginning of the twentieth century. For contributions to the prevention of infectious diseases, Gaynes singles out work by Edward Jenner (smallpox vaccination), Ignaz Semmelweis (statistics used to show that hand washing reduced childbed fever), Louis Pasteur (immunity to microorganisms by attenuation of pathogenic microbes), Robert Koch (bacteriological causes of disease), and Joseph Lister (antiseptic surgery). His biographies of Paul Ehrlich (antibody production) and Alexander Fleming (penicillin) illustrate major breakthroughs in the treatment of infectious diseases. Despite these advances, the author cautions against complacency and highlights some of the challenges ahead. Even today, scourges such as cholera are not completely eradicated and may recur in cycles, as Alexander Chizhevsky proposed by revealing associations with space weather, another factor usually dismissed in the West but worthy of further investigation.

This is a fascinating book that will captivate anyone with an interest in microbiology, infectious disease, and medical history.

Key Reporter

Reviewer: Germaine Cornelissen-Guillaume, Halberg Chronobiology Center at the University of Minnesota, Twin Cities.

Review Date: October 2012

Journal of Microbiology & Biology Education

23 June 2013

From Medieval Microbiology to Modern Medicine: A Concise History of How We Got to Where We Are Today

If one studies microbiology or medicine at all, prominent names and stories promptly rise to the surface. In this concise history of microbiology and medicine, the author brings those familiar stories to life. This is a well-written—even intriguing—historical chronicle of medical advances and microbial understanding. Robert Gaynes’ illuminating discussion ranges from Hippocrates’ foundational concepts of medicine to the challenges of creating an effective HIV vaccine.

Being a 'late adopter' of a lover for history, I now find books such as this informative and enlightening sources of accurate historical insight. Having taught microbial history to untold numbers of undergraduate students, many names and details were very familiar. Within the pages of this well-crafted discourse, Gaynes includes curious and sometimes intimate details about the people and discoveries which have sculpted the faces of microbiology and modern medicine.

Including detailed chapters on the thoughtful discoveries, lives and sometime even peculiar habits of Hippocrates, Avicenna, Fracastoro, van Leeuwenhoek, Jenner, Semmelweis, Pasteur, Koch, Lister, Ehrlich, Fleming, and Wald, the book provides an interesting read through thousands of years of medical history. In Gaynes’ own words, “This book is intended not just for the physicians or students of medicine but to be accessible to anyone with an interest inmicrobiology, infectious disease, (and) medical history.” Thelanguage and style Gaynes has chosen make this book an excellent historical source for introductory undergraduate microbiology students. Likewise, medical students and public health professionals will undoubtedly learn much about the history behind their chosen profession by reading this book.

The book is packed with details which I found new and enlightening, even after over 30 years of studying and teaching microbiology. One salient example surrounds the development and promotion of the smallpox vaccine by Edward Jenner. I had not realized the personal financial investment and travel commitments which Jenner necessarily made in the promotion and adoption of his newly developed vaccine.I had not known that the British government was hesitant to finance the production and distribution of the vaccine.

Gaynes includes the text of a personal letter written by United States President Thomas Jefferson to Edward Jenner. Jefferson wrote, “Having been among the early converts, in this part of the globe, to (your vaccine's) efficiency, I took early part in recommending it to my countrymen.” In that same letter Jefferson continues his communication to Jenner: "Yours is the comfortable reflection that mankind can never forget that you lived.”

Gaynes’ elucidation throughout the chapters of this book should ensure the same outcome for each discovery, contribution, and scientist discussed.

Gayes has crafted a book which I certainly will find myself reading again and again. It is a book in which anyone, from medical professionals to introductory microbiology students, will discover 'new' scientific and medical intrigue. This book is highly recommended for any educator or student of microbiology, public health or medicine. Educators at the high school, undergraduate, graduate, and medical school levels will benefit from reading Germ Theory. It is similarly well-suited for microbiology, biology, and medical students at these same levels.

Find a copy soon. You will have your eyes opened, and be glad you did.

JMBE: Journal of Microbiology and Biology Education

Volume 13, Number 1

Reviewer: Gregory D. Frederick, University of Mary Hardin-Baylor, Belton, TX

Review Date: May 2012

CHOICE

04 December 2012

Gaynes (Emory Univ. School of Medicine) presents a well-researched, inspiring narrative of the most important discoveries in the history of medical science. He weaves the origins of the germ theory of disease and the biographies of those who made significant discoveries together into intriguing, informative stories. The author provides vivid accounts of individuals such as van Leeuwenhoek, Jenner, Pasteur, Fleming, et al. who challenged the prevailing views of the times with their innovation and persistence, and highlights the struggles they encountered in the long processes of discovery. The book's 15 chapters are well written, thorough, and engaging, providing readers with a significant appreciation for the interplay of social, economic, and cultural forces, as well as good luck, which allowed for medical breakthroughs. This is an insightful book that serves as an excellent resource for understanding developments in medical history, how they evolved, and the details of their impact on all people. The volume includes references at the end of each chapter and an easy to use index.

Summing Up: Highly recommended. Upper-division undergraduates through researchers/faculty and physicians; medical students; general readers.

CHOICE Current Reviews for Academic Libraries

SCIENCE AND TECHNOLOGY Health Sciences

Vol. 49 No. 11

Reviewer: D.C. Anderson, Massachusetts College of Pharmacy and Health Sciences

Review Date: July 2012

Reprinted with permission from CHOICE http://www.cro2.org, copyright by the American Library Association

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