Before the germ:

William Brownrigg
-Medicine in the eighteenth century in Britain revolved around the idea of
humours, that is the bodys fluids, playing the pivotal role in a persons health
when combined with external factors such as humidity and an individuals
personal idiosycncharsies and state of mind.
-In the tradition of Hippocrates, doctors saw illness as a deviation from a state of
health caused by the violation of natural laws. These laws took into account a
number of environmental, physical and psychological factors such as air, food
and drink and movement and repose. Whenever a disharmony arose between
these non naturals and the individuals physical being, ill health was the result,
e.g a melancholy state of mind, poor quality air etc.
-These non naturals cuased illness by causing an imbalance or corruption in the
humours of the body. In response, doctors would aim to restore balance through
altering the volume of bodily fluids via leeching or other fluid draining measures.
-A striking feature of humoural medicine was that there was no such thing as a
specific disease. The disease that developed in a person was seen to depend on
the humours involved, where they settled and the site where the body was seen
to be attempting to expel them. Since all of these were very unpredictable,
disease was not thought of as having specific pathways. In keeping with this, it
was commonly thought that one disease could quite easily flow into another as
peccant humours might quit one area of the body and settle in another.
-Another side effect of this theory was that diseases were hardly even seen as
monocausal. Whereas now we might attribute a disease to a specific
microorganism, in the eighteenth centuty it was preferred to speek of a disease
of having a range of causes, predisposing (such as the climate) which had to do
with the preexisting state of the individuals humours and exciting such as over
indulgence or miasmas (inorganic particles floating in the air). Different ailments
were seen as peoples different reactions to these causes, while one person might
inhale a fume and get dysentery, another may get cholera depending on the
persons history.
-Cause of illness was seen as a matter of individual lifestyle.
Justification for humoural theory:
-Many observable diseases are in fact correlated with the expulsion, retention
and production of bodily fluids. Plague-lymph filled buboes, food poisoningvomit, tuberculosis bloody sputum. If the vomiting or buboes cessate, then that is
usually a good indication that the patient has recovered.
The doctor patient relationship
-the doctor patient relationship also played a considerable role in the acceptance
of the humoural theory. In the 18th century, a time of rigid social hierarchy, the
physician was very much subservient to their almost always wealthy client-e.g it
was the doctor who was expected to visit the client not vice versa. This lead to
the build up of an extremely narrow patient view, as the doctor would spend
most of his time at a few wealthy clients bedsides. Because of this, it was the
peculiarities of a persons lifestly that often stood out to the doctor whereas

common factors faded into the backdrop, leaving physicians a lot less open to the
fact that many of their patients were suffering from the same illness with the
same causes.
-The same sense of social inferiority also ensured that physciians were a lot less
likely to attempt to challenge the ideaological and intellectual status quo for fear
of startling their patients. Another side affect of the warped doctor patient
relationship was the doctors hesitance to conduct thorough bodily examinations.
With examinations limited to the face, pulse and bodily fluids, it is failry
unsurprising that knowledge of disease was fairly limited to its symptoms.
-However, doctors were in no hurry to change this, seeing themselves as
primarily intellectual beings who didnt want to transcend into the realm of the
barber surgeons, who were much more tactile. Doctors were also under
considerable pressure to justify their worth, vs the notorious cure alls
advertised by the local village quack. As a result, doctors favoured pugnitive
cures that left the patient bent over the privy. The effect of these treatment was
to at least make the patient feel like they were getting value for money.
Germs:
-The miasmatic theory was the prelude to germ theory, with british doctors such
as Sydenham and boyle arguing that disease was caused by minute, inorganic
particles called miasmas that often emanated from the ground. The proliferagcy
of this theory added credence to the growing movement of santation, as the
correlation between unhygienic conditions such as slums and disease became
very clear.
Immunity:
The concept of contagion, key to that of immunity had become a staple of
medical knowledge since the bubonic plague swept rapidly through Europe
(which, interestingly, also signaled the beginning of biological warfare as the
tartars laying siege to Caffa in 1347 catapulted the corpses of those who diesd
from plague into the walls of the city) anc was cememnted in the minds of the
public after the secual transmission of syphilis became obvious.
-However, the definitive example of a contagious illness was smallpox, which
provided the most compelling evidence of person to person transmission. In
regards to inoculation, it is Edward jenner whose name is most commonly
associated as it was through thte devoplemtn of the worlds first smallpox
vaccine using cowpox infested pus to famously provide James Phipps with
immunity in 1796, became the father of immunology. However, the chinese had
got there over 700 years before as there is evidence that by 1000AD the chinese
were successfully inoculating themselves against smallpox throough the
inhalation of powders from dried smallpox scabs, and even in Britain by 1791
there were several smallpox hospitals that promised immunity by injecting small
amounts of pus into the patient with hope that they would survive. This sounds
like folly, however only 1 in 400 died, although a complete lack of
standardization of the smallpox injections concentration did lead to many an
unnecessary death.
-The creation of a smallpox vaccine had wider implications than just the first
vaccine, as it gave a significant boost to the idea of disease contagion, and led to

the observation that the so called contagious effluvia that was used to explain
the person to person transferal of disease, always lead to the same disease.
Finally, the idea that a specific disease had a specific cause was cememented into
medical literature.
Leeuwenhoekss little animals:
-Dentist Anthony Leeuwenhoek became the first human ever to see
microorganisms in 1683, after he looked at the scrapings from his teeth,
however, leeuwenhoek did not make the connection between these little animals
and disease, and there was absolutely no reason to. Instead, the key question
was where these microorganisms were coming from.
Spontaneous generation
-Further research proved that these microorganisms were found consistently at
the sight of putrefaction. Three hypothesis were raised. Germs caused rotting,
germs gravitated to where rotting occurred, or rotting created germs. The latter
spawned the theory of spontaneous generation, which revolved around the idea
of a mysterious vital, vegetative force with occasionally gave life to inorganic
matter. This would prove to be an obstacle to germ theory for many years.
-The theory of spontaneous generation leading to the creation of organisms such
as rats and maggots was quickly dismantled by redi, who proved that by
covering meat with gauze, no maggots appeared as no flies could lay their eggs
on the meat, spontanoues generation was folly in regard to large organsims.
-However for the next 100 years it would prove almost impossible to dispel the
spontaneous generation of microorganisms. The method of proving it was setheat the medium until all germs on it were considered dead, then hermetically
seal it and wait. However, due to awful sterilization techniques results were
varied. Also, there was always the possibility of negatives-just because you ran
the experiment 1000 times doesnt mean that the 1001th time spontaneous
generation wont occur. Because of this, even when Spallazani (the man who first
came up with freezing sperm) seemed to disprove spontaneous generation by
heating his medium within vials which he then sealed by melting the gass
together and recording no putrefaction or animacula, it was not widely accepted
as it was argued that spontaneous generation required air-which he had
deprived the contents of his vials from.