Rereading The Gospel of Germs during a Pandemic

Field: Arts and Humanities (Social Sciences)

Previous articleNext article FreeSpecial Section: Second LookRereading The Gospel of Germs during a PandemicJohn Harley WarnerJohn Harley WarnerYale University Search for more articles by this author PDFPDF PLUSFull Text Add to favoritesDownload CitationTrack CitationsPermissionsReprints Share onFacebookTwitterLinked InRedditEmailQR Code SectionsMoreMy immediate response to the late April invitation to contribute to a second look at “notable books about epidemics” surprised me. Ever since the COVID-19 pandemic reached the United States the book most on my mind—Nancy Tomes’s The Gospel of Germs: Men, Women, and the Microbe in American Life (1998)—focuses on endemic, not epidemic, infectious disease.1 I regularly teach the history and historiography of epidemics: indeed, I first heard about what was then called the “Wuhan Virus” in January when, having listened to my lecture to undergraduates on the fourteenth-century bubonic plague, a physician auditing my course told me after class about an article in that morning’s New York Times. By late April, I was most especially wondering about what stories and questions would engage my students if the intensity and urgency of the pandemic gave way to everyday life under the lingering threat of infection.The Gospel of Germs traces how, starting in the 1870s, the lessons of the bacteriological laboratory were infused into the fabric of daily life, what Tomes calls “the private side of public health” (p. 6). At first, conversion to the belief that invisible germs caused disease and to the practices of germ avoidance it informed centered on the home, materially expressed in reformed ventilation and plumbing. The white china toilet emerged as an icon of hygienic enlightenment, while the burden of maintaining a germ-proof household fell heaviest on women.But privileged white Americans could not simply shelter in place in their sanitary homes. The central focus of this book is tuberculosis between 1890 and 1930, a disease that in 1900 was responsible for one in ten American deaths. People infected with tuberculosis could long remain active and unmarked by their disease, circulating freely in public. This was also true of the asymptomatic “healthy carrier” like the Irish cook Mary Mallon, demonized as Typhoid Mary and in 1915 condemned to life-long quarantine. Tomes shows in rich detail how the new belief in microbes restructured Americans’ daily lives as they ventured into the risky environments of the workplace, streetcar, church, hotel, and restaurant. Children were cautioned about the dangers of doorknobs and paper money, women were counseled to wear washable gloves when they went shopping, and everyone was warned against the shared drinking cup. This was the moment when Protestant congregations rethought the shared communion cup and when hotels introduced new cakes of wrapped soap for each new guest and extra-long sheets folded down over the blanket. Unchecked coughing, sneezing, and spitting became cardinal sins, as fear of germs fashioned a new kind of public health citizenship.Epidemics and pandemics provide the historian with a compelling dramaturgy. The story line varies from cholera to Spanish influenza, from AIDS to Ebola, but every script shares elements of both tragedy and thriller. By contrast, writing about the everyday—living under the shadow of endemic infection—poses notorious narrative challenges. Here, though, the kind of high drama that is such an easy hook in teaching about plague is instead found in the agency of those who proselytized for the gospel of germs and the strategies of persuasion they enlisted. In addition to health officials, physicians, domestic science teachers, and visiting nurses, manufacturers and advertising agencies sold the germ theory and its behavioral dictates by marketing such germ-conscious consumer goods as the Pasteur germ-proof water filter, household germicides like Listerine, and the new Dixie paper cup.But it is the pageantry of the antituberculosis movement that best captures the drama of the Progressive Era campaign to sell the gospel of germs. Founded in 1904, the National Tuberculosis Association (NTA) launched the first truly mass health education campaign in America directed at a single disease. Appropriating the new techniques and visual culture of advertising, its posters, pamphlets, and billboards were hard to miss, as were its traveling exhibits, plays, and parades. In 1908 the NTA joined with the American Red Cross in its first Christmas Seal Campaign, which combined education, spectacle, and fundraising. The peak of the antituberculosis crusade coincided with one other new medium for publicity and education—namely, motion pictures. In 1910, only a few years after the first commercial films were made in the United States, Thomas Edison began making a film for the NTA each year. Five years later, the director of sales came up with the idea of enlisting children as crusaders for the cause: as they sold more stamps and performed health chores, they moved from squire, to knight, to a seat at the Round Table of health chivalry, recognized by Scout badge–like pins. By 1922, over seven million children were enrolled in this children’s crusade against tuberculosis. Like other health campaigns of this era, the Modern Health Crusade not only sensationalized danger but also enlisted familiar ethnic, class, racial, and gender stereotypes, prejudices, and fears.Such stories about endemic contagion are well calculated to grab students’ attention and imagination. In a course on “Media and Medicine in Modern America” that I have cotaught with a clinician-filmmaker to 200–350 Yale undergraduates each year for a decade, the techniques developed in the antituberculosis campaign provide a model of the combination of education, marketing, and entertainment that has so marked the mediation of scientific precept in public health campaigns from the Progressive Era through our own. For first-year medical students in “Microbial Pathogenesis,” stories from The Gospel of Germs help me make the case for why they as biomedical practitioners should pay close attention to mass-media representations of etiology, health, and illness that shape their patients’ expectations and behaviors. For graduate students in my seminar “Problems in the History of Medicine and Public Health,” the book provides a springboard to discussing how to write about belief and ritual in everyday life and the constitution of public health citizenship. And for my public health students, the book invariably sparks discussion about the role that guilt, blame, and stigmatization play in public health messaging today.Historiographic change and epidemiological change often proceed hand in hand—and nowhere in Tomes’s lifetime (and mine) more than with the transformative role of AIDS in fostering and reshaping historical investigations of disease. With the emergence of AIDS in the early 1980s, there was a frenzied race among historians to find telling models for societal responses to HIV infection in epidemics such as plague, cholera, and yellow fever. It prompted one AIDS historian to suggest to me at the time that, pace Santayana, those who remember the past are condemned to make the wrong comparisons. Tomes’s book is no exception. AIDS opens her introduction and is the focus of her epilogue: “The Gospel of Germs in the Age of AIDS.” By the time Tomes was writing, however, epidemic models were losing their purchase, as HIV/AIDS was being reconceptualized as a chronic disease. Indeed, in the face of discrimination and violent persecution of people who tested positive for HIV, public health workers had to undo many of the lingering lessons of the gospel of germs, trying to convince a worried public that the casual contact of a handshake, toilet seat, or doorknob did not pose a threat.AIDS transformed not only the writing but also the teaching of medical history. My first experience as a teaching assistant came just before the advent of AIDS. I recall a discussion section on tuberculosis in which I was trying to capture turn-of-the-century physicians’ excitement at the possibility of discovering an internal antiseptic (ingested or injected) that would destroy the microbe and their frustration at the persistent failure to find one. And I still remember how hard I had to struggle to get a class of Harvard undergraduates to understand what I meant in saying that public health workers concluded that the only agent that killed the tubercle bacillus without also killing living human tissue was education. When, still a graduate student, I made that same proposition to a class in 1983, I was met with knowing nods. Now what I was saying was so obvious that it required no elaboration.My students now—most of them not yet born by the early years of HIV/AIDS—will read The Gospel of Germs in an age of COVID-19, which will redouble the book’s pedagogical power. The fears of the 1980s are not part of their lived memory. But COVID-19 is a formative experience in each of their lives. The anxieties that animated the crusade against tuberculosis before the 1940s when antibiotics inaugurated the pax antibiotica, for example, will be newly legible. And what they take away from The Gospel of Germs and the questions it inspires will change over time if the pandemic fades but endemic infection lingers.Tomes’s treatment of the Progressive Era concept of “the Socialism of the microbe” (p. 128) is particularly well calculated to capture the imagination of students as they consider the potential of contagion to propel social change. Those most likely to contract tuberculosis were those whose working and living conditions made them the least able to avoid infection, and the death rate among African Americans was as high as three to four times that of those who were native born, affluent, and white. Nativist and racist caricatures of those most afflicted—immigrants, the poor, African Americans—abounded. But germ theory was, as Tomes terms it, a double-edged sword, and reassuring themselves that “it’s not about us” was not a safe bet for those with privilege. However much the affluent made their homes sanitary fortresses, they worried about the germs that might cling to the tenement-made garments their families wore or infection from the asymptomatic laundress, cook, or maid who entered their homes. Labor unionists in the New York City garment industry and African-American health activists in Atlanta used the socialism of the microbe to turn fear of endemic contagion into demands for social and economic reform. The Negro Anti-Tuberculosis Association of Atlanta, founded in 1910 and led by Black community activists, used the implicit threat to white households in the contemporary slogan “Germs know no color line” (p. 220) to motivate attention to the health needs of Black neighborhoods. For my students—many of them attracted to the history of science by its activist potential and mindful of the ways that COVID-19 has brought into sharp relief health disparities rooted in structural racism, inadequate public health infrastructure, and a broken health-care system—such Progressive Era examples are suggestive of the ways that the gospel of germs might be placed in the service of social justice today.When I draw on The Gospel of Germs in the classroom, I almost always show a five-minute clip from the 1922 silent U.S. Public Health Service film How Disease Is Spread.2 The filmmakers tackled the challenges of making the invisible microbe visible and making innocuous daily behaviors seem deadly dangerous. Germs are depicted as black stars spread by the central character—a modern woman of the 1920s, independent, mobile, and a germ carrier with a slight cough. The stars appear first on the lips of the taxi driver who briefly holds paper money she has given him in his mouth as he gets change, then on the lips of a young man who moistens his finger in turning a magazine page at a sidewalk newsstand where she has just done the same thing, and finally on the lips of a young girl with whom the traveler shares her water glass. The intertitle tells us that our carrier has tuberculosis, but syphilis and gonorrhea top the projected list of diseases that can be spread by such careless habits. In the final frames, a pointer touches a map at Ellis Island, and from that initial infection multiplying black dots depict the spread of disease across the continent. The film is so melodramatic that it always elicits first nervous chuckles and then more confident laughter. Except when I showed it late this March. My students were somber, amusement gone, their faces transfixed. As they viewed this film from an era before antitubercular magic bullets, they had what I read as a new kinship with the past. So, too, when they read The Gospel of Germs once classes resume in the fall, I expect the stories Tomes tells will help them better understand their place in this new world while prompting questions for thinking about how that world might be—or how they might make it be—otherwise.NotesJohn Harley Warner is Avalon Professor and Chair of History of Medicine at the Yale School of Medicine, and at Yale University he is also Professor of History, History of Science and Medicine, and American Studies. His books include The Therapeutic Perspective (Harvard, 1986), Against the Spirit of System (Princeton, 1998), and (with James Edmonson) Dissection (Blast Books, 2009). His most recent coedited historical volume (with Hans Pols and Michele Thompson) is Translating the Body: Medical Education in Southeast Asia (Singapore, 2017). He is now writing a book titled The Quest for Authenticity in Modern Medicine. Section of the History of Medicine, Yale University School of Medicine, 333 Cedar Street, SHM L-132, New Haven, Connecticut 06511, USA; [email protected].1 Nancy Tomes, The Gospel of Germs: Men, Women, and the Microbe in American Life (Cambridge, Mass.: Harvard Univ. Press, 1998). Subsequent references to this work are indicated in the text by page number.2 How Disease Is Spread (Bray Productions, under the supervision of the Surgeon General of the U.S. Public Health Service, 1922). The film was part of the twelve-film Science of Life series (1922–1924). Kirsten Ostherr offers an insightful discussion of the film in Cinematic Prophylaxis: Globalization and Contagion in the Discourse of World Health (Durham, N.C.: Duke Univ. Press, 2005), pp. 4–11. 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