THE GOSPEL OF GERMS: Men, Women and the Microbe in American Life By NANCY TOMES Harvard University Press 351 pages
In the fall of 1997, the Los Angeles CBS television affiliate Channel 2 launched a public-health panic with "Behind the Kitchen Door," a special-assignment expose of noses blown, hands not washed, utensils reused, and vermin allowed to roam free in the sanctified realm of professional food service. The series was an enormous success: Viewers flocked to the station's Channel 2000 Web site to determine whether disease-spreading bugs had infested their favorite eateries; restaurant owners rushed to fill their bathroom soap dispensers. Authorities sprang into action, too. By December, the Los Angeles County Board of Supervisors had unanimously passed a "Dirty Restaurant Ordinance" to police not just restaurants, but grocery stores and pharmacies as well. On January 16, cleanliness letter grades began to appear in windows countywide.
That letter-grade system, ranging from "A" for 90 percent compliance to failure for any score below 60, echoes the one used by the Joint Board of Control in 1911, when it was believed that contagion could pass from worker to consumer on a brand-new shirt, to certify garment manufacturers. According to author Nancy Tomes in The Gospel of Germs: Men, Women and the Microbe in American Life, this collaborative effort of public-health officials and labor unions borrowed its rating system from the one used by state factory safety inspectors, but "control of contagious diseases, and primarily tuberculosis, was among its chief objectives." Today, the sources of threat have changed - E. coli and salmonella have replaced typhoid, consumption and cholera as bacteria to be feared, but what Tomes calls "the ritual of germ avoidance" remains the same, its influence on our habitus - French sociologist Pierre Bourdieu's term for reflexively repeated customs whose roots have long been forgotten - as potent as ever.
The Gospel of Germs chronicles the rise and fall and recent resurgence of the germaphobic ritual, the cough shielding and fly swatting that have been in practice since Louis Pasteur, as early as 1859, postulated that invisible organisms cause disease. On March 24, 1882, German scientist Robert Koch identified Mycobacterium tuberculosis, the most terrifying of those organisms (colloquially dubbed "germs" after the Latin verb "to sprout"), and the "germ theory of disease" began to supplant other etiologies like a dawning religious faith. No longer were ailments such as scarlet fever and cholera thought to spring de novo from the air. "Like born-again Christians, ardent germ theorists saw the world with new eyes," writes Tomes, "as a place where air, water and soil teemed with invisible life, and their own skin and secretions swarmed with microbes." By century's end, the process of transforming Western civilization to control those microbes was well under way. Smooth surfaces in chrome and linoleum, upon which no germ could take refuge, replaced intricate Victorian wood in furniture design. (Minimalism was quite likely the aesthetic descendant of a practical sanitary style.) Women's hemlines began to rise as long, voluminous skirts were cited as primary carriers of disease germs. The drinking fountain, the paper cup, even the way we make our beds, hark back to early efforts toward disease prevention: "To avoid the dangers of contaminated blankets in hotels," an early TB tract advised, "the careful traveller will . . . insist that the blanket be covered by a fresh clean sheet the turn down of which shall cover it for a distance of two feet from the top." Hotels have continued to adhere to this tradition long after bacteria on blankets ceased to be regarded as a menace to public health.
By and large, the crusade for sanitation reaped concrete rewards. Tuberculosis rates declined rapidly as awareness of the bacillus's presence in sputum, resulting in the Anti-Tuberculosis Society's "don't spit" campaign, took hold in the collective consciousness. Cholera virtually disappeared in developed areas as authorities took measures to purify public water supplies. Heightened awareness of microbial contaminants led to better living conditions for the poor and education for women, whose historical duties of cooking and cleaning required a thorough understanding of how and when bacteria could invade the home.
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Like many scientific milestones, though, germ theory had its negative side effects. While the science yielded tenement-house laws, factory inspection, food regulation and other collective sanitary measures, the higher incidence of disease among immigrants and blacks was also used to bolster ethnic prejudices and promote class-based segregation. Polio epidemics spread across the U.S. and Europe as contaminant-free water and milk supplies deprived infants of the opportunity to develop antibodies against the disease. And the newly "antisepticonscious America" inspired a wealth of new industries, many of them miraculous only in their marketing. "Pasteur's Marvellous Disinfectant" was touted as a germ killer over the protests of the American Public Health Association; Listerine took its name from surgeon Joseph Lister, although it had nothing to do with the early pioneer in sterile surgical techniques. (In 1977, the company was forced by the Federal Trade Commission to drop its age-old slogan "kills germs on contact.") After James Garfield's failure to recover from an assassin's bullet was attributed to deadly "sewer gas," ambitious engineers and plumbers, following George E. Waring's renovation of the White House, set to work re-imagining the American bathroom, a phenomenon Tomes refers to as "The Triumph of the White China Toilet."
As with so many symptoms of "the gospel" that Tomes unearths in her research, the selling power of disease paranoia only grew as the century progressed. "Clearly," she writes, "the same kind of commercial interests that kept alive the fear of sewer gas for so many years are hard at work trying to use the current germ panic to sell books, movie tickets, water filters and household disinfectants." Though experts dispute its powers, antibacterial soap sells briskly in an era of mutating viruses and antibiotic-resistant bacteria. Even the 1997 Los Angeles restaurant crisis has had market value: At least one Thai eatery in Los Angeles, all too aware of the cleanliness campaign's emphasis on Asian food establishments, has taken to stapling a miniature duplicate of its hard-earned "A" to its takeout fliers.
A professor of history at SUNY Stony Brook, Tomes writes in straightforward prose that's free of literary flourish. She's neither as polemical nor as passionate as other contemporary writers on the cultural impact of medical science, yet a humane social agenda is never far from the surface of her narrative. There are ways in which her book would have been better served had she chosen to embed her more instructive points in a few compelling life stories. For example, there is no place in The Gospel of Germs for the story, in all its pathos, of Robert Koch, who, after his landmark discovery, introduced a "cure" for tuberculosis that proved more aggressively lethal than the disease itself. (Koch went on to isolate the bacterium responsible for cholera in the aftermath of his disaster, but his reputation never quite recovered.) And despite Tomes' admiring treatment of Cornell University's pioneering home economists, Martha van Rensselaer and Ella Cushman, both compassionate scholars who devoted their careers to educating the rural homemaker, she includes little biographical detail on either woman's life. Their stories might have helped to explain why educating homemakers was a cause so urgent that it generated a new field of academic study.
The Gospel of Germs is absorbing nonetheless, in part because Tomes uncovers a wealth of material so fascinating that on nearly every page she reveals the root of some accepted habit, slogan or style, from the linoleum kitchen to the disposable communion cup. As a document of disease control that examines where germ theory collided with religion and politics, The Gospel of Germs owes something to Randy Shilts' And the Band Played On, which chronicles the struggle among politics, dogma and public health. As a book that charts the cultural impact of scientific paradigm, it belongs in a category with Timothy Ferris' Coming of Age in the Milky Way. Tomes is not as epic in her writing as Ferris: The Gospel of Germs is unlikely to appeal to as wide an audience as either Ferris' account of astronomy's impact on the social order or Shilts' study of the spread of AIDS. But her evidence, however plainly she presents it, has the same ability to alter fundamentally what we take for granted in the everyday world. After The Gospel of Germs, the letter in the L.A. restaurant window becomes not just a health-department seal of approval, but a marker steeped in a longer story of faith, fear and marketing.