The Day the Universe Changed - James Burke [116]
Koch was able to produce anthrax from infected soil and to show conclusively that specific bacilli caused specific disease. He was successful in doing so because of his technique for producing pure cultures of the bacillus in large enough numbers for identification and treatment. He had changed from the traditional method of growing cultures in broth; now he produced a solid culture of gelatin and nutrient, on which the bacteria were laid with a sterilised platinum needle. The cultures grew on the medium in groups sufficiently isolated to be free of contamination. In this way they responded better to new staining techniques, developed as the result of an accident suffered by Koch’s colleague Paul Ehrlich. In 1882 he had left a culture overnight on a warm stove, in contact with some of the newly invented aniline artificial dye. Next morning he discovered that the dye had selectively stained certain bacteria.
In the same year Koch and Pasteur announced the result of their research. Koch had isolated the great, perennial killer, the tubercle bacillus, and Pasteur had shown that degraded forms of micro-organisms carrying a disease would create immunity to the same infection. Disease was now firmly established as the product of micro-organism activity.
Rapid discoveries followed. Koch visited India, isolated the bacillus of cholera in pure culture and showed that the disease was indeed transferred on soiled clothing and in contaminated water. In 1879 gonorrhoea was isolated; in 1881 streptococcus; in 1883 diphtheria; in 1884 typhoid and tetanus; in 1905 syphilis.
The medical revolution was complete. In addition to discovering the mechanism of the transfer of disease it had generated a new concept of the role of the patient in hospital and of the individual in society. As medicine became more scientific, moving its attention from bedside to hospital to laboratory, the involvement of the patient in his diagnosis and treatment dwindled and vanished. Doctors removed themselves to a position of isolated specialisation in which medical research would acquire greater social and professional status than medical practice. Symptom analysis moved away from hospitals. In New York the first public bacteriological laboratories served all the city’s hospitals with a daily sample collection. The patient was now represented by numbers, temperature profiles, photographs of lesions and statistics.
The medical revolution also brought change to the world outside the hospitals. Because of their success in handling the epidemic crises of the nineteenth century, in terms first of public health and later of laboratory analyses, doctors began to take over the old social roles of priest and judge. Medicine became a unique repository of objective opinion where all types of social conditions were concerned. As more and more of life has since come within the province of medicine - from illness to contagion, living conditions, deviance from the norm, qualification for work, insurance and criminal guilt - social problems have become increasingly identified as involving medical aspects to be handled exclusively by doctors, who have thus become increasingly representative of the authority of the state.
The Victorian view that health was a moral duty and sickness a sin of omission has given credence to the medical views of matters not strictly related to disease, such as exercise, diet and generally ‘good’or ‘bad’behaviour. Social deviance has become ‘medicalised’and in the process doctors have been endowed with powers which are denied even to officers of the law.
By the beginning of the twentieth century the techniques developed by the medical profession over the previous hundred years were being adopted in a wider social context. The change in the condition of the body physical, with its new subjection to more impersonal treatment, its removal from the role of decision-maker to that of passive patient, its reduction to number and statistical analysis,