in the 1860s.”9 However, by pointing out the common goals of anticontagionists, Ackerknecht was able to transcend the national framework and make fruitful connections among different countries, liberal goals, and leading physicians.
In Germany, one of the main opponents to Henle’s contagionist views was his colleague Rudolf Virchow, who was also a famous liberal activist and pathologist. Virchow disagreed with the germ theory mainly because he believed that the cause of any affliction was not found outside an individual’s body. He ascribed the occurrence of pathologies to local disturbances of the cells. For him, a cell was not only the unit of life; it was also the pathological site.10 In his view, diseases were to be understood as mere alterations inside the organism of normal bodily processes. He also rejected Henle’s idea that an illness affected the body through the nerves and thought that attention should be directed to other anatomical parts too. Virchow’s major concerns at the time were democratizing the medical profession and making the field more scientific. Henle had similar goals, and throughout his career he advocated for freedom of thought in medicine. He wanted to open a space for theory and observation—which he termed “rational medicine”—in a profession that was becoming increasingly materialist. Despite their differences in approach—contagionist and anticontagionist—both Henle and Virchow were leading representatives of the new experimental turn in science that began to dominate the medical profession at a time when a new generation of German intellectuals was also considering different projects of national unification.
The rise of the medical profession in the 1830s and 1840s coincided with political and social revolutions that mobilized a young generation of German scholars with the goal of strengthening their voice in the political purviews of the German lands. Given that illnesses and treatments are constructed culturally as well as biologically, one can consider the different theories that connected diseases to the body as another form of continuing discussions about the relationship between an imagined German nation and the outer world. Whereas Henle emphasized connections of the individual body with popular mobility and other organisms in nature, Virchow underlined internal developments, local approaches, and environmental improvements. As Virchow expressed in 1848, “Everything political that we’re now doing, the whole constitution, is only the structure through which social reform will come into being, the means by which the conditions of society will be transformed right down to their foundations.”11 In this context, being anticontagionist was another aspect of being a social reformer and a critic of state authoritarianism. Anticontagionists questioned old draconian state measures, such as quarantine and isolation, that had failed multiple times in containing cholera and plague epidemics. Instead of controlling contagious diseases, these measures had only served to aggravate illness among the general population. Hunger, poverty, and filth were seen as the main causes of disease.
According to Ackerknecht, during this period anticontagionists throughout Europe were not merely scientists; they were also social and political reformers who fought for individual rights and commercial freedoms.12 Many of them were liberal physicians concerned with local and environmental improvements that ranged from cleaning the streets and teaching personal hygiene to canalizing rivers and installing new sewer systems. For them, these sanitary measures seemed to have better effects on the health of any given community than submitting individuals to quarantine ordeals. In Europe, anticontagionism seemed to go hand in hand with revolutionary and progressive ideals. However, while in the German and European contexts these medical views were used to safeguard individual rights and advance developmental and hygienic programs, in the colonial realms environmental approaches and miasmatic explanations served to underscore the fundamental sanitary differences between temperate and tropical zones.13 In colonial settings, miasmatic theories tended to identify natives with their natural environment in pessimistic and deterministic ways.
It is within this cultural and political context that one should understand the initial rejection of the germ theory in Germany. Although Virchow’s approaches were useful in the years leading to unification, Henle’s views made a successful comeback in the 1870s and 1880s as physicians began to work closely with the German Empire and demanded an aggressive colonial policy abroad. Without leaving behind the sanitary revolution of anticontagionists in earlier decades, a new generation of physicians went on the offensive against dangerous microbial intruders. As Baldwin observes, “bacteriologists and sanitationists could readily agree that unhygienic conditions promoted the spread of disease, even though the latter saw filth itself as the generator of disease, the former regarding it mediately as a condition favorable to propagating the microorganisms ultimately responsible for illness.”14 Although debates about disease etiology, which in Germany continued well into the 1890s, tended to separate the two camps, bacteriologists did not break away from the long tradition of sanitary and hygienic measures used to transform the environment. Protecting the “soil” against diseases was a metaphor used both for humans and for localities, usually generating similar disinfection responses.
In the 1860s, discussions about the microscopic world began to appear in Germany in the works of Ferdinand Julius Cohn, a Jewish botanist from the University of Breslau; Ernst Hallier, a German botanist from the University of Jena; and Karl Wilhelm von Naegeli, a Swiss botanist from the University of Munich. The main debate at the time was over whether or not bacteria could be classified into different groups with their own distinctive physiological and morphological features. Cohn was the main proponent of the taxonomic classification of microbial life. Other scientists believed that fungi, molds, and yeasts were all different stages of a limited number of fungal entities that changed according to environmental conditions.15 To ensure experimental success in the classification, bacteriology had to rely on techniques for the isolation and creation of pure cultures that helped identify the variability and pathogenic factors of microbes. The language that bacteriologists started to use reflected the politics of cultural struggle and the ethnolinguistic definition of German nationalism that began to dominate the public sphere in the 1870s and 1880s.
The rise of bacteriology and germ theory also coincided with the cultural and political establishment of the medical profession. The expansion of health care programs for poor and working-class people, along with the construction of hospitals and other public health facilities, had increasingly strengthened the position of doctors in German society. This medicalization process, in the Foucauldian sense of the word, began to happen in Germany before many other European countries.16 Since the end of the eighteenth century, different German states had become involved in the supervision of the sick and the regulation of medical practice. If during the 1830s and 1840s many members of the medical profession took an antistate stance, by the second half of the nineteenth century physicians trained in universities and state-sponsored institutions actively participated in the pursuit of the goals of the German nation and empire. Robert Koch became one of the best examples of this transformation in the German medical school.
Robert Koch and the Location of a Disease
In 1883, Robert Koch, one of the founders of the germ theory and perhaps the most influential physician in the late nineteenth century, joined the German Cholera Commission to study the disease in Egypt. An outbreak of cholera in North Africa had gained the attention of authorities throughout Europe, and a group of French and German researchers were quickly mobilized to Alexandria in search of ways to contain the threat.17 While political disturbances assailed the city and the rest of the Egyptian provinces, Koch found himself in a scientific struggle with both French and British physicians regarding the etiology of an illness that had played a significant role in the establishment of international sanitary regulations throughout the nineteenth century.18 For the first time, German authorities decided to send experts to other empires’ overseas colonies—first Egypt and then India—to examine a disease with the explicit aim of protecting people at home. For Germany, winning this battle against cholera represented yet another victory with respect to the French, and a powerful assertion of Germans’—particularly Koch’s—views in the realm of hygiene and epidemic diseases.19
The struggle was also fought at home, where the first cholera conference took place in July
