introduction from bacteria in britain, 1880–1939

7/30/2019 Introduction from Bacteria in Britain, 18801939

1/11

1

INTRODUCTION

In 1937, Croydon, a town ten miles south o London, was gripped by a typhoid

epidemic which killed orty-three people. One o the victims was Richard Rim-ington, a schoolboy aged only thirteen. As soon as Richard became ill, his ather,Charles, rose to the challenge o discovering the cause o his sons disease and thato his neighbours. With the local medical proession apparently stupeed by theoutbreak, Charles Rimington, his riends and the citizens o Croydon helped tounearth the means o transmission. Te outbreak led to charges o miscommuni-cation within local government, resulting in what was probably the rst successulmass case or compensation or a British epidemic. Te science o bacteriology wasseen as the key to conrming the cause o the epidemic and, as illustrated in FigureI.1, citizens, lawyers and doctors were eager or the results o bacteriological tests.

Figure I.1: Te chief administrator of the local council is depicted in the campaign againstthe epidemic and a Croydon chemist is illustrated testing the local water supply.Daily

Sketch, 20 November 1937, Croydon Local Studies Library and Archives Service, Sir WalterMonckton, KC, Outbreak of yphoid in Croydon, Nov. 1937, Press Cuttings November

425, Local Papers November 267, Volume 1, own Clerk Croydon, fs70 (614.4) CRO, p.61. Image reproduced courtesy of Croydon Local Studies Library and Archives Service.


2/11

2 Bacteria in Britain, 18801939

Tis incident encapsulates the novel approach o this book to one o the modernworlds most pervasive sciences: medical bacteriology.1 Te epidemic o bacterialdisease in Croydon reveals a knowledgeable response rom members o the localcommunity and rom lawyers. In each chapter o this book the esoteric technicaleld o medical bacteriology is examined through the eyes o people who were

working in various arenas outside o the laboratory, whether in the wards, theworkplace or in wider communities.

In 1880, when the book begins, proo o the bacterial aetiology o disease hadonly recently been announced and demonstrated. Te story ends in 1939, justbeore the age o antibiotics, with its own history o experts and publics.2Bac-teria in Britain is thus the rst sustained study showing how the new science obacteriology was not imposed upon, but used proactively and creatively by menand women in hospitals, workplaces and communities. A major contribution isthe revision o the historiographical idea o the resistance to, or reluctant accept-ance o, laboratory science by elite physicians, through detailed analysis o their

practice recorded in nearly 2,000 hospital case notes. Another is that the bookbrings to light the use o bacteriological knowledge by lay people threatened withdisease, and their collaboration with lawyers and doctors. By examining a vari-ety o interweaving communities o doctors, employees, citizens and lawyers, thesignicant changes in belies, practices and the use o new technologies are illus-trated. Tese changes were tempered by the continued use o existing methods odiagnosing, tracing and combatting disease in the hospital and in public health.3

Te book is divided into three interconnected parts the hospital, the work-place and the community. Te Hospital examines medical practice and policy, inparticular the debates around the unding o places and people or bacteriologi-cal diagnosis, diagnostic tests ordered by physicians or the diseases pulmonarytuberculosis, diphtheria and typhoid, and the discourse and representations ohospital physicians with regard to laboratory science. Te teaching hospital is acrucial venue or understanding the use o bacteriology as it is where inuentialleaders o medical practice consulted and where uture doctors were trained. Te

Workplace looks at anthrax in various settings, including the woollen and leatherindustries. It unearths the ideas o employees, the public and lawyers, and theirinteractions with physicians, surgeons and specialist bacteriologists. Industry pro-

vided an environment where employees and guilds could organize and complain

about their unsae conditions, utilizing the new science o bacteriology to justiytheir grievances. Te Community uses the history o typhoid in residential areasas a device to reveal and explore public knowledge o bacterial disease. How didcitizens, lawyers and doctors use epidemiological methods and bacteriological testresults to understand and respond to epidemics? Te three parts o the book arelinked by considering the impact o bacteriology on the authority o doctors, andhow lay knowledge o this science could be used to challenge expertise.


3/11

Introduction 3

Using Bacteriology

Te wide variety o case studies enablesBacteria in Britain to present a new viewo the history o medical bacteriology in Britain by exploring not the innovationsbut the use o the science and technologies o bacteriology.4 Te story is recon-structed rom a large volume o unpublished primary sources and is inormedby histories o everyday lie and technology in use, providing an alternative totop-down historiography.5 Tis approach is particularly appropriate or under-standing the use o a body o knowledge which is applicable to the everyday

practices o public health institutions, the clinic, and even ones bathroom.6 Inorder to explore the minutiae o various lives and environments, the key sources

or this book are hospital case notes and minute books, personal papers, localnewspapers, records o medical and workplace societies, correspondence andtranscripts o an inquiry and a trial.

A particular goal o this book is to illustrate the extent to which knowledgeo how to combat bacterial inections and to delineate blame and responsibil-ity or bacterial disease was shared between doctors, lawyers and publics inBritain.7 Brian Wynne has argued that concepts o modernity and reexivemodernity have been too simplistic in dividing scientic and public expertise,and he seeks to problematize and blur the boundaries o expert and lay knowl-edge.8 Te publics who practise citizen science or popular epidemiology9 maybe engaged with risk even beore an incident or expert conict occurs, and,although their knowledge is oen ignored, have contributed expertise in a vari-

ety o late twentieth-century contexts which are as diverse as the reduction onuclear contamination o sheep and the study o menstruation.10 However, as

Bacteria in Britain shows, this orm o citizen science is not novel. Patients, theiramilies and those at risk have complained about disease and collaborated withand exchanged knowledge with doctors since at least the nineteenth century.Indeed, Jean-Baptiste Fressoz has argued that the risk society should not be seenas a recent postmodernist condition, but historicizes it within the nineteenthcentury, arguing that complaints about risks led to saer technological systems. 11Keir Waddington and Abigail Woods have illustrated the importance o the roleo the public in arguing or prevention o inectious disease in relation to cattlein the late nineteenth and early twentieth centuries.12 Tis book examines pub-lic knowledge o the new science o bacteriology in this same period. It revealsthat in the context o industrial disputes and arguments or communicationbetween water engineers and public health doctors, members o the non-expert

public and their legal representatives could be knowledgeable, inuencing saerpractices.13 From the 1880s, doctors valued the opinions o lay experts work-ing in industry in Bradord where employees were at risk rom anthrax, and inCroydon the citizens local knowledge and contacts were very valuable or epide-


4/11


miological investigations into the cause o the 1937 typhoid epidemic. Patientsand at-risk groups have been seeking biomedical knowledge empowerment andcritiquing medical research and practice or a considerable time.14

Bacteriology in Britain

Te scope o this book spans rom 1880 to 1939, a period o great change andincreasing complexity or bacteriological research and practice in Britain. Rob-ert Kochs research in the late 1870s has been seen as pivotal in conrming thatspecic microbes caused human diseases. Koch developed reliable methods ogrowing and staining bacteria, and postulates or determining the pathogenic

cause o a specic disease.15 His research on inectious disease has been under-stood as the turn rom theory into technology.16 Tere was a rapid successiono discoveries including Kochs explanation o the lie cycle o the anthrax bacil-lus in 1876, his discovery o the tubercle bacillus in 1882 and identication othe comma bacillus causing cholera in 1883. Other bacteriologists discoveriesinclude Carol JosephEberths and Edwin Klebs discovery o the typhoid bacillusin 18801, and Friedrich Loe ers discovery o the diphtheria bacillus in 1883,to name but a ew.17 During Kochs career, bacteriology changed rom an exoticbody o knowledge to one o the leading disciplines o experimental medicine. 18

Developments in practices or diagnosis and prevention o typhoid can beused to illustrate the evolving techniques o bacteriology in the late nineteenthand early twentieth centuries. Hence, doctors, lawyers and the public had an

ever-increasing range o concepts to grasp. Methods o dening typhoid becamemore and more complex, rom the realization through anomalous serologi-cal diagnostic tests in 1896 that there were related paratyphoid organisms, tothe classication o more strains o paratyphoids in 1918 and o typhoid rom1934.19 Yet, new techniques were not uniormly used. For example, althoughthe distinction between strains was argued to have conrmed the link betweena carrier and the epidemic in the 1936 Bournemouth epidemic (see Chapter 5 othis volume),20 this method was not useul during the course o the outbreak orat the inquiry or test case regarding the 1937 Croydon epidemic (see Chapter 6),and there was a continued and lengthy debate about the use o the anti-typhoidinoculation, discovered in 1898. Te existence o bacteriophage viruses thatcould consume bacteria was suggested in 1915, but it was not until 1938 thatextensive research into phage typing was published by James Craigie and ChunHui Yen.21 Tey collected 706 examples o strains rom typhoid outbreaks inCanada, England and Scandinavia and tested them with phage; seventy-ourexamples were rom England, including bacilli rom the epidemics in Malton,Bournemouth and Croydon discussed in Chapters 5 and 6 o this volume. Tescientists retrospectively linked carriers to the strains involved in the epidemics.22


5/11

Introduction 5

Tis research resulted in the identication o ten diferent types o typhoid. 23Craigie and Yens phage research methodologies or typhoid were adapted to arange o other bacteria, includingStaphylococcus aureus.24 However, this technol-ogy was just too late to be o practical use or the epidemics studied in this book.

A major reason or the institutionalization o bacteriology and immunologyin the late nineteenth and early twentieth centuries was this increasing technical-ity in methods. Gradmann proposes that Kochs key innovations were practicalrather than theoretical. In establishing his postulates or bacterial aetiologyin the 1870s and 1880s, Koch and his team created a set o techniques whichinvolved staining, solid culture media, the Petrie dish, microphotography andanimal experiments.25 Edgar Crookshanks 1896 textbook on bacteriology liter-ally illustrates the complexity o apparatus required or diagnosis and researchby that date, rom the microscope, media or preservation o uids and tissues,cover-glass preparations, sterilization equipment, incubators and microphoto-graphic apparatus, with over 100 pages o instructions regarding this equipmentbeore any discussion o diagnosis begins.26 Christopher Crenner has shown howsome physicians in Boston, Massachusetts, ran laboratories rom their private

practices, but rom the 1910s these laboratories became increasingly commer-cialized or institutionalized.27 Te expense and space needed or such apparatusmeant that these activities could no longer easily take place in a physicians homeor the side room o a laboratory.28 As I discuss in Chapter 2, Barts physicianTomas Horder wrote in his 1910 textbook on pathology that the inormation

was intended to be useul or physicians in understanding how diagnosis wascarried out, and not or them to undertake the practices.29Bacteria in Britain contributes to the history o how British bacteriologi-

cal laboratories were established or routine examinations. Te detailed debatesinvolved in unding and building laboratories are discussed, showing how phy-sicians argued or hospital laboratories or diagnosis and research in Londonand Cambridge.30 In hospitals and institutions beore 1890, only Kings Col-lege Hospital, the Royal Colleges o Physicians in Edinburgh and London, andthe Brown Animal Sanatory Institution had experimental laboratories or bac-teriological work. Researchers also worked on bacteriological experiments atSt Tomas and St Bartholomews Hospitals. By 1894 other laboratories wereopening, conducting practical teaching and occasional research, including those

at St Bartholomews Hospital, Guys Hospital and University College London.Clinical laboratories undertaking bacteriological work were developed or local

public health departments and hospitals in the 1880s and 1890s. Organizationssuch as the Royal Colleges o Physicians o Edinburgh and London, and theClinical Research Association at Guys Hospital ofered diagnostic services or

practitioners and hospitals rom the 1890s, making specialist bacteriological ser-vices available to a wider range o physicians and general practitioners.31


6/11


At this time, the status and nancial reward or pathology and bacteriol-ogy remained low, being considered service work or bedside practitioners, asexplored in Chapter 1.32 Challenges were aced with regard to the inclusion obacteriology in the medical curriculum, with the Royal College o Physicians oLondon deeming that there was no room or the subject as late as 1896. Extra-mural courses were run by some medical schools during the 1880s and courses

were increasingly integrated into medical qualications during the 1890s.33 Ver-non has argued that, in general, British bacteriology only became a specialitydistinguished rom public health and pathology in the interwar period whenbacteriology commanded ull-time posts. Te discipline came o age by the Sec-ond World War, attracting philanthropic unding or research. Legislation suchas the Notication o Disease Act (1889, compulsory rom 1899) and the Vene-real Disease Acts o 1915 had cemented the role o the laboratory as general

practitioners diagnoses were oen conrmed bacteriologically by public healtho cials. Te Wassermann reaction became a mandatory means o diagnosis orsyphilis with the latter Act.34

Although the status o bacteriology was improving during the late nineteenthand early twentieth centuries, physicians were converting at diferent rates tothe belie that bacteria were the cause o disease. Doubts about the new theory

were partly as a result o demonstrations that healthy people secreted microbes,and that pathogenic microbes could be consumed and yet not result in disease.During the late nineteenth century many alse discoveries o pathogenic bacteria

were made which aided the discreditors o Louis Pasteurs and Kochs theories odisease.35 Further to this, in 1890, Kochs tuberculin cure or tuberculosis wasdramatically announced and made commercially available within months. Bythe end o the year, its therapeutic value was doubted and it was ound to be dan-gerous, with some patients dying ollowing its administration.36 Subsequentlyin Germany, an inamous challenge to the idea that inection with bacteria ledto disease came rom Max von Pettenkoer in 1892. In order to demonstratehis hypothesis that bacteria alone did not result in disease, he drank a concoc-tion o cholera bacilli, resulting only in a little diarrhoea.37 Te puzzle as to whyinection did not always result in disease, particularly or tuberculosis, led tocontinuity in ideas o the constitution o the body afecting disease susceptibilityand to the discipline o immunology.38 Tere was also a lack o consensus on the

principle o specicity o certain germs causing certain diseases with ideas otransmutation o bacteria rom one species to another in the 1880s and 1890s.Additional criticism included attacks on the technique o bacteriology or diag-nosis o diphtheria with di culties in nding the bacilli in cases which wereclinically considered to be diphtheria.39 Tereore, the introduction o bacterio-logical diagnosis in the hospital and into public health methodologies in the latenineteenth century by no means took place at a time when the precise natureand role o bacteria and bacteriology were completely dened and accepted.


7/11

Introduction 7

Indeed, the authority o bacteriologists was questionable throughout theperiod o this study, with only a ew successul therapies emerging or bacterialdiseases. Te therapeutic vaccine or rabies (1885), antitoxins or diphtheria, teta-nus, anthrax and a range o other diseases (rom the early 1890s), immunological

vaccines, including or typhoid (1898), and Salvarsan as a treatment or syphilis(190910), brought hope that bacteriology would bear more ruit in terms o pre-

vention and cure. Tese developments were slow to come, with chemotherapieswhich acted upon a wider range o diseases being developed rom the 1930s.40

Yet, the practices created by early bacteriologists alerted doctors, employers,employees and the general public to the dangers to which they were exposed byorganisms so miniscule that specialists with technical expertise and equipment

were increasingly needed to reveal their characteristics. However, many o thepractices revealed within the book hark rom the era beore bacteriology : boilingo milk and water with the aim o purication was not a new idea or exam-

ple, and personal hygiene, the soap industry, private bathrooms and householdcleanliness were developing in any case. Chapters 5 and 6 pay particular atten-tion to the perceived dangers within the home which changed with publicity othe new science o bacteriology such as pasteurization o milk, representationso ies, views on the chlorination o water, and the decline o the concept osewer gas.Te three sections o this book could be ramed as presenting the useo bacteriological resources and institutions within three sites the increasinglyroutine use o the technologies o the laboratory in the hospital; the knowledge

o aetiology o disease in the workplace; and the combination o bacteriologicalideas and practices, such as the search or typhoid carriers, with older method-ologies o epidemiology, in the community.

Te Hospital

Providing concrete evidence or the assimilation o bacteriology in hospitals,one o this books key contributions to historiographical debate is an analysis o1,823 clinical case notes, in order to examine the everyday use o bacteriologi-cal diagnostic technology in the hospital.41 Hospital committee minute booksare also invaluable or discovering the everyday decision making and problemsolving which occurs in the running o a hospital. Substantial evidence and anal-

ysis provide a revisionist approach to the history o the laboratory and clinicrelationship, in particular the idea that gentlemen physicians were reluctant toincorporate the laboratory into their everyday practice.42 Historiographical ideaso the tensions between the clinic and the laboratory led Andrew Cunninghamand Perry Williams to conclude that hospital physicians were the most powerul group o those sceptical o the necessity, the useulness or even the relevanceo the laboratories and that these physicians maintained erce opposition in theearly twentieth century.43 My research signicantly urthers the small number


8/11


o studies which have used case notes to examine hospital use o bacteriologi-cal diagnosis in the rst decades o the twentieth century. Tese existing studies

present a airly enthusiastic reception o bacteriology by clinicians, though withcaveats that clinical decisions could override evidence rom the laboratory, giventhe possibility o alse negative results.44 Other publications revising this histori-ography have shown that more nuanced accounts are necessary in order to reveal

positive responses to the clinical relevance o laboratory medicine.45Chapter 1 compares the unding o the laboratories and the increasingly

routine specialist diagnostic practices at St Bartholomews Hospital and Adden-brookes Hospital.46 Pulmonary tuberculosis, typhoid and diphtheria werechosen or study not only due to their prevalence in these two general hospitalsbut also because o early identication o bacteria and diagnostic methods orthese diseases, and a successul immunological therapy or diphtheria. Giventhat Brian Abel-Smith argued that general voluntary hospitals began to rejectcases o inectious disease rom the 1860s, two large general hospitals may seem astrange choice o ocus or a study o inectious bacterial diseases.47 Te numbero typhoid cases at Addenbrookes and Barts, and o diphtheria cases at Barts,shows that, at least or these hospitals, patients with inectious disease werecommonly admitted. In 1907, the Medical O cer o Health or Cambridgecomplained in his report that even though an Isolation Hospital had been con-structed with a special ward or typhoid ever, ourteen cases o typhoid wereadmitted to Addenbrookes Hospital, in comparison to only one at the Isolation

Hospital.48

At Barts between twenty-one and orty-our cases o diphtheria wereadmitted each year until at least 1920.49In addition to the availability o extensive case notes, Barts and Adden-

brookes have been chosen because o their heritage and the historiographicalrepresentations o the hospitals. Although records or a variety o London hospi-tals were surveyed, the records at St Bartholomews Hospital Archives capturedmy attention. I quickly discovered that current representations o the use othe laboratory and specialists were in need o revision as they were too relianton published sources, and that the language used in the case notes was verydiferent to that in American hospitals.50 Barts, the oldest continually openhospital in Britain, is contrasted with Addenbrookes, which was establishedin the eighteenth century and quickly became used as the teaching hospital or

the University o Cambridge. Te university was amous or laboratory scienceduring the period covered by this book, and the links between the hospital andthe university are considered, urthering Gerald Geisons and Mark Weatherallsdetailed studies o science and medicine in the town.51 Despite recent historiog-raphy, the quick acceptance o bacteriological diagnosis is not really surprisingas teaching hospitals were encouraged to become more clinical and scienticdue to the pressure o both licensing bodies and students in the late eighteenth


9/11

Introduction 9

and early nineteenth centuries, and rom the University o London rom themid-nineteenth century.52 Tis trend continued in the 1890s with the GeneralMedical Council extending the length o study or a degree in medicine romour to ve years in 1892, in order to allow more time or science. Competi-tion with provincial medical schools, which ofered a higher standard o scienceteaching, also encouraged the development o laboratory acilities in London.53

Chapter 2 aims to explore how the integration o the laboratory into the prac-tice o the gentleman physician was by no means straightorward. Te chapterbegins with an analysis o discourse in the case notes, revealing that the change inlanguage rom using the term natural to using the term normal when discussingthe body was much slower at St Bartholomews Hospital than at AddenbrookesHospital. Te word normal signied the standardization o measurements o thebody.54 Te continued use o the word natural at Barts is intriguing consideringthe decline o its use in the American hospitals studied by John Harley Warner.55Tis examination o discourse is ollowed by two biographical studies o Barts

physicians Samuel Gee and Tomas Horder. Teir individual use o diagnosticlaboratory services is analysed in order to understand contradictions in publicrepresentations o their opinions on bacteriology, in contrast to their everyday useo specialist pathologists or diagnoses o their patients conditions. Te chapterlinks to the ollowing sections on public knowledge with a discussion o Hordersopinions o his patients views o the value o specialist diagnostic services in com-

parison with the more expensive expertise o an elite consulting physician.

Te Workplace

Late-nineteenth-century anthrax provides an unrivalled opportunity to exam-ine how ideas o bacteriology were received at the outset o publicity aboutthe new science. Te incidence o the disease was increasing in Bradord just asKochs discovery o the liecycle o the bacillus was publicized in the late 1870s.Although Kochs anthrax studies did not have a resounding impact on Germanmedical researchers,56 his discovery did inuence workplace politics in Britain.

Anthrax was a risk to those who worked with animals and their skins andwool, and was occasionally a risk or the public, or example when shavingbrushes were made rom contaminated pony hair. Control o anthrax led tolocal, national and international investigations in order to understand how tocombat the threat o the disease rom abroad. Legal cases give the opportunityto urther explore the early use o bacteriology in the courtroom, a topic whichhas been briey explored by Waddington in relation to lawyers use o new anduncertain evidence regarding the dangers o tuberculous meat in 1889.57

Bradord was highly politicized and was continually exposed to new rev-elations in laboratory research through publicity regarding ve children and


10/11


three men who had been bitten by a rabid dog early in 1886. Tey visited Pasteurslaboratory or the therapeutic rabies inoculation, only ve months aer Pasteurdiscovered the treatment in October 1885. Te children became nationalcelebrities.58 Tereore, the study o Bradord in Chapter 3 is balanced with anexamination o anthrax within the hide and skin trade in London in Chapter 4,

where casual dockworkers were less organized but were able to enlist the supporto doctors at Guys Hospital.

As important in terms o morbidity as anthrax in Bradord, serious study othe disease in late nineteenth- and early twentieth-century Bermondsey, London,has been neglected by historians.59 Tese cases also received less contemporary

publicity. extiles was a key trade or the British economy and woolsorters werewell paid, whereas casually employed London labourers working with hide andskin were not always respected by their employers. However, by 1925 anthraxin leather was a high prole risk internationally. Tis problem became the rstbusiness o the Advisory Committee on Industrial Hygiene appointed by theInternational Labour O ce o the League o Nations in 1923, and in whichBritain reluctantly took a leading role.60 Providing another London workplacecomparison, an incident at Regents Park Zoo, where our workers contractedanthrax, is examined to explore the risk o autopsying and disposing o diseasedanimals. Lastly, the publicity regarding anthrax caught rom shaving brushes inthe 1910s and 1930s by civilians and soldiers, resulting in a ban on brushes rom

Japan, will be analysed in order to compare reactions to risk o the disease which

were not connected with occupational health, linking with the next chapters onpublic responses to bacterial disease.

Te Community

Anyone could be at risk rom typhoid, rom the lower classes to Prince Albert,who died rom the disease in 1861. Te bacilli could inect a towns water supply,milk and also ood. Te carrier concept meant that typhoid had to be ought withboth inclusive and exclusive measures, with bacteriology highlighting the needto concentrate eforts on the exclusive measures related to the typhoid sufereror carrier disinection o bodily discharges but also older sanitarian inclusivemeasures o tackling modes o transmission, such as monitoring the water supplyand ood.61 Chapters 5 and 6 illustrate that although the practices o bacteriology

were becoming increasingly complex, the basic concepts o bacteriology couldbe understood by the public, rom the value o diagnostic tests to the role ocarriers, and the hygienic practices which were required to prevent the spread obacteria. A variety o case studies across England and Wales show gradual changesin public responses during this period, in tactics or protection rom disease, todiscovering and blaming those responsible. Chapter 5 explores the history o


11/11

Introduction 11

typhoid through a series o major epidemics in England and Wales between 1882and 1936, particularly examining medical and public knowledge o the role obacteriology in conrming epidemiological ndings, the development o the car-rier concept, and ideas regarding typhoid vaccination. Te pivotal point o thechapter is a case study o typhoid in Malton, near York, in 1932, an epidemicduring the economic depression which generated a wealth o correspondence.

Te study o the 1937 typhoid outbreak in Croydon in Chapter 6 analysesa landmark medical and legal case, demonstrating how the ather o a typhoid

patient discovered the cause o transmission o the disease more quickly than theMedical O cer o Health, and brought together members o the local govern-ment in order to try to tackle the disease. Te epidemic was ollowed by 260claims or compensation. As John Fabian Witt has shown, there is no novelty intort actions regarding death by negligence. In Britain, an Act authorizing actions

was instituted in 1846, and American states quickly ollowed suit.62 A typhoidepidemic in New York in 1928 resulted in a claim or $425,000 ollowing 248cases and 25 deaths, and thereore Britain was behind America in terms o suc-cessul mass litigation in court.63 However, the 1897 Maidstone case, exploredin Chapter 5, suggests that legal ideas o blame and responsibility conrmed bybacteriology began much earlier, at the same time as compensation began to beseriously discussed in relation to bacteria in industry.

Bacteria in Britain concludes by asking whether recent historians o the lab-oratory and clinic have been inuenced by ideas o gentlemanliness, nostalgia

and declinism. Tis last chapter situates the history o medicine within widerperspectives on the historiography o modern Britain. I argue that the newknowledge and technologies o bacteriology were quickly absorbed in late nine-teenth- and early twentieth-century Britain by medical practitioners, lawyers,employees and the public. Tis led to ast integration o diagnostic practices inhospitals, increasing laboratory spaces in which specialists worked, and legalattempts to prove responsibility or disease.

introduction from bacteria in britain, 1880–1939

Documents