"Crowded, the world today, isn't it?" "And getting more so." "Amazing, really, all these people, thanks to science, fed, clothed, and housed, and reproducing themselves by the million, and not an epidemic in sight." "I don't mean flu and measles and that kind of kid stuff." "I mean the real killers:" "typhoid, Black Death, tuberculosis, and that's what's amazing." "If you think about the sheer numbers involved and the way we're all jammed together in a kind of giant ideal germ culture, that's when the full power of modern medicine comes home to you." "Every day, thanks to modern medicine and its lifesaving techniques, the population grows and gets older as doctors treat us from the cradle on, and it doesn't seem to matter that we don't understand medicine." "We take it all trustingly for granted:" "the drugs and the technology and the research... and the miracle of keeping these little babies alive, for instance." "And as for the diseases they can't cure today, well, they will tomorrow, won't they?" "I mean, nobody understands what they're doing, but then you don't exactly argue with the doctor, do you?" "He's not interested in your opinion." "It's the bug you've got he's after." "He says, "lie down; shut up;" "take your clothes off."" "You do." "Ironic, that unquestioning obedience, because it came into existence thanks to the help and inspiration of the fellow who founded this hospital for the poor here in Philadelphia." "His name was Benjamin Franklin, and the last thing he was was obedient." "He and his friends thumbed their noses at us." "They ran the American Revolution here in Independence Hall." ""We solemnly declare our resolve" ""to preserve our liberties" ""and die free men rather than to live as slaves."" "When it was all over in 1776, congress here sent Franklin off to France to buy guns, sign treaties, and export revolution." "Among other things, he took with him an entirely new american way of looking at public health." "Oh, and a copy of this too, of course." "If there was ever a statement of disobedient individualism, it was the anti-british Declaration of American Independence that Franklin helped to write." "When Franklin left America for France in October 1776, he was the second most popular man in the country after George Washington himself." "He had almost single-handedly made Philadelphia the most progressive city in the 13 states." "Thank you." "Step this way, please." "Franklin's Philadelphia hospital, above all, was better than anything in Europe, as was the health of the citizens." "For the would-be revolutionaries waiting across the Atlantic," "Franklin was living proof of the 18th-century unthinkable:" "that you could declare war on your own king, handle anything his professionally trained army then threw at you, invent an entirely new kind of government, take a vote on the whole affair, and get away with it." "So Franklin's credit rating with his french hosts was going to be slightly unlimited, in spite of one minor awkwardness:" "revolution-wise, they hadn't actually done the dirty deed yet." "There was still a king in residence, if "residence" isn't too humdrum a word for Louis XVI's cut-glass lifestyle." "Franklin turned up here in his moth-eaten fur hat and bifocals and stole the show." "Well, with the revolution in France just around the corner and Franklin the superstar of the one they just had in the U.S., small wonder he was an ideological sensation, added to which, he was a man of charm and wit," "and ladies fell... heavily, which is why we are in a salon." "See, in 18th-century terms, this is where the elite meet, and at the time, the salon for all the name-droppers was run by the lovely widow of a late leading liberal called Helvetius." "Madame Helvetius was crazy for... freemasons, scientists, philosophers, reformers, and americans." "Well, Franklin was all of them, so they became friends, and the future of France turned, as it so often has done, on a discreet mixture of politics and pillow talk." "Politics, because, come the revolution, this was all to be replaced by one House of Government, and Franklin had actually written a Constitution with only one house, the Constitution of the State of Pennsylvania." "Pillow talk?" "Well, Madame Helvetius also had a young friend, uh..." ""living in" at the time, a doctor called Cabanis, whose bedside manner was really something quite new, because that's what he wanted to do to french medicine." "And Franklin's long talks about american hospitals and public health programs back home convinced Cabanis that revolutionary democracy was good for your health, which, at the time, european medicine wasn't." "I mean, if you were sick and rich, this is what happened." "If you were poor, nothing happened." "So the doctor came, and you'd tell him what to do." "The patient, if you'll forgive the phrase, called the shots." "Doctors thought disease caused different symptoms in different people, so you really diagnosed yourself." "And every symptom was in the doctor's pocketbook of symptoms," "2,400 of them, diseases like "nostalgia," described... as a vehement desire to go home." "You can see why revolutionary young Cabanis went for Franklin's ideas on medical reform." "The question was, with incompetence like this around, how?" "Came the revolution..." "Fire!" "By 1793, the new republic was at war, and with a million men in the field, there were just too many wounded for the properly qualified, officially recognized doctors to handle, so they brought in surgeons, who, believe it or not," "weren't regarded as real doctors." "Well, this kind of mess was just what surgeons were good at:" "instant treatment and never mind what the patient thinks." "In most cases, the surgeons had to work without supplies and discovered things like:" "the best cure for wounds was water, not ointment;" "that shock killed you as quick as anything else, so they invented the idea of the ambulance to get soldiers treated fast;" "that if you didn't amputate within 24 hours, the patient would lose a lot more than his leg;" "and once you cut whatever it was off, the best bandage to use was the patient's own skin." "Scie." "With do-it-yourself instruments and shirts for bandages, grass poultices, and no drugs, the surgeons saved far more lives than the physicians." "And with so much raw material-- if you'll forgive the phrase-- to practice on, they learned more about treatment from the battlefield than from any textbook." "By 1794, after two years of this, the surgeons were finally awarded the status of "doctor."" "In most cases, given a horrific casualty rate, it was a posthumous award." "So many doctors had been killed by the time it was all over, they had to open new medical schools all over the country to replace them, not just because of the tens of thousands of returning wounded that had to be patched up," "but also because of the ambitious revolutionary plans to provide free medical care for every citizen in the new republic." "So the first thing they had to do was to find somewhere to put all the bodies." "Places like this one, the old Val-de-Grace monastery in Paris, were commandeered and turned into state hospitals where they sometimes had to pack 'em in six to a bed." "Still, at least the doctors were a new breed." "The surgeons ran the place now, and there were new rules." "Mugging up lists of phony symptoms was out." "On-the-job training was in." "If you wanted to get ahead, hospital doctoring was the way to go." "Hospitals started to look like they do now when the ex-officer doctors dropped the old bedside manner for good after Cabanis took over in 1798." "And the patients, well, they were obedient ex-soldiers used to taking commands, or they were the poor off the streets too scared to argue." "With new rules and regulations about everything, getting cured took on the regimented feel it has today." "The patient did what the doctor ordered, and with Cabanis' book on how scientifically accurate medicine ought to be, things looked set to become more efficient and less mumbo jumbo than ever before, except for one relatively serious impediment." "They might well have got it right on the battlefield about how to handle fractures and wounds and hygiene and such, but when it came to what disease itself was, well, they were still really going round in circles." "The answer to their problem was to come from a german university and the mathematics of a certain Gottfried Leibniz, who'd discovered a way to measure the infinitesimally small changes that happened in the speed of planets in orbit." "Leibniz had reckoned that being able to measure infinitely small things meant you could also get to grips with the fundamental structure of all existence." "Now, as you can tell by the expression of rapt attention here, the maths involved wasn't exactly 2 and 2, but according to Leibniz, if you understood his equations, you had the key to the universe." "Well, the philosophers had that off him faster than you could say "calculus", and by the 1790s, european thought was in the grip of people like a fellow who worked here at Wurzburg named Schelling," "called himself a nature philosopher, because he said," ""If you could break down any organism" ""into its infinitesimally small bits," ""you'd see how everything connected with everything else, and that would give you"-- wait for it" ""the secret of life."" "Well, the doctors had that off him faster than you could say nature philosophie... in particular, a doctor called Xavier Bichat." "Know who he was?" "One of those surgeons back in Paris." "Now, what can I tell you about Bichat?" "Except that he must have had absolutely no sense of smell, because what he did was go hunting for infinitesimally small bits in the human body, in graves, coffins, accidents, mortuaries." "If it was dead, he borrowed it." "And when he finished weighing it, boiling it, pickling it, drying it, cooling it, frying it, shredding it, and doing what, in general, I believe cooks call," ""reducing the stock,"" "in 1800, he announced that bodies were made of tissue:" "muscle tissue, lung tissue, skin tissue, 21 types of tissue;" "and that diseases didn't hit whole bodies, they hit tissues;" "and if you could look at the tissue of a corpse that died from a particular symptom, you could connect symptom with disease." "We call that pathological anatomy these days, invented by Xavier Bichat." "his only problem:" "Could you be sure of your conclusions if your supply of corpses was limited, which, unfortunately, it tended to be?" "Well, mathematically speaking, that possibility was on the cards." "Deux." "Mug's game, this, really, you know?" "I mean, take the roulette wheel:" "36 numbers and a zero." "You know what my chances are of breaking the bank at Monte Carlo just because my number comes up only 6 times in a row?" "133,488,702 to 1 against." "Now, those kinds of numbers attract two kinds of people:" "suckers and mathematicians." "And back in Bichat's time, there was a gambling epidemic, which is why a numbers freak and the head of Napoleon's science think tank, called Laplace, used the tables as research material and came up with the mathematics of probability." "Now, in very simple terms, that's the three-card trick." "Look, you bet on what I've got:" "3 red cards, 3 black cards, or a mix, and odds are, you'll get it right." "I'll shorten the odds for you." "There." "Now you know it wasn't 3 red cards." "Now, with these new mathematics, what Laplace could do was work backwards from this card to work out the odds on the possible combinations of the cards I started with:" "3 blacks or 2 blacks and a red or 1 black and 2 reds." "And going backwards like that was just what Napoleon wanted." "Part of his reason was outside." "Monaco, along with Nice, Holland, and northern Italy, annexed in the recent war, and the first thing they had to do to administer this new, bigger France was to count the population, and they couldn't afford to count everybody," "but with Laplace mathematics, they didn't have to." "They took 30 small areas, added up the people, and divided by the birthrate, got one baby per 28.353845 people." "Okay, for the whole country, the annual birthrate was known from Paris registers:" "1.5 million babies." "Multiply that by 28.353845, and you get 42,529,267." "Laplace used his math to tell him what the chances were that those accurate small-scale samples he'd taken had given him a national figure that would be valid." "Laplace gave that an inverse probability of being right to within half a million, close enough for Napoleon and just the idea for Bichat's pathologists." "For the first time in history, the patient was about, literally, to become a number." "Oh, the hand?" "3 blacks." "Back in Paris, the numbers game really caught on, because by 1820, there were over 50,000 patient beds there in new purpose-built hospitals split-- as they have been ever since-- into separate wards for men, women, and types of disease." "And in those wards, with hundreds of thousands of patients to examine every year, medicine became mathematics." "The numbers were big enough for statistical analysis of how diseases progressed and how well treatment worked, and with teaching going on during the new ward rounds and the teaching staff active doctors themselves and a new use of charts" "and regular records for a patient, the medical profession became what it is today: a profession with journals and societies and in-house rules." "And all the time, the patient became less involved in his own treatment as new instruments made it possible for a doctor to find out what was wrong with you without having to ask you." "By 1830," "Paris was the hospital center of the world, and foreign students were flocking in to find out how this clinical medicine worked." "One of the foreign students of the new medicine-by-numbers was a young fellow called William Farr, who, in 1831, after two years in Paris, sailed back here to London just in time to wish he hadn't." "You see, for the previous 14 years, a killer epidemic had been working its way inexorably outwards from India, and in 1831, it was in Hamburg, just across the North Sea, with 50 million dead behind it." "Well, there was total panic here." "Britain was the perfect target for any epidemic." "Why?" "Because she was right in the middle of the industrial revolution." "In 10 years, the number of towns had doubled to 1,000, and the population had gone up from 9 million to 14 million, and all the extra were jammed into the cities, where they lived in stink and filth," "40 to a house, ankle-deep in sewage, working 16-hour days in unspeakable conditions, and dropping like flies from malnutrition anyway." "And nobody knew what to do with them." "There'd never been that many people living that close together before." "An epidemic might tip the scales to anarchy." "Desperate attempts were made to quarantine the country." "They closed all the ports, crossed their fingers, and failed." "On Sunday, October the 23rd, 1831, in the northern port of Sunderland, a sailor called Bill Sproat collapsed with violent pains, diarrhea, vomiting, high fever, massive loss of body fluids." "3 days later, he was dead, the first british cholera victim." "The nightmare had come." "They put a ring of troops around Sunderland." "The cholera went through it like that." "Within one month, it was here in London." "4,000 people were dead, the cholera was spreading like fire, and nobody had the faintest idea how to stop it." "In the swarming city slums, doctors tried everything they knew:" "everything from splashing vinegar or nitric acid around to burning tobacco." "Was cholera caused by bad smell or by people touching each other or flies?" "As the cholera went through cities like a Ripsaw, attempts at prevention became more and more crazy:" "pepper, castor oil, hot bricks, whitewashing the houses, ringing church bells, evicting families into isolation." "Everything failed, including the favorite:" "burning pitch." "As the death toll climbed towards 32,000 by the end of the first year of cholera, something happened that was to bring William Farr and his french medical maths into the story." "See, most of the workers belonged to friendly societies." "They paid weekly dues to them in preparation for times like this, when they'd need sick pay or funeral expenses, and the friendly societies charged subscriptions based on the average age people got sick and died out." "Trouble was, their figures were way out of date," "A, because they'd been compiled 100 years earlier, and B, not only were conditions radically different now, but back then, the rate at which people died had been going down." "Now, it was going very definitely up, so more people were dying than the clubs expected." "So they were paying out more and going broke all over the country and making their million-odd poverty-stricken customers desperate enough without cholera." "So for various reasons, getting the numbers right seemed like the thing to do all around, and it was the actuary for this place," "Legal  General Insurance, who did the trick." "He pulled together all the up-to-date figures he could find, processed them, and found that all death rates went through three consistent stages." "Before the age of fertility, they fell." "During the fertile years, they remained more or less steady, and after the fertile years, they rose again." "And they did that at each stage at the same rate for everybody." "When William Farr saw that, he jumped at it." "This was evidence that human life obeyed mathematical laws, that you could treat people like numbers, and they'd respond like numbers." "So when the General Register's Office opened in 1836 to centralize all the data collecting and stuff like this started coming in-- millions of fact sheets on death with all details, including cause of death" "William Farr went at it like a sweet tooth in a chocolate factory." "In the 1840s, he did all the statistics for a major report on conditions in the cities." "The report scared the hell out of everybody." "In a nutshell, it said, "Pave the streets." ""Bring in clean water." ""Lock down the slums." ""Get the dung and the disease" ""and the cesspits out of people's homes, or what you will have is a revolution."" "Before the authorities could even harrumph, cholera exploded again, 70,000 people dead this time and enough numbers for Farr to do something about it." "Did poverty give you cholera?" "Bethnal Green, poorest place in London, number of deaths:" "less than places twice as rich, so it wasn't money." "Was it where you lived?" "Maybe." "Here's the nationwide death rate." "At these places, much higher, all of them, towns on water." "Farr double-checked." "He looked at the death rates from an inland county and compared it with London, up port, on a river, and yes, a higher death rate." "Liverpool, same kind of location, and even higher, both of them on water, both high death rates." "See?" "Now, Farr believed in the bad-smell theory of disease, and the Thames stank, so in 1852, he checked that connection he'd found with water." "There's the Thames." "Farr divided London into contour lines to see if how high above the water you lived had any effect, and there it was." "The cholera deaths followed the contour lines exactly:" "worst down at water level along the river where the stink was strongest, better higher up, and best of all in the sweet-smelling hills of Hampstead." "Oh, and by the way, that explained Bethnal Green." "It was there, poor, but 60 feet above the river." "The big question was, what was lethal in the smell coming off the Thames?" "And then Farr got a break." "The following year, during the next cholera attack, a local water pump started killing people," "600 in 10 days, and for no apparent reason." "It pumped water up from a deep well that had never given trouble before." "Then somebody took a closer look down below and discovered that the local cesspit was leaking into the well, and when you mapped out the deaths, there they were in the streets all around the pump." "Further out, none." "It began to look as if it wasn't the Thames after all." "This water..." "wasn't coming from the river, so was it something coming from the cesspit?" "Sewage?" "And if cholera was caused by something in the water, what did that do to the bad-smell theory?" "Well, in 1855, Farr finally came up with the answer." "During this last lot of cholera, of all the companies that piped water to places that didn't have wells, only one had obeyed a new law to stop getting its water from the river downtown, where all the sewage got dumped," "and instead, get it from further upstream, well above this polluted area here." "That single law-abiding water supplier was called the Lambeth Water Company." "Thing was, it supplied an area of South London-- over there on the other side-- street for street with a competitor who was still getting his water out of the unspeakable muck that flowed by here, and that turned out to be it." "Of the people getting Lambeth Company supplies, only 400 died." "The dirtier stuff killed 10 times that, so it was what they were drinking." "Well, those who could afford to leave all this took their resulted fixation with clean water to positively germanic lengths." "Now, I was going to list the weird things the cold water treatment brigade got up to in upper-class Germany and then throughout Europe, starting the fashion that still survives today that clean water equals good health, but the lunacy speaks for itself." "Ready." "Meanwhile, in England, the theory that cholera was a divine punishment found expression in an attitude that also still exists today, the idea of the sound mind and a healthy body and the mania for sport, born of victorian paranoia." "Go on, Ashby." "At the new public schools, the boys were driven by the belief that god hated the milksop and loved the manly athlete." "As the playing fields echoed to the sound of compulsory games, the school chapels thundered with the anglican answer to cholera... muscular christianity." "Oh, well-held." "And it was now, in the 1850s, from the sports we played out of sheer hypochondria, that we got our modern habit of apologizing for being sick and the myth about our national character, you know, being such jolly good losers." "Well-played." "All the cliches about the English started with cricket:" "team spirit, fair play, stiff upper lip, a straight bat, all victorian inventions designed to keep the boys in the healthy open air, to teach them command and discipline, and prepare them to handle the anarchy" "that might come in the cities if things didn't improve." "Oh, a bowl, Chris." "We have built a magnificent palace of legislature on the banks of a magnificent river." "Here in London, things were definitely not improving for one vital bunch of people, because little would be done until the stench and the filth got out of the slums and into the Houses of Parliament." "Well, in the long, hot summer of 1858, the stench did just that." "After halfhearted measures like paving streets and outflowing cesspits, the problem was now flowing by outside the medicated window blinds." "The Thames was now a public lavatory." "Oh, the smell is absolutely" "Asphyxiating MPs were now finally to bring the solution to the cholera problem and, in doing so, turn the citizen into the number he is today." "The stinking Thames outside is a scandal to us before all Europe." "Yes." "Something must be done." "Yeah." "If cholera were to visit the metropolis while the river is in the present state, the mortality would be something dreadful." "Their decision was to mount one of the most ambitious civil engineering projects ever undertaken by a major city anywhere:" "to clean up the Thames." "The man they gave the job to was a fellow called Bazalgette, an engineer, and you could say he flushed out the problem." "Come down and have a look." "You see, at the time, sewers were built to handle only dry human waste." "They'd break in every so often and cart it all away." "But now, with the increased use at the time of the new WCs-- and that road surfacing you recall the reformers wanted?" "Well, now there was loo water and drain water runoff coming down here and washing tons of sewage off into the Thames." "And, of course, at high tide, it would back up again out into the streets." "Bazalgette's plan was to build a network of intercepting sewers to stop it getting to the river at all." "This is one of those intercepting sewers coming in there behind me and then going away down there." "Look at how it works." "We're here." "The old sewers ran this way to the river and now hit Bazalgette's new network of intercepting sewers running parallel to the Thames," "3 to the north and 3 to the south, joining up there and there, and diverting the sewage from the river." "Where the north and south sewers ended, the latest in victorian pumping technology, capable of handling" "10,000 cubic feet of sewage a minute and double that during rainstorms." "The South London stuff ended up here at Crossness pumping station on the Thames estuary 12 miles down from London, where 4 giant beam engines like this one lifted the sewage 30 feet up into a reservoir to wait for the tide to turn, when it was dumped," "taken out to sea by the ebbing waters never to be seen again." "The scale of Bazalgette's grandiose scheme shows, typically, in the statistics they published at the time:" "318 million bricks, 1,300 miles of sewers, 480 million gallons a day." "Well, it all did the trick." "They flushed the cholera away with the sewage... and it never came back, all thanks to Farr's magic numbers." "There was just one minor fly in the ointment, if that's the right kind of image for this kind of story." "They still didn't have the faintest idea what the mysterious cholera actually was." "Meanwhile, unknown to everybody in Europe, events were to be spurred along by a gentlemanly G.P. in Georgia, U.S.A." "Back in 1842, here he was on his way to some rather dubious medical fun and games." "Everybody around knew about the kind of parties you could have with Crawford Williamson Long, parties where the wildest things happened because of what he could get people to do once they'd taken a sniff of what was in his mysterious bottle." "Even girls would misbehave." "The mystery ingredient in Long's bottle that got everybody all excited was called ether, and this get-together behind closed doors was called an ether frolic, because what sniffing ether did to the nicest southern ladies and gentlemen was to make them, well, frolic." "I mean, you might find yourself kissing somebody when you hadn't even been properly introduced to them." "Oh!" "Oh!" "Dr. Long and half the young people in Jefferson City, Georgia, were having themselves a whole lot of laughs two or three times a week turning on to the uproarious effects of ether." "Apart from all that misbehavior, ether turned the dullest fellow into the life and soul of the party." "The ether seemed to release every last trace of inhibition from even the most reluctant of people." "Before long, they'd be happily burbling away at each other total gibberish but who cared?" "Now and again, of course, some guy was bound to overdo it and take one too many sniffs with inevitable results." "It was at one of these incoherent little interludes that long realized the full potential of his magic potion." "Not only did it make you behave like a falling-down drunk, but just like the totally plastered, it left you feeling no pain." "No... no, I'm fine." "I'm fine." "After these..." ""clinical trials..."" "I'll be damned." "Long was to try the stuff on a patient during a minor operation with extraordinary results, because what he'd discovered was anesthesia." "Now, I know what it sounds like." "It sounds great." "But any sane patient in the mid-19th century, here in the sleepy South or anywhere else, needed anesthetic like a hole in the head, because while it did take your consciousness away, there was a good chance it wouldn't come back." "Why?" "Because anesthetics encouraged doctors to operate more." "That's why." "Look at the new tools they had to play with by 1860, things like viewing tubes for poking into every orifice." "They hurt, but not with anesthetic, so the doctors could look down their little tubes and see things worth taking out, and that was the problem, because with walls dripping with fungus," "60 to a ward, blood and sawdust on the floor, drunken nurses, filthy bandages and bedsheets-- this is a hospital I'm describing-- the very last thing you wanted was a cut of any kind," "or, to put it technically, you were a dead duck." "I mean, they tried to stop people going septic with bread poultices and tea, so most of the time, it was," ""the operation was a success, but the patient died."" "That is, until 1864." "That was the year some cows got sick in Carlisle back on the scottish border, and the locals threw carbolic acid into the sewage and all over the cows, and they got better." "So the Glasgow professor of surgery, a fellow called Lister, kind of threw carbolic acid all over 11 infected compound fracture patients who were pegging out, and 9 of them promptly didn't... peg out." "So Lister, being a thorough kind of fellow who took things to extremes, decided that if the germs were in the air, which is where he thought they were, that's where the carbolic acid should be," "with these." "Well, he converted scent sprayers." "As his fellow surgeons used to say before one of his ops," ""Let us spray."" "Bad joke, great idea." "In January 1878," "Lister made all this modern, lifesaving work possible with one of the most daring bits of," ""Put your money where your mouth is"" "in medical history." "He anesthetized one of his patients who had a compound fracture and then deliberately made an incision, and the patient survived." "Sinus." "Today even open-heart surgery is a commonplace thing, thanks to Lister's antiseptic and long's anesthesia and another shift in the attitude towards the patient, no longer even conscious to be consulted, his survival now a matter of killing germs" "to prevent infection." "But whatever the germs were;" "and whether they were in the air, as Lister thought, or not;" "and how they caused disease;" "and about a zillion other questions were still in the doctors' minds as they carried out one successful operation after another knowing only that they were surrounded by invisible bugs, like septicemia or gangrene, invisible but, thanks to Lister, dead." "However, they weren't to remain invisible for long." "In another part of the medical forest, so to speak, people had been beavering away with something-- would you believe" "Lister's father had developed:" "a fancy microscope, down which, for the first time, you could see clearly what it was you were peering at." "When they looked into a drop of water-- remember, water was still the mystery cholera carrier-- what they saw made them think, all right." "It was all very confusing." "They could focus in on the things in the water okay, things like cells and microorganisms." "Trouble was, some of them were dead, so obviously, something even smaller killed them." "Now, dead cells were caused by disease, but where was the disease?" "Stare as they might, the only strain they could come up with was eye strain." "The big unanswered question:" "if disease was caused by something you couldn't see, how could you find it?" "The fellow who found the answer here in Africa was an arrogant, fanatically methodical, hypochondriac german called Robert Koch, who started out life as a country doctor in a boring bit of Prussia, where the only excitement was guessing" "how many sheep would keel over that week from anthrax." "Koch shut himself away there for 3 years with a microscope and some unfortunate animals, solved the anthrax mystery, and kind of invented modern bacteriology." "He looked at drops of anthrax-infected blood... and, in among the blood cells, saw lots of little filament things everywhere." "You put these into healthy mice, and you get instantly unhealthy mice." "Koch made the little bugs comfortable with warmth, food, and air, and they turned into these:" "spores, which resisted everything you threw at them, just sat there for years." "But the instant they were back in an animal, they turned into the little filaments again, and the animal got taken seriously dead." "So that was it." "The highly resistant spores could live in the ground for ages and then get picked up by any passing sheep." "Big thing:" "Koch had proved one bug causes one disease, which left about a zillion others, so on he went." "First thing was to find a way to get the bugs to sit still, 'cause in the droplets, they whizzed about." "Koch hit on this stuff: agar." "You make jelly with it." "Agar plus 1% of meat extract is a bug's idea of gourmet heaven, and it's solid." "So they sit still and grow in little groups separate from other bugs." "Koch cultured any of these minute villains he could find and took the first ever micro mug shots:" "septicemia, gangrene, abscesses." "If it festered, he fed it and took its picture and identified six more diseases caused by specific bugs." "And then this maddeningly slow, obsessive, methodical approach was galvanized... by color." "See, in 1877," "Germany was becoming the world's industrial dye center, and when one of Koch's chemist friends showed him some, sure enough, Koch put it on a slide... and saw that it did nothing to the general junk in blood:" "fats, crystals, cells." "But what it did do was to color his little bugs, which is why, in 1882, it only took him six months' work to identify that." "See the blue bits?" "That's what gives you tuberculosis, the Tubercle bacillus." "One year later when-- since you've probably guessed I'd finally get to the point-- cholera came back to North Africa," "Koch was on the next boat." "Using his meticulous techniques, he found the cholera bug, cultured it, photographed it, and stained it in 3 weeks." "It looked like a comma, which is why he called it the Comma bacillus." "And yes, it was transmitted when you drank water that had been polluted by sewage or soiled laundry." "The mystery killer was a mystery no more." "Koch was a hero and just as arrogant as ever, but his laws for investigation-- make sure one particular bug is always there when the disease is present, culture that bug, use the culture to give the disease to a healthy animal," "and get the same bug back out of that animal-- made bacteriology a science and put the patient on a slide for good." "The transition by medicine from bedside to hospital to chemistry is complete and, with it, the disappearance of the patient from our story." "His complaint, once voiced personally and authoritatively, is now reduced to a string of numbers on a computer terminal." "Of all the sciences-- as that philosopher back in Wurzburg," "Schelling, you remember, said-- of all the sciences, medicine is king because it deals exclusively with us and our well-being, and there's nothing any of us likes more than ourselves." "So as medical science has become more capable of enhancing that well-being, we have happily invited it to become more and more involved in wider and wider areas of life, until today, the doctor does much more than just heal the sick." "Medical judgments rule." "They go unquestioned in such areas, for instance, as diet, exercise, working conditions, abortion, job application, military service, parenthood, insurance, social security, and, even in some places, political acceptability" "and ideological dissidence." "Doctors don't just cure us anymore." "They pronounce us fit members of the community in every sense, and in that, they have more power almost than anyone else." "That's what Koch and all the others achieved." "In 1892, the first public hygiene laboratory doing bacteriological testing was set up here at the Hospital of the University of Pennsylvania, and our unquestioned obedience to the power of medical statistics began to spread to the nonmedical parts of life," "because the man who ran the lab was a fellow called John Shaw Billings, and he had the idea of putting medical statistics onto punch cards." "The punch cards that gave birth to the computer, whose existence makes all of us, sick or healthy, statistics, numbers." "Like the sick patient, the population at large can now be diagnosed and treated, medically or not, without even knowing it's happening." "The irony is that it should have all begun here in Philadelphia, the home, some might say, of the inalienable right of the individual to lead a life freely and without interference."