In 1800 the medical profession was virtually powerless to prevent diseases, the foremost exception being Jenner's smallpox vaccine, announced in 1798. Physicians had no power over infectious diseases because they did not know what caused them. They also had limited ability to control pain or to perform surgery because they lacked anesthetic drugs. During the vital revolution of the 19th century, those facts changed: Scientists proved the germ theory of disease transmission (which led to antiseptic surgery and to the conquest of many infectious diseases) and they discovered effective anesthetics. Nothing in all of modern history is more important than these facts for the improved quality of daily life.

The germ theory of disease transmission held that organisms invisible to the naked eye caused contagious diseases. These microorganisms (a term coined in 1880) might be spread by air (as was smallpox), by water or food (as was cholera), or by sexual intercourse (as was syphilis). The germ theory had been proposed by a Roman physician in the first century B.C., but physicians repeatedly rejected it in favor of other theories, such as the humoral theory (humors in the body were unbalanced) of the ancient world. The microscope revealed the existence of microorganisms in the 17th century, but scientists still favored the miasmal theory of diseases, which stressed vapors arising from the ground. The medical establishment remained so reluctant to accept the germ theory that in 1892 a German physician drank a beaker full of cholera bacteria to prove that microorganisms did not cause the disease. He did not die, but his theories did.

The germ theory was important for several reasons. First, it led to greater cleanliness, thereby reducing disease transmission. Without the knowledge that invisible organisms transmitted disease, no need existed for antiseptic conditions. Without antisepsis, doctors' offices, hospitals, and surgeries were deadly places. Hospitals packed fifty or sixty people into shared wards, where they also shared diseases. Surgeries had walls and floors impregnated with the waste of recent operations, the floors typically sprinkled with sawdust to soak up the mess. Surgeons wore frock coats, spattered with the blood of their patients; they tied whipcord, used to sew incisions shut, to their buttonholes, where it dangled in the blood of other patients. Doctors treated one patient after another often without washing their hands, and surgeons operated without washing their implements. Not surprisingly, survival rates were low. Even maternity wards were deadly, often having a 25 to 30 percent death rate for new mothers from puerperal fever, spread by physicians who performed examinations with unwashed fingers. General infections were so common that they were simply called "hospital disease." As Florence Nightingale later lamented, "The very first requirement in a hospital is that it should do the sick no harm."

The research of French chemist Louis Pasteur and German physician Robert Koch convinced the medical world to accept the germ theory of disease transmission. Pasteur's early work proved that microorganisms in the environment caused fermentation in beverages and the decay of organic matter. This knowledge led Pasteur, Koch, and others to the identification of the bacilli causing various diseases and then to the creation of vaccines against them. Pasteur's research showed how to keep dairy products and beer fresh by eliminating microorganisms (through "pasteurization") and led to a vaccination against rabies. Koch conducted similar work on tuberculosis, and in 1882 he isolated the bacillus of the disease that had killed an encyclopedia full of the creative artists of the 19th century, including the English romantic poet John Keats (at twenty-five), the Polish pianist Frederic Chopin, the French painter Paul Gaugin, and the Italian violinist Nicolo Paganini. . . .

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