There have been at work among us three great social agencies: the London City Mission; the novels of Mr. Dickens; the cholera.” Historian Gertrude Himmelfarb quotes this reductionist observation at the end of her chapter on Charles Dickens in The Moral Imagination; her debt is to an English nonconformist minister, addressing his flock in 1853. It comes as no surprise to find the author of Hard Times and Oliver Twist discussed alongside Edmund Burke and John Stuart Mill in a book on moral history. Nor is it puzzling to see Dickens honored in his own day alongside the City Mission, a movement founded to engage churches in aiding the poor. But what’s V. cholerae doing up there on the dais beside the Inimitable Boz? It’s being commended for the tens of millions of lives it’s going to save. The nastiness of this vile little bacterium has just transformed ancient sanitary rituals and taboos into a new science of epidemiology. And that science is about to launch a massive—and ultimately successful—public effort to rid the city of infectious disease.
The year 1853, when a Victorian doctor worked out that cholera spread through London’s water supply, was the turning point. Ordinary people would spend the next century crowding into the cities, bearing many children, and thus incubating and spreading infectious disease. Public authorities would do all they could to wipe it out. For the rest of the nineteenth century, they lost more ground than they gained, and microbes thrived as never before. Then the germ killers caught up—and pulled ahead. When Jonas Salk announced his polio vaccine to the press in April 1955, the war seemed all but over. “The time has come to close the book on infectious disease,” declared William Stewart, the U.S. surgeon general, a few years later. “We have basically wiped out infection in the United States.”
By then, however, infectious diseases had completed their social mission. Public authorities had taken over the germ-killing side of medicine completely. The focus shifted from germs to money—from social disease to social economics. As germs grew less dangerous, people gradually lost interest in them, and ended up fearing germ-killing medicines more than the germs themselves.