The swamp, believed to be 3800 years ago in the two streams, gave birth to the boring worm. One day he crawled hungry and crying in front of the god Shamash, as shown by a plaque from the archives of the Assyrian king Assurbanirpal. “What will you give me to eat? What should I suck on?”, The worm barked, and the god countered: “I will give you the ripe fig, the apricot!”
But this delicious offer could not attract the worm: “What use should they be to me? Lift me up, let me live between my teeth and gums! I want to suck the blood of my teeth and gnaw my gums down to their roots!”
The bizarre Mesopotamian poem ends with a magic mantra called three times. She was supposed to banish the toothworm that contemporaries thought of not only as a tiny animal, but also as a disease-causing, pain-causing demon. To the supposedly progressive knowledge about the cause of toothache was joined by a treatment method that is unsuitable from today’s perspective.
Nevertheless, there is something remarkable about the story:
The board is the first document in which people explain health complaints with small, barely or invisible creatures.
The explanatory pattern was found on four continents and in numerous cultures: caries holes looked to people as if worms had drilled or eaten them in the tooth.
The toothworm remained a popular explanation for toothache until well into the 18th century.
This makes it a prime example of the extremely long process of knowledge until medicine ultimately recognized parasites and fungi, bacteria and viruses as “germs” for human diseases.
The discovery that tiny pathogens can transmit or cause diseases is possibly the most important discovery in medicine. It was only then that she started the targeted search for really suitable medication – and also made drug prevention possible. Both are vital for our survival today, both took a long time to get started.
You can see truth without realizing it
Antiquity interpreted illnesses intrinsically: illness was ultimately explained as a disturbance of the inner balance. In the ideas from ancient Greece to modern times, the “juices” of the body got out of balance when sick. For centuries, doctors have responded by trying to restore this balance. The choice of their remedies determined the theory rather than the empirical: it was treated on the basis of conjectures which “juice” was in excess or undersize. Anything that killed only a few sick people was considered a proven treatment.
When scholars came closer to the truth, they mostly didn’t notice. This even applies to the Persian universal scholar Ibn Sina alias Avicenna (980 to 1037). He is often mentioned as one of the fathers of “germ theory” because in his canon of medicine he described how dying rats announced the plague. Ibn Sina, however, interpreted this only as a sign – he did not recognize a connection to humans.
This was the first step taken by Girolamo Fracastoro (1478 to 1553). The Veronese put forward the theory of a “fever seed” in: In his writing “De Contagione et contagiosis morbis et eorum curatione” he conjectured that diseases were transmitted by tiny “animalcula”, which he thought of as animals or germs, and by “vermiculi” (worms, parasites) – both through touch as well as over distance “through the air”. A brilliant assumption, because nobody could see and prove such small creatures. This is probably why Fracastoro’s theory died away with almost no echo: the medical community was not interested, you stayed with juices.
Antoni van Leeuwenhoek (1632 to 1723) took another important step. The Dutch researcher and optician manufactured early microscopes and was also the first to observe microscopic creatures. In the yellowish stuff that he scratched his teeth – the toothworm sends his regards. Leeuwenhoek also found this interesting, but not very relevant.
Agostino Bassi (1773 to 1856) was the first to associate microorganisms with diseases. He discovered a microscopic fungus on sick silkworms and drew the right conclusion – a pathogen. However, this remained without real consequences, from today’s perspective hardly understandable: When cholera broke out shortly thereafter, Bassi explained the epidemic again with chemical reasons that would bring human juices out of balance.
The principle of vaccination
A strange break with the prevailing ideas of medical professionals has been the practice of vaccination for more than two centuries. The idea of preventing an illness from breaking out, by hopefully causing it in an easier form, actually bit into the common teachings of “juices”.
But apparently this was exactly what had been experimented with long before: vaccinations from China have been handed down anecdotally around the year 1000, shortly afterwards from the Arab world. One of the first methods was to stick healthy cotton balls with “sick material” (such as scab from smallpox scars) in the nose or to blow crushed wound material into their faces. Europeans first heard of the fact that such materials could also be placed in specially opened wounds in the early 18th century.
This method, known as variolation or inoculation, worked well, although many died of it. Most people vaccinated against smallpox – and there 10 percent “collateral damage” death rates of 30 percent and much more were clearly preferable. Napoleon saw it that way and had soldiers vaccinated.
The Englishman Edward Jenner developed a gentler method from 1796. He also vaccinated people against smallpox, but instead of human scab with germs of animal pox diseases (cow, horse). It soon became clear that the serum developed by Jenner was successful and also much “gentler” – its subjects developed immunity without noticeably becoming ill after the vaccination.
Country doctor Jenner, however, like most vaccinators, was a practitioner, more of a healer in the tradition of bathers and surgeons than a medical scientist. He developed his methods empirically without providing theoretical explanations.
A sensational breakthrough
A little later, the scientific knowledge came almost suddenly. Around 1860, Louis Pasteur reinterpreted fermentation, putrefaction and decay processes that had previously been thought of as chemical reactions. Pasteur proved that it was biochemical processes involving the smallest organisms. Five years later, the well-known British surgeon Joseph Lister read about it – and drew the consequences: In the same year, he specifically targeted suspected pathogens with chemicals during the first antiseptic operation.
The patient survived and was healed. A sensational breakthrough. In the years that followed, the knowledge alone that germs could get into the patient’s hands during treatment saved countless lives. The Hungarian-German obstetrician Ignaz Semmelweis (1808 to 1866) made hand hygiene compulsory and thus suppressed widespread child bed fever. Thanks to hand washing, Semmelweis was rightly celebrated as the “savior of mothers”.
In 1876 Robert Koch – the eponym of the currently prominent research institute for infectious diseases – was the first to provide direct evidence between a microscopic pathogen (anthrax) and a specific clinical picture. In 1882 he discovered the causative agents of tuberculosis and in 1883 that of cholera. At the latest now there was a new leading medical science. Doctors were educated with books, photographs and detailed drawings about the appearance and shape of an increasing number of bacteria.
The discovery had far-reaching consequences. From then on, treatments and medication ions could be developed in a much more targeted manner; Instead of experimenting on humans, substances were first tested on the pathogen itself. Even more: the knowledge of what spread diseases and in what ways also allowed prevention. When cholera was rampant in Germany in the 1890s, Robert Koch was brought in as an expert in Hamburg, Berlin and the Ruhr area. His analyzes led to far-reaching changes in the water and sewage systems of the big cities. After that, Germany no longer recorded any really large cholera outbreaks.
When the Koch students Emil von Behring (1854 to 1917) and Paul Ehrlich (1854 to 1915) then refined the vaccination procedures using serum-based immunization procedures, the basic steps towards modern medicine were taken. Only one component was still missing.
Viruses: The smallest of all killers
Already at the end of the 19th century, researchers began to suspect that, in addition to the bacteria, there had to be smaller pathogens that were not visible under the light microscope, which caused inexplicable but highly threatening diseases – such as the often fatal flu or the tens of thousands of measles that die every year.
What Friedrich Loeffler and Paul Frosch then proved for the first time in 1895 was called “virus” – after an ancient Roman name for an enormously strong poison. In the first century AD this was the name of the saliva of a rabid animal. A fitting namesake, because rabies is still the deadliest virus we know. The first vaccination against this was developed by Louis Pasteur in 1885, it can also help immediately after an animal bite. Rabies has not yet been effectively cured. As soon as symptoms appear, the chances are slim: To date, only seven survivors are known worldwide, most of whom suffer serious consequential damage.
Viruses remain a scourge of humanity to this day – by now we have at least understood them. The search for therapies or preventive vaccines is now targeted and mostly successful. And what helps until something like this is discovered by pioneers in research as early as the 19th century: distance and hygiene. Then, a look at medical history shows, everything will be fine in the end.