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When my son Clark was little, he was prone to upper respiratory infections. I used to call him over, pull out my handkerchief, and tell him to blow. Now and then, I commented, "Wow, you're leaking a lot of brain lubricant." The poor guy. Years later, he told me he had taken me at my word. As a result, he'd gone around sniffing to keep his brain from losing all its lubricant. I wonder what would have become of him if I'd told the truth about the teeming masses of bacteria in his runny nose.
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Clark, now age 19, has long ago forgiven, if not forgotten, my doctor humor. He was recently home on his college break when I received for review Jessica Snyder Sachs' Good Germs, Bad Germs: Health and Survival in a Bacterial World. Before I get to the book, I'll digress a bit more. Over Clark's school break, he asked me to go see the movie I Am Legend, starring Will Smith. As it turns out, Clark's movie choice was rather providential. Next fall my son will start medical school. I'm not sure his generation of doctors has more to learn from Good Germs, Bad Germs or I Am Legend.
The film begins with a scene from a TV newsroom. Karen at the health desk is interviewing Dr. Alice Krippen about her medical invention. "Give it to me in a nutshell," Karen prompts. "The premise is quite simple," Dr. Krippen begins. "Take something that is designed by nature and reprogram it to make it work for the body rather than against it." We learn that Dr. Krippen's team has done clinical trials on 10,009 patients using a genetically altered measles virus. In follow-ups, all are cancer free. The doctor is asked if she has found the cure for cancer. "Yes. Yes. Yes, we have," she says—as the scene shifts to a post-apocalyptic world a few years later.
Will Smith, in the role of virologist Robert Neville, is the last human inhabitant of Manhattan Island, except for a bunch of ghoulish, bloodthirsty cancer-vaccine "survivors." It seems the cancer cure has left everybody dead—or "undead"—except for Neville, who is immune to the vaccine's side effects. About thirty minutes into the film, Neville injects a captive, unconscious vampire girl. She lunges toward him, and that's when I told Clark I had to leave the theater.
In my first year of residency, I'd been surgically inserting a right subclavian line on a comatose, near-death patient when my needle must have hit a nerve. The unconscious patient sat bolt upright, opened his eyes, and stared at me just like the zombie Neville injects. Decades later, the memory of this patient still undoes my composure.
Now to Sachs' fine book. It begins with a real-life prologue about a college student who is well one day, and the next day rapidly goes into septic shock and dies. Throughout her narrative, Sachs interjects stories such as this, and herein lies much of the book's hold on the reader.
In Part 1, "The War on Germs," we meet the Renaissance physician Girolamo Fracastoro, whose 1530 text on "the French disease" was composed in Latin hexameter. His poetic treatise on syphilis was ahead of its time, correctly postulating a microbial vector and setting the stage for a branch of modern medicine.
Sachs does not mention that one of the early cures for syphilis was to have patients contract malaria—the subsequent high fever proved too much for the pesky spirochete—but she does trace other toxic cures, and then pauses at Paul Ehrlich's 1908 introduction of Salvarsan, which was effective against syphilis. From there she moves to the modern antibiotic era with Alexander Fleming's 1928 serendipitous observation of Penicillium mold, which had contaminated and thus inhibited the growth of colonies of Staphylococcus aureus.
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