The land of the germ-free

Ugh, germs! As Nancy Tomes points out in this fascinating book, nothing horrifies an American housewife more than the thought of that vast population of invisible creatures, covering every surface, issuing in uncounted numbers from every bodily orifice, and blowing through the air in tiny clotted lumps of concentrated evil.

It was not always so. Tomes, a professor of history at the State University of New York at Stony Brook, traces the complex web of events that have made the United States the most germ-conscious society on the planet. The forces involved are numerous, some noble and most less so.

The discoveries of Louis Pasteur and Robert Koch in the 19th century took place in a world that we can now only dimly imagine: a world of open sewers and untreated pit toilets, of filthy hospital surgeries with doctors operating in their street clothes, of common water pumps and fountains provided with unwashed cups on chains, drawing their water directly from sewage-filled rivers. And it was a world in which cholera, typhoid and tuberculosis carried away millions of children and adults every year.

Most histories of the transformations wrought by the germ theory of disease deal with the introduction of immunisation and of sterile surgical techniques. Tomes takes a more general view and examines the impact of the germ theory on daily life. And nowhere was it more substantial than in the US, where commercial forces were ready to spring into activity, marketing patented toilets that dispensed corrosive chemicals after every use, fierce cleansers and - most important - guilt. She examines in depth how, right from the end of the 19th century, advertisers harnessed housewives' guilt about sexual and social inadequacy and redirected it with a Freudian flourish to a new displacement activity - ridding the house of germs.

On the way, fusty Victorian bric-a-brac and germ-laden Victorian beards disappeared. Tomes admits that fashion played a large role in this transformation, but she points out how the fear of germs was able to change and direct fashion. Even little details of our daily life that we take for granted, such as turning the tops of bedsheets down over germ-laden blankets, had their genesis in this pervasive fear of contamination.

Darker forces were at work as well. In the most powerful sections of the book, Tomes examines in detail the way in which fears of immigrants and of racial minorities were harnessed by reform forces and by advertisers. The International Ladies' Garment Workers' Union was able to use these fears to gain better conditions for its (mostly immigrant) workers. And Tomes paints a vivid picture of the racially stratified society of early 20th-century Atlanta, showing how the fear of rampant tuberculosis among black cleaning women and other servants drove the white overlords - with immense reluctance - towards reform. It seems probable that nothing but the fear of germs could have caused the white medical establishment to work together with the Negro Anti-Tuberculosis Association.

Tomes concentrates her persuasive social history on the transformation of the US, leaving the rest of the world to others. Europe is now catching up to, and in some cases exceeding, US levels of cleanliness, but without perhaps such a freight of guilt. In Europe, old houses are refurbished, leaving their charming corners and crevices intact. In the US, everything old and quaint tends to be torn down or transformed beyond recognition into a sanitised and Disneyesque version of the past. But the fear of germs is growing in Europe as well. The filthy public toilets of the past, sometimes inhabited by whole families of pale troglodytes, are disappearing to be replaced by automated facilities of an unnerving sterility. I remember visiting Munich's Hofbrauhaus in the 1960s and watching the Junoesque waitresses as they swilled used beer steins once or twice through shallow zinc troughs filled with water contaminated by a thousand mouths. My US-trained sensibilities quivered at the sight. Readers can perhaps inform me if things have changed there - my guess is that they have.

In the US, the children and grandchildren of those distraught housewives are far more casual about cleanliness. At the end of her book, Tomes wonders whether the pendulum will swing too far, undoing some of the enormous gains made by the public-health movement. Perhaps, but it seems unlikely that we will ever return to the dark days of the 19th century.

This book is social history at its best. I recommend it to anyone interested in how our modern world came to be.

Christopher Wills is professor of biology, University of California, San Diego.