So Very Small

How Humans Discovered the Microcosmos, Defeated Germs--and May Still Lose the War Against Infectious Disease

About the Book

The centuries-long quest to discover the critical role of germs in disease reveals as much about human reasoning—and the pitfalls of ego—as it does about microbes.

“Essential reading . . . Thomas Levenson brings to brilliant life the social history of medical detective work and illuminates the fascinating world of pathogenic microbes.”—Deborah Blum, New York Times bestselling author of The Poison Squad

Scientists and enthusiastic amateurs first confirmed the existence of living things invisible to the human eye in the late seventeenth century. So why did it take two centuries to connect microbes to disease? As late as the Civil War in the 1860s, most soldiers who perished died not on the battlefield but of infected wounds, typhoid, and other diseases. Twenty years later, the outcome might have been different, following one of the most radical intellectual transformations in history: germ theory, the recognition that the tiniest forms of life have been humankind’s greatest killers. It was a discovery centuries in the making, and it transformed modern life and public health.

As Thomas Levenson reveals in this globe-spanning history, it has everything to do with how we see ourselves. For centuries, people in the West, believing themselves to hold God-given dominion over nature, thought too much of humanity and too little of microbes to believe they could take us down. When nineteenth-century scientists finally made the connection, life-saving methods to control infections and contain outbreaks soon followed. The next big break came with the birth of the antibiotic era in the 1930s. And yet, less than a century later, the promise of the antibiotic revolution is already receding due to years of overuse. Is our self-confidence getting the better of us again?

So Very Small follows the thread of human ingenuity and hubris across centuries—along the way peering into microscopes, spelunking down sewers, visiting army hospitals, traipsing across sheep fields, and more—to show how we came to understand the microbial environment and how little we understand ourselves. Levenson traces how and why ideas are pursued, accepted, or ignored—and hence how human habits of mind can, so often, make it terribly hard to ask the right questions.
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Praise for So Very Small

So Very Small is the wonderfully intimate and intertwined story of how humans discovered microbes and learned to tame them. Levenson is a master storyteller, and his latest book reads like an epic novel, spanning centuries, continents, and microbial calamities. It offers a compelling story of how microbes have influenced society, seamlessly intertwined with fascinating historical events, while vividly bringing the characters and scientific discoveries to life.”—Alanna Collen, author of 10% Human

“In So Very Small, Thomas Levenson brings to brilliant life the social history of medical detective work, notably the long quest to understand and to combat infectious disease. In doing so he illuminates the fascinating world of pathogenic microbes, the often unexpected ways we’ve achieved protection, and the often self-destructive ways we’ve undermined—and continue to undermine—our own public health successes. In a world where the next pandemic waits ahead, this is essential reading.”—Deborah Blum, New York Times bestselling author of The Poison Squad

“A penetrating chronicle of humanity’s fight against microorganisms . . . Buoyed by the author’s lucid prose, this is a first-rate work of popular science.”Publishers Weekly, starred review

“Every page is fascinating; every detail on this amazing journey through history affects our daily lives: the story of how humans discovered microbes and germs and created the world we know today. Never has science been so compelling, exciting and accessible as it is in the hands of Thomas Levenson. . . . Brilliant!”—Simon Sebag Montefiore, New York Times bestselling author of The World

So Very Small is very large and fascinating. Thomas Levenson expertly combines storytelling and big questions, most notably: Why not? Why wasn’t the germ theory of disease formulated 200 years earlier? Why, in general, are huge scientific discoveries delayed until they happen? This is exactly the sort of book that a literate citizen, keenly interested in science, reads for enlightenment, perspective, and fun.”—David Quammen, New York Times bestselling author of Breathless

“How can a book about small things be so enormously entertaining? Levenson’s command of narrative and eminently readable style zooms us effortlessly between two realms to tell the story of humanity’s relationship with the microcosmos—a drama tracing back to long before we knew the microcosmos existed. Both an opus and a page-turner, So Very Small is a work of grand-scale ambition, elegantly achieved.”—Jason Roberts, author of Every Living Thing and A Sense of the World

“By peering through the lens of the modern germ theory, and our protracted battle with disease, Levenson has crafted a vivid, engaging, and timely reminder that we are not as omnipotent nor as clever as we often believe ourselves to be. So Very Small is a deeply researched and thoughtfully compelling exploration of our successes, failures, and precarious future with deadly pathogens.”—Timothy C. Winegard, New York Times bestselling author of The Mosquito and The Horse

“A thought-provoking, engrossing account of one of the most momentous transformations in our understanding of the world and our place in it. So Very Small brings the history of science to life with vivid details and captivating anecdotes.”—Jonathan Kennedy, author of Pathogenesis

“[A] very enjoyable and informative read. . . . Levenson gives a good account of the vigorous competition between the early advocates of germ theory as well as the often-heated battles with their opponents, paying due attention to the traditional ideas those opponents held. And his research turns up some surprises. . . . An engaging survey of the discovery of microbes, their role in disease, and the efforts to combat them.”Kirkus Reviews, starred review

“[A] timely and robust medical history.”Booklist
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Excerpt

So Very Small

I

“God preserve us all”

Few facts remain from the life of good-woman Phillips.

We know this much: She was married. She and her husband lived in the parish of St. Giles in the Fields, just outside London’s city wall. The couple had some number of children. Mrs. Phillips fell ill late in December 1664 and died on Christmas Eve. As required, women hired by the parish to review local deaths examined her body. They reported their finding: Phillips, given name unrecorded, had succumbed to the plague.

The usual forms were followed. Her surviving family were shut into their home, given money to cover about a week’s worth of food, and quarantined from the community for thirty days. Outside that one household, Phillips’s death went almost entirely unnoticed except as an anonymous addition to the weekly Bill of Mortality, the regular report that tallied deaths and their causes parish by parish throughout the capital.

This single case of the plague in what is now the borough of Camden did not spark any immediate concern. In most years, a few cases in different sections of the city formed endemic sparks that then fizzled out. This time, however, the city had reason to stay alert. On the other side of the English Channel, an epidemic outbreak of the plague had been spreading since 1656, beginning in Italy then moving north and west. By the early 1660s it had reached the shores of both the North and Baltic seas—and the ports that traded regularly with England. In London, Charles II’s council imposed a quarantine on Dutch shipping in late 1663—but soon sailors were rumored to be escaping from ships at anchor to take their pleasures ashore.

Christmas came and went, and the rest of the Phillips family survived. St. Giles in the Fields recorded no further plague deaths that week, and none were reported in the rest of London. The capital’s inhabitants celebrated the holidays, and January began.

Especially for the well connected, London’s winter festivals heralded a year full of promise. That irrepressible diarist Samuel Pepys, a senior civilian member of the Navy Board and a confidant to the good and the great, thoroughly enjoyed himself that winter. On December 31 he tallied his accounts for the year and found that “by the great blessing of God, [I am] worth 1349l [pounds], by which, as I have spent very largely, so I have laid up above 500l this yeare above what I was worth this day twelvemonth.”

Thus enriched, he allowed himself some treats. On Friday, January 2, he enjoyed a tryst with a woman not his wife, flirted—at least—with another, and then arranged a romp with a third for the coming Sunday. Next came “a most noble French dinner and banquet,” after which he walked from Covent Garden to St. Paul’s Cathedral. On the north side of the cathedral yard, he found his favorite bookseller’s stall and browsed through the latest works. This was Pepys living his best life in the city he loved. He had plenty of ready cash, with more coming in. He relished his daily encounters with the powers in the land—up to and including James Stuart, the future King James II. Before, after, and around his working days, he traveled a constant round of entertainment: good food, fine drink, excellent conversation, a satisfactory marriage, and sexual sport outside that bond whenever (often) the mood took him, all lovingly recounted in his diary. Day after day that winter and into spring, the sheer joy of being Samuel Pepys leaps off the page.

Until, on April 30, 1665, he wrote: “Great fears of the sickness here in the City, it being said that two or three houses are already shut up,” adding: “God preserve us all!”

God preserve them! For a brief while longer, this was merely an expression of conventional piety. Most of Pepys’s April 30 entry was consumed by a reckoning of wealth that revealed that he was now master of “above 1400£, the greatest sum I ever yet was worth.” In the world beyond his diary, though, the plague was on the move. Cases had been reported in the Netherlands the previous year, and English authorities had reimposed restrictions on vessels crossing the North Sea. Some Dutch ships and sailors had evaded those barriers, however, and in late 1664, a few plague deaths were identified at Great Yarmouth on England’s east coast. Even under quarantine, exceptions were made for the right people. If important enough interests were at play, Dutch ships that came to London that winter got permission (or were ignored) as they unloaded their cargoes, up to the moment the Anglo-Dutch wars resumed in March 1665. The flow of people and crates from the middle of the Thames to its banks meant that an isolated victim or two along the docks or in the poorer districts would surprise no one. Into April, Londoners had no reason to believe that this season would be any different from those of recent years, when minor flare-ups of disease had burnt themselves out.

The calm held for a few weeks more. A handful of cases turned up in scattered locations both within and outside London’s city wall. A few deaths were recorded in the official tallies, but the numbers remained reassuringly low: nine in the first full week of May, just three in the next. Crucially, each such case had been isolated, turning up almost exclusively in poorer neighborhoods. The metropolis seemed safe, so much so that the fire-and-brimstone minister Thomas Vincent wrote, “Fears are hushed and hopes take place, that the black cloud did but threaten . . . but the wind would drive it away.”

Then came the week of May 16–23, and a Bill of Mortality that listed seventeen plague deaths. Forty-two more Londoners died of the disease during the week ending June 6; more than a hundred followed in the next seven days. Worse news: the victims came from neighborhoods far from the initial outbreaks. By June, the plague had spread through the city and its suburbs, and the wealthy joined the poor in its path.

Pepys kept watch. “The plague is come into the City,” he wrote on June 10, reaching all the way into a friend’s house, “which . . . troubles me mightily.” Five days later he noted that “the towne grows very sickly, and people to be afeard of it.” Chasing a wisp of hope, he wrote on June 20 that “people do think that the number will be fewer in towne than it was in the last weeke!” He had his own scare when the driver of a coach he had hired in central London collapsed at the reins, forcing Pepys to hail another coach, “with a sad heart for the poor man and trouble for myself.” He escaped untouched that time, but soon enough his city and himself were utterly beset. “The sickness is got into our parish this week,” he wrote on July 26, “and is got, indeed, every where.”

Pepys was right. From the end of June, plague deaths reported in the weekly Bills of Mortality accelerated, doubling about every fortnight. The toll topped one thousand in the week ending on July 18, hitting 2,010 for the week ending on August 1, then reached almost four thousand by the fifteenth. It would not drop back below that number until mid-October. This was no mere episode but a true epidemic, a catastrophe that could swallow London whole.

That’s how it was felt in the moment. London’s plague year was an apocalypse, the divine judgment in which sin and virtue collapsed into the same pit. “Lovers, and friends, and companions in sin have stood aloof . . . lest death should issue forth,” Reverend Vincent wrote. Their fear: “that the grave is now opening its mouth to receive their bodies and hell opening its mouth to receive their souls.” The physician Nathaniel Hodges left the theology to the ministers, but his account of the peak of the epidemic in August painted the same end-of-days picture. “In some Houses Carcases lay waiting for Burial,” he wrote, “and in other Persons in their last Agonies.” The living “bewailed both their Loss and the dismal Prospect of their own sudden Departure.” Family life was destroyed: “Death was the sure Midwife to all Children, and Infants passed immediately from the Womb to the Grave; who would not melt with grief to see . . . the Marriage-Bed changed the first Night into a Sepulchre.” Some staggered to their deaths in the street, others collapsed and vomited as if poisoned, and some, like Pepys’s coachman, were struck suddenly and died “in the Market, while they are buying Necessaries for the Support of Life.”

About the Author

Thomas Levenson
Thomas Levenson is a professor of science writing at the Massachusetts Institute of Technology. He is the author of several books, including Money for Nothing, The Hunt for Vulcan, Einstein in Berlin, and Newton and the Counterfeiter. He has also made ten feature-length documentaries (including a two-hour Nova program on Albert Einstein), for which he has won numerous awards. More by Thomas Levenson
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