The stories that make up the history of medicine are often complicated and multi-faceted. They incorporate aspects of the history of science and technology as well as social and cultural history. The skillful medical historian must weave together these various threads into one cohesive tale. Nancy Tomes has done just that in her 1998 book, The Gospel of Germs: Men, Women, and the Microbe in American Life.

Tomes' aim in writing the book was to explain how the general public came to believe in the existence of germs and to explore how this new belief changed the course of their lives. This is a daunting task, but Tomes proves herself more than up to the challenge. Through exhaustive use of both primary and secondary sources, she documents the rise of what she terms the “gospel of germs” in the last third of the nineteenth century, its widespread acceptance by the end of the nineteenth century, the changes it underwent as scientific knowledge increased, and its eventual decline as infectious diseases became less prevalent and less lethal in the middle decades of the twentieth century. Along the way, she highlights three especially interesting areas of consideration: the commercialization of medical and scientific knowledge, the role of gender in the spread of the gospel of germs, and the unexpected role class can sometimes play in the implementation of advances in medical knowledge.

Tomes does a particularly good job exploring the first of these areas, the complex relationship between commerce and emerging scientific and medical knowledge. She provides several examples of companies that took advantage of new discoveries about germs to sell their products and services. Although many of these companies' advertisements appear quaint to modern audiences, (she includes quotations from many of them and reproductions of a few) they are more than just amusing. They offer insight into the process by which the general public became aware of new discoveries and the ways in which these new discoveries impacted their lives.

While a few affluent urbanites were aware of the new thoughts on germs and disease prevention by the 1890s, the majority of the public was not. Over the next few decades, advertisements played a major role in informing and educating may people about the newly discovered dangers of germs. This meant that many people were learning about germs, becoming aware of the harm they could do, and being offered a solution to this problem all in one fell swoop, and by the company that stood to profit from the proposed solution. Tomes highlights some of the problems that grew out of this approach (advertisers offering incorrect or incomplete information) but also demonstrates how commercial enterprises were quick to embrace new discoveries and design ways to take advantage of them. This leads to an interesting consideration of how different sectors of society come to know of new advances in science and medicine and of the role of commerce in scientific education of the populace. The interplay between the 'pure' science of the laboratory, the commercialization of science by businesses, and the experience of the general public is a constant theme throughout the work. While the book may have benefited from a slightly more direct exploration of these issues, it still provides a good overview of this fascinating interaction.

Tomes also considers the ways in which gender influenced the spread of the gospel of germs. Women played a key role in both spreading the gospel of germs (as visiting nurses and leaders of the domestic science movement) and implementing it (as the housework it dictated was largely considered women's work). This both opened up new avenues of professional activity to women and placed greater demands on them. Tomes also touches on the unique circumstances of two often-overlooked groups, immigrant women and women on farms.

While her consideration of these issues is admirable, it is unfortunately incomplete. Her focus is primarily on how the gospel of germs was implemented in the the home (a female-dominated space) with some consideration of restaurants, hotels, and Pullman cars (all fairly gender neutral spaces). It would have been interesting to see what (if any) changes the new mindset had on more male-dominated spaces such as offices and universities. She also mentions in passing that advertisers switched their focus from men to women as awareness of germs spread, but does not explore the shift in much detail. Finally, she briefly mentions that changes began to occur in domestic science texts as more of their (female) authors began to earn advanced degrees in the sciences, a subject that would have been interesting to cover more fully. Despite these omissions, the material Tomes does provide is interesting and well documented and it strengthens her discussion of how knowledge of germs affected the lives of the general public.

Finally, Tomes examines the sometimes surprising role class can play in the spread of medical knowledge. She details the efforts of the Joint Board of Sanitary Control and the Negro Anti-Tuberculosis Association of Atlanta attempted to use the health concerns of the more well-to-do members of society to change the situation of garment workers and black laundresses. These two examples emphasize what she calls the “socialism of the microbe.” (206) This idea that the most affluent members of society can be motivated to improve the situation (and thereby the health) of the less fortunate members of society, not out of any sense of duty, but to avoid the diseases poverty encourages, is interesting and deserves a more thorough treatment than Tomes provides.

Despite a few minor omissions, Tomes presents a carefully documented and eminently readable account of the many ways in which a growing awareness of germs shaped the lives of the American public. She skilfully weaves together science, technology, medicine, gender, and culture into a cohesive narrative. She more than meets the goals she set out for herself in her introduction, and the end result is a work that is both informative and entertaining.