Phage therapy

Bacteriophage therapy could not have emerged before 1917. Not because Félix d'Hérelle was uniquely brilliant, but because the adjacent possible had only just opened. The therapy required precise convergence: germ theory (Pasteur, Koch), the porcelain filter (Chamberland, 1884), the concept of filterable infectious agents, and most critically, Petri dish cultures that made bacterial plaques visible.

The First World War was not incidental—it was the selective pressure. Soldiers dying of dysentery in field hospitals created both urgency and opportunity. D'Hérelle filtered stool samples from recovering patients, watched clear zones spread across bacterial lawns, and grasped what he was seeing: a self-replicating bacterial predator, thousands of times more potent than any chemical antiseptic. By August 1919, he successfully treated dysenteric children in Paris. By 1923, Giorgi Eliava had established the Tbilisi Institute in Soviet Georgia.

Then came the great divergence. Between 1935 and 1945, phage therapy collapsed in the West while flourishing in the East. The discovery of sulfa drugs (1935) and penicillin's mass production (1942) offered Western medicine simplicity: no bacterial typing, no phage-host matching, no refrigerated supply chains. Phage therapy was "too complicated for the state of American medicine in the 1940s."

The Soviet Union faced different constraints. Isolated from Western antibiotic production, Soviet military medicine refined what already worked. The Eliava Institute, employing 1,300 people at its peak, produced tons of bacteriophage preparations. Cold War politics calcified the divide.

Now the adjacent possible reopens. Modern phage therapy leverages genome sequencing, synthetic biology to engineer enhanced phages, and bioinformatics to predict resistance. In 2017, researchers successfully treated an Acinetobacter baumannii infection with personalized phage cocktails. The West rediscovers what Georgia preserved through the Soviet collapse.