Heredity and Infection

The History of Disease Transmission

Jean-Paul Gaudilliére, Ilana Löwy

• Publisher: Routledge
• Year: 2012
• Print ISBN:
  9781138867918
• eBook ISBN:
  9781135138615
• Topic: History
• Subtopic: World History
• Index: History

Ideas about the transmission of disease have long formed the core of modern biology and medicine. Heredity and Infection examines their development over the last century. Two scientific revolutions - the bacteriological revolution of the 1890s and the genetic revolution at the start of the twentieth century - acted as the catalysts of major change in our understanding of the causes of illness. As well as being great scientific achievements, these were social and political watersheds that reconfigured the medical and administrative means of intervention. By establishing a clear distinction between transmission by infection and genetic transmission, this shift was instrumental in separating hygiene from eugenism.
The authors argue that the popular perception of such a sharp divide stabilized only after 1945 when the use of antibiotics to end epidemics became commonplace. For health professionals the separation has never become an absolute one, and the book examines the various blends of heredity and infection that have preoccupied biology, medicine and the social sciences. Heredity and Infection recontructs the changing epidemiology of such historically important pathologies as tuberculosis , cancer and AIDS. In doing so, it demonstrates the role of experimental models, medical practices and cultural images in the making of contemporary biochemical knowledge.

Part 1

TUBERCULOSIS

Chapter 1

MEDICINE AND THE MAKING OF BODILY INEQUALITY IN TWENTIETH-CENTURY EUROPE¹

J. Andrew Mendelsohn

Perhaps the most memorable drama of bodily inequality before the external causes of disease was staged on 7 October 1892 in Munich by Max von Pettenkofer. On that day, the founder of scientific hygiene swallowed a pure culture of cholera bacilli. In the preceding two months, cholera had taken the lives of over 8,000 people in the city of Hamburg. Pettenkofer, however, survived his drink with nothing more than a bout of diarrhoea. Though remembered as the wrong-headed if heroic ‘last stand’ of anticontagionism against the bacteriological revolution of Pasteur and Koch, this simple self-experiment did create a riveting fact, a fact on whose existence everyone came to agree and puzzle over, not least Robert Koch himself (von Pettenkofer, 1892; Koch, 1893).² That Pettenkofer had lived with millions of cholera bacilli in his intestinal tract for over a week without suffering more than diarrhoea was a fact of immediate etiological relevance and, at the same time, of indeterminate meaning. It was a fact, moreover, of relevance to the wider structure of scientific medicine insofar as it was becoming, with the rise of bacteriology, a medicine of specific causes and insofar as it had been since the beginning of the nineteenth century a science of regular pathological reactions, a science of essentially equal bodies.

The Munich-school bacteriologist Hans Buchner, who was anathema to Koch and who publicly welcomed Pettenkofer’s interpretation of the self-experiment, struggled privately with what to make of the strange result, this ‘riddle,’ as he called it. ‘If the guinea pigs die from [the cholera] poison, why did Pettenkofer, with his massive comma [bacillus] production, remain so healthy?’³ Even a bacteriologist not of the Koch school was surprised by the apparent failure of specific cause. Buchner prided himself on his flexible view of the host-parasite relationship. But that was apparently no help here. Nor evidently was the concept of natural immunity.

‘Do you know that big news concerning cholera may be taking shape?’ wrote Louis Pasteur to one of his department chiefs on 20 November 1892:

Pettenkofer has announced in a Munich journal that he swallowed a cubic centimeter of a virulent pure culture of the comma bacillus without being inconvenienced by it. . . . Here, Metchnikoff to triumph or rather to be very encouraged. For several months, actually, he has done experiment after experiment with the idea that the comma bacillus is not the determining cause of cholera; that when there is cholera, the comma bacillus must be associated with another microbe . . . Let’s wait for more light.⁴

In the following months, Elie Metchnikoff and his assistants at the Institut Pasteur carried out no less than 16 self-experiments with various cultures of cholera and choleralike bacilli. But more light was slow to come. Etiology still seemed about as obscure as Pettenkofer’s self-experiment had suggested it to be (Metchnikoff, 1893, 1894).

In the remaining years of the century, phenomena of contamination or infection in the absence of disease came to occupy a central place in bacteriological investigation. Pettenkofer’s rearguard action, the last stand of anticontagionism, was inadvertently in the vanguard. Subclinical contamination or infection of the body with the micro-organisms of diphtheria, cholera (in times of epidemic), pneumonia, typhoid, and tuberculosis was found to be more common than disease-producing infection. By 1900, tubercle infection, above all, was deemed ‘ubiquitous’ by many. Even the standard early-twentieth-century bacteriological handbook looked back on a decade of doubt, in which, ‘the exclusive etiological significance of the pathogenic microbe seemed most threatened by the observation that it was found not only in cases of the infection it caused, but also in entirely healthy persons’ (Gotschlich, 1904, p. 2).⁵ Some of these observations of infected ‘healthy persons’ will be familiar to historians of medicine and public health as the so-called discovery of the healthy carrier, which indeed, from an epidemiological point of view, they were. All but forgotten, however, is the etiological problem they posed, that is, the problem for explaining disease causation (Mendelsohn, 1996).

The bacteriologists’ etiological problem was, at the same time, an invitation to other experts. By their own methods, bacteriologists mapped a disjunction between infection and illness such that clinicians, social hygienists, pathologists, and soon enough eugenicists could claim equal expertise. Having once threatened to exclude consideration of heredity and environment from disease explanation, bacteriology now provided the most suggestive evidence for including them. This evidence was, as in Pettenkofer’s self-experiment, differential susceptibility and, at its extreme, infection without disease. This paper is about the ways in which that disjunction, rather than the principle of necessary, specific cause, structured much of scientific medicine till the Second World War: its etiological thought, its understanding of the body, its expectations about and research on the role of heredity in common diseases, and eventually, in a new form lent by the methods and norms of biological science, its genetics. From the unravelling of deterministic bacterial etiology in the 1890s to the making of a non-deterministic, etiologically complex medical genetics in the 1930s, there stretched a continuous structure of what might be called the predisposed body, the body between danger and disease. Though the focus here will be especially on the body between infection and disease, its structure was more general. A wider lens would capture the history of the body’s inequality before cancer, allergy, mental illness, and perhaps as well the intrinsic moral history of this inequality.⁶

As the object of medical knowledge, this body, this differential susceptibility or, as it was sometimes called, reactivity often went under the name of constitution or, in France, terrain. It displayed a continuity with the perception of individual difference that had always been central to medical practice and experience. Yet no one in 1890, not even a champion of the ‘old medicine,’ could have predicted it would become partly paradigmatic of the new scientific medicine. Bacteriologists called it into exact, scientific being almost despite themselves. Nor was differential reactivity among those theories and principles considered to be the scientific basis of modern medicine. It did not bear the signature of a Virchow or a Pasteur. Indeed, while individual difference had remained important to practitioners, it had been deemphasized since the eighteenth century by those academic physicians who sought a science of regular relations between symptoms, morbid anatomies or physiologies, and environments. Thus a wider purpose of the paper is to point toward an alternative periodization of scientific medicine in the nineteenth and twentieth centuries and to explore ways in which a field of knowledge may be structured by an unintended experimental and experiential effect, such as the body as a configuration of differential reactivity. The history of the medical sciences, accordingly, might be written as a succession of such body configurations.

There is certainly an irony in the argument that much of the impetus for twentieth-century constitutionalism came from the bacteriological laboratory, rather than simply from clinical medicine. The formula usually taken to sum up this period of medical history is, after all, ‘physician versus bacteriologist’ (Maulitz, 1979). Yet the irony arises only because bacteriology is ordinarily understood to have embodied germ theory. In fact, its legacy was plural, even contradictory. On the one hand, bacteriological methods first showed how to reduce health and disease to necessary, specific causes, be they germs, genes, vitamins, or, to use Archibald Garrod’s famous phrase of 1908, ‘inborn errors’ of metabolism.⁷ Identification of necessary rather than sufficient causes did indeed create a new and often powerful kind of diagnosis, therapy, and prevention. Above all, it made eradication thinkable (Temkin, 1977; Latour, 1988; Carter, 1991; Schlich, 1996). On the other hand, in other professional and practical contexts, bacteriological methods and results ushered in an era, indeed perhaps the era of constitution in European scientific medicine.⁸ By 1931, Garrod could publish his rather less well-known, constitutional treatise, The Inborn Factors in Disease.⁹ Even the deficiency diseases were soon to be understood according to more complex constitutional mechanisms (Sinding, 1991). Thanks again largely to the stimulus provided by the methods and results of bacteriology, the decades after 1890 were also, in many contexts, an era of pronounced multicausal disease explanation. Constitution and multicausality do not here refer to particular doctrines. Of these, there were many: philosophies of causation such as medical energetics, antiontologism, conditionalism, nosoparasitism (Diepgen, 1926; von Engelhardt, 1985); competing constitutional concepts such as constitution itself, predisposition, terrain, resistance, natural immunity, Anlage, diathesis, and ultimately the full-blown psychosomatic, neo-Hippocratic ‘whole person’ of interwar French and German holistic medicine. The topic here is what these all shared, rather than what distinguished them: that is, the more fundamental and concrete, longer-lived structure of the medical body as a thing of differential reactivity, of essential inequality.

Though stable, this body configuration was marked by a tension: differences in susceptibility could as well be acquired as inherited. Consensus on this question, the question of heredity, was remarkably unstable. Three periods may be distinguished. They form the parts of this paper. In the period 1890–1910, which saw the emergence of complex etiological thought and constitutionalism (section 1), heredity promised to explain much of the differential susceptibility that marked the behavior of infectious and other common diseases (section 2). In the second, overlapping period, 1905–1925, acquired constitution steadily took shape in laboratory and clinic. Acquired factors, whether immunological or physiological or biochemical, were ultimately seen to account for most phenomena previously attributed to innate difference (section 3). The third and last period began in the early 1920s. The introduction into medicine of methods and norm...

Table of contents

• Cover Page
• Half Title page
• Series page
• Title Page
• Copyright Page
• Contents
• List of Figures and Tables
• List of Contributors
• Introduction Horizontal and Vertical Transmission Of Diseases: The Impossible Separation?
• Part 1 Tuberculosis
• Part 2 Etiology and Experimental Practices
• Part 3 Heredity, Medicine, Health Policies
• Part 4 Transmission and Medical Practices
• Conclusion: What Went Wrong with My Genes?
• Subject Index
• Author Index