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Epidemiology Expands: Germs, Genes, and the (Social) Environment (1900–1950)

Nancy Krieger

in Epidemiology and the People’s Health: Theory and Context

Chapter 4 encompasses the first half of the 20th century, whose contending epidemiologic theories of disease distribution newly grappled with germs, genes, and the (social) environment. The chapter ... More

Chapter 4 encompasses the first half of the 20th century, whose contending epidemiologic theories of disease distribution newly grappled with germs, genes, and the (social) environment. The chapter first analyzes germ theory's powerful new concepts, metaphors and mechanisms—along with contemporary critiques of its inability to account fully for population distributions of infectious disease, let alone rising rates of non-infectious disease. It next discusses the profound influence of eugenics on science and society, including on epidemiologic theorizing about heredity and health. It then analyzes a third trend in epidemiologic theories, arising in part to counter narrow approaches to germ theory and genetics, which focused on the health impact of what was termed the “social environment,” with much of this work addressing occupational, class, and racial/ethnic health disparities. Researchers whose work is discussed include: Winslow, Maclagan, Frost, Chapin, Greenwood, Crookshank, Galton, Davenport, Pearson, Fisher, Hoffman, Hamilton, DuBois, Trask, and Sydenstricker.Less

Two Revolutions

Stephen J. Kunitz

in The Health of Populations: General Theories and Practical Realities

The two revolutions of this chapter's title are the Industrial Revolution that began in England in the late 18th century, and the Epistemological Revolution that is conventionally attributed to the ... More

The two revolutions of this chapter's title are the Industrial Revolution that began in England in the late 18th century, and the Epistemological Revolution that is conventionally attributed to the enunciation of the germ theory of disease by Louis Pasteur in France and by Robert Koch in Germany in the last third of the 19th century. This chapter discusses the many ways in which these two revolutions have intertwined and shaped thinking about the health of populations.Less

Monocausalists, Multicausalists, and Germ Theory

Irvine Loudon

in The Tragedy of Childbed Fever

This chapter examines the impact of the discovery of bacteria on English medical authorities' view on puerperal disease during the 19th century. The arrival of germ theory intensified the debate ... More

This chapter examines the impact of the discovery of bacteria on English medical authorities' view on puerperal disease during the 19th century. The arrival of germ theory intensified the debate concerning the cause of puerperal disease. There were two divisions in the debate, the monocausalists and the multicausalists. The former attributed the disease to a single cause while the latter held tenaciously to a long list of causes and to the notion that it was not a single entity but a group of different diseases.Less

The Germ Theory and the Prehistory of “Pattern Differentiation and Treatment Determination”

Sean Hsiang-lin Lei

in Neither Donkey nor Horse: Medicine in the Struggle over China's Modernity

Chapter 8 examines the crucial debate on “the Unification of Nomenclature of Chinese Diseases,” the first and most important step in the efforts by the Institute of National Medicine to scientize ... More

Chapter 8 examines the crucial debate on “the Unification of Nomenclature of Chinese Diseases,” the first and most important step in the efforts by the Institute of National Medicine to scientize Chinese medicine. The key issues of this debate were whether or not to assimilate the germ theory and the related ontological conception of disease into Chinese medical theory, and second, what the proper categorical relationship should look like between infectious diseases as defined by the germ theory and the two major traditional Chinese disease categories of Cold Damage and Warm Disease? Despite the fact that this debate failed to reach a consensus, the official category of notifiable infectious disease was incorporated into the organizing principles of disease classification in Chinese medicine. Drawing on the Japanese style of Chinese Medicine, practitioners of Chinese medicine developed the incipient form of what later became the defining feature of so-called “Traditional Chinese Medicine” (TCM), namely “pattern differentiation and treatment determination.”Less

AIDS: The Disease That Fits

Paul U. Unschuld

in What Is Medicine?: Western and Eastern Approaches to Healing

AIDS unites the germ theory of disease with systems thinking. AIDS could only arise in the late twentieth century. The encounter with HIV/AIDS has brought tremendous inspiration to virologists' ... More

AIDS unites the germ theory of disease with systems thinking. AIDS could only arise in the late twentieth century. The encounter with HIV/AIDS has brought tremendous inspiration to virologists' research. The disease model of HIV/AIDS that emerged in the late twentieth and early twenty-first century was clearly marked by the social and economic circumstances of the time. It had plausibility, but it did not correspond with reality. This plausibility gained its persuasiveness through several factors. At its center were systems thinking in economics, criminal law, and many other domains, which had been emerging since the mid-twentieth century. By the late twentieth century, systems thinking were set off by a growing consciousness of living in a hitherto intact world, now increasingly threatened by intruders. Closed borders or openness to immigration were the big political issues that were reflected in the HIV/AIDS metaphor, in which an organism whose immune system is weakened by intruders becomes vulnerable to all kinds of trouble and is ultimately killed.Less

From the Ideology of the Township to the Gospel of Germs

Werner Troesken

in The Pox of Liberty: How the Constitution Left Americans Rich, Free, and Prone to Infection

This chapter describes how the evolution of three ideologies simultaneously influenced economic development and the provision of public health in American history. The first of these was the ideology ... More

This chapter describes how the evolution of three ideologies simultaneously influenced economic development and the provision of public health in American history. The first of these was the ideology of the township. This ideology fostered a public health system that was highly localized and predicated on individual consent and private action. The history of smallpox vaccination suggests this township approach worked well so long as communities were small, ethnically homogeneous, and tightly knit. But as America industrialized and urbanized, the ideology of the township began to break down. The demise of the ideology of the township was hastened by the ideology of commerce and the adoption of the Fourteenth Amendment, which created a new language of individual liberty. The rise of the germ theory of disease also undermined the ideology of the township because the public health initiatives it suggestedrendered state actionfar more effective than measures based solely on individual behavior.Less

A Germ Theory of Genes

Nathaniel Comfort

in The Science of Human Perfection: How Genes Became the Heart of American Medicine

This chapter argues that with false starts and sometimes misguided efforts, academic genetics became integrated with general medicine. The chasm separating the two disciplines was closed by means of ... More

This chapter argues that with false starts and sometimes misguided efforts, academic genetics became integrated with general medicine. The chasm separating the two disciplines was closed by means of a few pioneers who conducted experiments themselves and those who explored the discipline by exchanging correspondences. Though the earliest geneticists' motivations were different; two main views in genetics have emerged. First is the idea that heredity is constitutional, a part of the soil; and these geneticists sought, by using statistics and different theoretical approaches, to address health and diseases holistically. Others viewed genes as seeds of disease: and they played off the perceived successes of the germ theory of disease to articulate what is now known as the germ theory of genes: a medical genetics based on the idea of genes as agents of disease.Less

Ascendant Ecology

Frank N. Egerton

in Roots of Ecology: Antiquity to Haeckel

Darwin's Journal of Researches,coral reef book, and barnacle books contain significant ecological observations, but his revolutionary On the Origin of Speciesis a landmark ecological work. These and ... More

Darwin's Journal of Researches,coral reef book, and barnacle books contain significant ecological observations, but his revolutionary On the Origin of Speciesis a landmark ecological work. These and later books made him an important founder of ecology. His Beagleexpedition inspired Wallace, Bates, and Spruce to explore Amazonia, collecting observations and specimens that led to their own publications having ecological relevance. Soon Hooker, Huxley, and Wallace undertook expeditions elsewhere, with similar results. During the 1800s, plant physiology and plant pathology built upon achievements of the 1700s to become sophisticated sciences that elucidated photosynthesis, respiration, and diseases. Entomology became the most widely researched zoological discipline, as insects attack valuable plants, animals, and humans. Insects are also important vectors of diseases, as became clear during later 1800s, when the germ theory was established. Haeckel, a Darwinian, reorganized zoology along evolutionary lines, and he named and defined ecology in 1866.Less

Cancer and Contagion

Robin Wolfe Scheffler

in A Contagious Cause: The American Hunt for Cancer Viruses and the Rise of Molecular Medicine

Chapter 1 discusses how views of cancer as a contagious disease changed in response to the articulation of germ theory in the late nineteenth century. At first, many doctors and microbiologists ... More

Chapter 1 discusses how views of cancer as a contagious disease changed in response to the articulation of germ theory in the late nineteenth century. At first, many doctors and microbiologists regarded the idea that cancer was contagious as plausible, but abandoned this idea around 1915. However, there was much broader resonance between cancer and contagion among the public as a whole. Rather than following medical and scientific opinions alone, this chapter argues that we should consider public views of cancer alongside professional opinions—each group employed different “regimes of perceptibility.” Doing so yields a richer understanding of how and why the idea of cancer as a contagious diseases persisted in the face of medical doubts and experimental difficulties.Less

“Smallpox Is Dead”: The Public Health Campaign to (Almost) Eradicate a Species

Melanie Armstrong

in Germ Wars: The Politics of Microbes and America's Landscape of Fear

In the mid-twentieth century, a global war against smallpox demonstrated how microbial nature might be managed according to human desires. The germ theory of disease identified microbes as ... More

In the mid-twentieth century, a global war against smallpox demonstrated how microbial nature might be managed according to human desires. The germ theory of disease identified microbes as originators of disease, and vaccine technology produced immunity by using microbes to alter the human body, forever changing the interspecies relationship between germs and humans. While the Cold War was building a national security regime, the smallpox campaign was creating a global system of disease control, infusing the work of public health with new biopolitics of race and nationhood. Modern health institutions are built upon this belief that nature can be managed for the benefit of populations, a foundational premise of biosecurity. Smallpox effects endure in concerns that bioterrorists will revitalize the virus.Less

“I Gotta Get Out of This Place”: Workplace Stress as a Threat to Public Health

Sandra L. Bloom and Brian Farragher

in Destroying Sanctuary: The Crisis in Human Service Delivery Systems

Most people may not recognize that stress has become a major risk for a wide variety of health and mental health problems, although when surveyed most people talk passionately about the stress they ... More

Most people may not recognize that stress has become a major risk for a wide variety of health and mental health problems, although when surveyed most people talk passionately about the stress they confront at work. Nowhere is that more true than in human services. It is impossible to understand the full impact of the last thirty years of changes in human service delivery without understanding the impact of acute and chronic stress on workers at every level of the system. This chapter reviews what is known so far about the magnitude of stress impacting daily existence with a specific focus on workplace stressors. The issue of workplace stress is a public health problem of enormous proportion, not dissimilar to what existed two hundred years ago before we understood that microbes cause disease, only now the infectious agent is violence in all of its forms.Less

Fighting the Yellow Scourge:: Initial Sanitation Reforms in Cuba

in Epidemic Invasions: Yellow Fever and the Limits of Cuban Independence, 1878-1930

After decades of growing concerns in the United States for Havana's endemic yellow fever, the war of 1898 had put U.S. authorities in a position to take action. During the first two years of the ... More

After decades of growing concerns in the United States for Havana's endemic yellow fever, the war of 1898 had put U.S. authorities in a position to take action. During the first two years of the occupation of Cuba, the military government undertook a wide range of policies to eliminate at its source the disease that had threatened the southern states. These efforts were obsessively focused on sanitation. In order to control yellow fever, the occupation government cleaned streets and buildings, dredged the busiest ports of the island, quarantined boats and immigrants, disinfected mail and shipments, and isolated non-immunes from possible sources of infection. Although all of these disinfections and quarantines conformed to the most advanced understandings of disease provided by the recent development of bacteriology and germ theory, yellow fever—caused by a virus—posed a challenge. Conflicting cultural understandings of disease and medicine contributed to resistance to colonial public health measures. The sanitation of Havana, in the end, would not stop yellow fever.Less

Anthropologia Sexualis, Universalism, and the Macro Environments of Sex

Benjamin Kahan

in The Book of Minor Perverts: Sexology, Etiology, and the Emergences of Sexuality

This chapter argues that in spite of the dominance of the dynamic, humoral theory of the body for thousands of years scholars still have little understanding of what role humoralism plays in the ... More

This chapter argues that in spite of the dominance of the dynamic, humoral theory of the body for thousands of years scholars still have little understanding of what role humoralism plays in the invention of the homo/hetero binary. To this end, this chapter reads across a range of sexological writing encompassing Richard Burton’s climate-based Sotadic Zone, Havelock Ellis’s observation of a “special proclivity” for homosexuality in the “hotter regions of the globe,” and Victor Segalen’s claim that there is “not much Arctic Eroticism” to explore climate as the aspect of the permeable, humoral body with the longest afterlife. It argues that an examination of what Iwan Bloch calls “Anthropologia Sexualis” will highlight the meanings of the shift from the humoral body to a germ theory of the body for the construction of sexuality. Reading Thomas Mann’s Death in Venice (1912) as a text that roots homosexuality in the competing epidemiological regimes of anthropologia sexualis’s humoralism and scientia sexualis’s germ theory, this chapter reads Mann’s novella as providing a key switch point for understanding the divestment of sexuality in humoralism. Moreover, this chapter suggests that Mann's text provides rich models for theorizing sexuality as simultaneously climatic and microbial.Less

Darwin’s Impact on the Medical Sciences

Fabio Zampieri

in Integrating Evolutionary Biology into Medical Education: for maternal and child healthcare students, clinicians, and scientists

In early nineteenth century medicine, the concepts of organic evolution and natural selection emerged in different contexts, partly anticipating Darwinian revolution. In particular, the anatomical ... More

In early nineteenth century medicine, the concepts of organic evolution and natural selection emerged in different contexts, partly anticipating Darwinian revolution. In particular, the anatomical concept of disease favored the perception that men and animals were very similar from a morphological, physiological and pathological point of view, and that this could indicate a certain degree of kinship between them. The debate around human races and human pathological heredity saw first formulations of the principle of natural selection, even if without a full appraisal of its evolutionary implications. Charles Darwin took many inspirations from these medical theories. The impact of the theory of evolution formulated by him in 1859 was only apparently slight in medicine. It is even possible to support that evolutionary concepts contributed in a significant way to the most important medical issues, debates and new discipline in the period between 1880 and 1940.Less

“A Source of Horror and Dread”: Plague Camps in India and South Africa, 1896–1901

Aidan Forth

in Barbed-Wire Imperialism: Britain's Empire of Camps, 1876-1903

Plague infected India in 1896 and spread across the empire due to the transportation and communication networks fostered by imperial trade and military aggression. As microbes travelled to new ... More

Plague infected India in 1896 and spread across the empire due to the transportation and communication networks fostered by imperial trade and military aggression. As microbes travelled to new imperial outposts, so did British medical experts like William Simpson, who imported Indian technologies of disease control to South Africa. Inspections conducted at train stations identified disease carriers and detained them in segregation camps. In Bombay and other cities, urban cleansing campaigns by military and police forces systematically rounded up “suspects” and evacuated them to suburban camps. The “war against plague” depended on coercion and an unprecedented set of interventions into the health and welfare of colonial populations. It reflected tangible medical concerns but also operated according to the cultural proclivities of late-Victorian empire: discourses of race and class along with anxieties about security facilitated encampment as much as scientific analysis or the precepts of germ theory. Less

“A Means of Physical Culture” the Redefinition of Municipal Pools during the 1890s

Jeff Wiltse

in Contested Waters: A Social History of Swimming Pools in America

This chapter examines the transformation of municipal swimming pools in the United States during the mid- to late 1890s. It explains how popular acceptance of the germ theory of disease transmission ... More

This chapter examines the transformation of municipal swimming pools in the United States during the mid- to late 1890s. It explains how popular acceptance of the germ theory of disease transmission rendered pools obsolete as public baths and renewed enthusiasm for athletics and physical exercise among the urban middle class, resulting in the redefinition of municipal pools as sport and fitness facilities. The chapter also considers the exclusion from the pools of working-class boys, who offended pool administrators, and middle-class swimmers, with their rowdy and boisterous behavior, when public officials started to charge entrance fees. It looks at the “natatorium” in Brookline, Massachusetts as an example of how municipal pools were reconceived as sport and exercise facilities and as a site of social and cultural tensions that accompanied their use at the end of the nineteenth century.Less

Advances in Food Safety to Prevent Foodborne Diseases in the United States

Robert V. Tauxe and Emilio J. Esteban

in Silent Victories: The History and Practice of Public Health in Twentieth Century America

In the United States, the current food supply is broader and far safer than it was 100 years ago. At the start of the 20th century, contaminated foods frequently caused botulism, typhoid fever, ... More

In the United States, the current food supply is broader and far safer than it was 100 years ago. At the start of the 20th century, contaminated foods frequently caused botulism, typhoid fever, septic sore throat, and trichinosis, diseases that now rarely occur. Along with drinking water treatment, sewage sanitation, and pasteurization, food-safety measures have become routine; these measures have been developed and initiated in response to specific public health threats and are continually evolving. The shift of the U.S. food supplies from small local farms to huge global agribusinesses has opened new niches for pathogens, as well as the potential for more systematic disease prevention. The methods public health authorities use to detect, investigate, and understand these public health threats have also advanced over the last century. This chapter, which addresses the progress achieved in the field of food safety, serves to support the continuing effort to make food safer.Less

Sovereignty and the Microscope:: The Containment of the Manchurian Plague, 1910–11

Sean Hsiang-lin Lei

in Neither Donkey nor Horse: Medicine in the Struggle over China's Modernity

Chapter 2 addresses one question: why did four relatively independent developments of concern in this book—China’s increasing exposure to Western medicine, the greater control of epidemic diseases, ... More

Chapter 2 addresses one question: why did four relatively independent developments of concern in this book—China’s increasing exposure to Western medicine, the greater control of epidemic diseases, the state’s responsibility for public health, and the gradual acknowledgement of Chinese medicine’s inferiority—have to wait for the Manchurian plague (1910-1911) to reach their points of departure all at once? By way of assimilating this local history, especially the role played by its hero Wu Liande, into the global history of “laboratory revolution in medicine,” this chapter documents the formation of the alliance between the state and Western medicine since this plague. Along with the geopolitical context of this form of pneumonic plague, its specific characteristics played a crucial role in creating this watershed event. As its containment involved the institutionalization of a new category of disease—chuanranbing (infectious disease)—by the state, it irreversibly made the Chinese state the subject of the history of Western medicine in China.Less