Anti-contagionism

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As Antikontagionismus the represented mainly in the states of incipient industrialization in the early 19th century point of view is called that diseases such as the plague not contagion would spread from person to person. This theory was advocated particularly in connection with the discussion about the advisability of quarantine .

Health passport of the Republic of Venice of 1713, which exempted holders from quarantine measures

The opposite point of view of Kontagionismus (from Latin contagio , contact Plague ) results from the traditional assumption that some diseases can be transmitted from the patients, and represents the practice of isolation of patients (for example, already in the Bible dealing described with Lepers ), the quarantine of travelers and goods arriving in seaports, as has been practiced in Venice since the 12th century, or the establishment of a cordons sanitaire ( German  sanitary barrier ), i.e. of mobility restrictions in certain regions and border areas.

background

The background to the dispute was, on the one hand, the rapidly increasing Levant trade from the 18th century , which was no longer conducted through intermediaries such as Venice or Genoa , but directly from states such as France and Great Britain , and on the other hand, tourism, which developed from the beginning of the 19th century Targets in the Ottoman Empire , such as Egypt and Constantinople . For both of them, the practice of quarantine was an obstacle, the exaggerations and incompleteness of which were repeatedly criticized by travelers and traders. On the other hand, the massive outbreaks of diseases such as the plague (for example Smyrna and Constantinople in 1812 and Constantinople in 1836, each with tens of thousands of deaths) urged caution, although the danger due to the shorter travel times of the passenger steamers (for example Constantinople from 1827, with regular connections to the Black Sea ports from 1829 and to Liverpool from 1845) seemed to increase. In addition, there were challenges from new diseases such as cholera , which was now increasingly epidemic in Europe and which was not adequately covered by the previous quarantine practice, or yellow fever in the West Indies and South America .

Scientific controversy

On the scientific side, the anti-contagionists argued that their opponents would try in vain to convulsively keep alive a long-disproved, dusty theory of contagium vivum or contagium animatum , the living, microscopic carrier or cause of diseases. From the point of view of scientific verifiability, this was not entirely unjustified, because firstly, the discovery of the microbial pathogens by Louis Pasteur and Robert Koch and others was still pending, and secondly, the complexities of the transmission were not understood. For example, in the case of the plague, transmission can take place through intermediate hosts , namely rats and rat fleas , which is why diseases can then be observed without human contact being detectable, or in cholera, the sick person and its excretions are highly infectious because the disease but is primarily spread through contaminated drinking water, one also regularly sees cases here where no contact between sick people can be proven.

The view that the transmission of diseases through "microbes" was a theory that was only developed in the 19th century is widespread today; in fact, such theories were advocated as early as the 16th century by Gerolamo Cardano , Paracelsus and above all Girolamo Fracastoro . Later well-known representatives were Athanasius Kircher and Carl von Linné . One of the last advocates of the supposedly failed theory in the 19th century was Jakob Henle , Robert Koch's teacher.

Max von Pettenkofer swallowed cholera bacteria in 1892 to prove that they could not be the only cause of cholera.

The prominent representatives of anti-contagionism included Nicolas Chervin , François Magendie and Jean-André Rochoux , who declared in 1832 that the experience with the cholera epidemics must lead to the discrediting of the quarantine as a sanitary measure. The anti-contagionists trusted their cause so much that they tried - surprisingly often in vain - to contract the plague, cholera and yellow fever. There is a report of a self- experiment by the French military doctor Desgenettes with the plague in 1798 and an attempt by the Munich hygienist Pettenkofer , who swallowed a cholera culture in 1892, in both cases without fatal consequences. It must be noted that the anti-contagionists did not deny any form of infection, for example in diseases such as measles , smallpox or syphilis , the infection from person to person was undisputed. Rather, the main focus of the dispute was the usefulness of quarantine measures. In addition to plague, cholera and yellow fever, the diseases subject to quarantine also included typhus and leprosy . According to François Magendie, none of these five diseases - with the plague as a possible exception - are not contagious. In Germany, the representatives of anti-contagionism included Pettenkofer, the pathologist Rudolf Virchow , the chemist Justus von Liebig and the doctor Karl Friedrich Riecke , who wrote a number of epidemic studies.

The theories of the contagionists were therefore at least unsubstantiated, if not entirely discredited. At the time, however, the miasm theory was widely recognized, according to which so-called "miasms", evaporation from the earth, caused by the decomposition of dead animals and plants, were the cause of epidemics. Following this theory, great efforts were made in the 19th century to eliminate these miasms and the supposedly sick smells associated with them. These measures included infrastructure projects such as improving the sewer system. The fact that these measures not only removed the supposedly existing miasms, but also actually existing contamination with, for example, the pathogens of cholera, was regarded as a success and confirmation of the miasm theory, increased confusion and made it more difficult to recognize the real causes. In an attempt to distinguish the non-contagious from the contagious diseases, the British doctor Charles Maclean formulated the following characteristics. Accordingly, the contagious diseases such as syphilis and smallpox are characterized by the fact that they

  • have clearly identified clinical symptoms,
  • occur regardless of region and season and
  • a person has them only once.

In contrast, the non-contagious diseases such as yellow fever, plague, cholera and typhus, which Maclean described as "epidemic", are those that

  • develop a variety of symptoms,
  • occur depending on the region and season and
  • in which multiple illnesses in the same person are observed.

According to Maclean and other contemporary researchers, the morbidity of contact persons (family members, clinic staff) is not significantly higher than the average for the population for the "epidemic", in contrast to the contagious diseases.

From today's perspective, these differences can be explained by the specific transmission values, for example the occurrence of yellow fever is linked to the occurrence of mosquitoes as a vector and thus depends on the region and temperature (and outside the tropics on the season). This creates the confusing situation that members of the crew of a ship anchored on a coast where yellow fever is endemic can be stung and infected even if they do not go ashore and have no contact with the infected; On a subsequent sea voyage, there are no further infections, not even in those who care for the sick, and finally a yellow fever epidemic can suddenly occur at the destination port, even if the ship is in quarantine near the coast.

Antoine Barthélémy Clot, known in Egypt as Clot-Bey, wrote Derniers mots sur la peste , the “last words on the plague” , in 1866 .

Even if some of the fallacies of the time seem understandable today, the causes postulated instead of pathogens often seem astonishing. According to Maclean, the cause of Irish typhus is the lack of food, work and hope, yellow fever is caused by uncleanliness and cholera is due to "winds" and "local causes". Maclean was also a staunch opponent of quarantine, which he saw as the predominant cause of epidemics by forcing travelers to breathe polluted air in confined spaces. The French doctor and organizer of health care in Egypt Antoine Barthélémy Clot , who vehemently denied the infectiousness of the plague and fought the plague quarantine, was completely on the line of Maclean .

Political Consequences

Politically, the boundaries ran between the liberal and trade-driven positions on the side of anti-contagionism and on the other hand the representatives of a traditional, cameralist policy, which in cross-border trade poses a threat to their mercantilist economic structures and in travel and travelers a threat from uncontrolled introduction sensed foreign ideas and were therefore inclined to advocate maintaining the quarantine and similar obstacles.

Regardless of the almost complete victory of the anti-contagionists at times, health policy practice did not necessarily develop in conformity. In general, a certain inertia can be observed, i.e. states and regions in which quarantine or comparable measures (such as the Cordon sanitaire in Russia and Austria) were already in place tended to maintain them, to apply them again in the event of new epidemics or to have them lifted of the measures to be reversed soon. For example, in Marseilles with quarantine practice since the plague epidemic of 1721, the quarantine regulations were relaxed in 1835 and the quarantine was completely lifted in 1849, but reintroduced the next year, lifted for cholera in 1853 and reintroduced in 1866. Conversely, states in which there was no established quarantine practice, such as Great Britain, introduced quarantine only temporarily and then rather half-heartedly.

And even in those areas where anti-contagionists determined politics, work was done not only on removing dirt and miasms by improving hygiene and infrastructure, but also taking and maintaining quarantine and isolation measures. Christopher Hamlin, according to decision-makers, followed a pragmatic logic according to which one is judged more on what one has failed to do than on what one has done (perhaps too much) and that it is easier to introduce a plausible measure again than to prove the worthlessness of an established measure.

Medical history reception

Although the scientific debate and the resulting health policy measures preoccupied the public for decades, the contagionism debate fell out of the focus of historiography in the 20th century. The popular media in particular dealt more with the resistance that pioneers of microbiology such as Robert Koch and Louis Pasteur and epidemiology such as John Snow encountered and how they ultimately triumphed.

Fundamental to the scientific investigation of the dispute was a lecture by the medical historian Erwin Heinz Ackerknecht , which he gave in 1948 as part of a series of lectures in honor of Fielding Hudson Garrison and which he published in the Bulletin of the History of Medicine in the same year . A reprint appeared in the International Journal of Epidemiology in 2009 . In assessing the debate, Ackerknecht sees similar deficits on both sides. Both contagionists and anti-contagionists:

  • used unreliable or unrepresentative data
  • unquestionably adhered to the Hippocratic idea of ​​the air as the exclusive medium of transmission
  • believed in the fundamental similarity of febrile illnesses
  • were fixated on unicausal mechanisms of action
  • often drew inadmissible conclusions by analogy
  • made little and insufficient use of experiments, particularly animal experiments

Ackerknecht concludes:

"Intellectually and rationally the two theories balanced each other too evenly. Under such conditions the accident of personal experience and temperament, and especially economic outlook and political loyalties will determine the decision. Thesis, being liberal and bourgeois in the majority of the physicians of the time brought about the victory of anticontagionism. "

“Intellectually and rationally, the two theories were too balanced. Under such conditions, the contingencies of personal experience and temperament will be decisive, and above all economic views and political loyalties. Since the majority of doctors at the time were liberal and bourgeois, this brought about the victory of anti-contagionism. "

Since the article was published in 1948, several authors have criticized Ackerknecht's presentation in individual points. According to Christopher Hamlin, Ackerknecht implies too much a correspondence between theory and practice (see section Political Consequences ). Concerning the dichotomy contagionist-anti-contagionist, criticized by Hamlin as being too sharp , Ackerknecht repeatedly admits gray areas, difficulties of classification and inconsistencies in the viewpoints represented by individual persons.

The dispute over contagionism has been a passionate debate by a large number of people and institutions for decades. Like so many other big questions, it was ultimately forgotten, not resolved. When microbiology presented the pathogens that antibiotics made treatable many of the hitherto devastating epidemics, and increasing general prosperity had improved public and private hygiene, the questions of the details of the mechanisms of infection were no longer as important to the public. The forgotten debate always reappears in a changed form when a new epidemic such as HIV or COVID-19 , for which there is initially no therapy and apart from the classic measures of quarantine and isolation, no prevention , such as a vaccination, is added The question arises as to which measures are appropriate and scientifically justifiable and which are not.

literature

Individual evidence

  1. ↑ Aytug Arslana, Hasan AliPolatb: Travel from Europe to Istanbul in the 19th century and the Quarantine of Canakkale. In: Journal of Transport & Health , Vol. 4 (March 2017), doi : 10.1016 / j.jth.2017.01.003 , pp. 10f., 15.
  2. ^ Charles and D. Singer: The Scientific Position of Girolamo Fracastoro. In: Annals of medical history , 1 (1917).
  3. ↑ Girolamo Fracastoro: De contagionibus et contagiosis morbis et eorum curatione libri tres. Venice 1546
  4. ↑ Erwin Heinz Ackerknecht: Anticontagionism between 1821 and 1867. In: International Journal of Epidemiology , Vol. 38, Issue 1 (February 2009), pp. 7f.
  5. ↑ Erwin Heinz Ackerknecht: Anticontagionism between 1821 and 1867. In: International Journal of Epidemiology , Vol. 38, Issue 1 (February 2009), p. 9.
  6. ↑ Erwin Heinz Ackerknecht: Anticontagionism between 1821 and 1867. In: International Journal of Epidemiology , Vol. 38, Issue 1 (February 2009), p. 13.
  7. ^ A b Erwin Heinz Ackerknecht: Anticontagionism between 1821 and 1867. In: International Journal of Epidemiology , Vol. 38, Issue 1 (February 2009), p. 15.
  8. ↑ Erwin Heinz Ackerknecht: Anticontagionism between 1821 and 1867. In: International Journal of Epidemiology , Vol. 38, Issue 1 (February 2009), p. 16.
  9. ↑ Christopher Hamlin: Commentary: Ackerknecht and 'Anticontagionism' In: International Journal of Epidemiology , Vol. 38, Issue 1 (February 2009), p. 23.
  10. ^ A b Erwin Heinz Ackerknecht: Anticontagionism between 1821 and 1867. In: International Journal of Epidemiology , Vol. 38, Issue 1 (February 2009), p. 17.