Upon entering clinical medicine in the 1940s, antibiotic therapy seemed to complete a transformation of hospitals that originated in the late nineteenth century. Former death sinks had become harbingers of therapeutic progress. Yet this triumph was short-lived. The arrival of pathologies caused by resistant bacteria, and of nosocomial infections whose spread was helped by antibiotic therapies, seemed to be intimately related to modern anti-infective therapy. The place where such problems culminated were hospitals, which increasingly appeared as dangerous environments where attempts (...) to combat infectious diseases had instead created hothouses of disease evolution. This paper will focus on one aspect of that history. It caused clinical medicine and hospital hygiene in particular to pay attention to a dimension of infectious disease it had previously paid little attention to thus far: The evolution of infectious disease—previously a matter of mostly theoretical interest—came to be useful in explaining many phenomena observed. This did not turn hospital hygienists into geneticists, though it did give them an awareness that the evolution of infectious disease in a broad sense was something that did matter to them. The paper advances its argument by looking at three phases: The growing awareness of the hospital as a dangerous environment in the 1950s, comprehensive attempts at improving antibiotic therapy and hospital hygiene that followed from the 1960s and lastly the framing of such challenges as risk factors from the 1970s. In conclusion, I will argue that hospital hygiene, being inspired in particular by epidemiology and risk factor analysis, discussed its own specific version of disease emergence and therefore contributed to the 1980s debates around such topics. Being loosely connected to more specialized studies, it consisted of a re-interpretation of infectious disease centred around the temporality of such phenomena as they were encountered in day-to-day dealings of clinical wards. (shrink)

In the beginning of the 1990s, the concept of “emerging infectious disease” was elaborated in the United States in order to trigger institutional as well as conceptual changes in the fight against infectious diseases at national and international scales. For this reason it has been described as an “active concept” by sociologists Lorna Weir and Eric Mykhalovskiy. The impact at the institutional level of the EID concept has been described in detail, but the concrete consequences of this concept at the (...) level of research, on the agenda of researchers, remain poorly explored by historians, philosophers and sociologists of biology and medicine. One of the major consequences of the EID concept at the research level relies on the re-conceptualization of infectious disease emergence as a complex and multifactorial phenomenon, taking place inside a “dynamic and complex global ecology”. Taking rabies epidemiology as a case study, I illustrate how epidemiologists deal with the “global ecology” of this neglected old viral disease that is present everywhere on Earth except in Antarctica and still claims more than 55,000 lives annually. I further investigate the extent to which the complexity of rabies ecology is or is not perceived as an argument against the feasibility of rabies elimination or even eradication. Finally, this paper shows that the EID concept, finding its roots in the tradition of disease ecology, significantly impacts rabies epidemiology and despite its complexity, rabies ecology is not always perceived as an insurmountable obstacle to rabies elimination or eradication. (shrink)

Upon entering clinical medicine in the 1940s, antibiotic therapy seemed to complete a transformation of hospitals that originated in the late nineteenth century. Former death sinks had become harbingers of therapeutic progress. Yet this triumph was short-lived. The arrival of pathologies caused by resistant bacteria, and of nosocomial infections whose spread was helped by antibiotic therapies, seemed to be intimately related to modern anti-infective therapy. The place where such problems culminated were hospitals, which increasingly appeared as dangerous environments where attempts (...) to combat infectious diseases had instead created hothouses of disease evolution. This paper will focus on one aspect of that history. It caused clinical medicine and hospital hygiene in particular to pay attention to a dimension of infectious disease it had previously paid little attention to thus far: The evolution of infectious disease—previously a matter of mostly theoretical interest—came to be useful in explaining many phenomena observed. This did not turn hospital hygienists into geneticists, though it did give them an awareness that the evolution of infectious disease in a broad sense was something that did matter to them. The paper advances its argument by looking at three phases: The growing awareness of the hospital as a dangerous environment in the 1950s, comprehensive attempts at improving antibiotic therapy and hospital hygiene that followed from the 1960s and lastly the framing of such challenges as risk factors from the 1970s. In conclusion, I will argue that hospital hygiene, being inspired in particular by epidemiology and risk factor analysis, discussed its own specific version of disease emergence and therefore contributed to the 1980s debates around such topics. Being loosely connected to more specialized studies, it consisted of a re-interpretation of infectious disease centred around the temporality of such phenomena as they were encountered in day-to-day dealings of clinical wards. (shrink)

At a crossroads between biology and medicine, epidemiology is the study of infectious and non infectious diseases in populations. In particular, epidemiology of infectious diseases relies on the articulation between the biology of the germ and the biology of the host population. Virus-host interactions are studied by epidemiologists at different levels and from different perspectives. The concept of emerging infectious disease, elaborated in the 1990s, emphasizes the need to investigate both the molecular and ecological aspects of virus-host interactions. Molecular approaches (...) in epidemiology focus on the genetic, subcellular and cellular aspects of the host-germ relationship at the individual and population levels, while ecological approaches insist on the spatial distribution of host and germ populations, their relationships with their environment, and their interactions with other species. This paper describes integration processes at work between ecological and molecular approaches in the epidemiology of two RNA viruses since the advent of the concept of emerging infectious disease. Based on these two case studies, it further explores the meaning of integration, and aims at identifying the specific goals, challenges, expectations and issues associated with integration in these contexts. (shrink)

Environmental historians are not sufficiently aware of the extent to which mid twentieth-century thinkers turned to medical geography—originally a nineteenth-century area of study—in order to think through ideas of ecology, environment, and historical reasoning. This article outlines how the French–Croatian Mirko D. Grmek, a major thinker of his generation in the history of medicine, used those ideas in his studies of historical epidemiology. During the 1960s, Grmek attempted to provide, in the context of the Annales School’s research program under the (...) leadership of Fernand Braudel, a new theoretical framework for a world history of disease. Its development was inspired by several sources, most notably the French–American Jacques M. May, who was then pioneering an opening up of medical geography and movement towards the concept of disease ecology. The cornerstone of Grmek’s “synthetic approach” to the field was the notion of “pathocenosis”. The diverse uses of this notion in the course of time—from his early agenda focused on a longue durée history of diseases in Western Antiquity to his last, relating to the new epidemiological threat of emerging infectious diseases, specifically HIV/aids—enables us firstly, to note how concepts of ecology sat uneasily alongside those of medical geography; secondly, to assess the reach and limits of his theoretical contribution to historical epidemiology; and thirdly, to understand better the uneven fortunes of his concept of pathocenosis at the end of the twentieth and beginning of the twenty-first centuries. (shrink)