Antibiotic development and usage, and antibiotic resistance in particular, are today considered global concerns, simultaneously mandating local and global perspectives and actions. Yet such global considerations have not always been part of antibiotic policy formation, and those who attempt to formulate a globally coordinated response to antibiotic resistance will need to confront a history of heterogeneous, often uncoordinated, and at times conflicting reform efforts, whose legacies remain apparent today. Historical analysis permits us to highlight such entrenched trends and processes, helping (...) to frame contemporary efforts to improve access, conservation and innovation. (shrink)

: This article analyzes German debates on the microbiology of infectious diseases from 1865 to 1875 and asks how and when organic pollution in tissues became noteworthy for aetiology and pathogenesis. It was with Ernst Hallier's pleomorphistic microbiology that the organic character of alien material in tissues came to be regarded as important for pathology. The process that followed saw both vigorous biological critique and a number of medical applications of Hallier's work. Around 1874 contemporaries reached the conclusion that pleomorphous (...) vegetation was most likely of little importance if not accidental in relation to the aetiology of infectious diseases whereas the idea of monomorphous micro-organisms facilitated a causal explanation. It was only then that notions such a pure cultures, bacterial specificity, etc. favored by Ferdinand Julius Cohn and his school became popular in medical circles. (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)

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)

The ArgumentThe text analyzes the related semantics of bacteriology and politics in imperial Germany. The rapid success of bacteriology in the 1880s and 1890s was due not least to the fact that scientific concepts of bacteria as “the smallest but most dangerous enemies of mankind” resonated with contemporary ideas about political enemies. Bacteriological hygiene was expected to provide answers to social and political problems. At the same time metaphors borrowed from bacteriological terminology were incorporated into the political language of the (...) time. While the “high command of our doctors” fought diseases, some contemporaries were identified with members of the evil species of “bacillus communis odii.”Both imperialistic politics and bacteriological science relied on images of inferior and invisible but potent enemies. Both were able to increase their prestige via a mutual interchange of their vocabularies. (shrink)

ArgumentThis essay places some therapeutic vaccines, including particularly the diphtheria antitoxin, into their larger historical context of the late nineteenth century. As industrially produced drugs, these vaccines ought to be seen in connection with the structural changes in medicine and pharmacology at the time. Given the spread of industrial culture and technology into the field of medicine and pharmacology, therapeutic vaccines can be understood as boundary objects that required and facilitated communication between industrialists, medical researchers, public health officials, and clinicians. (...) It was in particular in relation to evaluation and testing for efficacy in animal models that these medicines became a model for twentieth-century medicine. In addition, these medicines came into being as a parallel invention in two very distinct local cultures of research: the Institut Pasteur in Paris and the Institut für Infektionskrankheiten in Berlin. While their local cultural origins were plainly visible, the medicines played an important role in the alignment of the methods and objects that took place in bacteriology research in France and Germany in the 1890s. This article assesses the two locally specific regimes for control in France and in Imperial Germany. In France the Institut Pasteur, building on earlier successful vaccines, enjoyed freedom from scrutinizing control. The tight and elaborate system of control that evolved in Imperial Germany is portrayed as being reliant on experiences that were drawn from the dramatic events that surrounded the launching of a first example of so-called “bacteriological medicine,” tuberculin, in 1890. (shrink)

This paper reassesses Robert Koch’s work on tropical infections of humans and cattle as being inspired by an underlying interest in epidemiology. Such an interest was developed from the early 1890s when it became clear that an exclusive focus on pathogens was insufficient as an approach to explain the genesis and dynamics of epidemics. Koch, who had failed to do so before, now highlighted differences between infection and disease and described the role of various sub-clinical states of disease in the (...) propagation and—consequently—in the control of epidemics. Studying pathologies of men and cattle in tropical countries eventually facilitated the application of such measures in Europe through the screening of healthy carriers of typhoid, which was carried out in 1902. The concept of the carrier state can be understood as a spin-off from tropical medicine into the study and control of infectious disease in Europe. With it travelled assumptions that were typical for colonial and veterinary medicine where the health of indigenous individuals or cattle would be a secondary objective compared to the control of diseases in populations. (shrink)

One of the common characteristics of science, technology, and medicine is their ambition to epistemologically and organizationally move beyond the confines of nation states. In practice, however, they develop differently in countries or regions. Scientists, engineers, and physicians are constrained as well as enabled by national boundaries and specific cultures. The cultural status of such practices in reverse is influenced by a country's history, politics, and the view of the role of science, technology, and medicine in society. It is the (...) relation between a specific region, Scandinavia, and the history of science, technology, and medicine within this region that this issue of Science in Context sets out to explore. But what is this “Scandinavia”? To many, Scandinavia besides being a specific geographical region of three countries (Denmark, Sweden, and Norway) with entwined histories and closely related languages is a way of denoting a specific style or movement. “Scandinavian design” is renowned for three interrelated features; minimalism or simplicity, functionalism, and “design to the people” i.e. functional products for the average citizen (Beer 1975; Glambek 1997; Fallan 2012). -/- . (shrink)

One of Ludwik Fleck’s ideas about the development of scientific knowledge is that—once a system of interpretation is in place—the process that follows can be characterised as one of inertia: any new evidence comes under a strong pressure to be incorporated into the established frame. This can result in what Fleck called a harmony of illusions when contradictory evidence becomes almost invisible or is incorporated into the established frame only by huge efforts.The paper analyses early explanations of the tuberculin reaction (...) as a case study of Fleck’s argument. For Robert Koch, who had presented tuberculin in 1890, the compound was supposed to be a diagnostic tool and a cure for tuberculosis. His conception of its effect was rather peculiar, but strictly in line with ideas on the pathogenesis of infectious diseases he had developed much earlier. After tuberculin was released in late 1890, whether Koch’s conception was convincing depended on the place that a given observer had in the medical world in late-nineteenth-century Germany. Inside Koch’s group, the status of the tuberculin reaction remained stable and tuberculin retained its value as a diagnostic and curative tool. On the other hand, observers from outside that thought collective, and in particular from clinical medicine, soon pointed to flaws in its conception. These critics developed a rather different picture of tuberculin as a mysterious and dangerous drug. No reconciliation followed and what we find instead in German medicine around the year 1900 is the presence of rather contradictory concepts and practices surrounding Koch’s wonder cure. (shrink)

This article discusses a paradox in the modern history of tuberculosis: its eradication has been seen as imminent ever since it was defined as a condition with a necessary bacterial cause in 1882, but, to date, has failed to arrive. The unwavering belief in an imminent end to tuberculosis mostly illustrates the degree to which modernity trusts in pharmaceutical interventions, whether in the form of Koch's tuberculin cure of 1890, the BCG vaccine of the mid-20th century, or global health control (...) programs that prioritize mass-treatment campaigns with antibiotics and chemotherapies. These visions of pharmaceutical-based solutions have not only failed to eradicate tuberculosis, but can often distract attention away from the social causes of the epidemic, such as poor housing and nutrition. (shrink)