Heredity and Infection: The History of Disease Transmission (review)

Here is that rara avis: the collection of essays from a conference that is well worth its spectacular publication price. Thirteen scholars, mostly historians or historians of medicine and/or science, who work in the United States, the Netherlands, the United Kingdom, Germany, and France came together in 1996 sponsored by INSERM U-158, Paris, and the Wellcome Unit for the History of Medicine, University of Cambridge, and overcame various obstacles, administrative, financial, and even stylistic, to produce a volume on the history of heredity and disease since the midnineteenth century. The major theme of the book is a most important question in the history of modern medicine: What is the role of heredity and of environment in the making of disease? In a helpful introduction, the editors first distinguish between the horizontal transmission of disease via infectious agents and the vertical transmission via hereditary agents.

The authors' thesis is revisionist. Conventional wisdom has held that the coming of scientific medicine caused the divorce between hereditary and infectious diseases (p. 3). The authors argue, on the contrary, that the separation of infection and heredity was usually problematic. The vertical transmission of disease and the horizontal were loosely intertwined. Thus, the "scientific revolution" in medicine was much less linear, the ruptures more important, the interdisciplinary lines more blurred, and the national settings more significantly distinctive than the standard version implied. In short, this is a book with rich, complex, and demanding lessons to teach: It bears thoughtful and careful reading, and rereading.

The editors have divided the essays into four thematic parts. First comes tuberculosis. In the leading essay, J. Andrew Mendelsohn argues that medicine followed in the footsteps of the other sciences of man, natural and social, from the mid-nineteenth century on in Europe. Constitutional explanations finally yielded to the exact science of differential pathologies among species, races, individuals, and even states of individuals; in this context, diseases like tuberculosis seemed especially difficult to treat successfully. Michael Worboys shows the transition in British doctors' thinking about disease from the mid- to the late Victorian periods, as conceptions of inherited constitutional disease gave way to ideas about inflammation that spread most easily from one weak body to another, especially in unsanitary and crowded circumstances. In the volume's most problematic piece, JoAnne Brown argues that the post-1900 association of contagious tuberculosis with African Americans increased white prejudice against African Americans in American society: A more sophisticated reading of America's instutionalized racism would accord, at most times in American history, only a contributory role, or perhaps even a minor one, to science or medicine in the making of racial prejudice. Anything more would be relentlessly positivistic and naive, too. In the second part, on the varieties of experimental practices, Olga Amsterdamska's chapter on experimental epidemiology, that of Jean-Paul Gaudilliere on the use of animal models in postwar human genetics, and above all, that of Gaudilliere and Angela N. H. Creager on the technologies of visualization in experiments sparkle with new information and useful, thoughtful insights. Part three contains two useful essays, on French medical thought on degeneration and on the nature-nurture problem in public health. The last three essays in the concluding part focus on transmission of disease and various medical practices, especially relating to cancer and AIDS. There is a meaty conclusion to the volume by Jean-Pierre Revillard, a professor of immunopharmacology at INSERM in Paris.

This volume's essays vary in length and quality, to be sure. But all are worthy contributions. It would have been helpful, especially for those with little background in the medical-biological sciences, to have stronger introductions to each of the volume's four parts; to have introductions to each essay that would "carry" the themes of each subsection; and to have a more integrative conclusion. For some readers some essays will be rather technical and the connections among the essays somewhat unclear. I found the...