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

This collection of essays is the product of a conference organized by INSERM and the Cambridge Wellcome Unit for the History of Medicine in May 1996. Exploring changing notions over the past century and a half of the necessary and sufficient causes for the spread of disease both contemporaneously and across generations, the participants take on the task of problematizing the roles of the two specific explanatory entities—discrete infectious agents, and hereditary factors—born of the nineteenth century and utilized to model disease transmission throughout the twentieth century. As such, these cherished entities are shown to have been problematic as distinct and/or sufficient causes in three general settings: when unable to explain the spread of an actual disease (such as tuberculosis); when exposed by their inadequacies in experimental laboratory settings; and in the context of the blurring of distinctions between vertical and horizontal transmission in the first place, particularly with respect to evolving conceptions of the in utero transmission of "infectious" or "hereditary" factors.

To address such issues, the book is divided into four sections. The first, centered upon tuberculosis, is the strongest. J. Andrew Mendelsohn not only demonstrates the degree to which the very limitations of bacteriology to explain the epidemiology of clinically apparent tuberculosis led to the reinvigoration of constitutionalism in France and Germany in the first decades of this century, but carefully places the evolving relative weight given to fixed hereditary characteristics and acquired factors (e.g., immunological development) as the foundation of such constitutions against the backdrop of changing developments in medicine and biology throughout the era. JoAnne Brown illustrates a more insidious outcome of the persistence of predispositional thinking in the postmicrobiological era, as the problematized boundaries between the roles of heredity and germs—as manifested in the social arena—could even permit the translocation of established prejudices across such lines, and racial segregation could be predicated upon the "segregation" of those (i.e., African Americans) considered prone to contracting tuberculosis.

The book's second section—featuring contributions by Olga Amsterdamska, Jean-Paul Gaudillière, and Angela Creager—focuses on the relationships between such models of disease specificity and transmission and the experimental laboratory practices designed to elucidate them. As such, not only are the relative contributions of heredity, infection, and environment found to be difficult to disentangle in the artificial laboratory setting, but the very models obtained thereby—whether for infectious, metabolic, or neoplastic processes—are considered to a large degree to be dictated by the "experimental arrangements" (p. 205) of the laboratory themselves. After a thin third section on the history and application of hereditarian thought in France in particular, the book's final section—including contributions by Jennifer Stanton and Virginia Berridge, and Ilana Löwy—examines the shifting emphases concerning "horizontal" and "vertical" (in utero) transmission as applied to such modern scourges as hepatitis B and HIV. While distinct, conceptually, from the notions of direct germline intoxication from a century prior (which had further blurred distinctions between infectious and hereditarian disease models), such shifting of focus from horizontal to vertical transmission would again lead to important changes in the public health approaches (with their own historical associations) to such diseases.

In her compelling final essay, Löwy further utilizes changing notions of the control of HIV infection by the body's immune system to demonstrate the ongoing tensions concerning the roles of infectious agents versus "predispositions," and the degree to which such tensions are mediated by evolving technological and sociological factors. When placed alongside Mendelsohn's contribution, her essay demonstrates nicely the persistence of such tensions throughout the past century. Unfortunately, while interesting observations appear throughout the book (such as the disjunction between emerging infectious...