Commentary: Disease etiology and political ideology: revisiting Erwin H Ackerknecht's Classic 1948 Essay, 'Anticontagionism between 1821 and 1867'

Virtually every academic society sponsors an annual address given by one of its leading lights, and the American Association of the History of Medicine is no exception. The Garrison Lecture, named for the eminent historian Fielding H Garrison, was established in 1940 and continues to be a major event for historians of medicine to this day. Yet relatively few are read and cited as much as the seminal lecture ‘Anticontagionism between 1821 and 1867,’ delivered by Erwin Ackerknecht in 1947 and published the following year (as is every Garrison lecture) in the Bulletin of the History of Medicine. For 60 years, this essay has shown remarkable intellectual staying power and continues to engage and provoke historians, above all those who study epidemics, public health and theories of disease causation and transmission across time. Moreover, even as scholars have mobilized fresh evidence that challenges and complicates Ackerknecht’s thesis, the analytical approach of ‘Anticontagionism between 1821 and 1867’ remains relevant and intellectually valuable in the 21st century. Acknerknecht delivered this lecture one year after accepting a newly-created chair in the history of medicine at the University of Wisconsin, one of the oldest established positions in the United States (the first was the Welch Professorship at Johns Hopkins Institute of Medicine in 1934). After a tumultuous decade of short-term posts at universities and museums that followed his escape from Nazi Germany in 1941, Ackerknecht relished the opportunity he found in Madison to immerse himself in research and writing. A refugee scarred by totalitarianism yet cynical toward leftist political organizations, Ackerknecht explored critical questions about the role of medicine and health in Europe during the emergence and consolidation of the modern nation-state. Reflecting his own traveled path and anticipating the recent turn towards global health, Ackerknecht consistently applied a transnational and comparative lens to the past. Indeed, ‘Anticontagionism between 1821 and 1867’ deserves a privileged place in the history of international health and epidemiology, as it poignantly reminds us that epidemics must be understood in their broader political, social, cultural, economic and geographic contexts. In ‘Anticontagionism between 1821 and 1867’ Ackerknecht pursued two principal lines of inquiry. First, he wanted to explain why anticontagionism and its attendant theories of disease transmission—based on shifting concepts of miasma, atmosphere and localism—crested not in the days immediately before the ground-breaking discoveries of Louis Pasteur and Robert Koch in the 1870s and 1880s, but almost half a century earlier. In other words, why had most physicians abandoned anticontagionism for contagionism by the 1850s, decades before the germ theory of disease and bacteriology crystallized as core tenets of modern public health and epidemiology? Second, Ackerknecht was eager to determine why, given shared medical knowledge, nation–states chose different strategies in their attempts to control and mitigate diseases. For example, while from 1800 to 1850 some countries, such as Germany and Austria, favoured quarantines and the strict regulation of the movement of people and things, others, such as Britain, avoided such heavy-handed interventions and instead focused primarily on environmental amelioration and sanitary campaigns. Ackerknecht answered both these questions with a structuralist analysis of political ideology, concluding that a physician’s beliefs about disease etiology were based first and foremost on his socio-economic * Corresponding author. Center for the History of Medicine, University of Michigan, MI, USA. E-mail: amstern@umich.edu Center for the History of Medicine, University of Michigan, MI, USA. ANTICONTAGIONISM BETWEEN 1821 AND 1867 31