American Journal of Epidemiology Advance Access originally published online on October 12, 2007
American Journal of Epidemiology 2007 166(11):1233-1238; doi:10.1093/aje/kwm279
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Epidemiologic Interactions, Complexity, and the Lonesome Death of Max von Pettenkofer
From the Center for the Biology of Natural Systems, Queens College, City University of New York, Flushing, NY
Correspondence to Dr. Alfredo Morabia, Center for the Biology of Natural Systems, Queens College, City University of New York, Flushing, NY 11365 (e-mail: alfredo.morabia{at}qc.cuny.edu).
Received for publication January 24, 2007. Accepted for publication May 22, 2007.
In the mid-19th century, the German hygienist Max von Pettenkofer viewed cholera as resulting from the interaction between a postulated cholera germ and the characteristics of soils. In order to cause cholera, the cholera germ had to become a cholera miasma, but this transformation required prolonged contact of the germ with dry and porous soils when groundwater levels were low. This hypothetical germ-environment interaction explained more observations than did contagion alone. Despite its attraction, von Pettenkofer's postulate also implied that cholera-patient quarantine or water filtration was useless to prevent and/or control cholera epidemics. The disastrous consequences of the lack of water filtration during the massive outbreak of cholera in the German town of Hamburg in 1892 tarnished von Pettenkofer's reputation and marked thereafter the course of his life. von Pettenkofer's complex mode of thinking sank into oblivion even though, in hindsight, germ-environment interactions are more appropriate than is bacteriology alone for explaining the occurrence of cholera epidemics in populations. Revisiting the fate of von Pettenkofer's theory with modern lenses can benefit today's quest for deciphering the causes of complex associations.
cholera; disease outbreaks; ecology; epidemiologic methods; epistasis, genetic; Germany; history, 19th century
Abbreviations: G6PD, glucose-6-phosphate dehydrogenase
Editor's note: An invited commentary on this article appears on page 1239, and the author's response is published on page 1242.
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Related articles in Am. J. Epidemiol.:
- Invited Commentary: The Context and Challenge of von Pettenkofer's Contributions to Epidemiology
- Gerald M. Oppenheimer and Ezra Susser
Am. J. Epidemiol. 2007 166: 1239-1241.[Abstract] [Full Text] - Morabia Responds to "The Context and Challenge of von Pettenkofer's Contributions to Epidemiology"
- Alfredo Morabia
Am. J. Epidemiol. 2007 166: 1242-1243.[Extract] [Full Text]
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  A. Morabia THE AUTHOR REPLIES Am. J. Epidemiol., July 1, 2008; 168(1): 120 - 121. [Full Text] [PDF]
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M. Wildner and A. Hofman RE: "EPIDEMIOLOGIC INTERACTIONS, COMPLEXITY, AND THE LONESOME DEATH OF MAX VON PETTENKOFER" Am. J. Epidemiol., July 1, 2008; 168(1): 119 - 120. [Full Text] [PDF]
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G. M. Oppenheimer and E. Susser Invited Commentary: The Context and Challenge of von Pettenkofer's Contributions to Epidemiology Am. J. Epidemiol., December 1, 2007; 166(11): 1239 - 1241. [Abstract] [Full Text] [PDF]
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A. Morabia Morabia Responds to "The Context and Challenge of von Pettenkofer's Contributions to Epidemiology" Am. J. Epidemiol., December 1, 2007; 166(11): 1242 - 1243. [Full Text] [PDF]
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