Invited commentary: The context and challenge of von Pettenkofer's contributions to epidemiology

Abstract

Max von Pettenkofer is largely remembered for swallowing cholera vibrio, trying thereby to falsify the claim of his rival, the contagionist Robert Koch, that the bacillus he had isolated was cholera's sufficient cause. In this issue of the American Journal of Epidemiology, Alfredo Morabia reminds us that von Pettenkofer was more than this futile gesture. He was a 19th century public health leader whose multifactorial theory of cholera etiology deeply influenced the dominant anticontagionist school of disease transmission. His authority was undercut by the massive 1892 cholera epidemic in Hamburg, Germany. As it took off, the German government sent in Koch, who successfully contained the epidemic through interventions that von Pettenkofer regularly repudiated-quarantine, disinfection, and the boiling of water. The authors situate the antagonism between these two individuals within a broader scientific and political context that includes the evolution of miasma theory and debates over the role of governments confronted by epidemic disease. They also note that Koch's approach, which focused narrowly on the agent and its eradication, was missing key elements required for applying germ theory to public health. As scientists later incorporated biologic, host, and environmental factors into the germ theory paradigm, they reintroduced some of the complexity that had previously characterized the miasma model.