HISTORIC PRESPECTIVE OF INFECTIOUS DISEASES

 

Just over a decade before the publication of the first issue of the Journal, President George Washington died of an acute infectious disease believed to have been bacterial epiglottitis.45 Washington's life reflects the history of his era and provides both a window into infectious diseases two centuries ago and a benchmark for measuring our remarkable progress since then. Washington was born in 1732, just before the deadliest diphtheria epidemic on the North American continent. He was scarred by smallpox, survived multiple debilitating bouts of malaria, suffered wound infections and abscesses, nursed his brother on a tropical island as he died of tuberculosis, and even had an influenza pandemic named after him (the Washington influenza of 1789–1790). During his presidency, he stayed in the then-capital city of Philadelphia while most of the government fled during the nation's deadliest yellow fever epidemic.5,12 At the time of Washington's birth, there was no well-defined concept of infection or immunity, no vaccines, almost no specific or effective treatments for infectious diseases,3,46 and little idea that any treatment or public health measure could reliably control epidemic diseases.

During Washington's lifetime, infectious diseases were the defining challenges of human existence. No one alive then could have imagined the astonishing breakthroughs that lay ahead. In this regard, it is noteworthy that almost all the major advances in understanding and controlling infectious diseases have occurred in the past two centuries (Table 3Table 3Selected Infectious Diseases of Importance from 1812 to the Present. and interactive timeline). Experimental animal-transmission studies that were conducted soon after the War of 1812 were followed by the development of better microscopes, which linked fungi to skin diseases and protozoa to mucosal diseases — for example, Alfred Donné's 1836 work with Trichomonas vaginalis and David Gruby's studies of Candida albicans in the early 1840s. The breakthroughs in the late 1800s, which taken together provided the compelling unifying principle of infectious diseases and must surely rank among the most important advances in the medical sciences, were the characterization of specific cultivatable microorganisms and proof of their association with specific diseases. This triumph was led by the work of Davaine and Koch in establishing anthrax as the first fully characterized infectious disease.47,48 This seminal process was facilitated by the development of defined criteria for establishing causality (Koch's postulates).

Additional breakthroughs followed quickly, including the discovery and characterization of pathogen-specific immune responses; the demonstration that when inactivated by heat or chemicals or grown under limiting conditions that changed certain biologic properties (e.g., attenuation), organisms or their products could safely stimulate protective responses in a host; and development of anti-infective serums and chemicals to destroy pathogens. Over the next 135 years, a wide array of vaccines and antibiotics and, more recently, antiviral agents have saved hundreds of millions of lives, greatly extended the human life span, and reduced untold suffering. Undeniably, these countermeasures against infectious disease rank among the greatest achievements in public health and medicine.

History reminds us that new challenges in infectious diseases will continue to emerge and reemerge. We must be prompt in identifying them and devising new countermeasures. In this effort, we still follow the familiar pathway that was set down in the late 1800s for the identification and characterization, both clinical and epidemiologic, of the causative agent; the characterization of the human immune response to the pathogen; and the development of pathogen-specific diagnostic tests, treatment strategies, and public health prevention strategies such as vaccinations.