Fantini B
Institut Louis Jeantet d'Histoire de la Médecine, Centre Médical Universitaire, Geneva, Switzerland.
Parassitologia. 1998 Jun;40(1-2):91-101.
At the end of the XIXth Century the attitude towards malaria changed dramatically from fatalism and resignation to an active policy that made the eradication of the disease a possible objective. This dramatic change in the scientific political and cultural attitudes towards malaria was the result of two main phenomena: i) the impact of the scientific medicine and Pasteurian revolution on medicine and health policies, and ii) the discovery of the theoretical simplicity of the cycle of malaria transmission and of the possibility to interrupt it, by avoiding the contacts between people and the Anopheles mosquitoes. However, scientifically based strategies against malaria were in place before the discovery of the real causative agents and of the transmission cycle at the end of the XIXth century, as the origin of the scientific medicine had already produced a 'rationale' for local and national campaigns against malaria. According to Tommasi-Crudeli, for example, the cause of malaria was not a 'chemical compound', a 'miasma', but a 'living ferment', specific and autonomous. As a consequence, the aim of antimalarial measures was to eliminate the conditions indispensable to the multiplication of the specific ferment contained in the soil. The theory of malaria aetiology changed after the discovery of the transmission cycle by Ross and Grassi, but the general strategy remained the same: to eliminate one of the factors indispensable to the multiplication and diffusion of the agent. The detailed knowledge of the malaria transmission cycle made it possible to define the exact conditions which were alone responsible for the propagation of the disease and its persistence in the endemic areas. The theoretical linearity and the specificity of the 'Grassi's law' was decisive and produced a fundamental paradigmatic shift in the antimalarial policies. The essential point for the epidemiology and prophylaxis of malaria became to clarify the conditions which contribute to facilitate or to prevent the infection of the Anopheles.
在19世纪末，人们对疟疾的态度发生了巨大变化，从宿命论和听之任之转变为一项积极的政策，使得根除疟疾成为一个可能的目标。对疟疾的科学、政治和文化态度的这种巨大转变是由两个主要现象导致的：其一，科学医学和巴斯德革命对医学和卫生政策的影响；其二，发现了疟疾传播周期在理论上的简单性以及通过避免人与按蚊接触来阻断该周期的可能性。然而，在19世纪末发现真正的病原体和传播周期之前，基于科学的抗疟策略就已经存在了，因为科学医学的起源已经为地方和国家的抗疟运动提供了一种“理论依据”。例如，根据托马西 - 克鲁德利的观点，疟疾的病因不是“化合物”“瘴气”，而是一种特定的、自主的“活酵素”。因此，抗疟措施的目标是消除土壤中所含特定酵素繁殖所必需的条件。在罗斯和格拉西发现传播周期之后，疟疾病因学理论发生了变化，但总体策略仍然相同：消除病原体繁殖和传播所必需的因素之一。对疟疾传播周期的详细了解使得确定那些单独导致疾病传播及其在流行地区持续存在的确切条件成为可能。“格拉西定律”的理论线性和特异性具有决定性意义，并在抗疟政策上产生了根本性的范式转变。疟疾流行病学和预防的关键要点变成了阐明有助于促进或预防按蚊感染的条件。
