Naissance de l’infectiologie en France

Abstract

Comment les médecins intègrent-ils à leur pratique clinique, jusqu’alors axée sur l’anatomie pathologique, la découverte des micro-organismes et la théorie des germes ? Portent-ils un nouveau « regard » sur le malade et son corps infecté ? Comment « traquer » ces microbes ? Comment les détruire ? Loin d’une « révolution pastorienne » foudroyante, ces questions nous plongent dans une histoire prudente, laborieuse, parfois dramatique, qui inscrit le laboratoire dans la clinique et intègre la science dans la médecine.

Between 1870 and 1918, the field of « infectious pathology » developped in France. It consisted of an overall reorganization; clinicians attempted to associate a « germ » with the living patient’s signs, symptoms and detectable lesions. A clinical symptomatology of infectious diseases was progressively elaborated, diagnostic procedures evolved, techniques of « hunting » for the germs and anti-infectious therapy were devised in parallel with the development of microbiological techniques to isolate and culture the microorganisms. Around 1870, the germ theory was assimilated into the established anatomical-clinical approach. Etiology became a central question, albeit not a new one. During the 1880’s, hospital physicians, for example G. Dieulafoy and C. Bouchard, refused to separate clinical medicine from that of the laboratory, claiming the necessity to combine the two. Based on clinical observations, doctors deduced the infectious nature of a disease; bacteriology added diagnostic and etiological elements. At the end of the 19th century, the idea of submitting a clinical diagnosis to the « verdict » of a bacteriological test progressively took form: « hunting » for the germs bay taking samples and then inoculating them into culture medium. This concept entails lab work closely associated with the clinical diagnostic procedure. Bouchard actively sought the antiseptics the best adapted to fight against certain infectious entities. According to him, to evaluate the therapeutic value of an antiseptic, it has to be established that it shortens the duration and counters the effects of the infection. Althoug the fundamental argument is clearly clinical, it must first be proven that the medication is effective against the microbe in vitro and that it is as non-toxic as possible in animals. At the Paris School of Medicine, the field of « medical bacteriology » took form around the concept of « infectious diseases », then located at Hôpital Claude Bernard.