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Pneumonia Before Antibiotics

Therapeutic Evolution and Evaluation in Twentieth-Century America

Scott H. Podolsky

Publication Year: 2006

Pneumonia—Osler's "Captain of the Men of Death" and still the leading infectious cause of death in the United States—has until now received scant attention from historians. In Pneumonia Before Antibiotics, clinician-historian Scott H. Podolsky uses pneumonia's enduring prevalence and its centrality to the medical profession's therapeutic self-identity to examine the evolution of therapeutics in twentieth-century America. Focusing largely on the treatment of pneumonia in first half of the century with type-specific serotherapy, Podolsky provides insight into the rise and clinical evaluation of therapeutic "specifics," the contested domains of private practice and public health, and-as the treatment of pneumonia made the transition from serotherapy to chemotherapy and antibiotics—the tempo and mode of therapeutic change itself. Type-specific serotherapy, founded on the tenets of applied immunology, justified by controlled clinical trials, and grounded in a novel public ethos, was deemed revolutionary when it emerged to replace supportive therapeutics. With the advent of the even more revolutionary sulfa drugs and antibiotics, pneumonia ceased to be a public health concern and became instead an illness treated in individual patients by individual physicians. Podolsky describes the new therapeutics and the scientists and practitioners who developed and debated them. He finds that, rather than representing a barren era in anticipation of some unknown transformation to come, the first decades of the twentieth-century shaped the use of, and reliance upon, the therapeutic specific throughout the century and beyond. This intriguing study will interest historians of medicine and science, policymakers, and clinicians alike.

Published by: The Johns Hopkins University Press

Contents

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pp. vii-viii

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Acknowledgments

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pp. ix-x

Beyond having a substantial impact on my clinical practice and thinking, researching and writing the history of medicine is simply fun (to echo Sherwin Nuland). Being able to thank those who have made this possible is perhaps even more fun. I have been...

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Introduction: Patterns of Resistance

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pp. 1-8

In September of 1937—two years after the introduction of Prontosil and sulfanilamide, the first of the sulfa drugs—a close relative of John D. Rockefeller Jr. was admitted to the exclusive Phillips House of the Massachusetts General Hospital with pneumococcal pneumonia. The patient’s physicians called in experts...

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PART I: SEROTHERAPY AND THE RISE OF THE SPECIFIC, 1891 – 1930

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pp. 9-11

“Pneumonia,” wrote two clinicians on the eve of antipneumococcal serotherapy in 1890, “is a representative disease.”1 From the standpoints of nosology (the classification of disease) and diagnosis, the tempo and mode of change regarding pneumonia as a disease entity over the past two...

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1 The Advent of Type-Specific Antipneumococcal Serotherapy

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pp. 13-21

The first twenty-two years of antipneumococcal serotherapy’s evolution were hardly auspicious. By 1897, while the treatment of diphtheria through the neutralization of its toxin with antitoxin was being hailed as the crowning glory of laboratory science, the existence of a pneumococcal toxin itself was called into...

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2 A “Specific” Specific and the Turbid Age of Applied Immunology

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pp. 22-34

In the first edition of his Principles and Practice of Medicine (1892), William Osler placed pneumonia, not within the section on specific infectious diseases, but under “diseases of the respiratory system.”1 Lamenting that “we have, then, no specific for pneumonia,” Osler perhaps nowhere else so firmly expressed a belief in...

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3 Fundamental Tensions: Clinical “Proof” and Clinical Resistance

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pp. 35-50

The treatment of pneumonia—on account of the disease’s marked variability in severity from patient to patient and from year to year—had long provided a challenging yet alluring subject for those concerned with the methodology of “proving” therapeutic efficacy. Pierre Louis, for example, had in the 1830s used...

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PART II: THE TRANSFORMATION OF PNEUMONIA INTO A PUBLIC HEALTH CONCERN, 1930 – 1939

From Boston and New York, proponents of antipneumococcal serotherapy in the early 1930s would continue to answer their critics while at the same time introducing methodological innovations concerning serotherapy’s efficacy, range, and ease of administration that would continue to change...

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4 The Massachusetts Experiment and New (York) Tensions

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pp. 53-67

Before describing in detail the advent of the Massachusetts and New York efforts to transform pneumonia into a public health concern, it is useful to place such efforts in the context of the rapidly changing nature of antipneumococcal serotherapy itself. As Lloyd Felton’s concentrated serum (either monovalent against...

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5 The New Standard, the New Deal, and the Pneumonia Control Programs

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pp. 68-87

By the late 1930s, many of the tensions exposed and further engendered by antipneumococcal serotherapy over the previous two decades (as discussed in chapter 3) seemed to be resolving in the wake of contingent technological improvements on the one hand, and a continued therapeutic reorientation toward the use and...

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PART III: RESOLUTION: THE ANTIMICROBIAL "REVOLUTION" AND THE DECLINE OF SEROTHERAPY, 1939 – PRESENT

Few events in modern medicine have been considered as revolutionary as the advent of the sulfa drugs and antibiotics in the late 1930s and early 1940s. On the one side of the divide stood, amidst a wealth of academic knowledge, a groping collective impotence; on the other, the conquest of

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6 Histology of a Revolution

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pp. 91-114

Histology, of course, depends as much on the mode of presentation of materials as it does on a magnified viewing of its subject. For ease of presentation, I have therefore divided this longest chapter into three chronologically ordered sub-groupings, highlighting: the resistance engendered by serum advocates against...

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7 A “Modern” Revolution: The Limits and Uses of Controlled Clinical Trials

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pp. 115-131

The tempo of the antipneumococcal chemotherapeutic “revolution” reflected the competing impacts of a number of clinical and economic forces. Chapter 6 has already emphasized the degree to which the pragmatics of practice—the inertias, implementation infrastructures, and variously defined costs of the two respective...

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8 The Dismantling of Pneumonia as a Public Health Concern

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pp. 132-146

The informational void that the pharmaceutical companies could fill with their rhetoric would be enlarged by the dismantling of pneumonia itself as a public health concern by the end of World War II. And as I relate in this chapter, many of the present dilemmas facing public health advocates with respect to...

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Conclusion: Overcoming Resistance

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pp. 147-149

Throughout this book, I have attempted to use the evolving treatment of pneumonia as a lens through which to examine the changing “therapeutic perspective” of twentieth-century American medicine. Several key themes have emerged: the profession’s increasing focus on the use of the specific; the changing means...

Notes

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pp. 151-246

Index

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pp. 247-254


E-ISBN-13: 9780801889288
E-ISBN-10: 0801889286
Print-ISBN-13: 9780801883279
Print-ISBN-10: 080188327X

Page Count: 248
Illustrations: 8 halftones
Publication Year: 2006

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Subject Headings

  • Serotherapy -- United States -- History -- 20th century.
  • Pneumonia, Pneumococcal -- Treatment -- United States -- History -- 20th century.
  • Pneumonia, Pneumococcal -- Chemotherapy -- United States -- History -- 20th century.
  • Pneumonia, Pneumococcal -- United States -- History -- 20th century.
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