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i n t r o d u c t i o n Patterns of Resistance 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 from the Rockefeller Institute and Boston City Hospital to determine the serological “type” of pneumococcus responsible for the illness, which they accomplished by directly examining the sputum, after processing it with diagnostic rabbit serum. These experts then administered to a Rockefeller himself the embodiment of “scientific” medicine: type-specific therapeutic antipneumococcal antiserum. Developed nearly a quarter-century earlier under Rufus Cole at the Hospital of the Rockefeller Institute, it had been studied and promulgated for use in the large hospitals of the Northeast for over a decade by Boston City Hospital’s Maxwell Finland, among others. Never mind that Max Finland was traveling in Europe at the time, that the patient was already recovering when the serum was administered, or that the treatment itself proved nearly fatal in this instance.1 By late 1937, antipneumococcal antiserum was not for use only by Rockefellers; rather it had become the focus of federal e¤orts to transform pneumonia into a national public health emergency, mandating that the public, their physicians, and the public health apparatus unite to provide patients with the wonders of this modern antimicrobial therapy. In December of that year, A New Day, a twelve-minute film dramatizing the wonders of antipneumococcal serotherapy that had been jointly produced by the Metropolitan Life Insurance Company and the United States Public Health Service, debuted at Radio City Music Hall and was seen by an estimated 121,000 people in its first week of release.2 Starring Gilbert Emery as Dr. Mason—who successfully diagnoses an ailing mother’s type I pneumococcal pneumonia and saves her at home through the use of antiserum while helping her son to name the family dog in the span of the showing—the film was ultimately shown to more than 17 mil- lion people at 65,000 presentations nationwide.3 By that time, Surgeon General Thomas Parran, who had coordinated one of the first “pneumonia control programs ” in the country in his previous role as New York State’s commissioner of health, had elevated pneumonia to nearly as pressing a public health issue as venereal disease and tuberculosis. In particular, Parran attempted to make centralized “typing” facilities and serum distribution centers accessible to the nation ’s general practitioners at large so they could treat patients in any location— home or hospital—as early in the course of the disease as possible. By 1939, when A New Day was revised, sulfapyridine, the first of the truly antipneumococcal sulfa drugs, had been released for general sale in the United States. Yet in the revised film, serotherapy continued to share equal billing with the novel chemotherapeutic agent.4 This was characteristic of the heterogeneous transition (in certain locations rapid, in others, dramatically slow) from antipneumococcal antiserum to chemotherapy that would take place over the next several years in the United States, a therapeutic transformation mediated by the inertia of the profession and the public health system, the needs of general practitioners and their patients, the emergence of a clinical trials ethos, and the influence of a growing pharmaceutical marketing apparatus. By the end of World War II, however, antipneumococcal serotherapy had been displaced; and not only would the immunologically specific therapy quickly be forgotten in the wake of the antibiotic “revolution,” but pneumonia’s status as a public health concern would be shed as well. By focusing on the treatment of pneumococcal pneumonia from the 1890s through the 1940s, in particular with antiserum, I thus intend to expand what may start as a narrow aperture into the history of this largely forgotten therapy into a window through which to view the history of therapeutic “specifics”—universally applicable remedies against localizable disease entities—in twentiethcentury American medicine.5 Antipneumococcal antiserum’s fascinating and largely forgotten rise and fall sheds historical light on the emergence of modern rational specifics in American medicine, the persistent diªculties in evaluating their eªcacy, the continually contentious boundaries between private and public health in their application, and the nature—and implications—of the so-called revolutions claimed in their names. Perhaps nowhere in medicine are...

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