Diphtheria Serum as a Technological Object: A Philosophical Analysis of Serotherapy in France 1894–1900 by Jonathan Simon (review)

The two key words in the title of this book, "technological" and "philosophical," should not discourage readers interested in infectious disease, public health, immunization, pharmacy, and the political aspects of medicine from adding it to their reading. Although Simon's approach is avowedly drawn from the philosophy of technology, his study enriches our historical understanding of the history of the diphtheria antiserum in refreshing and unexpected ways. In their effect on human bodies, medicines are, after all, as much technological objects as scalpels and syringes, and this understanding gives Simon's study originality and message. From his account of how the serum was made using the blood of specially selected and cared-for horses, through to his masterly analysis of how the serum was inserted into France's political economy as an instrument of revenge on German medical science for defeat in the Franco-Prussian War, this is no standard history of drug development, a genre that Simon describes as being "close to the model of biographies for living historical figures" (p. 142). The first three chapters deal with the making of the serum itself, from the stable and laboratory through the process by which the serum passed from generic substance to recognition as a legal medicine, to the forging of an international consensus on the effectiveness of the drug. It was indicative of the degree to which medicine had already become scientific that the doctors in the 1890s were not content simply to accept the effectiveness of the preparation—they wanted to know why and how it worked.

The later chapters focus on how this technology operated to shape late nineteenth-century French society and was simultaneously shaped by it. Chapter 5 considers medical practice—how the drug was administered, the emergence of bacteriological diagnosis of diphtheria and its links to serotherapy, and the existing surgical remedies, tracheotomy and intubation, in France, although Simon admits to omitting to examine key considerations needed for understanding the role of serum in "a specific historical, political and national context" (p. 70). He goes on to consider how the serum was "branded," and became not only a triumph of modernizing medicine for the Pasteur Institute, but also a transformative modernizing agent for the French medical profession, even though there were medicos who remained unconvinced. A large part of the cultural and medical significance of the antiserum lay in the fact that diphtheria was perceived as a dangerous disease of small children, and children in France were of particular importance at this period, since the country's population growth was very small compared to substantially rising populations in Britain and Germany. This demographic concern has escaped Simon, but he is good on the gendered aspects of the serum story, on the importance of women as mothers on the one hand and, on the other, in the manufacture of the serum (a woman's job), and in nursing roles supporting the male medical administration of treatment. The contemporary impact of the antiserum on France was further illustrated by Roux's elevation to Pasteurian status as a national hero, although he was eclipsed as such by Pasteur in the later twentieth century.

The final chapter in this book, "Serum and French Politics," is perhaps the most intriguing, turning as it does on the political aspects of the serum, not just internationally, in the antagonism toward Germany, but also internally, in the complex and historic regional resentments against the power of Paris that motivated the French provinces. Diphtheria antiserum became the means by which towns and cities across France set out to produce and supply serum locally, and so contributed significantly to improved medical education in provincial France.