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2 A “Specific” Specific and the Turbid Age of Applied Immunology
- Johns Hopkins University Press
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c h a p t e r t w o A “Specific” Specific and the Turbid Age of Applied Immunology 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 speci fic for pneumonia,” Osler perhaps nowhere else so firmly expressed a belief in the vis medicatrix naturae, arguing for supporting the functioning of the body’s organs while nature took its course.2 Disagreeing with the scripture of Osler, Rufus Cole and his own “apostles” instead elevated the role of the therapeutic specific on the basis of immunological specificity itself, considering that universally applicable antipneumococcal antiserum functioned because of the typespeci fic interaction between antibody and pneumococcus. At the same time, they redefined in tandem the notion of nosological specificity, stating that pneumococcal pneumonia could, paradigmatically, be subdivided as a disease entity on the basis of the serological subdivision of the o¤ending pneumococci themselves. And while commercial pharmaceutical houses would be quick to seize upon and popularize Cole’s elevation of the therapeutic specific, their uncoupling of such elevation from the tenets of humoral immunological specificity—as well as from Cole’s correlated notion of nosological specificity—would reveal approaches and motivations di¤ering markedly from Cole’s. A “Specific” Specific To understand the radical nature of Cole’s introduction of a specific for pneumonia , it is helpful to review briefly the history of this concept in American therapeutics . John Harley Warner has certainly shed the most light on the issue, maintaining that antebellum American therapeutics entailed the need to individualize disease treatment in the context of all of a patient’s contingent attributes (from age and sex to race, temperament, and geographical location), while speci fics represented the very types of quack empirics that ignored such individualization .3 By the 1860s, however, these antebellum principles had begun to wane as a generalizing rationalism, founded on the emerging universal principles of physiology, began to overshadow the individualization of treatment.4 As such, the therapeutic empiricism acquired through clinical experience was to be ascribed to the art of medicine, while the emerging physiology-based rationalism was to be considered medicine’s scientific basis.5 Under such precepts, according to Warner , precise physiological monitoring could partially replace wanton drugging in the “control” of the patient,6 and such an approach would dovetail nicely with an increasing belief in the vis medicatrix naturae as exemplified by Osler. Warner, however, further credits “physiological therapeutics” with re-legitimizing the notion of “specific” treatment, since particular drugs could be expected to generate universally specific physiological e¤ects.7 With the advent of bacteriology in the 1870s and 1880s, moreover, a novel connotation could be given to the specific in the context of a novel reformulation of disease itself. If the ontological notion of disease-as-germ could replace that of disease-as-physiological dysfunction , then a specific could be envisioned as an agent capable of the universal destruction of such fixed responsible entities. Warner notes that throughout the 1880s bacteriology failed to support the rise of a new class of such specifics. But by the 1890s, with the emerging findings of humoral immunology fueling the imagination of clinicians on both sides of the Atlantic, Osler’s approach was considered by some clinicians to be outdated by the time it had been published. For such clinicians, the application of physiology-based rationalism was to be consigned to the art of medicine, while the application of novel specifics was to be based on the experimental findings of science. Scattered expressions of this emerging ethos can be found with respect to pneumonia as early as 1892, the same year that Osler’s Principles went into print. Upon treating a patient with convalescent serum, two Philadelphia clinicians would declare a profound role for contemporary insight into immunity: “The day is dawning when we shall cure disease, instead of, as heretofore, guided only by empirical and often fallacious experience, endeavoring feebly to aid the vis medicatrix naturae, like the blind groping in the dark.”8 Of course, such expressions of hope were by no means universal. Twelve years later, for example, William Welch (who in 1892 had treated the Klemperers’ findings with the utmost caution ) would continue to deny...