Crafting Immunity: Working Histories of Clinical Immunology (review)

For more than a quarter of a century, the need to focus on practice has been the rallying cry of the history of science and medicine. Perhaps because the idea that historians of medicine should study practices has been so widely accepted, its meanings and implications have been very diverse. The collection of essays on the history of immunology under review here is no different in this respect: its very title—Crafting Immunity: Working Histories of Clinical Immunology—incorporates three different ways in which the injunction to study practice has been interpreted. First, the phrase "crafting immunity" tells us that the book focuses on how scientific/ medical objects of study are a result of intervention, craft, know-how, and technique rather than merely of thinking and theorizing. Second, the histories presented here document how doctors and scientists work: for example, who their patients are or what institutions and interests are involved. Third, the volume addresses the history of clinical immunology—of changing clinical practices such as vaccination, the treatment of asthma and allergies, or the use of serological diagnostic techniques—and not, as traditionally has often been the case, of immunology as a scientific, biological discipline. The articles assembled in the volume reinforce and elaborate on these various ways of understanding what it means to study medicine and science as practices.

Perhaps the most common interpretation of what constitutes studying "practice" in the history of medicine has been a focus on clinical activities at the bedside. In this volume, such interest in clinical practice appears in essays on smallpox vaccination by Andrea Rusnock and Jennifer Keelan and on the history of allergy by Mark Jackson and Carla Keirns, and in Ilana Löwy's chapter examining the understanding of anaphylaxis in interwar France. Rusnock makes a convincing case for situating smallpox vaccination in the context of natural history and the traditions of eighteenth-century disease classification. Keelan locates vaccination in late-nineteenth-century Canada in the context of debates about viral attenuation. Jackson's text emphasizes practical, patient-related concerns (preventing reactions to antidiphtheria serum or the development of desensitizing vaccines against allergic reactions) over a theoretical understanding of allergy. Keirns looks at how allergies, especially hay fever and asthma, were dealt with and understood in the context of two distinct theoretical traditions: the microbiological understanding of infectious diseases used as an analogy in studies of asthma and hay fever, and medical geography used to trace incidence of asthma and its relation to pollen counts and to provide advice to asthmatic patients. Löwy emphasizes theoretical heterogeneity in clinical practice, showing how French immunologists' understanding of anaphylaxis combined reductionist and holistic ideas within the framework of colloidal chemistry.

For other authors in this volume, looking at practice in immunology means examining the laboratory as well as clinical activities. In a chapter on flu research, Michael Bressalier emphasizes experimental systems, techniques, and instruments, and Kenton Kroker focuses on the visualization of viruses in interwar France and its role in the understanding of the viruses associated with herpes and encephalitis. Victoria Harden narrates the development of early NIH research on AIDS in the context of developments in molecular immunology. Angela Craeger examines the development of radioimmunoassays in both clinical research and in laboratory investigations. Each of these authors pays attention not only to practice, understood as the know-how and skill involved in laboratory research, but also to the work involved in linking such research meaningfully with clinical practices and understandings. In some instances, this involves redefinitions of disease: for example, Bressalier shows that when influenza became a viral disease, its features were demarcated from those of other respiratory disorders in a new way, and its incidence was redefined.

Although the book as a whole examines developments in a number of countries and although the practices of immunologists are often described as local and marked by national styles, there...