Pneumonia Before Antibiotics: Therapeutic Evolution and Evaluation in Twentieth-Century America

267 Pages·2006·2.11 MB·English

by  Scott H. Podolsky

Pneumonia Before Antibiotics
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Pneumonia Before Antibiotics
Therapeutic Evolution and Evaluation
in Twentieth-Century America
scott h. podolsky
The Johns Hopkins University Press
Baltimore
© 2006 The Johns Hopkins University Press
All rights reserved. Published 2006
Printed in the United States of America on acid-free paper
2 4 6 8 9 7 5 3 1
The Johns Hopkins University Press
2715 North Charles Street
Baltimore, Maryland 21218-4363
www.press.jhu.edu
Library of Congress Cataloging-in-Publication Data
Podolsky, Scott H.
Pneumonia before antibiotics : therapeutic evolution and evaluation in
twentieth-century America / Scott H. Podolsky.
p. ; cm.
Includes bibliographical references and index.
isbn0-8018-8327-X (hardcover : alk. paper)
1. Pneumonia, Pneumococcal—United States—History—2oth century.
2. Pneumonia, Pneumococcal—Treatment—United States—History—2oth
century. 3. Pneumonia, Pneumococcal—Chemotherapy—United States—
History—2oth century. 4. Serotherapy—United States—History—2oth
century. I. Title.
[DNLM. 1. Pneumonia, Pneumococcal—history—United States. 2. Drug
Therapy—history—United States. 3. History, 20th century—United States.
4. Immunization, Passive—history—United States.
5. Pneumonia, Pneumococcal—therapy—United States. WC 204
p742p 2006]
rc771.p72 2006 362.196(cid:1)241—dc22
A catalog record for this book is available from the British Library.
For Josh and Danny
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contents
Acknowledgments ix
Introduction: Patterns of Resistance 1
part i serotherapy and the rise of the specific,
1891–1930 9
1 The Advent of Type-Specific
Antipneumococcal Serotherapy 13
2 A “Specific” Specific and the Turbid Age
of Applied Immunology 22
3 Fundamental Tensions: Clinical “Proof”
and Clinical Resistance 35
part ii. the transformation of pneumonia into
a public health concern, 1930–1939 51
4 The Massachusetts Experiment and
New (York) Tensions 53
5 The New Standard, the New Deal, and
the Pneumonia Control Programs 68
viii Contents
part iii resolution: the antimicrobial “revolution”
and the decline of serotherapy, 1939–present 89
6 Histology of a Revolution 91
7 A “Modern” Revolution: The Limits and Uses
of Controlled Clinical Trials 115
8 The Dismantling of Pneumonia as a
Public Health Concern 132
Conclusion: Overcoming Resistance 147
Notes 151
Index 247
acknowledgments
Beyond having a substantial impact on my clinical practice and thinking, re-
searching and writing the history of medicine is simply fun (to echo Sherwin Nu-
land). Being able to thank those who have made this possible is perhaps even
more fun.
I have been fortunate to have had mentors who have challenged me at the
same time that they permitted me the freedom to dive in and challenge myself.
Fred Tauber first supported my over-enthusiastic tendencies with respect to the
history of science and medicine and continues to see through the trees and en-
able me to focus on the most pertinent questions at hand. Allan Brandt has shown
me how to approach medicine as inherently social and has served as a role model
as both teacher and historian.
Two colleagues in particular—Jeremy Greene and David Jones—not only fur-
ther taught me how to teach, but provided crucial feedback on the project
throughout its development. In addition to my mentors and colleagues named
above, Stephen Kandel, Calvin Kunin, Jennifer Rochow, and Peter Tishler worked
their way through the entire manuscript, o¤ering both insights and corrections.
Jack Lesch and Nick Rasmussen generously read and commented on particular
chapters. Wolfram Goessling provided expert assistance with the nineteenth-
century German literature. Harry Marks provided the opportunity to present my
work at Johns Hopkins, and I am grateful for the feedback provided by him and
Ed Mormon, in particular. I have always thought of this manuscript as continu-
ing a dialogue started by two Harry’s—Dowling and Marks—and inspired by
their e¤orts and aided by their leads, I can only hope to have approached the rigor
of their own work.
One of the great joys I have been exposed to has been that of the translocative
experience of intense archival research. I am particularly grateful to the sta¤s of
the Countway Medical Library here at Harvard (and its Center for the History of