PneumoniaOsler's Captain of the Men of Death andstill the leading infectious cause of death in the UnitedStateshas until now received scant attention from historians.In Pneumonia Before Antibiotics, clinician-historianScott H. Podolsky uses pneumonia's enduring prevalenceand centrality to the medical profession's therapeutic selfidentityto examine the evolution of therapeutics in twentieth-century America.Focusing largely on the treatment of pneumonia in the firsthalf of the century with type-specific serotherapy, Podolskyprovides unique insights into the rise and clinical evaluationof therapeutic specifics, the contested domains ofprivate practice and public health, andas the treatment ofpneumonia made the transition from serotherapy to chemotherapyand antibioticsthe tempo and mode of therapeuticchange itself. Type-specific serotherapy, founded on thetenets of applied immunology, justified by controlled clinicaltrials, and grounded in a novel public ethos, was deemedrevolutionary when it emerged to replace supportivetherapeutics. With the advent of the even more revolutionarysulfa drugs and antibiotics, pneumonia ceased to be apublic health concern and became instead an illness treatedin individual patients by individual physicians.Here Podolsky focuses on the new therapeutics and thescientists and practitioners who developed and debatedthem. He finds that, rather than representing a barren erain anticipation of some unknown transformation to come,the first decades of twentieth-century American medicineshaped the use of, and reliance upon, the therapeutic specificthroughout the twentieth century and beyond. 8 halftones.
AcknowledgmentsIntroduction: Patterns of ResistancePart I: Serotherapy and the Rise of the Specific, 1891-19301. The Advent of Type-Specific Antipneumococcal Serotherapy2. A ""Specific"" Specific and the Turbid Age of Applied Immunology3. Fundamental Tensions: Clinical ""Proof"" and Clinical ResistancePart II: The Transformation of Pneumonia into a Public Health Concern, 1930-19394. The Massachusetts Experiment and New (York) Tensions5. The New Standard, the New Deal, and the Pneumonia Control ProgramsPart II: Resolution: The Antimicrobial ""Revolution"" and the Decline of Serotherapy, 1939-present6. Histology of a Revolution7. A ""Modern"" Revolution: The Limits and Uses of Controlled Clinical Trials8. The Dismantling of Pneumonia as a Public Health ConcernConclusion: Overcoming ResistanceNotesIndex
""Podolsky thus examines a forgotten or unexplored aspect of medical history [and] his study also throws light on the antibiotic revolution itself.""
