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Kenton Kroker, Jennifer Keelan and Pauline M H Mazumdar (eds), Crafting immunity: working histories of clinical immunology, The History of Medicine in Context, Aldershot, Ashgate, 2008, pp. x, 308, £60.00 (hardback 978-0-7546-5759-0).
Of all medical sciences, immunology has long enjoyed a reputation of being one of the least medical. The historiography has fostered this view by focusing on theory-laden concepts such as Ehrlich’s side-chain theory. Studying the immune system seemed to entail both medical questions and those posed by biochemistry. Immunologists appeared to be people who laid rather more accent on generalized, systematic and abstract knowledge than, for instance, clinicians.
More recently such notions have been challenged by authors who placed the discipline more “between bench and bedside” (Ilana Löwy). Crafting immunity develops this into a systematic argument. In the introduction, the editors forcefully make the point that the history of immunology can be understood as one that is informed by clinical expertise and clinical concerns, as, for example, when clinical concerns in the diagnosis and treatment of cancer informed the recent development of immunology as a field. Given this approach, it is hardly surprising that the thirteen papers that make up the volume are all case studies. Divided into four parts, the chapters are arranged in a loosely chronological order that covers a period from 1800 to our immediate present.
The two initial papers by Andrea Rusnock and Kenton Krocker on the history of the smallpox vaccination testify to the charms of this approach. They refrain from squeezing this practice into the unsatisfactory frame of a prehistory where there was a handling of immunities but no immunology. Jenner’s ideas about the efficacy of his vaccine are shown to be informed by contemporary ideas about the natural history of diseases and their taxonomy. It was changes in the practical handling of the vaccine in societies that supplied new perspectives. Towards 1900, these created a fascinating immunological field of study by pushing the issue of minimizing the risk of the vaccine’s application in relation to the so-called serum sickness into the centre of interest. Moving on in time, two most interesting papers by Mark Jackson and Carla Keirns elaborate the extent to which one of the popular research objects in immunology at the time of the First Word War, namely allergy, was shaped by clinical concerns to interpret and treat such conditions. Departing from bacteriological ways of thinking, immunologists focused on bacteria-analogous objects such as pollen as a cause of hay fever, which they subsequently tried to target with therapies. In fact, those who researched hay fever frequently had a patient history of their own to offer. If we add contemporary serology to this, an interesting picture arises. Immunology in the early twentieth century responded to a current in the medicine of these days that was critical of the reductionism of classical bacteriology. Serology, vaccinology and allergology thereby appeared to be driven by concerns to fill in the gap between the abstractions of classical “bacterio-centrist” (Kochian) bacteriology and clinical practice. It was, as Ilana Löwy argues in her paper, a field that was aiming to overcome the division of “physician versus bacteriologist” that was so popular amongst fin-de-siècle doctors.
Dialogues of that sort also played a role in virus research which is the focus of Michael Bresalier and Kenton Kroker. In this case some more indirect connections become visible. While serological diagnosis of a viral disease like flu exerted little clinical relevance before the Second World War, the concept of flu as a viral infection resonated well with clinical dissatisfaction with the established (yet disputed) bacterial aetiology of the disease. This illustrates “how the construction of viruses and virus diseases as immunological problems facilitated the translation of esoteric virus work into medical problems, and how these problems were redefined in the process” (p. 135). In the closing chapter of this section Pauline Mazumdar examines the League of Nations’ hygiene commissions’ attempts at serum standardization. Such standards could easily be considered a showcase for a history of immunology as theory-driven discipline. Yet, as Mazumdar shows, success was rarely seen in the pursuit of such projects. Standards still existed, but their enforcement was difficult. Instead they served as boundary objects to facilitate communication between differing localized national cultures of serology. The final four papers of the volume take us beyond the Second World War and to the histories of radioimmunology, HIV-Aids, the immunology of pregnancy and finally the history of smallpox vaccines. For this reviewer, it was Angela Creager’s paper that was most interesting here. It shows how a popular diagnostic technology—radio-immunoassays—influenced the development of the field in the period in question.
What the volume convincingly shows is that the history of immunology can be assessed as one of a dialogue between bench and bedside. Yet a different picture arises. From a history of closely connected theories, it is transformed into one of sometimes loosely connected objects and practices: therapeutic vaccines, allergies, sera, radio-immunoassays and so forth. Sometimes, as in the case of allergies, the link to the other fields may even be fairly loose. The delimitation of what actually counts as immunology may not be easy at times if one follows such an approach. However, its virtues are that it provides us with a broader and more nuanced picture of historical processes.
All in all, the book is a very welcome addition to the historiography of immunology. With well edited papers, illustrations and an index, it is also very usable. It reminds us that in studying the history of medicine it is often quite rewarding to focus on what people do rather than on what they write. It is this point that the serologist Ludwik Fleck made when he opened his Genesis and development of a scientific fact (first German edition, 1935) with observations on the history of a serological diagnosis, i.e. with observations on immunology as a science of the clinic.