This book is a philosophical analysis of the development and production of the anti-diphtheria serum in France from 1894 to 1900. Jonathan Simon's unique approach considers serum, a medicinal drug, as a technological object and analyzes its insertion into the therapeutic environment of diphtheria.

Diphtheria is an acute toxin-mediated superficial infection of the respiratory tract or skin caused by the aerobic gram-positive bacillus Corynebacterium diphtheriae. The epidemiology of infection and clinical manifestations of the disease vary in different parts of the world. Historical accounts of diphtheria epidemics have been described in many parts of the world since antiquity. Developed in the late 19th century, the diphtheria antitoxin played a pivotal role in the history of public health and vaccinology prior to the (...) advent of the diphtheria-tetanus toxoids and acellular pertussis vaccine. One of the most significant demonstrations of the importance of DAT was its use in the 1925 diphtheria epidemic of Nome, Alaska. Coordinated emergency delivery of this life-saving antitoxin by dog-sled relay in the harshest of conditions has left a profound legacy in the annals of vaccinology and public health. Lead dogs Balto and Togo, and the dog-led antitoxin run of 1925 represent a dynamic illustration of the contribution made by non-human species towards mass immunization in the history of vaccinology. This unique example of cooperative interspecies fellowship and collaboration highlights the importance of the human-animal bond in the one-health initiative. (shrink)

Amid the diverse ways men and women have viewed the relationship between science and religion, explicit arguments that “Science is God's Provision” remain unexamined by historians. Such arguments are examined here as they relate to the problem of theodicy, by looking at a particular case study that inspired comments on the relationship between medicine and faith, namely, the discovery of the diphtheria antitoxin. This story highlights, first, the flexibility of the tradition of natural theology, and second, the important role (...) the problem of theodicy has played in the history of the relationship between science and religion. (shrink)

ArgumentIt is well known that the development of a diphtheria anti-toxin serum evolved in a competitive race between two groups of researchers, one affiliated with Emil Behring in Berlin and Marburg, and another affiliated with Émile Roux in Paris. Proceeding on the basis of different theoretical assumptions and experimental practices, the two groups developed a therapeutic serum almost simultaneously. But the standardized substance they developed took on very different forms in the two countries. In Germany the new serum was (...) marketed in the private sphere and subjected to state regulations, becoming a kind of prototype of industrial medications. In France, however, the same substance was marketed as a gift of science to humanity and distributed through the communal health care system. This article demonstrates how a new medication emerged from the efforts to produce, market, regulate, distribute, and apply it in the two respective countries. It attributes the difference to the negotiations between the respective actors (scientists, industrialists, politicians, officers, and the public) and institutions (firms, academies, private and public institutes, legislative bodies, professional corporations). I develop this argument on three different levels: First, I stress the importance of the institutional foundations of serum production; second, I illustrate the decisive role played by existing “ways of regulating” in the rapid development of new legal statutes; and third, I describe the consequences that flowed from the respective administrative organization of marketing and dissemination. In sum, I explore how an experimental object was transformed into an object of the public health system and stabilized by administrative means. (shrink)

ArgumentThe experimental development of a therapeutic serum against diphtheria between 1891 and 1894 was characterized by a scientific competition that pitted Emil Behring from the Institute for Infectious Diseases in Berlin against Émile Roux and Elie Metschnikoff from the Pasteur Institute in Paris. In general, their competition can be regarded as an extension of the fundamental differences that separated the research schools of Robert Koch and Louis Pasteur. However, to characterize the competition for a diphtheria-serum as “national rivalry” (...) fails to account adequately for the mutual adoption of experimental practices by the Berlin and Parisian protagonists, whose contributions to the development of a therapeutic serum were intertwined in complex ways. Nor can it be characterized as “cooperation,” given their fierce public disputes over scientific concepts and the fact that these disputes also shaped the peculiarities of the experimental procedures in Berlin and Paris. A close analysis reveals a complex picture of the dynamic interaction between the conceptual and experimental activities of Behring, Roux, and Metschnikoff – interaction that defined as well as bridged the “French” and “Prussian” experimental systems of diphtheria-serum research. (shrink)

“To be the first one.” – On the first Nobel Prize in Physiology or Medicine awarded to Emil von Behring in 1901. The German immunologist Emil von Behring is the first Nobel Prize laureate in physiology or medicine. Behring received the award in 1901 “for his work on serum therapy, especially its application against diphtheria”. Behring's name was strongly connected with progress in the field of diphtheria research through various publications. This study contextualizes the awarding of Behring and (...) shows that not only significant scientific and practical results made him primus inter pares in the eyes of the Nobel committee, but also factors like Behring's representation in the daily press and the broad public interest in diphtheria research. After the beginning of the industrial serum production in 1894, Behring was not only a “visible scientist”, he was also portrayed as the “savior of the children” and so ranked among the “great men” of his era. The paper argues that his public visibility and the popularity of “Behring's Diphtherie-Heilmittel” became a strong argument in favor of Behring during the selection process of the first Nobel laureate. The first part of the paper discusses the Nobel Prize nomination procedure from the views of the scientific community. Drawing on personal papers of the extended Behring Archives, the second part focusses on Behring from a private perspective and sheds light on the meaning and importance of the award for Behring and his family. (shrink)

This article offers an integrated account of two strands of global health justice: health-related human rights and health-related common goods. After sketching a general understanding of the nature of human rights, it proceeds to explain both how individual human rights are to be individuated and the content of their associated obligations specified. With respect to both issues, the human right to health is taken as the primary illustration. It is argued that the individuation of the right to health is fixed (...) by reference to the subject matter of its corresponding obligations, and not by the interests it serves, and the specification of the content of that right must be properly responsive to thresholds of possibility and burden. The article concludes by insisting that human rights cannot constitute the whole of global health justice and that, in addition, other considerations—including the promotion of health-related global public goods—should also shape such policy. Moreover, the relationship between human rights and common goods should not be conceived as mutually exclusive. On the contrary, there sometimes exists an individual right to some aspect of a common good, including a right to benefit from health-related common goods such as programmes for securing herd immunity from diphtheria. (shrink)

ArgumentThis essay places some therapeutic vaccines, including particularly the diphtheria antitoxin, into their larger historical context of the late nineteenth century. As industrially produced drugs, these vaccines ought to be seen in connection with the structural changes in medicine and pharmacology at the time. Given the spread of industrial culture and technology into the field of medicine and pharmacology, therapeutic vaccines can be understood as boundary objects that required and facilitated communication between industrialists, medical researchers, public health officials, and (...) clinicians. It was in particular in relation to evaluation and testing for efficacy in animal models that these medicines became a model for twentieth-century medicine. In addition, these medicines came into being as a parallel invention in two very distinct local cultures of research: the Institut Pasteur in Paris and the Institut für Infektionskrankheiten in Berlin. While their local cultural origins were plainly visible, the medicines played an important role in the alignment of the methods and objects that took place in bacteriology research in France and Germany in the 1890s. This article assesses the two locally specific regimes for control in France and in Imperial Germany. In France the Institut Pasteur, building on earlier successful vaccines, enjoyed freedom from scrutinizing control. The tight and elaborate system of control that evolved in Imperial Germany is portrayed as being reliant on experiences that were drawn from the dramatic events that surrounded the launching of a first example of so-called “bacteriological medicine,” tuberculin, in 1890. (shrink)

Tens of millions of adults and children die each year from illnesses that are treatable or preventable with existing medicines. Each year over 500 million people are infected with malaria, and the disease kills two million people annually. Hundreds of thousands more die annually from a myriad of lesser known diseases including diphtheria, measles, tetanus, and syphilis. Approximately 30 percent of the world’s population, over 1.7 billion people, has inadequate access or no access at all to essential medicines.Not surprisingly, (...) the vast majority of these illnesses are contracted in poor countries. Four million lives could be saved annually through prompt diagnosis and treatment of illnesses in Africa and Southeast Asia alone, and access to pharmaceutical drugs could likely save millions more. Many of the health problems facing the developing world do not arise from lack of understanding of complex diseases. Rather, the problem arises from a striking lack of availability of life-saving medicines for the consumers that need these medicines the most. (shrink)

Vaccines are responsible for many global public health successes, such as the eradication of smallpox and significant reductions in other serious infections like diphtheria, pertussis, tetanus, polio and measles. However, mass vaccination has also been the subject of various ethical controversies for decades. Several factors need to be considered before any vaccine is deployed at national programme like the potential burden of disease in the country or region, the duration of the protection conferred, herd immunity in addition to individual (...) protection, vaccine-related risks, financing and the logistical feasibility of the large-scale vaccination. Moreover, several ethical dilemmas revolve around authority and mandates for vaccination, informed consent, benefits vs. risks, and disparities in access to vaccination. This review paper aims to elaborate the ethical issues involved in mass vaccination programme and present some additional challenges in the context of a resource-poor settings of public health in Bangladesh. (shrink)

A medical narrative from a woman in her 90s describes her childhood bout with diphtheria in Kansas City, Missouri, apparently immediately after vaccination, her confinement in the “pest hospital,” and her treatment with what she understood as a blood transfusion from a donor who was found through a radio appeal. In this essay, we trace the narrative back to the institutions, medical practices, and historical context, examining both the underlying history of medical practice and scientific understanding that is reflected (...) in her experience and also the contexts of that history, including racial and religious attitudes. (shrink)