The changing fate of pneumonia as a public health concern in 20th-century America and beyond

Abstract

For a brief period from the 1930s through the early 1940s, public health advocates made pneumonia a leading public health concern. Predicated on the need for antipneumococcal antiserum, but also incorporating physician reeducation, state "pneumonia control programs" were established nationwide. However, with the advent of penicillin and the sulfonamides, the pneumonia control programs soon collapsed. Pneumonia reverted to the domain of the private practitioner, which was devoid of state oversight. With the emergence of pneumococcal antibiotic resistance in the 1990s, the possibility again arose that pneumonia could become a public health concern, given the nationwide need to curb unnecessary antibiotic usage and to encourage vaccination. An understanding of the history of pneumonia's changing status could shed light on current attempts to reformulate the disease and elucidate the contested domains of private practice and public health.

FIGURE 1—

Despite the ascent of chronic diseases such as heart disease and cancer to become the nation’s leading causes of death by the late 1930s, pneumonia remained the leading infectious cause of death in the nation. Illustration from 1940 US Public Health Service brochure.

FIGURE 2—

Pneumonia was explicitly reformulated as an “emergency” in the 1930s, as pressing as appendicitis, to which it was often compared. Illustration from 1940 US Public Health Service brochure.

FIGURE 3—

Given the logistics of serotherapy, the treatment of the individual patient was transformed into a “community” responsibility. Illustration from 1940 US Public Health Service brochure.

FIGURE 4—

In an era of intense resistance to encroachment by the American Medical Association on the private practitioner’s domain, the US Public Health Service attempted to portray its role as one of friendly guide, rather than usurper of practice. Illustration from 1940 US Public Health Service brochure.