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.