Jesse Bullowa, specific treatment for pneumonia, and the development of the controlled clinical trial

Abstract

Jesse Bullowa's 1928 report on the use of antipneumococcic serum in lobar pneumonia1 was subtitled ‘Data necessary for a comparison between cases treated with serum and cases not so treated, and the importance of a significant control series of cases’. It stands out as one of the most sophisticated invocations of the controlled clinical trial in the 1920s, and as a self‐conscious attempt to justify and promote the methodology. Indeed, Bullowa's contribution to a symposium on the treatment of pneumonia at the New York Academy of Medicine in December 1927 was entitled simply ‘The control’.2 In focusing explicit attention on methodological issues, Bullowa made clear that he wished to determine ‘whether there was conclusive proof that the serum is of value’.1 Bullowa, nearly 50 years old at the time of his presentation at the New York Academy of Medicine, was a clinical professor at the New York University College of Medicine3 and co‐director, with Milton Rosenbluth, of Harlem Hospital's pneumonia service, then ‘the largest therapy unit of any hospital in the city’.4 During the previous decade, Rufus Cole and his colleagues at the Hospital of the Rockefeller Institute had introduced serotype‐specific antiserum for the treatment of pneumococcal pneumonia (as of 1928, only four such pneumococcal serotypes were known). When the Metropolitan Life Insurance Company lost 24 million dollars in excess death benefits during the influenza epidemic of 1918, it established an Influenza Commission, which would soon focus its attention upon pneumonia and its treatment with antipneumococcal antiserum.5 Intending to fund alternate control studies at multiple institutions,6 the company would ultimately fund published studies arising from Bellevue and Harlem Hospitals in New York, and from Boston City Hospital.7–9 However, none of the pneumonia investigators – who included such eventual luminaries as Russell Cecil (at Bellevue Hospital in New York) and Maxwell Finland (at Boston City Hospital) – would so explicitly advocate the methodology of the controlled clinical trial as would Jesse Bullowa.