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Immunity
Perspectives
Historical keywords Immunity From Latin immunitas (immunis, meaning exempt), immunity entered English as a legal term in the 14th century. But it was not until the late 19th century that, together with immune and immunisation, it became familiar in medical discourse. An awareness of the underlying concept had, however, existed for centuries, because of the observation that children who recovered from certain viral diseases rarely suffered again from the same disease. Immunology—defining the science concerned with responses to substances foreign to animal or human bodies—came into use in the early 20th century. Studies showed that Pasteur’s initial observations of immunity, which had led to vaccines against chicken cholera, anthrax, swine erysipelas, and rabies in the 1880s and 1890s, were naive. The process was found to be far more complex and variable, giving rise to the doctrine of susceptibility or predisposition and to the differentiation of natural from acquired immunity. In 1886, D E Salmon and T Smith found that birds inoculated with hog cholera bacilli killed by heat could withstand multiple doses of otherwise fatal live bacilli. Similar attempts to protect humans against cholera, plague, and typhoid fever followed with equal success. Earlier indications of the bactericidal powers of arterial blood were elaborated around the turn of the century when E Behring and S Kitasato’s studies revealed the mechanisms of the capacity of cell-free serum to neutralise the toxins of tetanus and diphtheria infections. This work led to effective immunisation techniques to mobilise and stimulate the body’s natural defences and to an understanding of specific types of immunity, such as passive, phagocytic, and toxin-antitoxin. Another type of immune response, autoimmunity, deserves mention. At the end of the 19th century, Paul Ehrlich observed that the immune system required the body’s ability to distinguish foreign from indigenous antigens. Understanding this issue became acute in the wake of World War II when the grafting of tissues and organs from one individual into another was found to be possible only among identical twins. In 1953, Peter Medawar discovered that grafts were not always rejected in mice if donor cells were injected into the prospective recipient while still in the womb or postnatally. This problem of immune intolerance has undermined the metaphoric simplicity of “the body’s defence system” in medical, if not popular, discourse.
Lise Wilkinson [email protected]
www.thelancet.com Vol 365 April 23, 2005
Lifeline Liliana Risi is a South African sociologist and doctor. She was detained under apartheid legislation and joined the then banned African National Congress while studying medicine. She developed and evaluated a mass media package to increase Xhosa-speaking women’s awareness of cervical cancer. She was Marie Stopes International’s research programme manager and is currently a GP trainee on the Lewisham GP Vocational Training Scheme, in London, UK. What has been the greatest achievement of your career? Setting up the research programme for Marie Stopes International. This programme involved all aspects of research, from design to policy, in clinics in the developed and developing world. What do you think is the greatest political danger to the medical/scientific profession? A risk averse approach to medicine—the fear of blame which is bad for patients because it leads to inhumane care and is bad for doctors because it prevents us taking creative approaches to improving health. Which research paper has had most effect on your work, and why? Lang EV, Benotsch EG, Fick LJ, et al. Adjunctive nonpharmacological analgesia for invasive medical procedures: a randomised trial. Lancet 2000; 355: 1486–90. It confirmed my belief in a patient’s ability to modify his or her own pain. Who is your favourite politician and why? Nelson Mandela because he has consistently challenged the status quo, from fighting apartheid to recently publicly sharing his grief at losing his son to AIDS. Who was your most influential teacher, and why? Lynette Denny, professor of oncology at Groote Schuur Hospital, Cape Town. She is an outstanding surgeon and yet also a “social artist” who has created reproductive health projects in Khayelitsha township. What would be your advice to a newly qualified doctor? Visit your patients’ homes and communities and imagine their lives as this will help deepen your understanding of how to work with them to improve their wellbeing. What is the best piece of advice you have received, and from whom? Trust your life. Clarissa Pinkola Estes. What is your worst habit? I can’t resist a good argument. Where were you in your sibling order, and what did you gain or lose as a result? Middle child of three, having a brother 18 months older, with whom I endlessly fought. Because of this I am brave and fearless.
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Historical keywords Immunity From Latin immunitas (immunis, meaning exempt), immunity entered English as a legal term in the 14th century. But it was not until the late 19th century that, together with immune and immunisation, it became familiar in medical discourse. An awareness of the underlying concept had, however, existed for centuries, because of the observation that children who recovered from certain viral diseases rarely suffered again from the same disease. Immunology—defining the science concerned with responses to substances foreign to animal or human bodies—came into use in the early 20th century. Studies showed that Pasteur’s initial observations of immunity, which had led to vaccines against chicken cholera, anthrax, swine erysipelas, and rabies in the 1880s and 1890s, were naive. The process was found to be far more complex and variable, giving rise to the doctrine of susceptibility or predisposition and to the differentiation of natural from acquired immunity. In 1886, D E Salmon and T Smith found that birds inoculated with hog cholera bacilli killed by heat could withstand multiple doses of otherwise fatal live bacilli. Similar attempts to protect humans against cholera, plague, and typhoid fever followed with equal success. Earlier indications of the bactericidal powers of arterial blood were elaborated around the turn of the century when E Behring and S Kitasato’s studies revealed the mechanisms of the capacity of cell-free serum to neutralise the toxins of tetanus and diphtheria infections. This work led to effective immunisation techniques to mobilise and stimulate the body’s natural defences and to an understanding of specific types of immunity, such as passive, phagocytic, and toxin-antitoxin. Another type of immune response, autoimmunity, deserves mention. At the end of the 19th century, Paul Ehrlich observed that the immune system required the body’s ability to distinguish foreign from indigenous antigens. Understanding this issue became acute in the wake of World War II when the grafting of tissues and organs from one individual into another was found to be possible only among identical twins. In 1953, Peter Medawar discovered that grafts were not always rejected in mice if donor cells were injected into the prospective recipient while still in the womb or postnatally. This problem of immune intolerance has undermined the metaphoric simplicity of “the body’s defence system” in medical, if not popular, discourse.
Lise Wilkinson [email protected]
www.thelancet.com Vol 365 April 23, 2005
Lifeline Liliana Risi is a South African sociologist and doctor. She was detained under apartheid legislation and joined the then banned African National Congress while studying medicine. She developed and evaluated a mass media package to increase Xhosa-speaking women’s awareness of cervical cancer. She was Marie Stopes International’s research programme manager and is currently a GP trainee on the Lewisham GP Vocational Training Scheme, in London, UK. What has been the greatest achievement of your career? Setting up the research programme for Marie Stopes International. This programme involved all aspects of research, from design to policy, in clinics in the developed and developing world. What do you think is the greatest political danger to the medical/scientific profession? A risk averse approach to medicine—the fear of blame which is bad for patients because it leads to inhumane care and is bad for doctors because it prevents us taking creative approaches to improving health. Which research paper has had most effect on your work, and why? Lang EV, Benotsch EG, Fick LJ, et al. Adjunctive nonpharmacological analgesia for invasive medical procedures: a randomised trial. Lancet 2000; 355: 1486–90. It confirmed my belief in a patient’s ability to modify his or her own pain. Who is your favourite politician and why? Nelson Mandela because he has consistently challenged the status quo, from fighting apartheid to recently publicly sharing his grief at losing his son to AIDS. Who was your most influential teacher, and why? Lynette Denny, professor of oncology at Groote Schuur Hospital, Cape Town. She is an outstanding surgeon and yet also a “social artist” who has created reproductive health projects in Khayelitsha township. What would be your advice to a newly qualified doctor? Visit your patients’ homes and communities and imagine their lives as this will help deepen your understanding of how to work with them to improve their wellbeing. What is the best piece of advice you have received, and from whom? Trust your life. Clarissa Pinkola Estes. What is your worst habit? I can’t resist a good argument. Where were you in your sibling order, and what did you gain or lose as a result? Middle child of three, having a brother 18 months older, with whom I endlessly fought. Because of this I am brave and fearless.
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