GUEST COMMENTARY The Erwin Neter Memorial Lecture: Looking to the Future of Medical Laboratory Immunology, a Personal View

Immunologic techniques have become very useful and important in the diagnosis of disease. Although many people regard immunology as a new science, it can be traced back to antiquity. Egyptian writings from 4,000 years ago describe severe epidemics, and two Greek historians, Thucydides and Procopius, recorded details of devastating plagues (Table 1). These historians noted that survivors of the disease were safe from further attack and could care for the sick. Procopius coined the term immunity, from the latin immunitas, which means exempt from service. The concept of immunity was also known in ancient China, where children were inoculated with fluid from the pustules of smallpox patients to protect them fromthedisease(4).Thenextstepforwardoccurredinthelate 18thcentury,whenEdwardJennerusednonvirulentorganisms for immunization and reduced the risk of the procedure. This is where we are today, designing vaccines to prevent serious infections. Successful immunization does prevent disease and can lead to eradication of the infecting organisms. We are indebted to Louis Pasteur, who postulated and proved the germ theory of disease; to Emil von Behring, who saw that antitoxins could be used to treat existing disease; to Ilya Metchnikoff, who realized the importance of phagocytosis and cellular immunity; and to Paul Ehrlich, who proposed the concepts of cellular receptors and autoimmunity. The discipline of medical laboratory immunology is relatively new. When I began working in thisfield about 30 years ago, we did not have the reagents and techniques that are takenforgrantednow;weraisedourownantibodiesinrabbits, using antigens which we isolated ourselves. Sephadex and column chromatography, sucrose density gradients, and Spinco centrifuges were the workhorses. The detailed study of lymphocytes was in its infancy, and patient immunologic studies were limited to proteins in serum and urine and some skin tests. Decisions on the immune status of a patient were made on the basis of specific antibody titers and crude serum protein electrophoresis patterns. The concept of radial diffusion, developedbyManciniandhercolleagues(2,3)andbyFaheyand