The History of WWII Medicine
This page last updated 04/05/02
Gerhard Johannes Paul Domagk (1895-1964), a German biochemist, whose research with antibacterial chemicals resulted in the discovery of a new class of drugs that provided the first effective treatments for pneumonia, meningitis, and other bacterial diseases. Domagk’s research involved analyzing thousands of chemicals for their antibacterial properties. In 1932 he tested a red dye, Prontosil. The dye itself had no antibacterial properties, but when Domagk slightly changed its chemical makeup, Prontosil showed a remarkable ability to arrest infections in mice caused by streptococcal bacteria. Domagk tested the drug on his daughter, who was near death from a streptococcal infection and had failed to respond to other treatments. She subsequently made a complete recovery
After Domagk published his findings in 1935, doctors found that Prontosil could control many bacterial infections. Subsequently, other researchers developed derivatives based on the Prontosil sulfonamide group. The resulting so-called sulfa drugs revolutionized medicine and saved many thousands of lives.
SULFANILAMIDE, first used in 1936, was the grandparent of the SULFONAMIDE family of drugs that are still extremely useful today. Dramatic proof of the effectiveness of this new agent was provided during an outbreak of meningitis in the French Foreign Legion in Nigeria. While sulfanilamide was available, there was an 11% mortality rate. After the supply was exhausted, mortality climbed to 75%. Sulfanilamide and its derivatives, which soon followed, were said to have "dethroned the captain of the men of death," such was their effectiveness in treating pneumonia.
The discovery of Sulfanilamide greatly affected the mortality rate during World War II. American soldiers were taught to immediately sprinkle sulfa powder on any open wound to prevent infection. Every soldier was issued a first aid pouch that was designed to be attached to the soldier’s waist belt. The first aid pouch contained a package of sulfa powder and a bandage to dress the wound. One of the main components carried by a combat medic during World War II was sulfa powder and sulfa tablets.
The Scottish bacteriologist Sir Alexander Fleming, (1881-1955), discovered penicillin. In 1906, Fleming received his medical degree from St. Mary's Hospital in London. During World War I he began experimenting with antibacterial substances and in 1921 discovered lysozyme, an antibiotic enzyme that attacks many types of bacteria. .In 1928, Fleming discovered the germ-killing properties of the "mold juice" secreted by penicillium, he knew that it could have profound medical value. But Fleming could not make enough penicillin to be useful in practice, and his discovery was dismissed as no more than a laboratory curiosity. Ten years later, a team of scientists at Oxford University rediscovered Fleming's work. Armed with increasing evidence of the remarkable powers of penicillin, but unable to engage British companies due to the country's involvement in World War II, the Oxford scientists sought help in America
In 1941 John Davenport and Gordon Cragwall, representing the pharmaceutical company Pfizer, attended a symposium. At the symposium researchers from Columbia University presented clear evidence that penicillin could effectively treat infections. Inspired by the possibilities, the two men offered Pfizer's assistance. That same year, Pfizer was among the companies responding to a government appeal to join a high-stakes race to see which company would develop a way to mass-produce the world's first "wonder drug." Beginning with fermentation experiments conducted with the team at Columbia University, Pfizer would take many risks over the next three years in devoting its energies to penicillin production. The substance was highly unstable, and initial yields were discouragingly low. But Pfizer was determined to succeed in the quest to mass-produce this lifesaving new drug. In the fall of 1942, Pfizer scientist Jasper Kane suggested a completely different approach, proposing that the company attempt to produce penicillin using the same deep-tank fermentation methods perfected with citric acid. This was tremendously risky because it would require Pfizer to curtail the production of other well-established products while it focused on the development of penicillin. It could also place the company's existing fermentation facilities in danger of becoming contaminated by the mobile penicillium spores. In a small room in the Brooklyn plant, Pfizer's senior management team met to weigh the options and took the leap. The team voted to invest millions of dollars, putting their own assets as Pfizer stockholders at stake, to buy the equipment and facilities needed for deep-tank fermentation. Pfizer purchased a nearby vacant ice plant, and employees worked around the clock to convert it and perfect the complex production process. The plant was up and running in four months, and soon Pfizer was producing five times more penicillin than originally anticipated.
Penicillin, was, and is, one of the most active and safe antibacterial available. Because of their effectiveness and large therapeutic index, penicillin and many closely related derivatives, collectively known as the PENICILLINS, and the closely related CEPHALOSPORINS (discovered in the 1960s) are among the most important families of antibacterial available today. Fleming shared the 1945 Nobel Prize for physiology or medicine with the British scientist Ernst Boris Chain and Australian Howard Walter Florey, who were able to purify and obtain enough penicillin for human trials.
Recognizing the potential of the Pfizer process for producing penicillin and desperate for massive quantities to aid in the war effort, the U.S. government authorized 19 companies to produce the antibiotic using Pfizer's deep-tank fermentation techniques, which Pfizer had agreed to share with its competitors. Many of these companies could not come close to Pfizer's production levels and quality. Ultimately Pfizer produced 90 percent of the penicillin that went ashore with Allied forces at Normandy on D-Day in 1944 and more than half of all the penicillin used by the Allies for the rest of the war, helping to save countless lives.
A magazine ad for penicillin during WWII
For hundreds of years quinine was used in the prevention and treatment of malaria. Quinine is found in the root, bark, and branches of cinchonas and other trees native to the Andes mountains in South America. In 1820, a new method was developed to isolate quinine and cinchonine, another drug from the cinchona tree, from cinchona bark. These drugs were then used to combat malaria instead of the bark itself. In the 1930s the first synthetic antimalarial drugs were developed. However, quinine remained in wider use than its synthetic counterparts until World War II, when the supply of quinine from countries in the South Pacific was cut off by Japanese military conquest. Malaria reached epidemic proportions among American troops fighting the Japanese on islands in the South Pacific. Early in the war a campaign in the prevention of malaria was initiated. A synthetic drug invented by a German researcher before the war was distributed to American troops stationed on the South Pacific islands. This drug was sold under the name of Atabrine. Complaints against the yellow pills became common. Atabrine was bitter, appeared to impart its own sickly hue to the skin. Some of its side effects were headaches, nausea, and vomiting, and in a few cases it produced a temporary psychosis.
Yet Atabrine was effective, if only the men could be made to take it. A great part of the problem was that the proper dosage had not yet been worked out. In an effort to ensure that the Atabrine was actually swallowed by the soldiers, medics or NCOs from the combat units stood at the head of mess lines to carefully watch marines and soldiers take their little yellow tablets.
Plasma is the liquid portion of the blood--a protein-salt solution in which red and white blood cells and platelets are suspended. Plasma, which is 90 percent water, constitutes 55 percent of blood volume. Plasma contains albumin (the chief protein constituent), fibrinogen (responsible, in part, for the clotting of blood), and globulins (including antibodies). Plasma serves a variety of functions, from maintaining a satisfactory blood pressure and volume to supplying critical proteins for blood clotting and immunity. It also serves as the medium of exchange for vital minerals such as sodium and potassium, thus helping maintain a proper balance in the body, which is critical to cell function. Plasma is obtained by separating the liquid portion of blood from the cells.
In 1938, Dr. Charles Drew, a leading authority on mass transfusion and blood processing methods, set up a blood plasma system. By 1939, Dr. Drew had set up a blood bank at the Columbia Medical Center. He made a breakthrough discovery that blood plasma could replace whole blood, which deteriorated in a few days in storage. This discovery played a major role during World War II where many countries experienced extreme casualties.
Blood was urgently needed for wounded troops as war raged across Europe in 1940. Dr. Drew was chosen by the International Transfusion Association to organize the Blood for Britain project. This program collected, processed and transported 14,500 units of plasma - all within five months. Dr. Drew's scientific research helped revolutionize blood plasma transfusion so that pooled plasma could readily be given on the battlefield, which dramatically improved opportunities to save lives.
Fearing the U.S. would be drawn into World War II, the American armed forces requested development of a similar blood collection system. In February of 1941, Dr. Drew was appointed Director of the first American Red Cross Blood Bank. He established an effective plasma collection and preservation organization - a model for today's volunteer blood donation programs.
Because of its ability to reduce death from shock caused by bleeding, dried plasma became a vital element in the treatment of the wounded on World War II battlefields. By the time the program ended in September 1945, the American Red Cross had collected over 13 million units of blood and converted nearly all of it into plasma. "If I could reach all America," said General Dwight D. Eisenhower, supreme commander of Allied Expeditionary Forces, "there is one thing I would like to do--thank them for blood plasma and whole blood. It has been a tremendous thing." At war’s end, some 1.3 million plasma units were returned to the American Red Cross, which made them available to civilian hospitals.
An American medic administers plasma to a wounded soldier
(National Archives, Washington, D.C.)
Morphine, as a pain killer, was widely used during World War II. Morphine is processed from the opium poppy plant which in grown mainly in Turkey and India. As long ago as AD 100, opium was swallowed or taken with a beverage. In the 17th century, when opium smoking was introduced into China, a serious addiction problem resulted. After the invention of the hypodermic syringe during the American Civil War (1861-1865), morphine injections proved indispensable for patients undergoing surgery. Injecting morphine into the blood proved more addictive than smoking or eating opium.
During World War II, Squibb, a pharmaceutical company, developed a way for medics to administer on the front lines a controlled amount of morphine to wounded soldiers. What Squibb introduced was called a morphine syrette, which was like a miniature toothpaste tube that contained the morphine. Instead of unscrewing a top like you do on a toothpaste tube, it had a blind end that was sealed. A needle attached to the syrette was used by the medic to puncture the seal. The medic would come along, break the seal and inject the wounded soldier with the morphine syrette.
During World War II, Medics were allowed to administer morphine to alleviate pain, although the injection could also be given at the Battalion, or Collecting Stations. If the drug was applied , the syrette was pinned to the casualties collar to prevent overdosing of unconscious patients. Usually the 1/2 grain injection from the toothpaste tube shaped syrette, combined with physical exhaustion, was sufficient to knock the patient out, with the casualty often waking up in the hospital.
This is a facsimile of the Squibb produced morphine syrette used during World War II by doctors and medics. The needle attached to the syrette was used by the medic to puncture the seal. The medic would come along, break the seal and inject the wounded soldier with the morphine syrette.
Method of injecting morphine syrette from FM-21-11 Basic Field Manual –First Aid for Soldiers, April 7th 1943
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