Miracle Drug

In 1943 I was a second-year medical student in Kansas City, enrolled in an accelerated program designed to finish the four-year course in three years. We had little or no time for recreation, but, thanks to a scheduling quirk, those in my section of the class suddenly found ourselves with two open weeks. I seized the opportunity to gain a bit of practical experience by accompanying some physician mentors on their rounds at a hospital back home in Wichita.

One of these doctors had admitted a patient with subacute bacterial endocarditis (an infection of the inside lining of the heart), who was doing very badly. Back then there was no treatment for this disease, and most hospitals had little to offer except supportive therapy: giving the patient fluids and trying to prevent bedsores.

Penicillin, discovered in England in 1928, had just recently become available in some quantity, but nearly the entire production was reserved for the military. A doctor in Boston controlled any release for civilian use, basing his decision on the drug’s suitability for a given patient’s diagnosis. The physician I was following called Boston and won approval for this treatment.

At that time penicillin remained potent for only a few days. Once a supply was released, a military plane had to fly it to the civilian recipient. As it happened, about the time the plane was landing at the airport, our patient died.

Another doctor with whom I was working had admitted a seventeen-year-old with cerebral spinal meningitis (an infection of the membrane covering the brain). He was not responding to treatment, and we expected him to die within a few hours, the usual course for that disease. It was already known, or strongly suspected, that the meningococcus bacterium causing this infection would be sensitive to the penicillin we now had at hand, which would soon be useless. We again called the doctor in Boston, and he agreed that we could use it for the young man.

By that time our patient was moribund, completely unresponsive, and barely breathing. We began to give him the antibiotic. In comparison with the doses used today, the amount administered was minuscule. But within six to eight hours the patient was sitting up in bed, drinking water from a glass, and talking to us. A few days later his physician released him from the hospital in good health. Even a second-year medical student appreciated that he had just witnessed a revolution in medicine.

I went on to practice obstetrics and gynecology for thirty-seven years. In this happy specialty there was not too much need for antibiotics, but the occasional pelvic infection did indicate their use. As the decades went by, the bacteria were less and less responsive to penicillin or to any other antibiotic, and the doses administered had to be greater and greater. If my memory serves, in that first case in 1943 we were administering two thousand units of penicillin every third hour. Now forty million units a day may not be effective.

After penicillin, scores of antibiotics were discovered and added to our pharmacopoeia. It is a catastrophe that my profession and we as a society have so misused these wondrous medicines as to let bacteria develop resistance. Unless research turns up new and more powerful drugs, we may find we are returned to the pre-antibiotic era, our doctors able to offer little more than fluids and narcotics for pain.