Page 105 - JSOM Spring 2023

An Ongoing Series

Antibiotic Usage in the Management of Wartime Casualties

Justin Lee Anderson, SO-ATP, NRP ; Shane Kronstedt ;
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Matthew A. Bergens ; Jay A. Johannigman, MD, FACS *
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he end of the Great War (WWI) ushered in a new era for were dying, and doctors desperately sought more effective
humanity. With the resolution of the Spanish Flu pan- methods for treating burns. Penicillin was critically needed,
Tdemic, the modern world experienced a period of incred- but the daily bombing raids over Britain rendered its indus-
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ible growth and opulence over the ensuing decade. Then the tries and laboratories vulnerable to German bombs. Massive
stock market crashed, and, within another 10 years, the world amounts of penicillin would soon be required to address both
would be at war again. civilian and military casualties across the theaters of WWII.
With this being impossible in the war-torn nation, the Brit-
In this second installment of the “Lest We Forget” series, the ish medical community sought help in advancing the research
authors look to advancements made in the care of the war and production of the drug. Florey and Chain traveled to the
wounded during the Second World War. T. Clifford Allbutt United States and soon found themselves in the heartland of
said, “I would remind you again how large, and various was the Midwest. The place chosen to produce naturally fermented
the experience of the battle-field, and how fertile the blood penicillin was the Northern Regional Research Laboratory
of warriors in rearing good surgeons.” The unfortunate real- (NRRL) at Peoria, Illinois. Located in the middle of the great-
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ity is that World War II provided a high volume and intensive est corn-growing farmland in the world, NRRL was very keen
environment for advancing the care of trauma patients. While to find new industrial uses for surplus farm products, includ-
the horrors of this war were many, there were also numerous ing corn. Corn would be a key ingredient in the medium used
medical advances that would save lives over the subsequent in the culture of penicillin, and its use increased penicillin pro-
decades. This article highlights the first widescale introduction duction 10-fold, making possible the commercial manufacture
of antibiotics in a wartime setting for the treatment of combat of the much-needed drug. Researchers from Britain teamed
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casualties. with researchers and pharmaceutical companies in the United
States, and mass production of penicillin began. The US War
Keywords: Lest We Forget, combat casualty care, war wound Department pressed to rapidly upscale penicillin production to
therapy, antibiotic therapy, wound care have an ample supply on hand to treat the expected massive
casualties before the proposed invasion of western Europe on
D-Day. Consequently, penicillin earned the title of “Miracle
Introduction Drug of WWII” and saved countless casualties across both
theaters.
In 1928, Professor of Bacteriology Alexander Fleming intro-
duced the discovery of the novel agent penicillin, the “first true The article presented here highlights the challenges facing the
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antibiotic.” It would require an additional decade of research military surgeon in the forward and austere setting as modi-
regarding the efficacy of penicillin as a therapeutic agent in the fied by the introduction of a new class of drugs (antibiotics)
treatment of bacterial infections before this agent would be and medical protocols. While many research papers came out
accepted for human use. The advancement of the therapeutic detailing improvements in battlefield medicine, Colonel Ed-
benefits of penicillin may be attributed to Howard Florey and ward D. Churchill’s manuscript in the Annals of Surgery in
Ernst Chain of Oxford University, who worked to purify and 1944 set itself apart from the rest, being described as “one of
produce penicillin in the laboratory. The urgency of advancing the finest dissertations on the management of wounds which
this research was not lost on these British investigators as the has been submitted through the Office of the Surgeon General
advancing clouds of German aggression loomed on the Eu- of the U.S. Army.” 1
ropean horizon. The publication of the Oxford report on the
efficacy of penicillin coincided with the Battle of Britain and Edward Delos Churchill was born in Chenoa, Illinois, in
the beginning of the air war that raged over the skies of Britain 1895. He graduated from Harvard Medical School in 1920
in 1940 and 1941. British civilians injured in the air attacks and completed a surgical residency at Massachusetts General
*Correspondence to jay.johannigman@gmail.com
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1 Justin Lee Anderson is affiliated with US Army Special Operations Command, Fort Bragg, NC. Shane Kronstedt is affiliated with the Rutgers
Robert Wood Johnson Medical School, Piscataway, NJ. Matthew A. Bergens is affiliated with the Duke University School of Medicine, Durham,
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NC. COL Jay A. Johannigman is an emergency and trauma and critical care surgeon, Brooke Army Medical Center, San Antonio, TX.
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