432 ANNUAL REPORT SMITHSONIAN INSTITUTION, 1954 



WORLD WAR II 



Introduction of antibiotics. — Between World War I and World 

 War II there were many important contributions useful not only in 

 time of war but for medical and civilian defense. Undoubtedly the 

 most important were the developments in the field of the antibiotics. 

 Much research had been done on them before 1939, but their introduc- 

 tion as therapeutic agents was greatly expedited by World War II. 

 Sir Howard Florey and his resourceful team at Oxford were respon- 

 sible for establishing the therapeutic potentialities of penicillin. They 

 were the first to isolate it in pure form ; they were also responsible for 

 determining its effective dosage and for securing its large-scale com- 

 mercial production. Several years ago when someone referred to peni- 

 cillin as an outcome of wartime research Sir Howard protested, and his 

 objections were well taken, for he had begun to work on the antibiotics 

 in the early thirties ; but it would have been many years before peni- 

 cillin could have been made available in large quantities had it not 

 been for the stimulus of war. The story of penicillin has been fre- 

 quently told and need not be repeated here, particularly since Sir 

 Howard and Lady Florey have recently published detailed mono- 

 graphs ^° in which the meaningful story of the antibiotics has been 

 traced in detail. 



Surgery has probably been more benefited by wartime research than 

 any other branch of medicine. In World War I no surgeon would 

 have dreamed of closing an infected wound, or even one that was 

 potentially infected, without leaving a drain. Now, thanks to the 

 use of chemotherapeutic agents such as the sulfonamides and penicil- 

 lin, it is possible to close wounds of almost every description, even 

 those of the abdomen, without drainage and without fear of subse- 

 quent complication from infection, provided all dead tissue has been 

 carefully removed prior to the closure. So great at one time did con- 

 fidence become in the effectiveness of the new chemotherapeutic agents 

 that some of the younger surgeons grew careless and began closing 

 badly contused wounds without "debridement," i. e., without careful 

 removal of seriously damaged tissue. Such injured areas may be 

 without circulation, and they therefore become the foci of serious 

 infection, since the bloodstream is unable to carry antibacterial agents 

 into such regions. Penicillin thus cannot be regarded as a substitute 

 for good surgery but merely a highly important adjunct. These newer 

 principles of traumatic surgery, as worked out in the war theaters, 

 have had immediate application in all forms of civilian traumatic 



^"Florey, H. W., Antibiotics: a survey of penicillin, streptomycin and other 

 antimicrobial substances from fungi, actinomycetes, bacteria, and plants, 2 vols., 

 London, 1949 ; and Florey, M. E., The clinical application of antibiotics : Penicillin, 

 London, 1952. 



