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Penicillin, Private Citizens, and the State

Penicillin, the State, and Organized Medicine

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Penicillin, Private Citizens, and the State

"Dear Mr. President," wrote a Baltimore woman to President Roosevelt in November 1943, "I know you are busy with the war, but could you spare a few minutes and read my letter. I am in great need of your help. My husband is in great need of the new drug penicillin. … I have two sons serving Uncle Sam. One is a sergeant in the Army Air Corps and my other son is in the navy and is somewhere at sea. His ship sunk a German sub about a month ago. Mr. President, I gave Uncle Sam two sons, could you please try to get me that new drug and save my husband? … I'm almost out of my mind."

In pleading her case to the president, this woman highlighted her personal contributions to the war effort, linking her gift of two sons to the gift of renewed life and productivity she believed Roosevelt could grant her husband. This woman was not alone in her belief that the president and his wife could provide the public with the new miracle drug. Other writers also stressed the importance of their work to the war effort or to the support of their families - themes that Roosevelt used himself when he addressed the nation concerning infantile paralysis to the nation. In the fight against infantile paralysis, these exhortations were intended to persuade individual citizens to financially support medical science through charitable contributions, to do their part to conquer a disease that crippled individual and societal productivity. In the case of penicillin, individual citizens employed many of the same rhetorical strategies in order to persuade members of the federal and scientific bureaucracy - embodied for many Americans by the Roosevelts - to release to them the miracle drug they believed would restore them to full health and citizenship.

Yet the apparatus of federal bureaucrats, government and non-government scientists, and pharmaceutical manufacturers that was developing and producing penicillin felt that private citizens should not necessarily be informed about the drug, and certainly should not feel entitled to it. A. N. Richards, the chairman of the Committee on Medical Research (CMR) of the Office of Scientific and Research Development (OSRD), and Chester Keefer, professor of medicine at Boston University School of Medicine, director of Massachusetts Memorial Hospital and the chair of the Committee on Chemotherapeutic and Other Agents (COC), attempted to restrict the amount of information available to the public, providing only the most basic information in CMR press releases. Richards in particular believed that limiting the public's knowledge about penicillin was humane. He argued that with the little that was available going directly to the military for injured soldiers, it would be cruel to raise Americans' hopes for the treatment. Security restrictions may also have influenced Richards and Keefer's decision to limit public knowledge. Indeed, Keefer felt that journalists posed a danger to the COC and its rationing policy, and argued that the press hindered efficient and effective drug allocation by misrepresenting his role as well as COC policy, and further, that their sensationalized accounts of the drug's effects increased demand and threatened the COC's credibility.

Initially, all information about penicillin passed through the CMR before public dissemination. Nevertheless, the agency was not entirely successful in censoring journalistic coverage of the drug. In particular, the Office of War Information (OWI) resisted the CMR's attempts at information restriction, arguing that informed citizens were more likely to support the war effort. By mid-1944, the COC and the CMR eased their efforts to restrict publicity. Increased production resulted in greater stocks of penicillin for distribution, and allowed the COC (and subsequently the Office of Civilian Penicillin Distribution, the OCPD) to respond to civilian requests.

Ultimately the media's interest in the miracle drug resulted in extensive popular press coverage of penicillin. Medical and scientific research, increasingly popular subjects of press coverage since the 1880's, were still cast in very positive, often sensationalized and heroic terms. Penicillin in particular was portrayed as an incredible miracle cure with little or no ill effects. The popularity of medical topics did not guarantee that media representations of penicillin were entirely accurate. Although some popular press and magazine coverage during W.W.II referred to potential deleterious effects of penicillin; in general penicillin the drug's adverse potential was minimized. Thus press often focused on human interest stories, portraying suffering patients whose desperate families plead with the COC to release penicillin for their loved ones. For some, these articles represented examples of how to evade drug rationing policies. Others emphasized the human drama between disease and drug. A 1943 newspaper headline shouted "7 Hours to Live - Scarcest Drug Rushed to Baby," another followed the case of a two year old girl with septicemia, and "Last Hope Dims Out: White House Can't Help Dying Girl with Drug," referring to 19-year-old Marie Barker, whose request for penicillin was denied by the COC and died of subacute bacterial endocarditis, because there was no clinical evidence that penicillin would effectively treat her condition. Some papers, such as the Science News Letter and New York Herald-Times, went so far as to provide instructions on how to make penicillin in one's own kitchen!

Thus, while the press received only limited information about the development and therapeutic potential of penicillin, numerous articles on penicillin were published in Time, Life, Parents', Science Newsletter, Newsweek and other such popular magazines and journals, thereby increasing ordinary Americans' awareness of the new therapy and their demands for it. By the summer of 1943 ordinary Americans knew enough about penicillin's therapeutic promise to begin demanding its release to the general public. Civilian requests for penicillin increased dramatically - requests that came from the sick, their families and medical practitioners alike.

It is in this complex environment, where competing interests and activities resulted in an uneven and inconsistent portrayal of penicillin in the various sources available to the public, that Americans attempted to make sense of penicillin, its medical uses, its promise, its dangers, its availability and rationing, and relatedly, their entitlement to its use.

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Penicillin, the State, and Organized Medicine:

The OSRD and the CMR, both established specifically to mobilize American medical and scientific research personnel for the conduct of research related to national defense, worked closely with federal administrators, civilian pharmaceutical, industrial and agricultural manufacturing companies to bring about the successful development of penicillin, and actively negotiated with members of the federal bureaucracy and the military to secure support for their projects.

During 1942 and the first six months of 1943, only 22 specialists in infectious disease were selected by the National Research Council's (NRC) Committee on Chemotherapeutics (COC), in coordination with the CMR, to receive the drug for clinical testing in the treatment of very specific conditions: staphylococcal infections and certain streptococci and pneumococci infections that had already failed to respond to sulfonamide therapy. In April of 1943, Dr. Champ Lyons conducted the first American study of penicillin in the treatment of war wounds at the Bushnell General Hospital in Utah. By August, 500 patients, almost entirely composed of soldiers, had received penicillin therapy, and the results of these trials were published in JAMA during the fall of 1943. The success of these investigations, which provided evidence for the effectiveness and important information regarding critical dosage, was critical to securing federal and military support and funding for the transition to mass production. Indeed, without such support, the CMR would have an impossible time convincing pharmaceutical and other private firms to participate in the development of an effective production apparatus.

Initially, when WPB took over penicillin allocation in July 1943, all penicillin produced was assigned to the Army, Navy, and Public Health Service, along with a portion for research which was assigned to the OSRD. The OSRD continued to permit its limited distribution to physicians concerned with the treatment of infections in the disease categories of interest to the CMR (i.e. to the military). As production improved, and supplies of penicillin increased, the number of medical investigators with access to the drug also increased. By May 1944, production had increased to the point that the WPB allowed limited sale of the drug through hospitals, and by March 1945, the WPB released penicillin for sale through normal trade channels.

Throughout this period, the AMA took a supportive role in the pursuit of military medicine, often acting as the conduit conveying information about penicillin and other medical matters in the war effort to members of the medical profession. The AMA, certainly publicly, took their role in penicillin research quite seriously, and to a large extent, showed great deference to the wartime apparatus that directed penicillin development and distribution. Indeed, the AMA itself maintained a Committee on War Participation, and, for a time, issued weekly announcements in JAMA dedicated to issues related to medicine and the war, and even began a radio show broadcast entitled "Doctors at War" (for which the AMA received a commendation from the Surgeon General excellent service to the Medical branch of the US Army). But the AMA was still far from representative of the majority of medical practitioners, and was, during this period, still establishing itself, quite self-consciously, as the primary professional organization for members of the medical community.

Communicating directly with the AMA, the CMR directed the AMA to release relatively limited information and to support the narrow rationing policies that governed the early distribution of penicillin. Thus, the majority of physicians were in much the same position as the rest of the lay American public at this time, possessing relatively limited amounts of information about the drug, and little or no access to supplies. The reception of these restrictions did not go entirely uncontested among general physicians. As the letters attached to this section indicate, not all physicians felt that the limited distribution of penicillin for civilian use was just, and joined their patients in entreating the state and military to make exceptions.

Coordination between these various members of the medical community was initially quite divided, save communication directed by state and military sources. Instead, new and significant ties were established between the state and various sectors of medical researchers and practitioners. These new economic and political relationships, stimulated by wartime efforts to deliver penicillin (as well as other medical and scientific technologies) from production in the laboratory to mass production, were of lasting significance to the relationship between the state and medicine and the conduct of medical and scientific research in peacetime America - changes that included unprecedented state and military sponsorship of medical and scientific research and government recognition of the legitimacy of professional organizations like the AMA.

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Study and Research Questions:

How was penicillin framed in popular magazines, journals and newspapers of the time? How then was the public's understanding of the production, distribution and efficacy of penicillin, shaped by images and information provided by these sources? Explain your answer.

How do you think public perception and understanding of penicillin was also tied to the war effort as well as affected by other factors? Using those materials available on this page, consider the complex relationship between American patriotism, the war effort and wartime optimism, public opinion towards medicine, and the development of a new marketplace.

What expectations do you think the public had of medicine in general, and penicillin in particular at this time? Explain your answer and use of archival evidence.

How do you think private American citizens perceived their relationship to the federal government in the context of war and postwar America? Who does the public feel is responsible for its health and what is the nature of this relationship and responsibility?

What was the relationship of the medical community to drug research and development in this era? How do you think that different members of the medical community - i.e. researchers for the COC, CMR, clinical researchers, members of the AMA, military doctors and civilian doctors - viewed penicillin and its distribution?

The articles and ads from JAMA and The Smithsonian Report available in this section were intended for professional audiences. Explain the different ways they portray penicillin - i.e. as a science, therapeutic breakthrough, a weapon of war, a product and cultural idea? Compare the portrayals found in these journals to those found in popular audience magazines and newspapers like Life, Time, Parents, the Science News Letter and The New York Times.

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Sources and Approaches

The materials in this section explore the public's introduction to, knowledge of, and reaction to penicillin. This material helps address how the general public were introduced to and understood pencillin, and how they tried to negotiate their relationship to the federal agents who controlled access to the drug. Penicillin was not only a new and exciting therapy; its production was also a substantial business undertaking which would have profound effects when production problems were solved and the market opened. In order to gain a sense of the information available to the reading public about penicillin, begin by looking at the materials linked to this page. Articles and advertisements for penicillin appeared in newspapers and popular magazines throughout this period, and were chosen from a cross-section of popular magazines and newspapers: the New York Times, news magazines Newsweek and Time, the popular Parent's and Life and the Science News Letter.

This section also explores the role of the medical profession in the development and use of penicillin. Certain aspects of the medical profession in this era are well explored in other parts of the Golden Age site. In the Medicine and the State section, we focus more closely on how the divisions among medical researchers and doctors affected the use of penicillin. While the lines between these divisions could be fluid, the four major groups of physicians are medical researchers (employed by research organizations, including the federal government), academic physicians (those employed as medical school professors), general practitioners, and organized medicine (the American Medical Association and other professional associations). To gain insight into the perception and information available to the medical profession about penicillin, use the articles and ads from JAMA, The Smithsonian Report and related letters that appear in this section, and were intended for professional audiences.

When penicillin was first produced, its scarcity - as well as the lack of scientific knowledge about its effects - meant that the use of penicillin was restricted to military personnel. As production methods improved, civilians increasingly given access to penicillin, but only under specific, controlled conditions. Private citizens did, however, try to influence the distribution of penicillin by writing directly to the person they thought could most help them - President Roosevelt. In these letters, people describe their illnesses, and that of their spouses, parents, children, or patients, and plead with the president to intervene on their behalf and provide them with the new drug.

The materials linked to this page represent only a selection of the accounts of penicillin published in the mass media in the 1940s. A more complete title list can be obtained by consulting The Reader's Guide to Periodical Literature, found in the reference section of the library. Similarly, the letters to President Roosevelt reproduced here represent a fraction of the appeals members of the public sent to the Roosevelts and Keefer; further information about these materials can be obtained by consulting the source highlights and approaches available on this site, or by visiting the National Archives. Use the materials from this section, but also know that useful comparisons can and should be made with other sections of the Golden Age of Medicine site.

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