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| The Surgical Technologist | JUNE 2017 258 also summarized the logistical reality of delivering surgical care on the islands of the Pacific and the disparate terrain encountered around the Empire of Japan. In this article, part 2, the focus will be on the development of penicillin and how the medical history of WWII would be remiss without it. The first use of penicillin occurred in 1942 as a direct result of the war effort in the US and Britain. Penicillin was immediately recognized for its value to soci- ety. By 1945, the scientific team that discovered and brought it to market were knighted in England and given the Noble Prize in Physiology or Medicine. To put this in context: this Nobel Prize was awarded less than six years after the discov- ery of medical dose capable penicillin. The discoverers of DNA waited almost 12 years before they received theirs. Penicillin is still widely touted as one of 20th century’s most enduring breakthroughs, and its discovery has forever changed infection control in surgical practice. T H E W A R O N I N F E C T I O N Infection and disease are historically greater causes of death among both military and civilian popula- tions during war time than direct combat injuries. Early in WWII, both troops and civilian casual- ties were facing infections at an alarming rate. Pneumonia could race through barracks and ships before men ever reached the battle zone. Retained foreign bodies and dirt led to tetanus and devi- talized tissue causing gangrene and septicemia. Osteomyelitis festered in compound fractures for numerous months after injury and often tragically resulted in delayed amputations – essentially the same medical response to these conditions before and during the US Civil War. Many lessons were learned from World War I (1914-1918) and earlier conflicts regarding wound infections. The mortality rate and amputation rate for infected combat surgical sites took a staggering toll on veterans. After every conflict in our nation’s history, amputees and grieving families were a part of most Americans’ daily life. The impending war drove the quest for a better way to treat infection. The scientific community and fledgling pharma- ceutical industry embraced the challenge as the nation prepared for the start of WWII. When the war began, American GIs and corps- men (precursors to CSTs in some cases) carried sulfanilamide packets and were trained to use it as a wound powder and oral tablet. It was quickly determined simply sprinkling a soil-filled gunshot wound with powder as a means of mitigating infection did not live up to expectations derived in a lab or hospital setting. The lack of available irrigation for these soiled wounds could not be curbed by the topical application of the sulfur drug. While the sulfa-based drugs reduced systemic infection to some degree when taken as a tablet, confidence in this drug therapy declined. Sulfanilamide’s effectiveness was simply not greater than the risk of allergic reaction, toxicity and other serious adverse effects. S E R E N D I P I T Y A N D S C I E N C E Following WWI, Sir Alexander Fleming, a Scottish biolo- gist, was already well known in the scientific community for identifying enzyme lysozyme (present in tears and mucous) and for naming and discovering the cause of gas gangrene, c. perfringens. Fleming and his British contem- Sir Alexander Fleming, who first discovered the mold penicillin notatum, is shown at his laboratory at St Mary’s, Paddington, London. He was awarded the Nobel Prize in Physiology or Medicine in 1945 with Howard Florey and Ernst Chain. Photo credit: Imperial War Museum