In March of 1942, a young woman was
dying of sepsis in a New Haven hospital. In just one day, she would be
miraculously revived by a newly discovered experimental drug, seemingly by
“black magic” as one consulting physician would mutter. The woman’s full
recovery with the new antibiotic known as penicillin was the very first
occasion of its usage in the United States and would jump-start the pharmaceutical
industry’s interest in and manufacture of the drug (1).
At the time, penicillin was a rare
and valuable elixir. With the ongoing war raging in Europe and in east Asia,
there were few industrial plants and even fewer laborers that could manufacture
a relatively untested medication. This was precious stuff, scarce in quantity
but potent in implementation, and so it was a remarkably handy thing that the
drug known as the “magic bullet” wasn’t just a one-hit, one-person wonder, but
could be used and reused time and time again.
Wait, what?
Yes: After one administration of
injected penicillin, anywhere from 40 to 99 percent of the antibiotic is
excreted in urine in its fully functional form about 4 hours after
administration thanks to our efficient and hardworking kidneys (2). Due to this
distinct feature of its pharmacokinetics, penicillin could be extracted from
the crystalized urine of a treated patient and then used to treat another
patient in the throes of serious bacterial infection just next door. In 1943,
just shy of one year after its successful usage in saving the aforementioned
woman’s life, the total amount of penicillin that had been produced was enough
to treat only a hundred people, and this only if it was judiciously reclaimed
and reused (3). Recycling penicillin wasn’t just smart; it was a necessity for
such limited quantities of this wonder drug.
In his firsthand account of
penicillin’s debut in the United States, a young Dr. Charles M. Grossman wrote,
My fellow intern … saved all of the
patient’s urine because Dr. Heatley [an associate of Dr. Howard Florey, the
Nobel Prize winner that pioneered penicillin’s usage in medicine] had informed
us that more penicillin could be purified from it than could be produced by
cultivation.
Probably up to 95% of each
intravenous dose was excreted unchanged. When Dr. Heatley delivered a
subsequent vial, some of which had come from the patient’s urine, he carted the
gallons of urine back to Rahway [the New Jersey-based site of production for
Merck & Co]. The patient survived and later died of other causes at the age
of 90 years. (4)
The downside of penicillin’s quick
exit from the human body was that it never hung around long enough to fight an
infection to completion. Sure, the drug could be immediately recovered and
re-administered, but due to losses during processing and the time required for
crystallization and retrieval, this solution was clearly not the most
sustainable. Probenicid, an agent that would slow the excretion of penicillin
in the kidney’s tubules would later be used to allow penicillin the time to
diffuse throughout the body as it put its “black magic” into effect. Once
manufacturing of penicillin kicked into high gear, this necessity of recycling
excreted antibiotics would be be dropped in favor of just applying another vial
of the drug.
We live in an age of disposables, an
age of plenty, during which pharmaceuticals and even medical implements are
used and then discarded. The concept of harvesting a body’s excretions for substances to
be injected into the veins of another
is quite foreign to us, but it is worth remembering that this era of abundance
and easy access is a historical exception rather than the rule. Medicine,
for most of the vast expanse of history, has been a precious and limited
resource, and penicillin’s concatenated harvesting and reuse in multiple
patients was key for its use in extinguishing infections that would have
otherwise been death-sentences for those afflicted. The drug once widely known
as the “magic bullet” was far more efficacious as a “magic arrow” to be fired,
collected, and aimed once more.
Previously on Body Horrors
“It would be another fluke – the
discovery of a moldy cantaloupe – that would yield a particular strain of mold
that could produce prodigious amounts of this “magic bullet” antibiotic.” Read
more from my article on the manufacture of penicillin (and to watch a neat
movie!) at A Moldy Cantaloupe & The Dawn of Penicillin.
This is not the first time we’ve
harvested goods from infected humans and passed them on to others in the name
of science. Be sure to read Pyromania! On Neurosyphilis and Fighting Fire
with Fire to find out more.
Resources
References
1) W Saxon (1999, June 9) Anne
Miller, 90, First Patient Who Was Saved by Penicillin. New York Times. Accessed
online on Dec 31, 2014 at http://www.nytimes.com/1999/06/09/us/anne-miller-90-first-patient-who-was-saved-by-penicillin.html
2) JH Humphrey. (1944)
Excretion of Penicillin in Man. Nature: 154: 765-765
3) JE McCallum (2008) Military
Medicine: From Ancient Times to the 21st Century. Santa Barbara,
CA: ABC-CLIO
4) M Grossman (2008) The First
Use of Penicillin in the United States. Ann Intern Med; 149:
135-6
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