D-Day and the wonder drug: Penicillin

Enormous potential

Penicillin was discovered in London by Professor Alexander Fleming in 1928. At the time, doctors had nothing available to treat infections like pneumonia, and many people died of blood poisoning after minor injuries. Fleming’s discovery had the potential to change that – but it was extremely difficult to produce. Derived from penicillium, a mould with antibacterial properties, some scientists thought it was impossible to make in useful quantities.

Attempts were made to develop a usable medicine from penicillin, but this had not been achieved by the start of the Second World War. After 1942 saw breakthroughs made in the USA, the British Medical Research Council set up a Penicillin Therapeutic Trials Committee – though still the medicine could not be made in large quantities. By the autumn of 1943 the committee secretary, Professor Ronald Christie, was deep in correspondence with the War Office about how the antibiotic might be applied to military operations.

CONFIDENTIAL

Professor F. R. Fraser,

Ministry of Health,

Whitehall, S.W.1.

Nov. 25th 1943.

Dear Professor Fraser,

I am writing you as Secretary of the Penicillin Therapeutic Trials Committee. I expect you know that the Army is making preparations for the treatment of battle casualties with Penicillin and Sir Edward Mellanby has agreed that I should discuss with you the possibility of similar preparations in the E.M.S. [Emergency Medical Services] If possible I would suggest some time before Dec. 6th as I will be away from that date until Dec. 16th, when the Penicillin Therapeutic Trials Committee has its next meeting.

I am sorry to have to mark this uncompromising letter as "confidential," but those are my orders.

Your sincerely,

Ronald V. Christie

(Professor Ronald V. Christie)

The Emergency Medical Services (EMS) had brought the UK’s hospitals together under state control when the war began. Plans were discussed for how the EMS might work alongside the Army Medical Services to treat battle casualties with the newly developed drug. This would become particularly important if a ‘Second Front in Europe’ were to open up – which was exactly what D-Day hoped to achieve.

Trials and training

How penicillin could be used for long-term treatment was unknown. Professor F R Fraser, the Ministry of Health’s adviser on the organisation of wartime hospitals, saw an opportunity in the midst of drug testing. The EMS could follow up current cases where men had been treated with penicillin in Africa and repatriated to hospitals in the UK.

Trials in Africa and other tropical locations had shown that penicillin worked effectively on complex, open injuries, chest infections and venereal disease, to name but a few. The EMS proposed that a number of Home Base Hospitals could receive patients who had already been treated with penicillin, and liaise with surgical colleagues in the army to continue recording individuals’ progress. This would ‘provide valuable records and information on their condition on arrival’. The offer was quickly seized. Surgeons and pathologists at the chosen hospitals were prioritised for training on use of the new medicine.

In December 1943, only nine hospitals in the UK had staff with experience using penicillin. Therapeutic trials at EMS Hospitals were planned as soon as enough of the drug could be acquired, with plans for more to be issued as soon as possible. Top priority for training were surgeons and pathologists who would be in charge of treatment in coastal and transit hospitals, followed by those who would work on mobile teams at these, and then those who served at Home Base Hospitals.

By late January, the uses of penicillin were becoming a little clearer. A further four hospitals were selected to pursue additional trials by staff at the Ministry of Health’s Emergency Hospital Scheme.

The most pressing issue was getting enough of the drug. Fraser approached the Ministry of Supply to offer the services of the EMS to help acquire and supply penicillin. Professor Christie had been closely involved with observing how the US Army intended to distribute and control the use of penicillin within its own medical services. Regardless, supply issues remained.

A serious shortage

In January 1944, the government shared out its penicillin as follows:

• 50 million units a month to the medical trials
• 40 million to the EMS
• 200 million to the air force
• 330 million to the navy
• 1,500 million to the army.

Impressive as those figures sound, earlier that month Fraser had written to the Medical Research Council suggesting that 50,000–100,000 wounded could be expected from the second front, and that the Emergency Medical Services might need 5 billion units of penicillin per month. More than double what was currently available.

The government's intention to reserve supplies of the new drug for military use was also being tested. In August 1943 the National Research Council had noted that:

'Requests for penicillin to treat cancer, leukemia, subacute bacterial endocarditis, suppurative pylephlebitis, multiple brain abscesses, influenza meningitis, ulcerative colitis and lupus erythematosis have arrived in considerable numbers but have been uniformly denied.'

Meeting minutes, Committee on Chemotherapeutic and Other Agents. Catalogue reference: MH 76/184

In January 1944, Professor Fraser received the following message:

++ 168 2.1 TRURO T 34

FRASER DIRECTOR GENERAL EMS WHITEHALL =

IS THERE A POSSIBILITY TO OBTAIN URGENTLY PENICILLEN FOR CHILD AGE 10 SUFFERING FROM PREUMOCOCCAL PERITONITIS AND SEPTICAIMIA SULPHO DRUG RESISTANT NO HOPE WITHOUT PENICILLEN = HOOD ROYAL CORNWALL INFIRMARY ++++

Professor Fraser handwrote a telegram in reply – and followed it up with a message of apology, explaining that 'Penicillin is in such short supply still that it is being used for research purposes only or for the training of further surgeons and pathologists in its use ... Apparently it is still difficult to define the usefulness of penicillin and its contraindications.'

HOOD

ROYAL CORNWALL INFIRMARY TRURO

REGRET PENICILLIN NOT YET AVAILABLE

FRASER

Efforts were made to improve production methods, but soon Prime Minister Winston Churchill was complaining to his ministers about Britain’s inability to produce penicillin at scale. On 19 February, after the issue had been raised in the House of Commons, the Prime Minister scrawled in red ink on a Ministry of Supply report saying the Americans were producing greater quantities: ‘I am sorry we can’t produce more’.

‘Your report on penicillin showing that we are only to get about one tenth of the expected output this year, is very disappointing.’

Winston Churchill's correspondence with ministers, February 1944. Catalogue reference: PREM 4/88/7

On another report in the same file he instructed: ‘Let me have proposals for a more abundant supply from Great Britain.’

With secret preparations for D-Day stepping up, efforts to deliver enough American-made penicillin for frontline military personnel became a matter of urgency. Fraser and Christie discussed whether penicillin should be supplied as calcium or sodium salts or in tablet form. They agreed on powdered calcium salts for superficial wounds and sodium salts for use in deep wounds. It could also be injected, but there was great pressure not to waste it by using it in that form. Quantities needed to be tightly controlled, with unused medication to be passed onto colleagues carefully, not wasted.

Final preparations

Plans were made for casualties from the frontline in France to be brought back to coastal hospitals in Britain for treatment. Sixteen EMS hospitals were selected to receive patients who had been previously treated with penicillin – one per region, plus London.

Patients treated with penicillin were to be labelled according to ease of transfer, with ‘PENICILLIN’ written in block capitals in the top right-hand corner of their paperwork. Once treated at a coastal hospital, each patient was then sent to the selected hospital nearest their home. They were to bear a yellow label inscribed with the letters ‘PEN’ to allow easy identification, and to be treated in intervals of no longer than five hours, with injections of penicillin dissolved in distilled water.

On 24 May 1944, less than a fortnight before D-Day, Fraser reported: ‘Sufficient supplies of penicillin are now available for the treatment of battle casualties in EMS hospitals, but not for ordinary civilian patients.’ Six days later, hospitals were instructed by the Ministry of Health to treat battlefield patients en route:

‘In an endeavour to prevent the development of gas gangrene and sepsis in wounds the War Office have arranged for the treatment of selected cases by penicillin to be commenced as soon after injury as possible.’

Against the odds, the plan was rolled out in full in time for the D-Day landings.

D-Day and beyond

Shortly after dawn on 6 June 1944, D-Day began. Soon more than 150,000 Allied troops landed by sea and air on five beachheads in Normandy, France.

While British troops made good progress and pushed inland, US forces encountered the heaviest fighting on Omaha beach, where the nature of the geography and an initial lack of armoured support worked against the landing soldiers. With both sides taking many casualties, by the end of the day, the Allies had taken all their intended beaches.

Hundreds of personnel were treated with penicillin for infected wounds in the aftermath, with impressive results. According to one estimate, penicillin reduced the number of lives the Allied forces lost on the day by 12–15%. The success of the military operation was matched by the success of the new drug.

In the months that followed, as Allied forces made inroads into Europe, restrictions on the use of penicillin for civilians began to relax. In July 1944, Christie told Fraser that: ‘The War Office approves of American penicillin being used for medical conditions in service patients and for air raid casualties among civilians.’

By early September 1944, Christie and Fraser were beginning to consider how penicillin might be used once hostilities had ceased. It was decided that at first it should only be supplied to larger hospitals, where the staff had been properly trained to administer it.

Penicillin became fully available to the general public in 1946, and has been a cornerstone of medical treatment ever since. It provides a powerful example of how military medical innovations have the potential to touch all of our lives.

Records featured in this article

• From our collection

  MH 76/184

  Title

  Correspondence on distribution of penicillin and its potential use in war wounds

  Date

  1943–1944

• From our collection

  PREM 4/88/7

  Title

  Prime Minister Winston Churchill's notes on correspondence with the Ministry of Supply and Minister of Production

  Date

  February 1944 – June 1945

• From our collection

  DEFE 2/502

  Title

  Miscellaneous maps, traces and photographs from the Combined Operations Headquarters

  Date

  1944–1946

• From our collection

  INF 2/44

  Title

  General publicity photographs produced by government departments during the Second World War

  Date

  1944–1945

• From our collection

  ADM 234/366

  Title

  Naval battle summary of Operation Neptune (the Normandy landings)

  Date

  June 1944