Pharmacy and the War
THE "DRUG ARSENAL OF THE CIVILIZED WORLD"
By LOUIS GALLUBA, Secretary, Maine Pharmaceutical Association
Delivered before the Kiwanis Club, Westbrook, Me., October 10, 1944
Vital Speeches of the Day, Vol. XI, pp. 89-92.
WE all know the story of how American Industry transformed this country into "the arsenal of Democracy" and helped stave off the defeat of the United Nations at the hands of the Fascist Axis; how we were caught almost totally unprepared at the time of Pearl Harbor and in a matter of days swung the Nation's entire industrial output into the war effort. The magnificent performance of each separate industry is a chapter by itself in the history of this war.
But one of the least discussed chapters is that of the American drug industry and the profession of pharmacy, which, unlike many other industries, were faced with the absolute necessity of not only supplying the tremendous needs of the armed services throughout the world, but of continuing its big job of protecting civilian health. In most other industries, civilian production was reduced or eliminated altogether in favor of war production, but in the drug and pharmacy field, civilian needs became greater as the war effort expanded because health on the home front became more than ever important with all-out armament production, demanding more and more healthy, able-bodied people.
But we in the drug industry and the profession of pharmacy were not caught totally unprepared. Many months before we were attacked by Japan, leaders in the field examined our actual and possible resources to see how we would stand in the event of total war. With government officials, we checked over the list of vital medicinal agents for which we were dependent upon foreign countries. The picture was not very bright. The list of imported drugs was a long one, and many of the items came from lands already under Axis rule or almost certain to fall into enemy hands.
We remembered how in the first World War we had been almost completely shut off from our chemical and drug supplies by the German monopoly. Our job was to avert a similar situation this time. To do this our chemists worked feverishly to find suitable substitutes for products cut off by enemy conquest; our manufacturers doubled and redoubled their output; our wholesalers constantly changed and improved their distribution to meet the ever-changing needs and demands of the armed services and the civilian front. And our pharmacists, just like millions of war plant workers, worked man-killing hours to meet the increased demands on the home front, with the job made even more difficult by the shortage of manpower. More than 14,000 pharmacists were taken by the armed services in the first two years of the war and that number since has increased. At the same time, the number of replacements from our Colleges of Pharmacy were reduced to a negligible figure because of the war.
Early in 1941, with war almost certain, the Federal Security Administrator, Paul V. McNutt, called the leading drug manufacturers and pharmacists of the country together and told them they faced the herculean task of making America the "drug arsenal of the civilized world," just as other industries were engaged in making it the armaments center of the world.
In pursuit of this purpose, when we reviewed the startling list of imports upon which we depended, such as quinine and benzoin from the Dutch East Indies; stramonium and belladonna leaves from Hungary and Austria; aconite and ergot from Spain, Italy and Portugal; cod liver oil from Japan, Norway and Egypt; ipecac from Mexico and South America; orris root from Italy; psyllium seed from India, France and Spain; saffron from Spain; valerian root from Holland and Spain; sweet almond oil from France, Italy and Norway; cassia from China; mineral oils from Germany, Japan and Holland; menthol from China and Japan; terpin hydrate and calcium lacetate from Germany, to name just a few, we got a headache no aspirin in the world would cure. How were we going to replace these drugs with products of our own?
It was a staggering problem. But we rolled up our sleeves—and took it on. And I'm proud to say that we licked it. Today we are virtually independent of the rest of the world so far as medical and pharmaceutical supplies are concerned. Substitutes for all the medicinal and pharmaceutical products cut off by the enemy have been found and in some cases the substitutes have proved better than the originals. Pharmaceutical formulae were revised to include these new discoveries, and thus adequate health protection for our men on the battle fronts and our people on the home front, who are turning out the fighting weapons for them, was assured. So today it is no longer a dream but a fact that the drug industry and the profession of pharmacy together have made this country the "drug arsenal of the world."
Among the accomplishments of which we are especially proud—are the much-discussed penicillin, the so-called miracle drug, and while this drug was actually discovered in England, the American drug industry can be proud of its part in making it available through large scale production; atabrine, the "yellow magic" we developed to replace our lost supply of quinine; the sulfa drugs to which so many fighting men and civilians owe their lives; the tremendous output of vitamins and the improvement of these preparations, and the methods of preparing and handling blood plasma, which has actually saved the lives of countless numbers of our fighting men.
The story of the production of penicillin is almost as dramatic and exciting as the healing wonders of the drug itself. A couple of years ago penicillin was little more than another unpronounceable name to most of us, until its life-saving qualities were revealed in the Coconut Grove fire disaster in Boston, when the supply was virtually nil.
Today there are 19 plants in the United States and two in Canada—built at a cost of $20,000,000—producing penicillin at a rate twenty thousands times greater than a year or so ago. And the cost has been reduced by 85 per cent. The monthly rate of production is increasing today at such a pace that it probably will be doubled by the end of this year.
However, only 15 per cent is allocated for civilian use. But even with that limited amount available, penicillin has effected astounding recoveries from pneumonia, venereal diseases and other virulent infections.
Here, for example, is a recent report of progress on penicillin as reported in a recent issue of the "American Professional Pharmacist":
"The formation and experimental use of penicillin aerosols is reported in Science by Bryson, Sansome and Laskin. Penicillin aerosols penetrate into the lungs and diffuse into the blood stream, and their use appears feasible in the treatment of infections of the respiratory tract, particularly those caused by pneumococci, staphylococci and streptococci. Administration is by means of a nebulizer.
"Cashell and Willoughby, in British Medical Journal, report the efficacious use of penicillin in ocular infections. Successfully treated were such conditions as acute infections and perforating wounds of the eye, acute conjunctivitis, and dacryocystitis.
"Rosenberg and Sylvester report in Science that within from 60 to 140 minutes penicillin was found in the spinal fluid of eight subjects suffering from meningitis to whom 20,000 to 40,000 Oxford units of penicillin has been administered intravenously or intramuscularly.
"This would indicate that adequate doses of the drug administered in these two fashions may be effective in the treatment of this disease without supplemental intrathecal therapy.
"Thirty of 31 patients suffering from cerebrosinal fever recovered after the administration of penicillin, as reported by Rosenberg and Arling, in U. S. Naval Med. Bull"
You can well imagine what a boon to public health this one drug will be when the war is over and the entire ouput can be devoted to civilian use.
A year ago penicillin cost about $20 per hundred thousand units. That would amount to about $150,000 a pound. Today the average cost to civilians is about $4.50 per hundred thousand units. A very little penicillin goes a long way in the treatment of disease and the cost of it ranges from about $5 for enough to cure a venereal disease to $35
for a severe case of septicemia. The record of penicillin production is so remarkable that Mr. Fred Stock, chief of the drug branch of the WPB Chemical Bureau said:
"The drug manufacturers, by their splendid cooperation and the mobilization of their entire organizations, put the production program over in months rather than in years."
The story of atabrine is almost as thrilling as that of penicillin. It is so compelling and dramatic a story that atabrine is often referred to as "yellow magic." When the Japs seized the Dutch East Indies, our supply of quinine was cut off just at a time when we needed it most as a preventative and cure for malaria for our men fighting in the tropics where, as you know, malaria is rampant. About 3,000,000 humans are killed each year by malaria most of them in the very regions where today hundreds of thousands of American men are fighting—and where the war against Japan must be fought to a finish. Thanks to atabrine, our men are now receiving anti-malarial protection.
As in so many other cases, atabrine, the American-developed substitute for quinine, has been found far more effective than the original product. A ton of quinine is sufficient to treat between 30,000 and 100,000 cases of malaria—a ton of atabrine is enough for 600,000 cases and the treatment is reported to be far more effective than in the case of quinine. And this is most important—Atabrine production has been increased by eight thousand per cent in two years' time and is literally being turned out by the ton. That's why our malaria casualties are being held to a minimum in tropical regions where it always has taken a terrific toll of lives.
Another proud accomplishment of the American drug industry and pharmacy is the method of processing and delivering blood plasma, the life-giving substance that has saved countless American lives on the battlefields. Less than three years ago, the government gave the drug industry the first contract for production of blood plasma, an insignificant $175,000 order. Since then purchases have run into the millions of dollars! The only limitations on increased production are the number of persons on the home front who will come forward and donate their blood.
Another problem solved by the close working cooperation of the drug industry and the profession of pharmacy was a shortage of vitamins, which threatened to develop as a result of their increased use by war workers and others on the home front. The government supplied high priority ratings for the essential ingredients of vitamin preparations and now these products are being turned out in sufficient quantities to counteract diet deficiencies of both fighting forces and civilians and to help supply the energy needed by our people for sustenance of morale and physical vigor. It is a significant fact that one out of every three drugstore customers purchases vitamins in one form or another. The total sales to civilians alone exceed two hundred million dollars a year, and many medical men say that field has barely been touched.
The profession of pharmacy—in spite of the severe drain on its numbers by the armed services—not only has helped the drug industry in this big job, but has also performed an equally difficult role in protecting public health at home in keeping with its high professional and ethical status. Although we lost more than 14,000 pharmacists to the armed forces, the number of prescriptions we filled throughout the country increased from about 225,000,000 a year to more than 255,000,000—graphically demonstrating the importance of the pharmacist as partner-consultant to the doctor. Just as there has been an inadequate number of doctors left at home and forced to work day and night to meet the emergency of war, so have the pharmacists of the nation toiled long hours compounding and filling prescriptions so that public health would not suffer. As an illustration—through close work between the drug industry, the profession of pharmacy and the government, we are seeing to it that the 600,000 diabetes sufferers in the United States get their daily supplies of insulin without fail. Truly, the needs of none have been overlooked in spite of the heavy demands of war.
And with all of these extra demands, retail pharmacists have still managed to participate in a number of patriotic undertakings, such as the various salvage campaigns, and the sales of millions of dollars worth of war bonds and stamps. And then in the recent campaign to recruit sixty thousand young women for the United States Cadet Nurse Corps, the drugstores of the country—at the specific request of Dr. Thomas Parran, our surgeon general, who thought that pharmacies as community health centers, would be logical for the purpose—have served as information centers for prospective young nurses. The campaign was a big success.
There have been numerous cases of self-sacrifice and outright heroism by individual pharmacists. At the Boston Coconut Grove fire disaster, for instance, the pharmacists of that vicinity with characteristic devotion to duty remained at their posts throughout that tragic night and the following day, without hope of reward, to keep down the heavy death toll. During this past summer Philip Jaivin of Hartford, Conn., whose store stands a block from the scene of the tragic circus fire in which more than 150 persons lost their lives, became a hero to his town when he quickly transformed his pharmacy into a first-aid station and set himself and an assistant to the task of treating and bandaging victims before sending them on to their doctors. A half hundred men, women and children were saved from pain and shock by this pharmacist who gave freely of medical supplies without thought of remuneration.
Similar scenes involving pharmacists occurred at the Coney Island fire in New York and a day later at the Pali-sides Park fire in New Jersey. In both cases the nearby pharmacists helped to reduce the toll by turning their places into first-aid stations.
Among the 14,000 or more pharmacists in the armed services cases of heroism have been classics of the war, at least one of them forming the basis for a motion picture. The whole country was thrilled early in the war by the story of how Pharmacist's Mate Wheeler Lipes of Upper Darby, Pa., saved the life of a fellow seaman aboard a submarine deep in Japanese waters by operating on him for appendicitis, using bent spoons as retractors, a tea-strainer for an ether mask, and alcohol from a torpedo as disinfectant. Pharmacist's Mate Harry R. Roby of Salt Lake City performed a similar operation on a submarine in enemy waters, using a rubber band to hold the incision open and removing the appendix with a pair of long-nosed pliers borrowed from the engine room. There were several other like cases.
On the invasion beachheads on both sides of the world there have been countless cases of life-saving by pharmacists under perilous conditions. High decorations and citations have been conferred on many of these heroes. They come from all over the country—John X. Balog of Stamford, Conn., for rescue work in the Philippines; Karl B. Coleman of McAndrews, Kentucky, Griffin H. Kerfer of Philadelphia, Jay A. Brown of Cleveland, John W. Fletcher of Lima, Ohio—all heroes of Guadalcanal; Alfred W. Cleveland of Portsmouth, Massachusetts; William D. Kincannon of Riverside, California, and Thaddeus Parker of Riverside, Florida—the list goes on and on and includes almost every state in the Union. It is a record of which the profession of Pharmacy will always be proud.
In the midst of all these war-time services, pharmacists throughout the country have been active in an effort to reduce home front casualties. Some surprising figures show the need for this service. In the 18 months following Pearl Harbor, total war front casualties of the United States were 72,233—killed, wounded, captured or missing. In the same period the civilian casualty list, in home, factory and street, totalled 14,089,700—killed and wounded—representing a little more than one-tenth of our population—and in that time there were 34,056,000 cases of illness of a week or more duration. Altogether, there are 100,000,000 cases of illness in the United States each year, according to best available estimates. That gives you an idea of the immensity of the public health responsibility of the pharmacists and drug manufacturers in their cooperation with the medical profession. As part of this casualty-reducing campaign, the pharmacists are listing the symptoms of various common ailments and encouraging the people to see their doctors before more serious illness results.
The public service rendered by the pharmacists will not end when the war is won—their's has always been a never-ending battle to preserve the health of every community. in close cooperation with the doctors. In the postwar period almost limitless opportunities will be open in the field of public health. It is likely that many of the countries which heretofore supplied us with raw drugs will themselves look to us for supplies of the substitutes we have developed to a point of effectiveness greater than their own original products.
Atabrine, replacing quinine, is a notable illustration. It is predicted that sections of the Orient where malaria is rampant—and where we previously obtained our anti-malarial quinine—will depend heavily on us for their supply of atabrine. The World's needs of anti-malarial medicines have never been met. And much of the rest of the world is already looking to North America to supply it with the almost-miraculous penicillin, the sulfa drugs, the vitamin preparations and many other American-developed health-giving agents.
The end of the war naturally will result in important demands upon the profession of pharmacy and the drug industry in connection with the rehabilitation of our war veterans and the health programs in war-ravaged countries abroad. For that reason pharmacy offers one of the richest opportunities for high-caliber young people who are seeking a professional career of service. The war has reduced our ranks and decreased the stream of necessary replacements. In addition there are increasing calls for pharmacists for rapidly-expanding allied fields. New members joining the profession will find important work awaiting them. They'll be called on to use their careful training with foresight and recognition of the world's health needs to aid importantly in the many problems of reconversion after the war. The profession of pharmacy and the drug industry together look forward eagerly to a greater future of service in the light of brilliant research and important new discoveries in therapeutic agents. And as in the past, we are ready and anxious to. receive additional responsibilities which will provide greater opportunities for us to continue our important work in the interests of the Nation's health.