The Long Sepsis: A World Without Antibiotics
From The Long Sepsis, an encyclopedia of a world that didn't happen
The Long Sepsis is the name given by historians and public health writers to the continuing state of affairs, beginning in the early twentieth century, in which bacterial infection remained largely untreatable by any chemical means once established in the body. No drug after the azo drugs of the 1930s ever achieved reliable systemic bacterial kill, and medicine developed instead around avoidance, containment, and the replacement of cure by prevention. The term is retrospective; nobody living through the 1930s or 1940s used it, since they had no comparison against which their circumstances could be named. It entered common use only after the Bacillary Congress of Geneva of 1952, when delegates began referring to the preceding half-century as a single unbroken emergency.
The condition has an identifiable near-miss at its root. In 1897 the French army surgeon Ernest Duchesne (Ernest Duchesne) observed that a mold of the genus Penicillium appeared to suppress the growth of certain bacteria in culture, but his thesis was never published in a form that reached a wide readership, and his early death in 1912 ended any further work. The observation was not repeated. In 1928, the Scottish bacteriologist Alexander Fleming (Alexander Fleming) left culture plates of Staphylococcus exposed in his laboratory before a holiday; several were later found contaminated by an airborne mold, a genus whose bacterial antagonism might have been noticed by a careful eye. The plates were instead washed and discarded by a laboratory assistant as a matter of routine housekeeping, and the contamination went unremarked in any surviving notebook. No comparable observation followed for another generation, and by the time bacteriologists turned again to fungal antagonism in the 1950s, the chemical pathway that might have led to a mold-derived antibacterial had grown cold; the compounds proved difficult to isolate by the methods then in favor, and the field was by then dominated by the azo drugs and by the emerging discipline of serum pharmacology. Historians of science, notably at the Institute for the History of Bacteriology in Lyon, continue to debate whether the 1928 incident represented a true missed discovery or merely one of many contaminations that occurred routinely in unrefrigerated laboratories of the period; the surviving correspondence of Fleming's colleagues makes no mention of it at all, which some read as proof of its insignificance and others as proof that it was never examined closely enough to matter.
Through the 1930s the only systemic antibacterial agents in clinical use were the sulfonamide dyes, developed from industrial azo dye research in Germany and marketed from 1935 onward as Prontosil and its successors. These drugs saved lives against certain streptococcal infections but proved useless against the gram-negative organisms responsible for most wound and postoperative sepsis, and physicians of the period had no substitute to offer once an infection became established. Childbed fever and surgical sepsis remained near their pre-1928 levels throughout the decade, a fact recorded in the vital statistics returns of Britain, France, and the United States and later collated by the Geneva Sanitary Bureau.
The consequences became acute during the Second World War. Allied casualty registers from the Sicily and Normandy campaigns of 1943 and 1944 show rates of gangrene and fatal sepsis several times those recorded in earlier conflicts, a discrepancy that field surgeons attributed at the time to soil-borne organisms in cultivated Mediterranean and Norman farmland. The slower evacuation of wounded men, combined with the total absence of any drug capable of arresting an established wound infection, is credited by military historians with measurably slowing the tempo of both offensives; the surgeon-general's reports of the period recommend earlier and more radical amputation as the only reliable means of halting the spread of infection, a policy that left a visible mark on the veteran population of the following decades.
References
- 1.Ainsworth, Margaret, The Plates That Were Washed: Fleming and the Lost Decade (Lyon: Institute for the History of Bacteriology, 1988), pp. 40-67.
- 2.Geneva Sanitary Bureau, Comparative Vital Statistics, 1900-1955 (Geneva: Bureau Press, 1958), table 12.
- 3.Delacroix, Henri, Wound Fever at Normandy: A Surgical Reckoning (Paris: Presses Militaires, 1967), pp. 88-114.
- 4.Umezaki, Kenji, Serum and Toxin: The Making of a Method (Osaka: Kansai Medical Press, 1981), pp. 3-29.
- 5.Halloway, Constance, Minutes of the Bacillary Congress of Geneva, 1952 (Geneva: Bureau Press, 1953).