Medications in WWII: Part 3/3

Today is Sarah's final post on medications used during WWII. I think this has been a fantastic overview for any historical writer. Thank you, Sarah, for all your hard work.

Medications in World War II (Part 3)

Illness and injuries are a great way to build conflict and drama in your novel—but they’re hard on your characters. Be a nice author and learn how to treat them properly. In my World War II novels, A Distant Melody, A Memory Between Us and Blue Skies Tomorrow (coming August 2011), my characters suffer from pneumonia, combat injuries, and burns, plus the heroine in the second book was a nurse. Researching medical treatment of the time allowed me to include accurate period details.

On April 4^th  I covered the basics of medication use during the war years, and then on April 6th and today I’m reviewing categories of medications available at the time.

Infectious Disease

During World War II, the death rate among the wounded who made it to field hospitals was significantly lower than in earlier wars, due to the availability of plasma and antibiotics.

Sulfa Antibiotics

Sulfa medications were introduced in the 1930s. Those available during the war included sulfanilamide, sulfaguanidine, sulfadiazine, sulfathiazole, and sulfapyridine. Sulfas were used to treat pneumonia, dysentery, infected wounds, gonorrhea, and other infections. All soldiers carried a first aid kit containing twelve tablets of sulfanilamide as well as sulfanilamide powder. If wounded, the soldier poured the powder directly onto the wound and started taking the tablets. This reduced the rate of wound infection significantly.

Penicillin



PCN WWII Advertisement. (Credit: Schenley Laboratories, Inc., Lawrenceburg, Indiana)



Penicillin was discovered by accident in 1928 by Scottish scientist Alexander Fleming, but scant attention was paid to this discovery. In 1940, scientists isolated the compound, and on May 1, 1941, the discovery of a wondrous new antibiotic was announced. However, the complicated manufacturing process slowed production.

Penicillin was first tested in military hospitals in North Africa in April 1943 by Fleming himself, and experiments expanded to soldiers hospitalized in England in May 1943. On November 25, 1943, a new manufacturing process was announced. By December 1943, penicillin was available to Allied soldiers for life-threatening, sulfa-resistant infections, and by April 1944 was widely available in military hospitals. Civilian hospitals began to receive it in May 1944, and a new oral formulation was available in civilian pharmacies in August 1945.

Penicillin was used for a variety of infections, such as pneumonia, wound or surgical infections, and gonorrhea and syphilis.

Anti-malarials

Quinine was the drug of choice for prevention and treatment of malaria. However, the Japanese conquered the countries where quinine was produced. The US military requisitioned most of the civilian supply, but it wasn’t enough. Atabrine, a synthetic substitute, was used by the millions of military men and women serving in the Pacific or Mediterranean Theaters. Atabrine produced unpleasant side effects, including diarrhea—and it tended to turn the skin yellow. Quinine was reserved for treatment of patients who could not tolerate atabrine.

Other Antibiotics

Before penicillin was available, syphilis was treated with mapharsen or with sobisminol. Amebic infections were treated with carbarsone or chiniofon, and worm infections with arecoline, hexylresorcinol, or Santorin. A new class of antibiotics was introduced in May 1945 when streptomycin came to the market.

Resources:

US Army Medical Department Office of Medical History. http://history.amedd.army.mil (Official site with full textbooks about military hospitals and medical treatment from 1775 to present).

WW2 US Medical Research Centre. http://www.med-dept.com (A large and thorough website containing lots of information about military medicine during World War II.)

Worthen, Dennis B. Pharmacy in World War II. New York: Pharmaceutical Products Press, 2004. (A comprehensive account of pharmacy practice in the military and on the home front.)

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Sarah Sundin is the author of the Wings of Glory series from Revell: A Distant Melody (March 2010), A Memory Between Us (September 2010), and Blue Skies Tomorrow (August 2011). She has a doctorate in pharmacy from UC San Francisco and works on-call as a hospital pharmacist.

Medications in WWII: Part 2/3

Today, we're continuing with Sarah's series on medications used during WWII.

Medications in World War II (Part 2)

Illness and injuries are a great way to build conflict and drama in your novel—but they’re hard on your characters. Be a nice author and learn how to treat them properly. In my World War II novels, A Distant Melody, A Memory Between Us and Blue Skies Tomorrow (coming August 2011), my characters suffer from pneumonia, combat injuries, and burns, plus the heroine in the second book was a nurse. Researching medical treatment of the time allowed me to include accurate period details.

On April 4th I covered the basics of medication use during the war years, and then today and April 8th I’ll review categories of medications available at the time.

Pain and Fever



WarCorr/PhotoBucket

Aspirin was used for minor pain and for fever. “APC capsules” for pain were compounded by pharmacists from aspirin, phenacetin, and caffeine. Ergot and ergonavine were used for migraines, but wartime shortages affected the supply. Narcotic analgesics included morphine, apomorphine, hydromorphone (Dilaudid), and as of 1942, meperidine (Demerol). Military medics and some officers carried morphine syrettes, small tin tubes with an attached needle containing half a grain (32 mg) of morphine. On the battlefield, prompt treatment of pain decreased deaths from shock.

Cough, Cold, and Allergy

Cough syrups contained codeine or terpin hydrate with codeine. Ephedrine, phenylephrine, and phenylpropanolamine were available as nasal decongestants. Treatment of severe allergic reactions, such as anaphylactic shock, involved the use of adrenaline and morphine. Antihistamines and corticosteroids were not on the market yet.

Gastrointestinal

For nausea, sodium bicarbonate (baking soda) with or without peppermint was used. Laxatives included cascara, senna, castor oil, and mercurous chloride. Diarrhea was treated with belladonna or homatropine, but shortages of belladonna occurred due to the war.

Endocrine and Metabolic

For diabetes, insulin was available, but no oral medications. For hypothyroidism, thyroid tablets were given. Vitamins A, C, D, E, K, and the B vitamins were used, as were electrolytes such as sodium, potassium, magnesium, and calcium. IV fluids, such as dextrose 5%, normal saline, and lactated Ringer’s solution were also used.

Dermatology

Itching was treated with menthol, camphor, or calamine. Burns were treated with boric acid solution or ointments, and with petroleum jelly (Vaseline) pressure dressings.

Respiratory

Asthma attacks were treated with aminophylline, which was subject to shortages, and epinephrine (adrenaline). Ephedrine was used as a long-acting oral bronchodilator for asthma. Corticosteroids such as prednisone were not on the market yet, nor were inhalers.

Cardiovascular

Digitalis was used for congestive heart failure, amyl nitrate for chest pain, and quinidine for heart arrhythmias. Shock could be treated with adrenaline, ephedrine, or vasopressin. Heparin was used to dissolve clots, but oral anticoagulants such as warfarin were not available. For diuretics, doctors turned to theobromine and mersalyl-theophylline.

Psychiatric Medicines

Severe depression and schizophrenia were treated with electric shock therapy, or as of May 1940, insulin shock therapy. Camphor and metrazol were used for psychiatric illness, and lithium for manic-depression (bipolar disorder).

Sedatives and Stimulants

To treat anxiety or combat fatigue, various barbiturates were used, such as phenobarbital, amobarbital (Amytal), secobarbital (Seconal), and pentobarbital. These were also used for schizophrenic or manic patients when agitated. Chloral hydrate was used for sleep.

For pilots making long flights, the Army Air Force distributed Benzedrine (amphetamine) tablets and inhalers. Air crew escape kits also contained Benzedrine tablets.

Resources:

US Army Medical Department Office of Medical History. http://history.amedd.army.mil (Official site with full textbooks about military hospitals and medical treatment from 1775 to present).

WW2 US Medical Research Centre. http://www.med-dept.com (A large and thorough website containing lots of information about military medicine during World War II.)

Worthen, Dennis B. Pharmacy in World War II. New York: Pharmaceutical Products Press, 2004. (A comprehensive account of pharmacy practice in the military and on the home front.)

***********************************************************************

Sarah Sundin is the author of the Wings of Glory series from Revell: A Distant Melody (March 2010), A Memory Between Us (September 2010), and Blue Skies Tomorrow (August 2011). She has a doctorate in pharmacy from UC San Francisco and works on-call as a hospital pharmacist.

Medications in WWII: Part 1/3

I'm so pleased to have Sarah Sundin back this week. Her WWII research posts are always very popular. This week, she'll be focusing on medications used during WWII. Welcome back, Sarah!

Medications in World War II (Part 1)

Illness and injuries are a great way to build conflict and drama in your novel—but they’re hard on your characters. Be a nice author and learn how to treat them properly. In my World War II novels, A Distant Melody, A Memory Between Us and Blue Skies Tomorrow (coming August 2011), my characters suffer from pneumonia, combat injuries, and burns, plus the heroine in the second book was a nurse. Researching medical treatment of the time allows you to include accurate period details.

Today I’ll cover the basics of medication use during the war years, and then on April 6th and April 8^th  I’ll review categories of medications available at the time.

Generic vs. Brand Name

Most medications have a generic name and a brand (or proprietary) name. The generic name is not capitalized, but the brand name is. For example, Seconal (brand) and secobarbital (generic), Pitressin (brand) and vasopressin (generic). Today many medications are available from the original manufacturer and from generic manufacturers, but before 1984, most medications were manufactured by a single company. Therefore, the issue of picking a cheaper generic over a pricier brand name didn’t exist in the 1940s.

Dosage Forms

By the 1940s, more and more medications were commercially produced as pre-made tablets, but pharmacists still compounded a large percentage of prescriptions from raw ingredients. Compounded prescriptions included cough syrups, elixirs, antiseptic solutions, capsules, suppositories, powder papers, powders, creams, and ointments.

Administration



robthecubehead/PhotoBucket

Intravenous medications and fluids were used during the war years. However, our disposable, “Universal Precautions” age would seem foreign to the health care professional of the 1940s. Syringes and IV bottles were made of glass, and IV tubing and gloves out of rubber. Everything (even gloves) was cleansed and sterilized for re-use.

Measurements

Today most doses are expressed in metric units (milligrams, milliliters, etc.). In the 1940s the metric system was used to a lesser extent, and the term “cc” (cubic centimeter) was preferred over “ml” (milliliter).

In the 1940s most medications were measured in apothecary units. Weight was measured in grains (abbreviated “gr” while gram is “g”), scruples, drams, ounces, and pounds. The apothecary ounce (31.3 g) is fairly close to the avoirdupois ounce (28.4 g). For comparison purposes, one grain is approximately 65 milligrams. Therefore a five-grain tablet of aspirin is equal to 325 mg.

Fluids in the apothecary system are measured in minims, fluidrams, fluidounces, pints, quarts, and gallons. The apothecary fluidounce equals 29.6 ml.

Resources:

US Army Medical Department Office of Medical History. http://history.amedd.army.mil (Official site with full textbooks about military hospitals and medical treatment from 1775 to present).

WW2 US Medical Research Centre. http://www.med-dept.com (A large and thorough website containing lots of information about military medicine during World War II.)

Worthen, Dennis B. Pharmacy in World War II. New York: Pharmaceutical Products Press, 2004. (A comprehensive account of pharmacy practice in the military and on the home front.)

***********************************************************************

Sarah Sundin is the author of the Wings of Glory series from Revell: A Distant Melody (March 2010), A Memory Between Us (September 2010), and Blue Skies Tomorrow (August 2011). She has a doctorate in pharmacy from UC San Francisco and works on-call as a hospital pharmacist.