"A startling new chemotherapeutic agent": Pediatric infectious disease and the introduction of sulfonamides at Baltimore's Sydenham Hospital

Bulletin of the History of Medicine

Volumn 86, Issue 1, 2012, Pages 66-93

  Connolly, Cynthia ^a   Golden, Janet ^b   Schneider, Benjamin ^c  

^a UNIVERSITY OF PENNSYLVANIA SCHOOL OF NURSING   (United States)

^b RUTGERS UNIVERSITY   (United States)

^c UNIVERSITY OF PENNSYLVANIA   (United States)

Author keywords

Meningitis; Pediatrics; Pneumonia; Sulfonamides

Indexed keywords

EID: 84859951818     PISSN: 00075140     EISSN: None     Source Type: Journal    
DOI: 10.1353/bhm.2012.0014     Document Type: Article

References (200)

1. On the history and historiography of infectious disease treatment (serum, sulfonamides, and penicillin), see Scott H. Podolsky, Pneumonia before Antibiotics: Therapeutic Evolution and Evaluation in Twentieth-Century America (Baltimore: Johns Hopkins University Press, 2006).
2. John E. Lesch, The First Miracle Drugs: How the Sulfa Drugs Transformed Medicine (New York: Oxford University Press, 2007).
3. Robert Bud, Penicillin: Triumph and Tragedy (Oxford: Oxford University Press, 2007).
4. A recent pharmaceutical history that is adult focused is Jeremy A. Greene, Prescribing by Numbers: Drugs and the Definition of Disease (Baltimore: Johns Hopkins University Press, 2007).
5. On the history of children's health and the rise of infectious disease treatment, see Thomas E. Cone, Jr., History of American Pediatrics (Boston: Little, Brown, 1979), 201-28.
6. and Janet Golden, Richard A. Meckel, and Heather Munro Prescott, eds., Children and Youth in Sickness and Health: A Historical Handbook and Guide (Westport, Conn.: Greenwood, 2004).
7. There are, of course, numerous accounts of specific pediatric illnesses and of pediatric hospitals.
8. We are not asserting that new treatments are better, nor do we claim that the persistence of therapies is evidence of their efficacy.
9. On this point, see, e.g., Gerald N. Grob and Allan V. Horwitz, Diagnosis, Therapy, and Evidence: Conundrums in Modern American Medicine (New Brunswick, N.J.: Rutgers University Press, 2010).
10. Data from Sydenham can be found in the Annual Reports of the Department of Health, Baltimore, Maryland. Calculations of most common diagnoses are based on those reports. All medical record numbers have been coded to protect patient privacy.
11. Finding Aid, Sydenham Hospital, http://oculus.nlm.nih.gov/cgi/f/findaid/findaididx?c=nlmfindaid;id=navbarbrowselink;cginame=findaid-idx;cc=nlmfindaid;view=reslist;subview=standard;didno=sydenham.
12. For a discussion of race, medicine, and blood diseases, see Keith Wailoo, Drawing Blood: Technology and Disease Identity in Twentieth-Century America (Baltimore: Johns Hopkins University Press, 1997).
13. For an overview of clinicians' understanding of sickle cell disease in this era, see Keith Wailoo, Dying in the City of the Blues: Sickle Cell Anemia and the Politics of Race and Health (Chapel Hill: University of North Carolina Press, 2001).
14. We are not arguing that racial disparities did not exist in Baltimore, only about treatment. Finally, although there is no evidence that Sydenham doctors chose therapies based on race, there has been research that suggests the use of the sulfonamides diffused more slowly to the black population.
15. See Seema Jayachandran, Adriana Lleras-Muney, and Kimberly V. Smith, "Modern Medicine and the 20th Century Decline in Mortality: Evidence on the Impact of Sulfa Drugs" (Working Paper No. 15089, National Bureau of Economic Research, June 2009), http://www.nber.org/papers/w15089 (accessed March 30, 2011).
16. During the second decade of the twentieth century, for example, whooping cough (pertussis) mortality was three to six times higher in Baltimore's black infants than white infants.
17. Samuel K. Roberts, Infectious Fear: Politics, Disease and the Health Effects of Segregation (Chapel Hill: University of North Carolina Press, 2009), 69.
18. Also in the 1920s, patients could choose to be followed by their private physicians.
19. Harry F. Dowling, "Politics, Medical Education and the Control of Contagious Diseases: Sydenham Hospital of Baltimore," J. Hist. Med. & Allied Sci. 40 (1985): 5-21.
20. "Baltimore's Sydenham Service for Hospital Care of Communicable Diseases, 1909-1924-1949," Baltimore Health News 24 (1939): 147-56.
21. and Harry Haller, "Sydenham Checks Two Scourges," Baltimore Sun, August 6, 1939, TM2.
22. Russell Viner and Janet Golden, "Children's Experiences of Illness," in Medicine in the 20th Century, ed. Roger Cooter and John Pickstone (Amsterdam: Harwood, 2000), 575-87.
23. Case 25271, box 10, Sydenham Hospital, Baltimore Records, 1909-1962, National Library of Medicine, Bethesda, Md. (hereinafter Sydenham Records).
24. Kenneth Blackfan, "The Treatment of Meningococcus Meningitis," in Medicine: Analytical Reviews of General Medicine, Neurology and Pediatrics, ed. David L. Edsall, John Howland, and Paul D. White (Baltimore: Williams and Wilkins, 1922), 139-212, here 147-51.
25. Julius H. Hess, "The Present Status of Serum Therapy in Pediatrics," N. O. Med. & Surg. J. 90 (1937): 134-42.
26. Hattie E. Alexander, "Treatment of Haemophilus Influenzae Infections and of Meningococcic and Pneumococcic Meningitis," Amer. J. Dis. Child. 66 (1943): 172-87.
27. On the use of serum in diphtheria control, see Evelynn Hammonds, Childhood's Deadly Scourge: The Campaign to Control Diphtheria in New York City, 1880-1930 (Baltimore: Johns Hopkins University Press, 1999).
28. For an example of a case of fatal serum reaction in a pediatric patient see case 973, Babies Hospital Case Histories, 1932-1955, Archives and Special Collections, Columbia University Medical Center, Columbia University (hereinafter Columbia Archives).
29. J. P. Crozer Griffith and A. Graeme Mitchell, The Diseases of Infants and Children, 3rd ed. (Philadelphia: W.B. Saunders, 1933), 176.
30. See also Isaac A. Abt, Baby Doctor (New York: McGraw-Hill, 1944), 117.
31. Waldo E. Nelson, "On the Changing Patterns of Pediatric Practice," Acta Paediatrica 56, Suppl. S173 (1967): 170-76.
32. Charles A. Janeway to Estes Kefauver, July 23, 1962, box 62, folder 13, Helen Taussig Papers, Alan Mason Chesney Archives of the Johns Hopkins Medical Institutions, Baltimore, Md. (hereinafter Chesney Archives).
33. Harry Marks, The Progress of Experiment: Science and Therapeutic Reform in the United States, 1900-1990 (Cambridge, UK: Cambridge University Press, 1997), 20.
34. James Harvey Young, "'Even to a Suckling Infant': Nostrums and Children," Trans. Stud. Coll. Physicians Philadelphia 1 (1979): 5-32.
35. James Harvey Young, Pure Food: Securing the Federal Food and Drugs Act of 1906 (Princeton, N.J.: Princeton University Press, 1989).
36. James Harvey Young, The Toadstool Millionaires: A Social History of Patent Medicines in America before Federal Regulation (Princeton, N.J.: Princeton University Press, 1961).
37. W. Steven Pray, A History of Nonprescription Product Regulation (Binghamton, N.Y.: Pharmaceutical Products Press, 2003), 84.
38. Abraham Jacobi, Report on the Clinic for Diseases of Children, Held in the New York Medical College, Session 1860-61 (New York: Ballière, 1861),
39. as cited in Russell Viner, "Abraham Jacobi and German Medical Radicalism in Antebellum New York," Bull. Hist. Med. 72 (1998): 434-63, quotation on 457.
40. Griffith and Mitchell, Diseases of Infants and Children (n. 11), 179.
41. For a history of pediatric dosing schemas, see Horatio C. Wood, "The Origin of Young's Rule," J. Amer. Pharm. Assoc. 8 (1947): 36-39.
42. The historiography of pharmaceuticals has devoted little attention to pediatric issues. There are recent well-regarded studies that trace the changing role of pharmaceuticals in American society, but typically children are mentioned only in passing, usually as having spurred new legislation or an investigation of some kind.
43. Although the articles in Andrea Tone and Elizabeth Siegel Watkins, eds., Medicating Modern America: Prescription Drugs in History (New York: New York University Press, 2007), include one case study of a pediatric drug, Ritalin, the focus is almost exclusively on advertising.
44. James Harvey Young studied soothing syrups and their role in the passage of the 1906 law, but his work did not engage with children and pharmacotherapeutics more broadly, nor did he focus on the antibiotic era and beyond.
45. James Harvey Young, "'Suckling Infant'" (n. 13), 5-32.
46. Edwards A. Park, John W. Littlefield, Henry M. Seidel, and Lawrence S. Wissow, The Harriet Lane Home: A Model and a Gem (Baltimore: Department of Pediatrics, School of Medicine, Johns Hopkins University, 2006), 62, 69, 236.
47. "History of the Harriet Lane Home, Presented by Edwards A. Park, May 14 1964" (Washington, D.C.: National Library of Medicine).
48. Francis F. Schwentker (obituary), Pediatrics 16 (1955): 132-34.
49. Johns Hopkins pediatrician Edwards A. Park actively promoted Schwentker for the position and did the same for his successor Horace Hodes.
50. See Letter from Edwards A. Park to Myron G. Tull, June 21, 1934.
51. Letter from Edwards A. Park to Huntington Williams, June 21, 1934.
52. Letter from Edwards A. Park to Huntington Williams, December 29, 1935, box 81 Sydenham Records; "Horace Hodes, a Pediatrician, 81.
53. "Linked Virus to Gastroenteritis" (obituary), New York Times, April 25, 1989, B10.
54. Lennie Washington and B. Lee Ligon, "Margaret H.D. Smith, MD: Researcher, Teacher, and Pioneer in Treating Tuberculosis and Other Infectious Diseases," Semin. Pediatr. Infect. Dis. 10 (1999): 258-68.
55. The overlapping research and training programs at Sydenham and Harriet Lane Home can be seen in the correspondence of Edwards A. Park and Rustin McIntosh of the Babies Hospital, New York.
56. See Letter from Edwards A. Park to Rustin McIntosh, June 13, 1941, and Letter from Edwards A. Park to Rustin McIntosh, January 4, 1943, folder 6, box 5, and Letter from Edwards A. Park to Rustin McIntosh, March 17, 1945, folder 7, box 5, Rustin McIntosh Papers, 1917-86, Columbia Archives.
57. A. McGehee Harvey, "The Story of Chemotherapy at Johns Hopkins: Perrin H. Long, Eleanor A. Bliss, and E. Kennerly Marshall, Jr.," Johns Hopkins Med J. 138 (1976): 390-400.
58. Perrin H. Long and Eleanor A. Bliss, "Para-Amino-Benzene-Sulfonamide and Its Derivatives: Experimental and Clinical Observations on Their Use in the Treatment of Betahemolytic Streptococcic Infection: A Preliminary Report," J. Amer. Med. Assoc. 108 (1937): 32-37.
59. For sulfa and childbed fever, see Lesch, Miracle Drugs (n. 1), 88-89.
60. Francis F. Schwentker, Freeman P. Clason, William A. Morgan, Janvier W. Lindsay, and Perrin H. Long, "Use of Para-Amino-Benze-Sulphonamide or Its Derivatives in Treatment of Beta Haemolytic Streptococcal Meningitis," Bull. Johns Hopkins Hosp. 60 (1937): 297-306.
61. The collaboration modeled by academicians such as Long, Bliss, and the pharmaceutical industry would become a common framework for the development of drugs in the postwar era.
62. For more, see Dominique A. Tobbell, "Allied against Reform: Pharmaceutical Industry-Academic Physician Relations in the United States, 1945-1970," Bull. Hist. Med. 82 (2008): 878-912.
63. Marshall became known for his pioneering work in renal physiology and pharmacokinetics. He grew interested in therapeutic medicinal chemistry during World War I when he worked on mustard gas during his tenure in the Chemical Warfare Service in Washington, D.C. He received a Ph.D. in chemistry and an M.D. from the Johns Hopkins University and was chair of the new Department of Pharmacology and Pharmacokinetics from 1932 until 1955.
64. Marcel H. Bickel, "Eli K. Marshall, Jr. (1889-1966): From Biochemistry and Physiology to Pharmacology and Pharmacokinetics," Drug Metab. Rev. 28 (1996): 311-44.
65. and Eli K. Marshall, "Autobiographical Notes and Assessment of Scientific Work," 1952, typed transcript in Chesney Archives.
66. Robert M. Kliegman et al., Nelson Textbook of Pediatrics, 18th ed. (Philadelphia: W.B. Saunders, 2007).
67. and Morton N. Swartz, "Bacterial Meningitis-A View of the Past 90 Years," New Eng. J. Med. 351 (2004): 1826-28.
68. Blackfan, "Treatment of Meningococcus Meningitis" (n. 10), 208.
69. The treatment protocol is detailed in Memorandum from Francis F. Schwentker, July 1, 1936, box 81, Sydenham Records. See also Minutes of the Staff Meeting, Sydenham Hospital, October 17, 1935, box 81, which notes the similarity in mortality rates at Sydenham and Harriet Lane Home; and Letter to Huntington Williams from Myron G. Tull, May 22, 1935, box 81, Sydenham Records. Some clinicians also practiced "substitution" therapy, meaning they withdrew infected cerebrospinal fluid via lumbar puncture and injected varying amounts of therapeutic serum, hoping to reduce cerebrospinal fluid pressure.
70. George M. Lyon, "Serum Therapy in Meningococcus Meningitis," Amer. J. Dis. Child. 43 (1932): 572-76.
71. There was controversy about this approach, and it does not appear to have been employed at Sydenham.
72. Harvey, "Story of Chemotherapy" (n. 20), 390-400.
73. Frances F. Schwentker, "The Uses of Sulfonilmide in the Treatment of Infections," Med. Clin. N. Amer. 21 (1937): 1449-60, quotation on 1449.
74. Frances F. Schwentker, Sidney Gelman, and Perrin H. Long, "The Treatment of Meningococcic Meningitis with Sulfanilamide," J. Amer. Med. Assoc. 108 (1937): 1407-8.
75. see also Gilbert B. Forbes and Grace M. Forbes, "A Historical Note on Chemotherapy of Bacterial Infections," Amer. J. Dis. Child. 119 (1970): 6-11, here 6-8.
76. By the middle of the 1930s, parents signed a consent form upon their child's admission to Sydenham that was presumed to permit all therapeutic interventions physicians considered appropriate. This was standard practice and not considered unethical, although it is clear that experiments were taking place. We plan to address pediatric sulfonamide experimentation in a future publication.
77. The pace of change from serum, to serum and sulfa in combination, and then to sulfa only is not clearly documented for the years 1937 to 1940. By 1941, however, the annual report noted, "All cases of meningococcus meningitis received one of the several sulfonamides but anti-meningocococcus serum was not used."
78. City of Baltimore, "One Hundred and Twenty-Seventh Annual Report of the Department of Health" (Baltimore: Health Department, 1941), 121.
79. Schwentker, "The Uses of Sulfanilamide in the Treatment of Infections" (n. 26).
80. and Frances F. Schwentker and Sidney Gelman, "Sulfanilamide Rash," Bull. Johns Hopkins Hosp. 61 (1937): 136-39, here 138-39.
81. Letter from Francis F. Schwentker to Huntington Williams, July 1, 1936, box 81, Sydenham Records; and City of Baltimore, "One Hundred and Twenty-Fifth Annual Report" (Baltimore: Health Department, 1932), 31-32.
82. Letter from Francis F. Schwentker to Huntington Williams, July 1, 1936, box 81, Sydenham Records. Within the first ten months of its inauguration, the laboratory examined 14,176 specimens.
83. See Memo from Francis F. Schwentker to Huntington Williams, June 30, 1936, box 81, Sydenham Records. According to the American Academy of Pediatrics' Committee on Hospitals and Dispensaries, Schwentker's efforts with regard to the laboratory made Sydenham an exception in the world of infectious disease hospitals.
84. "Report of the Committee on Hospitals and Dispensaries: A Review and Summary of the Reports on Contagious Disease Hosptials in the United States and Canada," J. Pediatr. 10 (1937): 136-42.
85. We draw on the recent work of Steve Sturdy, who argues that the division between bench and bedside has been overdrawn.
86. Steve Sturdy, "Looking for Trouble: Medical Science and Clinical Practice in the Historiography of Modern Medicine," Soc. Hist. Med. 24 (2011): 1-19 (pagination for advanced access article).
87. When Sydenham became affiliated with Johns Hopkins, the departments of both pediatrics and medicine came under the control of the Johns Hopkins University School of Medicine. Letter from Edwards A. Park to Rustin McIntosh March 17, 1945, box 5, folder 7, Rustin McIntosh Papers 1917-86, Columbia Archives. At that juncture, Sydenham became a place where there was consensus about the importance of research and its mission became much more deliberately and consciously like that of Johns Hopkins.
88. Horace L. Hodes and Paul S. Strong, "The Treatment of Meningococcic Meningitis with Sulfonamides," J. Amer. Med. Assoc. 119 (1942): 691-94.
89. City of Baltimore, "One Hundred and Twenty-Seventh Annual Report" (n. 27), 28.
90. and City of Baltimore, "One Hundred and Twenty-Eighth Annual Report" (Baltimore: Health Department, 1942), 30.
91. The annual reports show new sulfa drugs were introduced very quickly: 1936 para-amino-benzene-sulfonamide, 1937 sulfanilamide, 1938 sulfapyridine, 1939 sulfathiazole, 1941 sulfadiazine, 1943 sulfapyrazine. In addition to the drugs, other changes to clinical practice may also have been at work, including better fluid and electrolyte management, more aggressive rehydration, and the more liberal use of oxygen to treat hypoxia.
92. Schwentker and Gelman, "Sulfanilamide Rash" (n. 27), 138-39.
93. A meningitis outbreak that occurred at the end of 1942 and continued into 1943 gave physicians the "opportunity" to examine yet another new sulfonamide: sulfapyrazine. This became the drug of choice at Sydenham for the treatment of meningitis.
94. City of Baltimore, "One Hundred and Thirtieth Annual Report" (Baltimore: Health Department, 1943), 28.
95. With the introduction of new sulfa compounds, pediatric clinicians began to work out toxicity, dosing, and administration and to assess side effects.
96. See, e.g., "Proceedings, Eleventh Annual Meeting of the American Academy of Pediatrics, Round Table Discussion on Chemotherapy," J. Pediatr. 21 (1942): 805-18.
97. For another discussion of dosing and the treatment of twelve cases at the St. Louis Children's Hospital, see Merl J. Carson and Alexis Hartmann, "Diagnosis and Management of Severe Infections in Infants and Children: A Review of Experiences since the Introduction of Sulfonamide Therapy," J. Pediatr. 29 (1946): 183-88.
98. Case 42005, box 44, Sydenham Records.
99. Sydenham staff members and other area physicians received direct instruction about the pharmacology of sulfanilamide from Johns Hopkins pharmacologist E. K. Marshall, Jr. at a Sydenham Hospital staff meeting in October 1937. Minutes of the Twelfth Sydenham Hospital Staff Meeting, October 12, 1937, box 81, Sydenham Records.
100. On Marshall's role in chemotherapy and bacteriology, see Bickel, "Eli K. Marshall" (n. 21), 311-44.
101. Hodes and Strong, "Treatment of Meningococcic Meningitis" (n. 30), 691-94, quotation on 694.
102. Case 39792, box 36, Sydenham Records.
103. Letter from Horace L. Hodes to Huntington Williams, June 16, 1941, box 81, Sydenham Records.
104. Hodes and Strong, "Treatment of Meningococcic Meningitis" (n. 30), 691-94.
105. and Benjamin W. Carey, Jr., "The Use of Para-Aminobenzenesulfonamide and Its Derivatives in the Treatment of Infections Due to the â Streptococcus Hemolyticus of the Meningococcus and the Gonococcus: Report of 38 Cases," J. Pediatr. 11 (1937): 202-11.
106. Rustin McIntosh, Daniel A. Wilcox, and F. Howell Wright, "Results of Sulfanilamide Treatment at Babies Hospital, New York City: A Survey of 58 Cases Observed Prior to June 10, 1937," J. Pediatr. 11 (1937): 167-82.
107. Julius M. Waghelstein, "Sulfanilamide in the Treatment of 106 Patients with Meningococcic Infection," J. Amer. Med. Assoc. 111 (1938): 2172-74.
108. Gilbert B. Forbes, Anne Perley, and Jean Dehlinger, "The Use of Sulfamerazine in Infants and Children," J. Pediatr. 28 (1946): 24-36.
109. Stella Goostray, "Nursing Care in Cerebrospinal Meningitis," Amer. J. Nursing 27 (1927): 252-54.
110. E. J. Anderson and Martha L. Reidel, "An Epidemic of Meningitis," Amer. J. Nursing 30 (1930): 381-87.
111. Mildred Struve, "Epidemic Meningitis," Amer. J. Nursing 36 (1936): 111-18.
112. and Yvonne Bost, "Epidemic Meningitis," Amer. J. Nursing 38 (1938): 87-91.
113. On administration of the sulfonamides, see Perrin H. Long, "Sulfanilamide and Its Derivatives: The Nurse's Responsibility Toward the Patient Who Is Receiving," Amer. J. Nursing 39 (1939): 719-27.
114. Henry S. Christian, Gilbert M. Jorgensen, and Catherine Ellis, "Treatment of Pneumococcic Infections in Children with Sulfapyridine," Amer. J. Dis. Child. 59 (1940): 1-18.
115. Margene O. Faddis, "New Drugs," Amer. J. Nursing 41 (1941): 759-63.
116. and Hendrika Vanderschuur, "Nursing Care of Patients Receiving Sulfonamides," Amer. J. Nursing 45 (1945): 39-41.
117. "Sulfa Drugs Saving 75% of Meningitis Patients," Sci. News Letter 42 (July 4, 1942): 9.
118. Waldemar Kaempffert, "The Growing Miracle of Sulfa Drugs," New York Times, July 19, 1942, SM12.
119. Carey, "The Use of Para-Aminobenzenesulfonamide and Its Derivatives" (n. 38), 202-11.
120. For other summaries of work with sulfa in pediatric cases, although not exclusively for meningococcal meningitis, see McIntosh, Wilcox, and Wright, "Results of Sulfanilamide Treatment" (n. 38).
121. Forbes, Perley, and Dehlinger, "Use of Sulfamerazine" (n. 38), 24-36.
122. and American Academy of Pediatrics, "'Roundtable' on Chemotherapy in October 1941," J Pediatr. 21 (1942): 805-18.
123. Harvey N. Vandegrift, "Experience with Sulfapyrazine in Children," J. Pediatr. 25 (1944): 386-93.
124. For more on public health nursing, see Karen Buhler-Wilkerson, "Bringing Care to the People: Lillian Wald's Legacy to Public Health Nursing," Amer. J. Pub. Health 83 (1993): 1778-86.
125. For an overview of American nursing, see Patricia D'Antonio, American Nursing: A History of Knowledge, Authority, and the Meaning of Work (Baltimore: Johns Hopkins University Press, 2010).
126. For more on the history of nurses and technology, see Margarete Sandelowski, Devices and Desires: Gender, Technology, and American Nursing (Chapel Hill: University of North Carolina Press, 2000).
127. Margaret Currie, Fever Hospitals and Fever Nurses: A British Social History of Fever Nurses: A National Service (London: Routledge, 2005).
128. Although its practitioners were not "fever nurses" per se, tuberculosis nursing was a recognized specialty, mostly because a number of tuberculosis sanatoria founded schools so that recovering patients would have work and the institution would have staff.
129. Barbara Bates, Bargaining for Life: A Social History of Tuberculosis, 1876-1938 (Philadelphia: University of Pennsylvania Press, 1992).
130. Department of Studies, National League of Nursing Education, "Find the Children!" Amer. J. Nursing 46 (1946): 124-27.
131. Myron G. Tull to Huntington Williams, August 11, 1938.
132. Anne Roebuck, City Service Commission of Baltimore Application for Examination; Roebuck CV and accompanying references; all box 81, Sydenham Records.
133. Myron G. Tull to Huntington Williams, August 24, 1936.
134. Francis F. Schwentker to Huntington Williams, December 28, 1937.
135. Myron G. Tull to Huntington Williams, September 13, 1940.
136. Horace L. Hodes to Huntington Williams, October 19, 1940.
137. and Myron G. Tull to Huntington Williams, May 23, 1940; all box 81, Sydenham Records.
138. Katharine Dodd and S. Rapoport, "Intravenous Alimentation of Infants," J. Pediatr. 29 (1946): 758-69.
139. "Sulfa Drug Saves Baby," New York Times, February 23, 1941.
140. See also "Sulfa Saves Newborn," Sci. News Letter 44, September 25, 1943, 197.
141. The military impact of sulfa drugs would gain the most media attention. See, e.g., S. R. Winters, "Pearl Harbor: A Victory for Naval Doctors," Hygeia 20 (1942): 342-43, 358, 392-93.
142. Faith in the sulfonamides led to its prophylactic use. See, e.g., David O. Woodbury, "Sulfas May Stop Winter Epidemics," Collier's 114 (December 30, 1944): 26.
143. Discussion of sulfa drugs in the British press can be found in Lesch, Miracle Drugs (n. 1), 184-93.
144. "Meningitis Fatalities Are Reduced," Baltimore Sun, April 24, 1943, 22.
145. John Price Crozer Griffith and Albert Graeme Mitchell, eds., The Diseases of Infants and Children, 2nd ed. (Philadelphia: W. B. Saunders, 1937), 308-9.
146. Waldo E. Nelson, ed., Mitchell-Nelson Textbook of Pediatrics, 4th ed. (Philadelphia: W. B. Saunders, 1945), 367.
147. This edition mentions that serum was occasionally used when patients did not respond to sulfonamide therapy.
148. "Status of Antimeningococcic Serum and Meningococcus Antitoxin," J. Amer. Med. Assoc. 124 (1944): 95.
149. Griffith and Mitchell, Diseases of Infants and Children (n. 11), 742.
150. Sophia A. Joffe, "Treatment of Pneumonia in Children," Amer. J. Nursing 31 (1931): 1402-6.
151. Jesse G. M. Bullowa and Evelyn Greenbaum, "Pneumococcic Pneumonia in Infants and Children," Amer. J. Dis. Child. 53 (1937): 22-31.
152. On the development of pneumococcal serum, see Marks, Progress of Experiment (n. 13), 60-62.
153. Camille Kereszturi and David Hauptmann, "The Serum Treatment of Pneumonia in Children," J. Pediatr. 4 (1934): 331-41.
154. Roderick Heffron, Pneumonia: With Special Reference to Pneumococcus Lobar Pneumonia (New York: Commonwealth Fund, 1939), 514, 617, 703, 834-35.
155. Horace Hodes et al., "The Use of Sulfapyridine in Primary Pneumococcic Pneumonia and in Pneumococcic Pneumonia Associated with Measles," J. Pediatr. 14 (1939): 417-46.
156. Stafford McLean and Charles A. Lang, "Fluid Injections in Dehydrated Infants," Amer. J. Dis. Child. 19 (1920): 359-69.
157. Griffith and Mitchell, Diseases of Infants and Children (n. 48), 718-19.
158. Langley Porter and William E. Carter, Management of the Sick Infant and Child (St. Louis: Mosby, 1938), 579.
159. Luther E. Holt, John Howland, and Rustin McIntosh, Holt's Diseases of Infancy and Childhood: A Textbook for the Use of Students and Practitioners, 11th ed. (New York: D. Appleton-Century, 1939), 56.
160. See case 33821, box 22, Sydenham Records.
161. Sulfapyridine was the first drug to undergo FDA approval in the wake of the 1938 Federal Food, Drug, and Cosmetic Act requiring drug safety testing before sale and marketing, a law prompted in part by a disaster involving sulfanilamide. In 1937 the S. E. Massengill Company marketed "elixir sulfanilamide," a product containing the sweet-tasting but poisonous diethylene glycol, resulting in the deaths of more than one hundred people, including dozens of children who received the drug for a streptococcal infection.
162. Carol Ballentine, "Taste of Raspberries, Taste of Death: The 1937 Sulfanilamide Incident," FDA Consumer (1981): 18-21, http://www.fda.gov/AboutFDA/WhatWeDo/History/ProductRegulation/SulfanilamideDisaster/default.htm (accessed February 21, 2011).
163. and James Harvey Young, "Sulfanilamide and Diethylene Glycol," in Chemistry and Modern Society: Historical Essays in Honor of Aaron J. Ihde, ed. John Parascandola and James C. Whorton (Washington, D.C.: American Chemical Society, 1983), 105-25.
164. City of Baltimore, "One Hundred and Twenty-Fourth Annual Report" (Baltimore: Health Department, 1938).
165. and City of Baltimore, "One Hundred and Twenty-Fifth Annual Report" (Baltimore: Health Department, 1939).
166. Hodes et al., "Use of Sulfapyridine" (n. 51), 417-46, quotation on 439.
167. See also case 36901, box 28, Sydenham Records.
168. Horace L. Hodes, James F. Ziegler, and Helen D. Zepp, "Development of Antibody Following Vaccination of Infants and Children against Pneumococci," J. Pediatr. 24 (1944): 641-49, quotation on 641.
169. Podolsky, Pneumonia before Antibiotics (n. 1), 141-46.
170. Nelson, Mitchell-Nelson (n. 48), 770.
171. See, e.g., case 38460, box 32 and case 37991, box 31, Sydenham Records.
172. Henry L. Barnett et al, "The Treatment of Pneumococcic Infections in Infants and Children with Sulfapyridine," J. Amer. Med. Assoc. 112 (1939): 518-27.
173. Benjamin W. Carey, "Use of Sulfanilamide and Related Compounds in Diseases of Infancy and Childhood," J. Amer. Med. Assoc. 114 (1940): 924-29.
174. Joseph Greengard et al., "Effect of Chemotherapy on Pneumonia in Infants under One Year of Age," Amer. J. Dis. Child. 62 (1941): 730-42.
175. Maxwell Finland, "The Present Status of the Higher Types of Antipneumococcus Serums," J. Amer. Med. Assoc. 120 (1942): 1294-1307.
176. On the transition from serum to sulfa and the debate over combination therapy in adults, see Podolsky, Pneumonia before Antibiotics (n. 1), 106-14.
177. Wood, "Young's Rule" (n. 16), 36-39.
178. Christian, Jorgensen, and Ellis, "Treatment of Pneumococcic Infections" (n. 39).
179. Glenn E. Cullen and Armine T. Wilson, "Levels of Sulfapyridine in Blood of Children Following Dosage by Body Weight," Amer. J. Dis. Child. 60 (1940): 891-96.
180. and Charles A. Janeway, "The Use of the Sulfonamides in the Treatment of Respiratory Infections in Children," New Eng. J. Med. 229 (1943): 201-7.
181. Nelson, Mitchell-Nelson (n. 48), 183.
182. Case 38180, box 28, Sydenham Records.
183. Case 37981, box 31, Sydenham Records.
184. City of Baltimore, "One Hundred and Twenty-Ninth Annual Report" (Baltimore: Health Department, 1943), 28.
185. Harry F. Dowling, Fighting Infection: Conquests of the Twentieth Century (Cambridge, Mass.: Harvard University Press, 1977), 138.
186. Lawrence Weld Smith and Ann Dolan Walker, The Penicillin Decade, 1941-1951: Sensitizations and Toxicities (Washington, D.C.: Arundel Press, 1951), 33.
187. Wailoo discusses the impact of penicillin on the way physicians visualized childhood illness and how they came to understand the conditions the underlying infectious diseases.
188. Wailoo, Dying in the City of the Blues (n. 5), 116-17.
189. Case 42525, box 41, Sydenham Records; Waldo E. Nelson, ed., Textbook of Pediatrics, 7th ed. (Philadelphia: W. B. Saunders, 1959), 222.
190. City of Baltimore, "One Hundred and Thirtieth Annual Report" (n. 32), 23.
191. Dowling, Fighting Infection (n. 65), 137-39.
192. George S. Husson, "Oral Penicillin in Infants," J. Pediatr. 31 (1947): 651-57.
193. Smith and Walker, Penicillin Decade (n. 66), 34.
194. Henry A. Reisman, Arthur A. Goldfarb, and Molly Molloy, "Oral Administration of Penicillin in Pediatrics," Amer. J. Dis. Child. 74 (1947): 19-31.
195. The adoption of penicillin and subsequent antibiotics led to the demise of the infectious disease hospital as a distinct institution. Sydenham closed in 1949. Children with infectious disease in Baltimore, as elsewhere, received treatment in general or pediatric hospitals, or at home.
196. Dowling, "Politics, Medical Education and the Control of Contagious Diseases" (n. 7), 5-21.
197. Margaret H. D. Smith, "Review Article: Acute Bacterial Meningitis," Pediatrics 17 (1956): 258-77, quotation on 267.
198. and Nelson, Mitchell-Nelson (n. 48), 367-68.
199. Nelson, Textbook of Pediatrics (n. 67), 787-92.
200. For more on therapeutic standardization, see Marks, Progress of Experiment (n. 13).