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History Part 11 : Penicillin’s Ascendancy and the Decline of Phage Therapy: Medicine at the Close of World War II (1942–1945)
Penicillin’s Ascendancy and the Decline of Phage Therapy: Medicine at the Close of World War II (1942–1945)
Introduction: A Revolution Takes Hold
In the early 1940s, the world of infectious disease treatment stood on the edge of a revolution. As World War II reached its crescendo, one compound reshaped not only battlefield medicine but the entire trajectory of 20th-century therapeutics: penicillin. Isolated in 1928 by Alexander Fleming, penicillin had remained a laboratory curiosity for more than a decade—until the pressures of global war, industrial urgency, and multinational collaboration launched it into the medical mainstream.
While bacteriophage therapy continued to be deployed in the Soviet Union and scattered across neutral or resource-constrained countries, penicillin’s dramatic success on the Western front shifted the paradigm. Between 1942 and 1945, it went from a scarce experimental substance to a mass-produced miracle drug. Its adoption marked the beginning of the antibiotic era, and with it, the gradual decline of phage therapy in most of the Western world.
Penicillin Production: From Scarcity to Scale
In 1941, penicillin was still so rare that its total global stock could not treat a single patient fully. But the war changed everything. The U.S. War Production Board, working with pharmaceutical companies like Pfizer, Merck, and Squibb, launched “Project Penicillin,” a public-private initiative to industrialize production using deep-tank fermentation.
By 1943, American factories were producing over 100 billion units of penicillin annually. Just one year later, that number surged to 649 billion units, enabling the Allied forces to deploy the antibiotic on an unprecedented scale. The cost of treatment dropped from $20 per dose in 1943 to less than $1 by the end of the war.
The British government, under the Ministry of Supply, coordinated parallel efforts through Imperial Chemical Industries (ICI) and Glaxo. These initiatives transformed penicillin into a symbol of scientific progress and Allied superiority. Winston Churchill himself, after recovering from pneumonia in 1943 with the help of sulfonamides and later penicillin, praised the drug as a "miracle of modern science."
Battlefield Breakthroughs: Penicillin on the Front Lines
The Allied invasion of Europe in 1944 became the first major military campaign in history to be accompanied by widespread antibiotic deployment. Field hospitals in Normandy and Italy received penicillin kits that treated everything from infected wounds to pneumonia and gonorrhea.
The U.S. Army Medical Department reported that penicillin reduced mortality from wound infections by over 80%, saving tens of thousands of lives. A 1945 report by the U.S. Surgeon General’s Office concluded that penicillin was the single most effective medical intervention of the war, outperforming sulfonamides and all previously available therapies.
By the end of the war, over 2.3 million Allied soldiers had received penicillin treatments. Its impact was so profound that the drug was likened to radar and the atomic bomb in strategic importance—an invisible weapon that helped secure victory.
Scientific Prestige and Industrial Capital
Penicillin’s rise was not solely due to its efficacy—it also benefited from a convergence of scientific prestige, institutional support, and economic power. The Rockefeller Foundation, which had previously invested in virology and phage research, shifted its focus toward antibiotics. Leading journals like The Lancet and JAMA prioritized antibiotic studies, while pharmaceutical giants realigned their R&D portfolios toward antibiotic synthesis and distribution.
This momentum marginalized phage therapy in Western Europe and North America. Seen as imprecise, biologically unstable, and rooted in pre-war paradigms, phage treatment lost ground in the eyes of a medical establishment now enthralled by the pharmacological predictability and scalability of antibiotics.
Moreover, the postwar reconstruction efforts gave antibiotics a prominent place in global health development. The World Health Organization, founded in 1948, embraced penicillin and its successors as part of a modern, standardized medical toolkit for developing nations. Phage therapy, lacking patentability and standardized protocols, was relegated to peripheral roles—mostly in Eastern Europe and parts of Asia.
Phage Therapy in Retreat: The Western Perspective
In France, where phage research had once flourished at the Pasteur Institute, the postwar years saw a dramatic decline. By 1946, most phage programs were shuttered, with key researchers pivoting to penicillin and streptomycin studies. In the United Kingdom, where penicillin was a point of national pride, bacteriophage work was dismissed as outdated or unreliable.
In the United States, the shift was even more pronounced. Although interest in bacteriophages persisted in some academic circles—especially in bacterial genetics and molecular biology—therapeutic phage application virtually disappeared from hospitals. The FDA never approved clinical use of phage therapy, and most physicians regarded it as an artifact of a bygone era.
Postwar Division: The Cold War Legacy
Ironically, just as phage therapy was being abandoned in the West, it became institutionalized in the East. In the Soviet Union, the Eliava Institute in Georgia expanded its programs, producing millions of phage doses annually well into the Cold War. Soviet military medicine continued to invest in phage applications, particularly for gastrointestinal diseases and wound infections.
Poland, Bulgaria, Romania, and East Germany followed suit, often with Soviet guidance. This East-West medical divide—rooted in politics as much as in science—would persist for decades. It created a situation in which two generations of clinicians grew up without exposure to phage therapy in the West, while Eastern doctors accumulated tens of thousands of case studies, often unrecognized or untranslated beyond the Iron Curtain.
Conclusion: The Cost of a Miracle
The success of penicillin was—and remains—a cornerstone of modern medicine. Its ability to cure once-lethal infections revolutionized healthcare, saved millions of lives, and sparked the development of dozens of antibiotics that would follow in its footsteps.
Yet, the singular focus on antibiotics came at a cost. In the rush to embrace the chemical age, phage therapy was largely forgotten in the West—relegated to scientific margins despite its demonstrated potential. It would take another global health crisis—the rise of antibiotic resistance in the 21st century—for the world to rediscover what wartime scientists in Tbilisi, Warsaw, and Haifa already knew: that the war against bacteria might require more than one weapon.
References :
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Bud, R. (2007). Penicillin: Triumph and Tragedy. Oxford University Press.
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U.S. War Production Board (1945). Project Penicillin Final Report. National Archives.
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Lax, E. (2004). The Mold in Dr. Florey’s Coat: The Story of the Penicillin Miracle. Henry Holt.
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Madigan, M. & Martinko, J. (2012). Brock Biology of Microorganisms. Pearson.
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Eliava Institute Historical Records, Tbilisi, Georgia (1942–1948).
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Le Fèvre, R. (1950). La Phagothérapie en Retrait: Une Évaluation Post-Guerre. Revue Médicale Française.
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Wainwright, M. (1990). Miracle Cure: The Story of Antibiotics. Blackwell Scientific.
Copyright of https://scfh.ru/en/papers/phages-attack/ /////
Pokrovskaya M. P., Kaganova, L. S., Morozenko M. A., et al. Lechenie ran bakteriofagom (Treatment of Wounds with Bacteriophage). Moscow: USSR People’s Commissariat of Public Health (Narkomzdrav), Medgiz. 1941 [in Russian].
Instruktsiya po metodam khirurgicheskogo lecheniya (Guidelines to Surgical Treatment Methods). Moscow: USSR People’s Commissariat of Public Health (Narkomzdrav), Medgiz. 1942 [in Russian].
This article uses illustration materials from the archive of NPO Microgen and from the books “Treatment of Wounds with Bacteriophage” (1941) and “Guidelines to Surgical Treatment Methods” (1942)
The editors thank B.A. Ryzhikov (NPO Microgen) for his help in preparing this article /////
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