Introduction:
The Promise of the Art
I remember how it was before penicillin. I was a medical student at the
end of World War II, before the drug became widely available for civil-
ian use, and I watched the wards at New York's Bellevue Hospital fill to
overflowing each winter. A veritable Byzantine city unto itself, Bellevue
sprawled over four city blocks, its smelly, antiquated buildings jammed
together at odd angles and interconnected by a rabbit warren of under-
ground tunnels. In wartime New York, swollen with workers, sailors,
soldiers, drunks, refugees, and their diseases from all over the world, it
was perhaps the place to get an all-inclusive medical education. Belle-
vue's charter decreed that, no matter how full it was, every patient who
needed hospitalization had to be admitted. As a result, beds were packed
together side by side, first in the aisles, then out into the corridor. A
ward was closed only when it was physically impossible to get another
bed out of the elevator.
Most of these patients had lobar (pneumococcal) pneumonia. It didn't
take long to develop; the bacteria multiplied unchecked, spilling over
from the lungs into the bloodstream, and within three to five days of the
first symptom the crisis came. The fever rose to 104 or 105 degrees
Fahrenheit and delirium set in. At that point we had two signs to go by:
If the skin remained hot and dry, the victim would die; sweating meant
the patient would pull through. Although sulfa drugs often were effec-
tive against the milder pneumonias, the outcome in severe lobar pneu-
monia still depended solely on the struggle between the infection and