Pneumonia Research
Maxwell Finland’s career in infectious diseases began when he became Resident Physician for Pneumonia Patients at Boston City Hospital in 1928.
During the 1920s and 1930s pneumococcal pneumonia accounted for half of the deaths at Boston City Hospital. The type specificity of pneumococci based on capsular polysaccharides had been identified and the potential value of specific antisera was under investigation. Finland was responsible for the bedside care of his patients and for identifying optimal treatment for them. Working as his own technician, he took specimens from his patients to investigate the importance of the capsule of pneumococcus.
Finland had a repository of type specific sera for diagnosis and therapy from which he identified the type causing disease and administered the homotypic sera to the patients. When house officers cared for a patient with pneumococcus identified from sputum, blood, or other body fluid, they consulted with Finland to have the organism typed and obtain type specific serum with which to treat the patient.
The mortality of untreated pneumococcal bacteremia was almost 90%; type specific serum therapy resulted in the survival of more than half the patients. Between 1930-1940 Finland published almost 100 papers, most focused on pneumococcal infections, their diagnosis and management; he became a nationally recognized authority on the treatment of pneumonia.
In 1933, Gerhard Domagk announced the discovery of Prontosil, the diazonium derivative of sulfanilamide; a new era of antimicrobial therapy had begun. Finland began testing the combined action of the new compounds with antisera. His research demonstrated that sulfonamide derivatives, and later penicillin, were more effective than antisera for the treatment of pneumonia and other infections.
The first of many papers on the treatment of pneumococcal meningitis with sulfonamides with or without type specific horse or rabbit antisera appeared in 1938 in the New England Journal of Medicine. The sulfonamides saved lives and were considered to be wonder drugs, but it was not long before Finland became concerned about drug resistance. He and his colleagues demonstrated the rapid development of resistant strains during multiple passages of pneumococci.