Testing Antibiotics
During the next 40 years, in the laboratory and on the wards of Boston City Hospital, Finland and his staff evaluated more than 70 new antimicrobial agents, including the tetracyclines, aminoglycosides, semi-synthetic penicillins, and in the 1960s the first generation of cephalosporins. To determine the optimal dosage schedule, blood samples were obtained at frequent intervals. The proportion of drug excreted was identified by collecting 24-hour urine samples. The normal subjects who provided blood and urine for the pharmacokinetic studies were his fellows and the residents on the Second and Fourth Harvard Medical Services at Boston City Hospital. Finland paid $2 per specimen of blood and $5 for 24-hour urine specimens.
Finland’s meticulously detailed reports, which gained a reputation for their thoroughness and impartiality, were widely read. Characteristic of these articles, many of which were published in the New England Journal of Medicineand other prominent medical journals, was that all the relevant data were presented (to the despair of some of the editors who preferred brevity). A number of pharmaceutical companies relied on Finland’s laboratory to test and evaluate their products. Individual physicians frequently sought his advice on the proper use and dosage of new agents, especially in difficult cases. As an advisor to government agencies, pharmaceutical companies, and physicians, Finland sounded the alarm on the indiscriminate use of antibiotics in the treatment and prevention of disease.
Even as Finland continued testing the effectiveness of new antibiotics, he carefully recorded growing evidence of changing patterns of antibiotic susceptibility to bacteria. Resistance to the sulfonamides was identified in the early 1940s. Resistance to penicillin and other antibiotics became a recurrent theme in his work in the 1950s. Of particular concern were outbreaks of multi-drug resistant staphylococcal infections in hospitals. As early as 1942, he used the term “nosocomial” to describe institutional or hospital-acquired infections. Later he detailed the development of hospital-acquired infections caused by gram-negative bacilli.