Karl H. Beyer Jr. (1914–1996)
In 1941, soon after penicillin had been extracted from the Penicillium mold, its potentially lifesaving effects were first demonstrated in a human patient: a policeman dying of blood poisoning. At three-hour intervals, he was given intravenous injections of penicillin G. Because only meager amounts of penicillin were available then, each day penicillin was extracted from his urine and reinjected. It worked, and after five days, he appeared to be on his way to recovery . . . until the penicillin supply became depleted. His medical condition deteriorated, and he died one month later.
In 1951, Karl Beyer, a research pharmacologist at Merck, discovered that probenecid (Benemid) greatly slowed the loss of penicillin in urine. This enabled the antibiotic to attain much higher levels in the body for much longer periods, more effectively fighting severe bacterial infections. Although penicillin G is now plentiful, Benemid continues to be used for this purpose.
Beyer recognized that Benemid’s effects on the kidney had another important medical application for the treatment of gout. Excessive levels of uric acid in the blood cause gout. Uric acid, a breakdown product of purines from meat, is normally eliminated in urine, but when urate levels build up in individuals predisposed to gout, hard crystals form and are deposited in the joints. Intermittent gouty attacks occur, in which the patient experiences sudden, intense burning pain, swelling, and redness, most commonly in the big toe.
While Benemid retards the elimination of penicillin, it promotes the loss of uric acid by the kidney (a uricosuric effect). As the blood levels of uric acid decrease, the crystals in the joints dissolve and the frequency of debilitating attacks decrease. While colchicine and anti-inflammatory drugs such as ibuprofen (Motrin) or cortisone-related steroids are used to treat an acute attack, Benemid was the first drug that could prevent acute gouty attacks from occurring in the first place.
SEE ALSO Colchicine (c. 70), Penicillin (1928), Cortisone (1949), Zyloprim (1966).
Hans Holbein the Younger painted this portrait of Henry VIII (1539–40). This English king (1491–1547) was a classic gout sufferer whose condition was brought on by gluttony and drink. As a young man, he had an athletic build, reaching 6'3" (190.5 cm), while in his last years he weighed 300–320 pounds (135–145 kg) and had a waist measuring 58–60 inches (147–152 cm).