Twentieth Century Medical Marvel

The last century saw some incredible developments in the field of medicine, including the ongoing identification of viruses, the discovery of DNA and perhaps one of the most important of all, the invention of penicillin, an invaluable weapon in the fight against bacterial infections. The antibiotic era truly began eighty years ago in 1941, when the US developed widespread availability of penicillin. Although invented by Alexander Fleming in 1928, previously it had only been available in small batches. It seems hard to imagine a life without antibiotics now, but prior to its development people would routinely die from even minor bacterial infections. Antibiotics are produced from bacteria and fungi compounds that attack microbes, including other bacteria. But before Fleming’s discovery, human beings were already benefitting from antibiotics although they did not necessarily fully understand or appreciate why. Traces of Tetracycline, possibly absorbed through diet or natural remedies, have been found in the skeletons of the Nubian people in Sudan dating back as early as 330AD and the ancient Egyptians would place poultices made of mouldy bread onto infected wounds, demonstrating that they knew this helped curb infection and promote healing. In the late nineteenth century, a German physician named Paul Erlich noted that the newly invented chemical aniline dyes could stain and even destroy some bacteria but not others. This led him to believe that there must be chemical substances that could kill certain microbes while leaving others unharmed. He subsequently used a chemical called

arsphenamine to successfully treat syphilis although he called this treatment ‘chemotherapy’ (as in chemical therapy) rather than an antibiotic. In 1928, Alexander Fleming was Professor of Bacteriology at St Mary’s Hospital, London when he discovered penicillin quite by accident. He had been culturing a type of bacteria known as Staphylococcus, which causes sore throats, abscesses, and boils amongst other infections. On returning from a holiday in Suffolk, Fleming discovered that one of his petri dishes had been left uncovered and had developed patches of mould. Fleming noticed that there were no bacteria growing around the mould in this dish. The mould was called Penicillium notatum (today it is known as Penicillium rubens). Fleming began to investigate further and discovered that compounds produced by this mould could kill not only Staphylococcus but a wide variety of bacteria. However, the compounds were unstable and he was only able to produce them in tiny quantities. Fleming carried on his research but it wasn’t until eleven years later in 1939 that a team at Oxford University began work to purify and make penicillin available as a therapeutic drug. In order to do this, they had to produce gallons of mould filtrate. In 1940, one of the Oxford team, a pathologist and pharmacologist named Howard Florey, demonstrated how mice could be protected from Staphylococcus bacteria by using penicillin. And in 1941, the first human being was injected with the drug: a fortythree-year-old policeman named Albert Alexander, who had developed serious abscesses after scratching himself while pruning roses. Unfortunately, after making an initial recovery, Alexander died. But by the time Fleming successfully treated a patient named Harry Lambert in 1944 for streptococcal meningitis, penicillin was proven. With Britain absorbed in the war effort and research virtually on hold, Florey realised that any development potential lay with the US pharmaceutical industry. Following research into stabilisation of the drug, and large-scale production through collaboration with the chemical and fermentation industries in America, a meeting was organised by the Committee on Medical Research (CMR) with the top pharmaceutical companies: Pfizer, Merck, Squibb and Lederle. The meeting went favourably and production of penicillin began in earnest, but it wasn’t an easy process. Pfizer’s John L. Smith summed it up by saying: “The mould is as temperamental as an opera singer, the yields are low, the isolation is difficult, the extraction is murder, the purification invites disaster, and the assay is unsatisfactory.” Despite this, Pfizer succeeded in opening the first major manufacturing facility for penicillin on 1st March 1944. By the end of the war, penicillin had been successfully used on wounded soldiers from the front line and was being dubbed ‘the wonder drug’. In 1945, Fleming, Florey and biochemist Ernst Chain (their Oxford colleague) received the Nobel Prize for Medicine for the discovery and development of the first antibiotics. The twentieth century was the golden age of antibiotics, with different spectrums subsequently being discovered, adapted, and used successfully, such as Streptomycin (an organism found in soil) and Cephalosporins. However, there is a downside. Not all bacteria succumb to antibiotics and it is said that widespread use has led to resistant bacterial strains such as MRSA. Today, antibiotics have to constantly evolve to try and tackle this.

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