The Mold That Worked Miracles in Medicine
The image of the man who discovered penicillin, Sir Alexander Fleming, is etched into a stained-glass window in St. James’ Church in London, not far from the hospital where he made his discovery in 1928.
The artwork is an apt metaphor, considering the significance of Fleming’s revelation.
Physician as saint.
But it’s comical, too. While the discovery of penicillin elevated doctors to almost godlike status in the Western world--ensuring them prestige, high salaries and public adoration--Fleming, a successful doctor but no brilliant scholar, discovered the antibiotic by accident.
It took about 15 more years and the backbreaking work of a team of doctors at Oxford during World War II to refine Fleming’s discovery into usefulness. In 1945, Fleming was joined by Howard Florey and Ernst Chain in receiving the Nobel Prize for medicine. By then, the world had hungrily embraced the miracle elixir.
Before penicillin, there was little help for patients with serious infections. Gangrenous limbs could be amputated and sick gallbladders removed, but patients with systemic infections were at the mercy of God and their immune systems.
Fleming was not looking to resolve this dilemma in the late 1920s. He was hired at Saint Mary’s Hospital in London in part because he was a good shot and the hospital needed another member for its rifle team. He made a nice living treating London’s many rich syphilis patients with a medicine called salvarsan that required 18 months of injections (later to be supplanted by a two-week course of penicillin).
In September 1928, before going on a two-week vacation, Fleming prepared petri dishes with a strain of staphylococcus bacteria for an experiment. One floor away in the hospital, a colleague was growing the species Penicillium notatum to advance his studies on molds. Fleming left for vacation unaware that his dishes were contaminated with the mold, which floated breezily through the hospital.
When he returned, he found that a yellowish ring of Penicillium mold had carved its way through the culture of staphylococcus.
Fleming recognized that penicillin had killed bacteria, but he soon dropped his studies. He viewed the new drug as a possibly useful remedy for topical infections, such as an infected eye, but never considered its use for systemic infections.
At this time, however, Fleming was certainly not alone in the dark. In the 1920s, no one in medicine thought a bacterial infection could be treated with a drug, wrote Dr. Meyer Friedman and Dr. Gerald W. Friedland, the authors of the 1998 book “Medicine’s 10 Greatest Discoveries” (Yale University Press).
“It was not the first time, nor would it be the last, that recognition of a revolutionary medical discovery was delayed for many years because medical thinking was constrained by an obsolete paradigm of reasoning,” they wrote.
Fleming, however, published his findings in 1929, and others soon took up experiments on the mysterious “mold juice.” At Oxford, Florey, Chain and others performed the basic science and conducted initial animal and human trials, lobbied for funding and even rigged up their own production line to reproduce and stabilize the medicine.
Working under the constant threat of attack during World War II, the scientists took to routinely rubbing the mold into the linings of their coats in case they were suddenly forced to flee Britain during an invasion.
The Oxford group published its work in August 1940, and soon the Allies had the benefit of the new wonder drug. It was a far cry from the experience of soldiers during World War I when the influenza pandemic often caused fighting to sputter to a halt so both sides could bury their soldiers who had died from bacteria-related complications of the flu.
Penicillin galvanized medicine. Now, patients on the verge of death could recover swiftly and without consequence. The drug and the various antibiotics that followed eventually became cash cows for companies such as Squibb, Merck and Pfizer. Penicillin also “made sex easier,” says Friedman. “People knew if they got gonorrhea or syphilis that they could get cured in two weeks.”
And doctors, of course, were invested with a new kind of power. They could cure their patients quickly, privately and relatively cheaply with antibiotics.
In the United States, the advent of antibiotics also eclipsed the era of natural medicine, homeopathy and folk healing. At the end of the century, however, antibiotics have been overused to the point where some bacteria are resistant to the drugs. Meanwhile, natural medicine is making a resurgence that coincides with the decline in stature of the postmodern physician.
The doctor’s image is no longer one to be seared into stained glass.
