Breaking the mould – how a humble Scottish genius saved the lives of millions
Ninety years after Alexander Fleming created penicillin...
ICLEARLY remember my great-grandfather, but not his wife Annie, who died half a century before I was born. My father is still most alive and active, but I never knew his elder sister – also Annie – who died shortly before his own arrival into the world.
She, an infant of 15 months, was stricken one 1940 summer afternoon with meningitis and perished, convulsing and screaming, within hours. And my great-grandmother succumbed in 1915 to ‘puerperal fever’ – post-partum sepsis – days after being delivered of her third child.
Both would have been saved by a medicine we now take completely for granted – penicillin, not then available. So when my father was once asked who he thought the greatest Scot of the 20th century, it’s small wonder that he replied unhesitatingly: ‘Alexander Fleming.’
For 90 years ago it was that quiet Ayrshire man who discovered what, by the end of the Second World War, was the first true antibiotic. Saving innumerable lives, it was the greatest medical breakthrough of the age.
It is hard for younger generations to grasp how useless, even in living memory, most medicine once was. A child could die of something as simple as a dirty cut.
Childbirth was so dangerous that, in the 1930s, a bride’s trousseau always included her shroud. Entire asylums were built for the victims (often wholly innocent wives) of untreatable tertiary syphilis.
School magazines dolefully record the loss of pupils to such ills as scarlet fever, and strong, strapping young men were regularly borne away by chest infections. The best of doctors could do little more than wait and hope – until Fleming made his discovery.
He was born in 1881, the son of an elderly farmer by his second wife, at Lochfield, near Darvel. He lost his father when he was seven, but prospered at the local school, won a scholarship to Kilmarnock Academy then headed south briefly to study at a London polytechnic.
Fleming was 20 and had been working with a city shipping line for four years when his uncle died and left him a significant legacy. Encouraged by his older brother, a doctor, he elected to enter the medical profession, enrolling at St Mary’s Hospital Medical School in London’s Paddington and graduating with distinction in 1906.
He would be associated with St Mary’s for most of his career – now joining its research department, studying and bacteriology winning for the a – second but Gold Fleming’s Medal degree for subsequent the Great War. course was defined by He served throughout as a captain in the Royal Army Medical Corps and was once mentioned in despatches. But he was appalled at how many soldiers he saw – not mortally wounded – who died of sepsis. The usual care was to pour antiseptic onto and into the injury, but it struck him forcefully
that this seemed only to make things worse. Fleming argued in a paper for The Lancet that this was a very bad idea. Not only did antiseptics fail to penetrate the depths of a wound – wherein such anaerobic bugs as clostridia bred – but they killed white blood cells, our natural defence against infection.
SALT water, Fleming insisted, should be used instead. Although he was strongly supported by his boss, Sir Almroth Wright, few paid him attention and troops continued to die unnecessarily.
Fleming now made the defeat of sepsis his life’s work. His first breakthrough – having noted that nasal mucus had antibacterial properties – was the discovery of lysozyme. It had limited therapeutic value in tackling infections but did not harm white blood cells – and might not something else, similar but far stronger, be out there?
‘One sometimes finds what one is not looking for,’ he would muse many years later. ‘When I woke up just after dawn on September 28, 1928, I certainly didn’t plan to revolutionise all medicine by discovering the world’s first antibiotic, or bacteria killer. But I suppose that was exactly what I did…’
He had returned on September 3 to his St Mary’s laboratory from a summer break, and was sorting through a clutter of glass petri dishes ripe with cultures of staphylococcus – annoyed that someone had left a window open, allowing all manner of bugs to blow in.
Then he noticed one dish thick with staphylococci, save for an area where there was a clot of blue mould, just as you might see on a stale loaf. And around this, like a moat, was a circle with no staphylococci.
What was in this ‘mould juice,’ as Fleming unpretentiously called it, that so spectacularly inhibited bacterial growth? He experimented, and found with rising excitement that it was just as lethal on streptococcus, meningococcus, the diphtheria bacillus… Fleming finally gave it a name:
Penicillium notatum. But he was not a chemist and, hard as he and his assistants tried, it was very hard to isolate it in purity. Worse, Sir Almroth loathed chemists and refused to allow one on the payroll or in the building.
Fleming subsequently published his findings in June 1929, with passing reference to penicillin’s potential therapeutic benefits – and continued to grow penicillin in culture, doing his best to find someone who might develop it.
BuT it would not be until the Second World War, and an urgent need for effective treatment of its wounded, that two Oxford scientists at the city’s Radcliffe Infirmary, Howard Florey and Ernst Chain, secured funding from both the British and uS governments and set about penicillin with a will.
The help of a mechanically minded colleague, Norman Heatley, was critical. ‘He devised a method for extracting and purifying penicillin from the cultures of mould grown in hundreds of vessels throughout the Dunn School labs,’ says one account. ‘The automated process he came up with made use of bedpans, milk churns and baths all rigged together, yet it worked very well…’
The result was tested on eight white mice, all ruthlessly dosed with streptococci but only four of them injected with penicillin: by morning, only these lived. Then a 43-year old policeman with a serious infection, Albert Alexander, was treated. He recovered rapidly, and was doing fine when they ran out of penicillin, even after trying to recycle it from his urine. Sadly he then repined and died.
Fleming himself stopped by, asked for some penicillin, and soon successfully treated a child at St Mary’s. Over in the States, professional pharmacists greatly improved penicillin production. It was not easy. ‘The mould is as temperamental as an opera singer,’ wrote one exasperated expert. ‘The yields are low, the isolation is difficult, the extraction is murder, the purification invites disaster…’
Yet they did it. By the middle of 1944, the wonder drug was being produced on a huge scale – enough to treat all wounded during the critical D-Day landings – and, by July 1946, it was available on prescription to anyone. Fleming was knighted in 1944 for his discovery and, in 1945, the Nobel Prize for Medicine was conferred on Fleming, Florey and Chain.
There is still strange bitterness in some quarters that Fleming is so associated with penicillin while Florey and Chain are largely forgotten. It’s little more than anti-Scottish spite.
Fleming had fought for years to have penicillin developed – without the other two’s Government backing or handsome funding – and the Ayrshire man himself always deplored what he called the ‘Fleming myth’.
In 1945, when Fleming was touring the uS, a grateful pharmaceutical industry offered him $100,000 – then a colossal sum – as reward for his achievement. He promptly donated the lot, without publicity, to the research laboratories at St Mary’s Hospital.