From The Editor’s Desk

Alexander Fleming and Penicillin

It is not even 100 years since Alexander Fleming found the 1st wonder drug that would cure most infections. Today the misuse of antibiotics is a major global health concern.The antibiotic resistance is something that Fleming thought about even while it was just being released for health care in the 1940s. It is important that every medical student reads about the discovery of Penicillin.

Alexander Fleming was born at Lochfield near Darvel in Ayrshire, Scotland on 6th August, 1881. After schooling he moved to London and spent four years in a shipping office before entering St. Mary’s medical school in London. He qualified with distinction and began research at St. Mary’s under Sir Almroth Wright, a pioneer in vaccine therapy. He gained his M.B., B.S., (London), with a Gold Medal in 1908, and was a lecturer at St. Mary’s until 1914. During the entire world war I he served as a captain in the Army Medical Corps and returned to St.Mary’s in 1918. He was elected Professor of Bacteriology in 1928 and became Emeritus Professor, University of London in 1948. He was elected Fellow of the Royal Society in 1943 and knighted in 1944.

Throughout his military career and on demobilization he worked on antibacterial substances which would not be toxic to animal tissues. In 1922, Fleming discovered lysozyme by accident as a result of his nose leaking some mucus on a dish containing some bacteria. The bacteria seemed to disappear. Fleming realised that a natural substance found in tears and nasal mucus helped the body fight harmful microbes.

Much of Fleming’s work focused on the search for a “wonder drug.” Though the concept of bacteria had been around since Antonie van Leeuwenhoek first described it in 1683, it wasn’t until the late nineteenth century that Louis Pasteur confirmed that bacteria caused diseases. However no one had yet found a chemical that would kill harmful bacteria but at the same time not harm the human body.

Back from a vacation in September 1928, Fleming was sorting through a stack of Petri dishes that he had piled up before he left on vacation to determine which ones could be salvaged. Many of the dishes had been contaminated.  While rummaging through the pile Fleming noticed something  strange on one particular plate. While he had been away, a mold had grown on the dish. The mold probably came from a room downstairs where a collection of molds had been kept for John Freeman, who was researching asthma. Fleming noticed that this particular mold had killed the Staphylococcus aureus that had been growing in the dish. Fleming thought that this mold had potential.

Fleming spent several weeks after this trying to find the substance in the mold that killed the bacteria. Working with a mycologist he determined it was a Penicillium mold. Fleming called the active antibacterial agent in the mold, penicillin. He then continued to run numerous experiments to determine the effect of the mold on other harmful bacteria. To his surprise, the mold killed a large number of them. Fleming then ran further tests and found the mold to be non-toxic. Though he saw its potential, Fleming was unable to isolate the active antibacterial element, penicillin, and could not keep the element active long enough to be used in humans. In 1929, Fleming wrote a paper on his findings, which did not garner any scientific interest.

Use of penicillin did not begin until the 1940s. During the second year of World War II, two scientists at Oxford University, Howard Florey an Australian and Ernst Chain a German refugee began working with penicillin. Using new chemical techniques, they were able to produce a brown powder that kept its antibacterial power for longer than a few days. They also found the powder to be safe.

As the war with Germany continued to drain industrial and government resources, the British scientists could not produce the quantities of penicillin needed for clinical trials on humans. They turned to the United States for help. They were quickly referred to the Peoria Lab where scientists were already working on fermentation methods to increase the growth rate of fungal cultures. On July 9, 1941, Howard Florey and Norman Heatley, Oxford University Scientists came to the U.S. with a small but valuable package containing a small amount of penicillin to begin work.

Pumping air into deep vats containing corn steep liquor (a non-alcoholic by-product of the wet milling process) and adding other key ingredients they were able to produce larger amounts of penicillin at a faster rate than by the previous methods. Ironically, after a worldwide search, it was a strain of penicillin from a moldy cantaloupe in a Peoria market that was found and improved to produce the largest amount of penicillin.

By November 26, 1941, Andrew J. Moyer, the lab’s expert on the nutrition of molds, had succeeded, with the assistance of Dr.Heatley, in increasing the yields of penicillin 10 times. In 1943, the required clinical trials were performed and penicillin was shown to be the most effective antibacterial agent to date. Penicillin production was quickly scaled up and available in quantity to treat Allied soldiers wounded on D-Day. As production was increased, the price dropped from nearly priceless in 1940, to $20 per dose in July 1943, to $0.55 per dose by 1946.

Needing the new drug immediately for the war front, mass production started quickly. The availability of penicillin during World War II saved many lives that otherwise would have been lost due to bacterial infections. Penicillin also treated diphtheria, gangrene, pneumonia, syphilis and tuberculosis.

Though Fleming discovered penicillin, it took Florey and Chain to make it a usable product. Though both Fleming and Florey were knighted in 1944 and all three of them (Fleming, Florey and Chain) were awarded the 1945 Nobel Prize, Fleming is still credited for discovering penicillin.

Fleming married Sarah Marion McElroy of Killala, Ireland, in 1915. She died in 1949. Their son also became a doctor. Fleming remarried Dr. Amalia Koutsouri-Voureka, a Greek colleague at St. Mary’s in 1953. In his younger days he was a keen member of the Territorial Army and he served from 1900 to 1914 as a private in the London Scottish Regiment.

Following the discovery of Penicillin Fleming received several awards from all over the world. He died on 11th March 1955 and is buried in St. Paul’s Cathedral.

This article was sourced from several publications including Nobel Lectures, Physiology or Medicine 1942-1962, Elsevier Publishing Company, Amsterdam

K. Badrinath