The Mold in Dr. Florey's Coat: The Story of the Penicillin Miracle
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The Mold in Dr. Florey's Coat: The Story of the Penicillin Miracle
320eBook
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Overview
The dramatic, untold story of the discovery of the first wonder drug, the men who led the way, and how it changed the modern world
In his wonderfully engaging book, acclaimed author Eric Lax tells the real story behind the discovery and why it took so long to develop the drug. He reveals the reasons why credit for penicillin was misplaced, and why this astonishing achievement garnered a Nobel Prize but no financial rewards for the doctor that discovered it and the team that developed it.
Alexander Fleming's discovery of penicillin in his London laboratory in 1928 ushered in a new age in medicine. But it took a team of Oxford scientists headed by Howard Florey and Ernst Chain four more years to develop it as the first antibiotic, and the most important family of drugs in the twentieth century. At once the world was transformed -- major bacterial scourges such as blood poisoning and pneumonia, scarlet fever and diphtheria, gonorrhea and syphilis were defeated. Penicillin helped to foster not only a medical revolution but a sexual one as well.
The Mold in Dr. Florey's Coat is the compelling story of the passage of medicine from one era to the next and of the eccentric individuals whose participation in this extraordinary accomplishment has, until now, remained largely unknown.
"Admirable, superbly researched . . . perhaps the most exciting tale of science since the apple dropped on Newton's head." -- Simon Winchester, The New York Times
Product Details
| ISBN-13: | 9781627796446 |
|---|---|
| Publisher: | Holt, Henry & Company, Inc. |
| Publication date: | 06/02/2015 |
| Sold by: | Macmillan |
| Format: | eBook |
| Pages: | 320 |
| File size: | 479 KB |
About the Author
Eric Lax is the author of Woody Allen, A Biography and Life and Death on 10 West, both New York Times Notable Books. His work has appeared in The New York Times Magazine, Vanity Fair, Life, The Atlantic Monthly, and Esquire, as well as in many other magazines and newspapers. He lives with his wife and two sons in Los Angeles.
Read an Excerpt
The Mold in Dr. Florey's Coat
The Story of the Penicillin Miracle
By Eric Lax
Henry Holt and Company
Copyright © 2005 Eric LaxAll rights reserved.
ISBN: 978-1-62779-644-6
CHAPTER 1
THE QUIET SCOT
Anyone able to associate a name with the development of penicillin almost invariably thinks of Alexander Fleming, whose fame in the middle of the twentieth century was such that he was a celebrity on every continent of Earth and on the Moon as well, where a crater was named for him. Those who don't recall Fleming often but incorrectly think credit lies with Louis Pasteur, Marie Curie, or Jonas Salk. But Howard Florey, Ernst Chain, and Norman Heatley, who turned quirky mold into the life-saving drug, are virtually unknown.
However, penicillin's development does begin with Fleming, a keen observer, a dexterous, even playful, manipulator of microorganisms and scientific equipment, and a member of the Inoculation Department at St. Mary's Hospital in London, just up Praed Street from Paddington Station.
The seventh of eight children, Fleming was born August 6, 1881, near Darvel, Ayrshire, in southwestern Scotland. His father, Hugh, kept several hundred sheep on the family's eight-hundred-acre farm in the almost barren hills and valleys, where Alec led an active outdoor life that honed his natural skill of observation. He had light hair and a flattened nose, and he grew to be slightly less than five-foot-six. His most noticeable features were large, strikingly blue eyes. They were also his most disconcerting, in that they often seemed focused through rather than on the person with whom he was talking. This unease he created in others was compounded by his lack of conversational skills. Later in life, he had friends across a wide expanse of society, but for the most part, one noted, "He was not a conversationalist and awkward silences were sometimes broken by awkward remarks ... talking with him was like playing tennis with a man who, whenever you knocked the ball over to his side, put it in his pocket." More reticent than rude or shy, he made few close friends other than his four brothers; he was particularly devoted to Robert, two years his junior.
Hugh died in 1888, leaving his oldest son tenancy of the farm and most of his other children without prospects. One by one, they moved to London. Alec left school the summer he turned fourteen and joined the exodus south to live with his brother Thomas, a doctor thirteen years his senior who specialized in ophthalmology, and their sister Mary and brother John. Robert soon followed, and the two youngsters enrolled at the Regent Street Polytechnic Institute, founded by the philanthropist Quentin Hogg in 1892 "for the promotion of industrial skill, general knowledge, health and well being of young men belonging to the poorer classes."
Because it had been difficult for Thomas to establish his practice, he recommended that Alec might have an easier life if he took commercial courses for what Thomas thought would be a safer career in business. Alec found the studies easy; he moved up four classes in his first two weeks and at sixteen had passed all his courses. He landed a job as a junior clerk with the America Line, one of the leading fleets in the Atlantic trade, doing the mind- and finger-numbing work of copying letters and documents, filling in ledgers, and preparing cargo manifests.
Alec refreshed himself by joining in family competitions arranged by Thomas. Everyone anted a penny for winner-take-all contests in almost anything that could be contested: history, math, and geography; poker, bridge, and snooker; bowling, croquet, and even the occasional intrafamily boxing match.
He was a good shot as well. So many British soldiers were sent to South Africa to fight the Boer War from 1899 to 1902 that volunteers were sought to man home regiments based on county or regional affiliation. In 1900, Alec, a natural athlete and a good shot, and Robert enlisted in the London Scottish Rifle Volunteers, a brigade that was as much a club as it was a fighting force; Alec joined their rifle and water polo teams.
That same year, the Fleming children's uncle died, leaving them each the considerable sum of £250. Thomas invested his share in a better office. His practice soon flourished, and he encouraged Alec to use his promised inheritance (he could not receive it until he was twenty-one) to attend medical school. Alec, now nearly twenty, more anxious to escape a dead-end job than he was enamored of medicine, agreed. That he was two or three years older than the others beginning their medical studies and singularly unqualified by his previous education did not strike him as drawbacks. He discovered that a diploma from the London College of Preceptors was regarded as the equal of more formal schooling, and he hired a tutor for evening studies. In July 1901, he took the medical school entrance exams in seventeen subjects that included three kinds of math, Latin, French, English, geology, physiology, scripture, and shorthand. He scored at or near the top in every one.
Entitled to enter any of the twelve London medical schools, Alec chose St. Mary's, for reasons apparently no more complicated than it was the one nearest home and because he and others of the Scottish Rifle team had once played water polo against the team from the hospital's medical school. He promptly won the entrance scholarship exam; the £145 prize paid for his tuition and equipment. It was the first of more than a dozen prizes he would win in examinations that comprised every field of medical study. Despite his reticence, he became a member of the Debating Society and of the Dramatic Society. His relatively short height often relegated him to women's parts; the two feminine leads in one production were Fleming and Charles McMoran Wilson, who in 1920 became dean of the St. Mary's Hospital Medical School and, in 1943, became Lord Moran, Winston Churchill's personal physician. This association would play a pivotal role when it came time to apportion credit for the development of penicillin.
At the turn of the twentieth century, surgeons were at the top of the medical profession, and, in January 1905, Fleming passed the examination to become a fellow of the Royal College of Surgeons. His interest was logical, considering his dexterous hands and great knowledge of anatomy — he won the Anatomy Prize in 1902 as well as the Senior Anatomy Prize in 1904 — but, despite his ability and qualification, he never performed an operation, preferring research instead.
After Fleming completed his studies in 1906, he joined the Inoculation Department to bide his time while he settled on a specialty. He stayed forty-nine years.
The Inoculation Department was a fiefdom with no equal in British medicine. The department was independent of both the hospital and the medical school and earned its own income from the treatment of private patients and the sale of vaccines it prepared and sold to doctors through the pharmaceutical firm Parke, Davis and Company. A notice on the label assured doctor and patient that the product was prepared "under the supervision of the Director, Sir Almroth Wright, MD FRS, etc." The department also relied on the generosity of its patrons, among them Arthur Balfour, the prime minister from 1902 to 1905. It paid rent to the hospital for its space and in return was given a wing of the hospital for laboratories and a ward of patients to treat. In effect, it was the first private clinical research institute in England.
Almroth Wright, the multidegreed director of the Inoculation Department, was a large, imposing man with hard eyes, a walrus mustache, and equally imposing views. Wright was one of the foremost medical men of his time — in the 1890s, he developed the vaccine for typhoid — and one of the most controversial. His admirers revered him, his detractors called him "Sir Almost Wright" or "Sir Always Wrong," and he reveled in any attention, whether positive or negative. Wright was outspoken in the extreme in his disdain of medicine-as-usual, an opinion shared by George Bernard Shaw, who exaggerated Wright in the character of Sir Colenso Ridgeon, the physician in his 1906 satire The Doctor's Dilemma, who must choose between saving the life of "an honest decent man, but is he any use?" and "a rotten blackguard, but he's a genuine source of pretty and pleasant and good things."
In 1909, Fleming devised a method of testing for syphilis using only a drop or two of blood rather than the larger amount required for the eponymous test invented three years earlier by the German pathologist August von Wassermann. The three papers on the method that Fleming published in the next year brought him patients — very welcome because of his meager salary — and requests from other doctors for consultation. Then, in 1910, the German researcher Paul Ehrlich developed "606" (the first 605 compounds he tested were useless) for the treatment of syphilis. Though later called Salvarsan by physicians, it was more popularly known as the "Magic Bullet." It was the first chemically synthesized chemotherapeutic agent, which is to say, it fights a disease in every part of the body and not just where it is applied, as is the case with an antiseptic liquid or ointment.
The practice of medicine at the beginning of the twentieth century often included treatment of the diseases associated with syphilis over its decades-long course. Salvarsan offered the possibility of curing millions. Ehrlich, a friend of Wright's, sent him some of the first samples of the drug for trials on English patients. Wright had little faith that chemicals would prove the best treatments for disease, so he passed on the "606" to Fleming and Leonard Colebrook, another member of the department. By 1911, Fleming had begun giving shots of "606" to some of his private patients.
Administering the drug was a cumbersome and dangerous process. Treatment generally lasted for a year, and Salvarsan, a compound of arsenic, was so nearly toxic that it could be given only once a week. Syringes of the day were made of thick glass; their metal plungers fit so badly that often whatever was injected spewed out of the top as well as through the broad needle. The powdered drug had to be mixed in at least 600 cc's of water — about twenty ounces. If this massive amount was not injected into the arm properly, the drug escaped into the surrounding tissue. If enough did, the drug would kill the tissue and the arm might have to be amputated to prevent further damage or even death. Fleming's surgical training made him adept at handling the cumbersome hypodermic equipment, and it was soon well known that his dexterity reduced the unpleasant and dangerous side effects that resulted from less skillful injections. His private practice became lucrative.
Apart from his skill as a clinician, Fleming the researcher had a curious and frolicsome mind. "I play with microbes," he once said. "There are, of course, many rules to this play ... but when you have acquired knowledge and experience it is very pleasant to break the rules and to be able to find something nobody had thought of."
Fleming well knew that different bacteria take on different hues as they grow, and he was adept at carefully planting various microbes on a plate of agar — the waxy, gelatinous laboratory food trough for bacteria — so that when they bloomed, the plate turned into a colorful painting of, say, a ballerina in a red skirt or a mother nursing her baby with a bottle. Arranging such scenes required a deep understanding of the peculiarities of bacterial growth and coloration, as well as the imagination to see a finished picture as he planted the microbes: the drawings developed like a slow-motion Polaroid photo, with the color appearing only after the bacteria began to divide.
Some of Fleming's contemporaries felt this whimsy lacked the dignity and seriousness appropriate to the high-minded work of science, but many important discoveries had an underpinning of play. Albert Michelson, the first American to win a Nobel Prize in physics, measured the speed of light in 1878 with $10 worth of apparatus. He said he liked to experiment "because it is so much fun!" When a visitor to the lab of the Danish physicist Niels Bohr told him with some disgust, "In your institute nobody takes anything seriously," Bohr answered, "That's quite true, and even applies to what you just said."
* * *
Bacteria are everywhere. A human body is host to between five hundred and a thousand species, with more than two hundred of these in the mouth alone. There are 10 trillion cells in a human body and more than ten times that number of bacterial cells in the digestive tract; there are more bacteria in one person's gut than there have been humans on Earth.
Only about one in one thousand species of these microbes is harmful to humans. The rest are productive citizens of our corporate bodies and together constitute a support and maintenance group. We would not be human without bacteria. Some aid in digestion and development, others eat carbohydrates that the body can't digest; some initiate the growth of the network of capillaries that move blood, and still others ensure that blood flows properly to the intestine.
But as in any society, sometimes the good turn bad. Mobile bits of DNA can wander on their chromosomes, picking up new genes from other organisms and morph benign bacteria into drug-resistant troublemakers. From the bacterial point of view, of course, human bodies are simply their homes and places of business, and these changes allow them to stay well and prosper.
Bacterial life is a simple combination of survival and reproduction, achieved through constant warfare with other microbes for space and food. Bacteria in the soil are particularly beneficial to farming, just as the bacteria in our bodies provide a multitude of housekeeping services. Bacteria that live in humans and other animals but don't cause disease are called commensals. Those that cause disease are called pathogens. Until the advent of antibiotics, pathogens were unstoppable serial killers.
Fleming's inventive approach to his work proved valuable in the struggle against pathogens. During World War I, Sir Alfred Keough, the director general of the Army Medical Services, wanted better control of wound infection. Wright accepted his request to study how best to accomplish this, and, along with Fleming and several others of his St. Mary's staff, he was given an army commission and sent to France. In October 1914, Lieutenant Fleming was billeted in the casino at Boulogne, a recreation center turned British Army General Hospital on the north coast, under the command of Colonel Wright. The main floors of the building, parceled into high-ceilinged, ornate, and once elegant rooms, were now wards filled with soldiers crazed from high fevers brought on by infection. Many of the wounded had spent a day or more lying on the field of battle because so vast a number were injured — in 1914, an average of twelve hundred patients a day was handled by the staff of clearing stations designed to help two hundred. Then once in Boulogne, they sometimes had to wait days for surgery.
The accepted treatment of open wounds was not to clean and suture them but instead to pack them with cloth bandages usually soaked in carbolic acid, the foul-smelling antiseptic widely used to clean sewers that Lister found was lethal to microbes at a strength just tolerable to human tissue. The bandages hastily applied by medics in the field were more factories of infection than aids to healing. As the bandages became sodden with pus, they were replaced with new ones. This treatment made sense, at least in theory; Lister's use of chemicals destroyed bacteria on the surface of skin and on operating utensils and also was effective in preventing infection, so it was logical to think it would also cure established infection. It didn't. Yet even after the rampant infection of soldiers' wounds in France showed that in many cases antiseptics were almost useless, Sir William Watson Cheyne, the president of the Royal College of Surgeons, stubbornly advocated the use of stronger and stronger chemical antiseptics because they had been effective during the Boer War.
Soldiers continued to die in droves from infection because the weapons and the terrain of this war were markedly different. The fighting in South Africa took place on rocky, sandy ground unaltered and unadulterated by cultivation and fertilizers and therefore not particularly prone to cause infection; the battlefields in France were muddy stews of earth and horse manure, and the trenches where the soldiers sheltered were cesspools that were spawning grounds for deadly bacteria. The guns of the Boer War shot high-speed bullets that left a clean wound. Nothing about World War I was clean. Uniforms soaked up the bacteria. Shrapnel from explosive shells drove pieces of uniform into a wound and embedded bacteria in tissues or bone so far beyond the wound itself that antiseptics were not strong enough to reach them. The most efficient killers of all were bacteria that were invisible to the naked eye and often had only to rely on the power of weapons or even the soldiers themselves for their transport.
(Continues...)
Excerpted from The Mold in Dr. Florey's Coat by Eric Lax. Copyright © 2005 Eric Lax. Excerpted by permission of Henry Holt and Company.
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Table of Contents
Contents
Title Page,Copyright Notice,
Dedication,
Epigraph,
Introduction: The Reclaimed Life,
1. The Quiet Scot,
2. The Rough Colonial Genius,
3. The Money Talks,
4. The Temperamental Continental,
5. The Micro Master,
6. "Without Heatley, No Penicillin",
7. Eight Mice,
8. Blitzed,
9. "Will These Plans Come to Grief?",
10. The Friend in Deed,
11. The Kilo That Never Came,
12. The Laurel Wreath of Credit,
13. The Thinking in Stockholm,
14. The Makers of Great Medicine,
Notes,
Bibliography,
Acknowledgments,
Index,
Also by Eric Lax,
Praise for The Mold in Dr. Florey's Coat,
About the Author,
Copyright,