The Mold in Dr. Florey's Coat By Micronesia RPCV Eric Lax.
The Mold in Dr. Florey's Coat
Reviewed by Howard Markel NYT
By Eric Lax. Nonfiction. 320 pages. $25. Henry Holt & Co.
The word penicillin conjures images of the modern age of antibiotics, when doctors have the tools to cure their patients of infections that once killed with a vengeance. In 1928, after examining some colonies of staphylococcus aureus at St. Mary's Hospital in London, Alexander Fleming noted that a mold called penicillium notatum had contaminated his petri dishes.
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There was something especially intriguing about this bit of sloppy lab work. The mold prevented the normal growth of the staphylococci. Fleming's contribution was his realization that something in the penicillium mold not only inhibited the growth of the bacteria, but also, more important, might be harnessed to combat infectious diseases.
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Fourteen years later, Anne Miller became the first patient to be successfully treated with penicillin, lying near death at New Haven Hospital in Connecticut, after miscarrying and developing an infection that led to blood poisoning.
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Since 1942, penicillin has saved millions of lives. The rest is history. Or is it? In this deftly written book, Eric Lax argues that there is a great deal more to the story. Fleming had neither the laboratory resources at St. Mary's nor the chemistry background to take the next giant steps of isolating the active ingredient of the penicillium mold juice, purifying it, figuring out which germs it was effective against and how to use it.
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Instead, Lax writes, Howard Florey, a professor of pathology who was director of the Sir William Dunn School of Pathology at Oxford University, carried out that work, in part because of his ability to raise grants from foundations and government agencies and in part because of his organizational skills in administering a large lab filled with talented but often quirky scientists.
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In 1938, Florey, who had long been interested in the ways that bacteria and mold naturally kill each other, came across Fleming's paper on the penicillium mold while leafing through some back issues of The British Journal of Experimental Pathology. Soon after, Florey and the group of scientists he assembled in his well-stocked laboratory decided to unravel the science beneath what Fleming called penicillium's "antibacterial action."
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One of Florey's brightest employees was a biochemist, Ernst Chain, an abrupt, abrasive and acutely sensitive man who fought constantly with Florey over who deserved credit for developing penicillin. Despite the battles, they produced a series of crude culture fluid extracts.
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Another vital figure in the lab was a biochemist, Norman Heatley, whom Lax interviewed extensively. (Heatley died in January at his home in Oxford, at age 92.) Heatley used every available container, bottle and bedpan to grow vats of the penicillin mold, suction off the fluid and develop ways to purify the antibiotic. The makeshift factory was about as far removed as one could get from the enormous fermentation tanks and sophisticated chemical engineering that characterize modern antibiotic production today.
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In the summer of 1941, shortly before the United States entered World War II, Florey and Heatley flew to the United States, where they worked with American scientists to develop a means of mass producing what became known as the wonder drug. Aware that the fungus penicillium notatum would never yield enough penicillin to treat people reliably, Florey and Heatley searched for a more productive species.
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One hot summer day, a laboratory assistant, Mary Hunt, arrived with a cantaloupe that she had picked up at the market and that was covered with a "pretty, golden mold." The mold turned out to be the fungus Penicillium chrysogeum, and it yielded 200 times the amount of penicillin as the species that Fleming had described. Yet even that species required enhancing with mutation-causing X-rays and filtration, ultimately producing 1,000 times as much penicillin as the first batches from penicillium notatum.
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In the war, penicillin proved its mettle. Throughout history, the major killer in wars had been infection. In World War I, the death rate from bacterial pneumonia was 18 percent; in World War II, it fell to less than 1 percent.
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From January to May in 1942, 400 million units of pure penicillin were manufactured. By the end of the war, American pharmaceutical companies were producing 650 billion units a month.
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That era, said Allan Brandt, a professor of the history of medicine at Harvard, "marked the beginning of a genuine revolution in medical therapeutics, fulfilling the promise of the germ theory of infectious disease." Paradoxically, Fleming did little work on penicillin after his initial observations. Beginning in 1941, after reporters began to cover the early trials of the antibiotic on people, the unprepossessing and gentle Fleming was lionized as the discoverer of penicillin. And much to the quiet consternation of Florey, the Oxford group's contributions were virtually ignored.
