Penicillin
Click on the years below to explore the brief history of penicillin in Oxford.
Let’s begin with the ‘medical’ account:
Penicillin, or antibiotics in general, have become a common term used in both hospitals and households around the globe. Penicillin derives its name from the Latin word for ‘a painter’s brush’, due to the visual appearance of the fungi when seen under a microscope in 1928. Sir William Dunning School of Pathology and Radcliffe Infirmary in Oxford witnessed the first successful clinical trials of penicillin in 1939-1941 as a systemic chemotherapeutic agent against bacteria, kickstarting the ‘Antibiotics Era’
[Fig 1] Dunning, Hayley. ‘Genome of Alexander Fleming’s Original Penicillin Producing Mould Sequenced’, Imperial College London (24 September 2020) <https://www.imperial.ac.uk/news/204713/genome-alexander-flemings-original-penicillin-producing-mould/> [accessed 12 May 2023].
[Fig. 2] Oiseth, S., L. Jones, and E. Maza (eds.), ‘Penicillins’, Lecturio (4 Aug. 2022), <Penicillins | Concise Medical Knowledge (lecturio.com)> [accessed 12 May 2023].
This mechanism arises from the specific chemical structure of penicillin, isolated by Dorothy Crowfoot Hodgkin while she was working in X-Ray crystallography at Oxford in 1945. The beta-lactam ring punctures holes in bacterial’ cell walls.
‘Antibiotics’ is the broader term describing medications that developed after Penicillin with similar capacities to eliminate foreign harmful bacteria within humans.
'Yellow' Magic'
What is the social relevance of clinical trials?
How did pencillin translate from laboratory science to clinical practice? This book says that it is only ‘when a manufacturing company starts producing the material in large quantity’ that it can start to save lives.
[Fig 3] Ratcliff, J.D. Yellow Magic: The Story of Penicillin (New York: Random House, 1945), Image reproduced from <Yellow magic : the story of penicillin : Ratcliff, J. D. (John Drury), 1903-1973, author : Free Download, Borrow, and Streaming : Internet Archive > [accessed 12 April 2023].
That doesn’t sound like my experience, when i was treated in the early stages of development before mass-production had started. Production had expanded dramatically in American labs only after Florey and Norman Heatley were flown to the U.S. on the Rockefeller dime, meeting representatives of Standard Oil and science and industry executives in June 1941. Oil money directly funded penicillin’s development, and it looks like it funded a lot of press telling ‘the story of penicillin’ too, yet were the intentions ever purely for public good? Or were there other motives?/p>
War Poster
How does society remember research?
[Fig 4] The National World War II Museum Education Department, ‘”Thanks to Penicillin, He Will Come Home!” The Challenge of Mass Production’, The National World War II Museum (2017), <thanks-to-penicillin-lesson.pdf> (nationalww2museum.org) [accessed 12 April 2023].
An advertisement for penicillin - in Life magazine, fancy that! Reading this, you’d think penicillin won the war singlehandedly…well, not quite - it looks like Schenley Laboratories wants some of the credit, too. And the United States, for producing it. And Britain, for inventing it. The poster portrays a narrative of penicillin saving the common soldier, yet who truly had access? Does war or geopolitical alliance affect who has access to what medicine, when?
Nobel Prize
What is the purpose of scientific research, for whom does it serve?
[Fig. 5] Nobel Prize, ‘Howard Florey’, Human Accomplishment, < Human Accomplishment>, n.d. [accessed 10 May 2023]. Florey’s Nobel Prize is currently on display in the Oxford History of Science Museum.
This is Howard Florey’s Nobel Prize in the Physiology of Medicine, shared with Ernst Chain and Alexander Fleming in 1945. I wonder how they decided the recipients? Most of the people I talked to were nurses, and the only Florey I met was Ethel, Howard Florey’s wife, who came in to administer the drug, record my progress and to collect undigested bits of penicillin mould from my urine. But Howard Florey and Alexander Fleming sure liked to talk themselves up as the founders of penicillin. In fact, those great men seem to be all anybody wants to talk about...
‘Florey Unit’ glass ampoule of powder
Who does the work of research?
It looks like the dose of penicillin was named after those guys, too. That’s because they’re the ones at the lab who figured out the amount in each treatment - though I could tell you a little bit about that too. At first no one knew how much was enough - or too much! So it was trial and error on individuals like me. When I was treated, there was a lot of uncertainty about the side effects, and where to get more if they ran out. My second injection had a chemical impurity which caused ‘pyrexia’ - a fancy word for fever, and some rigor. Despite these side effects, penicillin cleared me up anyway, and when we ran out doctors had to get the drug I hadn’t ingested out of my urine!
[Fig. 6] Science Museum Group, ‘Glass ampoule of penicillin powder, United States, 1942-1943', Science Museum Group Collection Online, <https://collection.sciencemuseumgroup.org.uk/objects/co61272/glass-ampoule-of-penicillin-powder-united-states-1942-1943-penicillin>, 1964-458/1 [accessed 12 May 2023].
Nurses checked on my appetite, my fever, and asked how I was feeling, and then, through hundreds of patient experiments like mine, researchers at Florey’s Oxford lab at the William Dunning School of Pathology decided on standard numbers for doses. And that’s how we got the Florey unit - or as it was called when it was first introduced in the United States, the ‘Oxford unit’. But of course it was developed and used all over the world - during the war, my cousin was given penicillin in North Africa, and never met Florey! You can read more about his story or the first trial in the U.S. in the second folder, the untold stories.
Robert Fulton's diary entry on Mrs. Miller
What is the purpose of scientific research, for whom does it serve?
The first systematic treatment in the U.S. occured in March 1942, on Anne Miller in New Haven, Connecticut. This excerpt from the diary of her doctor, Robert Fulton, sounds a lot like my experience as a patient. Appetite and temperature were closely monitored by nursing staff for several weeks. But because Mrs. Miller was in the U.S., the penicillin had to be flown in secretly - the researchers knew from cases like mine that they were onto something and were scared Nazi Germany might get a hold of the drug and use it to their advantage!
Unlike me, Mrs. Miller wasn’t chosen randomly, she was the wife of an teacher at Yale University, where Fulton worked. Fulton knew of penicillin because he was a close personal friend of Florey’s from their university days at Magdalen College, Oxford. During the war, Florey’s children even stayed with Fulton in the U.S. It looks like Fulton was very grateful for these connections and for the drug – and for the opportunity to write himself into the story of penicillin! How do you think people are chosen to partake in or benefit from medical progress today? Does everyone have equal access?
Albert Alexander Death certificate
What is the social relevance of clinical trials?
Some patients weren’t as fortunate as Mrs. Miller and me! Police constable Albert Alexander was the first person ever to receive systematic penicillin treatment. He checked in to the Radcliffe Infirmary in January 1941 with a staph and strep infection
due to lacerations sustained in an air raid. Ethel Florey discovered his condition and recommended him for the new experimental treatment. At first, he seemed to make a miraculous recovery! But because it was still an experimental treatment and hadn’t
been mass produced, they ran out of the mould and his infection returned to take his life.
After Alexander, Florey’s team turned towards experimentation on terminally ill children instead because they required less of the drug. How do you think researchers make ethical decisions about testing today for medical treatments that lack convincing
evidence? Would you take an untested drug with low supplies, if nothing else had worked? Does it make sense to test on children if all their other treatment options have failed?
Postal Survey
How does society remember research?
My cousin’s testimony shows how penicillin treatment began to expand during the war years. He sustained a shrapnel injury to his skull in North Africa and was initially treated by a Mobile Neurosurgical Unit which packed a powdered distillate of penicillin into his skull in layers. Then he was flown to St. Hugh’s College, Oxford, which was being used as a war hospital. Hugh Cairns, who had helped set up the mobile units, also supervised patients at St. Hugh’s and continued to treat infections with penicillin. [include coordinates – St Hugh’s College] For years after my cousin’s recovery, he responded to postal surveys like this one describing his progress. It sounds like he was grateful for the treatment he received - although he didn’t really know what he was being given at the time, and there was still some experimentation around how to administer the drug. I wonder if penicillin development would have been different without the war. In your era, how does war medicine differ from standard care? How do discussions of patient consent happen – if at all?
My cousin kept in contact with the head injury hospital until the 1980s, answering surveys like this and doing a whole range of tests. Does the story of medical treatment stop at the door of the war hospital, or do people continue to need different forms of treatment? In what circumstances do doctors have ongoing relationships with patients?
Nurse testimony
Who does the work of research?
Who actually checked on all us patients? I remember being surrounded by nursing staff. It sounds like this nurse remembers patients like me, too, and Ethel Florey who ran the ‘Pee Patrol’!
I wonder why people like nurses don’t come up so much in Florey and Fleming’s accounts, even though, as she says, her role was ‘just as important’. I wonder if there was knowledge they held that Florey may have lacked? Why does the public not discuss their contributions more? Do you think nurses could be appreciated more in hospitals today?
Penicillin girls
Who does the work of research?
I never met these ‘penicillin girls’ because they were always working in the lab. Ruth Callow, Claire Inayat, Betty Cooke, Peggy Gardner, Megan Lancaster, Patricia McKegney, and Margaret Jennings all worked at the Dunning School of Pathology, making more of the mould culture from bedpans and reclaiming it from patient urine.
[Fig 8] Swain, K., ‘Exhibition: The penicillin girls (and guys)’, The Lancet, 389 (15 April 2017), p.1507.
I wish there was more material available to read about them, instead of all those ‘Great Men!’ Why do we not celebrate the many skilled individuals who enabled the advancement of science, but rather only the few individuals who landed their names on publications?
