The Antibiotic Revolution and the Threats to It

FROM THE LECTURE SERIES: Turning Points in Modern History

By Vejas Gabriel Liulevicius, Ph.D., University of Tennessee

The discovery of penicillin by Dr. Alexander Fleming was just the first step in the journey to antibiotic revolution. Fleming had made this individual discovery, but producing penicillin on a purified and substantial scale was not what his laboratory was designed for. How did the large-scale production of penicillin begin? And what was Fleming’s warning about the misuse of penicillin?

A healthcare worker holding out five blister packets containing antibiotics.
As early as 1946, Dr. Alexander Fleming had warned that incorrect use of penicillin could actually backfire on humanity, because eventually he argued bacteria would evolve to develop resistance to penicillin. (Image: Fahroni/Shutterstock)

Formal Research on Penicillin Started Over a Decade After Its Discovery

Some years after the discovery of penicillin, a collective effort to utilize the discovery more effectively began. This was done by Howard Florey and Ernst Chain at Oxford University.

Florey was born 1898 in Australia, became a doctor, then went to Oxford as a professor of pathology. On reading an article of Fleming’s about his findings, he decided to follow up on his research. In a large laboratory at Oxford, Florey worked together with Ernst Chain, a German-Jewish chemist who had fled Nazi Germany, as well as other technicians and scientists.

It was a large group undertaking, not a serendipitous venture by one man. Their work was also further supported by funding from the Rockefeller Foundation.

This large team purified penicillin in greater quantities than Fleming had been able to. They showed that they could cure mice injected with bacteria. In 1940, they tried out their product for the first time on a human being, a policeman, who recovered from a very serious infection as a result.

Learn more about the discovery of penicillin.

First Life to be Saved by Penicillin

A gloved hand is injecting medicine into a person's arm.
In 1942, in New York, a woman named Anne Miller, who was battling a near fatal streptococcal infection, was injected with a small sample of Penicillin, which cured her and made her the first human life saved by Penicillin. (Image: Enuengneng/Shutterstock)

Research also extended to the United States. It was there in 1942 that the first person whose life was saved was to be found. This was a native New Yorker, Anne Miller. After a month at the New Haven Hospital, battling a streptococcal infection, she was at death’s door. Her fever had soared to 107 degrees Fahrenheit, and she was lapsing in and out of consciousness. Nothing doctors could do seemed to help.

In the desperate situation, her doctors got a small sample, the very first, of penicillin being produced in New Jersey, and injected it into her as a last resort. Overnight the fever went down. By the next morning she was not delirious and soon was on the road to recovery. Mrs. Miller in fact lived another 57 years after that moment of medical history.

Second World War Triggered Large-Scale Production of Penicillin

The next astonishing chapter in this story was how the arrival of the Second World War created the desperate need for and the mobilization to produce vast quantities of penicillin at breakneck speed. The American and British governments backed this effort. Howard Florey even went to the Soviet Union, the ally of the United States and Britain, to help them set up production as well.

When the invasion of France was launched with D-Day in 1944, vast quantities of penicillin were on hand to treat the wounded. During the war, and in the difficult reconstruction of a ruined world after the war, penicillin saved millions of lives that otherwise would have been lost.

In 1945, the Nobel Prize committee awarded a shared prize for penicillin to Alexander Fleming, Howard Florey, and Ernst Chain. This was highly merited praise, but the drama ever since Fleming’s accidental discovery has tended to overshadow the contributions of Florey, Chain, and other members of the teams that had developed penicillin for practical and extensive use.

Learn more about turning points in modern history.

Start of the Antibiotic Revolution

After penicillin showed its potency during the war, other antibiotics were also developed, part of that much larger antibiotic revolution. In 1944, American researcher Selman Waksman developed streptomycin, against tuberculosis, an ancient scourge of mankind. Tuberculosis was not eradicated worldwide, but much reduced and controlled.

Then in the 1950s, came the development of so-called broad spectrum antibiotics, for a range of bacteria not covered by penicillin. These were exciting and heady days, at a time when it seemed reasonable to feel and think that medicine’s advance was so successful and relentless that soon perhaps all diseases might be wiped out by medicines that function almost like magic bullets.

In our own times, progress continues, with the eradication of smallpox in 1980, and guinea worm disease also likely to be eradicated soon. Efforts are continuing to wipe out polio.

Learn more about Darwin and the origin of species.

This is a transcript from the video series Turning Points in Modern History. Watch it now, on The Great Courses Plus.

Fleming’s Warning against the Misuse of Antibiotics

How good and pleasant it would be to end the story right there, looking forward to the inevitable progress and improvement that continues. But the real story is actually much more complicated and threatening.

Around 1946, Fleming warned that incorrect use of penicillin could actually backfire on humanity. If the doses of penicillin that were used were too small to absolutely really wipe out an illness, eventually he argued bacteria would evolve to develop resistance to penicillin.

This was a warning taken right out of Darwin’s teachings about natural selection that we considered as an earlier turning point, and it’s precisely what has happened and is happening since.

The very confidence in the seemingly miraculous powers of antibiotics led to their overuse and misuse. Ordinary patients, feeling a certain improvement once they had started a regimen of antibiotics, would then discontinue taking their medicines.

Other patients, craving the reassurance of being under good treatment with powerful medicine, insisted to their doctors that they prescribe them with antibiotics, even in cases when antibiotics were not going to be of any use, for instance against viruses.

As a result, like Fleming predicted, we’re seeing more and more diseases that have developed resistance to entire generations of antibiotics. That’s the reason why tuberculosis is making a comeback. Illnesses that decades ago could be treated with penicillin pills may now instead demand hospitalization and intensive care.

Antibiotics also have been extensively used in livestock agriculture; indeed many more antibiotics go to animals than to humans, and experts are warning of the possible dangers of this use as well. In fact, in the United States it’s estimated that 80 percent goes to livestock.

Learn more about Van Leeuwenhoek’s microscope.

Grim Possibilities Awaiting Us in the Future

The prospect before us is in many ways a frightening and discouraging one. The head of the World Health Organization stated, “A post-antibiotic era means, in effect, an end to modern medicine as we know it … Things as common as strep throat or a child’s scratched knee could once again kill.”

This is one other worry to add on to the anxieties of our present day, with the threat of global pandemics, or of the global transmission of diseases, monitored by the Centers for Disease Control.

In a paradox, the ability of air travel to move increasing numbers of people around the world, with all the good that that can imply, also has inadvertently created another effective vector for the wide spread of disease.

A sobering observation to make here thus is that some profound historical turning points, paradoxically, are not always permanent. They function, they have their results, and then they can be overtaken by other great forces, for good or ill.

Yet in a sense improved understanding is always a source of hope. This may be the case in new ways of understanding the very existence of a human being biologically.

Human Body-an Ecosystem

Before the advent of germ theory, the human body was seen as a hydraulic machine sloshing about with humors, those fluids that make us go and determine wellness or sickness. Today, a new model is coming to the fore. That is a new vision of the human being, in a sense, as an ecosystem, as an extensive environment.

Each of us harbors some 100 trillion bacteria of hundreds of species, many of them crucial to our digestion, health, and life; collectively this is called the microbiome. So one question we face now is how better understanding of our own interdependence with the larger microbiome might yield new strategies for health and fighting sickness.

Common Questions about the Antibiotic Revolution and Threats

Q: Who was the first person to receive penicillin?

In 1940, penicillin was first used on a human being at Oxford University. A policeman, who was suffering from a very serious infection, recovered after being treated with penicillin.

Q: How did Florey and Chain develop penicillin?

Alexander Fleming discovered penicillin, but his laboratory wasn’t built for large-scale testing and production. A collective effort to utilize the discovery more effectively began a few years later, headed by Howard Florey and Ernst Chain at Oxford University. In a large laboratory at Oxford, Florey and Chain, along with other technicians and scientists purified penicillin in greater quantities than Fleming had been able to. They also successfully demonstrated that they could cure mice injected with bacteria.

Q: Why was penicillin considered a miracle drug?

During the Second World War vast quantities of penicillin were on hand to treat the wounded. And both during the war and in the difficult reconstruction of a ruined world after the war, penicillin saved millions of lives that otherwise would have been lost. That’s why penicillin was considered a miracle drug at that point in time.

Q: Who won a Nobel Prize for discovering penicillin?

In 1945, the Nobel Prize committee awarded a shared prize for penicillin to Alexander Fleming, Howard Florey, and Ernst Chain.

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