The discovery of Penicillin stands out as the greatest advancement made in medicine amongst the 1000s of discoveries in the last 100 years to date – that is what I believe!

It all started when the biology aficionado Sir Alexander Fleming was tirelessly working on his passion: microbiology. He was studying influenza in his research lab at St Mary’s Hospital Medical School at the University of London under Sir Almroth Wright, a pioneer in vaccine therapy. Often described as a careless lab technician, on the morning of Friday, the 28th of September 1928, Fleming returned from a two-week vacation. He returned to find that a mould had developed on an accidentally contaminated staphylococcus culture plate. Upon examination of the mould, he noticed that the culture had prevented the growth of staphylococci. Regardless of whether it was accidental, it was definitely a discovery that changed the world forever. Antibiotics were discovered in the name of Penicillin. In 1929, Fleming published an article in the British Journal of Experimental Pathology that reads, “The staphylococcus colonies became transparent and were obviously undergoing lysis…the broth in which the mould had been grown at room temperature for one or two weeks had acquired marked inhibitory, bactericidal and bacteriolytic properties to many of the more common pathogenic bacteria. Published reports credit Fleming as saying

“One sometimes finds what one is not looking for. When I woke up just after dawn on the 28th of September 1928, I certainly did not plan to revolutionize all medicine by discovering the world’s first antibiotic or bacteria killer. But I guess that was exactly what I did.”

So, what was life-like before antibiotics? In the past, sexually transmitted infections (STIs) were often completely incurable and deadly, not to mention they could cause dreadful and extreme disfigurement before killing. 90% of children with bacterial meningitis died. Among those that lived, most had severe and forever lasting disabilities, from deafness to mental retardation. Just imagine a child going through these symptoms, a child!  Streptococcal sore throat was at times a fatal disease and ear infections sometimes spread from the ear to the brain, causing severe problems. That is what life was like before the blessing of Fleming: antibiotics. Nowadays, we can’t even imagine these situations coming up. It would be part of the 21stcentury’s human beings’ worst nightmare. Even in wars such as WW1, soldiers dropped like flies as a result of a bacterial infection. Giving birth was far, far more dangerous before antibiotics. The standard treatment for tuberculosis before antibiotics used to be fresh air. That even included surgery of any kind. Times were awful, dark, and completely unimaginable by us. Doctors felt helpless and frustrated as they failed to treat case after case. People were grieving all the time at the loss of loved ones. Children were missing out on the opportunity to explore the world. Everything was nasty, ghastly, and horrid.

Therefore, antibiotics came as a true blessing to mankind, like superman for civilians, like doctors for patients, like parents for children. The discovery of penicillin marked the beginning of the antibiotic revolution. Ernst Chain and Howard Florey purified the first penicillin, penicillin G, in 1942 but became widely available outside the Allied military in 1945. This marked the beginning of the antibiotic era. This era witnessed the discovery of many new antibiotics, and the period between 1950s and 1970s was named the golden era of discovery on novel antibiotics, and no new classes of antibiotics have been discovered since then. What did this mean for people? Well, since then, STIs spread by bacteria often require just a simple trip to the clinic and a course of antibiotics, same treatment went for meningitis, strep throat, ear infections, papercuts, and infections post-surgery. There was even a dramatic decline in deaths during birth. Today the risk of a woman dying in England during labour is between 40 to 50 times lower than 60 years ago. To be specific, in the US for example, the leading cause of death changed from communicable diseases to non-communicable diseases (cardiovascular diseases, cancer and stroke). Average life expectancy rose from 48 to 78.8 years and older population changed from 4% to 13% of the entire US population. Even dating all the way back to World War II and today with the war in Syria, soldiers experienced injuries that would have been fatal without penicillin and other antibiotics developed subsequently. Medicine today wouldn’t have been as effective as it is without the discovery of penicillin.

Modern Medicine would not be nearly as advanced, had it not been for antibiotics. Technological advances in surgery would have meant very little if the patient died with wound infection even after a robotic surgery. There has been lots of discoveries in the past 100 years that have changed and shaped modern medicine today such as the discovery of DNA, immunology, tissue culture, oral rehydration therapies, 3D-printed body parts, robots and lasers, foetal ultrasounds, insulin pumps and a lot more. However, the most ground-breaking discovery I believe, is and will be penicillin because it has singlehandedly saved countless lives. It has given people second opportunities to live. It totally converted those pessimistic, dark, awful times when doctors were helplessly failing to these optimistic, magical, lifesaving times when all of modern medicine has changed into something as successful as today’s NHS in the UK. Even today doctors are relying on Penicillin to save patients infected with the dreadful Coronavirus.

However, it’s interesting that using penicillin or the treatment of infections like pneumococcal pneumonia and bacterial endocarditis never had a randomized, controlled trial because the difference with treatment was so clearly apparent that no one even thought of doing a randomized controlled trial. The success of antibiotics has been immensely impressive but excitement about them has been tempered by a phenomenon called antibiotic resistance. Now that antibiotics have become so important to the survival on human lives, this is a threat to the usefulness of this medicine. Some serious infections have become more difficult to treat, forcing doctors to prescribe a second or even a third antibiotic when the first treatment doesn’t work. Hence, many doctors have become much more careful while prescribing. In fact, one recent survey of physicians published in JAMA: The journal of the American Medical Association in 2002, showed that doctors lowered the number of antibiotic prescriptions they prescribed for children with common respiratory infections by about 40% during the 1990s – good practice always helps. The other significant negative impact of antibiotic resistance is the discovery of costly antibiotics. While richer nations can still manage the cost, many non-affluent countries struggle to provide this costly treatment to their citizens when it is needed. The end result is untimely death and loss of human life due to the lack of proper medicine. In fact, antibiotics are one of the most commonly prescribed medication currently in any hospital around the world.

As concerning as this sounds, the discovery of penicillin did shape modern medicine in a way that even our latest healthcare system will still continue to be benefitted from this. Since modern medicine is all about saving precious human lives, the issue of antibiotic resistance is clearly a red signal. But I have to admit this problem is nothing to undermine how vital the discovery of penicillin was. It’s proven by all the lives that it has saved since its discovery. It has rarely killed but only saved. Sir Alexandra Fleming gave us penicillin. Penicillin saved millions of lives and has every potential to continue doing so. Therefore, undoubtedly, over the past 100 years, I believe the discovery of penicillin has definitely had the greatest contribution towards shaping modern medicine.

 

By Angona Sarkar