Editorial: Howard Florey and the penicillin story

Journal of Orthopaedic Surgery, Dec 1997 by Bauze, Robert

Human testing was then required and obviously larger quantities of this unstable product needed to be produced. It was extremely difficult, but there was finally developed a method which produced a yellow powder containing 500 units of penicillin per milligram. This firstly involved the use of domestic baths, and large numbers of specially designed ceramic patient urinals used as incubators of the mould. Despite requests by Florey, the industrial chemical industry in England, in the early days of the Second World War, was not interested or able to support this work.

The first patient to be treated with penicillin was at the Radcliffe Infirmary in Oxford, a policeman dying of septicaemia from an infected scratch at the corner of his mouth. The organism was Staphylococcus aureus. He had not responded to sulphonamide. His condition deteriorated with multiple abscesses and death was imminent. On 12 February 1941, an intravenous injection of penicillin was given to the dying man and then 100 mg every three hours. After 24 hours there was a startling improvement in his condition. There was very little penicillin and it was being used up very quickly. His urine had to be collected, penicillin recovered from his urine and readministered. But soon the supply of penicillin and the decreasing concentration in the urine meant that there was an inadequate therapeutic dose. His condition deteriorated and he died on 15 March 1941.

When a further supply of penicillin was produced, three other cases of severe infections were treated, with complete recovery in two and great improvement in the third. By this time it was 1941 and the Battle of Britain and the London Blitz were underway. Major chemical manufacturers in England were unable to organise commercial production.

In 1941, Florey and his colleague Norman Heatley (still alive) went to New York taking some of the precious penicillin strain. Florey contacted friends from his previous visits to the USA and ultimately settled on the Mycological Laboratory in Peoria, Illinois. The effort there was supported by the United States Government and Florey handed over all the Oxford data and experimental findings. The patent for penicillin was thereby lost from England.

A search was made throughout the world for different moulds that might give a larger production of penicillin. The laboratory encouraged the community to bring along mouldy items for assessment. In the backblocks of Peoria, Illinois, a derelict lady nicknamed 'Mouldy Mary' found a rotten cantaloupe melon discarded from a local fruit market. This produced a particularly productive strain of Penicillium notatum and most of the strains used today come from this rotten melon. Production of penicillin commenced in much greater quantities.

Further clinical trials were carried out by Florey and his wife Ethel in 1941-43 and studies were subsequently done on battle casualties in the North African campaign. It might be mentioned that a special battle casualty was that of gonorrhoea and syphilis which caused a big toll on the armed forces. But small doses of penicillin quickly returned soldiers to the front line. The pressures of war greatly accelerated the production of penicillin on a mass scale. This eventually led to the availability of penicillin for the allied forces landing in Normandy in June 1944. Penicillin caused the virtual disappearance of gas gangrene after battle casualties.