How Alexander Fleming Changed the World

Alexander Fleming was a Scottish doctor and microbiologist who discovered the world's first effective antibiotic, penicillin. This discovery revolutionised medicine and has been described as the single greatest victory ever achieved over disease. It's estimated that well over 200 million people have had their lives saved by penicillin and it continues to be an effective medicine used all around the world to this day. In this video we're going to tell the story of Alexander Fleming's life, examine how he discovered penicillin, how it transformed medicine and how Fleming's discovery ushered in a new age of civilisation and then finally explore the terrifying possibility of antibiotics like penicillin no longer working. This is how Alexander Fleming changed the world. Alexander Fleming was born on the 6th of August 1881 in East Ayrshire, Scotland. He lived a relatively normal childhood until the age of seven when his father sadly passed away. Luckily his family made it work with his father not being there and Alexander earned a scholarship to the Kilmarnock Academy which then later enabled him to move to London where he attended the Royal Polytechnic Institution in Westminster. From there Alexander followed the career path of his brother Tom Fleming who was a doctor and in 1903 Alexander enrolled at St Mary's Hospital Medical School in Paddington, London. Whilst at medical school Alexander joined the Rifle Club and was reportedly a good shot and a vital member of the team. So once Fleming finished his degree and was set to leave the medical school and the Rifle Club, the captain of the Rifle Club wishing to keep Fleming as a member of the team suggested he join the research department at St Mary's Hospital. Fleming joined the research department becoming assistant bacteriologist to Sir Almroth Wright who was a pioneer in vaccine therapy and immunology. This was a key moment in Fleming's life and quite frankly for humanity. Joining this research department set him on a path to discovering penicillin and changing the world. Fleming went on to earn a Bachelor of Science in bacteriology and become a lecturer at St Mary's Alexander Fleming served throughout the First World War in the Royal Army Medical Corps. During his time in the First World War Alexander and his colleagues from St Mary's Hospital effectively moved the entire inoculation department of St Mary's to the British Military Hospital at Boulogne-sur-Mer in France. Whilst serving Fleming witnessed the deaths of many soldiers from sepsis. Sepsis is a life-threatening condition where your body overreacts to an infection and starts attacking its own tissues and organs. Fleming observed that the antiseptics which were commonly used to treat infected wounds at the time often didn't work or even worsened the injuries. In an article he published in 1917 in the Lancet, a medical journal, he explained how antiseptics are actually killing more soldiers than the infections they were trying to treat. Antiseptics worked well on the surface but deep wounds tended to shelter bacteria from the antiseptic agent. Antiseptics also appeared to remove beneficial substances created by the body to help fight the infection and once these were removed the bacteria the antiseptic failed to kill had free reign to infect the body. Alexander Fleming's mentor Sir Almorth Wright strongly supported Fleming's findings but despite this most physicians working during the First World War continued to use antiseptics to treat infections even in cases where it worsened the condition of the patient. After the First World War Alexander Fleming went back to working at St Mary's Hospital where he investigated antibacterial substances and their effects on animal tissues. It was here in 1921 that Fleming made one of his first great discoveries, lysozyme. Lysozyme is an antimicrobial enzyme produced by animals including us humans that forms part of the innate immune system. Whilst working in his laboratory he found one of his agar plates had been contaminated. Agar plates are petri dishes that contain a growth medium that is solidified with agar and agar is a jelly-like substance created from algae. He found one of his agar plates was contaminated with bacteria from the air. For some reason he then decided to add nasal mucus to the contaminated agar plate and to his surprise he found the mucus inhibited the growth of bacteria in the contaminated agar plate. Surrounding the nasal mucus that he had put in the agar plate was a clear transparent circle which indicated a killing zone of bacteria. Fleming then decided to test nasal mucus on a different type of bacteria that was growing in a yellow saline solution. Within two minutes of adding fresh nasal mucus the yellow saline turned completely clear. Fleming then had the idea to experiment with tears rather than mucus asking all of his co-workers to contribute. As VD Allison, one of Alexander Fleming's research colleagues recalled, for the next five or six weeks our tears were the source of supply for this extraordinary phenomenon. Many lemons were used after the failure of onions to produce a flow of tears. The demand by us for tears was so great that laboratory attendants were pressed into service receiving three pence for each contribution. Alexander Fleming went on to not just test mucus and tears but also sputum, cartilage, blood, semen, ovarian cyst fluid, pus and egg white, showing that the antimicrobial enzyme lysozyme that inhibited bacterial growth was present in all of these. Fleming reported his new discovery to the Medical Research Club and Royal Society, but no one seemed that interested. His paper describing lysozyme received no questions and no discussion, which was a pretty clear indication that people viewed it as insignificant. Lysozyme had very little therapeutic potential as the enzyme was only really effective against small amounts of relatively harmless bacteria, but it was still an important discovery that helped to understand how animals' immune systems, including our own, worked. It wasn't until the late 20th century that the importance of Fleming's discovery of lysozyme was recognised. It was actually the first antimicrobial protein ever discovered and made up part of our innate immune system. VD Allison, one of Fleming's research colleagues, also recalled that Fleming was not a tidy researcher and as a result would regularly expect unusual bacterial growths to appear in his culture plates. But this untidiness was not necessarily a bad thing. In fact, it was probably a good thing. VD Allison actually attributed Fleming's untidiness to his success in discovering lysozyme and later penicillin. After Fleming's discovery of lysozyme, he continued to study bacteria for many years in his laboratory at St Mary's Hospital. In September of 1928, Fleming was going on holiday with his family to Suffolk. Before leaving his laboratory, he inoculated Staphylococcus bacteria on culture plates and left them in a corner of his lab. On his return from his holiday on the 28th of September 1928, Fleming found that one of the culture plates he'd inoculated was contaminated with a fungus and the Staphylococci bacteria immediately surrounding the fungus had been destroyed. Upon seeing this, Fleming famously remarked, that's funny. Alexander Fleming identified the mould growing on the culture plate as being from the genus Penicillin. He went on to grow more of this mould and quickly discovered it contained antibacterial properties. After further investigations, Fleming found it had a pronounced impact upon Staphylococci bacteria and other similar gram-positive pathogens that can cause things like scarlet fever, pneumonia, meningitis and diphtheria. This accidental discovery would turn out to be one of the most significant medical breakthroughs in human history. Little did Alexander Fleming know at the time, but he had just discovered something that would go on to save hundreds of millions of lives and totally change the world. Fleming initially just called what he had discovered mould juice, but after several months of work, he gave the antibacterial substance present in the mould the name Penicillin, which it is still known as today. Alexander Fleming presented his new discovery to the Medical Research Club in 1929, but once again nobody seemed that interested. The chair of the meeting later reminisced that he didn't sense any importance in Fleming's discovery at the time. Fleming went on to publish his work in the British Journal of Experimental Pathology. Once again, little attention was paid to the article. The difficulty of isolating the main compound of Penicillin and producing large amounts of it were one of the main reasons for a lack of interest. If production couldn't be scaled up, Penicillin was deemed effectively useless to the medical community. Fleming later received help from Howard Reinstick and his team of biochemists from the London School of Hygiene and Tropical Medicine, but they came to the conclusion that chemical purification of Penicillin was futile. They thought it just could not be done. As a result, Penicillin was largely forgotten about throughout the 1930s. But Alexander Fleming did not give up. He knew Penicillin's potential. Fleming first tried to use Penicillin clinically in 1929 when a research scholar named Stuart Craddock, who had developed a severe infection of his nasal cavity. But the Penicillin didn't seem to have any effect. Fleming thought this was likely because the infection was caused by a type of bacteria he had already discovered was resistant to Penicillin. The first recorded successful use of Penicillin was not actually conducted by Alexander Fleming, but by Cecil George Payne, who was a pathologist and former student of Fleming. Payne successfully used Penicillin to treat one adult and three infants of conjunctivitis eye infections in 1930. It wasn't until 1932 that Fleming first successfully treated someone with Penicillin. Keith Bernard Rodgers, who was a medical student at St Mary's Hospital and captain of the university rifle team at the time, developed a severe conjunctivitis eye infection. Rodgers had planned on participating in a rifle shooting competition, but due to his eye infection was going to pull out. However, Fleming applied Penicillin ointment to Rodgers eye, curing his conjunctivitis. It's even reported that Rodgers went on to actually win the shooting competition, all thanks to Fleming's Penicillin. In 1936, at the Second International Congress of Microbiology, Alexander Fleming gave presentations about Penicillin's importance and potential value for the treatment of infections. But once again, no one really listened to him. There was a complete lack of interest or discussion about Penicillin. Whilst there, Fleming had the opportunity to read a paper of his work on Penicillin at a meeting attended by the most prominent bacteriologists from all over the world. But once again, they failed to see any value in his work. Fleming's core idea was that Penicillin could be used to prevent and treat bacterial infections, but many of the bacteriologists there simply did not support this view. As a result, Alexander Fleming was utterly deflated. His fellow bacteriologists from all over the world, people who had dedicated their lives to studying bacteria, just as he had, could not see any value in his work. It must have been so disappointing. This setback did not dissuade him from continuing to work on, investigate and experiment with Penicillin. He was convinced of Penicillin's potential value to the world and was determined to make it a reality. Looking back now, it really is staggering how almost no one during the 1930s, besides Alexander Fleming, saw the potential of Penicillin. Without Fleming's perseverance, Penicillin may never have become a widely available drug. Alexander's conviction and determination was a real gift to humanity. The millions upon millions of people who have had their lives saved by Penicillin owe a great debt to Fleming. In 1939, Fleming's perseverance paid off. Ernst Chain, a biochemist, joined the School of Pathology at the University of Oxford to investigate antibiotics. Whilst there, Ernst Chain happened to randomly come across one of Fleming's papers from 1929 on Penicillin. Ernst instantly saw Penicillin's potential, and after reading the paper, he went straight to his supervisor, a gentleman by the name of Howard Flowery. Howard Flowery was an Australian pharmacologist and pathologist working at Oxford who had just received a $25,000 research grant, which was a lot of money back then, from the Rockefeller Foundation, to study antibiotics. And so, Howard Flowery and Ernst Chain assembled a team of researchers at Oxford to begin work on the isolation and purification of Penicillin. Fleming's tireless work had finally paid off. Ernst Chain and Howard Flowery not only saw the potential of Penicillin, but wanted to do everything they could to make it a reality. The team at Oxford worked to produce a concentrated extract of Penicillin that could be used in a powdered form. And in May 1939, they conducted their first study of Penicillin, injecting eight mice with a virulent strain of bacteria, then injecting four of those mice with Penicillin extract. After just one day, the four mice that didn't receive any Penicillin were dead. But the four that did receive Penicillin survived. Ernst Chain remarked upon seeing the result, it's a miracle. The team published their findings in the Lancet in 1940. Shortly after publication, Alexander Fleming telephoned Howard Flowery to say that he would be visiting the team at Oxford within the next few days. When Flowery told the team Fleming was coming to visit, Ernst Chain remarked, good God, I thought he was dead. In 1941, the Oxford team attempted to treat their first human patient with Penicillin. Albert Alexander, a police officer, had a severe face infection. Upon receiving Penicillin, his condition did start to improve. However, at this time there was only a limited supply, so they actually ran out of Penicillin before they could finish treating him, and sadly he passed away. Not a great start for the Oxford team, but it did teach them a valuable lesson. For Penicillin to be effective in treating severe infections, it needed to be given in much larger quantities. A year later, in 1942, Alexander Fleming carried out an important clinical trial for Penicillin. Harry Lambert, who was a colleague of Alexander Fleming's brother, was suffering from a potentially fatal infection of his nervous system. Fleming asked the team at Oxford for a purified sample of Penicillin, which he then used to inject into Harry Lambert's spinal canal. Within just a day Lambert started showing signs of improvement, and within a week he had recovered. Fleming reported this clinical trial in The Lancet in 1943, and this evidence would later prove vital in helping to convince governments to mass-produce Penicillin. I think it's important to stop for a second and realise just how monumental this moment was for humanity. Before Penicillin, contracting a bacterial infection had the potential to be life-threatening. At that time, 90% of children with bacterial meningitis died. Common problems like strep throat near infections could spread throughout the body and cause serious medical issues. But Alexander Fleming's discovery of Penicillin changed all of that. For the first time in human history, we had a powerful and effective medicine to fight bacterial infections. It opened the door to the mass rollout of antibiotics and completely changed our world. During the early 1940s, whilst these developments of Penicillin were occurring, the Second World War was raging. As with all previous wars, infected wounds were a huge problem. A mild cut or injury acquired on the battlefield had the potential to become infected and turn into a life-threatening issue. Penicillin offered a solution to this problem, and it would be a real advantage in the war to have an effective antibiotic to treat your troops. The only issue was how to scale up production of Penicillin. Initially, in 1941, the team at Oxford tried to convince the British government to mass-produce Penicillin. But at that time, they just couldn't persuade them. The British government was in the midst of war and likely didn't have the resources to spare on such an unproven and risky project. So, Howard Flowery and other members of the Oxford team travelled to the United States of America to persuade the American government and pharmaceutical companies to help mass-produce Penicillin. They met with a number of government and pharmaceutical officials, who immediately saw the potential of Penicillin. Work quickly began at a USDA laboratory in Peoria, Illinois, and by the end of the first month, they were making their own culture of Penicillin. However, they realised Alexander Fleming's original mould sample that all previous cultures had been grown from was not efficient enough to produce large quantities of Penicillin. So, with the help of the US Army Transport Command, a great search began to find similar but more efficient mould samples from all around the world. They brought back samples from China, India, South Africa, but the single best sample was actually from a cantaloupe melon purchased in a fruit market in Illinois near the laboratory. Between 1941 and 1943, researchers in America focused on industrialising Penicillin production and isolating higher-yielding strains of Penicillin. Simultaneously, researchers working for Pfizer, a pharmaceutical company, developed a practical deep-tank fermentation method that would enable large quantities of pharmaceutical-grade Penicillin to be produced. At this point, Penicillin had proven to be effective and there were realistic methods for mass production, so the British Ministry of Health were contacted and convinced of the importance of Penicillin. The British War Cabinet was convened and also convinced of Penicillin's potential, and as a result, the Penicillin Committee was formed in April of 1943. On the committee was Alexander Fleming, Howard Flowery and representatives from the pharmaceutical industry. The main goal of the committee was to facilitate the production of large quantities of They planned to do this in collaboration with American pharmaceutical companies, who were realistically the only people at the time capable of ramping up production. The Penicillin Committee aimed to exclusively supply Allied armed forces with the drug in an effort to help win the Second World War, and by June 6th 1944, otherwise known as D-Day, enough Penicillin had been produced to treat all the wounded troops of Allied forces. And so, the world's first effective antibiotic, Penicillin, became available to fight bacterial infections. A huge victory for humanity in modern medicine. And it didn't take long for Penicillin to become available to the public. Here's an advert from 1944 that reads, Penicillin cures gonorrhoea in four hours. See your doctor today. After the Second World War had ended, Penicillin was rolled out on a massive scale and immediately began saving lives. Doctors who had previously had few options in the fight against bacterial infections now had a powerful medicine. Truly a momentous moment for humanity and modern medicine. Fleming's discovery and the hard work of the people at Oxford and in the United States had changed the world. Alexander Fleming's discovery of Penicillin earned him a long list of prestigious awards and titles. In 1943 he was elected a Fellow of the Royal Society. In 1944 he was knighted, becoming Sir Alexander Fleming. He was awarded the Medal of Merit by the President of the United States, was made a Grand Cross of the Legion of Honour by the French Republic and was made Grand Cross of the Order of the Phoenix of Greece. And in 1945, Alexander Fleming, along with Howard Flowery and Ernst Che shared the Nobel Prize in Physiology or Medicine for the discovery of Penicillin and its curative effects. Alexander Fleming and the members of the Oxford team did not patent Penicillin as they thought doing so would be unethical. However, that didn't stop American pharmaceutical researchers from patenting the production of Penicillin and when Alexander Fleming discovered what they had done he said, I found Penicillin and have given it free for the benefit of humanity. Why should it become a profit-making monopoly of manufacturers in another country? It's easy to understand Fleming's frustration. He'd worked so hard discovering Penicillin not to make money but to help humanity and here were individuals in America trying to get rich from the hard work of Alexander Fleming and the team at Oxford. On the 11th of March 1955, aged 73, Alexander Fleming died at his home in London of a heart attack. His ashes are buried in the crypt of St Paul's Cathedral in London. But his death isn't the end of this story. Fleming's discovery of Penicillin ushered in a new age of medicine. There are now over 100 different types of antibiotics available to help treat minor and life-threatening bacterial infections. Hundreds of millions of people have had their lives saved by Penicillin and it has been estimated that antibiotics have increased average life expectancy in a developed world by as much as 20 years. Today antibiotics have become so widespread and easily available even in the developing world that it's hard to imagine life without them. They are crucial to so many aspects of modern healthcare. Every year millions of operations are carried out and antibiotics are used to prevent pre and post-operative infections. One in four births are by cesarean and antibiotics are used to protect both mother and child from infection. 50% of all women will suffer a urinary tract infection at some point in their life and most of them will need antibiotics to treat the infection. Cancer treatments can suppress the immune system so antibiotics are needed to help keep people alive whilst they receive their cancer care and I could list a hundred other examples of how antibiotics are now vital to modern healthcare. But here's the scary thing. We may soon be facing a reality where antibiotics no longer work. This is because of the rise of antibiotic resistance. Antibiotic resistance is a consequence of evolution by a natural selection. Bacteria that cause infections would naturally develop resistance over time but when antibiotics are used it creates an environmental pressure on the bacteria, wiping out bacteria that are susceptible to antibiotics but leaving the few bacteria that have a resistant mutation alive. These mutant bacteria live on to reproduce, passing their resistant mutation on to their offspring which in turn creates a resistant generation of bacteria. Already today antibiotic resistant infections are a leading cause of death around the world, particularly in developing countries. It's estimated that in 2019 1.3 million deaths directly resulted from illnesses caused by drug resistant bugs. Antibiotic resistance is not a new phenomenon. Alexander Fleming discovered early in his research that bacteria developed antibiotic resistance whenever too little penicillin was used or when it was used for too short a period of time. In many of his speeches he cautioned doctors to not use penicillin unless there was a proper diagnosis for it to be used. He's also quoted saying that the time may come when penicillin can be bought by anyone in the shops then there is the danger that the ignorant man may easily underdose himself by exposing his microbes to non-lethal quantities of the drug making them resistant. Sadly we did not heed Alexander Fleming's advice and today we face the very real threat of antibiotic resistance that he warned us about. If we failed to stop antibiotic resistance it could render most if not all of our antibiotics useless. Without effective antibiotics modern medicine would grind to a halt and our lives would become immeasurably worse. The United Nations estimates that by 2050 antibiotic resistance could kill up to 10 million people a year. So what can we do to fight antibiotic resistance? A good place to start would be to tackle over prescription. Over 30 percent of antibiotics are given out unnecessarily in America and that figure can rise up to 50 percent in developing countries like India. There is a common misconception that antibiotics can treat any infection. That's just not true. If you take antibiotics when you have a viral infection like a cold, flu or COVID-19 it will do nothing to help you. Antibiotics only work against bacterial infections. The more we use antibiotics the more likely resistance is to develop. So by wasting them on people who don't need them we're only making the situation worse. Another major contributor to antibiotic resistance is animal agriculture and animal farming. Our consumption of meat, dairy and eggs plays a major role in this crisis. It's estimated that 80 percent of all antibiotics sold in America are used for animal farming. Antibiotics are routinely given to animals to make them grow faster and to prevent disease rather than to treat infections like they should be used. This then lets farmers pack more animals into awful, unhygienic and cramped conditions which creates the perfect breeding ground for antibiotic resistance to flourish. We're already seeing antibiotic resistant strains of Salmonella and Campylobacter that have originated from animal agriculture. If farmers are not stopped from using antibiotics like this we will have no chance of stopping antibiotic resistance. Developing new antibiotics will also be vital in fighting antibiotic resistance. All those years ago in 1929 Alexander Fleming effectively discovered penicillin through trial and error but today discovering and developing new antibiotics is exceptionally difficult. In most countries the price of antibiotics is kept low by governments in order to make sure such vital medicine is easily available to the public. This means pharmaceutical companies have little incentive to develop new antibiotics as they make almost no profit from them. It's also expensive and arduous to bring a new drug to the market typically taking 10 years or more and costing around a billion dollars. As a result pharmaceutical companies simply don't develop new antibiotics anymore. The most recent discovery of a new antibiotic class that made it to market was in 1987. Since then there has been very little investment and innovation in the antibiotic field. On a positive note though in the last few years innovation and research around antibiotics has slowly begun to ramp up again. We're nowhere near where we need to be but progress is slowly being made in the right direction. So to conclude Alexander Fleming discovered penicillin giving humanity a powerful and world-changing medicine. Without Fleming's hard work and perseverance we may never have developed penicillin. As a direct result of his discovery hundreds of millions of people have had their lives saved. There are very few people throughout history who can claim to have been involved in saving so many people. That alone should grant him a place in human history. It's rare you come across someone who was so dedicated to using their knowledge and expertise for the benefit of humanity. Alexander Fleming devoted his life to penicillin not for fame glory or wealth but for the good of humanity. Our world needs more people like him and without a doubt Alexander Fleming changed the world.