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Public Health Classics
This section looks back to some ground-breaking contributions to public health, reproducing them in their original form and adding a commentary on their significance from a modern-day perspective. To complement the theme of this month's Bulletin, Sir Richard Sykes reviews the 1929 paper by Alexander Fleming on the antibacterial action of cultures of a penicillium. The original paper is reproduced from the British Journal of Experimental Pathology.
A bacteriology student reading the title of Fleming's landmark paper (1) today in an electronic Current Contents list might well ignore the article. Antibiotic use is commonplace and isolating bacteria is relatively straightforward on modern, selective media. But we need to consider this paper in its 1929 context to appreciate its significance.
Fleming's succinct 10-point summary shows the extent to which he had explored his original finding "that colonies of staphylococci near a mould colony were degenerate". His research covered conditions for optimizing production of the new natural product, penicillin, named following the nomenclature applied to other natural products, e.g. digitalin from Digitalis. Fleming explored the spectrum of activity of his novel compound using techniques that he devised to estimate its potency, bactericidal activity, interaction in the presence of leukocytes, efficacy and toxicity in animals. This broad evaluation of penicillin encompasses many of the key areas that would be used today in support of an application to use a new antibiotic for the first time in man. Fleming particularly appreciated the lack of toxicity and irritancy, evidenced by its application topically in the eye and by intravenous injection in mice.
Fleming assessed his own contribution to the discovery of penicillin in his address to the University of Edinburgh in 1952 when he took "Success" as the topic for his inaugural lecture as the newly elected Rector (2). He referred to the phenomenal success of Louis Pasteur, attributing it to hard work, careful observation, clear thinking, enthusiasm, and a spot of luck. He acknowledged the place that chance had had in his own career, beginning with his choice of St Mary's Medical School because he liked swimming and it had an active swimming club. His own assessment of his role in the discovery of penicillin was that he saw something unusual and appreciated something...