Management
 
 
“As to diseases, make a habit of two things – to help, or at least do no harm.” - Hippocrates. (Epidemics I, Ch. XI) -
 
Under management, you might employ such subheadings as conservative, medical, and operative. Notes on prevention might also be useful, or for a big topic you might wish to include other subheadings – its up to you!
The Incredible Story of Penicillin
Another of the greatest stories in the history of medicine concerns the discovery of penicillin by Dr Alexander Fleming. It involves such an incredible run of luck that it is probably the single most serendipitous event ever in the history of science. The story begins during a heatwave in London, 1928, when Fleming was conducting research on the influenza virus. Fleming was a somewhat messy worker and on this occasion had left his window open and an inoculated plate of staphylococci open on his bench. It just so happened that in the lab upstairs where somebody was working with fungi a window was also left open. A mould spore quietly drifted through Fleming’s open window and landed on his plate of staphylococci. Fleming subsequently covered the plate but for some unknown reason did not put it in the incubator. Fleming went away on holiday for the next few days and came back in a tidier mood. He saw a funny looking plate on his desk and with a passing glance he threw it in the rubbish bin. However, he went back to the bin later and chanced to glance again at the plate. This time he was struck by an observation that one area of the plate grew a strange blue-green mould while the staphylococci in the adjoining area had been killed off. Fleming was immediately interested and set to work isolating the mould. He then examined its fluid (which he ingeniously called ‘mould-juice’) and wrote up his discovery. He briefly tried using ‘mould juice’ as a treatment for bacterial infection, but had no success and soon abandoned the whole idea as too much trouble. Scientists subsequently tried to reproduce Fleming’s work, but strangely dripping mould on plates of staphylococci never seemed to work again. Years later, Fleming’s assistant discovered the key to the puzzle, and also just how lucky Fleming had been. Penicillium mould grows best at 20oC, staphylococci at 35oC. The weather records were examined… during the heatwave, there suddenly occurred an exceptionally cool period for nine days, starting the day that the penicillium mould had landed on Fleming’s plate. The mould grew well. After this time, the heat returned, and the staphylococci grew, but enough ‘juice’ had been produced by the mould to kill the bacteria. Furthermore, the particular specimen of Penicillium mould that landed on Fleming’s plate was one of the strongest natural producers of penicillin ever encountered. A typical Penicillium mould would have had very little effect on the staphylococci. Ten years after Fleming’s work the Oxford chemists Chain and Florey decided to take up the penicillin challenge. They painstakingly isolated some of Fleming’s ‘mould-juice’ and successfully treated mice who were inoculated with what should have been a lethal dose of staphylococci. Hugely excited, they set about producing as much extract as they possibly could, employing bathtubs, bedpans and milk-churns. Finally they produced enough to try on a human patient. Policeman Albert Alexander was selected, an unfortunate man dying of staphylococcal poisoning after being scratched by a rose thorn. In four days, he was showing a miraculous recovery, but sadly the penicillin ran out and he died. However their second patient, a 15-year-old boy suffering from septicaemia after a hip-operation was saved. The antibiotic era had begun. Renamed penicillin, mould juice was employed late in World War II, saving many lives. Fleming, Chain and Florey were given the Nobel Prize. Few predicted how staphylococci would soon be fighting back.