Penicillin, Modern Surgery and the Wars
A Mouldy Plate in 1928
In September 1928 Alexander Fleming returned from holiday to a stack of staphylococcus plates left on his bench at St Mary’s Hospital, London. One plate had been contaminated by a blue-green mould — Penicillium notatum — and around it the bacteria had been destroyed. Fleming named the active substance ‘penicillin’ and published his observation in 1929. He could not purify it in useful quantities and moved on. For ten years penicillin sat in journals as an interesting laboratory finding, not a medicine. Chance had handed Britain a discovery; it took two more individuals and a war to turn it into a drug.
Penicillin needed three people, not one. Fleming spotted it in 1928. Howard Florey and Ernst Chain at Oxford purified it from 1939 and treated the first human patient in 1941. The three shared the 1945 Nobel Prize for Medicine.
Florey, Chain and the First Patient
In 1939 Howard Florey and the German-born biochemist Ernst Chain led an Oxford team that purified penicillin in measurable quantities. Their 1940 mouse experiment was decisive: eight mice were injected with deadly streptococcus, four were given penicillin, and the four treated mice survived while the four untreated ones died. In February 1941 they treated PC Albert Alexander, a policeman dying of sepsis after scratching his face on a rose thorn. He improved dramatically — until the supply ran out, his infection returned, and he died. Britain in wartime could not produce penicillin at the scale clinical medicine demanded.
War Forces Mass Production
Florey flew to the United States in 1941 to find industrial partners. American pharmaceutical companies, backed by the US War Production Board, scaled penicillin from milligrams to tonnes using deep-tank fermentation. By the D-Day landings in June 1944 there was enough purified penicillin for every Allied soldier wounded in Normandy. Battlefield mortality from infected wounds collapsed. War, science and individuals had combined: without WWII, mass-produced penicillin would have arrived years later, and possibly not at all in time to matter for the wounded of 1944–45. Fleming, Florey and Chain shared the Nobel Prize for Physiology or Medicine in 1945.
Plastic surgery: Harold Gillies pioneered facial reconstruction at Queen’s Hospital, Sidcup, treating WWI soldiers disfigured by shrapnel. His pupil Archibald McIndoe ran the Guinea Pig Club at East Grinstead in WWII, rebuilding burned RAF aircrew with skin grafts. Blood transfusion: Karl Landsteiner identified the ABO blood groups in 1901, making safe transfusion possible. WWI surgeons developed citrate anticoagulant and refrigerated storage, allowing blood banks. The National Blood Transfusion Service was founded in 1946. X-rays: Wilhelm Röntgen discovered X-rays in 1895; by 1914 mobile X-ray units were locating shrapnel and bone fractures behind the front lines. Each technology was accelerated by the demands of war.
Modern Surgery and Pharmaceuticals
After 1945 surgery was reshaped by new tools and a booming pharmaceutical industry. Christiaan Barnard performed the first heart transplant in Cape Town in 1967. Keyhole surgery (laparoscopic surgery), using small incisions and fibre-optic cameras, spread from the 1980s and reduced recovery times for gallbladder, appendix and joint operations. Lasers replaced scalpels in eye surgery and tumour removal; radiotherapy targeted cancers with controlled radiation. Pharmaceutical companies multiplied antibiotics — streptomycin (1944, tuberculosis), tetracyclines, cephalosporins — and added drugs for previously untreatable conditions. Britain’s NHS, founded in 1948, became the largest single buyer of these drugs in Europe.
The antibiotic age created its own crisis. Methicillin-resistant Staphylococcus aureus (MRSA) emerged in the 1960s as bacteria evolved resistance to over-prescribed antibiotics. By the 1990s ‘superbugs’ threatened to undo the gains since 1944, prompting hospital hand-hygiene campaigns and tight prescribing rules in primary care.
Modern medicine also faced diseases earlier eras barely recognised: HIV/AIDS from the 1980s, an ageing population’s dementia and cancer burdens, mental health conditions previously hidden behind stigma, and lifestyle illnesses linked to diet, smoking and alcohol. Alternative treatments — acupuncture, herbalism, homeopathy — gained popularity as patients sought options outside conventional pharmaceuticals, though evidence for their effectiveness remained mixed and contested by NHS clinicians.
The penicillin story shows four factors interlocking. Chance: Fleming’s contaminated plate. The individual: Florey and Chain’s purification. Science and technology: deep-tank fermentation. War: WWII demand and US government funding. Remove any one and mass antibiotics arrive late or not at all.
Linking to the Factor Essay
Modern medicine sharpens the chance-versus-other-factors debate that runs through the whole thematic study. Compare three accidental discoveries across periods: Ambroise Paré’s 1530s salve (running out of oil forced a substitute that worked better), Pasteur’s 1879 chicken-cholera vaccine (a forgotten culture lost its virulence), and Fleming’s 1928 mould. In every case chance opened the door, but science explained the result, individuals chased it down, and government or war scaled it up. Chance alone discovers nothing useful — it requires a prepared mind, working in a system that can act on the discovery.