Five Days

I

On 12 February 1941, in the infirmary of the Radcliffe in Oxford, a forty-three-year-old policeman was given a hundred and sixty milligrams by vein of a brown powder that barely existed in the world. Two hundred units, as it was put then, because the thing was not measured by weight but by activity: the measure was called the “Oxford unit” and it came out of the very laboratory that made it.

His name was Albert Alexander. He had had an infection for months that had started on his face and had gone to his eyes, his scalp and his lung. One eye had been taken out. He had abscesses that were drained and came back, sustained high fever, and the rest of the body was following behind [in 1941 that was called septicaemia and one died of it, and that was that]. The wound came from a German bombing of his police station on 30 November 1940 —shrapnel in the face—, although for decades the story went that he had scratched himself on a rose bush.

Within twenty-four hours his fever came down, he ate again and the suppurations began to dry. Nobody had ever seen such a thing; people with that infection got better or did not get better, but they did not get better in a day.

The team that gave it to him had spent months making it by hand, in a university laboratory in wartime. Florey directed, Chain had solved the chemical part and Heatley had invented the contraptions: trays, flasks, a centrifuge made from a milk churn and a bookshop's pump.

The problem was the quantity. At Oxford they produced it by growing mould in trays and in ceramic bedpans —it was the only thing they found with the right shape and in sufficient number—, and the whole output of the laboratory was not enough for one adult man. Since the kidney expels it almost entire and within a few hours, his urine was collected, taken to the laboratory and the drug recovered from it to be injected back into him.

Even so it ran out. Five days: a hundred and twenty hours of treatment for an infection that had been installed for four months.

The treatment was suspended because there was no more. The infection climbed again, and he died on 15 March 1941, one month to the day after the first injection.

II

Drug stories usually end with the thing working and costing money. This one ends somewhere else: the thing worked, it was demonstrated in his body, and there was none.

It is worth pausing on that, because it was not a failure of the laboratory or a tragedy of fate [nor did anyone get the dose wrong]. The molecule had been discovered since 1928 and purified well enough in 1940. What was missing was not science; it was a factory. In February 1941 the world's penicillin production capacity fitted into a room with trays, and that room could not cure an adult with a spread infection.

The next patient was a boy of fifteen, with less weight and less infection, and that one was cured with what there was. The difference between the two was not the diagnosis or luck: it was how many milligrams were needed to fill a body.

The discovery saves nobody. What saves is the capacity to manufacture, and that is a story of chemical engineering and tanks, not of geniuses looking at a plate.

That story begins five months after Alexander's death. In the summer of 1941 Heatley crosses the Atlantic with samples of the mould, and the work moves to an agricultural laboratory in Peoria, Illinois, where somebody tries feeding the culture with corn steep liquor, a residue of the local industry. The yield multiplies. Then a better strain turns up in a rotten melon bought at the market in the same city, and then the culture goes from trays to tanks with injected air.

With that, and with nothing else, there came to be enough penicillin for the wounded of the Normandy landings in June 1944 [the same product, another scale]. Three years from the man who ran out of his flask.

III

I had an abscess in January, on the right side, with that swelling that deforms the face and that by the second night stops you sleeping on one side.

The dentist looked at me for eight seconds, said a word I already knew and wrote a prescription. At the chemist's, a box of twenty capsules for less than four euros, one every eight hours, with food or without, it makes no difference [that indifference to the stomach is precisely the invention of 1972].

The first three doses I remember by the hour [two in the afternoon, ten at night, six in the morning], and the sixth I no longer do, because by then the pain had become a nuisance and a nuisance does not make you look at the clock.

By forty-eight hours the business was over [swelling down, normal temperature, sleeping on whichever side I liked]. On the fourth day I forgot the morning dose and caught up in the afternoon, with no consequences. I finished the box out of discipline and not out of symptoms [eight more capsules, with nothing left to cure], and I took the last capsule standing up in the kitchen, my mouth already fine, thinking about something else.

Every time I urinated, in those seven days, I was flushing down the lavatory the drug they collected from Alexander to put back into him.

IV

Inside, what happens is a badly finished building job.

The bacterium is building its wall all the time and cannot stop, because that wall is the only thing keeping it from bursting under its own internal pressure. It has more salt and more matter inside than out, the water pushes inwards, and without a rigid wall the creature swells until it breaks; the pressure in there is several times that of a car tyre.

There is an enzyme that acts as the bricklayer and goes stitching the courses to one another. Penicillin resembles closely enough the piece the bricklayer takes hold of to stitch. The bricklayer takes hold of it. He stays holding on, with the false piece in his hand, put out of use for ever.

The wall goes on growing and is no longer stitched. Longer and longer, slacker and slacker, until the bacterium bursts from inside for going on building. It does not poison it: it leaves it working.

Our cells have no wall, and that is why the drug can be so brutal with one and so indifferent to the other.

What was happening to the molecule in 1941 explains the rest of the story. The acid of the stomach undoes it, so it could not be swallowed; it had to be put in a vein or a muscle. The kidney, besides, recognises it as something surplus and throws it out within a couple of hours almost intact; hence the bedpans, and hence the bicycle they carried the stuff to the laboratory on.

The one I took is a cousin of hers from 1972, to which a piece was added so that it holds against the acid. Everything that changed between his body and mine fits into that sentence: the same idea, able to survive a stomach.

From there comes the cardboard box, and from the cardboard box comes everything else. A drug that is swallowed is prescribed by telephone, taken at home, a dose forgotten and bought without anyone seeing the patient. One that is injected requires a hospital, a nurse and a register.

V

My four-euro box exists because the scarcity was solved, and the scarcity was solved so well that now the problem is the opposite. Every time somebody takes one of these, the bacteria that suffer it worst die and the ones that best withstand it are left with the place. That is not a side effect; it is the mechanism working the right way round. I took twenty capsules for an abscess that might have been resolved with a drainage and three days of patience.

Alexander lacked the abundance I have to spare. The abundance I have to spare is what is using up the drug he lacked.

There is no clean way of saying this without it sounding like a sermon, so I will say it dirty: I took it, it relieved me, and I would do it again.

VI

Little is left of Alexander's file and the little that is left is bookkeeping.

A hundred and sixty milligrams the first day, two hundred units. Doses repeated every three hours while there was any, day and night, with the laboratory working in parallel to replace what came out through the kidney. Urine collected for five days to recover what his own body gave back. Suspension on exhaustion of stock. Relapse. Death one month after the first injection.

It was his daughter who told, many years later, about the bombing. A granddaughter of his has described the rose bush version as propaganda of the period.

What is not in that file is the word we would use today. He did not die of the infection; he died of a break in supply, which is a thing that happens in warehouses and not in bodies [in his file, however, the first is what is recorded].

12 February 1941, a hundred and sixty milligrams intravenously.

Five days of treatment, with the urine recovered.

15 March 1941.

Box of twenty five-hundred-milligram capsules, today, in a Spanish pharmacy: less than four euros.