ALBERT ALEXANDER

The time had now come to find a suitable patient for the first test of the therapeutic power of penicillin in man.  Every hospital then had a “septic” ward, filled with patients with chronic discharging abscesses, sinuses, septic joints, and sometimes meningitis.  Patients with staphylococcal infection would be ideal because sulphonamides had no effect on them and were inactivated by pus.  In the septic ward at the Radcliffe Infirmary there was then an unfortunate policeman aged 43 who had had a sore on his lips four months previously from which he had developed a combined staphylococcal and streptococcal septicaemia.  He had multiple abscesses on his face and his orbits (for which one eye had been removed): he also had osteomyelitis of his right humerus with discharging sinuses, and abscesses in his lungs.  He was in great pain and was desperately and pathetically ill.  There was all to gain for him in a trial of penicillin and nothing to lose.

Penicillin treatment was started on 12 February 1941, with 200mg (10000units) intravenously initially and then 300mg every three hours. All the patient’s urine was collected, and each morning I took it over to the Dunn Laboratory on my bicycle so that the excreted penicillin could be used again. There I was always eagerly met by Florey and Chain and other members of the team.  On the first day I was able to report that for the first time throughout his illness the patient was beginning to feel a little better.  Four days later there was a striking improvement, and after five days the patient was vastly better, afebrile, and eating well, and there was obvious resolution of the abscesses on his face and scalp and in his right orbit.  But, alas, the supply of penicillin was exhausted: the poor man gradually deteriorated and died a month later. The total dose given over five days had been only 220 000 units, much too small a dose, as we now know, to have been able to overcome such extensive infection; but there was no doubt about the temporary clinical improvement, and, most importantly, there had been no sort of toxic effect during the five days of continuous administration of penicillin.  This remarkable freedom from side effects, apart from allergy, has remained one of penicillin’s most fortunate features.  

Sources: as above