Eyeworld

14 July 2018 EW NEWS & OPINION by J.C. Noreika, MD, MBA Fleming who observed halos free of bacteria around fibrillar excrescenc- es of mold, it was Florey who was tasked with isolating and purifying penicillin during World War II. The story of penicillin is one of kismet. Had Fleming's colleague Merlin Pryce not prevented the fateful culture from submersion in disinfectant, Ian "shaken, not stirred" Fleming would be Britain's only famous Fleming. It was Alex- ander who identified the unknown mycelial interloper, a "rare and un- usual member of the common bread mold family, penicillium." The Fates were not finished. The mold's growth was possible because of anomalous weather in London. Fleming went on vacation, leav- ing his plates on a lab bench. The weather was unusually cool. Atypical heat followed. Professor Ronald Hare later postulated that this climatolog- ical phenomenon favored the mold's growth and effectively retarded the heat-loving staphylococci. London's customary weather returned and prevented Fleming from replicating his findings. But he did keep a sam- ple of the mold. The contamination of the culture by the rare penicillium was itself a fluke. It wafted up to Fleming's lab from a laboratory a floor below. History little notes that Fleming missed the import of his observation. His earlier research on lysozyme's anti-bacterial properties led him down a comfortable but unproductive pathway. Ten years lat- er, chemist Ernst Chain discovered Fleming's brief 1929 report. With Howard Florey's encouragement, Chain investigated the forgotten work. It gets better. Leaving the research library, Chain, "a friendly, charming man … stopped to chat with Miss Margaret Campbell-Ben- ton." She was carrying a test tube containing the culture Penicillium notatum, the very mold Fleming had once sent to her now deceased boss, Professor George Dryer. The rest is history. There is more to the Fleming/ Florey story. In 1942, Fleming, whose friend was dying of strep- Winter is not afraid to name names. He paints Sir William Stewart Duke-Elder as an obstructionist to Ridley's innovation. At the 1951 Oxford Ophthalmologic Conference, the world's most famous ophthal- mologist refused to examine Ridley's patients. "To be sure, a few of the younger, less doctrinaire attendees offered positive comments, and one even congratulated Ridley." In 1974 a small cadre of eye surgeons led by Dr. Ken Hoffer would find resonance in the gesture. Time being circular, Ridley later implanted an intraocular lens into the aging Cleaver's sighted eye. The book has modest aspi- rations; careful readers may find some inaccuracies. But it is a dense, entertaining compendium of events neglected or forgotten. Surprises abound: Sigmund Freud's colleague ophthalmologist Karl Koller and co- caine; renewed interest in LSD and post-traumatic stress disorder; the link between effluent from Sardinia's sewers and cephalosporin C; Anto- nio Sobrero—not Alfred Noble—dis- covering nitroglycerin's explosive and medicinal effects. Destiny does not preclude unintended conse- quences. Thorazine's irrefutable suc- cess treating schizophrenia gutted insane asylums and helped foster the homeless crisis. And worthy of the book's price, its penultimate chapter describes Pfizer's contortions to parse a name for UK92480. Vigor, Niagara? Viagra! Really? Echoing Fleming, Isaac Asimov best sums up this book: "The phrase that heralds a new discovery is not 'Eureka'! It's 'that's funny.'" EW Editors' note: Dr. Noreika has practiced ophthalmology since 1981. He has been a member of ASCRS for more than 35 years. Join the discussion on this article and others on the EyeWorld blog at blog.eyeworld.org. Contact information Noreika: jcnmd@aol.com tococcal meningitis, petitioned Florey to provide the impossibly scarce drug. "Florey felt he could not refuse the discoverer of penicil- lin. He boarded the next train and hand-delivered the penicillin to Fleming at St. Mary's Hospital." The friend recovered. The London Times published the story and Fleming was celebrated. Florey's group eschewed the limelight. Winters writes, "It is a bit ironic that even though (Flo- rey's) Oxford Group had successfully treated 172 patients, Fleming had treated only one." Fortune eventual- ly smiled on Florey and Chain. They shared the Noble Prize in Physiology and Medicine with Fleming in 1945. The book's 25 chapters excavate the narratives of "twenty-six import- ant medical discoveries." Chapter 5 revisits the hoary account of Dr. Harold Ridley's lucky encounter with Lt. Gordon "Mouse" Cleaver, whose eye harbored plastic shards from his RAF Hurricane's cowl. After 8 years of care, the polymer remained inert within the eye. For Ridley to note this anomaly, Cleaver first had to forget his aviator goggles when scrambling to meet German bombers, survive his plane being shot up, parachute after maneuver- ing it upside down, and be spotted by rescuers who provided emergency care. Insights Book review of Dr. Robert Winters' Accidental Medical Discoveries, an exposition of the stories behind the stories of 26 revolutionary therapeutic miracles J uly! The high season of "just so" destinations like the Hamptons, Cape May, and Provincetown. The month when you dare not sample oysters or be admitted to teaching hospitals. The time when eye surgeons trade thoughts of Ar- gentinian flags for sunlit shadowed porches. So many books, so little time. If a spark of curiosity for your life's work still flickers, consider Rob- ert W. Winters' Accidental Medical Discoveries: How Tenacity and Pure Dumb Luck Changed the World. This is a small book organized into seven sections. Topics include innovations in anesthesia, antibi- otics and vaccines, licit and illicit psychopharmacology, nitroglycerin and digitalis, insulin, and vitamins. "Let's try Vitamins for $400. 'Noble Prizes Awarded for Vitamin Re- search.' What is 7, Alex?" This book tells the backstories of discoveries that changed history. It showcases creativity, serendipity, inference, and sheer luck. The extent to which karma intervened to save lives is astonishing. Egos bewitched by the Sirens, Money and Fame, clash repeatedly. In his first year at the Yale School of Medicine, the author admired Professor John Fulton, "a great scholar of medical history." Fulton had worked with Sir Howard Florey. Although it was Alexander You can observe a lot just by watching J.C. Noreika, MD, MBA

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