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shortly after the end of the war to spend the next fifteen years in Rome.
He shared the Nobel Prize with Florey and Fleming in 1945, but even
that seemed not to console him. The Floreys marriage also went sour,
although they remained together through many unhappy years until
Ethel s death in October 1966. Eight months later, Margaret Jennings
became Lady Florey (Florey had been given a life peerage and the Or-
der of Merit).
Much has been made of the fact that neither Fleming nor Florey at-
tempted to patent penicillin. But under British law of the time, it is
unlikely that any patent application from Fleming would have suc-
ceeded. He had invented neither penicillin itself, a natural substance,
nor any new procedure to produce penicillin. Nevertheless, he was
considered saintly for never having tried for a patent. Florey and his
colleagues, in contrast, would have had an ironclad claim for a patent.
Florey chose not to apply because that would have violated the aca-
demic ethos of the time. When Chain appealed his case to other col-
leagues, he was accused of money grubbing. Chain s desire for a pat-
ent arose in part from what he had learned of such matters from his
father, an industrial chemist.73
It was Fleming who emerged with the greatest glory. Over the last
decade of his life, he traveled the globe in triumphant progression,
feted by universities, cities, and nations. Today, virtually every major
European city has a street that carries his name. There is even a Flem-
ing crater on the moon. Suitably, one of the early successes of penicil-
lin was its use to save the life of a friend of Fleming, who had been
moribund with meningitis. As treatment of the patient progressed,
Fleming found it necessary to inject penicillin directly into the spinal
fluid. The drug had never before been administered to a human by this
means. So at Fleming s request, Florey tried it on an animal (the spe-
cies of which is no longer known). Fleming did not wait for the out-
come (just as well, since the creature died within hours), but instead
proceeded with the injection and achieved one of the earliest miracle
cures by penicillin. Fleming had obtained the penicillin by a direct
130 People and Pestilence
appeal to Florey, who supplied the antibiotic and told Fleming how to
use it. In the end, it was Fleming who had needed Florey to propel
him to lasting fame, and to render an exquisite personal service.
In the decades to come, further triumphs would follow. The dis-
covery of streptomycin in 1943 produced a miraculous therapeutic for
tuberculosis and earned Selman Waxman a Nobel Prize.74 Pharmaceu-
tical chemists became virtuosos at diversifying the structure of antibi-
otics in order to achieve activity against a broader spectrum of bac-
teria and to frustrate the mechanisms of antibiotic resistance. The
medical armamentarium against bacteria and fungi now boasts a be-
wildering variety of chemical structures, nomenclatures, and applica-
tions. It remains far from perfect, but it would surpass even the wildest
dreams of Paul Ehrlich and Gerhard Domagk.
Viruses proved the most difficult of microbial adversaries, largely
because their intricate dependence upon normal cells made it difficult
to repress their replication selectively. An early success was achieved
with agents that could suppress life-threatening infections with her-
pesviruses. Then the devastation of AIDS added new impetus to re-
search on antiviral agents, and success followed in remarkably short
order, greatly extending the lifespan of most individuals infected with
HIV. Now even the common cold faces mitigation by chemical anti-
dotes not a cure, mind you, but at least mitigation.
The Future
So we have well-forged tools for the isolation and characterization of
microbial pathogens, for the interruption of their spread, for the pre-
vention of disease caused by infection, and for the treatment of infec-
tious diseases once they occur. But infectious diseases are still the third
leading cause of death in the United States, and the leading cause
worldwide. Infections are responsible for more than 12 million deaths
annually in developing nations alone and represent 90 percent of the
global disease burden. The global epidemic of AIDS has become one
of the great plagues in the history of humankind. Venereal diseases are
rampant, their effects only amplified by the advent of AIDS. A century
People and Pestilence 131
after the work of Robert Koch, tuberculosis remains among the most
common microbial causes of death (more people are now dying of tu-
berculosis than ever before in history), in part because the bacterium
has developed a versatile resistance to antibiotics. Recurrent epidemics
of influenza and diarrhea still kill by the tens and hundreds of thou-
sands. Hepatitis viruses kill millions annually and cause liver cancer
among the most common of human malignancies. And the risk of
food-borne infections has been rising steadily with the globalization
of the food supply and the increased consumption of fresh produce.
Old microbial adversaries reappear unexpectedly recall the 1994
outbreak of the Black Death in Surat. New adversaries present them-
selves with remarkable frequency: Legionnaires disease, Lyme disease,
toxic shock syndrome, Reye s syndrome, five new hepatitis viruses,
AIDS, Kaposi s sarcoma virus, hantavirus pulmonary syndrome,
Helicobacter pylori (the bacterial cause of both ulcers and cancer in the
stomach), Ebola, West Nile virus, the transfer of mad cow disease from
cattle to humans none of these was known two generations ago. We
can be sure that there will be more. There can be no end to pestilence
in our lifetime, perhaps in any lifetime. As the ecological dynamics of
our planet evolve, so do the vast hordes of microbes with which we
share the planet.
Some of the new plagues are of our own making. The profligate and
too often unjustified use of antibiotics both in the practice of medi-
cine and in the rearing of livestock has resulted in drug-resistant ad-
versaries that we are not likely to defeat in the near future. Many au-
thorities consider the abuse of antibiotics to be one of the major
plagues of our times, nothing less than a medical crisis. The dimen-
sions of this plague are staggering: we put 70 percent of all the antibi-
otics produced in the United States into healthy livestock, creating a
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