Wee Bugs And Wonder Drugs

Outlander Science Club

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A Dram of Outlander Voyager Read-Along (Listen HERE)

Chapters 34-37:

Wee Bugs And Wonder Drugs
Listen HERE!

“I’ve germs in my arm, have I?”

Yes, indeed.  Courtesy of one Mrs. Laoghaire MacKenzie MacKimmie Fraser, in fact.

Jamie has been shot.  The bullet has pierced his upper arm, exited out the other side, and has come to rest about 1 inch deep in the soft tissue of his chest wall.  Fortunately the bullet has avoided any bones and did not penetrate the chest wall deep enough to damage his lungs and vital organs. Jenny has cleaned the wounds as best she can and has removed the bullet but a serious infection has settled in Jamie’s arm.

The wound itself was a ragged dark hole, scabbed at the edges and faintly blue-tinged. I pressed the flesh on either side of the wound; it was red and angry-looking, and there was a considerable seepage of pus. Jamie stirred uneasily as I drew my fingertips gently but firmly down the length of the muscle.
From Voyager by Diana Gabaldon, Chapter 36

Gunshot Wounds

Gunshot wounds become infected frequently, and are considered to be contaminated wounds, which makes sense:

  • Soiled clothing is forced into the skin and various injured tissues during the penetration of the bullet
  • Debris and foreign material is forced into the wound canal
  • Trauma causes nonviable (dead) tissue which enables the proliferation of bacteria
  • The trauma causes the local blood supply to the area to become disrupted, decreasing the ability of one’s immune system to defend against bacteria

Throughout history, death in combat was more often due to infection than battle injuries. Things are not looking so good for Jamie.  In fact, had young Ian not rode a full day’s journey to beg Claire to return to Lallybroch to help save Jamie, the Outlander story may have had a much more rapid resolution!

Fortunately for Outlander fans, Claire had the wisdom and foresight to include a special item in the pocket of her dress in her travel back through the stones. Or perhaps it was just plain good sense, knowing she was returning to Jamie Fraser, a man whom trouble seems to find!

pcn-box

I laid the small, flat case on the table and flipped the latch.  “I’m not going to let you die this time either,” I informed him, “greatly as I may be tempted.”  I carefully extracted the roll of gray flannel and laid it on the table with a soft clicking noise.  I unrolled the flannel, displaying the gleaming row of syringes, and rummaged in the box for the small bottle of penicillin tablets.
“What in God’s name are those?” Jamie asked, eyeing the syringes with interest.  “They look wicked sharp.”
I didn’t answer, occupied in dissolving the penicillin tablets in the vial of sterile water.  I selected a glass barrel, fitted a needle, and pressed the tip through the rubber covering the mouth of the bottle.  Holding it up to the light, I pulled back slowly on the plunger, watching the thick white liquid fill the barrel, checking for bubbles.  Then pulling the needle free, I depressed the plunger slightly until a drop of liquid pearled from the point and rolled slowly down the length of the spike.
“Roll onto your good side,” I said, turning to Jamie, “and pull up your shirt.”
From Voyager by Diana Gabaldon, Chapter 36

Penicillin

Penicillin was indeed a game changer for Jamie, but also for the entire world, even playing a significant role in the success of the Allies in World War II.  The discovery of penicillin was a fortunate accident and starts with Scottish scientist Alexander Fleming.  The story goes that upon returning to his lab in the basement of St. Mary’s Hospital in London in late September 1928 after a two week holiday, Fleming noted an interesting phenomenon in a petri dish that had been left accidentally open.

The petri dish contained Staphylococcus bacteria he had been studying, but now also contained a blue-green mold which he suspected had contaminated his petri dish from an open window.  Upon closer examination, he noticed that there was a clear zone around the mold where no staph bacteria grew, as though the mold and prohibited the growth of bacteria in that area.

petri
From Alexander Fleming’s Nobel Lecture, December 11, 1945

Fleming identified the mold as penicillium, and thus named the active substance capable of killing the surrounding bacteria penicillin.  He authored a paper describing his findings but this was met with little interest.  Penicillin was unstable and Fleming had difficulty producing it in any significant quantity.  No further progress would be made for another decade.

quote

In 1939, a group of scientists at Oxford including Howard Florey and Ernst Chain developed a method for purifying and producing penicillin, though the yield still remained rather low.  A year later, their experiments showed that penicillin could successfully treat strep infections in mice.

Florey and Chain showed that penicillin could treat infections in human in 1941 when they treated a 48 year old policeman by the name of Albert Alexander.  Mr Alexander had scratched the side of his nose while pruning roses and developed a significant infection with abscesses involving the eye, face and lungs.  He was treated with penicillin and within days had a remarkable recovery.  However, the supply of penicillin ran out after 5 days.  His infection worsened again and he died.

By this time, the world was fully engaged in World War II.  The US drug company Merck started production of penicillin and successfully treated in 1942 a patient with streptococcal septicemia – an infection of strep in the blood.  However, treatment of that one patient required half of the total supply of penicillin available at the time.  Work began in earnest to figure out a way to mass produce large quantities of the drug.

The US government hoped to produce enough penicillin for mass distribution to the Allied troops in Europe.  In 1943, the US War Production Board took over responsibility for the increased production of penicillin with the goal to have adequate supply for the planned D-day invasion in France. Ultimately, 2.3 million doses were available in time for the invasion of Normandy in the spring of 1944.  During the war effort, penicillin was limited to military use, with rare exceptions made for civilians in cases where other treatments had failed.  By 1945, increased production allowed for penicillin to be available to consumers for the first time without restriction.  Fleming, Florey and Chain were awarded the Nobel Prize in Physiology or Medicine in 1945.

(L to R:  Alexander Fleming, Howard Florey, Ernst Chain.  From Wikipedia Commons)

Prior to the era of penicillin, seemingly minor infections were often life-threatening: strep throat, scarlet fever, dental infections, skin infections from simple scratches, etc.  Infections like bacterial pneumonia, meningitis and endocarditis (infection of the lining of the heart and the heart valves) were often death sentences.  In World War I, the death rate from bacterial pneumonia was 18%.  With the availability of penicillin in World War II, that fell to less than 1%.  Untreated skin infections from trauma as minor as a simple scratch carried an 11% mortality rate prior to the discovery of penicillin.

pcn-poster
Credit: Research and Development Division, Schenley Laboratories, Inc., Lawrenceburg, Indiana

Fleming, though, foresaw the risk involved with this miracle drug and in his Nobel Lecture, provided this ominous warning:

But I would like to sound one note of warning. Penicillin is to all intents and purposes non-poisonous so there is no need to worry about giving an overdose and poisoning the patient. There may be a danger, though, in under-dosage. It is not difficult to make microbes resistant to penicillin in the laboratory by exposing them to concentrations not sufficient to kill them, and the same thing has occasionally happened in the body.

-Alexander Fleming, Nobel Lecture, December 11, 1945

Antibiotic Resistance

Some suggest that we are headed to a post-antibiotic era – a time when we once again will be defenseless against seemingly simple infections.  Now we have antibiotic resistant pneumonia, tuberculosis, blood infections and even gonorrhea and few, if any, effective antibiotics against them. The CDC estimates that antibiotic resistance has been responsible for over 2 million illness and 23,000 deaths each year.

Antibiotics resistance happens naturally as the bacteria adapt but we must avoid accelerating this process.

resist
From: Center for Disease Control

As patients, we can minimize antibiotic resistance by:

  • Working to prevent infection with good hand washing, food hygiene and common sense, avoiding close contact with those who are ill.
  • Always finishing the full course of prescribed antibiotics and not taking left over antibiotics or someone else’s

It is scary to think we could be headed toward a time when we are unable to effectively fight bacterial, viral, and fungal infections. Progress continues in the development of new antibiotics, but resistance continues to develop at an alarming rate.

Fortunately, the bacteria infecting Jamie’s wound was no match for penicillin.  With no prior exposure to penicillin or similar antibiotics, the bacteria would have had no resistance and would easily succumb to the novel medication. And good thing, too – without antibiotics, this wound could have been fatal for Jamie. Thus, the Outlander saga could have ended much too early, and at the hands of Laoghaire no less (as though we needed any further reason to despise her)!

mold

 

Title Image: Mold Cultures in Petri Dishes (Public Domain)
References:
About Antimicrobial Resistance. (2015). Retrieved October 29, 2016, from http://www.cdc.gov/drugresistance/about.html
American Chemical Society International Historic Chemical Landmarks. Discovery and Development of Penicillin. Retrieved October 29, 2016, from http://www.acs.org/content/acs/en/education/whatischemistry/landmarks/flemingpenicillin.html
Antibiotic resistance. (2015, October). Retrieved October 29, 2016, from http://who.int/mediacentre/factsheets/antibiotic-resistance/en/
Markel, H. (2013, September 27). The real story behind penicillin. Retrieved October 29, 2016, from http://www.pbs.org/newshour/rundown/the-real-story-behind-the-worlds-first-antibiotic/
Sir Alexander Fleming – Banquet Speech. Retrieved October 29, 2016, from http://www.nobelprize.org/nobel_prizes/medicine/laureates/1945/fleming-speech.html
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