Lest We Forget
Authors: Robert Bud
Journal: BMJ (2008)

Recalling the deeds of our predecessors is a worthy and devout act. It keeps their memory alive and gives our own lives meaning as we visualise ourselves as further links in the chain of history. The ambition of David Greenwood, the distinguished emeritus professor of antimicrobial science at the University of Nottingham Medical School, is to celebrate “as many of the antimicrobial pioneers as possible.” His aim is to widen the circle of memorialised pioneers beyond the narrow confines of Ehrlich, Fleming, and Waksman. It is a serious and worthwhile ambition.

The challenge for Greenwood is that modern pharmacology grew up in the era of industrial technoscience. In the 19th century the contributors to most subjects were measured in tens. Even by 1990 the contributors to smaller specialties could be listed individually, and as late as the 1930s papers with as many as three authors were rare. The wartime explosion of science changed that. Greenwood points out that the 1950 paper announcing the results of testing oxytetracycline for the first time was authored by 11 scientists. The name of one only, Gladys Hobby, can be cited in the book. As for the 18 authors of the 1993 paper announcing the discovery of zanamivir, we are told not a single name. Greenwood is well aware that with the locus of production moving to industry “the brilliance of individual scientists was submerged in the teamwork that business efficiency demanded.” The text provides footnoted brief sketches of the histories of several of the companies mentioned. 

Greenwood therefore shows a tragic sense of awareness that, however hard he trawls the literature of review papers and obituaries, he can preserve the memory of just a fraction of the community. In consequence this is a book of two halves. On those subjects recently covered by professional historians, including such issues as the sulphonamides, Greenwood’s treatment covers the known ground well, in perhaps less detail than other recent works. In other substantial parts (rather more than half the book) Greenwood covers drugs that generally have not been so well explored by historians. In comprehensive chapters entitled “The taming of tuberculosis and leprosy,” “Progress against parasites,” and “The poor relation: fungi and viruses” he often goes beyond the current specialist literature. His scouting missions on the one hand and enthusiastic storytelling on the other reveal developments and details that might otherwise have lain untouched.

The book is full of good stories that are based on a huge variety of sources. I was unaware of the origins of the antifungal drug griseofulvin, encountered shortly after the second world war when an ICI team under Percy Brian was investigating the poor growth of conifers in a plantation in Dorset. They found that the growth of mycorrhiza in the roots was inhibited and reasoned that this might be caused by some product of a penicillium mould they found in the soil. It appeared that the “curling factor,” as Brian called it, might prove to be a useful agricultural fungicide, but the cost of production told against this use. A decade later it was tested on guinea pigs by teams at ICI and Glaxo and at the University of Glasgow. The book recalls a dramatic moment in the transition to use in treating humans, in those pre-thalidomide days, during an emergency in Miami, when Harvey Blank risked a pioneering application and rescued a patient near to death from a fungal infection. In 1959 griseofulvin was launched as the first chemotherapeutic treatment for nail dermatophyte infections. 

The sources of Greenwood’s stories are, regrettably, not always clear. Even oft told stories may not necessarily be easily verifiable. A familiar tale, here without reference, is of the US surgeon general William Stewart boasting to Congress in 1969 that infectious diseases had been defeated. Readers are invited to find and justify the elusive detailed reference of this event.

Enterprises such as this book require huge efforts from the author and pay great dividends to the loyal reader. For the origins of such drugs as avlosulphon and zanamivir, and many in between, this volume is a thorough and entertaining introduction.