The First Human Patient February 1941

You are advising Howard Florey’s team at the Sir William Dunn School of Pathology, Oxford.

The team has managed to purify small amounts of penicillin, an antibacterial substance made by a mould whose effect on bacteria Alexander Fleming noticed in 1928. An Oxfordshire police constable, Albert Alexander, is critically ill with an infected wound that has not responded to other treatment.

Known information

In May 1940 the team showed that penicillin protected mice against deadly bacterial infections.
In January 1941 a volunteer, Elva Akers, who was dying of cancer and could not be helped by it, was given a test injection to check whether penicillin was safe to give to a person.
Producing it is painfully slow; the mould is being grown in improvised vessels, and the supply may not last a full course of treatment.
No one knows the right dose to treat an infection, how long treatment should last or what side effects might appear.
Alexander is in his forties, the infection has spread, and doctors believe he may not survive without a new treatment.

Reveal what happened (spoilers: decide first)

Fact

What actually happened

The team treated Albert Alexander with its small supply of penicillin. (Treat him now)

On 12 February 1941 Albert Alexander became the first patient treated with Oxford-purified penicillin for an infection. He improved dramatically within days, and the team even recovered penicillin from his urine to reuse it. When the supply ran out, the infection returned and he died on 15 March. Further patients were treated successfully in 1941, and large-scale production was later developed, particularly in the United States.

Important

Possible consequences · Analysis and speculation, not fact

Waiting would likely have delayed the first clinical evidence for months, possibly slowing investment in mass production; but it is also possible the team would have started later with a larger supply. Historians cannot measure the difference precisely.

History does not reveal what would definitely have happened under the other choice. Many factors could have changed the outcome.

Context · Why it was decided this way

Alexander’s treatment showed that penicillin could work in people and that the main problem was supply. Florey and Norman Heatley, who had worked out how to grow and extract it in quantity, travelled to the United States in 1941, where government laboratories and drug companies worked to improve fermentation methods.

Fleming, Florey and Ernst Chain shared the 1945 Nobel Prize in Physiology or Medicine; Heatley was not among them. The story is also a reminder that medical breakthroughs often involve difficult choices made with incomplete information.