Read Online Happy Accidents: Serendipity in Major Medical Breakthroughs in the Twentieth Century by Morton A. Meyers - Free Book Online Page A
Authors: Morton A. Meyers
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failed to detect it. More to the point, stomach bacteria may have been overlooked simply because pathologists were not looking for it.
Despite his intriguing findings and repeated attempts to interesthis hospital's gastroenterologists in the bacteria, Warren consistently encountered indifference. At this time, an unlikely deus ex machina appeared on the scene.
Barry Marshall, a lanky twenty-nine-year-old resident in internal medicine at Warren's hospital, was assigned to gastroenterology for six months as part of his training and was looking for a research project. The eldest son of a welder and a nurse, Marshall grew up in a remote area of Western Australia where self-sufficiency and common sense were essential characteristics. His personal qualities of intelligence, tenacity, open-mindedness, and self-confidence would serve him and Warren well in bringing about a conceptual revolution. Relatively new to gastroenterology, he did not hold a set of well-entrenched beliefs. Marshall could maintain a healthy skepticism toward accepted wisdom. Indeed, the concept that bacteria caused stomach inflammation, and even ulcers, was less alien to him than to most gastroenterologists.
Is There Such a Thing as Stagnant Knowledge?
Thus in subjects in which knowledge is still growing, or where the particular problem is a new one, or a new version of one already solved, all the advantage is with the expert, but where knowledge is no longer growing and the field has been worked out, a revolutionary new approach is required and this is more likely to come from the outsider. The skepticism with which the experts nearly always greet these revolutionary ideas confirms that the available knowledge has been a handicap. 5
—W. I. B. Beveridge, medical historian,
Cambridge University
Marshall's first indication that the bacteria were clinically relevant occurred in September 1981, when he treated a patient with severe abdominal discomfort caused by gastritis with tetracycline, an antibiotic. After fourteen days of treatment, the gastritis cleared up. Clearly, the next step was to culture the bacteria for identification and testing.
L EFT B EHIND ON A L ONG E ASTER W EEKEND
Culturing a microorganism in a sterile medium with the proper nutrients is essential for its further investigation, including establishing its identification, characterization, and degree of susceptibility to antibiotics. This is generally accomplished by streaking a bacteria-laden site upon an agar plate or in nutrient broth.
Over the latter months of 1981, Marshall repeatedly tried to grow the bacteria in both oxygen-rich and oxygen-depleted environments but was unsuccessful. He thought the spiral bacteria were of the Campylobacter genus, bacteria that require only two days to grow in incubation, and on this reasoning the clinical laboratory discarded the agar plates after forty-eight hours if no growth was visible. In April 1982, after many months of failed attempts at culturing the bacteria, Marshall left for the four-day Easter weekend feeling dejected.
Marshall's agar plates were inadvertently left in the dark, humid incubator for five days. No one had ever thought to give the culture this much time to grow. But five days did the trick. Returning to the laboratory, Marshall was elated to find thriving colonies on some of the plates. Peering through a microscope at a culture smeared on a slide, Marshall saw dozens of corkscrew-shaped organisms. He and Warren had grown the bacteria! It was now evident that longer culture time was necessary. Within a few months, it became clear exactly what the fastidious organism required: an enriched culture medium, such as sheep blood or chocolate agar, incubated under humid, microaerobic conditions for five to seven days.
M ARSHALL-ING THE F ACTS
Marshall then designed a clinical study in one hundred patients to look for the occurrence of the bacteria and the presence of stomach disorders. He found that bacteria were commonly
Despite his intriguing findings and repeated attempts to interesthis hospital's gastroenterologists in the bacteria, Warren consistently encountered indifference. At this time, an unlikely deus ex machina appeared on the scene.
Barry Marshall, a lanky twenty-nine-year-old resident in internal medicine at Warren's hospital, was assigned to gastroenterology for six months as part of his training and was looking for a research project. The eldest son of a welder and a nurse, Marshall grew up in a remote area of Western Australia where self-sufficiency and common sense were essential characteristics. His personal qualities of intelligence, tenacity, open-mindedness, and self-confidence would serve him and Warren well in bringing about a conceptual revolution. Relatively new to gastroenterology, he did not hold a set of well-entrenched beliefs. Marshall could maintain a healthy skepticism toward accepted wisdom. Indeed, the concept that bacteria caused stomach inflammation, and even ulcers, was less alien to him than to most gastroenterologists.
Is There Such a Thing as Stagnant Knowledge?
Thus in subjects in which knowledge is still growing, or where the particular problem is a new one, or a new version of one already solved, all the advantage is with the expert, but where knowledge is no longer growing and the field has been worked out, a revolutionary new approach is required and this is more likely to come from the outsider. The skepticism with which the experts nearly always greet these revolutionary ideas confirms that the available knowledge has been a handicap. 5
—W. I. B. Beveridge, medical historian,
Cambridge University
Marshall's first indication that the bacteria were clinically relevant occurred in September 1981, when he treated a patient with severe abdominal discomfort caused by gastritis with tetracycline, an antibiotic. After fourteen days of treatment, the gastritis cleared up. Clearly, the next step was to culture the bacteria for identification and testing.
L EFT B EHIND ON A L ONG E ASTER W EEKEND
Culturing a microorganism in a sterile medium with the proper nutrients is essential for its further investigation, including establishing its identification, characterization, and degree of susceptibility to antibiotics. This is generally accomplished by streaking a bacteria-laden site upon an agar plate or in nutrient broth.
Over the latter months of 1981, Marshall repeatedly tried to grow the bacteria in both oxygen-rich and oxygen-depleted environments but was unsuccessful. He thought the spiral bacteria were of the Campylobacter genus, bacteria that require only two days to grow in incubation, and on this reasoning the clinical laboratory discarded the agar plates after forty-eight hours if no growth was visible. In April 1982, after many months of failed attempts at culturing the bacteria, Marshall left for the four-day Easter weekend feeling dejected.
Marshall's agar plates were inadvertently left in the dark, humid incubator for five days. No one had ever thought to give the culture this much time to grow. But five days did the trick. Returning to the laboratory, Marshall was elated to find thriving colonies on some of the plates. Peering through a microscope at a culture smeared on a slide, Marshall saw dozens of corkscrew-shaped organisms. He and Warren had grown the bacteria! It was now evident that longer culture time was necessary. Within a few months, it became clear exactly what the fastidious organism required: an enriched culture medium, such as sheep blood or chocolate agar, incubated under humid, microaerobic conditions for five to seven days.
M ARSHALL-ING THE F ACTS
Marshall then designed a clinical study in one hundred patients to look for the occurrence of the bacteria and the presence of stomach disorders. He found that bacteria were commonly
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