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Understanding antibiotic resistance
Understanding antibiotic resistance

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3 Pre-antibiotic era

Before antibiotics were discovered, the treatment options for bacterial infections were limited, as you will see next.

Activity 4 Life without antibiotics

Timing: Allow about 15 minutes

Watch the following video about infection in the pre-antibiotic era. As you watch, consider:

  • a.which bacterial infections were common and what the usual outcome was
  • b.how bacterial infections were treated.
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Transcript: Video 3 Living in the eighteenth century.

MICHAEL MOSLEY:
On Saturday the 14th of December, 1799, George Washington, one of the founding fathers of the United States of America, lay dying. A couple of days earlier, he'd been out riding in cold and wet weather. He developed a sore throat. Early on the Saturday morning he said to his wife, I'm feeling very ill.
Within hours, his personal physicians had arrived, the finest in the country, the best money could buy. They had all sorts of suggestions as to what was making him ill-- his humours were unbalanced, or perhaps he breathed in miasmas, foul air. His doctors gave him the standard medical treatment for someone who was as severely ill as he obviously was.
They took a knife, found a vein, and bled him-- repeatedly. They drained him of more than four pints of blood. By nightfall, Washington was fading fast, so his physicians applied even more scientific treatments. This Spanish fly, although it's actually a green beetle. They would have ground it up and then applied the paste to his throat. But all that did was blister the skin.
He said to his doctors, I die hard, but I'm not afraid to go. By late that evening, the first president of the United States was dead. Washington probably died from a simple infection. At the end of the 18th century, it made no difference if you were a pauper or the president. What you got was little more than quackery.
The Centres for Disease Control and Prevention in Atlanta is not for those of a nervous disposition. It holds some of the world's most deadly life forms. This facility contains some of the greatest evils ever collected in one place. This bacteria causes the plague. Your flesh dies and rots while you're still alive.
The Black Death of the 14th century killed a quarter of Europe's population. And then there's tuberculosis, a slow and deadly killer, the creator of oozing lung abscesses. The poet Keats, all three Bronte sisters, and Chopin are a few of its more artistic victims. And this is gangrene caused by any number of bacterial infections that lurk unseen in every dirty bullet, scalpel and delivery wood.
Some bacteria don't need a wound to get inside you. They're already there, waiting patiently. Patiently for our defences to drop, and then they pounce. That's probably what did poor George Washington.
DR DRUIN BURCH:
In 1790s America, sudden death was utterly common. And you clustered round people's bedside when they got cold and when they got chills because they could die.
MICHAEL MOSLEY:
Washington's doctors would have laughed in your face if you'd told them that microscopic life was killing him. They still clung to theories passed down from the ancient Greeks.
DR WALTER SNEADER:
They believed that if you had a disease, the humours were out of balance. If you had a fever, you were considered to have an excess of a blood humour-- well, you were flushed after all.
End transcript: Video 3 Living in the eighteenth century.
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Video 3 Living in the eighteenth century.
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Discussion

  • a.It is striking that common infections such as sore throats, which are considered ‘non-serious’ today, were often killers in the pre-antibiotic age. Routine procedures such as childbirth were also dangerous. People were not only vulnerable to potentially deadly infections like TB (tuberculosis) and meningitis, but also the infection of simple cuts or more serious wounds by opportunistic pathogens could lead to sepsis and death.
  • b.In the absence of powerful, antibacterial drugs, treatment was largely ineffectual. Examples referred to in the video are ‘bloodletting’, which was an established treatment until the 1940s, and the draining of pus from wounds and sores. Other treatments from this period, but not mentioned in the video, include herbal remedies, noxious chemicals such as mercury – used as a treatment for syphilis – and fresh air for TB. While these approaches could have helped relieve a patient’s symptoms, they did little to treat the underlying cause of the infection and outcomes were generally poor.

Unlike George Washington’s physicians, we now know that infectious diseases are caused by microorganisms. This discovery, known as germ theory, was a pivotal moment in medicine.

Activity 5 Proving germ theory

Timing: Allow about 10 minutes

Read pages 3 & 4 of the article below, about the work of Louis Pasteur and Robert Koch, who provided the scientific proof of germ theory. Why was their work so important to understanding how infectious diseases could be successfully managed?

Article 1 The history of germ theory. [Tip: hold Ctrl and click a link to open it in a new tab. (Hide tip)]

Discussion

Pasteur discovered the link between microorganisms and disease, while Koch established that a particular type of bacteria was responsible for a specific disease. Being able to identify the pathogen responsible prompted research into potential tailor-made treatments for specific infections.

By the early twentieth century, efforts to tackle infectious diseases were focused on finding drugs that killed the bacterial pathogen without harming the patient – so-called ‘magic bullets’. Alexander Fleming’s chance discovery in 1928 of the first antibiotic – penicillin – paved the way for research into other ‘magic bullets’ to cure bacterial infections. This was the start of the antibiotic era, which you will look at in Section 4.