The Emperor of All Maladies: A Biography of Cancer

by Siddhartha Mukherjee

In July 1984, with his experiments stalled and his grant applications in jeopardy, Marshall performed the ultimate experiment: “On the morning of the experiment, I omitted my breakfast.… Two hours later, Neil Noakes scraped a heavily inoculated 4 day culture plate of Helicobacter and dispersed the bacteria in alkaline peptone water (a kind of meat broth used to keep bacteria alive). I fasted until 10 am when Neil handed me a 200 ml beaker about one quarter full of the cloudy brown liquid. I drank it down in one gulp then fasted for the rest of the day. A few stomach gurgles occurred. Was it the bacteria or was I just hungry?” Marshall was not “just hungry.” Within a few days of swallowing the turbid bacterial culture, he was violently ill, with nausea, vomiting, night sweats, and chills. He persuaded a colleague to perform serial biopsies to document the pathological changes, and he was diagnosed with highly active gastritis, with a dense overlay of bacteria in his stomach and ulcerating craters beneath—precisely what Warren had found in his patients. In late July, with Warren as coauthor, Marshall submitted his own case report to the Medical Journal of Australia for publication (“a normal volunteer [has] swallowed a pure culture of the organism,” he wrote). The critics had at last been silenced. Helicobacter pylori was indisputably the cause of gastric inflammation.