Thursday, November 29, 2012

Dawson long been obsessed with SBE ? Show me ! 'Cause I'm from Missouri ...

Dawson & SBE ?! well I'm from MISSOURI
Even Gladys Hobby says so.

And God Knows, she should know almost better than anyone but Dawson himself.

In her book on penicillin, "Meeting the Challenge", she claims that Dawson had become "especially interested in subacute bacterial endocarditis" (SBE , a heart valve disease).

But no dates when and no specifics. All other writers repeat her claim and again offer no specifics.

I have always been skeptical.

Dawson's day job was running an outpatient clinic in chronic arthritis .

This , at a pre-war large research hospital where discipline borders were heavily policed and where there was a distinct pecking order , from live-saving surgery at the top and outpatient clinics at the bottom.

It still remains true today that dentists don't do open heart surgery and outpatient clinic directors don't handle heart valve diseases.

It is admitably true that in his course of Dawson's job, which consisted in handling the arthritis ( joint inflammation) aspects of every single sort of disease that offers it (and virtually every disease imaginable can offer arthritis pain, if only in a few patients and only transiently) , he would on occasion come across patients with a potential for endocarditis.

But normally a patient who actually had endocarditis in the 1930s was someone with a 99% certainty of a quick death and their arthritis issues were hardly a priority.

In his subsection of his overall department (Internal Medicine) there were people who did work on Rheumatic Fever (RF) and RF frequently ends in SBE, but they specifically tasked not to share RF research with Dawson's clinic.

(They surely exchanged insights and gossips, but only informally.)

During the hospital Grand Rounds, Dawson would definitely come across SBE patients as it was a heart-breakingly common disease to be seen at big hospitals in those days.

But so would every doctor in every big hospital on Earth in 1940 --- so why didn't  hundreds of other doctors  also take up the chance to try the new penicillin on SBE ?

Instead of SBE, Dawson had many other diseases to interest himself in that were closer to the nominal limits of his clinic.

To give but one example of alternate diseases Dawson could have branched into, Dawson did frequently work with patients who had gonorrhea (VD/the clap) because a very common aspect of their disease was arthritis problems.

So, for example, he was one of the first to use the new sulfa diseases on patients with gonorrheal arthritis, starting in March 1937.

But he did not, as a result of this frequent and work-related contact with patients with venereal disease, decide to try Meyer's experimental penicillin on syphilis --- that bold experiment was left to others years later.

So we circle around the issue again : why SBE, a disease so far away from his job definition that him getting involved could only rankle all-powerful senior doctors across the entire hospital?

And if Dawson had a long interest in endocarditis ,where was the proof ?

I am not aware of any published articles by Dawson*, between 1926 -1940,  that even mentioned SBE .

His many recorded comments at conferences in those years also fail to include words involving SBE.

In that same period, Dawson wrote various chapters in medical handbooks (Nelson's Loose Leaf and Cecil's) that involved many aspects of oral strep bacteria , an area where he was considered a world expert, but again nothing on endocarditis, even though SBE originates with the actions of two varieties of oral strep bacteria.

He could have waxed widely here, without raising too many hackles - but again nothing. (By contrast, his young co-worker Thomas H Hunter did write the chapter on SBE in both these textbooks, after Dawson's premature death.)

No specifically medical or scientific explanation for Dawson's sudden and overwhelming interest in SBE

The strong possibility remains - in my studied view - that his sudden and permanent interest in curing SBE with penicillin even at the cost of his own life, has to be set, instead,  against Fall 1940's political and military background in still-neutral America.

We might have to look at why and how Dawson finally got involved in a tremendous effort in WWI , to suggest why and how Dawson choose to get involved in a parallel tremendous effort in WWII.

Substitute WWII Belgium for SBE and Dawson's actions start to become clearer....

* I am unable to find any articles by his three co-workers on the SBE-penicillin project that reference endocarditis, even in passing.

I may be wrong on all this : but show me !

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