Tuesday, November 13, 2012

The MORAL invention of impure-systemic antibiotics by Martin Henry Dawson

When asked, in strictest confidence by a worried Howard Florey, "what's this guy Dawson really like ?" , establishment bacteriologist Stanhope Bayne-Jones said  'he is honest - but much too enthusiastic at times'.

One of those times was September 1940.

America's medical establishment was happily slipping into war medicine mode, so it could drop all this nonsense about helping the poor via the social medicine movement ("socialist medicine if you ask me", they snorted.")

In was aviation medicine for our middle class flyboys, the 1As of the country club set.

Out was help for Rheumatic Fever and SBE, that Polio of the poor, the colored and the ethnic immigrant : the peacetime 4Fs.

Dawson noticed that ,up into the late 1930s, many middle to upper class people gave generously , as a charitable act, to hospitals aiding those children with Rheumatic Fever, the leading cause of death for school kids and a disease that rarely hit the well to do.

Now they were shifting their dollars and attention to Polio - the Rheumatic Fever of the well to do. Polio hit hardest in those leafy green Republican-voting Protestant suburbs obsessed with cleanliness being next to godliness.

Self-help groups of patients and their families banded together to help their own cope with polio. Admirable perhaps, but not charity - not in the strictest sense, rather it was self-interested help.

Against this backdrop, when Dawson failed to get SBE experts (of which he was definitely not one) to look at penicillin's advantages over the new sulfa drugs for treating SBE , he probably "reacted badly", got "emotional" "angry" , worse : "enthusiastic".

Because the heart valves - ironically enough - lack their own internal blood supply, a drug has to saturate the blood supply to get at them. Try that with the sulfa drugs and their toxicity would kill the patient before it killed the SBE bacteria.

But penicillin is still about the least toxic lifesaver known and it is readily diffusible - unlike sulfa which can not penetrate the SBE bacteria's biofilm shield of matted bacteria goo and human blood platelets (aka "vegetations").

The dirty and the pure, in an eugenic age

True, Sulfa was "pure" and "synthetic" , both highly fashionable attributes in that chemistry-obsessed age, but so what ?

Penicillin was natural and impure - but safe - as even those researchers unwilling to inject it into patients publicly admitted.

Dawson said, ' if impure natural safe penicillin can save people dying of SBE and pure synthetic sulfa can't, we have a moral duty to put it to work - now ! - not five years from now when it has been perfected and all the SBE patients are dead...' .

That is why this Nova Scotian born and raised doctor became the first doctor in the world to use penicillin to save lives.

He took only 5 weeks from hearing about penicillin to building a penicillin-growing factory and injected two young men - one black, one Jewish - with the live-saving mold, though as an arthritis outpatient clinic doctor he knew he had no business mucking about in the cardiologists' domain.

But his parents' Scottish Presbyterian sense of duty, engrained in him as a child, drove him to it and thanks to him, our whole world changed for the better, for ever......

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