Monday, September 6, 2010

Thanks to DOCTOR MOM, "he (and she) will be coming home!"

Most wartime GIs who drank too much Schenley whiskey and ran their jeeps off the road and woke up in the hospital with a penicillin drip in their arm, never realized that not only did Schenley sell them the bite of a snake but they also sold them the cure.

That wartime penicillin might have come from Schenley Labs.

Their whiskey is still here  - but their penicillin is long gone.

But Schenley did have the satisfaction for having produced the most iconic image of the entire saga of early penicillin.

Printed in rich vivid glossy magazine color, this ad featured the realistic style painting of a medic putting penicillin in the arm of a wounded Marine in a place that looks to be Tawara, as photographed by Marine photographer Norman Hatch.

 Seventy years later, Hatch's photos remain the gold standard of 'you are there' combat photography.

This famous island battle first brought home to America just how bloody this war was going to be - particularly because of the casualty count.

 But mostly because Hatch's grim photographs were deliberately released, rather than censored, to toughen up Americans at home to the mounting death toll that lay ahead.

So the ad's painting immediately conjured up a grim backdrop to any magazine readers in 1943-1945.

But the cutline below was pure uplift : "Thanks to PENICILLIN...
he will come home !"

Often rendered in the retelling as "Thanks to Penicillin, he will be coming home !"

The combination of image and cutline basically assures home viewers worried about their relative overseas that "Despite the vicious fighting and the terrible jungle conditions, thanks to penicillin, he WILL be coming home !"

This ad went totally unremarked upon during the war.

 But in the 65 years since, it has grown by leaps and bounds in importance as almost every scholar today finds it to be the best single wartime expression of the sheer hope that grew in a world (bone tired of 15 years of Depression and War) that something good must lie ahead.

Usually, their subtext when recalling this ad is "Thanks to Big Science bringing us Penicillin, he will be coming home !"

I don't think this is true at all.

I believe that if left to their own devices (along with scads of our tax dollars) it would have been 1946 or later before enough penicillin would had been produced to help the soldier at the front , let alone the patient back home.

I think there were two competing strategies to speed up the production of wartime penicillin.

One was develop scientific evidence on a very wide and deep front ("Big Science") to convince scientists in universities, hospitals, corporate research labs and in bureaucratic offices that a small shift in international wartime priorities was justified to produce large amounts of penicillin as a supplement to the sulfa drugs for illnesses resistant to sulfa like those caused by staph bacteria.

But that only enough penicillin needed to be produced to aid the fighting men, at least until the war was finally won.

I hope you sense the contrast between a massive effort of "means" to secure a limited "end".

This was Howard Florey and his supporters' thesis.

The other strategy was proposed by just one man - a soon-to-be dying man - in  September 1940 and maintained by him until his death in April 1945.

Martin Henry Dawson.

He said penicillin had already been privately discovered, in 1928 by Fleming, but no one had been roused and no lives had been saved.

Penicillin had also been publicly discovered,( ie published in the scientific media) in 1929 by Fleming and again in 1940 by Florey but no one had really been roused and no lives had been saved.

Dawson proposed instead to have penicillin popularly discovered - by Doctor Mom.

It was a Man's World back in 1940 .

(It mostly still is, but not as bad as back then !)

But even in 1940 women voted, bought much of the family's purchases and they were the daughters, mothers, sisters and spouses of the prominent men who ultimately ran things.

If they got on the case of the men to bring them penicillin and they stayed on the case (as women are very good at doing - some dare call it 'persistent nagging') , even reluctant men will eventually give in and get moving.

So Dawson persuaded Meyer and Hobby and Chaffee, his entire team of 'little science', to refocus their primary aim of their newborn penicillin pilot project.

He said they should immediately and narrowly focus on curing  a single disease, Rheumatic Fever-induced Subacute Bacterial Endocarditis.

This disease was the one that all parents in the western world regarded as a constant Sword of Damocles over their heads ,at least until all their children had gotten safely into their early twenties.

Tuberculous might be the disease feared more by the poorest families and Diphtheria and Scarlet Fever  might have been feared more in grandma's day, but from about 1910 to 1960, Rheumatic Fever (RF) was the number one killer of school age kids .

In addition, the invariably fatal subacute bacterial endocarditis (SBE) it brought to many Rheumatic Fever 'survivors' was a big killer of youth and adults all along life's journey.

But the main point of the myth of The Sword of Damocles was not the pain of the instant the sword actually did fall and kill you but rather that the situation made you afraid all of your life, just waiting for the day the sword might fall.

Most parents never experienced their children getting RF or SBE but all dreaded it might happen someday.

RF starts with a child getting a sore throat or tonsillitis from strep bacteria.

Think about it - what child doesn't get tons of those, even today with antibiotics?

Before antibiotics, the kids might cure themselves.

But one attack did not bring immunity.Your children got them again and again  - like the common cold they were common, endemic ,ubiquitous.

Always the fear was that this strep throat attack will lead to something worse. Many kinds of worse, but the deadliest and the most common was Rheumatic Fever (RF).

Most times, nothing happened. But like Russian Roulette, for no good reason one strep throat attack or tonsillitis attack could lead to RF.

Now RF could kill your child outright, during the very first attack.

But in most cases, the child lived, even emerged unharmed.

But again it did not bring immunity.

Far from it, one incident of RF made a child more vulnerable to another and more severe attack of RF and so on and so on, ever downhill.

Now suppose the child survived all those severe repeater attacks but with a damaged heart - particularly damaged heart valves.

Now in their teens, the child was less likely to see RF ever again, but instead they faced the fact that ordinarily harmless tooth bacteria, swept into their blood stream by a single vigorous tooth brushing, could settle in on their damaged heart valves and lead to an 'invariably fatal' case of SBE.

They might , nevertheless, fight off a single bout of SBE - as perhaps as many as 10 to 20% did.

(The near 100% death rate for SBE as normally reported, was biased by only counting cases sick enough to end up in hospitals. But autopsy work often revealed hints of healed SBE scars on the valves of young traffic accident victims.)

But again, and I know I am a broken record, one cure of SBE did not prevent those tooth bacteria from settling in again on your valves - and the second bout was fatal.

RF induced SBE was a chronic ,invariably fatal, disease.

Dawson treated patients as young as 10 and as old as 60. After penicillin, patients were found to dying of RF mediated SBE into their seventies - deaths often disguised as a 'stroke' .

More bad news : the kind of strep throat bacteria that gives you RF grow more virulent by being passed back and forth repeatedly between humans in close contact.

If you had lots of children,  that meant that your chances that several would get RF and SBE was higher than the statistical average, even when corrected for the number of children you had.

That is if you had six kids and a small house, their chances that one
of them would get RF should be six times 3.3 per 100,000 ( ie 1 in 5,000) but in fact it was much higher than this - more like 1 in a 1,000.

Small houses and big families being more common among poorer families, they got hit the hardest, resulting in it being called The Polio of the Poor.

But no family was really immune.

Dawson knew that a report of a cure for either RF or SBE would grab the attention of every single DOCTOR MOM in the world.

And Doctor Mom, not Dad (in charge of the bread winning), was the person in charge of the entire family's health -- if she wanted penicillin , now, she would get it - or governments (even wartime governments) would tremble.

Drug companies would rush in to take her money.

This was Dawson's thesis.

He had a small crew - four people, no government or foundation funding, with curing a single disease as its sole thrust. But against those small 'means', look at its broad 'ends'.

Doctor Mom, said Dawson, would see to it that her entire family all got lots of penicillin, now, not after the war - penicillin enough for  both Frank on the battlefield on Tarawa and for little Susie in the Rhemuatic Fever ward in America.

Was he right - or did Florey's view prevail?

I will 'tell all' - on October 16th this year - in my e-book "MO goes PO".....

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