Tuesday, October 12, 2010

Leonard Colebrook is CENTRAL CASTING's penicillin hero

Time to wake up.

This isn't Hollywood.

"This Reality talking: Put your hands in the air and move slowly away from the World of Fiction".

In the World of Reality, Leonard Colebrook actually did bugger-all to advance the development of penicillin.

But Hollywood isn't totally wrong - he should have been the one to make penicillin a world wide success by 1932 or so.

He actually did do so in 1936 with a later - and lesser - 'miracle drug' : the sulfa family of drugs.

He did it by using some of the first commercially available sulfa to reduce childbed fever deaths to a very low figure - a feat that alone should have earned him immortality from grateful young mothers and families.

Childbed fever - actually commensal GAS strep bacteria (long term residents of the throats of the many attending doctors and nurses) settling in on the huge wound that is every new mother's uterus - is a particularly dreaded form of infectious death.

The death itself is often very painful. By definition the patient is relatively young (ie in her child-bearing years) . The death leaves a new born baby to be raised alone by a grieving young father and his young family.

Next Colebrook went on to pioneer new techniques to combat other forms of cross-infections that frequently develop in hospitals - starting with World War Two burn victims.

Even in retirement he led yet another crusade to modify the ubiquitous space heater so they all had clothing guards installed by law. Until this law was in place, thousands of people a year - in the UK alone - got severely burned or died, when their night clothing got set alight when it got entangled on the bare heating element.

His parents had raised him to be a Non Conformist missionary and reformer. In the event,Colebrook did as many would-be missionaries did at the turn of the last century - he channelled his missionary impulses into the field of medicine.

His highly moral impulse remained as intense as ever in everything he did.

He joined the Territorial (Reserve) Army and when he was called up in 1914, was prepared to go to the front as an infantry officer, not as a doctor.

But he was judged too valuable as a medical researcher to remain on the front lines - he spent the rest of the war in the rear echelons, with Fleming and Wright.

But at least- and unlike Fleming or Florey - he was willing to go to the Front.

In World War Two, he was again at the front, in a medical military capacity - teaching medical teams how to use sulfa powder in new war wounds ( he knew little more they did !) - and as the Front Line dissolved and became meaningless in the Battle for France he had a number of very close escapes.

He was 57 years old - and still at the front,  still in the thick of it, trying to save lives 'right here, right now'.

Colebrook was the near-perfect example of  the type of doctor I call the ward-doctor type.

This type of doctor may suffer from EED (Empathy Excess Disorder), in that they care too much for the patient, feel too much of their pain.

When they see patients dying needlessly around them, they are inclined to throw themselves even deeper into the battle at the bedside level - trying to use any or all of the best available techniques as best they can, as hard as they can.

What they can not see themselves doing, is beating what they'd call 'a cowardly retreat' to the quiet of a laboratory to 'study' the disease at its most fundamental level, hoping to find a cure - 'sure ,in about 6 years time'.

JV Duhig, Robert Pulvertaft, RH Boots, Perrin Long, Frank C Queen and even Karl Meyer are all doctors in the penicillin saga that fit this type.

There is a totally different type of doctor I will call a lab doctor. They probably suffer, to some extent, from EDD (Empathy Deficiency Disorder).

 They too find it very hard to see patients dying needlessly, but they reject 'simply'  providing 'band aid' palliative care for those who are dying without a cure in sight.

They spend their careers in the laboratory seeking the fundamentals of a disease and its cure in the universalities of chemistry and physics - as far as possible away from living, breathing, capricious individual human beings.

They may serve - if they must - in the military but they contrive that it is done in the rear echelons.

 However, once over draftable age, they frequently display a newly bellicose attitude to war service that one rarely find among the ex-veterans who actually faced death on the front lines.

I am thinking of Fleming, Florey, Keefer, Richards, and their ilk.

Now they may have something to offer society as scientists, despite the negative picture I paint of them.

They are no more quitters in the lab than the clinician doctors are on the ward.

They might have the skills to grow something as difficult as penicillium and the strength to hang in there when their first ten months of efforts are marked by nothing but failure.

One could see Florey and Colebrook as the perfect combination of two men who are incomplete as individuals, when it comes to successfully developing penicillin.

Colebrook would be too focused on 'saving this patient - today'  to ever set aside the months of time needed for the effort in the lab to learn how to grow penicillin.

 Florey ,on his own, would be too focused on purifying penicillin to 100% pure to remember that there is a war on and patients dying while he fiddles.

But Florey and Colebrook had nothing in common, in terms of their personalities---- I couldn't see it ever happening.

Colebrook, by contrast, had worked successfully for years with Fleming at St Mary's but the relationship had soured when Fleming moved to displace Colebrook in Wright's affections.

Colebrook regarded Wright as his second father and could never forgive Fleming for this.

Besides, Fleming clearly lacked the drive to do hard work for months on end, needed if a hospital lab was to produce enough penicillin for human trials.

Colebrook succeeded with sulfa where he failed with penicillin because sulfa was abundantly and cheaply available in a stable form, ready to have any nurse give the patient as a pill as scheduled.

Penicillin had to be grown by the doctor determined to use it - as no drug company was really that willing to help.

He or she would have to concentrate and purify it and then preserved this highly labile drug long enough for it to make it to the patient's arm. It had to be given IV, and hence by doctor,likely themselves in fact ,a needle every three hours around the clock for weeks at a time.

Few doctors - even of the heroic cast like Colebrook or his American counterpart Perrin Long - were up for this.

Only Martin Henry Dawson combined the rare strengths of Fleming/Florey and Colebrook /Long in just one person.

That is why 70 years ago this week ,it was he - and him alone - that gave that long awaited first ever needle of penicillin, that sent a young boy named Charles Aronson home from his expected deathbed.....

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