Thursday, October 21, 2010

'AGAPE penicillin' project was ALL about smallness and simplicity

Manhattan's other Project was one of World War Two's smallest projects in what turned out to be History's biggest ever human effort; our biggest effort - if one of our least moral - by what ever measure is taken.

Smallest is rarely an indicator of importance, and never less so than when set against the world's largest ever war.

In addition, this small project happened seventy years ago, and great distance back in time tends to render small projects even less of importance to us.

Everything about World War Two was gigantic.

Armed military occupied the deeps of the middle of the oceans, the heights of the skies and the tops of mountain ranges. They were found in the high Arctic and the deep Antarctica - in fact for the first time ever war touched every continent on earth simultaneously.

Fighting occurred year around, night and day, in all kinds of weather, for six long years - fighting in the dry heat of desert sands,  in the cold of ice and snow, in the wet heat of dark jungles.

Geographic spread was matched by the number of people pulled in directly as soldiers, war workers, in occupied nations and as refugee peoples. 

Indirectly, almost everyone on Earth suffered restrictions on where they could travel or what they could buy and at what price.

Globally, about 100 million people either died during the war, or not long after the war, because of wartime conditions.

In terms of non-renewable resources consumed - literally - blown up, burnt up or sunk deep in the ocean, our share of the world's bounty took a hit we will never ever recover from.

We are still paying the debt of fighting the war and for repairing the structures and bodies affected.

The opportunities lost for what we might have achieved, as a human race ,without WWII, can never be known - only regretted.

Set against all these Big Battalions of facts and figures, why should historians, anymore than God, care about a truly tiny project ?

Well, I happen to believe, with all my heart and soul, Napoleon to the contrary, that God is actually totally on the side of the small battalions.

AGAPE penicillin was not just a small project, it was a project  about smallness, all about smallness.

 In fact, it seemed almost designed to defend the worthiness of smallness and simplicity and to rebuke Modernity and WWII's bigness obsession, doing so by both its ends and its means.

The smallness of its ends --- the people it was intended to help -- is blindingly clear.

RHD was the leading killer of working class school kids and the resulting invariably fatal SBE, the leading killer of slightly older working class RHD victims.

 However, the upper middle class medical and scientific leadership of the Allies had determined that the working class SBEs were unworthy of a share of the small amount of natural penicillin the scientific establishment had half-heartedly produced in the 15 years after its discovery.

Dawson and his AGAPE team resolved to make their own semi-concentrated impure natural penicillin to treat these '4Fs of the 4Fs' , these 'lives unworthy of penicillin' - and hence - of life.

But what is my  point in exalting the smallness of the  AGAPE team, the small means to that small end ?

Again, the physical - or surface - smallness of Dawson's project is clearly self evident.

The team consisted of between two and six individuals - but most of the time consisted of just three or four individuals  - people who already had busy jobs in the rest of their work day.

In terms of treating SBE patients - its main emphasis - it treated about 35 patients during World War Two - set that against the seventy million war who died during and because of World War Two.

NONE of those war dead died of SBE - it is doubtful that any sort of war action made an individual's chances of getting SBE any more likely.

In direct terms, the AGAPE project contributed nothing to the direct war effort - and many argued, then and since, that it actually hurt the war effort, albeit in a small way.

The project occupied a small lab or two, the wall of part of a corridor and a typical hospital ward of the smaller sort. (And whatever space they could temporarily scrounge for their equipment - including an outside fire escape.)

AGAPE penicillin consumed a small amount of resources that weren't particularly scarce.

It doesn't seem to have won more than lukewarm support from Dawson's hospital and university colleagues.

 And I have found no evidence of any government agency or large foundation voting to earmark funds specifically for the AGAPE project - so it had not been formally peer-financed/peer-approved by any of the scientific establishment.

Its cost in terms of dollars couldn't have been much - seemingly absorbed out of normal department and clinic budgets.

An impressive catalogue of 'smallness' , but this is not at all what I mean by saying that its means were as small as its ends.

I mean that literally: many of the team members, the biological agent they employed, even their bacterial adversary were all about as 4F as the 4F patients they treated or afflicted.

Henry Dawson - because of his weak lungs - had Terminal-MG-just-waiting-to-happen. He frequently was stuck in an oxygen tent and could only be permitted to get away to work, if he agreed to be tethered to an oxygen tank and mask, probably in a wheelchair.

His soul mate and writing/editing assistant, his wive Marjorie, had a congenital hip problem that was never successfully treated and she needed a cane at times.

His leading clinical aide, intern and then resident Dr Tom Hunter, had had polio and needed two crutches to get about.

His friend when he really needed him,the big industrialist Floyd Odlum had contracted an extremely severe case of Rheumatoid Arthritis --- while employed to worry about the fate of ( irony !) of tiny businesses under a war economy that favoured only the biggest firms.

As a result, he frequently needed to get about with  crutches or a wheelchair.

When 4F patient Charlie Aronson got his SBE-induced stroke, he too got a wheelchair  and his oxygen tank- but among this 4F medical bunch, he'd scarcely stick out !

During most of the war, informed medical opinion rejected the idea that NATURAL impure (but totally safe) penicillin could have any war role.

NATURAL penicillin, not to put too fine point on it, is produced when penicillium molds 'pee'  a yellow liquid  into their own bathwater.

No 'pee water' of dirty, smelly basement molds and fungi
was going to sully the veins of the White Races - anymore than black Negro blood was going to go into those veins, even if needed to save a life.

Artificially made (chemically synthesized like the existing Sulfa drugs) all-white ,crystal pure, 1A penicillin had to be created in mass amounts before the medical and scientific establishment was even going to tell the wartime laity about the wondrous life-saving qualities of natural penicillin.

In a war all about 1A men and 1A chemicals, the penicillium mold was smalltime and 4F.

In fact, it was suspected that very soon, there wouldn't even be an adversary for natural or artificial penicillin to test its mettle against.

Edward Mellanby, the head of Britain's all-powerful MRC and the chief financial backer of Howard Florey, had said in 1937, that in fifty years there wouldn't be any hospitals about devoted to infectious diseases, because they would all such diseases would have been conquered, permanently, by chemical medicines like the thousands of sulfa variants.

So, too, the Strep and other pathogenic bacteria were assigned to the 4F, loser, section of Life.

All penicillin books to date - even that written by AGAPE team member Gladys Hobby's, at least to some extent - devote almost all their length to Howard Florey's effort to create chemically pure penicillin.

But midway through their 300 pages and 120,000 words, they break long enough to devote a paragraph or page to the AGAPE team.

One can accurately summarize all their writing thusly:
"Actually, and unknown to them, the Florey team was not the first to treat a patient with systemic (antibiotic) penicillin. That happened a few months earlier at New York's Columbia University when Dr Martin Henry Dawson gave a small amount of weak penicillin to a patient, Aaron Alston, with incurable SBE.
The amount was far too small to have an affect but was judged to be non-toxic. 
 Alston died and Dawson, already suffering from incurably MG, was too weak to do any further work and also died. His brief report, read before a medical conference, was never published and while noted in the New York Times, had no impact on the further course of wartime penicillin and he necessarily passes out of our story."
None of this was true.

Aaron was treated on that first day back in October 16th 1940, and he did seems to have died, perhaps by February 1941.

 But the first patient ever treated with penicillin was almost certainly Charles Aronson, also treated that same day, with an amount of penicillin that also was far too small to have any effect on his heart bacteria.

But Charlie was made of the stuff God usually assigned to cats with nine lives and the fact that he knew he was getting not the back of medicine's hand but rather receiving the first ever systemic dose of a new wonder drug may have affected his heart - his emotional heart.

In any case, he survived this bout of SBE - a very rare but very real possibility with any case of a supposedly 'incurable' disease - perhaps because this 'boost to his morale' was converted into a 'boost to his immune system'.

This was no temporary event - he remained free of SBE for three years and was cured a second time by Dawson - again with penicillin - and was still alive at the war's end.

In 1945, Charlie could say "I'm still here !", despite being written off years earlier by all the doctors.

Worse, he has been written out of history by stupid,dumb,lazy,f-king brain-dead writers ever since.

(His history, the best recorded of any of Dawson's three dozen SBE patients, can be found in two frequently cited landmark medical articles, easily available to any writer seriously researching Dawson's part in penicillin's story.)

Dawson did get terminal MG a few months after beginning the AGAPE project, but he hung on for four and half years, the normal time patients with serious MG hung on in the early 1940s.

He worked steadily until a month before he died, and the long list of published articles and recorded appearances before public scientific meetings, demonstrates that fact to even today's stupidest,laziest writers - if they hadn't a semi-conscious agenda to bury him even deeper in the ground than any grave digger could arrange.

In early 1945, he also could say "I'm still here !" and point to the fact that not only was he still alive and active, but that even the AMA had accepted his claim that systemic natural penicillin could cure the incurable SBE.

Further, his close medical companion, the penicillium mold, if it could only speak, could also claim that it too was "still here !"

Florey's seven year effort to find chemically pure penicillin to inject into patients had failed - synthetic penicillin was a disaster in terms of yield and even in terms of its chemical rationality.

Naturally produced penicillin was the only penicillin used to save lives during World War Two--- and in the seventy years ever since.

And Dawson's first time use of systemic (internal) penicillin to treat human disease had not only ended up near the business pages of the New York Times - it had influenced at least some of those all important men-with-money.

A then small 'fine chemical' company with only a toe hold in the outskirts of the drug business (Pfizer) answered his clarion call for help.

 Eventually, moved emotionally ( just like Charlie) by the AGAPE project, they betted their house on the unpopular NATURAL penicillin and won big - they ended up producing most of the penicillin of World War Two.

Today they are not just one of the biggest drug companies in the world , they are one of the biggest companies in the world, period.

Dismissed by Florey, in preference for 1A chemically-oriented MERCK , Florey never even visited Pfizer in 1941.

But in 1944 he simply HAD to go to Pfizer driven there by the dictates of the PR battle touting the hope of penicillin as the best single reason for everyone to hang on until the war's end.

So there he was, standing beside the AGAPE project's Gladys Hobby, and pretend to be moved by all the vials of natural penicillin tumbling off their production line while his own baby, synthetic penicillin, lay stillborn.

Pfizer too could say in 1945, "we may have been judged 4F by Howard Florey, but we too 'are still here' !"

Even Dawson's adversaries, the bacteria, could prove Edward Mellanby's proud boast wrong by 1945.

 Even in 1945, sulfa and penicillin-resistant bacteria were abundant -- and the situation is even more serious today -  so the small bacteria too could say "I'm still here !"

And of course ( because there always is a 'of course' in my blog entries) of course PostModernity is all about smallness, localness, variety, diversity, alternative modes of existence --- just as Modernity is all about 'bigger always being better'.

AGAPE penicillin - in all its dimensions - was the first successful postmodernist rebuke of the life-hostile ethics of Modernity and the Modernist war that was WWII.....

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