Tuesday, October 12, 2010

why MUCOID mattered: Henry Dawson and Rheumatic Fever

Recently having had a sore throat or tonsillitis - when it is caused by our normally throat and nose inhabiting (commensal) strep bacteria- is the only way you can get Rheumatic Fever.

There has never been a confirmed incident when huge life-threatening amounts of virulent strep bacteria rolling about in a gaping wound (the type of dramatic situation that makes strep the most feared word in the medical lexicon) has ever caused a single case of life-threatening Rheumatic Fever.

Rheumatic Fever (RF) is (and was) a very serious and very common disease, yet it begins with the quietest possible onset - one third of all its victims can't even remember having had a recent sore throat.

'Sore throat', undefined, is so common throughout all our lives, that we find it hard to tell those ones that were caused by strep bacteria from those that weren't.

The safest rule is if the sore throat hurts much and hangs on more than a day or two - run to a doctor and ask for a swab test.

If we are very unwell and have had endless rounds of sore throats and even previous bouts of RF, probably almost any strain of strep can cause another round of RF.

But for most of us that are healthy and well fed, being in an stressful new situation in an enclosed space for weeks at a time with a particularly virulent strain of strep running from person to person back to person, is our only way to get it.

I mean a wartime military recruit camp - the best possible natural laboratory we have ever had to see just how many people can get RF if the conditions are perfect.

The observed percentages are high enough, often enough, to put real fear into that doctors that do statistics and are paid to keep an eye on epidemics ---this despite the fact that RF is almost totally gone in the western world.

(It is still common in third world countries that until fairly recently historically never saw a case of it.)

We still don't know enough about it, to be terribly confident that it will remain beaten here in the western world.

Currently, the biggest focus of research effort is something that Martin Henry Dawson would not have found surprising : it is the fact that it is the most heavily mucoid of hemo strep colonies that seem to cause RF among populations normally felt to be at least risk.

Mucoid heavy strains of hemo strep turn RF from a social disease affecting the poor mostly, to something that could kill any or all of us.

A deep interest in raising the awareness of the virulence of Mucoid colonies of GAS strep generally (along with his pioneer use of penicillin to cure RF's final effect, SBE) was Dawson's particular contribution to the world wide effort to explain and prevent RF from the 1920s to the 1960s.

I do not believe that Dawson had actually pinpointed mucoid strains of hemolytic strep as the leading agents of the most deadly versions of RF - he simply knew that mucoid colonies were usually the most deadly agents in all of the dozens of serious diseases that strep deals out to us humans - and in the 1930s, RF was the most important hemo strep disease around.

Having his thesis proven in the case of acute RF wouldn't have surprised Dawson - but it would have pleased him.

 His 1930s mucoid work, sandwiched as it was between his pioneering work on recombinant DNA in the 1920s and his pioneering penicillin work in the 1940s has naturally been overshadowed by these two, the two biggest medical stories of the entire 20th century and beyond.

But to explain how in 1940 that an arthritis 'aspirin doctor' ended up in the area of endocarditis, today the domain of heart surgeons, we need to see this intellectual connection between mucoid hemo strep causing RF, which in turn led to SBE.......

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