Saturday, September 29, 2012

Dr Martin Henry Dawson and the MORAL INVENTION of 4F penicillin ---- during a 1A war (PART 1)

Thalidomide has had 9 lives...
Is it truly unfair that only Paul Gelmo initially invented Sulfa-the-(useless)-chemical, but is was Gerhard Domagk , 25 years later, who won the Nobel prize for Sulfa?

Not in the eyes of  99.9999999% of contemporary (and very grateful) observers.  Because what Domagk invented was something called Sulfa-the-lifesaving-miracle.

Though you'd never notice from our "initial discovery" obsessed journalists, many, many important things were invented several times over.

Thalidomide is a particularly spectacular example : it had already had several medical applications ( with good successes but also very severe side effects that were kept secret) before it was promoted to cure morning sickness.

We all know the results that that particular application caused.

But, believe it or not, it is still in use - for forms of leprosy in particular, - and still being investigated for its ability to inhibit some tumours: new uses still being invented for an old "initial invention" .

AZT and carbolic acid were both much later "re-invented" when they were dragged out of the medical gutter and first used for the uses we best know them for today.

We don't - but we should - most highly honor those people who first put a product to its highest use, rather than merely honoring those who first invent or discover it as a mere substance.

Those who only honor  those who initially discover or invent something are unconscious devote disciples of Auguste Comte and his dogma of Positivism.

That school of thought, if it can be called that, sometimes assumes that the mere act of discovering or inventing something will also instantly inform that inventor/discoverer as to its many self-evident uses and to its self-evident highest possible use.

Anyone else who later does put it to such uses, in this view, was merely taking advantage of information that is open to all that gaze up the substance---- and hence not worthy of any honor.

Put like that, Positivism use in this case does seem childishly ridiculous - as many unstated assumptions often are - when they are more closely examined.

Most re-inventions are of a technological nature : something long thought capable of merely reducing the pain of leprosy turns out to actually - and unexpectedly - reduce the advance of the disease. ( In this case, the drug in question is thalidomide.)

But probably the most famous medicine and science story of all time also saw a substance re-evaluated for a new use , but for moral reasons.

A doctor's moral anger drove him to break a whole bunch of rules and norms to stick the first ever needle of (dirty) penicillin in a dying patient's arm : and the patient lived.

There had never been any technological barriers to putting Alexander Fleming's penicillium juice in a needle and sticking it in a patient's arm to save their life.

Not even to sticking penicillin into someone's arm to save them from invariably fatal Subacute Bacterial Endocarditis (the dreaded SBE).

Doctors and Scientists' objections to natural (impure) systemic penicillin were only ones of an aesthetic nature

The objections had only been quasi-aesthetic : in a modern scientific age, was it worth the risk to the dignity of the medical profession, to be seen sticking something seen as mostly dirt into the human bloodstream, even if it was in a worthy attempt to save the life of someone otherwise facing immediate death?

Many doctors, faced with lots of patients dying of an invariably fatal disease, will indeed throw a kitchen sink of oddball medical treatments at them, in the hope one will stick. SBE saw many such attempts.

But from September 1928 till October 1940, no doctor in the world ever stuck penicillin in someone's arm, to see if it might save their life --- for any disease. Amazing but true.

Since 2004, I have lived and breathed and dreamt why this might be so - and why the unlikely doctor who finally did so , Martin Henry Dawson, chose to break that mental barrier.

It matters because it is only his Penicillin (Penicillin-the-natural-systemic) that the world has used since 1940 - not Alexander Fleming's Penicillin-the-synthetic-antispetic or Howard Florey's Penicillin-the-synthetic-systemic.

It is his penicillin - and his penicillin only - that we use, but it was those two who got the Nobel Prizes for penicillin.

Dawson probably backed his way into penicillin - driven by his anger over the way that the "4F" in society were so quickly abandoned at the first opportunity --- in this case, in preparing to fight a war using the best "1As" in society.

His special area of interest - Rheumatic Fever (RF) - was mostly a disease of the poor, so the well-off donors to the cause of RF were largely motivated by pure altruism.

But it had been recently replaced (by the Fall of 1940) by Polio as the number one child health "Cause" for America's well off .

Polio deaths were far ,far outnumbered by RF deaths, but polio was a disease of the well off mainly, and this was the first evidence of a now common organization : the patients (families) self-help group : mothers going to door to door to find a cure for a disease that might hit their own children.

We generally think this is a good thing, but it is also another example of a society of individuals increasingly looking out for Number One.

In 1940,mighty  America collectively looked out for itself as Number One and did not come to the aid of about a dozen of Europe's small weak nations : Czechs, Poles, Danes , Belgians etc etc.

Dawson who had gone to war to help the people of little Belgium in 1915, was in agony - too old to fight, but also too principled to just sit back.

When he arrived in the Fall of 1940 back at his employer (Columbia University Medical School), he found that the research and teaching efforts were to be dialled back in social medicine (medicine to help the poor) and put into war medicine (making the armed forces better fighters).

By sheer coincidence, his fellow researcher, German Jewish refuge (and potential internment camp alien) Dr Karl Meyer, wanted to revenge himself upon another biochemist who he felt had downplayed Meyer's successes. This biochemist was also a German Jewish refuge and potential alien in an internment camp), Ernst Chain.

Both men were not evil or naive : they simply knew the best way to be kept out of a miserable internment camp in the event of war, was to be judged very useful by their anti-semitic hosts. So they were holding nothing back to avoid an internment camp for themselves and their families.

Meyer thought he was a far better biochemist than Chain (very true !) and could more quickly and easily synthesize penicillin  than Chain (very untrue !)

Would his friend, Dawson the bacteriologist and clinician, help out by testing the resulting product ?

Dawson read up on what little there was on penicillin and noticed its unique combination of extreme non-toxicity and extreme diffusiveness could possibly be the best shot in a long time to cure SBE.

Now SBE was usually a matter for the heart specialists (an elite in every hospital) and Dawson's main job was in an arthritis out-patient clinic (at the low end of  any hospital's pecking order).

Moreover, some people had made SBE their primary lifelong research and clinical interest and Dawson had never - as far as I can tell - written or spoken on SBE.

To barge into their area of expertise would be a disaster.

I can only presume that Dawson first suggested his idea to SBE and heart experts and then to his contacts at the big Drug Companies.

Only when none responded positively and he had two dying SBE patients in front of him, did he act.

Because he felt that penicillin might save their lives, he pulled out all stops and broke all the rules and norms, to try and save their lives --- with this urgency additionally fueled by his anger at how the 4Fs of society were now being treated.

SBEs, in a month of the first ever peacetime Draft registration ( an entire nation trying to find all the 1As in society), were everyone's 4Fs of the 4Fs : about the most useless to the war effort young males imaginable.

Many medical staff felt they'd only consume precious medical attention for months and then invariably die anyway.

So, when Dawson stuck that first ever penicillin needle into an SBE's arm on that first ever peacetime Draft Registration Day, I feel sure his first finger was cocked in the air while the other four were wrapped around the needle.

"Down goes the needle - and 'up yours' !!!!! " .....

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