Tuesday, January 15, 2013

Penicillin's four most famous patients shouldn't have been PATIENTS... according to the research protocol

When anal-retentive children grow up, if indeed they ever grow up, they either became clients of Madame X the Dominatrix... or they become medical research scientists devoted to extremely strict and rigid clinical trials with firm protocols and hard-fast deadlines.

So it was with wartime penicillin and a group of such anally-oriented researchers swore to devote whatever scarce natural penicillin they could produce to test on cases of staph (and gas gangrene) infections.

After all, the various patented and chemically synthesized  sulfa drugs could be relied upon to look after the far more common and more deadly strep infections, couldn't they ?

Or maybe not.

Let us look at those famous four early cases.

By chronology , the first was Charles Aronson ,dying of SBE (subacute bacterial endocarditis) caused by strep viridans in October 1940.

Dr Henry Dawson gave him a tiny amount of penicillin (to boost his morale) and a whole lot of sulfa to help his body defences and he unexpectedly survived this invariably fatal disease.

Case One : success one.

(About his fellow SBE patient, Aaron Alston, little is known for certain,  only that he received the exactly same tiny dosage of penicillin as Aronson at first and later got some additional slightly larger doses of penicillin.

It is implied that he died of his disease early in 1941: but then this is also said to be true of Aronson and that claim is definitely wrong.)

Case Two.

That famous policeman dying from the prick of a rose : Albert Alexander of Oxford would have lived, should have lived, if only Howard Florey hadn't polished the apple so long testing penicillin on healthy animals (his forte) rather than on dying humans.

That and stopping the course of antibiotics too soon (today a widely known elementary error but something I can't really blame Florey's team for back in February 1941.)

Alexander had a mixed infection of strep and staph that had gradually consumed most of his face and was now threatening his brain. At the stage of his disease when he first met penicillin, conventional wisdom was that he was a definite goner.

 It was second miracle that he recovered from this --- until the penicillin needed to totally clear up his infection was given to someone else who were not dying of their infection.

Case Three : Anne Miller.

The OSRD/CMR and the NAS/COC (the medical war lords of Washington, to adapt Bruce Catton's famous phrase) had agreed, along with the only two (out of over 200) drug companies in America that agreed to join in their restrictive government effort on penicillin, that the first priority on investigating the healing powers of penicillin was to look at staph infections.

In addition the two drug companies, Merck and Squibb , felt would be at least mid-1942 before any of this government-sanctioned penicillin would be released for clinical trials.

But strings were pulled to save the live of Florey's best friend, John Fulton, a top member of America's medical research elite --- by claiming the badly needed penicillin was actually for his fellow patient Anne Miller, dying of strep infection after a miscarriage.

So in March 1942, her life, too, was saved, in a dramatic fashion and post-the-awkward-fact that this totally broke all the agreed-upon protocols, the OSRD and NAS began touted Miller as the first patient treated in America.

 (Obviously not true, but "embedded historians", ie historians who do most of their research in the lush gardens of the self-selected "official" archives of the OSRD and NAS, have generally fallen for this hook and sinker.)

Case Four : Harry Lambert.

Lambert was an employee of Fleming Brothers, a very successful optical wholesale firm run by Alexander Fleming's family.

When his strep infection wasn't helped by sulfa, Alexander was pressured by his family to try some of his wonderful penicillin on the case.

Awkward that : cause Fleming claimed he didn't have any and never did have any of his miracle drug.

Fact was, Fleming was still totally repugnant to putting his own "crude" penicillin into the temple of a human body. So he went cap in hand to Florey to get some "refined" penicillin.

Florey, to his credit, gave him as much as he had - pulled from experiments in purification and synthesis of penicillin.

(Florey's penicillin was still 75% junk, just as Fleming's penicillin was 99% junk , but it had been manipulated by a real live chemist, so that made it alright to put in a body !)

Lambert's life was saved, partly by Florey's penicillin and partially by Fleming's surgeon manque skill in injecting it into Lambert's spine.

As a result, Fleming overnight became a true believer in his own medicine's systemic healing powers ,14 years after he first discovered it.

Sulfa-resistant strep was a leading cause of death by 1942...

Four cases, among many, where the first wonder drug , the sulfa family of medicines, were not working and where only penicillin saved a life.

But still a great reluctance (except from Henry Dawson) to say this aloud in front of the customers : that a mold-medicine was beaten the pants off a man-made synthetic and was not merely a supplement to sulfa for frontline staph wounds, but an all-around better life-saver and needed to be mass produced, like yesterday.....

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