Thursday, March 28, 2013

WWII's sins of uncaring omission as War Crimes

Even animals would be discomforted at the audible and visual pain as millions of Indians starved to death during the Bengali Famine of 1943.

It is a pity that so many of us,supposedly more sophisticated, humans have been less discomforted about the event ever since.

Most of us - at least in the Allied West - would strongly reject the  idea that this totally unnecessary mass famine was a war crime and and a sin of uncaring omission.

To ease our own consciences, we much prefer to limit our definition of war crimes to sins of commission, done by obvious evil-doers : the direct shooting, gassing or bayoneting of civilians as at Nanking, the Katyn Forest or at Auschwitz.

But it is not enough to save "oops -sorry !" when bombs we intend for rail yards or oil refineries happen to fall upon 250,000 soon-to-be dead civilians in occupied countries - not if we also clearly know that most of our bombs always fall widely off target.

Claiming that anything and everything is justified if our intent (to defeat Hitler) is good is not a moral claim with legs.

It puts one to mind of the claims of George W Bush that he just had to suspend civil liberties in America ----- in order to bring them instead to the oppressed of the Middle East !

We must always demonstrate extremely due care when we kill some in an effort to save others : clearly seeking to see if there are not other ways to defeat evil without killing so many of the innocent.

Famine , fortunately, was not general throughout the Allied and Neutral world, between 1939-1945.

But many (powerless) people needlessly went more hungry than they had to , in many of the Allied-controlled colonies.

But if Allied famine had been widespread and prolonged - caused perhaps by normally reoccurring weather disasters adding to uncaring imperial government mis-management - would it have been moral to continue to treat DDT as a war secret and deny its use to civilians, to reduce additional loss of food to insect pests ?

The militarizing of wartime DDT thus escaped - just - being another war crime of uncaring omission.

But there are more uncaring crimes of omission in the Allied closet.

In 1940-1941, several years into WWII, the new class of sulfa drugs which had emerged only 5 years earlier, seemed a gift that just kept on giving.

Today when the doctor comes in with the test results and says "I'm very afraid it appears that the cancer has metastasized" , the room gets very still as patient, family and nursing personnel absorb the grim news.

In the years before sulfa and antibiotics, people rarely lived to an age where they could learn that their original primary (localized) cancer tumour had spread throughout their body and that their chances of survival were now slim.

Instead what they feared was something not un-similiar happening with an infection that had originally been localized to one lesion , something most bodies, and good nursing care, could eventually fight off on its own.

Now in came the doctor with the blood tests (indicating colonies of bacteria were thick throughout the entire blood supply) and the room would go similarly silent.

Septicemia (Sepsis) was what the doctor would call it, but laypeople  would whisper to friends "blood-poisoning" , just we tend today to whisper "the doctor says the cancer is all through the body".

While we are correct to say that cancer spreading throughout the body (ie a systemic cancer rather than a localized tumour) is deadly and will directly kill us, our concept of what blood poisoning actually means is only half accurate at best.

It is correct that a bacteria infection flourishing in the blood will spread through out the body (is now a systemic disease) but the bacteria will not directly kill us - not by their "poisons" or their physical actions.

Rather it is that our body overreacts to any massive (systemic) assault upon it - not just to systemic bacterial infections - and it is the body's immune defenses' overreaction that kills us in sepsis.

The 1930s - modernist - mindset thought everything humans did - including our immune system - was marvellous beyond words and simply much preferred to blame those nasty little devils, the bacteria.

Until Sulfa drugs came along, nothing but God's will and dumb luck could prevent sepsis from ending in death.

The arrival of the sulfa drugs had meant all sides in WWII went to war a bit more confident that infection deaths would be much reduced on and off the battlefield.

So, despite the war between them, both the Allies and the Axis went on investigating tens of thousands of sulfa drugs, publicly* patented thousands of them and seriously trying hundreds of them on animals and humans.

*Yes, even in wartime - on both sides ! A notable contrast with the Allied secrecy on DDT and penicillin.

The new sulfa drugs of 1940-1941 tended to be less toxic and more effective than the slightly older ones - some even treated diseases originally thought beyond the reach of sulfa.

How could life ever get much better than this ?

But a year is a very long time in infectious disease treatment when practised massively and on a global basis.

By late1942, the sulfas were in a dire crisis.

Two American chemists, Roblin and Bell- who had helped invent the latest in the sulfa wonder drugs - had just published a convincing chemical explanation for their claim that the sulfa molecule (whatever its other medical uses) would no longer produce any new antibacterial drugs.

Seventy five years on, their claim has stood the test of time.

Typically the popular media (Newsweek, September 21st 1942, for example) played Roblin and Bell's research as a good news story - saying that now chemists could tell if a drug would work, before actually assembling it in the test tube.

But frontline chemists in the sulfa-synthesizing business could not help but hear it as a death knell.

The sulfas had other problems.

A few strains of bacteria had always and instantly shown a resistance to their bacterial action. But now the numbers of strains so displaying resistance had exploded in numbers and their resistance was more potent.

The first human response was to up the dosages to overcome the resistance.

The sulfa drugs had always been moderately toxic even at low dosages and required attention to detail in monitoring their use.

But now heavy dosages and careless doctor and nursing care was leading to needless deaths from the drug itself.

More thoughtful doctors faced a horrible choice : too big and too long a sulfa treatment might kill or permanently damage the patient, but without it , the patient was almost certain to die from sepsis.

They jungled frantically, trying different sulfas as well as backing them off for a while and then returning to them.

This disaster in the sulfa treatment of systemic infections was effecting military hospitals as least as hard as civilian hospitals.

The dirty little secret of war wound medicine is that soldiers rarely die from localized infections, anymore than they do in civilian life.

Soldiers die all the time from massive wounds - as do civilians - but rarely is the fact that the wound is also locally infected the critical factor in their death.

But if any sized wound permits the infection to spread to the blood - then soldiers do die from the indirect result of a wound that was originally just locally infected.

Just as well then that the local curing of local wounds was largely irrelevant to life survival.

Because the sulfas were proving to be totally useless in curing local wound infections. In 1940, two British researchers, Fildes and Woods, had offered up an explanation for how sulfa works (that it is mistaken for a vital food bacteria needs) that has also stood the test of time for 75 years.

Their research also explained why sulfa sometimes didn't work even if the bacterial strain wasn't resistant to it.

If bacterial lesion had lots of the real food around, enough bacteria ate it, instead of the useless sulfa lookalike, to keep the infection going.

Wounds - badly tended war wounds in particular - had lots of that food provided by dead and dying flesh.

So no new sulfas on the way - ever , the ones now in use were proving to be either useless, toxic or increasingly resisted by more and more bacteria.

Today,at any one time, we prefer to use about a dozen different drugs to fight serious infections.

But also we have about one hundred we could use - including the sulfas - if the current dozen all suddenly proved useless.

More importantly, these one hundred represent many different classes of drugs - never is any one bacteria infection resistant to all of them.

These discarded drugs are both more toxic or less effective than those in preferred use, but if death by sepsis is the alternative, even a highly toxic drug is the better - more moral - choice.

But the sulfas were the one and only class of drugs in use in 1942 against systemic life threatening infection ; they all shared the same good and bad features, all shared the same fate.

So it appeared that inevitable death by blood poisoning , for both military personnel and civilians, was on its way back.

Unless .......penicillin was put into serious mass production.

But in 1942, both the British and American medical elites had already decided that penicillin was to be kept as secret as possible and used only as a weapon of war - used only to cure our side's wounded on the QT,  so no one else would pick up on it.

Letting civilians have it and above all letting civilian newspapers chatter on about miracle cures would only alter the enemy into making their own penicillin and the Allied military advantage would be gone.

Powerful figures in Britain and America decided that wasn't about to happen.

But in the Fall of 1942, one man realized that if penicillin was now the only thing between blood poisoning death and a nice long life, he would have to up his own ante in this relentless game of chicken.

So that Fall, Dr Henry Dawson stole his first supply of government-issued penicillin and put it to work saving lives from systemic SBE disease , again against strict government orders to let the SBE patients die.

By his reckoning, if the Allies could militarize penicillin, there seemed no reason why one - dying - doctor couldn't un-militarize it back again......

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