Monday, March 25, 2013

1940 Penicillin : localized Gas Gangrene or systemic SBE ?

Within days of reading war-dodger Howard Florey's published conclusion that the as-yet-unproven penicillin was particularly suited to the military's most feared infection, gas gangrene, war-hero Henry Dawson defiantly decided - by pointed contrast - that penicillin was particularly well suited to defeat the ultimate in non-military infections, deadly subacute bacterial endocarditis, SBE.

The timing of Dawson's decision - during the most critical days of the expected Invasion of Britain - only heighten this highly unusual contrast between how we expect war-heroes and war-dodgers to behave and how these two examples actually did behave.

Florey had declined to serve his country when he was young but now was very eager to aid it (as a draft-proof middle ager) by steering the new penicillin towards use as as a local antiseptic for gas gangrene infections in frontline casualty tents.

For centuries, gas gangrene infections were the most dreaded and also the most uniquely wartime forms of death (rarely causing death in peacetime).

Any talk of the possibility of finally ending gas gangrene's terrors was acutely pitched to catch the ears of war's political, military and medical leadership.

By contrast, when on the day of America's first peacetime Draft Registration, a day dedicated to locating all of America's 1A youth,  Dawson choose to instead try and save the lives of two SBE sufferers, one Black and one Jewish, he was focused on the most 4F imaginable of the unwanted 4Fs.

The most 4F of all the 4Fs : the SBEs

For no nation's military , no matter how hard pressed for manpower, was likely to regard SBEs as more than just a particularly costly burden for a wartime economy to bear.

It usually hit young adults , the prime category for draft boards and munition factories, but no matter what modern medicine threw at it, it always ended after months of expensive effort with the inevitable death of the patient.

In that Fall of 1940, the Medical School at Columbia University, which employed Dawson, had moved to reduce its offerings in Social medicine and up its offerings in War medicine, in response to the battle for civilization not taking place over the skies of Britain.

It certainly had no cause to expect any complaints from professor Dawson, he of all its employees.

He was, after all, from a Canadian family of five brothers, all who volunteered to fight in WWI, all who were wounded in the front lines - one who had paid the ultimate price and others who got medals for bravery and leadership under fire.

Dawson likely had more front line experience - in the medical corp, the infantry and in artillery - than any one else in the Medical School.

When he wasn't serving in hospitals dealing with wounded soldiers, he was in military hospitals himself as a patient - fighting off life-threatening infected war wounds he himself received.

Surely such a patriot and such a veteran of battlefront infections  saw the sense on Howard Florey's proposal to focus penicillin research on battlefront wound infections  and to agree with his university's decision to focus on war related medical research ?

But clearly he did not - and the mystery is to account for why he did not - but instead, precisely and perversely, did exactly the opposite.

Penicillin did not, in the end, reduce deaths due to gas gangrene - in fact penicillin pioneer ( and WWI veteran) RJV Pulvertaft found that the evidence suggested that the percentage of gas gangrene sufferers who died actually went up in WWII , compared to the results obtained in the last years of the previous war !

By contrast, in the end, penicillin proved to be the best medicine ever seen to stop deadly systemic (body-wide) infections like SBE and blood-poisoning.

Explaining the mystery and the paradox

Based on just the evidence, part of the mystery might therefore seemed to solve itself: the modest Dawson was simply a far better scientist than the very pushy and ambitious, but ultimately plodding, Florey.

But Dawson was also extremely patriotic in ways that Florey couldn't begin to imagine and we still must explain why he felt  that his best way to personally aid the war effort was to come to the aid of Life's weakest members.

Saint Peter had only denied Christ's pleas three times, but between 1931 and 1941, America had denied pleas for help from smaller, weaker countries under attack over two dozen times, only deciding
to put the Greatest Generation Ever to work fighting the only Good War, after it itself was attacked.

Helping Life's weakest members is all very nice in theory said America - but what in the hell does it have to do with fighting WWII - which was all about one's own naked self interest ?

Perhaps Dawson was merely confused -  was still fighting WWI - was still fighting for poor bleeding little Belgium.


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