Thursday, November 5, 2015

Henry Dawson: Fermenting IV, STAT !

Historians of medicine and science, to the small extent that they care at all about it, have never had any problem deciding what in the name of God Dr Henry Dawson was up to, back in the Fall of 1940 seventy five years ago.

But I think they got it completely wrong. And this blog is the result of my doubts - the forum for expressing all my doubts --- and proving them up.

Well, not all wrong - they did more or less capture the surface and concrete facts of Dawson's pioneering activities in September and October of 1940.

However they then proceeded to boldly offer up totally wrong reasons for Dr Dawson's actions, completely unsupported by any evidence.

The other Manhattan Project was symbolically important precisely because it was so small, not in spite of it 

And they missed - I believe - the highly symbolic nature of his actions and Dawson's overwhelmingly personal and emotional feelings that lay behind them.

So, yes, Dawson did successfully manage to ferment masses of natural penicillium slime in the sterile corridors of a world class research hospital.

This despite working in an era when senior hospital support staff were more cleanliness obsessed housecleaners than the administrators or scientific assistants that they have become today.

Yes he did then inject the resulting 'crude' (his own words) penicillin into two patients.

Albeit, at least not then, directly into the veins (IV).

Still these historical injections on October 16th 1940 were the first ever injections (into a Black and a Jewish patient) of a life-saving antibiotic and ushered in our Era of Antibiotics.

And yes, the two young patients were rapidly dying from SBE (the form of endocarditis that then made Rheumatic Fever the highly feared and greatest killer of school age children) and with all conventional methods a failure, any new approach had to come fast - STAT !

So yes Dawson did move extremely rapidly from deciding to look into this medically totally unknown substance 'pen-i--cill-i-um not-a-tum' in the first week in September to injecting some of its metabolic waste into human patients five weeks later.

And yes, given that it presented the start of a totally new class of medication (and even a totally new way thinking about treating illness) and that there was no industrial tradition for  producing and purifying this class of drug, the whole process today would take at least ten years, cost billions and involve thousands of scientists and technical helpers.

But then historians have spun out an explanation basically projecting unproven assumptions backwards from a known fact.

Because yes it is completely true that Dawson did indeed literally gave up his life to see SBE move from a common, dreaded and invariably fatal heart disease to one that was the easily cured heart disease and then disappeared from sight all together,.

And yes they were only acting upon direct testimony from his closest associate, that Dawson had long been 'consumed' with finding a cure for this horrible disease.

But this associate, Dr Gladys Hobby, offered up no published printed or verbal communications from Dawson's pen and mouth to back up this claim - because there were none.

Google hasn't been able to pair Henry Dawson and SBE, before May 6th 1941

Dawson published freely and widely and attended many conferences where the scientific discussions were paraphrased in print.

But I have found nothing - and Google has a way of peering into obscure nooks no pre-internet researcher would likely go looking.

Dawson was a relatively junior researcher in rank, with unconventional views (since proven correct !) and ran an outpatient clinic for a chronic disease - arthritis.

SBE then and now was the domain of heart specialists (and today, the domain of open heart surgeons).

Dr Dawson was working in the top medical research complex in the world --- today known as New York City's CUMC , then known as Columbia Presbyterian Medical Centre, oriented - to a great fault - upon quickly treating and curing acute illnesses.

One doesn't have to be an expert or victim of professional firewalling and silo building to begin to imagine the vast social and professional distance between, in their words, "life-saving open heart surgeons" and a "day clinic catering to the complaints of little old ladies with arthritis in their fingers".

True Dawson was a specialist in Rheumatoid Arthritis and there was thought then to be a connection between it and Rheumatic Fever and yes, he was a world expert in Strep bacteria.

But in 1940, the vast Strep bacteria family of killers, rather than say Staph or viruses, was the dominant bringer of death from acute infection in the Northern Hemisphere and so even every GP had to be a sort of expert in it.

But a threat that big was naturally broken down into many sub specialities, each researched very throughly by experts who devoted a lifetime to their narrow field.

Dawson's narrow area of expertise was the remote possibility that the body reacted to a strep throat infection by beginning an unknown process that led to permanent rheumatoid arthritis, in somewhat the same way that the body was known to attack its own heart, nervous system, kidneys, skin and even - temporarily - its own joints.

His research was a long shot in a relatively low priority (life-shortening but not life-ending) disease while life-threatening Rheumatic Fever was a huge threat and a big area of active research - while invariably fatal SBE was moderately big area of medical research.

Dawson was an unusually diffident researcher in the alpha male world of medical science - he would never venture into areas beyond his competence.

And I have written before just how far out there it was for Dawson to be growing and processing industrial pilot plant amounts of a fungus mold in a mold-fearing hospital setting, without the support of any outside drug company, and then injecting it into ward patients.

He was used to simply growing test tube size amounts of strep bacteria for small scale experiments that remained safely inside his lab and outside any patients.

If anything, this was an even more unlikely new area for Dawson to get into than treating SBE was.


But Dawson also was Truro Nova Scotian born and raised decorated military veteran of WWI - frustrated beyond measure by the lassitude of the Phoney War and torn up inside by the coming German invasion of Britain.

Part of Truro's famed Band of Patriotic Brothers

He was just aching to go back overseas and do his patriotic duty but the Canadian government wasn't about to send him,even if they did accept him, anywhere near a front line.

Because Dawson was also middle aged, overweight and with some noticeably loss of limb function from two serious war wounds.

And his wife would remind him that he was also a father and husband with a young family (new baby on the way) and a wife with her own limb difficulties restricting her employment.

His tenure and all his career projects tied Dawson to keeping his job at Columbia in still-neutral America.

His head said stay in New York and keep to your knitting.

But his heart said otherwise.

We mustn't forget that Canada had been an invisibly small military power at the start of WWI - the 'peaceable kingdom' in myth and practise.

But emotionally drawn in, like millions of others, by learning of the German Kaiser's abuse of tiny Belgium, Dawson had joined an inclusively wide morally-driven coalition that spanned from incredibly small helpers (Canada) to incredibly small 'helpees' (Belgium).

Canadian infantry troops like Dawson had become the soldiers feared the most by ordinary German soldier (like Hitler - who served not many miles from Dawson at one point in time !)

The big Allied superpowers like France and Britain would never have survived being defeated by the German led coalition without help from small military powers like Canada and Australia.

He didn't see any of this idealistic-and-effective inclusive coalition-building in the world's (non) response to the even greater evil represented the murderous Hitler's attack on Poland.

Even Belgium had stayed resolutely neutral - the entire world had seemingly rejected the idea of the bigger coming to the defence to the smaller as hopelessly idealistic - replacing it with the Realpolitik  idea of 'might is right' and 'every man for himself'.

The whole matter seemed to have come to an emotional boiling point in inside the soul of Henry Dawson in the darkest week of the war, the week when Germany was widely expected to easily invade and conquer Britain, a week when still neutral America revealed itself to be divided on whether or not to do the morally right thing by aiding Britain.

Fusing another Nova Scotian Henry's 'divided self'

To adapt William James' famous phrase used to describe an earlier Nova Scotia 'Henry', the 'divided self' of Dr Dawson seemed to have fused about September 8th 1940 with his decision to symbolically recreate a WWI style moral and inclusive coalition to defeat evil inside his own small lab.

For now discounted reasons (insert here the Holocaust among others) that make the mind of Modernity as foreign to us Post-moderns as the planet Mars, the mere thought of injecting the natural metabolic waste (poop and pee) of primitive mold slime into the human temple of the bloodstream, instead of man-made synthetic chemicals, made most scientists want to retch back in 1940.

Dawson had his own discoveries, such as in the area of  HGT, horizontal gift transferring of DNA genes from bacteria to bacteria to bacteria, to make him confident that the supposedly primitive microbes were hardly that - either as chemists or as four billion year survivors, thanks to the inclusive coalition building activities of HGT.

And Dawson correctly gathered by listening to the conversations of his conservative colleagues that SBE victims would be number one on the list of patients judge unworthy of scarce life-saving resources in the event of a total war.

Their crime ?

 SBE, like the Rheumatic Fever that caused it and unlike Polio (whose research was never curtailed during the war) hit mostly Democratic voters - working class minorities and immigrants - Jews and Blacks.

For interesting technical reasons, the feeble form of strep that caused SBE and was so easily defeated in a test tube seemed impossible to cure secure under a dense biofilm on damaged heart valves.

Ever possible approach had been tried --- and the alpha male medical research community seemed to have responded to this attack to their collective ego by hitting out at SBE's human victims.

In any case, treating SBE consumed lots of hospital beds and staff over many months and still always ended in early death.

Best the SBEs died quietly at home and didn't reduce research hospital success records --- and the excuse of total war would be time to beat back the forces of social medicine to aid the small and weak.

Substitute Belgium for SBE and Canadian 'troops' (sic) for penicillium mold and we can begin to see what was coming.

Dawson deliberately set out to cure the not-worthy-of-saving (the SBEs) with help from the not-worthy-of-helping (the slimy smelly molds) - rather like saving Belgium with the help of Canadian troops.

So he quietly decided to hijack the agreed protocol for the small conventional effort of his colleague Dr Karl Meyer, to synthesize artificial penicillin to be tested on patients five months later in the New Year.

Echoing Edith Cavell's dying bravery in a dying doctor delivering penicillin-for-all

And the day he chose to inject his first patients, October 16th 1940, was highly freighted with emotional significance.

It was registration day for America's peacetime draft : the whole world, the Axis and Allies in particular, was eager to find if there were many 1As among America's youth after the hardships of the Great Depression.

October 16th was to be all about the 1As, all the time.

Except inside Dawson's ward, where the very 4Fs of the 4Fs, the SBEs, a Black and a Jew, were to be the first ever to receive this wonder drug.

"Up yours !", in other words.

And exactly twenty five years earlier, October 16th 1915, Dawson had first read of the execution of Edith Cavell, dying defending the Belgians - and was moved to volunteer with his university's Military Hospital overseas, beginning his medical career.

So yes indeed Henry Dawson was fermenting.

But not so much fermenting penicillin for an IV (intravenous injection) as in fermenting an IV (inclusive vision) of 'help from all resulting in hope for all'.

All by widening people's mental vision of who could help and be helped in the larger Allied war coalition, by the example of his tiny medical project going the extremes in who could help it (the unspeakable slimey mold) and who could be helped by it (the not-worth-saving SBEs).

And yes, he did it all "STAT ! " And why not?

After all, the moral and physical fate of the world literally hung in the balance...

No comments:

Post a Comment