Wednesday, August 25, 2010

May 1940: our two protagonists enter stage left

The Penicillin Story had been underway for almost twelve years when our two protagonists, Howard Florey and Henry Dawson, first seriously entered the story in May 1940, Mensis Horribilis, and changed the Story's direction completely.

It is true that Ernest Chain, Leslie Epstein, and Norman Heatley had been working with penicillin at the Dunn Pathology Institute at Oxford University for about two years by that point.

But only when it became intensely and personally important to the Dunn's director, Howard Florey, (when he injected the first therapeutic doses for some artificially infected mice),did it gain some real momentum for the side of the war time penicillin story that I will call "Chemistry".

Dawson's team (Karl Meyer specifically) didn't display any interest in penicillin still sometime between June 10th 1940 and September 7th 1940 when he first heard of it from Leslie Epstein, newly arrived from Oxford and the Dunn.

Dawson didn't become directly involved in penicillin until he first heard of Florey's published results from Meyer, sometime around September 9th 1940.

But he was emotionally ready for committing to penicillin as his ABF agent (Anti BioFilmic agent) since a series of New York area symposiums on Rheumatic Fever and Subacute Bacterial Endocarditis (SBE) in April and May 1940, that had just been published in article form in August 1940.

After the development of the Sulfa drugs, bacterial diseases seemed passe to the ambitious medical researcher.

As a result, it was becoming clear that the victims of (middle class) virus diseases like Polio would soon occupy the emotional and charitable space once occupied by (working class) Rheumatic Fever patients.

But Rheumatic Fever/SBE was still the major killer of school age children and young adults, killing far more than Polio by at least ten to one.

Dawson was not employed by his hospital and university to worry himself over SBE, to put it mildly.

Endocarditis was generally thought of as a disease for heart specialists, while Dawson operated a day clinic for chronic arthritis - in 1940, about as low as you could go on status
ladder in an acute-life-threatening-disease-oriented teaching hospital.

But it seems he stepped in, early in September 1940 when he found no heart specialists felt penicillin could be the long sought cure and he found no drug company willing to make clinical penicillin for such a disease.

His heart drew him in.

But his head kept him there.

His lifelong hobby or personal research focus, as opposed to his day job, had always been the commensenality shared between humans and their live-in microbes, a sort of uneasy co-existence or cold war as we and they struggled to survive against the activities of the other side.

His two previous developments ( HGT/Q-Sensing for s. pneumoniae and Molecular Mimicry for s. pyogenes)  had profound implications for all Biology, not just Medicine.

Unfortunately, they had no immediate application for fighting back these two sometimes-deadly bugs.

But his instant and intense conviction that penicillin's combination of non-toxicity and extreme diffusability made it the perfect ABF tool for penetrating SBE vegetations ((biofilmic colonies) on heart valves would let him get three bugs for the price of one.

This was because it was s. pyogenes that caused our bodies to attack its own heart valves - damaged areas that later were colonized by s. pneumoniae or s. viridans - leading to  fatal acute or subacute endocarditis.

I will call this side of the wartime penicillin story, "Commensality" ....

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