Friday, March 13, 2015

Was Martin Henry Dawson's sub clinical MG pushed into a severe MG case by his penicillin work ?

Thousands of deaths later, doctors have come to realize that many,many drugs can turn quietly sub clinical cases of Myasthenia Gravis (MG) into full blow cases.

Situations that turn ordinary people into lifelong patients who now require constant and closely monitored medical interventions for their very survival and well being.
If the full blown case happens unexpectedly while the patient is out for the count, during a routine surgery, it can even cause an unexpected respiratory failure that could prove quickly fatal.

MG is by the most common member of a sizeable group of diseases that hinder the vital transmission of nerve control signals from the stem of the brain though to the nerve ends and then across a gap to the special muscles that control things like breathing and swallowing.

Thankfully, mammal bodies have a huge redundancy in signal sending and signal receiving receptors at either end of that gap to cover most possible problems.

So these diseases are not a simple matter of either being full on or full off but rather exist in a fluctuating continuum depending on our general health and stress levels .

Many of us have conditions that interfere - somewhat - with that nerve transmission process but we don't even realize it - just that sometimes we feel sort of 'punk' and 'out of it'.

These large number of until recently unnoticed sub clinical cases of MG does produce an example of a common situation where we are basically lied to, when fundraisers for the treatment and cure of a disease insist a disease's survival rate is "way up".

Here is how it happens :

Often, a new disease is only 'noticed' when enough people with the most severe symptoms arrive at some big city research hospital and form the basis of an article.

Most - having such severe symptoms as to be readily obvious - naturally die at first.

The disease researchers then say that the disease is very rare --- and with a very high morbidity rate.

But then gradually some reliable and sensitive diagnostic tests emerge, tests that indicate the disease actually exists mildly in many more people than was ever imagined.

Now the new 'survival rates' much quoted are in fact spread over a vast number of people who were never ever going to die of the disease, with or without medical intervention.

I don't wish to deny that many people who used to die from MG are now kept alive thanks to over a hundred years of research on this disease.

Just to warn you that all disease fundraisers are past masters at 'lying with statistics' , all trying to do good by getting as much success stories into their PR as possible.

Now all kinds of stresses - external chemical ones (like drugs and bugs) as well as internal (mental) ones - can make a person's MG condition suddenly worsen.

'Worsen' can extend as far as a sudden failure to breath - the dreaded "MG Crisis" - a situation that can kill the MG patient in minutes.

Lists of drugs that have - on occasion and with particular MG patients - made their condition worse, temporarily or forever - are so long and extensive as to make depressing reading.

But some types of drugs do it more consistently than others.

Penicillin is one such drug, with the breakdown components of it even more deadly : D Penicillamine is one such sub-compound.

Today a useful if dangerous drug, in the early 1940s, it was just something that chemists produced regularly in their attempts to break down fungus-made natural penicillin into its chemical sub components.

They were hoping that analyzing the resulting smaller bits would help them to put it all together again - but via human chemical synthesis.

Penicillin work at Columbia Presbyterian had started out strictly as an effort by German Jewish emigre chemist Karl Meyer to quickly synthesize penicillin.

He hoped, if he succeeded, to prove himself valuable enough to the American defence establishment to allow him to avoid possible internment, in case of a shooting war with Germany.

He wanted his colleague and friend Dawson to merely test tiny amounts of the resulting compounds for biological activity on equally tiny samples of bacteria.

There was no real need at this time, Meyer felt, to 'waste' scarce penicillin by using it on real patients.

Instead almost all of the natural penicillin produced by the team with great difficulty was then quickly destroyed by Meyer in repeated chemical efforts to try to break it into its smallest building block compounds.

Dawson had naturally helped out and had probably absorbed some of these penicillin sub compounds while breathing in the hot moist fumes - the idea of proper effective fume hoods being routinely provided to all labs was something many decades into the future.

If he got his subclinical MG stimulated by such fumes, he'd hardly be alone - there are other cases of scientists showing MG symptoms from simply working in rooms that a number of years before had seen much penicillin activities!

I suspect by October 16th 1940 and the first injections of what small amounts of penicillin that Dawson could pry away from Meyer's chemical work, Dawson's latent or sub clinical MG had already been stimulated.

He had been, in a sense, a ticking time bomb, being in his fifth decade, which is still the decade when most serious cases of MG first become noticed in males.

Then the stress of dealing with the paperwork of his father's death in distant Nova Scotia, instead home at busy exam time in NYC, may have really moved his MG into high gear.

High enough to be seriously noticed and to send him to some specialists, sometime in late December 1940 ...

No comments:

Post a Comment