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Phil-osophically Speaking: May 31, 2012

Little Things Mean A Lot

In 1858, with much of the literary world entranced by the fantastic stories of Jules Verne, Fitz James O’Brien penned a charmingly delightful short story called “The Diamond Lens.” It’s about a microscopist enthralled by the mysterious, unrevealed and indiscernible universe of the infinitesimal. By depressing the wondrous lens of his miraculous instrument just a few hairbreadths downward, the curtain between the visible and invisible worlds is parted, revealing a heretofore unseen magical and enchanting existence. He is thus bewitched by the dazzling expanse and boundless dome of a hidden world; its images pied by countless hues and microscopic forms previously concealed.

We are essentially unconscious of the miniature universe that is about us and inside of us. It is all so magnificently complex, insulating and lethal. In H.G. Wells’ existential novel, or at least in its 1953 portrayal on the big screen, Martian invaders are pummeling earthlings back into the Stone Age. Our big military guns are useless against the extraterrestrials and just when all seems lost, their spaceships, one after the other, come crashing to earth. The Martians, it turns out, had no defenses against our viruses and bacteria. The movie ends with the voice of a narrator: “It was the smallest creatures that God and his wisdom put on this earth that saved mankind from extinction.

It’s almost enough to make you start loving germs. But we know that our world, the seen and unseen, is quixotic, unscripted and not vouchsafed by immutable laws. That old saying, “It is the little things that matter” has special resonance for the microscopic universe. These molecular flagella that are often our allies in combating sickness can turn into our most implacable enemies. Bacterium is the oldest living organism on our planet, and there are about 10 times more bacteria in our bodies than there are cells. Its abundance protects us from many inimical influences, but it can also turn into a Kamikaze pilot targeting the human body. Take the recent case of 24-year old Aimee Copeland, who became a victim of a flesh eating bacteria called Aermonas hydrophilia that are found in warm rivers and streams. Her condition resulted in kidney failure and organ damage. Despite being administered the most potent antibiotics, the spread of the infection was unstoppable and doctors had to amputate both hands and a foot and, as of this writing, she struggles to survive.

The war between health and disease is as old as man. The view of the ancients was that disease was spontaneously generated instead of being created in microorganisms that virulently reproduce —- no different than those same innocuous forms so lovingly described in “The Diamond Lens.” It wasn’t until the second half of the 19th century that it was conclusively determined that germs cause infectious diseases. That discovery must rank as the greatest discovery in all of medical history. The microbe hunters who track down that elusive and resistant predator are deserving of far more credit than they have received. We tend to remember political figures and famous generals, but forget that there was another battlefield that mankind has waged war on. One where the guns were silent but the human toll even more deadly.

When the inventor of the microscope and the father of microbiology Antoni van Leeuwenhoek, back in the 17th century, reported seeing worms and other organisms in diseased tissues, it was uncertain whether these were the cause or the consequence of the disorder, especially when the overwhelmingly prevailing view on epidemic diseases were anti-contagionist. The stops and starts in discovering how a bacillus enters the body and reproduces in the blood is the most fascinating adventure in molecular science. The breadth of these efforts is too vast to chronicle in a single article. But a few of these stories have a kind of dragon-slayer appeal that bears repeating:

Throughout the centuries, smallpox wiped out swaths of populations. Humanity was helpless before its murderous onslaught. In 1796, during the midst of another epidemic, Dr. Edward Jenner heard of a milkmaid who boasted that she could never catch smallpox because she had already caught cowpox (a pathogen whose effects on humans are far milder). Observing that other milkmaids appeared immune to smallpox, an intrigued Jenner injected fluid from a cowpox sore that he scraped from the blistered hands of Sarah Nelmes, a milkmaid who had caught cowpox from a cow named Blossom, into the arm of his gardener’s 8-year-old son, James Phipps. The boy showed no symptoms because his system had developed antibodies from the fluid. Jenner called the practice, which produced immunity, vaccination, after vacca, the Latin word for cow. Smallpox was virtually eradicated and a trophy of that war, Blossom’s hide, now hangs on the wall of St. George’s Medical School Library.

In the 1840s, Hungarian obstetrician Ignaz Semmelweis, working in Vienna, noted the appallingly high incidence of death from puerperal fever among women who delivered at the hospital as opposed to women whose birth was attended by midwives. Puerperal fever is often fatal for pregnant women. It had killed three of Henry VIII’s wives (he didn’t always behead them) as well as Mary Shelley, the author of the gothic horror classic Frankenstein. What Semmelweis discovered had a macabre element worthy of Shelley’s timeless story. The doctors who were delivering these babies were the same ones who just came directly from performing autopsies without any hygienic intervention between the examination of death and the delivery of life. Recognizing the high prospect of contagion, Semmelweis ordered the doctors to wash their hands with chlorinated lime water. The subsequent drop in mortality, nearly 90 percent, would change medical practices forever.

Mary Mallon, a large blustery woman who would become known as Typhoid Mary, is a classic example of germ warfare and contagion. Throughout Manhattan and Long Island in the early 20th century, an outbreak of the salmonella bacteria in homes of the wealthy and affluent mystified the medical profession. No one discerned a pattern until an enterprising doctor discovered that all the afflicted families had hired the same cook. Tracking down the carrier, he presented the evidence. Unreceptive to reason, the fiery Irish cook threatened the doctor with a meat cleaver. He called the police and Mary Mallon was compelled to undergo medical testing which disclosed that her gallbladder was shedding an appalling number of typhoid bacteria. Forced out of her livelihood, the authorities tried to get her to work as a laundress. Unimpressed with the diagnosis, Mary Mallon now dubbed Typhoid Mary, continued to hire herself out as a cook becoming a fugitive of justice. She cleverly kept one step ahead of the law until finally apprehended on Long Island, when she was quarantined until her death in 1938.

In March of 1942, a 33-year-old New Haven, Connecticut nurse and mother named Ann Miller was stricken with a streptococcal infection. Her temperature soared to 107 and by all appearances she was in a rapid terminal descent. Doctors treated her with sulfur drugs, blood transfusions and surgery all to no avail. Desperate, they grasped at an experimental drug largely untested. The only dosage they could locate was at a Merck Pharmaceutical lab in New Jersey. They had it rushed to New Haven. There were no instructions on how much to administer. They guessed. Within 4 hours Ann Miller’s temperature dropped to 99 and then 98.6. The drug was called penicillin and though Alexander Fleming had serendipitously discovered its therapeutic qualities nearly 14 years earlier, it lay dormant until Ann Miller’s miraculous recovery (penicillin’s first official cure).  Mrs. Miller lived another 57 years when, at age 90, surrounded by her children, six grandchildren and seven great-grandchildren, she succumbed to the death she had cheated so long ago. Her 1942 medical chart is on display at the Smithsonian Institution.

Pasteur, Lister, Salk and so many others, often uncompensated and unheralded, have been pioneers in the evolution of medicine and the treatment of the sick and afflicted. I’m encouraged by advertisements featuring young people expressing the ambition of entering the medical research sciences to cure cancer or some other dreaded disease. At 16, I worked at a medical lab and witnessed firsthand the dedication that marks this profession. Its legacy is rich and humane; giving succor to the sick and suffering. May today’s budding scientists be worthy of their benefactors and serve as an example to their heirs.