HANGING ON

 

I find it fascinating how we can easily forget things that were once common place. Consider this fable; in the final hours of Saturday, 20 May, 1995, Mrs. Paula Dixon leaped on the back seat of a motorbike, rushing to make a plane – British Airways flight 32, bound for London. Trying to stretch out her ten day vacation in Hong Kong, the 38 year old divorcee had left herself precious little time to make her 11:45 pm flight out of Kai Tak airport. 

During her dash to make that plane, Paula fell off the moving bike, hitting the pavement and bruising and cutting her arm. After scrapping her self off, and finishing the trip, Paula made it to the departure gate with just moments to spare.  

But while the 747 was waiting on the tarmac Paula Dixon's (above) arm began to hurt and swell. So she notified a flight attendant, who luckily was a trained nurse. And thus began a swirl of currents in which the fate of this mother of two would be swept between an obsessed turn-of-the-century factory worker, and a Dadaist acolyte born in South Philadelphia in the summer of 1890. 

As the eldest of four children, Emmanuel Radnitzky grew up surrounded by threads and swaths and shreds of things. He was the first child of Russian immigrants, his father a garment factory worker who earned extra money by doing a little tailoring and his mother with an artistic flair who assembled collages out of errant scraps of clothing. When he was seven the family moved to the slums of the Williamsburg section of Brooklyn, New York City. And at about the same time, suffering the insults of  anti-antisemitism the family shortened their name from Radnitzky to Ray. Emmanuel would soon shorten his first name to simply Man. So he became Man Ray.

The flight attendant asked if there was a a doctor among the passengers , and two responded - Professor of Surgery Angus Wallace and Doctor Tom Wong.  Together they decided Paula had broken her arm, and at her urging, fashioned a quick fix -  a splint out of a Hong Kong newspaper, and rubber bands. She was given morphine from the aircraft's first aid kit, and tried to relax while the plane took off, bound for Heathrow airport, 14 hours away. 

But just an hour later, at 33,000 feet above the Bay of Bengal, Paula bent over to take off her shoes and felt a stabbing pain in her left side. Suddenly she couldn't catch her breath. One look convinced both doctors Paula had not only broken her arm, but a rib as well. And, when she bent over that broken rib had punctured the tissue surrounding her left lung, suddenly inflating it like a child's balloon and thus preventing her lung inside that tissue from expanding. Without immediate surgery, Paula Dixon was going to strangle to death.

Seventy miles east of Detroit, the town of Jackson, Michigan grew because people who thought they were going somewhere else, paused here for whatever reason, and stayed for whatever reason. The railroads came because the soil was good for farming, and since it was a convenient place to change crews, they built railroad shops here, which attracted other industry. 

By 1900 the town of 25,000 included a mechanically inclined Canadian tinkerer named Albert J. Parkerhouse (above).  He found work at the Timberlake Wire and Novelty Company, pulling cold brass and copper through dies to form lampshade frames, bed springs, paper clips, wheel spokes and wire fences, anything that could be sold for a profit. 

Albert stayed because the work was steady and because if any of the workers stumbled upon an idea, the owner, John B. Timberlake, encouraged them to follow it. And one cold morning in 1903, Albert Parkerhouse was irritated because when he got to work there were no empty hooks to hang his heavy jacket from.

With Paula stretched out across an entire row of seats, and the improvised instruments sterilized with five star Courvoisier brandy, an incision was made just below her collar bone. Then while one doctor held the cut open with a knife and fork, the other took a catheter from the first aid kit. One end, with a flap in it, was slipped into a bottle of seltzer water - the flap keeping the fluid from rising into the tube. And then the open end of the catheter, stiffened at the suggestion of a flight attendant with a straightened wire coat hanger, was slowly forced through the muscle tissue and into Paula's chest cavity. The patient, Paula, who had no more anesthetic, said she felt like beef on butcher's hook.

In 1913 the young Man Ray was exposed to the electrifying Armory Show, which Teddy Roosevelt walked out of, declaring “This is not art!”  But Man Ray thought it was, and he was, he said,  "elevated" by it. 

At the show he met the cubist painter of “Nude Descending a Staircase”(above),  Marcel Duchamp. The two became fast friends, and enthusiasts of the heady freedom of "the Dada" movement. The word meant various things in various languages, but to German writer Hugo Ball who adopted it, it meant nonsense, the rejection of art as only things worthy of inclusion in a museum. In 1915 Man Ray had his first one man show in New York and bought a camera to document his art. Eventually he became best known for his surrealistic and absurdist photographs. But he never let go of the wonder and whimsy he had learned from mother, and what he now called his “ready-mades”.

Once the catheter had penetrated the tissue surrounding Paula's left lung, the coat hanger was removed, and the air pressing around Paula's lung could now escape into the catheter. Each time she expanded her lung, a little more of the air strangling her was expelled. The flap in the catheter and the seltzer water kept what was expelled from slipping back, and each breath got easier. Within ten minutes Paula Dixon was breathing normally. With a doctor at her side, the exhausted patient fell asleep. The exhausted doctors drank the remaining Courvoisier.

On and off for weeks, Albert Parkerhouse twisted and bent various lengths and thicknesses of wire from the factory floor. Finally he hit upon what he thought was the best design to support his jacket without wrinkling it. Timberlake filed a drawing of that twisted wire for a patent in January of 1904 (Number 822,981) (above) and made profits for the next 77 years pulling wire coat hangers. 

Albert Parkerhouse (above) was not bitter he had received no share of the profits from his invention, but he was annoyed that on the patient application he was not listed as the inventor. A few years later he moved to Los Angeles where he started his own wire company. He died in 1927 of a ruptured ulcer at the age of 48.

The big white British Airways 747 landed at London's Heathrow airport at 5:00 in the morning of Sunday 21 May, 1995. Paula, who felt good enough that she had eaten breakfast, was immediately transported to Hillington Hospital, just north of the airport . Here her make-shift surgery was closed and she slowly recovered from the ordeal, One year later she returned to Hong Kong to be married to her motor biking driver, German banker Thomas Galster. She told reporters, “If it wasn’t for my doctors I wouldn't be here today”.  And, she might have added, she also owed her life to a wire coat hanger. If one had not been invented by an irritated Albert Parkerhouse in 1903, Paula Dixon would have died on that plane in 1995. That is what you call an unintended consequence.

Man Ray was finding it difficult to make a living as an artist in New York City. He wrote, “All New York is Dada, and will not tolerate a rival.” In July of 1921 he burned many of his older, unsold works, borrowed $500, and set off for Paris, where he would live the rest of his life. 

One of his last works created in New York City was “Obstruction”, a three dimensional collage, described by the N.Y. Museum of Modern Art as a “pyramid of coat-hangers, each with two more hangers suspended from its ends...in arithmetic progression until almost an entire room was obstructed. This pyramid had an even, but changeable equilibrium; if only one hanger was set in motion, the entire pyramid oscillated with it.”

It must have reminded Emmanuel of his childhood, surrounded by a forest of hangers, all suspended just out of reach, representing a whimsical playground for the child and a crushing existence of endless work for his parents, the pattern of their collective and individual lives, connected yet separate, each suspended from the others. Life, Emmanuel seemed to be saying, is mostly just hanging on.

                                        - 30 - 

TAKE YOUR BEST SHOT, Edward Jenner

 

I look at her face, and honestly, I just don't see whatever it was that captured his heart. They had the ultimate Age of Enlightenment cute-meet, but where he was a 38 year old endlessly curious bon vivant sociable genius, a doctor, a scientist and a poet, she had few friends and her only interest was religion. And at the age of 27, Catherine Kingscote must have thought, as her down turned mouth seems to indicate (above) that she had missed her chance to find a suitable husband.

And then on a fair September afternoon, his balloon landed in a meadow near her home, and two years later she married one of the greatest men – ever . He was to be the man responsible for saving hundreds of millions of lives by applying the scientific method to an obvious problem. Clearly Catherine must have had a secret appeal. And Edward Jenner was smart enough to recognize it.

Edward Jenner started life with a few advantages. He was born wealthy, but not so rich he didn't have to work for a living, just rich enough he never cared more about money than about people. He never patented his great discovery, because he didn't want to add his profit to the cost of saving lives. And maybe that was Catherine's influence. And maybe it was the humanity he'd always had. And maybe it was because when he was still a child, his own father had inoculated him against small pox.

The two most deadly diseases in the 18^th century were the Great Pox (syphilis) and the Small Pox (Variola – Latin for spotted). Reading the genetic code of Variola hints it evolved within the last 50,000 years from a virus that infected rats and mice, and then moved on to horses and cows and then finally to infecting people. 

It disfigured almost all of its human victims, leaving their features scared and pockmarked, even blinding some survivors. It killed half a million people every year – and 80% of the children who were afflicted. The chink in Variola's protein armor was that it had evolved into two strains, one which preferred temperatures of around 99 degrees Fahrenheit before it started dividing, and the second which preferred something closer to 103 degrees.

They called the lesser of these two evils the cow pox, and sometimes the udder pox, because that was where the blisters often showed up on infected milk cows. And it was the young women whose job it was to milk the cows who were the only humans who usually contracted the cow pox. 

They would suffer a fever, and feel weak and listless for a day or two, and, in sever cases have ulcers break out on their hands and arms. But recovery was usually rapid and complete, and there was an old wife's tale that having once contracted cow pox, the women would never suffer the greater evil of smallpox.  It was mucus from a cow pox ulcer which Richard's father had applied to his son's open flesh, in the belief it would somehow protect him from smallpox.

The working theory behind this idea was first enunciated by the second century B.C. Greek doctor, Hippocrates. Its most succinct version was “Like cures like.” Bitten by a rapid dog? Drink a tea made from the hair of the dog that bit you, or pack the fur into a poultice pressed against the wound. The fifteenth century C.E. Englishman, Samuel Pepys, was advised to follow this theory by drinking wine to cure a hangover. “I thought (it) strange,” he wrote in his diary, “but I think find it true.” 

In 1765 London Doctor John Fewster published a paper entitled “Cow pox and its ability to prevent smallpox.” But he was just repeating the old wife's tale, and offered no proof of his own. So the idea was out there. It only waited for someone smart enough to put the obvious to a scientific test.

In early May of 1796, Sarah Nelms, a regular patient of Doctor Edwards, and “a dairymaid at a farmer's near this place”, came in with several lesions on her hand and arm. She reported cutting her finger on a thorn a few weeks previous, just before milking her master's cow, Blossom.  Upon examining both Sarah and Blossom,  Edward diagnosed them both as suffering from the cow pox. 

And he now approached his gardener, Mr. Phipps, offering to inoculate ( from the Latin inoculare, meaning “to graft") his 8 year old son James, against small pox. The gardener agreed, and on 14 May 1796 Edward cut into the healthy boy's arm, and then inserted into that cut some pus taken directly from a sore on Sarah Nelms' arm.

Within a few days James suffered a slight fever. Nine days later he had a chill and lost his appetite, but he quickly recovered. Then, in July, 48 days after the first inoculation, Edward made new slices on both of James' arms. This time he inserted scrapings taken directly from the pustules of a smallpox victim. And this time what should have killed the boy did not even give the child a fever.  Nor did he infect his two older brothers, who shared his bed. 

Over the next 20 years James Phipps would have pus from a small pox victims inserted under his skin twenty separate times. And not once did he ever contract the disease. He married and had two children. And when Edward Jenner died, James was a mourner at his funeral. The original boy who lived did not pass away until 1853, at the age of 65.

Edward Jenner (above) coined the word vaccine for his discovery, from the Latin 'vacca' for cow, as a tribute to poor Blossom, whose horns and hide ended up hanging on the wall of London's St George's medical school library. And that was the whole story, but, of course it wasn't, because it wasn't that simple, because nothing is that simple - certainly not the immune response system developed on this planet over the last four billion years, nor the stupidity of simple human beings.

Edward duplicated his procedure with nine more patients, including his own 11 year old son, and then wrote it all up for the Royal Society of London for Improving Natural Knowledge. And those geniuses rejected it. They refused to publish it because they thought his idea was too revolutionary, and still lacked proof. So Edward, convinced he was on the right track, redoubled his efforts. When he had 23 cases and the Society still refused to publicize his work, Edward self published, in a 1798 pamphlet entitled “An Inquiry Into the Causes and Effects of the Variolæ Vaccinæ, Or Cow-Pox”

By 1800, Edward Jenner's work had been translated and published world-wide. And a few problems were revealed. There was a small percentage of patients who had an allergic reaction at the vaccination sites, and eventually it would be decided not to inoculate very young children, as their immune systems were not yet strong enough to resist even the cow pox.

And without a fuller understanding of how the human immune system functioned, it was still impossible to know “to a medical certainty” (to use legal jargon) how the vaccine would affect specific patients. Still, the over all reaction was so positive that Edward was surprised by the reaction of the people he called the “anti-vaks”.

Opposition became centered on the Medical Observer, a supplemental publication by the daily newspaper, The Guardian.  After 1807, under editor Lewis Doxat, it condemned Jenner's introduction of a “bestial humor into the human frame”. 

In 1808 its readers were assured they should presume “When the mischievous consequences of his vaccinating project shall have descended to posterity...Jenner shall be despised.” Edward was even accused of spreading Small Pox, for various evil reasons. 

The argument presented from the pulpit was that disease was the way God punished sin, and any interference by vaccination was “diabolical”.  

Under this barrage of fantasy and conspiracy the percentage of vaccinated children and adults in England still climbed up to around 76%.   But without 100% protection Variola found enough victims and survived. 

In January of 1902 there was yet another smallpox outbreak in England that killed more than 2,000 people.  But after that disaster, the doubters were finally silenced, at least in England, and vaccinations were required for all children.

About 500 million human beings world wide have died from Smallpox after Edward Jenner introduced his vaccine. But the last victim on earth was Rahima Banu, a 2 year old girl in Bangladesh, in 1975. At 18 she married a farmer named Begum, and they gave birth to four children (her again, below), who were all vaccinated against the disease. And each of her children is living proof that while religion may save souls, science saves lives.  Science, not snake oil.

The scientists working for the World Health Organization issued a report on 9 December, 1979, which announced, “...the world and its people have won freedom from Smallpox.” Variola was finally extinct, wiped out to the last living cell, by the dedication of scientists and doctors and nurses working under their guidance. 

It was, as Jenner himself wrote after the first successful eradication of Smallpox on Caribbean islands, “I don’t imagine the annals of history furnish an example of philanthropy so noble, so extensive as this.” It is hard to believe there are still idiots today who question the value of vaccinations.   

Jenner's dear Catherine died of tuberculosis in 1815, and Edward followed her in January of 1823. And for his life – and her's – we all owe a great debt. He was like the bird in his poem “Address to a Robin”: “And when rude winter comes and shows, His icicles and shivering snows, Hop o'er my cheering hearth and be, One of my peaceful family: Then Soothe me with thy plaintive song, Thou sweetest of the feather'd throng!”

- 30-  

APPENDIX TO THE THEORY

 

I have a neat medical trick you can try at home. You will need to take off your shirt, and have a mirror and a marking pen at the ready. What you are first looking for is your hipbone. If you are an old fart like me, with 70 some years of subcutaneous fat accumulated, gently press in on the right front corner of your waist until you feel a sharp hard bone.  This is your hip and is called your illiac crest, and the most forward part of that is your anterior superior illiac crest. Mark this with a dot. 

Now find your belly button. Mark that with a dot, and try not to giggle while doing so. Now connect the dots with a straight line. Two thirds of the way down that line from your belly button is your McBurney's Tender Point. And directly beneath your McBurney's Point is your appendix. Ta Da!

This magical location was discovered by Dr. Charles Herber McBurney (above).  And because he was a surgeon, Doctor McBurney's only interest in the appendix was in cutting it out. This was not easy, because between your magic marker dot and your appendix are your abdominal muscles. Slicing willy-nilly through these could make it very hard to continue breathing, which is very bad. But then if your appendix bursts open, that is also very bad. And will kill you quicker.

It was Dr. McBurney  (above, center) who developed the life saving operation called an appendectomy, during which an appendix is safely removed. The procedure has become so standard that some people have their appendix taken out in advance, even though only 10% of the population ever develops appendicitis. “Better safe than sorry” is their motto. However the second most important motto in medicine should always be, “Not so fast.”

The proper name for this 4 inch long unprepossessing organ is the vermiform appendix, which means “a worm-shaped" organ (center), "...a blind pouch near the beginning of the large intestine".  And humans aren't the only creatures with one. 

Reptiles, birds, marsupials and mammals all share this structure, even some gastropods, but no fish, and very few creatures without backbones. Most are vegetarians, which has inspired human vegetarians to celebrate the appendix as a vestige of their vegetarian ancestors. Unfortunately, it turns out, it isn't. In the first place most animals are vegetarians, but in true vegetarians the appendix is very large.  In humans it's so small it seems like an after thought, an appendix to the main digestive story.

The human appendix juts out just below the junction of the large and the small intestine. But it appears to be an  empty sack that leads no where, inspiring Mark Twain to observe, “Its sole interest is to lie and wait for stray grape-seeds and breed trouble.”  

The trouble arrives with an infection, when the appendix swells up and bursts, spilling nasty bacteria all over your nice clean abdominal cavity. If you have a fever and are feeling a pain in your middle, find your McBurney's point and press down with one finger. If that causes excruciating pain, you are the unfortunate owner of a burst appendix, and you have a few hours to have it removed and your system flushed with antibiotics. Other wise, you are dead.

So here is this small, squishy sack, not much bigger than your index finger, that isn't connected to anything but your intestines, doesn't seem to produce anything, and you don't seem to miss it much when it's gone and occasionally it tries to kill you. Humans can be forgiving for thinking it was pretty much useless, like the last three vertebrae of your spine, all that is left of our once magnificent prehensile tails, reduced in modern humans to helping you balance when sitting on your butt.  What good is an appendix?. For the last hundred years, the opinion of the medical community was almost universal, echoed by the authors of the medical textbook, “The Vertebrate Body”, “Its major importance would appear to be financial support of the surgical profession.”: written like a true diagnostician.

There is one hint about what the appendix might be doing, in that when you look at it in place it doesn't look like its neighbors, even when inflamed and surrounded by puss (above). Where the intestines are various shades of red, pink and purple, the appendix is white, and this is clue that it is made up of lymphatic tissue, Latin for “connected to water”. 

The most common member of this variety of cells are lymphocytes, are also known as white blood cells (above).  Their job is to identify invaders floating in our blood stream, and swallow them. So any lymphatic tissue, like that found in the appendix, must be concerned with defense: right?. But the appendix has only a tiny opening connecting it with the intestines, and a healthy appendix contains no bacteria that are not also present in the intestines. What could it be doing for humans, if anything?

Well, it must be doing something, since the latest evolutionary genetic research indicates it has been invented at least 30 separate times in the history of life on this planet. And then about a decade ago it was discovered that lymphocytes also raise the “PH” level in your intestines, thus encouraging reproduction and increase of the 700 or so different species of “friendly” bacteria that we require to digest our food.

See, the healthy human gut is acidic - the small intestines have a PH factor of 6.8. This will not burn through steel, but the 10 trillion Prevotella, Bacteroides and Ruminococcus bacteria (amongst others) in your gut, require that acidity to thrive. They break the proteins and sugars that pass through your intestines into smaller molecules, small enough to filtered into the blood stream. 

An invasion of “bad bugs” reduces the acid level. That's why those bugs are bad. And you know the bad bugs outnumber the good ones in your gut when you get diarrhea. In other words you are not what you eat, but what you digest. Now, eventually your lymphocytes will eat the invaders in your blood stream, and the diarrhea will flush them out of your intestines. But how do you replace the good bugs the bad bugs have murdered?

Well, according to Pediatrician Indi Trehan, at Washington University in St. Louis, that's where the lowly appendix comes into play. “The appendix has a unique anatomical location that is out of the way. Bacteria can be kept safe there for repopulating as needed,” he writes. In other words, the appendix is a biological panic room. It keeps the good guys nice and safe, warm and happy, acidic and reproductive, even when your waiter forgets to wash his hands, or the tuna fish in the refrigerator goes bad, or the three bean salad is left out on the picnic table in the sun. It is in fact a validation of the theory of evolution- the use of available material to preform new functions.

Charles Darwin thought the appendix was vestigial, like your tail bone. He was wrong. Given the information available to us, he would have realized he was wrong. But its role as a panic room in the gut, and its construction from cells that had been evolved for other uses, and that it was re-invented over and over in species with and without placentas, (mammals and marsupials) is proof of Darwin's  fundamental idea of evolution. And so are the 10 trillion bacteria in your gut at this moment happily chomping away at your food, just like the bacteria in the gut of every living thing, from mosquitoes to elephants, even those without an appendix. .

This new view of the human vermiform appendix as a panic room, has supported a rethinking of Dr. McBurney's approach to an inflamed appendix. Increasingly patients with inflamed appendixes  are being admitted to hospitals, not for surgery, but for a heavy course of IV antibiotics. And as long as the appendix has not yet burst, usually, this works. It is cheaper and safer for the patient, and easier on the doctors, as it cuts down (pardon the pun) on panic surgeries. And it also makes the 10% of Christian Scientist with appendicitis,  happier as well.

I'm not sure what the “homeschooled” children of fundamentalist will do about all of this information, the next time one of them has a pain in their gut. If, to quote Georgia Congressman Paul Broun, who is a medical doctor, the theory of evolution is a lie, “straight from the pit of hell”, then why would an IV course of antibiotics calm an inflamed appendix, regardless of the state of grace of the owner of the appendix or the doctors, or the nurse who hangs the IV bag? I've said it before and I will say it again here; belief in an almighty God does not require stupidity, no matter how many stupid people say otherwise.

                                                                           - 30 -