Richard Atwood

NOW, CSL

I was unable to attend the fabulous NOW conference in Arizona this weekend, for women with bleeding disorders, where I was supposed to give a speech on Saturday. This assumes you have a voice. Which I did not. Returning from the Caribbean with a devastating chest cold (I think I inhaled mold from the AC system in the old hotel I slept in) and a voice that made me sound like a serial killer with laryngitis, I opted sadly to stay home and recover. So now (NOW) I don’t have a report on this great event, funded by the way by CSL Behring.

Speaking of which, here’s a book review by our colleague Richard Atwood in North Carolina about a book about CSL, or CSL Behring as we know it now. Even if you don’t read the book, the facts below are interesting. Having a business background, I’m always interested in knowing how these companies formed, and became what they are. Especially while I was in Barbados, a country which imports factor VIII from two companies, CSL Behring being one of them. Some of the there doctors didn’t realize it’s an Australian-based multinational company. 


Committed to Saving Lives: A History of the Commonwealth Serum Laboratories
A.H. Brogan, 1990,  Melbourne, Victoria, Australia: Hyland House Publishing Pty Limited. 301 pages.
SUMMARY: The government of Australia formed the Federal Serum Institute in 1916 and subsequently changed its name to the Commonwealth Serum Laboratories the following year. Despite its name, CSL had the mission to prepare vaccines, serums, and anti-toxins. As a pioneering public-sector manufacturer, CSL was prepared for the 1918 influenza pandemic by providing the diphtheria and tetanus immunizations. Subsequent public health achievements were the extraordinarily quick provisions of insulin in 1923, penicillin in 1944, Salk antipoliomyelitc vaccine in 1956, anti-D antiserum to prevent Rh disease in 1966, and tuberculosis vaccine. Although CSL had the statutory authority to run a pharmaceutical business, tension persisted for the next 75 years as to whether CSL was a commercial manufacturer or a national public health and research organization. Regardless, the government wanted a profit from a company that provided pharmaceuticals for both humans and domesticated animals.
   CSL conducted blood typing research, and then for the Second World War preserved whole blood and dried human serum for blood proteins. Whereas the UK, USA, and Canada used plasma for war casualties, CSL used serum to prevent spreading hepatitis. The war stimulated blood fractionation around the world beginning in 1941, using either the ethanol method developed by Cohn at Harvard or the ether method developed by Keswick in the UK. CSL implemented the Cohn method in 1945 using voluntary non-paid blood donors through the Australian Red Cross. Production began in 1953 for globulin, albumin, and fibrinogen, then in 1961 for AHG using the Cohn method modified by the Blombacks of Sweden, followed by cryoprecipitate until 1969, AHF in 1970, AHF HP (high purity) in 1972, Improved Intermediate Purity AHF in 1979, PPSB (Prothrombin, Proconvertin, Stuart Factor, Haemophilia B Factor) in 1968, and Prothrombinex in 1972. After learning from America in 1982 about the virus that was later to be called HIV, CSL began experiments in 1983 of heating AHF products and then implemented heat sterilization of FVIII products in 1984. CSL also produced the confirmatory Western blotting test for HIV-I beginning in 1984. Meanwhile, CSL upgraded and expanded the facilities for plasma fractionation.
COMMENT: The history of CSL for its first 75 years up to 1990, whose book title has the same acronym, was written by its recently retired personnel director. As an insider, the author confesses to be a partisan, and rightfully highlights the many medical accomplishments, but also includes some of its misfortunes. The book, which includes 121 photographs, 17 pages of Notes, 3 appendices, and a 9-page Index, ends with several questions regarding an uncertain future, whether CSL would continue to be owned by the government or be a candidate for privatization. CSL is a model for a government-owned commercial enterprise in the public health sector that accomplished its mission. It is also a case study for the continual difficulties imposed by government meddling in the public health research, development, and commercial activities that hindered its mission. Blood and blood substitutes were only a small part of the many commercial activities performed by CSL for the citizens of Australia and world-wide.

Great Book I Read
The Greatest Salesman in the World by Og Mandino [Kindle]

Published in 1968, this has become a timeless classic not just for sales, but for business, for life. A very simple story, set in the time of the birth of Christianity, with profound principles about being your best, making your life, not being a victim to chance but defining who you are, what you are and what you are to become. You can finish this in one sitting, but guaranteed it will stay withyou a long time. You can read this as a business self-help book, or as a way to build better character and life. I read it a long time ago for one and now read it for the other. Much in the style of Paolo Coelo, though Og came first! Five/five stars.

Did Yeats Have Hemophilia?

Richard Atwood, our colleague from North Carolina who researches all things in print and media hemophilia, has uncovered a great literary question: did William Butler Yeats, the Irish poet, have hemophilia?
He looks to Oliver St.
John Gogarty, who published in 1963 William Butler Yeats:
A Memoir (
Dublin, Republic of Ireland: The Dolmen Press. 27 pages). Richard provides a summary and comment:
Oliver
St. John Gogarty, an Irish poet and physician, intended to write memoirs for
nine of his famous friends. Regrettably only three were written before his
death in 1957. Luckily he finished the memoir about William Butler Yeats
(1865-1939), an Irish poet and dramatist. Gogarty mentions some of the
accomplishments by Yeats, such as receiving the Nobel Prize and serving as a
foundation Senator in the Irish Free State. He also states that Yeats disdained
science while delving into the occult, mysticism, astrology, magic, seances,
ghosts, and the spirit world. Gogarty praises Yeats for his poetry, especially
his “intensity” of phrase by using the pouncing or surprising word. (p. 24). According
to Gogarty, Yeats has the physical attributes of being 73 inches in height,
being tone deaf, and having poor eyesight. Also that after undergoing the
rejuvenating operations, Yeats claim

s to have been greatly benefited. In
addition, Gogarty relates another physical condition when he and Helen Wills, a
tennis champion, visit Yeats in a rented country home: “To our disappointment
the maid announced that Mr. Yeats could not leave his room on account of a
nosebleed. I knew that he was inclined to haemophilia. I ran up the stairs to
his bedroom only to find that he had cut himself with a razor at the edge of
his nostril as he was preparing to look his best.” (p. 17).

The brief
memoir includes a photograph of the medallion, or plaque, of Yeats cast by T.
Spicer-Simpson and a photocopy of a short poem hand-written by Sir William
Watson that seems to refer to Yeats. The personal observation by a close friend,
who also happens to be a physician, that Yeats is “inclined to haemophilia” is
still not a medical diagnosis, though this raises serious suspicions by being
from a primary source. Gogarty provides no dates for his observations, but the
medical events he mentions probably occurred in 1934. The memoir may not add
much to the understanding of Yeats and his poetry, but it provides an
interesting personal perspective. No information is provided on the author.

Leeches: A Treatment of Hemophilia


This is an amazing account sent to me by my colleague and the president of Hemophilia of North Carolina, Richard Atwood. Richard is a regular PEN contributor. This article is about…. leeches. Not for the faint of heart.

In 1839, Mr. R. Liston at University College Hospital in London, England reported on a case of hereditary hemorrhagic diathesis. His patient, S.P., was a 32-year-old farmer with temperate habits. He was a large man, strong and healthy, with a smooth, fair complexion, dark-grey eyes, dark hair, and sandy whiskers. S.P. reported having lost alarming quantities of blood from extraction of teeth; he was treated with pressure and cautery. At age 19, he had a small wart cut from his hip; he lost so much blood that he fainted and was debilitated for several days. The family history revealed that his maternal grandfather and 6 brothers were also affected with the same peculiarity of constitution.

In February 1839, S.P. fell and hurt his back and loins. Several days later he experienced sudden pain in his left groin, with pain in his left thigh down to his knee. A surgeon examined the subsequent swelling in the groin and ordered leeches. After 2 leeches were applied, the resulting hemorrhage could not be suppressed. The mass in the left groin was about the size of the patient’s fist, similar to a hernia. S.P. was admitted to University College Hospital on March 8, 1839. The abscess was opened with the potassa fusa resulting in slight bleeding. This blood was examined under microscope and found to be deficient of fibrine and in a bad state, containing a proportion of globules characteristic of pus. The patient was discharged… cured.

In 1840, David Burnes MD of Bloomsbury Square, in London, England reported on hemorrhagic diathesis in 3 brothers: 44-year-old William, 30-year-old Charles, and 25-year-old John. In addition, 2 maternal uncles had a tendency to bleed easily, while their mother, 4 sisters, and 3 other brothers, all over 20 years, did not develop this peculiarity.

In July, 1939, William was seized with inflammation of the testis. The usual remedies were ordered including 4 leeches to the scrotum. This treatment removed the disease, but blood continued to ooze from the leech-bites for several days to the point of debilitation. After spontaneous coagulation of the blood over the wounds, William improved much in about 28 days. He then pushed his hand through a pane of glass while opening the window and cut his thumb on the outer side. The free bleeding from the wound was temporarily arrested with adhesive straps until the inflammation of the hand required their removal. The subsequent freely oozing blood continued in spite of the use of styptics, pressure on the radial artery, and ligature. The irritable, greatly debilitated, and almost blanched patient was kept in bed and starved! The treatment of digitalis, ipecacuanha, and nitrate of potash was ordered, along with keeping the wound constantly wet with a lotion of spirit and muriate of ammonia. After a clot formed, the wound healed 24 days from the accident.

Charles, who had a slender frame and great muscular strength, presented in March 1837 for symptoms of enteritis. Charles stated that he and other family members bled easily and declined being bled from the arm. Instead, 6 leeches were applied over the pain on the left side of the umbilicus. This treatment instantly arrested his disease, but blood continued to ooze for 8 days from the leech wounds. After a vexatious confinement to bed caused more by the remedy than the disease, Charles recovered.

While out shooting in October 1827, John fell from his horse and sustained a severe injury to his arm. The day after his biceps were swollen and exceedingly inflamed and his forearm was bruised from elbow to wrist. An order was made for 12 leeches with bleeding encouraged by warm fomentations along with aperients and other medicines. The hemorrhage could not be stopped by pressure, alum, flour, or cobwebs, until nitras argenti was applied. John had constant oozing of blood over several days and subsequently died from loss of blood.

Dr. Burnes noted that hemorrhagic diathesis is hereditary and peculiar to males. He corroborated the opinion that hemorrhagic diathesis arose from a deficiency in the contractile power of the arteries, though he mentioned that the blood seemed less disposed to coagulate and appeared to be mixed with water.

And why leeches? Leeches were used for every kind of ailment during this time in medical history. They certainly didn’t stop bleeding; while attached, leeches secrete hirudin to prevent coagulation of the blood!

References:

Burnes D
1840 Haemorrhagic diathesis Lancet ii:404-406.
Liston R
1839 Haemorrhagic idiosyncrasy. Lancet i:137-8.

Great Book I Just Read
The Johnstown Flood by David McCullough [Kindle edition]

The Johnstown Flood is usually a sidebar and two paragraphs in a high school history book. McCullough, our nation’s master storyteller of American history, makes this a page-turning, electrifying account of the Katrina of the 1880s. You will gasp and may cry while reading this. McCullough at once has given an accurate account, written like a novel, and serves as a memorial. The South Fork Dam served to create an aquatic playground for the super rich of Philadelphia, and despite warnings of the lack of an overflow drain, and various weak spots, nothing was done. Townspeople who lived below the dam often wondered and worried, but no one ever believed anything could possibly go wrong. Then it rained… like the Deluge. And the consequences were as dire. On May 31, 1889, the weakened, earth-made, South Fork Dam burst, and pounded and shredded everything in its path. Trees, dirt, horses, fences, barbed wire gathered like a wall of destruction, hell-bent for Johnstown, its denizens unaware of the horror about to be. Over 2,000 lost their lives in the most horrific ways; entire families of hard working people died. When it was over, grief turned to anger at the rich, at the paparazzi that came to gawk. This is a fascinating story, gut-wrenching and masterfully told. Read it. And take the time to read all the names at the end of those who died. Four stars.

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