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Making a drama out of a crisis

June 25, 2018

When all else fails after 90 years it’s time to throw the kids into battle.

Which is why Gullane Primary youngsters were the stars of a new musical premiered this month at the National Museum of Scotland. Next week Hitherfield Primary takes up the baton at the Science Museum in London.

The Mould that Changed the World is a production from Charades Theatre Company which specialises in putting on shows for and by schools. And not many can count on two chief medical officers in the audience: Catherine Calderwood in Scotland and Sally Davies in England.

It was written and produced by Robin Hiley with support from James Ross and Meghan Perry.

The two shows are one-offs but there a free resource will be available for any school to put on its own production next year.

And you can book tickets here for the grown-up version on the Edinburgh Fringe for adults and families running at Surgeons’ Hall.

It tells the story of Alexander Fleming’s discovery of penicillin in 1928. It opens with a recent meeting of the UN General Assembly debating the legacy of drug resistance which has rendered many frontline drugs useless.

And yes, we’ve already got into military metaphors. The show then switches to France in 1915 when medics were very concerned at loss of life by wound infections.

The most feared of these was gas gangrene – nothing to do with poison gas but a horrible death caused by bacteria all too common in the Flanders soil which created blisters of foul –smelling gas.

Standard application of antiseptics did little for deeper wounds and often harmed treatment of gas gangrene. Surgeons on both sides could do little.

Among the most successful was Frances Ivens, head of the Scottish Women’s Hospital at Royaumont and her colleague Agnes Savill, who achieved a 75 per cent success using the débridement technique to rid the wound of dead tissue.

Despite the disgusting destructive effects of bacteria, under a microscope they do have a certain beauty. Staphylococcus Aureus translates as “golden bunch of grapes” and was first identified by Alexander Ogston in Aberdeen. Put Methicillin Resistant in front of it and you have MRSA.

Annie Cavanagh, Wellcome Images

Fleming was targetting staphylococcus when he discovered penicillin. He served in the First World War in the Royal Army Medical Corps. On the German side there was medical student Gerhard Domagk equally appalled by the loss of life from septic wounds.

It was Domagk who produced the first antibiotic to be widely used. Prontosil, derived from a chemical dye, was the first of the sulfa drugs became available from 1935. It was ideal for treating women who contracted sepsis after giving birth, saving thousands of lives.

In Scotland it brought a significant reduction in maternal mortality prior to 1939. This decline accelerated between 1940 and 1945. Maternal mortality was almost halved in the war years  – thanks to a drug from Germany.

Domagk was awarded the Nobel Prize for Medicine in 1939 but Hitler stopped him from collecting it. The Gestapo arrived at his home and kept him prisoner for a week.

The potential value he had , along with Philipp Klee, his clinical colleague at the Wuppertal -Elberfeld hospital, in combating gas gangrene gave them some protection – until the SS took Klee’s Jewish wife Flora to Theresienstadt  concentration camp. By sheer chance and the camp’s early liberation, she survived. As Domagk remarked in his diary: “The National Socialist system started with lies and suffocated in cruelty and blood”

It was the war which propelled intense UK and US efforts to turn Fleming’s discovery into a practical drug.  This was developed by Florey and Chain in Oxford and paved the way for mass production.

The Mould that Changed the World chronicles subsequent events.  As early as 1945 Fleming spoke of the dangers of drug resistance – as you can hear in this short clip

At the end he also mentions the prospects of a new drug for the tubercle (TB) against which penicillin was no use. Streptomycin arrived soon after.

Desperate patients fuelled black markets – streptomycin was illicitly traded outside the Brompton Hospital in London’s Fulham Road and the lethal racket in counterfeit penicillin in Vienna provided the backdrop for the classic 1949 film The Third Man.

Ignorant physicians in private practice could prescribe one drug – and then another when that failed due to the bug becoming resistant.  The patient could then spread drug resistant bugs caught by others. But the doctor could say everything had been tried…. before the patient died.

That changed with Medical Research Council’s streptomycin trial – probably not the first randomised controlled trial but certainly the most influential in shaping what we now know as evidence-based medicine.

Crofton (left) and colleagues

John Crofton learned a lot from his involvement of that trial at the Brompton. By the time he had moved to Edinburgh two new drugs had become available But no-one knew how to use them to best effect and overcome drug resistance. The radical step was to give new patients all three drugs at the outset.

Much to their own initial astonishment they found they were curing virtually every patient. They reported that with meticulous bacteriology to monitor each patient’s progress a 100% cure for tuberculosis was a reasonable objective. Between 1954 and 1957 TB notifications in Edinburgh were more than halved – a feat unmatched anywhere before or since.

This became the gold standard treatment in affluent countries. Despite major efforts, however, TB remains a huge problem around the world. Lack of resource and access to treatment, the impact of HIV and the relentless advance of multi-drug resistance means cure across the world remains just a vain hope.

How much of this is inevitable? Patients demanding – and clinicians dispensing – antibiotics as though they were sweeties don’t help . Nor does not completing the full course for treatment.  Some countries like the Netherlands have controlled it much better.

Overuse of military metaphors can oversimplify – medicine and disease are far more complex. Patronising government campaigns like Public Understanding of Science in the 1990s provided just the acronym you need for anti-microbial work.

Which is why musical theatre in schools may help.

As Gullane Primary showed, it is brilliant fun for children and hugely enjoyable for the audience.

The show is actively supported by Antibiotic Action and  the British Society for Antimicrobial Chemotherapy. It is the second brilliantly inventive original drama to come out of East Lothian this year following Wonderfools 549 telling the story of four International Brigade volunteers from Prestonpans.

Will it work? Joan Littlewood’s Oh What a Lovely War premiered at Stratford East in 1963 but went on through school productions to transformed a whole generation’s understanding of the Great War.

You can make a drama out of a crisis. Time now to spread the word – not the germs.

2 Comments leave one →
  1. Christine Hoy permalink
    June 25, 2018 9:08 pm

    Hi Rachel.

    Hope you’re well and getting a chance to enjoy the wonderful weather.

    I get posts from Chris Holme, who has set up a medical history media company (I met him at St Andrews House when worked in media). Forwarding this one about Robin’s show as might be of interest. It was a great show, hopefully it will take off, what a brilliant way to inform the nation, many congrats to Robin.

    I know Robin won’t be short of ideas but there’s a fantastic story about how the IV infusion was introduced by a GP in Leith, in 1832.

    cx

  2. Brian Thomas permalink
    June 28, 2018 10:12 am

    Thanks for that Chris. Always a pleasure to read your informative material.

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