Part One: Going Back to Neanderthals
The antibiotic chloramphenicol (Chloromycetin) was isolated from a culture of Streptomyces venezuelae in 1947. During a large typhus fever outbreak in Bolivia in December 1947, Doctor Eugene Payne from the pharmaceutical firm, Parke, Davis & Company, arrived at La Paz General Hospital carrying a small supply of a new drug. Four patients who were sick with typhus and presenting signs and symptoms of probable death were chosen to receive the limited supply of drug.
A death certificate, complete except for date, had been made out for Case 10, a man named Gregorio Zalles, and arrangements made for his burial. He had been in a coma for three days when he was given an injection of the drug chloramphenicol. Forty minutes later he asked for water. While many others died, Zelles was well in a few days, as were all the others treated with the drug. It was the first use in man of Chloromycetin, resulting in this handful of patients surviving their near-death experience with typhus.
Unfortunately, this inspiring bit of history about the origins of one of the most important broad spectrum antibiotics ever discovered could not be repeated today and all these patients, plus millions of others with a wide range of dangerous infections. would have gone untreated and perished.
In fact, chloramphenicol would never even see the light of day in our modern era of drug invention, because its potentially severe side effects can kill the patient. These include: 1) Aplastic anemia, a rare and sometimes fatal condition; 2) bone marrow suppression; 3) leukemia, plus an increased risk of childhood leukemia; 4) gray baby syndrome, which includes hypotension and cyanosis; 5) hypersensitivity reactions including fever, macular and vesicular rashes, angioedema, urticaria and anaphylaxis; 6) neurotoxic reactions, including headache, mild depression, mental confusion, and delirium; and 7) optic and peripheral neuritis. However, when large numbers of sick patients were dying from untreatable infections, Society was far less fastidious about such side effects risks.
At least a 1/3rd of the unexpected 10 million rise in the US population in the 1950 census was due to the impact of new life-saving medicines. The TB (the white plague and #2 killer in the US in 1900) sanatoriums were closing by the mid-50s as a result of the revolution in new antibiotics after WW II. The National Leprosarium at Carville Louisiana was vacated in the 50s. Between 1944 and 1972, life expectancy increased 8 years mainly due to the introduction of antibiotics. We are about to reverse this history, and it will happen within our children’s lifetime.
Using genetics and molecular clock analysis, modern human infectious diseases can be traced to the Paleolithic era, 10,000 to 2.5 million years ago, and suggest that many of these pathogens co-evolved with our ancestral hominids in Africa.
For example, TB appears to have its origins in Africa 2.7 million years ago, and jumped into hominids around that time. On the other hand, leprosy may be a disease of recent origin, given its absence in pre-Columbian Americas and lack of genetic variability among isolates. Other data suggest leprosy is as old as 10 million years. Smallpox might have originated in an African rodent during the Paleolithic period. Zoonosis, diseases originating in animals, might include diseases arising in other primates, including Neanderthals. Typhoid bacteria seem to have entered humans during a time when Homosapiens intermingled with Neanderthals.
Next: Part two, Emerging Infections: 1940 - Today
