Free Radicals - Michael Brooks [54]
Evolution has equipped its pathogens well. Think of the way cholera spreads: through diarrhoea loaded with bacteria that contaminate water supplies, ensuring that they reach new hosts. Bacteria and viruses have become highly adept at reproducing within an infected host, and causing that host to behave in ways that pass on the infection to new hosts. The new hosts then fall ill and pass the pathogens on again.
It was up to Marshall to do nature’s job, under strict laboratory conditions – and he fell at the first hurdle. At the beginning of 1984, Marshall tried to infect piglets with the spiral bacteria. The infection refused to take. Though it was clear to him that bacteria were causing stomach ulcers, his failure to fulfil even the first of Koch’s postulates meant that his colleagues would not take him seriously. They considered his ideas ‘far-fetched’. Experimental results that Marshall considered dramatic, they called ‘subtle’. Yes, they said, perhaps these spiral bacteria are there, but there is no reason to think that they are doing anything – a view supported by the fact that many people carry the bacteria and suffer no illeffects. In a crude study of samples taken from local blood donors, all of whom were healthy with no reported gastric problems, 43 per cent tested positive for the spiral bacteria. It seemed that infection was commonplace. Worse, none of Marshall’s patients could say where they might have picked up the infection. Without a source of infection, Marshall had no medical story to tell.
Marshall is fond of quoting these words of historian Daniel Boorstin: ‘The greatest obstacle to knowledge is not ignorance; it is the illusion of knowledge.’ Marshall’s peers, his superiors and almost his entire professional world knew why people got ulcers. They were caused by stress, smoking, genetics, alcohol, poor diet, and so on. It did not matter that this list was a vague set of conditions that covered almost everybody and anybody – and thus meant nothing. And when someone with a stomach ulcer fell outside this set, they were referred to a psychiatrist: it was a psychosomatic problem. Marshall had seen this at the outset, in a patient who appeared on Robin Warren’s initial list of curious cases of infection with spiral bacteria. Desperate to make a diagnosis, Marshall’s supervisor had sent the woman for psychiatric evaluation. The psychiatrist said she was depressed, and sent her home with a prescription for amitriptyline, an antidepressant.
Just how desperate Marshall was at this point is shown by the fact that, years later, he telephoned that woman. He was curious to know whether she had ever been treated for the spiral bacteria, and whether she still had gastric problems (no and no were the answers). He has never, however, been able to bring himself to contact the patient whose treatment drove Marshall to his most reckless act. What happened within the walls of that hospital was, it seems, much too painful.
Towards the middle of 1984, Marshall admitted a young man who had blood oozing from his stomach. There was so much blood loss that he was receiving daily transfusions. No one could find the cause. And that included Marshall: after samples were taken during an endoscopy, Marshall looked for the spiral bacteria, but found none. There was plenty of pus, the smoking gun of an infection, but no bullet.
A few days later, Marshall tested the man’s blood. He found antibodies for the spiral bacteria. What to do? Marshall knew, after all his frustrated efforts, that his currency at the hospital was low. No treatments had worked, the bleeding was continuing and the hospital’s surgeons had taken over