BY DR. MANU L. KOTHARI
Anatomy Department, King Edward Memorial Hospital, Parel, Bombay 400 012, India.
The macrobial world comprising plants and animals evidently try their best to feed man, pamper man. In the bargain, man has given ceaseless, inclement, thoughtless destruction.
Consequently, 'mankind is heading for terrible loneliness'. Trees and tigers, corals and cuckoos are gone. So are beauty, music, humaneness.
The microbial world is as indispensable for man's existence. It works hand in hand with the macrobial world to protect man, feed man, vitaminise man, even work against fellowmicrobes by offering antimicrobials. Yet man's ingratitude to the microbial world has meant a paranoia. Man's ingratitute is a veritable hell that will soon destory man. Read how. - Dr. Leo Rebello, Editor.
I feel that in the world of microbes and man we do not know what microbes are, or what we are. What we learn in a teaching institution is that man is the host and the T.B. bacillus is a parasite invading man. So the tubercle is the parasite and the patient is the host. But let me tell you that the microbial biomass outweighs the total animal biomass which includes cockroaches, elephants, whales, dinosaurus, girafffe and mankind by a factor of twenty. So it is they who are the hosts and we are the parasites.
In the entire visible universe, including the solar system and whatever else surrounding it, in terms of materiality there are 1084 atoms and the density is one atom per cubic mile. So these figures, in a way, give the size of the current universe and give its content and yet of the 1084 atoms, what you see as stars, planets and formed matter constitute 10% of the atomic mass; 90% is in terms of invisible plasma. So let us not pay importance to what is seen and forget what is invisible. It will be readily accepted that this muscle on my upper arm is attached to the humerus and this arrangement helps me to move my arm. Now the nerve coming out of the brain passes through a foramen in the skull and this will be found written in all text books. However, it is not that the muscle is attached to the bone, but it is the bone which is attached to the muscle; it is not the nerve which passes through the foramen in the skull, but the skull is formed round the nerve, because during embryonic development, for quite some time till the embryo is completely formed, there is not a spicule of bone to be seen around, although all the muscles in the shoulders, back and elsewhere are there, but neither skull, humerous or scapula exist. They arrive later, to get attached to the bone and not the other way round. Similar is the case with the nerve, it is the skull which arrives later and attaches itself round the nerve. What happens in practice is that when an X-ray of the skull is taken, islands of sharp opacities of bones are seen but we don't see the ocean of soft tissues in which these are islands. So we recognise the bone. So we take the bone as the central axis of the body, so goes Conningsam, Gray and every one else.
The burden of my thesis is that discovery is to see what is not ordinarily seen. That is what expands one's horizon. We are assumed to be the 'acme' of evolution. But the Huxleys think that man is a degenerate gorilla, that evolution reached its peak with a gentle primate called gorilla and then came a degenerate animal called 'Man'. In Bronx museum in New York is a gallery of most dangerous animals - there is the cobra, the python, the tiger and the last specimen is a full scale mirror on which they write, 'you are looking at the most dangerous animal on earth'. This is because we humans are lost in the battle between intelligence and brilliance. If my child gets 99% in the exam, I consider it intelligent, though to achieve this result, it had lost sleep, stopped playing or eating properly or might have neglected to attend to the needs of its ailing grandmother when needed. This child is brilliant but it isn't intelligent, because the word intelligent comes from intertelligere. One who can read between lines, one who has 'viveka' one who has discrimination. Therefore, let it be understood that it requires brilliance to make the atom bomb but intelligence to decide not to make it. Frankly, there are only a very few intelligent men, Lord Buddha, Vivekananda, Paramahans. We are a bunch of brilliant people.
The earliest life that appeared on this earth was a procaryocyte in which the nucleus was not visible - it was 4.2 billion years ago; we all are made of caryocytes, because every cell except the red cell has a nucleus. But cytology says that enzymatic apparatus, the basic bio-chemical machinery, in fact every thing basic in a procaryocyte is no different from that in a caryocyte and to that extent no cell of mine is more evolved than a procaryocyte i.e. a microbe.
The next question is - are my caryocytes something special or owe their existance to the procaryocyte? Now I will come to the evolution of mightochondria... you note the change in spelling. Mitochondria have been described as the power houses of the cell. So I like to call them mighty chondria and the mightochondria in animal cells have a DNA which is different from the DNA in the nucleus. Now it has been established that when my first caryocyte developed i.e. when the first higher animal cell developed, it invited bacteria to lodge and the bacteria which got lodged within became the mitochondria. So you breathe, you move, you do everything thanks to mitochondria which are nothing else but microbes. So I am here thanks to microbes. Going one step further, the master pigment of the global universe is chlorophyl which by magic converts the ambient air CO2 and water into juicy sugar.
Last year's global turnover of business was 3.3 trillion dollars. Chlorophyll, world over, per year manufactures 3 billion tons of sugar without machinery and plant. So if a ton of sugar were to cost 110 dollars, chlorophyll outclasses the total global business in one gentle stroke. No industry can produce even a pumpkin out of air and water. Therefore, there is only one efficient element around i.e. Nature. But there is a problem - chlorophyll manufactures sugar, whereas cell life is characterised, specified, individualised by protein. Now sugar and fat have CHO, it is only when the Nitrogen element is added, protein is formed and who adds this Nitrogen but bacteria in the soil, called Nitrogen fixing bacteria or nitrifying bacteria.
These give us chicken, pulses, cheese. So every meal I am able to have is because some microbes have worked. This explains why if one gram of soil contains 30 million organisms the potato which ripens in the soil, the amormopherous which ripens in the soil, and others similar have much more protein than the vegetable which hangs in the air. It explains why the amines which we call vital amines, the vitamins manufactured in our colon can be done by microbes residing in the colon. Therefore, our every breath, every morsel of food and the enzymes which work on the food are entirely due to the microbes.
Embryologic studies tell us that animal is formed of three basic germinal layers, ectoderm outer, mesoderm intermediate, entoderm the inside.
If we take a cucumber and cut it across, the luman is the cavity lined by entoderm, the whole pulp is mesoderm and the skin is ectoderm. But these are overlapped by a fine film of microbes, which cover one's entire body, which are symbiotic with you and which keep other mircobes at bay.
But for these microbes, one can't survive. So soon after a child is born, even the stomach gets populated by microbes and so does the skin. My mouth can boast of 85 different species of microbes because of which I am healthy. The vagina has specific Doderlein bacillus without which it will become unhealthy. Suppose one dives into the Dead Sea, one can't sink and drown but will actually float. This is because of its high salt content. Even if one just dives into it, one will come out with a film of salt. So I am swimming in the bacterial ocean and I have developed a film of microbes. It is this microbial film which is protecting me all the time and without which I cannot live. Therefore, there is no way I can get away from microbes, because in a way microbes on me and around me are the only license to survive.
The acid fast bacilli, Hansen's or Kochs are the laziest on earth, possess not many toxins, have no enzymes, they remind of a rich-fat-lazy money lender, who has to be fed by his dutiful wife and indulges only in the act of chewing and swallowing. These two bacilli behave similarly with few toxins and no enzymes. They are all the time going in and coming out of every one's lungs and do not bother to lodge inside. But we feel that we must improve the situation and react a little too violently and hurt ourselves in the process of reacting. Today's understanding about Tuberculosis and Leprosy is that anybody whose immune system reacts a little powerfully is like the monkey who was asked to guard his master with a hammer - the master told the monkey 'I am going to sleep. If anybody comes to disturb me, hammer him'. So there came a mosquito and went over his head. As instructed the monkey took the hammer and hit, the master died and the mosquito flew away. Likewise, there is a large section in the medical world which believes that in Tuberculosis and Leprosy, it is my immunocyte that wants to do away with the tubercle in my spine. They go there and start punching the microbe which can be assumed to say "Go away, leave me alone", but the bone gets attacked and the result is a cavity in my spine or simlarly in the lung. Therefore, I would say that the fault is one's reaction to the situation. You will notice that in everybody's breath microbes go in and out but everyone does not fall sick. When you give penicillin to everybody, everybody does not die of anaphylactic reaction. In an anaphylactic reaction, is it the penicillin that kills or the anaphylactic reaction that kills? We give very little penicillin which has no mechanism to block my enzymes or block by respiration. But my system reacted so violently against it that it fractured its own hand.
Now I come to the anti-microbial, antibiotics: Domagk's Sulfa, Fleming's Penicillin, Samuel Waksman's Tetracycline, etc. In medicine there are too many antis - the anti-hypertensive, anti-diabetic, anti-cancer, an anti-arthritis drug. When we analyse, we realise there is not a single antidiabetic drug. The insulin, the sulphonyl ureas or whatever, only lowers the blood glucose and no more. In no way do they touch diabetes at all. So the more knowledgeable now call them Glucostatic and not anti-diabetic agents. The anti-cancer drugs, whatever they are, began in the laboratory as a procancer drug because they cause cancer in animals and precisely that is the reason why they are used against cancer in mankind. In books on cancer chemotherapy, the guiding statement is that those chemicals which cause cancer in animals should be tried out against cancer in mankind. But by calling them anti-cancer drugs, they get sold.
So now I am questioning the legitimacy of the very word anti-biotic. Let me say that in the case of a severe sore throat one is given an anti-biotic Amoxycyllin and the patient feels better. But the question is, was it an anti-biotic and if it was, it would have destroyed most of the 84 species in the pharynx, but actually at the end of the anti-biotic therapy all the 84 or 85 varieties of organisms are still there. So what anti-biotics do is to push out one species and as Nature will not tolerate a microbial vacuum, it allows another to come in. Therefore, in current thinking, the anti-biotic is called microflora fluctuator. Infact, if it was a genuine anti-biotic you and I will not survive because it will be anti-life. That is why we talk of broad spectrum, narrow spectrum because we realise that the anti-biotic pushes out a number of organisms and allows others to enter. In fact anti-biotics cause secondary infection and that is one of the biggest problems in modern medicine. Hence, it is essential to change the nomenclature of antibiotics.
Now the question arises that atleast in cases of tuberculosis or leprosy there are very specific drugs like INH, Rifampicin, Streptomycin, Dapsone. But are these drugs anti-tubercle? If they were, then there would be no problem of tubercle resistance and they would always be against the tubercular organism. But there also we find that there are certain organisms which sit tight and don't shift. So you can't call them anti-tubercle. You will have to say anti-species 427 tubercle which may be lying, say in my throat. But if it is species 428 that is there, they will proliferate fast since 427 is gone. So there was a time when a person was blissful with Streptomycin although it led to vertigo and deafness. Now in Bombay a high incidence of liver disease and jaundice due to Rifampicin is recorded. There also we should realise that the so-called anti-tubercle agent should come and having come should be assisted by bright sun-shine, fresh air, and good food, in which case the body will undertake the elimination of the organism where the anti-biotic acts as a temporary support. Then the question would be, 'what does all this lead to?' : What has happened is that we all felt secure now that the anti-biotics had come.
But reality is that in the U.S.A, for example, more beds in hospitals are occupied by infectious diseases than before the advent of anti-biotics. This is because we should realise that Fleming was forced to discover penicillin and pump it as an injectible because of war wounds, the conditions of dirt, fith etc. In those conditions may be it was worthwhile giving an anti-biotic.
But to give it to a patient who walks into a clinic on his own and is fit enough to pay the fees, go to the medical shop and buy the drug, and take it, is a major mistake. Let us not forget that even in Fleming's time, penicillin was only a micro flora fluctuator. Koprowski is a man from Rockefeller Foundation and he said that if a universal anti-biotic were to be found, fight against it as an agent worse than the atom bomb and throw it out because it will create too many problems. In an article which appeared in Lancet, in 1973, Prof. Raeburn, Professor of Immunology and Infectious Diseases at the Postgraduate Medical School, London, says that our children are growing up without adequate exposure to microbes and the symptoms caused by them. Our children are growing up as immuno-deficient children. He concluded - that the future generation will look upon anti-biotics as God's most malicious trick on mankind.
I shall now round up my article on man, microbe and anti-biotics:
1.. Man is utterly, helplessly, blissfully, ignorantly at the mercy of microbes for his food, breath, enzymes and for his health. He can't do without them.
2.. If we are swimming in a microbial ocean, and yet everyday we get up without fever and infection, don't you think microbes are kind to us?
3.. Epidemiological Studies do not show that we have terribly improved the fate of mankind after the arrival of anti-biotics. Statistically speaking there are more people who are ill becase of infection than in the past. So it may be shocking to realise that if Prof. Raeburn is right and if we are increasingly growing up with immuno-deficiency, then the AIDS virus which was quietly lurking in a corner now finds a suitable soil. In the Darwinian evolution, it has now taken the upper hand, and it should not surprise us if 10 or 15 years hence it is proved that AIDS virus is basically a gift of anti-biotics.
Then the question would be, what is the role of micro-flora-fluctuator. Its role is like a knife in a surgical theatre. It is very useful if used on the right tissue, but quite dangerous when used wrongly. I would like to generalise the concept, and if you had heard of Starling's Law of cardiac contraction that greater the stress the heart is subject to in the initial stages, the more powerful will be the cardiac contraction. In similar fashion the more powerful the muscles are stretched the more powerful they will become; the more microbial challenge is thrown on one's body, the more immune bodies the body will generate. We are all fond of bringing down fever. As soon as there is fever, especially infectious fever, we want to bring it down. In this context I would like to refer you to a textbook now in its 3rd edition titled 'Pathophysiology of Infectious Diseases' by Youmans, Peterson and Sommers published by Saunders, where they refer to an American study which shows, that whenever after infection there is fever, circulating serum ferritin comes down and the moment this occurs, microbial multiplication comes to a halt. Now give aspirin or paracetamol and the fever comes down, serum ferritin goes up, microbial multiplication goes up and you now have to give an anti-biotic. So, now, fever also has been proved conclusively to be friendly. Likewise, the urinary flow can take away kidney infection or a diarrhoea can take away the organisms in a colon infection.
Before I close, a word or two on the very concept of an antibiotic would be in order. Biologists in the 19th century were aware that one type of microbes may oppose the growth of another. Such antagonism was called antibiosis. Fleming's chance observation was carried to a climax at Oxford by Florey and Chain, the first set of patients getting penicillinised in 1941. Salman Waksman discovery of streptomycin, neomycin and other antibiotics, coined the term antibiotic, in 1941.
By an unintended semantic error something patently anti-life became a cornerstone of modern medicine.
It has taken medical science 50 years to realize that may be Waksman's neologism was prophetic. Antibiotics have turned out to be menace much larger than anyone could have expected. They have been a major cause of ecodisaster, microfloral fluctuations, and possibly, AIDS virus. From numerous angles, HIV looks like a gift to mankind off the antibiotic era, a problem that will stay with us till such time that we allow man's immunity to be compromised by antibiotic. The rallying cry against antibiotics is best gleaned from Koprowski's plea : "If a universal antibiotic is found, immediately organize societies to prevent its use. It should be dealt with as we should have treated, and did not treat, the atomic bomb. Use any feasible national and international deterrents to prevent it falling into the hands of stupid people who probably will still be in the majority in your time as they were in mine". It is significant that Koprowski was talking on the "Future of Infectious and Malignant Diseases" at a Ciba Symposium on Man and His Future.
Dr. Leo Rebello's