October 16 1940 : upending the team's protocol

To put it bluntly, twice-wounded Lieutenant Dr Martin Henry Dawson (MC with citation for bravery) was very far from being given to routinely performing bold, brave and lonely gestures.

This despite the fact that he performed some very brave actions indeed on at least a half dozen times during his shortened life.

Beside his wartime actions, those brave acts include his June 1928 sacrificing of the start of a wonderful research career at the then citadel of medical research - the Rockefeller Institute.

All to stand up for what this very junior pro tem researcher believed in scientifically, against his all powerful and very senior lab chief (and fellow Nova Scotian) Oswald Avery on the matter of the importance of bacteria transformed with DNA.

Or consider his December 1940 decision to sacrifice his own life, if need be, (against the wishes of his wife and doctors) to try and save the lives of others (the world's patients with deadly SBE) with his pioneering penicillin.

And his well known November 1942 decision to 'steal' (according to his hostile opponents) scarce government penicillin - during wartime ! - all to further his success in finally saving SBEs with penicillin, set against deliberate government 'indifference' to their dire fate - success with penicillin or not.

But my vote for his bravest, his boldest, his most lonely gesture was that which occurred on October 16th 1940.

For his solo determination to inject 'dangerously primitive' penicillin - right now ! - into a young black man and a young Jewish man in an attempt to save them from an inevitable death from SBE (subacute bacterial endocarditis) was not like his usual conflicts with higher authorities.

The people opposing his sudden decision were his own friends, down at his own level, on his own tiny team of researchers.

The protocol he was suddenly abruptly 'upending' was one he himself had helped create and agreed to adhere to.

The plan was to allocate five months (September 11th 1940 - January 11th 1941) to 'safely' purifying primitive penicillin - if not to actually totally synthesis it - before it would be clinically tested with internal - systemic - injections.

Tested upon Dawson's SBEs, if he insisted - though SBE was universally seen as the very Mount Everest of infectious disease and thus hardly a first choice for a team intent on getting those vital convincing early successes out of an untried drug.

It was always clear that Dawson wanted very much to save the lives of SBE patients.

But if he felt a drug was more likely to kill than to save - as he had earlier worried about massive doses of some new sulfa drugs - he would have been characteristically cautious rather than uncharacteristically bold.

No doctor in the world (most much bolder than Dawson), in the twelve years since penicillin was discovered, had dared to risk injecting it into the human circulation system.

This despite the fact that there were very few drugs effective against any of the deadly infectious diseases back then.

And despite the fact that in repeated internal animal testing and in repeated external testing with human blood, the primitive penicillin was very effective against the worst of the deadly bacteria cells and yet didn't harm human or animal cells, even when given in far larger doses than needed to kill the bacteria.

And despite the fact that man-made drugs with far less effect against deadly bacteria and far far worse toxicity issues had been quickly injected into test patients and brought to market.

Collective Cognitive Dissonance

With hindsight, what was going on here was a worldwide, profession-wide and prolonged case of collective cognitive dissonance.

But not all nations and not all doctors back then did any bold research into the unknown and untried --- only a few pacemaking nations and institutions led the way, for all the others to follow.

So it was actually the collective unwillingness of a small subset of the world's doctors that we must really lay blame.

Upon a few thousand upper middle class white, mostly Protestant, males from the largest medical research facilities of the most civilized nations on earth.

The Big Dogs, the Alpha Dogs, of the human medical food chain.

(Dawson's own institution, Columbia Presbyterian Medical Complex in NYC, was in the top twenty five of such institutions world wide.)

They semi-consciously simply refused to accept that possibly the world's best and safest antibacterial agent could ever come from the sort of smelly fungal slime that covered their basement walls and not from the civilized world's best clinicians and chemists.

Even when the evidence lay in the published test results before their very eyes : classic cognitive dissonance.

(Feel free to substitute negro or gypsy traveller or New Guinea 'savage' for fungal slime to better understand the popular (semi-digested) social darwinism that lay behind their attitudes.)

For fifteen years, his entire career as a medical researcher, Dawson had been proving up his point that the small, tiny, weak, simple, primitive microbes were far far smarter than we give them credit for - sometimes capable of doing things we humans are not able to do, even badly.

If penicillin was as old as the intermittent competition between soil fungus and soil bacteria over dwindling foodstuffs (at least hundreds of millions of years old) then perhaps the slime chemists had polished penicillin's abilities --- and their skill at making it --- into a fine art.

Why not 'give them a fair go' ?

The injecting only took a New York Minute - but it changed everything

So, seventy five years ago this October 16th 2015, the Age of Antibiotics finally began - and with it - our current Postmodern Age as well.

For what all the variants of postmodernity (the word 'variants' itself being a characteristic postmodern concept !) have in common is a commitment to welcoming the mixing of High and low.

Not just in Art and Architecture either --- almost all of our antibiotics today, seventy five years later, are still based upon the lowest of medicines - based upon primitive penicillin made by the slime, not synthesized by Man - the same sort that Dawson injected that day.

And when sold to doctors by the slick ad efforts of some of the world's largest and most technically advanced corporations - those antibiotics can seem to be very High medicine indeed.

But penicillin is really penicillium excrement - fungus turds.

And no matter how much High science polishes it, a turd is still a turd - even if here a lifesaving turd .

Two hundred years of a smug world of linear and hierarchical progress leading up to Civilized European Man at the very top ------ permanently upended in a New York Minute.

The lowest of the low, the slime of the slime, medical missionaries daily saving the precious children of the uncivilized world, because The Smartest Chemists In The Civilized Universe couldn't ...

Columbia-Presbyterian was midway between Rahway on one side of the Hudson River and Pearl River on the other

In 1940, it was generally thought that Merck at Rahway, NJ (firms on the New Jersey side were considered leaders in the chemical synthesis of medical substances) represented the most advanced, most progressive part of the North American drug industry.

By contrast, Lederle at Pearl River, NY on the other side of the Hudson, was considered a prime example* of the dwindling, old fashioned biological side of North American pharmaceuticals.

Columbia Presbyterian Medical Complex was in the very middle of this, lying as it was astride the Washington Bridge connecting both sides of this Hudson River internecine conflict within the drug industry.....

* A role taken up during WWII by Pfizer.

Dawson: I've treated pneumonia in the richest AND the poorest

Nothing made Dr Henry Dawson more angry than hearing his more 'progressive' colleagues pontificate on about how the poor were only kept alive because a misguidedly kindly society persisted in giving them the best possible medical care for their bloody pneumonias.

"Out there in Nature, the poor would all be dead".

The famed medical science research centre known as the Rockefeller Institute had a very tiny hospital attached and most of its patients were friends of the Rockefeller family, the equivalent of today's New York City billionaires.

It was Henry Dawson's job for his two years at the Rockefeller Institute hospital to treat the pneumonias of the city's rich and famous with the world's best medical care.

Now he was a clinical researcher at Columbia Presbyterian teaching hospital where many of the patients were among the city's poorest and he treated their pneumonias as well.

So Dawson well knew - contrary to Social Darwinism theories from the medical progressives - that the survival of the people regarded as humanity's 'fittest' was just as dependent on good medical care as were the lives of the poor.

"Out there in Nature, the rich would all be dead as well..."

Salon des Refuses, NYC 1940 : Columbia Presbyterian Medical provides home for fungal slime, unwanted inside the World's Fair's synthetic autarky

Mother Nature was not wanted, more accurately, not needed , inside the 'World of the Future' so rhapsodized by the infamous 1939-1940 New York World's Fair.

The Fair planners had seen the future and the future , in 'just one word', was plastics : "get into nylon, Ben."

Nylon- through the alchemy of modern scientism - was made solely out of air, water and a carbon source.

Almost as in in response, a few kind souls (Dawson, Meyer, Hobby & Chaffee) arranged for M. Nature to have a sort of Salon des Refuses.

It happened - very sotto voce - in two small labs on Floor G of the Columbia Presbyterian Medical, about eleven mile to the north west of the Fair site at Flushing Meadows , Queens.

There trillions of tiny, primitive, ancient penicillium cells were set to work at the bottom of two litre Erlenmeyer flasks , happily spinning out the life-saving molecules of penicillin (penicillin G) from nothing more than ...air, water and a carbon source !

It was a pioneering example of postmodern commensal science at its best - and it all happened 75 years ago this Fall....

Birthing Antibiotics & The Little Red Lighthouse --- their true life unlikely connection in space, time and intent

Antibiotics :

(1) A class of lifesaving drugs  (2) more powerful than anything yet invented by advanced Big Science, made by tiny and primitive microorganisms.

So what on earth is their connection to a beloved children's picture book ???!!!

Let's take that definition apart , separating part 1 from part 2:

Antibiotics needn't be used only as lifesavers, but to the general public it is their use as lifesavers, working when nothing else modern medicine could do to save a life, that so rouses our admiration and wonder.

So, for example, Penicillin can be used - relatively ineffectively - as an external antiseptic.

It was used almost exclusively, for its first twelve wasted years, by Alexander Fleming as a minor laboratory clearing agent in certain throat swab tests.

Lifesaver ('Systemic') : drugs taken internally and spread systemically throughout the entire body

To be a lifesaver, almost all drugs must be taken internally (by pill or needle) and thus distributed throughout the entire body (including the surface skin, from blood vessels below the skin's surface.)

This is because for an infection to kill us, it usually must be in blood stream and spreading to different parts of the body than where it first started.

Because - often - infections can been successfully combated by the body's defences alone, if confined to only one initial spot.

Infections usually kill not by direct action in any one spot, but by overwhelming our defences on multiple fronts : creating too many infectious sites, all happening at once, for even a healthy body - by itself - to stop.

So the antibiotic penicillin first became the ANTIBIOTIC PENICILLIN on October 16th 1940, when it stopped being dabbed on the skin and was first injected, ie used as a systemic, into two patients in at the Columbia Presbyterian Medical Centre in New York City.

Now here is where the beloved classic children's illustrated storybook , The Little Red Lighthouse, comes in - unexpectedly - into the story of Antibiotics.

Two classic 'come from behind underdog stories' of the little guys besting the big guys came from this same site :

Little Red Lighthouse, George Washington Bridge, Columbia Presbyterian Medical Centre

The doctor who first used penicillin as an antibiotic , Martin Henry Dawson (1896-1945) and the woman who wrote the story of the Little Red Lighthouse , Hildegarde Hoyt Swift (1890-1977) both did so, at about the same time and for much the same reasons.

WWII was a six years long miserable period in history when Big Science invented Big Weapons manufactured by Big Corporations for Big Armed Forces, under orders from the Big Governments of the Big Powers - to use mostly on the lands of the little powers and the little people.

People left like minor cogs in Big Machines - they felt like they were being treated like children.

Children feel that way all the time .

Which is why stories like Hildegarde Swift's 1942 story about the Little Red Lighthouse besting the brand new 'Great Gray Bridge' and its big lights were always popular about the young ones.

(The little red lighthouse still exists, lying just below the real life George Washington Bridge completed in 1931 and just in front of the Columbia Presbyterian Medical Centre.)

The brand new George Washington Bridge's big lights were indeed much brighter than those of the little red lighthouse, but they were also very high above the water and in a fog couldn't be seen by ships as well as the little red lighthouse's light down at sea level.)

Swift, during the darkest days of the war, also wanted to reassure children that 'might wasn't always right' and that the horrible events in Europe (with small nation after small nation being quickly swallowed up by Germany between 1939 and 1941) won't go unaddressed.

Adults read the story to their children but probably didn't absorb its subtle wartime message.

Naturally made penicillin : 'The Little Fungus That Could'

But Dawson suspected - correctly - that war-weary adults might absorb and enjoy the story of how a medicine made naturally by the humble - primitive - little - basement slime fungus was besting the finest medicine made by Big Science in Big Factories.

He hoped his new medicine would save lives but above and beyond that, he hoped it would send a subtle message to the powers to be and their true masters - the public.

Yes, early penicillin did save lives when nothing before it could.

 But don't underestimate slime-made penicillin's appeal, as a classic 'come from behind' story , to a war-weary public simply tired of being pushed around and tired of six years of seeing all the innings going to the big guys....

The little Project that Could

Once upon a time there was a little yellow penicillin factory located very near that Great Grey Bridge that connects Fort Lee, New Jersey and Upper Manhattan.

It wasn't a very big operation - particularly not compared to the huge war-dealing projects located all over the world in all the combat nations in those years between 1940 and 1945.

But the long term impact it has had on all of us is far greater than any of its much bigger wartime rivals --- even the one that produced The Bomb and promised us safe perpetually renewable electricity at prices too cheap to meter.

It is only natural for our children and grandchildren, being very small themselves, to feel that a small person or group can never best those much bigger than themselves.

But I think my book on the story of the smallest Manhattan Project can be an object lesson  to our children and grandkids that size isn't everything in matters moral --- that a strong heart and a fierce determination to do right can indeed move mountains.

If I can even move a handful of kids to grow up determined to do the right thing by all the smallest and weakest among us, I will feel that my book efforts will have been worth it....
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WWII: the horrific medical 'Triaging' of New York Jews and Blacks

Here is a challenge I throw out to New York City's many amateur historians and genealogical detectives : find out more about the young New Yorker who was the first person ever in the world to be treated - successfully - with penicillin-the-antibiotic.

Particularly if you interested in uncovering more about the harsh wartime treatment afforded many first generation inner city New York Blacks and  Jews.

So, again, a challenge : find out more about PATIENT ONE , the young New Yorker(s)  who first introduced the Age of Antibiotics against fierce resistance from the medical establishment.

Here's a little what we already know for certain (past and future posts on this blog will add more details : the keywords to search are Charles Aronson , Aaron Alston and (Martin) Henry Dawson.)

Patient One , A and B

Actually, two young New Yorkers were given a needle of penicillin by Doctor Martin Henry Dawson on that same history-making day (October 16th 1940) at the famed Columbia Prebyterian Medical Centre : a young Black and a young  Jew, both probably poor.

Its quite a story from how these two young ,poor, men from these ethnicities, traditionally regarded as 'last' , came to be 'first' ever in the world to receive the miracle of antibiotics.

Both young men were dying of then common dreaded and 99% invariably fatal SBE (Subacute Bacterial Endocarditis), a disease that hits the heart valves.

Heart valves damaged earlier by RF (Rheumatic Fever).

Working in tandem, these two related diseases were the most common way for school age children to die in the 20th Century , until about 1960.

The Polio of the Poor

RF was "The Polio of the Poor", because just as the much less common Polio was highly selective and tended to hit the children of well to do WASPs in the leafy suburbs, RF tended to hit  hardest among the poor children of inner city immigrants and minorities.

Unless you are wilfully naive , you probably have guessed by now why you have heard so very much more about relatively uncommon serious cases of Polio than about the much more common - and commonly fatal - RF & SBE !

There is no doubt at all that first patient to be selected for this experimental treatment was a young black man, Aaron Alston.

Penicillin had been discovered exactly 12 years earlier and a little ( very primitive work) had been even been published on growing it , but it remained basically unknown and unused in 1940.

So Dawson and his co-workers ( Meyer, Hobby and Chaffee) were still at the square one of square one, a few weeks into their first attempt to try and grow the mold in their hospital lab,  when a seriously ill Aaron Alston arrived on a ward that Dawson 'attended' (had some limited medical authority over).

It had not been expected that they would have enough penicillin made, purified and tested for clinical trials for another four months.

But Dawson's heart went out to Alston, because Dawson reasoned, based on what little he knew of penicillin, that  penicillin might finally conquer SBE.

(A disease by the way he had never published even one word on - he was in fact hired to work in an area that was very neglected and directed to leave a well researched disease like SBE to the time- proven experts.)

The disease then (and perhaps still now) was regarded as the Mount Everest of all infectious disease, the Gold Standard test of any new anti-bacterial medication.

Delay meant Death

He decided to ignore laborious hospital protocols for pre-testing new drug treatments : Alston would die before he got this one last shot at life , if they choose to wait four further months  down the road.

Dawson would first test penicillin's potential toxicity (of which there was , to put it extremely mildly, absolutely no evidence of, judging by lots of  previously published work on small animals and human blood cells) on himself.

Then he'd give a little at a time to Alston, slowly and cautiously.

The team was only making very little amounts of a very weak penicillin at that time, so this was really just making a virtue of necessity !

How did Dawson know that Alston was so rapidly dying, that haste was imperative ?

There is no direct evidence but the indirect evidence is compelling, I believe, that Alston had already received the conventional treatment for SBE in 1940, prolonged and massive treatments by the new miracle drugs, the sulfas.

Most SBE patients in 1940 got at least a brief improvement with sulfa drugs.

 But the bacteria fought back and the same miserable one percent survived with sulfa treatments (only to die when the disease returned a year or two later)...... as with those receiving no treatment what so ever.

However some patients got no relief from sulfa - the number of bacteria colonies in the blood went up (and not down) after treatment and the doctors then knew these patients' particular strain of oral strep bacteria in their heart valves were particularly resistant to the sulfa drugs and that death would be swift and certain.

 I believe Alston was one of these patients and this is why Dawson decided to go to clinical trial four months early, and after only five weeks from first even learning of what very little was known about penicillin.

And why the other more senior doctors let him try his penicillin on the clearly dying Alston.

Since massive and prolonged amounts of sulfa had failed to kill off all the heart valve bacteria, it seemed pointless to hope that a very little bit of very weak penicillin would do the trick.

But it was worth the effort to Dawson and the others doctors really couldn't see why he couldn't at least try, this once - but only in his own spare time, when he won't be neglecting his own proper duties.

 Dawson's ideas on the immense worth of penicillin were regarded as madness by his hospital colleagues and he really needed to show even a small , if temporary, reduction in the number of bloodstream bacterial colonies if he hoped to receive further help, not further hinderance, from his hospital chiefs.

In fact, it took three more years before any more than a few dozen doctors in the whole world thought that penicillin was worth bothering about.

 Need I add, three more war years, filled with additional millions  of patients dying from war-related bacterial infections ?

For the fact is that for the first fifteen long years, penicillin's worst enemy wasn't bacteria but rather doctors themselves.

Antibiotics arrives, despite doctors' best efforts

By and large, the Age of Antibiotics arrived in this world despite the best efforts of doctors, not because of their efforts.

Hence Dawson's decision to use all of a tiny amount of a weak solution, pushed into just one patient, in hopes of seeing even a hint of successful, if temporary, results.

 A chance to keep his hospital bosses off his back and a chance they'd let him continue his massive mold-growing efforts inside their precious neat and tidy ultra-modern medical centre.

That first needle offered up a potential lifeline to a young dying black man.... and a potential lifeline to billions of future patients.

Enter Charles Aronson

But then Dawson deliberately chose to blow it - or so it seemed.

Another dying young man, a  twenty seven year old Jewish boy named Charles Aronson, arrived on the ward, days before Alston was to get all the meagre penicillin that had been hand-grown so far.

Spontaneously, Dawson added him to this first clinical trial, dividing the meagre lifeline into two thinner lifelines, like a latter day Solomon.

Why ? Why when this further weakened any slim hopes of observing a clinical response?

Several reasons.

Firstly, lots of test tube results had confirmed that penicillin, by weight, was thousands as times potent as the sulfas.

This, despite the fact that their 1940 homegrown 'penicillin' was actually 99.5% dross -- but luckily they'd didn't know this .

Ordinarily, even their small amounts of weak penicillin, even divided in two, would have given clear signs of response, in almost any other bacterial disease.

Except SBE : its unique combo of 'gotchas' rightly made it the Mount Everest of infection, and thought Dawson ultimately did cure SBE with penicillin, he did so only after rolling many massive stones of Sisyphus  penicillin up that Mount.

But again they didn't know this at the time.

Secondly, Aronson had an uniquely complicated, and sad, medical history revolving around repeated attacks from all kinds of seemingly different strep bacteria diseases.

To Dawson, 'seeming different' was the key phrase.

For Dawson's personal/private research interest was in relating all the varied survival techniques he saw as shared by the strep bacteria that co-exist with us.

They live in our mouths, throats and nose much of the time and very occasionally causing serious disease by the ways some of our bodies choose to respond to those sophisticated survival techniques.

But I think this was a minor part of what got Dawson to add Aronson to that first clinical trial.

Dawson hated Triage

Because one of the abiding qualities of Dawson was his lifelong hatred of Triage , which unfortunately happened to be the chief and defining characteristic of the era he lived in, The Era of Modernity.

Modernity was all about, always, the dividing the world into two piles ---- those humans, beings and places worthy of continued life and succour and those unworthy of further life and support : in a word, Triage.

Think of all those medical doctors in jack boots, standing at the railway siding in places like Auschwitz, deciding in an instant if you were to die quickly in a shower or die slowly working too hard for too little food : Triage.

Triage had hit Dawson's hospital that Fall of 1940 : orders had gone out to focus resources on the diseases that affect front line 1A troops and to downplay devoting resources on diseases that only affect the useless 4Fs.

A wonderful time for medical political conservatives to gleefully call for a massive rollback of 1930s efforts to reduce the death rates among the poor, the minorities and the immigrants ("Social" Medicine) , under the guise that all resources were needed to keep our "boys" alive at the up-coming frontline : "War" Medicine.

Now if there ever was a Poster Child of a disease the war medicine hawks didn't want to treat, it was SBE and here is why.

Unlike Polio ( whose research efforts expanded during the war years) , the conservatives' own kids weren't likely to get RF and SBE.

And unfortunately both diseases were different from many other potentially fatal diseases like smallpox where if you got it once and survived, it would never hit you again.

Even 'curing' a bout of RF and SBE left behind permanent damage which made it not just likely you'd be hit again with new bouts, but hit harder each time as your delicate heart valves further weakened.

These were progressive, re-occuring, infectious diseases with a strong component of deadly auto-immunity to add to the mix.

Any success with SBE was going to be long and expensive in hospital resources, leave the cured patient still unable to serve in the military and do anything very arduous in a war plant - and a year later they be back in hospital again with another potentially fatal bout.

Neglect them and let them die quickly and quietly at home, at least until this war is over,  was the Allied medical establishment's decision worldwide.

Since this also was the Nazis' line, Dawson doubted we would really 'win' a war against them by taking up their horrific tactics.

This is why he deliberately choose to begin the new Age of Antibiotics on October 16 1940,  the first registration day for the
first ever peacetime draft, a day devoted to seeking out and celebrating the 1A youth of America.

He would mark that historical date by instead seeking out and celebrating the 4Fs of the 4Fs of America, celebrating the worthiness of  the least of these.

Cynical, clinical, trials

Conventionally having two (or more) patients suffering from the same disease under your medical wing at the moment when you are about to begin a new form of medical treatment was considered a godsend.

One half would get the old treatment and the other half the new treatment.

Officially and publicly the doctor(s) claimed to agnostic between the virtues of both treatments but that was rarely really true for the first pioneering medical teams.

Inside the privacy of their mind and conscience, they really didn't think the older treatment worked or at least didn't work very well.

This is because a strong belief in the likely success of a new drug was needed before any doctor is willing to do the extremely arduous work of being the first to try out a totally new treatment.

If the disease being treated was acute and had a high fatality rate, the trial would mean some would die who could have been saved , by the time good results came in.

The discussion of the early mass clinical trials of sulfa for dangerous diseases like pneumonia make extremely disturbing reading 75 years later.

Blithely it is - briefly - noted that hundreds died in these various trials.

Hundreds who could have lived if these pioneering true believers in the virtues of sulfa had consistently given their (abundant) supplies to everyone they felt might be saved by it.

The tiny amounts moral dilemma

The worst moral dilemma for many initial trials is that only a tiny amount of a potentially life-saving drug for an acute (rapid) disease has been made - because making this new drug is still hard and expensive and the pharma firm is unwilling to scale up production before there are good signs it might work.

(One drug in a thousand survives the normally long, long expensive trek from the first look at it, to mass production and mass use.)

Such new life-saving drugs tend to go to specialists in the disease it is judged best suited for and these doctors frequently have many
rapidly dying patients at hand who might live if they get it.

The only moral, ethical, solution is to grit one's teeth, stop up your tears and resolve to divide the limited supply among the healthiest/youngest/smallest patients, hoping in this way to get a few successes that will spur on greater production of the drug.

A dozen small children might use the same weight of limited drug as one elderly , weak, fat, adult ---- and get better results.

But with this very biased success could come more of the drug, to then humanely treat all the dying without selecting one over another.

Carefully applied, triage can be highly moral.

But there didn't seem any reason, in advance, to pick one of these young men over the other for the initial clinical trial.

The war medicine hawks had already put the 1As in one worthy pile and the 4Fs in another unworthy pile and Dawson did not want to divide 4Fs into further piles based on no morally fit grounds.

Dawson refused to pick and choose between Alston and Aronson : both got a few days treatment until the supply ran out.

As it turned out, Alston later got a more extensive penicillin treatment but still died. Aronson got no further penicillin but lived - because his particular strain turned out to respond well to massive sulfa doses given for months at a time.

He didn't get another bout of SBE for about three and a half years - a true cure by even exacting standards.

This is why I believe, despite the fact that both men both penicillin within minutes of each other, Aronson got the first needle.

Alston , I  feel certain, had been getting sulfa for weeks but it is known that Aronson didn't get any sulfa until a few more weeks after his first penicillin treatment.

If Alston was in fact the very first patient ever treated by penicillin , any success with penicillin would be quickly and loudly explained away by the many, many pioneers of sulfa --- all claiming it was really due to the use of their drug.

But if the first ever patient was Aronson, any success penicillin had with him would be due to penicillin alone and hard to refute.

Convincing scientists - and their egos - is harder than making major scientific discoveries

The sad fact is that success in science is based on facts and evidence and is relatively easy to achieve.

But convincing other scientists of that success in science really means reminding a lot of awfully big egos that their particular hobby horse isn't the right path to success after all - an extremely difficult process.

Rhetoric, not facts, is key here ----- it might seem ridiculous to highlight the success of one patient given a medication just moments before another , but to truthfully claim that my medicine cured the very first patient it treated was (and is) a potent bragging point.

Dawson's ego was small but he was not naive : I believe he did treat Aronson first, if only by mere moments, to help him win his rhetorical battle with his doubting bosses.

Dawson was extremely modest and truthful : he only ever claimed that Aronson lived through this first bout of SBE due to sulfa, not his penicillin.

 (Though Dawson later did cure him of a second bout in 1944 with enough penicillin to make a real difference.)

William Osler's take on the whole affair ?

But perhaps you believe, along with the world famous Dr William Osler and a boatload of distinguished clinicians ever since, that bedside moral support is at least as important as drugs in helping a body fight off an infection.

Then you might be forgiven in thinking that the compassion Dawson displayed to Charles Aronson, in not 'triaging' him out of the penicillin trial, was at least as important as the tiny amount of penicillin he did receive, in allowing him to live.

One way to look at Dawson's early penicillin was regard it as only .56 of one percent pure.

But alternatively - particularly if, like me,  you are a big fan of New York born  Eddie Rabbit - you could regard it as being made of "nighty nine and forty four one hundreds percent pure love".

Then you can rationally believe that Dawson's penicillin did at least help cure an invariably fatal disease in the very first person in history ever to be treated by an antibiotic ....

Re-setting the Allies' moral compass : the acid test of penicillin for wartime endocarditis

Please correct me : but in all my research I could find no indication that in his 15 years of medical research before October 16th 1940, (and he was a world-class expert in the area of strep bacteria) Henry Dawson had never written or spoken one peep - not one peep - on the subject of endocarditis, a very common and deadly disease, usually caused then by a variant of strep bacteria.

Dawson was a scientist who spoke and wrote a lot , so his silence , until October 16th 1940, was surely hardly from lack of opportunity.

Nor was it bureaucratically and professionally easy, in October 1940 anymore than it would be today, to go from being the director of an outpatients' clinic on chronic arthritis to suddenly becoming the lead doctor on a totally new treatment of such an acute cardiac illness as subacute bacterial endocarditis (SBE).

At least not in a big teaching hospital, with all boundary-conscious specialists rigidly defined in each area.

So we are still left with the puzzle explaining why Dawson literally gave his life to suddenly treat and cure this hitherto incurable disease, endocarditis.

It helps to recall that as a paid up member on the side of Social medicine at a time when War medicine was in the ascendancy in the corridors of Columbia Presbyterian Medical Centre that Fall, Dawson's ears must have zeroed in on the disease quickly voted "the absolutely lowest priority disease in all War medicine" : and that SBE.

The overall consensus that that the SBEs consumed endless amounts of medical care, generally only to quickly die anyway.

Or if they did by some weird chance recover - this time - they couldn't much useful war work with their weakened heart and anyway would surely succumb to a second bout of SBE.

Dawson might even have agreed with this assessment , albeit reluctantly, before October 1940 : nothing, not even the much vaunted brand new sulfa drugs, did anything to extend the SBEs' chances.

But to Dawson, if not to any one else in the world,  the written claims about this new , as yet untested, drug penicillin seemed to offer a way out.

It promised activity against SBE's green strep bacteria, good diffusibility and above all , near absolute non-toxicity.

The latter was critical because ("Blood, blood everywhere and not a drop to drink") ironically the heart's values have almost no internal blood supply and must be 'dabbed' by a drug filling the entire blood supply, as it whistles past the heart valves at break neck speed.

An internal "antiseptic" as it were.

Any drug strong enough to instantly push its way through the thick vegetation on the heart valves and quickly kill the strep within , as it rushed on by at 'breaking the speed limit speeds' was also strong enough to be toxic to the entire human body.

SBE was a "disease designed by a committee" : a committee of Devils creating a disease so devilish as to even frustrate God Himself.

SBE seemed an impossible cure -- surely a quick death following upon benign neglect was the most merciful choice ?

But none of the SBE experts seemed to feel as he felt ; none was willing to do the sort of heroic medicine required to at least give crude penicillin and SBE  the old school try.

Did Dawson begin to feel that this indifference to the possibility of curing SBE, "the polio of the poor", was just an excuse?

Did he not buy the claim that the difficulties of preparing penicillin together with all the preparations for war medicine and  for prioritizing medicine for the 1A fit  was the real reason for inactivity on SBE ?

Or was it really just an excuse to roll back New Deal efforts to do something medically for the poorest and weakest (the 4Fs) among us ?

Were there not strong rumours about that the Nazis were also abandoning the poorest and the weakest among the German patients, also using the necessities of war to justify their actions ?

Whatever ethical speculation led him to his decision, it is a fact that on October 16th 1940, Henry Dawson made the wartime treatment of the weakest of the weak, the 4Fs of the 4Fs, the ultimate acid test for the moral compass of the Allied cause.

It took him years - and cost him his life - but he got that moral compass set right, right in the middle of a bloody war.

Finally, treating the SBEs, the least of these, as we would want ourselves to be treated, became the practise of the Allies, not just another plank in their hollow public rhetoric....

Medical ethics - not medical techniques - are probably the leading way to decrease or increase deaths due to war

How doctors and nurses morally regard all of their fellow human beings, rather than how they medically treat their actual, relatively few, patients, is probably the number one determinate in whether wars are relatively bloodless or particularly bloody.

The entire culture takes many of its moral cues from the medical professionals and when they (as in WWII Germany and America )  sanction or even advocate neglecting or killing those judged lesser than others, this attitude bleeds across the whole country and into the actions of its troops --with horrendous consequences.

But when doctors and nurses publicly stress , particularly in wartime , that every life (even those weak and destined never to be able to contribute much directly to the war effort) is infinitely valuable and infinitely worth saving, they indirectly shorten wars and reduce bloodshed.

Because wars drag on and killing is unlimited when (a) participants feel that the other side is so worthless that it isn't wrong to kill them even after they surrender and (b) the other side is reluctant to negotiate a surrender, correctly believing they will then be all killed after they laid down their arms.

The Geneva Conventions do shorten wars and do reduce war deaths when all sides accept them and act upon them , observing the spirit of those conventions, and just not 'the letter of the law'.

In many ways, the Allies failed to observe the spirit of those conventions.

By way of pointed contrast, Henry Dawson felt it critically important that his nation be publicly seen as expending great efforts to save the lives of its most worthless citizens, even in the midst of an all-out world war.

Hence his accelerated offering of a little penicillin-of-hope for two young men dying of invariable fatal SBE infection, precisely on the morning of October 16th 1940.

He wasn't assuming it would actually save their lives, but it might* , and he was determined that they and their families would know that all efforts possible had been done to save them, despite being in a teaching hospital gearing up to focus on 1A war medicine instead.

(* Just as Dawson hadn't given up his place in a WWI  stretcher for the battlefield wounded to a man triaged as dying, in the belief that it would thereby save his life, only that it might and was worth a try.)

These two youths  can be regarded as representative of all those  about to be regarded as the 4Fs of the 4Fs, "mere useless mouths", as the first day of America's first peacetime draft registration process remorselessly triaged American citizens into those worthy and those unworthy.

Green Ward or railway siding ...

This relatively inexpensive simple act, Dawson felt, if extended  to all of America's weak and sickly, would reassure all of its citizens, all those of neutral and occupied nations, even all those of enemy combatant nations, that joining such a nation as an ally or surrendering to it, would not result in their own deaths.

Sometimes, as Medicins Sans Frontieres has shown time and and again ,the publicly perceived ethics of doctors have done far more to save lives than any surgical or chemotherapeutic procedure they could devise.

Doctors, whether in a terminal SBE "Green Ward" at Columbia Presbyterian or at a railway siding at Auschwitz, set an crucial example that all the rest of society observes and acts upon......

Was there a Parran-Hearst Telegram ? (You provide the penicillin, I'll provide the pictures)

"Operator, get me Washington, tell 'em I'm from Hearst..."

There is no firm evidence that Citizen Hearst ever sent that infamous telegram to the famous war artist Frederic Remington in Cuba.

We all know which telegram:  the one where Remington is sent out to illustrate the ongoing civil war in Cuba, but finds all is quiet and begs to go home.

Hearst supposedly telegraphs him to stay : "(If) you furnish the pictures, I'll furnish the war."


Hearst proceeds to puff up the accidental explosion on board the battleship The Maine as an act of sneaky warfare by the Spanish, ("Remember Pearl Harbour" 50 years ahead of schedule) and the rest is history: Yellow Journalism's finest moment.

Or is it ?

For a start, that particular telegram was apparently never sent.

But did the aging Hearst later intervene with US Surgeon General Thomas Parran in August 1943, to get penicillin to a dying baby girl in Manhattan ?

Was this Yellow Journalism's finest moment ?

The Pulitzer Committee apparently felt so - and it is worth noting that Pulitzer and Hearst were the most bitter of bitter enemies.

Consider what we know (or think we know).

Supposedly the whole thing started with a phone call from the distraught father (Lawrence J Malone) of a dying two year old girl called Patricia Malone, made to the city desk editor of the Hearst media empire's flagship newspaper, the New York Journal-American.

Actually Malone quickly fades back into the wallpaper , as do the nominal doctors for the baby girl.

Because in fact, Malone was set up for the call by a crippled Italian-American surgical resident named Dante Colitti, then working at the tiny Lutheran Hospital in upper Manhattan, about a mile from pioneering penicillin doctor Henry Dawson's hospital, Columbia Presbyterian.

The little girl was dying of blood poisoning and normally a surgical staffer - a mere resident at that - has no place in treatment decisions for that sort of illness.

But Colitti was raised right, with a good moral education and he couldn't stand by and let her die, when he knew that not a mile away, Henry Dawson was dragging babies like her back from the grave with his Floor G penicillin.

And Colitti had no cause to love the New York medical establishment which supported the limiting of penicillin to curing VD cases among the unfaithful husbands and boyfriends of the combat corps.

In the 1930s, he had been rejected from attending any New York medical school, by an informal quota system designed to keep out Catholics and Italians.

 (And Jews and Blacks and Asians and Women. Colitti's parents were recent immigrants to America).

Colitti had a permanently bent spine as a result of childhood TB and had to use crutches so it was probably the excuse given him for his rejection.

But Colitti knew that Henry Dawson, just a mile north of him, was working with a doctor who used crutches thanks to polio and another doctor who was missing an arm.

The only real difference was that these were Protestant men, with native-born parents.

Colitti paid a private medical college in Massachusetts to get his MD degree but no New York hospital would recognize any degree not granted by one of the quota-oriented establishment schools.

It was a closed loop.

But WWII led to a desperate shortage of medical staff and even New York's medical establishment had to let people like Colitti in to do the lowest medical jobs, at least until the war was over.

But the highly morally minded Colitti felt that if they had displayed no charity towards a cripple, that did not mean he would follow suit.

Hence his setting up of the phone call to the Hearst paper : he knew exactly who would cause the most noise.

The Journal-American photo-journalists were then world famous for their large, vivid, gripping front page photographs and a dying baby story was just made for their skills.

The Hearst editor got no where ( says the AP press agency) with the OSRD's Dr Richards or with the NAS Committee on Chemical Therapeutics.

But somehow or other the newspaper knew of the ongoing conflict between those who felt we could best win the war ("Hearts & Minds") through well publicized Social Medicine versus those that felt that secretive and rationed War Medicine would save more scarce resources for "Guns & Bullets".

Because the newspaper ultimately got the penicillin it needed from that supply reserved for the US Public Health Services (at that time, it only had a tiny amount of penicillin and it was only normally used for treating cases of VD among merchant seamen.)

Released by drug company Squibb upon the direct order of Thomas Parran, US Surgeon General and head of the US Public Health Services (then a relatively small and powerless body compared to its status today.)

Parran versus Weed over the fate of wartime penicillin

Parran was the de facto head of the Social Medicine forces, while the NAS's Lewis Weed was the voice of War Medicine.

Did Hearst or his senior staff know of this ongoing debate and approach Parran directly, dismissing his concerns about tackling the all-powerful OSRD and NAS by reminding him he had no love for the NAS's Weed anyway , and that if he would only provide the penicillin vials, Hearst photographers would provide the poignant pictures.

Yellow Journalism and the Yellow Magic then proceeded to make beautiful music together : because the Patty Malone Story ultimately spelled the end to the Age of Modernity ...

"Little Belgium" : Floor "G" Columbia Presbyterian Hospital , Oct 16th 1940 - Feb 4th 1945

"LITTLE BELGIUM"

On October 16th 1940, the first day of registration for America's WWII Draft, Belgium was well past defending from the Boche.

Like Czechoslavia, Poland, Denmark, the Netherlands, Luxenbourg and Norway, Belgium was one of many small nations of Europe that had already fallen to Nazi Germany, without America so much as putting up a squeak.

WWII was not like WWI - if the Great War had been dominated by Victoria sentimentalism - WWII was Victorian social darwinism's war : a cold, hard-faced, ruthless war.

No "poor bleeding Belgium" this time - no "poor bleeding Poland" either.

Belgium was not an area of vital political or economic interest to America and so 'sentiment be damned' : America was not about to waste money and lives defending the small and the weak on the basis of mere humanitarian sentiment : 'we're living in the Modern Age, not the Victorian Era'.

But Dr Martin Henry Dawson had earlier felt much differently.

As a very young man, he abandoned his promising university career to join up the same day (October 16th 1915) that he first read in the North American newspapers that Edith Cavell had been executed for aiding the Belgians.

That meant that today marked his 25th year in Medicine, because he had initially joined up for a year in the medical corps, despite being a non-medical student.

Then, later, as first an infantryman and then as an artilleryman, he had spent most of the rest of the war in and out of hospital because he had twice been seriously wounded and won the Military Cross with Citation for bravery for his efforts while wounded.

Now, giving up his established career and family in still neutral America to get a Canadian Medical Corps desk job in England (as a middle aged/ middlingly healthy bacteriologist that was all he could hope for) didn't seem to be much in the way of help for Belgium and all the other small poor weak people being stomped upon by the Mighty and the Powerful .

Besides, the poor and the weak here at home in America were once again be stomped upon by the Mighty and Powerful of their own nation using the pending threat of war as an excuse to do so.

"We can't afford to waste scarce medical resources on Nature's 4Fs : eugenics teaches us that we need to preserve our best and that means our 1A fighting men".

So the few timid attempts at what was then called Social Medicine were halted and the money re-directed into War Medicine : research on the unique problems and diseases of fighting a modern world-wide war.

Social Medicine had its origins in the ferment around the Great Depression and the New Deal .

It combined directing more money on traditional public health measures aimed at the poorest citizens together with discussions on how best to ensure working class and middle class people had insurance against major medical emergencies.

All the powerful - from the AMA leadership on down - saw this as a giant intellectual threat to individualism and unfettered business enterprise.

The universities, then Republican Party hotbeds, led the charge against Social Medicine : and Columbia University-Presbyterian Hospital loyally signed up in the Fall of 1940 : directing its School of Medicine to put more teaching dollars into War Medicine courses without offering any new dollars to pay for it.

Guess what was hinted could be usefully cut,  to pay for the new courses ?

So the dawn of October 16th 1940 and all eyes of the media were on Columbia University's two campuses on Manhattan.

Columbia  was widely seen as a bellweather on whether American students, who had earlier talked about refusing to fight anymore wars, would obey their elders and register for the Draft.

To ensure all did, the university closed the two campuses and cancelled all classes for the day. Almost all the students and professors of young enough age, did indeed march off obediently to register before the lights and motion cameras of the newsreel crews.

(Including undergrad Jack Kerouac, who took time off from hefting big mysterious blocks of something or other for Fermi and Szilard's Atomic Pile in the basement of the Physics building.)

On October 16th 1940 and until the Actual Belgium's total liberation on February 4th 1945, Floor G became a defacto "Little Belgium"

But in Dawson's tiny team on Floor G of the Presbyterian building , no member had to go register : two (Hobby and Chaffee) were the right age and health, but as women were not valued as potential draftees.

Karl Meyer, like Dawson, was a Great War veteran but was now overage : Dawson was not only overage, his war wounds made him even more unattractive, even as a potential volunteer recruit.

The team's two patients (Aronson and Alston) were young men of the right age, so had to be registered in theory , despite being universally regarded as terminally ill.

I think that the draft officials might well have regarded it as a waste of time and needlessly cruel to register the two clearly dying boys , only to send 4F notices to their grieving parents two months later.

But I suspect Dawson would have urged the draft officials to register the two lads, because he believed that hope - along with his untried penicillin - was the best possible cure for their "invariably fatal" SBE.

"Register the boys - please - because I intend to have them up and in fighting trim in no time !"

(Those would have to be words for the boys' ears only, because no army ever knowingly took anyone with damaged heart valves , "cured" or not.)

SBEs, to be brutally frank, were the world's 4Fs of the 4Fs, probably the first victims of any rollback of Social Medicine .

To start their cure on the very day that North America's eyes were all focussed on War medicine's much touted 1As , had to be Dawson's silent rebuke to a nation and a medical community eager to overlook the poor and weak , in Poland, in Belgium and at home.

Morever, Dawson was rebuking Big Pharma's focus on the big as well, because they saw no reason to help Dawson and his foolish crusade to inject crude natural penicillin into humans.

So his medicine was not made in any huge factory by man-made techniques, but produced by billions of tiny fungus factories at the bottom of a handful of flasks in Dawson's own lab.

Verily, the weak and the foolish would have to come to the aid of the small and the weak, if the Mighty and the Wise were unwilling.

So it was on Day One of the start of the Age of Antibiotics.

And as Dawson abruptly lifted the needle into the air before sinking it gently along the skin of the boys' arm, the Italian in us might have seen it as a medical "up yours !".

And looking back from almost 75 years later, would we be so wrong.....

If you don't like NEEDLES....

.... here is the guy you don't like:

MARTIN HENRY DAWSON
1896-1945

On October 16th 1940, on the 8th floor male ward of New York's famous Columbia Presbyterian Hospital, Dr Dawson stuck the first ever needle of antibiotics (penicillin) into patient
Charles Aronson, launching a billion needle jabs of antibiotics in the seventy years since.

OUCH !

This Fall marks the 70th anniversary of the much feared/ much revered antibiotic needle - at New York City's CUMC.

And if  CUMC are true to form, they will totally ignore it:

Plus ça change (plus c'est la même chose)