Way out of his comfort zone

I was not truly 'surprised' that the normally highly diffident Dr Martin Henry Dawson broke his own team protocol and became the first person in history to inject an antibiotic (dirty natural penicillin) into a patient, 75 years ago this October 16th.

For the diffident Dawson had done something similar at least once before, pushing on with his equally pioneering research into the horizontal transfer of DNA between microbes, against the express orders of his boss at NYC's Rockefeller Institute.

That totally ruined his career prospects at the world's most attractive centre for doing medical research --- so this new decision to merely jump his own tiny team's protocol would have far less dire career consequences.

But what did surprise me - and did so for a very long time (years and years and years in fact) - was his twin decisions made the month earlier.

Fungus growing - and starving - on a massive scale

First was his decision to grow massive amounts of the fungus mold, penicillium n.

Massive as in obtaining 50 US gallons of penicillium liquid per run - the very size of a typical drug industry pilot plant project.

Like most ambitious bacteriologists, Dawson was extremely narrowly focused on learning all he could about just one tiny segment of the bacteria world and so he gave only a glance at all the other bacteria - and tried to ignore viruses and fungus, etc,etc completely.

In his case, he had focused on the then deadliest of all microbe families - the streps (which included the s. pneumococcus).

He had grown massive amounts of the various streps successfully and routinely but massive fungus growing for clinical not lab work would be much different.

Firstly, it would all have to be done with an eye to making penicillin economically on a long term basis, particularly when set against penicillin's cheap and abundant competitors, the sulfa drug family.

Occasionally growing small amounts of pathogens like pneumococcus for some personal science experiments is one thing - 'costs versus sale returns' don't really come into it.

It is far different when one grows de-natured pathogens to supply a huge public market demanding equal and cheap access to vaccines, as Alexander Fleming well knew, because he ran such a business in his London hospital.

His hard earned knowledge of costs versus profits may have lessened the willingness of Fleming and his huge drug company partner (Parke Davis) to grow large amounts of 'his' penicillium, considering how small the amounts of penicillin produced as a result.

Unlike his naturally made - and very profitable - vaccines, Fleming always insisted his penicillin would only come into clinical use when it was made artificially by chemists.

Secondly, Dawson would be growing massive amounts of penicillium fungus to an effort to scale up tiny amounts of an infrequently produced and highly fragile distinctly second rate secondary metabolite.

Why is that so noteworthy ?

Because all bacteriologists, like all farmers, work to make as much biomass as possible, as cheaply, quickly and easily as possible.

As many big viable bacteria/apples/pigs as quickly, cheaply and routinely as possible.

It was a piece of cake to get the penicillium n. to bulk up quickly and cheaply but when they did so, they produced no penicillin at all !

It seemed to everyone that penicillin was sort of like green poop in humans - a rare waste product produced when a body ate a food it didn't like and got very sick as a result .

Learning to grow penicillium n. so as to make lots of penicillin routinely and economically went on after the war as well as during it and it involved at least as much scientific manpower hours as did the entire nuclear Manhattan Project.

And - a distinct rarity - most scientists thought this might be the case, right from the start, and this is why Fleming and Howard Florey and almost all the others differed from Dawson and focused totally on man-made synthetic penicillin making efforts.

I can't really explain Dawson's decision to get involved in mass fungus making except to say that his career had been devoted to demonstrating how smart the supposedly stupid microbe really was.

He certainly thought the penicillium might be damed good at making penicillin, merely by dint of hundreds of millions of years of trying.

Perhaps then it was the overweening hubris of the 'synthetic penicillin' crowd that might have perversely pushed him much further into mass making of fungus than his own personal inclinations would have done.

SBE rather than septic arthritis

Dawson ran a day clinic for chronic arthritic patients, people who normally who returned to their home and daily work afterwards.

About as low on the totem pole in status at a world famous research-oriented teaching hospital as one can go.

SBE, sub-acute bacterial endocarditis, is today seen as a dire medical emergency disease, likely to be fatal even with the best and extremely extensive treatment, and something managed by the top heart specialists and heart surgeons.

A disease near the top of the status world of big hospitals.

Not to be handled by the guy in the basement running a day clinic for little old ladies with badly bent fingers.

If it was an impossibly long stretch for Dawson to focus on SBE we must ask why he did not focus on septic arthritis instead.

This (surgically oriented) disease of dangerously infected joints was still a bit of a stretch for a day clinic director but it was a form of arthritis, his speciality after all, and like SBE it also a disease likely to prove fatal and one that would only be cured by penicillin.

Now, Dawson certainly did deal with septic arthritis cases in his wartime penicillin work but he didn't really focus on them.

As a result of his wondering off his own arthritis estate onto the faraway property of the SBE experts, Dawson greatly aroused a lot of anger from his colleagues.

He may have intended just that.

I have found no indication that the efforts by medical conservatives to use "war preparation" as an excuse to roll back Social Medicine ever evoked septic arthritis as a disease and patient type to be abandoned and left to die.

But that definitely turned out to be the case with SBE - I suspect Dawson saw this plan coming early on and for this reason, and this reason alone, he focused on the SBE patient rather than the septic arthritic patients....

Bakhtin's Carnivalesque : 'Slime Piss' still saving more kiddies annually than Advanced Civilization ever killed

Without today's antibiotics, the dangerous bacterial infections that currently afflict only a child here and a child there would rage freely as epidemics or pandemics, killing millions upon millions of kids.

And when we say 'antibiotics' we basically mean the beta lactams antibiotics - the huge and highly effective family of the penicillin-like antibiotics.

The human use of penicillin (Penicillin G) to save lives is almost ninety years old and yet it is still in every hospital's pharmacy, albeit relatively rarely used.

However, as the starting base to make most all of our other antibiotics, penicillin g is still produced in the tens of thousands of tons.

And still made as it always was - made in incredibly tiny ---natural--- fungus factories invisible to the naked eye.

It is a mere 'secondary' metabolite of the penicillium slime - and for long time the secondary metabolites were considered to be just 'metabolic waste', a fancy grown-up's word for poo and pee.

Considering its liquid nature and its bright yellow color (leaving aside its strong acrid smell for a moment) , the scientists of yesteryear considered it to be nothing more than 'slime piss'.

It took a brave doctor indeed (Martin Henry Dawson) to first inject that foul stuff - raw - into a the bloodstream of a young male, in an attempt to save his life.

But the patient (Charles Aronson) lived and so our Age of Antibiotics began, on Ward G-East, at NYC's Columbia Presbyterian Medical Centre ----- seventy five years ago this October 16th 2015.

In WWII's brutal war of high tech science, this was low tech life saving at its very finest.

A stinging rebuke then, to Scientism at its very apogee of hubris, delivered by the lowest of the low, delivered by slime piss.

So be sure to tell Mikhail Bakhtin (wherever he might be) that it just can't get anymore carnivalesque than that...

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 ...

Dawson's opponents, not Dawson, had special concern about SBE patients in September 1940

Pity the poor historian ( like me !) trying to recover the substance of the visual glances,the brief shoulder shrugs,  the sotto voce verbal hints and half finished sentences, all very typical of conversation within small cliques in a small staff room, when the group is divided up into various opposing factions of colleagues, who must still at least pretend to get along at work.

I believe that in September 1940, upon his return to medical school and hospital, Dr Martin Henry Dawson half overheard some conversations between members of a group of his colleagues who not well disposed to social medicine, even in peacetime.

The Fall of France had happened and many Americans believed the Fall of Britain was soon to follow.

The American medical elite, made up mostly of  conservatives not in favour of medical intervention towards the weak at home or abroad, were now all claiming to be preparing for a possible war.

Maybe they were - in part.

But for many of them, talk of war preparation allowed them to reduce the alarming amount of social medicine (treating the poor dying like the rich dying) being practised.

They insisted they were only seeking to reduce medical intervention among the domestic weak and small because all existing resources (and more) were needed for possible future medical intervention in support of Europe's weak and small nations.

Reducing domestic comfort and aid because of possible foreign intervention ---- which they were still strongly opposed to !

I call that classic 'Bad Faith' and template Orwellian Double Talk.

I think it was these colleagues who mentioned the SBE patients as the classic sort of 'bed waster' that a war medicine hospital could no longer afford.

We know there was already some existing consensus on ignoring the SBEs under war conditions because there was almost no resistance from doctors in America in the Fall of 1942, when the disease was declared by the NAS 'death panels' to be of no military value and so denied penicillin - the only medicine that could save its patients' lives.

This censenus was also found among doctors in Canada, the Uk and Australia as the NAS ban on the use of wartime penicillin for dying SBE patients was extended by the medical establishment in those countries again without almost any controversy.

But Dawson himself had never before spoken or written or researched on SBE and its patients.

His sudden concern in September 1940 to make the 4F SBEs the focus of his wartime natural penicillin crusade, I believe, came from him half overhearing his conservative colleagues dismissing them as worthy of equal treatment to the war wounded 1As.

Dawson's empathy for the unjustly neglected simply kicked in ....

Where and when was first ever intradermal penicillin sensitivity test given ?

At NYC's Columbia-Presbyterian Hospital, on  October 16th 1940.

In fact it was the historical first ever antibiotic injection given to a patient (two patients actually) followed up a few hours later, after no reaction was observed, by a larger (and later still larger) doses given subcutaneously.

Amazingly, Dr Martin Henry Dawson's careful and cautious technique on that historical day are still followed to the letter by all well trained nurses and doctors....

October 16 1940 : ending the era of human-only progress and ushering in our era of bio-diverse cleverness

Purifying and then synthesizing such a comparatively small molecule like penicillin (produced after all by the primitive and simple basement slime) couldn't take very long, said an entire generation of chemists.

And then, and only then, with plenty of pure man-made penicillin at hand, would it finally be safe for clinicians to inject the blessed stuff into a dying patient's bloodstream.

But by mid October 1940, one clinician (Dr Martin Henry Dawson) had had more than enough of waiting for human chemists to put their synthetic money where their hubristic mouth was.

for even his highly talented co-worker, biochemist Dr Karl Meyer, had also failed to make much initial progress on determining the structure of the penicillin molecule.

And Meyer was miles and miles away from attempting to synthesize the stuff.

Dawson had two dying patients before him, for whom he sincerely believed penicillin was their only possible lifeline.

He knew they would need a great deal of clinical penicillin to be saved, but only a little penicillin was at hand.

But a little was better than nothing --- and even a token injection might raise their morale higher even if it did little to lower the microbe count inside their damaged heart valves.

The relatively small amounts of native penicillin that the tiny team at NYC's Columbia Presbyterian medical complex had grown so far had all been divided between Dawson's co-worker Gladys Hobby's microbiological tests and Meyer's (and his assistant Eleanor Chaffee's) chemical tests.

But in 1940, Henry Dawson had a much greater faith in the ability of (raw - impure - natural - native - crude) fungus-made penicillin to cure patients than any other doctor in the world.

Like many other infection experts around the world, he had read of Howard Florey's Oxford team's success with raw penicillin injections in safely curing many experimental infections in many different animals.

But all the other infection experts had read and remained unmoved .

Unmoved to to attempt injecting raw penicillin into humans, whether healthy volunteers or dying patients.

Not so Dawson - he had already had over a dozen years experience confirming that the supposedly simple and primitive microbes had at least as much native chemical ability under their tiny belts as had enormous conference halls filled with chemical PhDs.

His own colleagues had long grown weary of his endless informal lectures on the ability of tiny microbes to practise genetic/chemical engineering (bacterial transformation - HGT) at a skill level that the best human geneticists could only dream of.

The man was not just a bore, he was also 'letting down the side', at least as the Era of Human-Only Progress saw it.

For he had long claimed that the tiny, ancient and simple microbes were much, much cleverer than they were ever given credit for - cleverer than the most civilized of humanity, in many ways.

But he was harmless enough - for all this had only been talk so far.

But on this day - October 16th 1940 - Dawson decidedly 'went off the reservation' and crossed a deep cultural Rubicon.

For on this day, Dr Dawson finally gave his tiny chemists 'a fair go' when he injected SBE patients Aaron Alston and Charles Aronson with fungus-made penicillin.

Thus ending The Era of Human-Only Progress ---- and ushering in our present Era of Bio-Diverse Cleverness...

1940 : native penicillin, Deus Ex Machina, arrives to 'smite the arrogant' as much as to 'succour the humble'

If the only earthly job for native penicillin, ancient beyond time, was to succour the humble and to comfort the weak and afflicted, it could have crossed the human consciousness at any time throughout human history.

But if  native - natural - humbly made - penicillin's main purpose here  was really to smite the arrogant, its arrival in 1940, at the very height of a war to the finish between the world's most 'modern', most 'progressive' civilizations, it couldn't have come at a more appropriate time.

For it's defeat of modern synthetic penicillin confounded the  whole notion of 'biological evolutionary progress' so decisively that the Era of Progress came to an abrupt end in 1945 ---- and our current post-Modern, post-Progress era began .

That Dr Henry Dawson fully intended to use penicillin to succour the humble and save the lives of young people dying from SBE endocarditis caused by Rheumatic Fever there can be no doubt.

Still one can ask, why then did he jump the gun in that effort, and start the process three months early (on October 16th 1940) with clearly inadequate amounts of very crude 'native' penicillin, if saving lives was his only aim ?

Could it just be that his history-making injections to two '4Fs of the 4Fs', on a day otherwise devoted to honouring the worth of America's 1As and dismissing the worth of her 4Fs, was designed as much to smite the arrogant, as it was to succour the humble ?

Age of Antibiotics' Patients Zero : Aaron Alston of St Nicholas Ave, Harlem and Charles Aronson of Vyse Ave, the Bronx

Thanks to the hard work of two relatives of these penicillin pioneers (Claude Jay for Aaron and Lisa Liel for Charles), these forgotten individuals can emerge from the shadows almost fully formed.

We don't know everything about them (we never do about anybody) but we sure know far more about them than we learned from the scanty evidence published up to now.

They were poor, came from unpopular minorities (one black, the other Jewish) and had a disease (SBE) then considered incurable and so they (and thousands like them) were written off by the Allied medical establishment as 'lives unworthy of wasting a lot of medical attention upon during a total war'.

A sentiment that was cheered upon by their counterparts in Germany, Russia and Japan during the same war - and for the same 'eugenic' reasons.

But one individual, Dr Martin Henry Dawson, gave up his own life to fight to keep them and people like them alive.

What good a military victory over Nazi medicine if the Nazi doctors won the moral war when the Allies agreed upon 'discarding the unfit in times of war and stress' ?

Aaron, the super athlete, might have been expected to do better fighting off his disease than the always sickly Charles but in fact he died in January 1941, just as Charles went home cured of his first bout of SBE ---thanks in part to his pioneering penicillin shots.

He had three more years of normal existence granted to him but got a second bout of SBE, which again he and penicillin beat.

But he also survived a severe stroke during the process which left him speechless and paralyzed .

Dawson's JAMA article of 1945 records "CA" as being transferred to an institution for chronic care on August 15 1944.

Since Dawson held a key post at Goldwater hospital, I had always guessed that is where Charles was sent.

Lisa send me Charles's 1951 death certificate which records that her relative went to Goldwater hospital on that exact same date and died there 7 years and a few months later.

Not the ending I - Charles - or anyone  - might have wished for ....

Bickel penicillin book vivid -- at cost in accuracy

Lennard Bickel's 1972 book, "Rise Up To Life", was the first book that covered the wartime saga of penicillin as it occurred around the entire world.

But it was also one of the first written by someone who was not an eyewitness to the actual events.

But Bickel, an Englishman who emigrated to Australia in mid life, was a very good journalist and interviewed all and everyone he could find from the wartime era and got lively quotes from all.

Unfortunately, as a journalist rather than a historian, he sometimes chose to sacrifice all the facts in order to keep things lively and vivid.

I believe that as a result, he chose to detail almost no pioneering penicillin patient -- unless they could be fully named in his account --- regardless how important they actually were in historical terms.

But even back in the more innocent era of the 1940s, peer reviewed medical articles tended to simply describe but not name patients -- or just given them unique numbers or initials.

Revealing full names was simply no indication of relative historic or scientific importance.

How this historical travesty all began :

Bickel, probably in 1971, interviewed American Gladys Hobby, who as a PhD in microbiology had personally witnessed many pioneering wartime penicillin events from late 1940 through to late 1945.

But she recalled them mostly from memory and a few personal papers.

In the early 1970s, she surely knew the birthdate, medical history and the initials (CA) for one patient from wartime's pioneering Patients Zero.

Because she had surely read - many times -  the medical article her friend and co-worker, the late Dr Martin Henry Dawson, had written in late 1944.

The Patients Zero were the first people ever in history to get injections of life saving antibiotics - doing so on October 16th 1940 from Doctor Dawson at New York's famous Columbia Presbyterian hospital.

But she had forgotten what name lay behind those initials CA.

Fatal SBE was their fate

For the first half of the 20th century, Rheumatic Fever was the leading killer of young people.

Most actually died a few years later, when their heart valves earlier damaged due to Rheumatic Fever, failed because of an attack by common and usually harmless mouth bacteria.

The dreaded SBE - then an invariably fatal form of endocarditis - was what was due to shortly kill this historic duo of patients.

Hobby remembered the other Patient Zero well enough.

Aaron Alston, a young black man from Harlem, had received quite extensive penicillin treatment from Hobby's teammates while Hobby was employed at the hospital but had still died in late January 1941, despite all her's and their best personal efforts.

Louise Good to the rescue

It wasn't till the 1980s, while writing her own book on wartime penicillin, that Hobby contacted a Columbia Presbyterian Hospital employee named Louise Good, who did have access to more detailed contemporary records.

Good revealed that CA was Charles Aronson and confirmed that Hobby was correct in believing that the other was Aaron Alston.

Charles Aronson was actually treated far more extensively with penicillin than Alston - but treated in 1944, when Hobby was then employed elsewhere.

Employed at Pfizer, which had earlier worked very closely with her and Dawson.

Still, she stayed in very close touch with Dawson's team and had certainly read the medical article describing CA's extensive second penicillin treatment.

But that wasn't the same as actually being there at his bedside, daily for months, to burn his real name permanently into her memory.

Bickel lays his thumb on the history balance

This was unfortunate, because Bickel - for reasons perhaps not altogether honourable - chose to focus only on Hobby's fully named patient, the one who died.

By not also including the patient with only initials, the one who survived his invariably fatal disease twice thanks to Dawson's penicillin, he tilted his account of Dawson's work to the side of failure.

Failure, rather than the actual facts - which was that five years of life-costing hard work by Dawson - and Dawson alone - had made an once common and then invariably fatal heart disease the most curable heart condition known.

Bickel's brief account of Alston's early death - followed by Dawson's 'early' death, became the gospel on the whole fascinating penicillin story at Columbia-Presbyterian and Pfizer to generations of writers.

I will satisfy the natural curiosity

I fully and truly understand the curiosity that drives people to inquire as to who is the real person behind mysterious initials .

That is why I have worked so hard to recover the lost story of CA - and of Alston and the handful of other patients of Dawson who were given full names names in Hobby's 1985 book, "Penicillin : Meeting the Challenge" ...

October 16th 2015 'Red Letter Day' for Selective Service System AND Medicine !

Two extraordinary anniversaries -----connected by two extraordinary individuals

On October 16th 1940, 75 years ago this year, America's system of registering for selective service began - a process that continues to this very day.

On that very same day, 75 years ago, the Age of Antibiotics began.

Unlikely as it may seem, both events are intimately united in the persons of patients Aaron Alston and Charles Aronson.

For these two received history's first ever injections of penicillin at Columbia Presbyterian Hospital in New York on October 16 1940 ---- and then were immediately registered for selective service by a special team of hospital visiting registrars on that same day.

Both young men were suffering from subacute bacterial endocarditis.

The much dreaded "SBE" was then regarded as invariably fatal  --- the terminal disease that made Rheumatic Fever - not Polio - the leading killer of school age children throughout the western world.

Regardless of their likely fate in a few weeks or months, the selective service law was firm : both men must be registered ---- and so they were.

Born in 1910, Alston had been an almost Olympics class boxer and a winning track coach - he would have made an excellent leader of soldiers.

But neither he or the penicillin could fight off these strep bacteria and so he died in January 1941.

In his own quiet way, Aronson was also quite a fighter.

Born in 1912, he had already survived three frequently fatal childhood illnesses. He grew up to join the National Guard and hold down a full time job as a teletype operator at a newspaper.

And with the help of penicillin, he went on to survive not just one, but two bouts, of SBE. He then suffered a severe stroke that left him paralyzed and unable to speak.

But he bravely battled on for seven more years and then died in October 1951.

No important anniversaries should go un-noted, as these two anniversaries appear about to be, least of all when both anniversaries are united in the most extraordinary and unlikely of circumstances....

75 years ago, on a day supposedly devoted to 1As, two New York City 4Fs made medical history instead

It is an irony beyond all measure that on America's first ever peacetime Draft Registration Day, October 16th 1940, a day designed to separate the 1A sheep from the 4F goats, two 4Fs (a black man from Harlem and a Jew from the Bronx) instead made medical history by ushering in our current Age of Antibiotics !

And they made history not by accident of sheer coincidence either.

For their doctor, Martin Henry Dawson of Columbia University's Presbyterian medical campus,was incensed that his colleagues were using the move to a War Medicine footing (of which the separating of valued 1As from unvalued 4Fs was but one part) as an excuse to drop Social Medicine - the extending of life-saving medical care to those in need, regardless of their income, color or origins.

Dawson felt that a Double V Victory was needed to defeat the hold that Fascist values held among much of the world's Neutral nations - both a military defeat and a moral defeat.

Abandoning America's weakest and the smallest to medical benign neglect, just as the Nazis were currently doing with their own weak and small, was no way to win the 'hearts and minds' of the neutral nations.

These two young New York City boys, famed athlete Aaron Leroy Alston of St Nicholas Avenue and teletype operator Charles Aronson of Vyse Avenue, were dying of then invariably fatal subacute bacterial endocarditis, known to all as SBE, the disease that made Rheumatic Fever the most feared and fatal of all school age children's diseases.

It was also known as "The Polio of the Poor", which gives an indication that minorities , immigrants and the poor were the hardest hit by it.

For these two reasons, people with it were judged, by a medical establishment echoing the Manhattan of Gordon Gekko, to be of no value to the military or to hard-slog war-factory work ---- and so best left to die.

But Dawson, perhaps channelling the spirit of Manhattan's equally famous Emma Lazarus, saw the pair as worth saving and their disease as curable if only.

If only, twelve long years after penicillin's non toxic and bacteria killing nature were first discovered, some doctor plucked up enough courage to test its toxicity in the human blood stream.

Dawson did that crucial test - injecting it in himself.

Convinced it was safe, he then injected his team's home made penicillin into the pair and quietly, off stage in all that day's media splash, made history.

For journalistic hindsight is always 20/20, but back then it seemed clear that reporting upon possible student resistance (on the same Columbia campus) to the draft registration process was a far,far bigger story.

Hopefully, this time around, on the October 16th 2015 seventy fifth anniversary of those historic pair of antibiotic injections,  the NYC area media will run with the ball ...

First injection of penicillin into patients : October 16th 1940 New York

The first penicillin needle into a patient, ushering in our present Era of Antibiotics, was one of the most signal events in all medical history and it happened exactly 75 years ago this Fall.

Yet, until this present article, even the barest of its bare facts have never been publicly reported accurately - not even by the three key team leaders that first performed them !

Here is how it went, based on cross-checking the various published report by the three team leaders against public records and newspaper accounts:

On October 15th 1940, after a hectic six weeks learning from scratch just where to find the right strain of penicillium and then how to coax the temperamental  fungus to produce raw penicillin juice, the three key members of the tiny team at New York's Columbia Presbyterian Medical Centre were finally ready.

The team leader (Nova Scotia born and raised Dr Martin Henry Dawson) would inject the penicillin into himself, a healthy volunteer, to test whether the never-before injected drug was dangerous to human life once in the bloodstream.

If he survived unharmed, the team planned to use the free time provided the next day by the university's registration of students and young staff in America's very first peacetime Draft to inject some penicillin into two young male patients dying of then invariably fatal SBE.

More formally known as subacute bacterial endocarditis, SBE was the then common disease that made Rheumatic Fever the leading killer of the young.

So only October 16th (in between the two dying boys being registered for the Draft) and once again on October 17th 1940, Dr Dawson injected some of the team's hospital brewed penicillin into the two young men.

One was a young black star athlete , Aaron Leroy Alston born 1910 and residing on St Nicholas Avenue in Harlem and the other was a deathly-sick-all-his-life young Jewish man, Charles Aronson, born 1913 and residing on Vyse Avenue in the Bronx.

Next, the two young men got a much longer and and a much larger regime of oral Sulfa drugs.

Unexpectedly, the Sulfa worked on the sickly Aronson and he went home apparently cured, on a maintenance dose of Sulfa, in late December.

His cure held and he survived alright for three and a half years until another bout of SBE brought him back to Dawson.

This time Dawson had plenty of penicillin to cure SBE reliably and he did so again with Aronson.

Unfortunately, star athlete Alston did not respond to Sulfa drugs (more accurately his particular strain of SBE-causing Viridans Strep didn't respond) and Dawson started him again on a larger and longer regime of stronger injected penicillin on December 31st 1940.

He died mid-treatment in mid January 1941 and his tragically short sports career was celebrated and mourned by many sports fans across the city.

The penicillin brewed for him but not used was given to a third patient, a young middle class salesman in his thirties from upstate New York - Middletown to be precise ; his name George Milton Conant.

He got at least one course of Dawson's penicillin in late January.

He died on May 31st 1941 -nearly a month after Dawson gave a cautious report May 5th on his treatment of four SBE patients with penicillin , delivered before a huge convention of medical researchers at Atlantic City and given extraordinary wide coverage in the news media.

I (and even the team itself) know nothing of the fourth patient - but Dawson's May 5th report specifically says four were treated ( thus treated between between October 16th 1940 and late April 1941).

(It is is worth remarking, given the canonical status and wide circulation of this newspaper, that The New York Times' science correspondent William L Laurence (who wrote the famous eye-witness account of the first atomic explosion ,"Dawn Over Zero") reported the next day that he had heard  Dawson saying that he had treated 4 patients suffering from SBE with his penicillin.)

As of the May 5th date, we know for sure that only one patient had definitely died but Dawson refused to crow about his small successes ---- or give specifics of just when the first injections were given and to how many patients.

Dawson later referred , in his 1944 JAMA article, to treating five SBE patients with early hospital brewed penicillin, of a potency not stated.

This allows us to assume that the fifth patient was probably treated very early in the Fall of 1941.

Because that was before Dawson had been introduced, after a visit from Norman Heatley, to the idea of calibrating the biological activity of penicillin by using Oxford units - as we still do to this day.

(The team seems to have stopped making penicillin during the high summer months because the temperature in the hospital, anywhere than in a bottom basement room, was far too high to successfully grow penicillium that would give off penicillin juice.)

Later he and his fellow team mates bacteriologist Dr Gladys Hobby and chemist Dr Karl Meyer would all give partially accurate and incomplete public accounts of those early (clearly non-dramatic) days - so who could blame the lay press or science historians for repeating their errors and adding some of their own ?

October 16 1940 : the Eyes of History focus in on a small hospital room on the nearly deserted Columbia University campus

Global contemporary opinion (and global contemporary journalism) was unanimous : the most important event in the world on October 16 1940 was Registration Day for America's first ever peacetime draft.

A world at war (Allied, Axis and Neutral) was momentarily united in wanting to know two things and two things only.

After the deprivation of the decade-long Great Depression and all the American university anti-war protests , were the young men of the world's greatest power able to fight and were they willing to fight ?

The fate of the world literally hung in the balance.

So all contemporary eyes were on the registration of America's potential A1 males.

But the Eyes of History, distilling events through the long glass tubes of time and sober second thoughts , may differ from global contemporary opinion , even when that global opinion was as united as it was on October 16 1940.

Because history - 75 years on - is agreed that a rare world-changing event actually did happen in America on October 16 1940 but it wasn't the coming of the Draft.

Instead it all happened, unnoticed at the time , in a small hospital room on the medical campus of New York City's Columbia University.

Despite the fact that almost all assumed that both in that hospital room would shortly be dead from then invariable fatal subacute bacterial endocarditis , the young black man (Aaron Leroy Alston) and the Jewish youth (Charles Aronson) had been earlier been dutifully registered by a selective service team specially assigned to hospital patients.

Clearly these two were not just 4F , but 'the 4Fs of the 4Fs'.

But one man - Dr (Martin) Henry Dawson - didn't assume their death was inevitable.

He hoped to have them both up and around and turning up for their selective service medical exam when called.

The engine of his hopes lay in a small hypodermic needle in his hand.

By his own admission his medicine was new, untested, crude.

To the sceptical nurses watching in the corridor, it was also as dirty as rust and smelt like a moldy old damp basement.

Their response was natural - successful 1940 nursing was less about high tech machines and more about extreme cleanliness.

The nurses in the corridor couldn't believe that Dr Dawson was actually thinking of injecting something so dirty and foul smelling into the temple of the human body.

But he was - and he did.

And with that needle sliding into the young mens' arm began the Age of Antibiotics - because that crude moldy powder was penicillin, made - as the nurses suspected - from a mold of the penicillium family .

This was the first time ever that penicillin (available for a dozen years as a lab clearing agent) was given its proper - real job - lifesaving.

Thanks partly to that October 16 1940 penicillin shot, Charles Aronson went on to beat his endocarditis death sentence.

A small Brooklyn supplier to the soda pop industry (Pfizer !) got inspired by Dawson's success with penicillin and went on not just to produce most of WWII's penicillin but also to develop the biological production techniques that still used to produce most of today's antibiotics.

All of this was reported in a seminal book (Penicillin : Meeting the Challenge) by a women scientist (Dr Gladys L Hobby) who was not merely a close participant at many of the seminal events of the entire Age of Antibiotics but who was part of the tiny team that day in that small hospital room.

She confirmed her memories by consulting hospital records that have since been destroyed and she too has since died.

It has been possible to trace relatives of Aaron Alston but the sole survivor of the pair, Charles Aronson, has slipped from the grasp of historians.

The best hope we have of learning more about this Patient Zero of our Age of Antibiotics is - ironically enough - in those registration records complied by the Selective Service personnel and now held in the US government archives in St Louis.

So in the end, in a surprisingly satisfying way - both stories (Draft and Penicillin) come together to a happy conclusion...

Topical and local antiseptics versus life-saving antibiotics

When did 'the miracle of penicillin' , as opposed to just penicillin itself - really begin ?

If your life is in imminent danger from a massive bacterial infection your medical team may well use antibiotics topically (around the skin next to an opening in the skin) or locally (inside that opening).

But unless your doctors are criminally insane, they will not limit their use of antibiotics to these two methods.

Instead, their main weapon will be massive repeated doses of antibiotics given by needle (perhaps also by mouth).

Only by this method will the drug be able to travel quickly and thoroughly, via your bloodstream, to every single living cell in your body to engage any and all the offending bacteria all at once : a full-out , full-frontal attack.

So, to the public - and to all but pedantics in the medical world - giving 'antibiotics' without a qualifying adjective , really means the systemic (through the bloodstream to all the body) use of those drugs on human patients.

Penicillin had been occasionally used on patients for twelve years before that fateful October day in Manhattan - topically and locally with mixed results .

As well it had found use in hospital labs as a simple means to clear most regular oral bacteria from suspected samples of "flu" bacteria (sic).

But penicillin had never been used as an antibiotic (and nor had any other microbe-produced metabolite) in the common meaning of that word.

Not until Dr Martin Henry Dawson gave those first shots of hospital-grown penicillin to two young men dying of subacute bacterial endocarditis (the dreaded SBE) : October 16th 1940 , in Manhattan's CUMC (Columbia University Medical Centre) .

Thats when the miracle of penicillin truly began ....

Help celebrate Manhattan's 75 years of life-saving penicillin Oct 16 1940 --- Oct 16 2015

Manhattan gave the world's first shots of life-saving penicillin , seventy five years ago next October 16th (2015).

And if Manhattan and New York City is too damn modest to blow its own horn , well we in the rest of the world should start by thanking Manhattan for all the good penicillin and other antibiotics have done for us in the three quarters of a century since.

Starting January first next year, let us start sending cards, phone calls and online* messages to the mayor of New York City to thank Manhattan for changing our world for the better forever.

http://www.nyc.gov/html/static/pages/officeofthemayor/contact.shtml

Yes, wartime Manhattan also birthed the A-Bomb.

But let us never forget that NYC not only produced most of the wartime world's penicillin, it also established the fundamental right of ALL in the world to cheap abundant life-saving penicillin in wartime.

And that was the best possible moral rebuke to those like the Nazis who advocated that medicine, food and life itself should only go to the fit of the fittest nations ....

Oct 16 '40 : Dies Mirabilis , marking 75 years of Antibiotics and Draft registration

I might just do an Erik Larson and interweave Jack Kerouac and Martin Henry Dawson's experiences of that Dies Mirabilis, October 16th 1940, together in one book - and not separately as two books ...

Oct 16 '40 : for Jack Kerouac, a 1A's first ever Draft registration day was eventful ...

October 16th 1940 : Dies Mirabilis

As a husky football player from a poor family ,  John "Jack" Kerouac was not earning his usual drinking money that day by being part of the team of Columbia U football players hauling about tins of graphite or uranium for Leo Szilard and Enrico Fermi's forerunner to the Manhattan Project .

Yes this gridiron hero drank.

Lord he drank , drank mostly to drown out memories of the painful prolonged death of his saintly slightly older brother Gerald,  from Rheumatic Fever in 1926 when Jack was only four.

Rheumatic Fever - and not the rather more famous polio - was far-and-away the leading killer of school age children, but it tended to kill the poor mostly .

(And because New York book editors are themselves rarely poor,  we don't hear much about this Sword of Damocles that hung over America's families for almost a hundred years.)

So with no tins of uranium to muck about, our future Poster Boy of the Beat Generation was instead enthusiastically obeying his legal requirement to be part of the historic registration process for America's first ever peacetime draft .

After registering * in the morning - he was certain to be classed 1A at any subsequent medical - job two for our future Beat that day was to go off in the afternoon to play his second ever football match for Columbia - and to promptly break a leg tibia bone.

Coach Furey didn't take the leg break seriously, told him to 'walk it better' - so Kerouac never went to Columbia university's own hospital , the Presbyterian, to have it checked out properly.

So - and rather ironically - he never got to meet Dr Martin Henry Dawson there that day , busy succouring some of NYC's 4Fs of the 4Fs ( sufferers from the endocarditis complications of childhood Rheumatic Fever) by giving them history's first ever antibiotics.

That broken leg - plus his string of arguments with his head coach Lou Little - doomed Kerouac's football scholarship to Columbia and he soon dropped out.

This 1A exemplar of American manhood went on instead to write novels and poetry , join the Merchant Marine and US Navy , drink lots more, travel, find world fame - and die young at age 47...

* Jack was only 18 in 1940, so it doesn't appear he even could be registered - the lower age limit for draft registration was 21 in 1940.  But Kerouac's biographers insist he did register too - he certainly joined his slightly older classmates in enjoying this big moment on campus - but actually registering ? -- Who knows for sure !

Oct 16 '40 and the 4Fs : Draft rejects them , Antibiotics succours them

I will have two books in my 'Agape Penicillin' series out in early 2015 -- they will be published simultaneously and hopefully reviewed together...

"Oct 16 '40 -- 75 years of Draft Registration : rejecting the 4Fs"

"Oct 16 '40 -- 75 Years of Antibiotics : succouring the 4Fs"

Aaron Alston - Antibiotics pioneer on '40 draft count but not on '40 census ?

In the Spring of 1941 *, the US Census discovered a major embarrassment : it counted far fewer young black men in April 1940 than did the draft registration process in October of that same year, only five months later.

Three percent of draft age men were missed by the census overall, but a whooping 13% of blacks - an even higher difference in the correct count in inner city places like Harlem New York.

This (fiscally important) undercounting of the poor and minorities has never really stopped and probably never will --- not if Republican congressmen have any say in the matter.

But it might mean a little bit of information on Aaron Alston may still be found found on the (sealed) US draft registration card made out for Alston October 16 1940 at the Columbia-Presbyterian Medical Center , the same day he was becoming one of history's first antibiotics patients.
Because there is no Aaron Alston on the April 1940 census in the state of New York or in states nearby to New York City like Connecticut, New Jersey or Pennsylvania .

I have speculated he may have moved to New York from rural America seeking work between April and October that year but the possibility he was already in the New York City area near the hospital and simply uncounted in the census can't be discounted.

In the case of this truly historical event - perhaps that draft registration record might even be unsealed - who knows ?

* Daniel O. Price, "A Check on Under-Enumeration in the 1940 Census" American Sociological Review, Volume 12, Issue 1 (Feb., 1947), pp.44-49

Oct 16 '40 : marking 75 years of Antibiotics AND of Draft Registration !

The Draft (conscription) process tends to implicitly lay bare the utilitarian instrumentalism that form the true backbone of most civilizations - the values Christianity rose to oppose.

This is because how most ordinary people chose to interpret the results of draft board medicals.

They tend to regard only those people judged draft board 1As (as fit enough to fight for their country or to work in heavy war industries) are deemed worthy of full public praise and honour.

And ultimately, of being worthy of full food rations,  decent housing and proper medical care --- if those three necessities of life run short, as they frequently do in war.

But those judged unfit are publicly mocked as '4Fs', the scorn of every teenage girl seeking a date and the sort of people whose life-threatening illness is left on the back burner of "Code Slow",  because that illness is  judged 'not a military priority'.

On Draft registration Day,  October 16th 1940, Dr Martin Henry Dawson choose to oppose those instrumentalist values head on.

He choose that date to give very first ever injections of life-saving antibiotics.

But not to 1A youths.

Instead, to two young men judged to be the 4Fs of the 4Fs.

These two young patients  were dying of invariably fatal SBE (the form of endocarditis that made Rheumatic Fever the leading killer of the young before penicillin).

SBE is a disease mostly of the poor and of minorities.

Treating it was often regarded as a form of Social Medicine --- and thus was highly suspect in the eyes of many isolationist members of the American medical fraternity.

That was because treating it - or going to the defence of Poland or Belgium -  meant selflessly helping people outside their own religious, economic and ethnic community.

It meant walking the Christ-like walk on Monday instead of just doing the talk on Sunday.

In the Fall of 1940, conservative and isolationist members of the medical community seized upon the interventionalists' talk of getting the country ready for war.

They manipulated that talk of war preparation to urge the need to divert resources towards War Medicine for 1A youth (particularly in light of the upcoming Draft Registration process planned for October 16th).

And away from the left wing's emphasis on helping those sick among the poor and minorities (Social medicine) --- the likely majority of those judged 4F.

But what were the moral values that Americans would be dying to defend if they went to war against Hitler ?

Were they not the moral values that said all humans should be treated equally ?

The moral values that said human beings were not to be regarded as mere instruments for the larger collectivity - to be tossed aside like used condoms when they were no longer useful ?

Dawson certainly felt so - but it would be years later before even a bare majority of his fellow Americans would agree ...