It's Milton's AGAPE not the Greek AGAPE...

I have been going backwards and forwards in my mind - and in my heart - about the exact spelling (and pronunciation)  of my book title.

Francis W Peabody : agape starts in the mind and moves to the heart

In the mid-1920s a busy dean of medicine, among many other things, briefly addressed a student body.

And then a year or two later he died, the early victim of fatal sarcoma.

Normally a dean of medicine from 80 years ago is remembered, if at all, only as one name among many underneath the long lines of dusty portraits in the hallway leading up to the office of the current med school dean.

But in fact Francis W Peabody lives on, bigger than he ever was in real life, because of a very short phrase he spoke to that student assembly, just one of the many things he did in the course of a short but very busy, productive life.

Aktion 4F : something done to 4Fs, rather than something done for 4Fs ?

For years, I have thought and written of Dr Henry Dawson's efforts to try and save the lives of young SBE patients ,"The 4Fs of the 4Fs" , as if it was a sort of counterpoint to Nazi Germany's efforts to kill similar chronically ill people, the infamous Aktion T4 campaign.

His own Aktion 4F as a sort of counterblast to their Aktion T4.

But Dawson wasn't actually directly opposing the German Nazis' murderously utilitarian disposal of humans judged useless consumers of badly needed resources in a Total War.

He was combating similar notions held by the powerful in the Anglo-American medical establishment.

Allies gave penicillin only to 1A soldiers for same reason they gave Czechoslovakia only to Hitler

The Allies weaponizing penicillin was as morally wrong as appeasing Hitler by giving him Czechoslovakia on a platter , and for exactly the same reasons.

The Allies totally failed to see that giving everything to the mighty and nothing to the weak was exactly what caused the war in the first place: weaponizing penicillin was not going to win the war but rather cause Allies to lose the moral peace.

'Eugenicide with an English accent' was not a moral counterweight to Hitler's values, but merely an Anglo-Saxon cousin of his.

Henry Dawson realized, very early on in the Fall of 1940, that any cause willing to save the lives of its very weakest, such as the SBEs, even during a Total War, would be a cause worthy of dying for.

By contrast, any cause that was only a weak 'me too' of its enemy's morality wasn't going to get 20 year old infantrymen up and out of their foxholes with any alacrity when the whistle blew.

Justice is only truly just when it is as fair to the weak as it is to the mighty, as fair to the foolish as it is to the wise : but God knows it isn't easy to make each new generation of humanity realize this.

The Germans, Japanese, Soviets did have a cause they believed was worthy of dying for, perverted as it was ---- one reason why as individuals and in small groups, they were usually much better troops than any of their opposing Allied troops.

Interestingly, the free Polish troops were also considered to be braver than the other Allied troops : they knew they were going to have to fight very hard to secure the postwar fate of Poland - to keep it out of Allied Russian as well as Axis German hands.

They lost, thanks to FDR - but Dawson didn't.

Penicillin was de-weaponized , albeit only by loud public demand and against government wishes,  and the Allies narrowly escaped being accused, postwar, having having caused a war crime of omission....

1939-1945 : Nesvizh Jews fight for life, at home and abroad

While Jews in the democratic West during WWII were unwilling  to do something even as minor as chaining themselves to government fences ( a la the suffragettes) to protest the mass killing of their counterparts in Europe, this did not mean that other Jews were not fighting for their right to life in those years.

Consider the brave Jews of Nesvizh.

Ninety percent of the Jews of that small city, 60 miles south west of Minsk (today part of Belarus, then part of Poland), were killed by the Germans, in one day, in October 1941.

The remaining 600, locked in a tiny ghetto, resolved to try an armed breakout, rather than die quietly.

The forests were right next to the city and the ghetto and once the Jews were in the woods, filled with lethal partisans hidden behind dark trees, the Germans and their helpers quickly lost their dutch courage and gave up the chase.

On July 21 1942, hearing a police company of Nazi collaborators was coming to kill the remaining 600, the Jews started their break out.

Yes, most got killed in the process, but perhaps 10% of the 10% got away to try and survive the grim and short lives of forest partisans.

Maybe a handful of the original 6000 survived to the end of the war.

Nevertheless, this tiny ghetto was the first, or one of the very first, groups of Eastern European Jews to fight to the death in an effort to stay alive.... and is widely honored worldwide today for doing so.

Particularly by those children of Western Jews who know their own parents and grandparents, under far more safe circumstances, did basically nothing, certainly nothing so bold and courageous, during WWI to hinder the Nazi efforts to kill all of the world's Jews.

Most of the Jewish people of  Nesvizh survive today as the children, grandchildren and great grandchildren of the people of that shtetl who emigrated to places like New York in the brief window of opportunity between the 1890s and the start of WWI.

Charlie Aronson 

We still know very little about this man, the very first person to receive lifesaving penicillin-the-antibiotic (systemic penicillin) and who did so on October 16 1940 in New York.

We do know a fair bit of his medical history, but as to Charles Aronson himself, we only know he was born about 1913.

We are very lucky that in 1944 much of his complicated medical history was abstracted by his doctor in a published article because today's America would let us know nothing of this man born a 100 years ago.

America is a country where it is much easier to buy an assault rifle then it is for a historian to get any personal information about historical figures.

But importantly we do know a fair bit of the career of his doctor (Dr Henry Dawson) , particularly with regard to the disease that Charlie Aronson was being treated for (subacute bacterial endocarditis) (SBE).

Prior to Charlie, Dawson had never treated SBE and obviously , at that point, no one had treated anyone anywhere with systemic penicillin.

From these few scant facts, we can make a few educated , aka statistical, guesses about the identity of Charlie.

Because some academics have studied the matter thoroughly, we have a pretty good idea of how ordinary (non well-to-do) New Yorkers picked the solutions to their medical problems in 1940.

The densely populated centre of New York City is also home to one of the world's largest arrays of hospitals and doctors in the world.

A short bus ride in any direction in the three mile circle around your home threw up lots of possible healers.

Even the poorest weren't short of choices - many NYC hospitals and doctors were also research oriented and if you submitted to their new therapy trials, you got (hopefully) cutting edge treatment for little or no cost.

Generally, distance was a big factor : since so many good hospitals lay close at hand in every direction, so why go further only to find your family and friends can't easily visit you daily ?

The exception was if a doctor or hospital was very famous for its special advanced treatment of a particular fatal disease : then people would come from all over the continent or the world, desperate for a possible lifeline.

Dr Henry Dawson ,and systemic penicillin, in October 1940, were the furthest possible from that sort of fame in the case of SBE.

In October 1940, nobody had a cure for SBE : when you got very sick with it, you went to any old hospital and patiently waited to die from this 99% invariable fatal disease.

So in looking for a patient named Charles Aronson, born around 1913, who attended Columbia Presbyterian Hospital in upper Manhattan in October 1940, the first place to look is in the recent release of the 1940 federal US census, seeking a man of that name and age living pretty close to the hospital.

As it happens, the only man having that name and age in the 1940 census living within a few miles of Columbia- Presbyterian lived very close indeed: two miles away at 1202 Vyse Avenue in the (South) Bronx.

(The handwritten census indication of the street is often misread as Nyse Avenue (sic!).

Most - but not all - of the people in New York City in 1940 named Aronson were recent Jewish immigrant families from The Pale of Russia , places like today's Poland, Ukraine and Belarus.

Places like Nesvizh.

The Charles Aronson born around 1913 living at 1202 Vyse Avenue, has a brother Samuel, a sister Lillian, a mother Olga and a father Alex.

Vyse Avenue, in 1940, was home to a closely knit community from the Minsk and Nesvizh areas and so when we see an Alex Aronson from the Bronx on two lists of members of a Nesvizh landsmanshaften, we may well have something.

(Landsmanshafts were Jewish fraternal organizations based on all members being former residents of a very small part of the Old World. Think of it as a big neighbourhood emigrating en masse and re-constituting itself in another country. It functioned as a hometown collective self-help, burial and social organization.)

The 1940 census says that Alex and Olga were born in the former Russian Empire in the late 1880s (and Minsk/Nesvizh was certainly part of that Empire back then.)

Charlie and his siblings were all born in New York and I feel we can safely speculate that Olga and Alex migrated to New York as twenty year olds just before WWI and started their family there.

The 1940 census tells us not just ages and birthplaces and current residence, it tells us of the education, occupations and incomes of all on the census.

Luckily the youngest Aronson of this family , Samuel, was asked a few more questions - in particular he said his childhood home language was Jewish (Yiddish), indicating this family was in fact Jewish.

Alex had 3 years of school, worked as a machine operator making ladies cloaks, earning $1400 a year ( a typical skilled working class wage in that year.) Olga had no formal education and worked at home as a homemaker.

Samuel had one year of college and was looking for work as a machine operator making ladies belts.

Lillian had 4 years of High School and made $900 a year as a machine operator making ladies belts.

Charles also had 4 years of High School and was making $950 a year working as a teletype operator at a newspaper.

Perhaps at a gentile newspaper but far more likely at a Jewish newspaper.

If this Charles Aronson was the same one who received history's first ever shot of antibiotic and went on to recover from invariable fatal SBE not just once but twice, it was remarkable he had so much education and had a skilled job.

Because the SBE Charlie had had many close calls with death and permanent disability.

When he was eight,in the early 1920s, Charlie had gotten Rheumatic Fever (RF) , which until 1960, the leading case of death in school age children.

His was an unusually severe version, as it hit the cells of his joints, the cells of his heart and the cells of his nerves.

He was lucky not to die - most poor kids at that time did die outright from this severe an attack.

Then he went right on to get a severe attack of the post WWI worldwide epidemic of a mysterious sleeping sickness, encephalitis lethargica, not at all to be confused with the disease caused by the tropical tsetse fly.

Today the evidence points away from what was originally seen as the cause, flu, and towards an auto immune response to particular strains of strep bacteria causing a case of strep throat weeks or months before the onset of this particular disease.

Rheumatic Fever is another in a whole series of auto-immune diseases caused by some people's particular gene set over-reacting to certain strains of strep throat bacteria.

Thanks to Oliver Sacks, most people today know far more about sleeping sickness than do they of Rheumatic Fever, and most know that while many died of the initial attack, others survived it only to become victims of permanent post-infection parkinsonism.

Such was SBE Charlie's unlucky fate.

Still he survived two should-be fatal attacks by strep before 1940 and remarkably he would survive two more should-be fatal attacks by different strep bacteria between 1940 and 1944.

And a life-threatening stroke : a cat of more than just nine lives !

These latter strep were the normally harmless mouth strep bacteria than can invade damaged heart valves caused by Rheumatic Fever and almost always (before systemic penicillin) kill the patient : the dreaded SBE.

Attacks to your nerve cells  such as hit Charlie twice, can give a person temporary or semi-permanent mental, emotional and behavioral issues.

The Nazis in particular feared those with this form of sleeping sickness and their Aktion T4  murder teams usually sought out and killed such people, even when the person generally functioned as a hard working tax paying citizen.

Such as poor Martin Bader, who was murdered by German doctors in late June 1940.

This was the very same time as two American doctors, Dawson along with Dr Karl Meyer, were first learning of penicillin's unknown systemic potential from unpublished verbal reports from an American student forced to leave Oxford University after the Fall of France.

Already the two were thinking of it for a new use as a life-saving therapy.

Dawson was a humanitarian doctor but in addition his particular private research interest was oral strep diseases.

Charlie may have been a last minute attention to the initial SBE penicillin trial (despite Dawson not having enough penicillin for one, let alone two SBE patients) because he had survived both RF and sleeping sickness and now was under attack from strep bacteria for a third time.

Charlie never faced direct assault from Nazis as did his remaining relatives in Nesvizh, if that is where indeed his dad came from.

But Charlie's life was threatened by Nazi-like thinking by the American medical elite, who felt, like Himmler and Hitler, that SBE patients, particularly if they also suffering from parkinsonism, were just useless mouths to feed in an all-out total war, and so should be left to die---- in this case, by deliberate neglect.

They ordered doctors not to waste penicillin on SBE patients.

Charlie and Doctor Dawson fought back - not with guns - but Dawson did break the wartime laws and did steal scarce government controlled penicillin, all to keep SBE patients alive.

His "ACTING UP" finally provoked a national and then international public reaction against the Allies' Nazi-like attitude to SBE patients and penicillin.

The character of Allied penicillin also changed at that moment - from a secret weapon of war, to a public and universal life-saver.

Dawson himself was dying of an auto-immune disease from 1940-1945 and did not live to see the end of the Nazis, but Charlie did.

To the Polish government at the beginning of the war, Charlie was a Polish citizen living overseas.

No country in the world had a worse war than the Poland of the 1939 boundaries.

The Allies with great consistency treated it as badly in 1945 as they did in 1939, matching the Nazis stroke for stroke.

It is satisfying to know that at least one citizen of Poland was treated fairly during WWII, treated as fairly as every individual should be treated all the time,  and that the result of his being treated with compassion, penicillin became about the only good news story that ever did come out of that bad news war ....

1940 Penicillin : localized Gas Gangrene or systemic SBE ?

Within days of reading war-dodger Howard Florey's published conclusion that the as-yet-unproven penicillin was particularly suited to the military's most feared infection, gas gangrene, war-hero Henry Dawson defiantly decided - by pointed contrast - that penicillin was particularly well suited to defeat the ultimate in non-military infections, deadly subacute bacterial endocarditis, SBE.

The timing of Dawson's decision - during the most critical days of the expected Invasion of Britain - only heighten this highly unusual contrast between how we expect war-heroes and war-dodgers to behave and how these two examples actually did behave.

Florey had declined to serve his country when he was young but now was very eager to aid it (as a draft-proof middle ager) by steering the new penicillin towards use as as a local antiseptic for gas gangrene infections in frontline casualty tents.

For centuries, gas gangrene infections were the most dreaded and also the most uniquely wartime forms of death (rarely causing death in peacetime).

Any talk of the possibility of finally ending gas gangrene's terrors was acutely pitched to catch the ears of war's political, military and medical leadership.

By contrast, when on the day of America's first peacetime Draft Registration, a day dedicated to locating all of America's 1A youth,  Dawson choose to instead try and save the lives of two SBE sufferers, one Black and one Jewish, he was focused on the most 4F imaginable of the unwanted 4Fs.

The most 4F of all the 4Fs : the SBEs

For no nation's military , no matter how hard pressed for manpower, was likely to regard SBEs as more than just a particularly costly burden for a wartime economy to bear.

It usually hit young adults , the prime category for draft boards and munition factories, but no matter what modern medicine threw at it, it always ended after months of expensive effort with the inevitable death of the patient.

In that Fall of 1940, the Medical School at Columbia University, which employed Dawson, had moved to reduce its offerings in Social medicine and up its offerings in War medicine, in response to the battle for civilization not taking place over the skies of Britain.

It certainly had no cause to expect any complaints from professor Dawson, he of all its employees.

He was, after all, from a Canadian family of five brothers, all who volunteered to fight in WWI, all who were wounded in the front lines - one who had paid the ultimate price and others who got medals for bravery and leadership under fire.

Dawson likely had more front line experience - in the medical corp, the infantry and in artillery - than any one else in the Medical School.

When he wasn't serving in hospitals dealing with wounded soldiers, he was in military hospitals himself as a patient - fighting off life-threatening infected war wounds he himself received.

Surely such a patriot and such a veteran of battlefront infections  saw the sense on Howard Florey's proposal to focus penicillin research on battlefront wound infections  and to agree with his university's decision to focus on war related medical research ?

But clearly he did not - and the mystery is to account for why he did not - but instead, precisely and perversely, did exactly the opposite.

Penicillin did not, in the end, reduce deaths due to gas gangrene - in fact penicillin pioneer ( and WWI veteran) RJV Pulvertaft found that the evidence suggested that the percentage of gas gangrene sufferers who died actually went up in WWII , compared to the results obtained in the last years of the previous war !

By contrast, in the end, penicillin proved to be the best medicine ever seen to stop deadly systemic (body-wide) infections like SBE and blood-poisoning.

Explaining the mystery and the paradox

Based on just the evidence, part of the mystery might therefore seemed to solve itself: the modest Dawson was simply a far better scientist than the very pushy and ambitious, but ultimately plodding, Florey.

But Dawson was also extremely patriotic in ways that Florey couldn't begin to imagine and we still must explain why he felt  that his best way to personally aid the war effort was to come to the aid of Life's weakest members.

Saint Peter had only denied Christ's pleas three times, but between 1931 and 1941, America had denied pleas for help from smaller, weaker countries under attack over two dozen times, only deciding
to put the Greatest Generation Ever to work fighting the only Good War, after it itself was attacked.

Helping Life's weakest members is all very nice in theory said America - but what in the hell does it have to do with fighting WWII - which was all about one's own naked self interest ?

Perhaps Dawson was merely confused -  was still fighting WWI - was still fighting for poor bleeding little Belgium.

Perhaps....

Resetting the Allied moral compass so that it diverged from the Nazis, not merely followed a muted parallel course

It remains unknown whether Henry Dawson expected his quixotic wartime efforts (to "waste" weaponized penicillin on 'useless' SBEs ) to go as far as they ultimately did.

He certainly was extremely unhappy that America was treating its wartime 'SBE lives unworthy of life' in almost as bad a fashion as Nazi Germany was known to be doing to its SBEs and others seen as "useless mouths".

But did he suspect his assault on weaponizing penicillin would extend beyond the Allies' horrific wartime neglect of the poorer chronically ill ?

He probably couldn't have foreseen just how quickly the pipeline of ever-newer ever-better sulfa drugs would dry up or just how quickly so many strains of deadly bacteria would become resistant to any sulfa drug , leaving penicillin as the  only  wartime lifesaver between disease and death.

This meant de-weaponizing penicillin had consequences far beyond those people suffering from SBE and denied their only chance at life.

If weaponized penicillin had remained throughout the war successfully censored and had remained denied to the civilian world (as weaponized DDT successfully was, never let us forget) , it would have ranked as one of WWII's major war crimes, like Katyn Forest or Auschwitz.

Millions of people around the world during WWII would have died needlessly from massive infections that only penicillin alone could have stopped.

Penicillin in 1943 was not as it is today,  just one among dozens of antibiotics - it was the only one - and in addition, no new anti-bacterial sulfa drugs were coming along to replace the ones that bacteria had so rapidly grown resistant to.

Refusing to divert a tiny amount of war resources to make penicillin available to civilians - anywhere and everywhere - was to refuse them Life itself.

Worse, there was no trade-off  to debate ; penicillin, like sulfa before it, was no war-winning secret medical weapon, at least in its intended war-winning use at the front .

Brand new (front line) wounds either contain abundant alternative bacteria foods to the deadly sulfa 'food' (the Fildes theory, known since 1940) or contain abundant proteins to bind to penicillin and render it useless.

However penicillin, and sulfa, were very useful a little further back in the military hospital system, as a life-saving systemic in cases of possible blood poisoning.

The case against secret weaponized penicillin gets even worse.

As an impure natural drug, penicillin would have taken the Germans at least a year or two or three to successfully mass produce it , even if its virtues had been sung from the heavens by the American media in 1942.

But as a pure synthetic penicillin in supposedly cheap abundant mass production (an event that in fact as not yet ever occurred) the chemistry-minded Germans would have rapidly back-engineered the drug and synthesized it rapidly themselves.

Because remember it took 15 years of hard effort to purify natural penicillin enough to determine its structure - but only months thereafter to 'synthesize' it artificially.

Back-engineering that synthesis would also only have taken months.

Penicillin's real secret was just how difficult the mass production of natural penicillin could be if you set your mind on doing everything the hard way ---- not the OSRD-Merck-Oxford fantasy of secret synthesis.

Dawson certainly set up the stage for the Allies re-setting of their moral compass , from his endocarditis efforts from September 1940 to September 1943 : but it was the immediate outcry resulting from the Patty Malone and Marie Barker cases that forced them to actually do something concrete.

His gut instinct in 1940 ,that not treating the otherwise fatal subacute bacterial endocarditis would prove the acid test for the Allies' pernicious morality, certainly was correct.

But while he couldn't have foreseen how far his actions would impact, he wouldn't have been unhappy that they did so......

The Cure for Auschwitz Disease : "Dawson's Crude" : .56% penicillin ...and 99 and 44/100ths pure love

Pray there comes a day when most premature deaths really are 'Acts of God', when even the best of money and the best of medical care could not result in a happy ending.

But until that happier day, most premature deaths in the world - in peace as in war - are 'Acts of Humanity' , or rather 'Acts of Lack of Humanity'.

Sins of Omission : premature death caused because the people dying are not judged (by others more fortunate) as worthy of devoting much money or effort towards saving.

In war, comparatively few people die as soldiers dying of mortal wounds gained in combat.

The Nazis' behavior provides a particularly clear example of this.

They fed and cared for  the captured POWs and enemy civilians of some nations (the Dutch for example) but for other (Russians and Poles for example) many or most of these people were shot after battle or left to starve and die of disease from lack of food, medical care and shelter.

The food and fuel saved as a result meant that no German citizen went hungry or cold.

The right kind of German civilian anyway.

Using the war as excuse, the Nazis killed many German civilians, those judged 'life unworthy of life' , to free up food and hospitals for other Germans.

In another well known example of  WWII's Sins of Omission, Winston Churchill ignored the pleas of his top British officials in India and let four million poor Bengali civilians needlessly starve to death in 1943-1944 ,rather than divert some food and some shipping from  Allied peoples he judged more worthy of receiving them.

Even the different death rates from wounds gained in combat  , among the so called "modern" nations engaged in World War Two is revealing.

The Americans and British generally devoted more resources to saving their wounded compared to the Germans, Japanese, Russians and Italians.

 As a result,more western Allied troops survived the same severity of wound as experienced by troops of these other nations.

'Of course', I hear you say, 'they were richer nations, it was easy for them !'

But no : they had a choice, because the extra money devoted to this extraordinary care of the wounded could have been allocated elsewhere: to more and better anti-tank artillery, for example.

An extraordinary effort to produce the best anti-tank artillery ever made was , in fact, probably the cheapest way for the Western Allies to have ended the war against Germany at least a year earlier than it did, saving millions of lives all around.

I raise the genuine issue of better earlier anti-tank artillery versus the best possible military health care to remind us that even total war still leaves us with genuine moral choices.

More Lancaster bombers versus more 17 pounder anti-tank guns versus raising everyone's morale by generously providing penicillin enough for all people were some of the choices - part political, part moral, part economical - that leaders had to make in WWII.

Making the wrong ones meant the war dragged on longer than it had to, costing more lives lost.

It is not enough to say Churchill won the war in 1945 ; better to ask, could he have won the war in 1943 ?

In 1940, Henry Dawson was battling a near universal mindset among the world's research-oriented doctors of that time : that a medical researcher's only task was to determine that disease A was caused by bug B and that bug B was killed by compound C.

Then, like sleeping under a bridge, the researchers considered that the cure for disease A was open to rich and poor alike : pay for three weeks of needles at $10 a shot: together with doctors fees, say $250 in total.

When the annual wages of the working poor, if they found work, was very lucky to be $750 in 1940, that was a cure well beyond their reach.

Besides the fact that their disease might be far harder to cure than that of someone well off, due to the cumulative affect of their lack of good nutritious food for years and years.

Or that fact that living, as they did, in poor and crowded housing, disease A was more likely to come back again, even after an impossibly expensive cure.

Now what if disease A is something one gets from having open wounds - such as the open wounds all civilian mothers have after childbirth, or the open wounds that soldiers get after exposure to shell fire in battle.

How do we judge western Allied governments unwilling to provide the only life saver for disease A , either to any civilian moms (except those personally known to lead disease A researchers) or to any soldiers with wounds so severe they will be discharged and pensioned off, if they live ?

And how do we judge these governments when at the same time, they are gladly willing to provide live-saving compound C  (totally free !) to men who had either very high and very low peacetime incomes, just as long as their war wounds (by sheer luck) are only moderately severe and they can be expected to return soon to combat duty ?

Is this attitude not different in kind from that of the Nazis, but merely different in degree ?

Dawson had no realistic expectations that a few small injections of a very crude penicillin powder, hastily made in a few weeks, would cure such an incurable invariably fatal disease as subacute bacterial endocarditis, (SBE), then as now the acid test of all infectious diseases.

His powder had only about 8 to 9 units of penicillin per mg in it ; ie it was only about .56% pure.

The rest (the remaining 99 and 44/100ths worth),was in many researchers' minds, "junk".

Rather as they later described most of our DNA : "junk".

I believe Dawson considered his little bit of brown powder to be .56% penicillin and 99.44% pure love.

99.44% pure care, concern, caring.

For Dawson was judging his attempt to save Aaron Alston and Charlie Aronson by a much different - and much more moral - acid test.

To Dawson, SBE in the Fall of 1940 was not the acid test of infectious disease, but rather the acid test of pernicious morality.

These SBE patients were be judged to be 1940 America's "4Fs of the 4Fs", suffering from the militarily most useless disease on earth and not worthy of wasting any precious medical resources upon.

Now a doctor named Francis Peabody that Dawson had hoped to train with (but who died of cancer before that could occur) had earlier and famously said that the care of the patient begins (only begins in fact ) if the doctor first cares about the patient.

A single doctor can't hope to directly save everyone dying in a big war.

But by setting a very public example about caring for the least of these, those judged "unworthy of life", even in the midst of a war , they can hope to begin to still the trigger fingers of those all too willing to kill prisoners  just because 'it is too much bother to bring them back to our own lines'.

Only when the world is willing to care about "useless" others, even in the midst of wars, can we expect to begin to see war deaths reduced to combat mortal wounds, and then to ultimately see lesser and shorter and less brutal wars.

Only in a world where ordinary people care about others judged "useless", can we expect to still the hand that dropped the pellets at Auschwitz .

Which is why I earnestly claim that Dawson's Crude was the best and only cure for the Auschwitz Disease ....

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....

Most of the penicillin grown in its first 15 years, was wasted on useless attempts at synthesis, not used to save the dying

If my claim be wrong : show me the money !

Open all the archives on university, hospital and corporate penicillin files.

Show us the size and number of penicillin production runs, month by month, from September 1928 to September 1943 ( ie including the first four years of the war).

Then shows us the amount of penicillin units actually released for therapeutic use on human patients suffering from infections suspected of  being defeatable by penicillin,  during that same time period.

Patents, Profits and Patriotism : pick two out of the three...

I have never seen any published accounts where the responsible authorities complained about all the precious potentially life-saving penicillin that was being wasted ---- during an all-out Total War ! ----on a futile 20 year long effort to synthesize patentable profitable penicillin from PD (public domain) natural penicillin.

But there are plenty of complaints from the higher-ups about all the penicillin being wasted on saving the lives of ("useless feeders") young people dying from hitherto invariably fatal SBE  (endocarditis)......

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......

Like Germany, Howard Florey effortlessly won all the tactical battles, losing only the strategic war to Henry Dawson

Eugenics was on the side of the Big Battalions...

Howard Florey was a WWII chicken-hawk, so it little surprises that his chosen hobby-horse, Allied war medicine, was vigorously and publicly 'On the Side of the Big Battalions'.

That meant making a virtue of denying aid to dying 4Fs, to give it instead to healthy 1As.

 But as Hitler had earlier found out to his cost, this was not a position designed to win over the small battalions of the world's hearts and minds.

Dawson's Folly

Dr Dawson's 'folly' - by contrast - was to give up his own life, during a Total War against the Ultimate Evil, trying to save the lives of the 4Fs of the 4Fs, those 'useless mouths' young people with SBE.

His folly was near-universally damned by those in America's scientific and medical elite who knew of it.

Only those who the British call "the punters" : ie, the housewives, the customers and the voters all over the world, approved his idea.

They chose not to judge the Allied Cause by when it ventured into Nazi like behavior (denying aid to the weakest) but only in its better moments, as when it changed its mind and came to the aid of the SBEs' small battalions, aiding the least of these.

A small gesture perhaps, but in the end, more than enough ....

The Allied battle for the world's 'hearts and minds' : NS-born Henry Dawson's patient-penicillin vs OSRD war-penicillin

Army is - wrongly - blamed for her SBE death

The idea that successful American governments need first to win over the 'hearts and minds' of people, before they rush to impose their objectives by legal and military fiat is an old, old , old one.

Presidents John Adams used the phrase "hearts and mind" in this sense early in the 19th century, long before Presidents FDR, Kennedy and Johnson made it famous in the 20th century - and before recent presidents George W Bush and Obama dragged it out of the archives to use in this century.

(And to share the blame around, their wartime Ally Britain also used the phrase during its 1950s war in Malaysia.)

When American finally joined The Coalition of the Willing  (December 1941), many of the world's nations still remained strictly neutral in the battle against Nazi evil , or were, at best,  nominal friends but in reality merely laying back on the oars.

The world's largest, richest, most militarily-advanced economies in the world (America and the British Commonwealth) had a real job on their hands trying to convince the neutrals (all much smaller and weaker than these two superpowers) that their interests would not be subsumed before the interests of these global colossus.

Unhelpfully, America and Britain's scientific and medical elite - centred in the American National Academy of Science (NAS) and the British Medical Research Council (MRC)  made the job much harder.

Reactionaries of all stripes (from Germany to America) had been determined to roll back the1930s move to Social Medicine (the claim that more poor people got sick than rich people because they were too poor to pay for adequate housing, food or routine medical care).

However, the dire effects of the Great Depression had put wind behind Social Medicine's sails and confounded the reactionaries.

Now - Thank God ! - war, or even just the possibility of war, gave the reactionaries new hope.

 Hitler killed off his first "useless feeder" the same week that he declared war on the Poles and soon his Aktion T4 program was killing Germany's weakest and smallest members by the tens of thousands.

In America, people like Dr Lewis Weed (a mid-level medical researcher) dropped his unsuccessful research to become a war-medicine advocate at the NAS and its action-oriented NRC (National Research Council).

War medicine wins opening rounds against social medicine

He locked horns with Dr Thomas Parran, the American Surgeon General from 1936 to 1948, who was a strong (and powerfully-positioned) advocate of social medicine.

A war medicine proponent advocates that any nation at war - even the richest, least attacked nation at war - needs to divert resources normally assigned to civilian medicine towards making bullets instead.

 In addition, much more money would have to be spent providing for the high medical requirements of an activity (war) whose stated aim is maiming and killing people on muddy fields miles away from the nearest hospital.

Limited research dollars would have to focus on war-related  medical needs ( such as finding new ways to keep factory workers and bomber pilots alert for long hours) and put before finding  new ways to keep elderly retirees alive) .

War medicine is, in a very real sense, 'eugenics in uniform' : the best citizens (those that are tested and rated physically and mentally to be A1) end up in the military and get top notch medical care at no cost.

Those citizens who fail these tests and end up as 4F, are second rate eugenically and get second rate medical care during the war.

Proudly promote this concept to the outside world - and America's still relatively free press during WWII did just that - and it comes across quite differently in those neutral nations still sitting on the fence with regards to whole-heartedly backing the Allied cause.

As individuals, the elites in these neutral nations could see themselves as A1s  --- but as nationalistically minded citizens they could only see their nations as 4Fs in America's eyes : mere inconvenient dirt beneath their advancing wheels.

When the Patty Malone vs Marie Barker debate broke in the United States media (basically, scarce penicillin for dying civilians : yes or no ?) , it broke even bigger overseas, as worried American and British diplomats noted.

Heartless or caring : the public image of the Allied cause had reached past the unimportant front pages and onto the most important page of any newspaper or magazine --- the women's page : home to Doctor Mom.

It suddenly mattered what the mothers and parents and grandparents from neutral nations thought of America and Britain's harsh dictates on penicillin.

Put your small neutral nation, say Eire or Turkey, in the place of the unfortunate Marie Barker and then ask yourself, how would you feel to just be Marie Barker-like 'incidental collateral damage' , on the pathway to the ultimate Allied Victory ?

And the Home Front within the Allied nations was just as caustic about their own governments' inactions : 'penicillin the miracle cure' had been around for 15 years and still no one in charge had bothered making enough of it for all ?

Don't the bosses know "there's a war on" ???!!!

And let us set this debate (occurring between the late Summer of 1943 and the early Spring of 1944) in its full context.

The western Allies still hadn't invaded Europe and left the heavy lifting of killing German soldiers to the beleaguered Russians.

Instead they were busy bombing Europe into rubble : busily killing civilians from both Axis and neutral nations alike.

The Germans and Allies had co-operated on censoring the results of the fire-bombing of Hamburg of July 1943, (right before the story of little Patty Malone broke) but on-site reports from neutral Swedish journalists had laid the whole horrific affair out on the newspaper pages of the world.

It had led to considerable unease - in neutral country and allied country alike.

Hadn't FDR himself raged that the bombing of civilians was a crime against all humanity and now weren't the Americans and British far out-doing the earlier Nazi efforts to bomb enemy and neutral civilians ?

Allied fire bombing of  innocent babies in occupied Europe - denying life-saving penicillin to innocent young moms in America so that their unfaithful husbands in Italy could be get a quicker ( via penicillin) cure for the Clap - it all didn't seem morally right.

Perhaps surprisingly, the American Army revealed far greater political and cultural savvy on this matter than American doctors and scientists were capable of.

The Army was sick and tired of being blamed for hogging all the penicillin and refusing to give any to the nation's dying babies.

'For Christ's Sake', they could rightfully protest, 'we can't get anywhere enough penicillin for our own dying boys, and we hadn't even heard of this stuff penicillin till a few months ago --- you ask the drug companies and the doctors what they were doing with the stuff for the last 15 years !'

Somewhere in the American Army Air Force some bright mind (s) decided to solve both PR problems (the fire bombing uproar and the penicillin uproar) at one stroke.

(And before you ask, no .)

No academic historian has yet brought us the true story behind this highly imaginative response: I see a great PhD thesis for some bright light.)

Soon, American Army "heavy" bombers were pulled off their bombing practises and were sent out on a still risky flight (because at top speed and at night) "pounding" across country with a tiny 8 grams of penicillin (instead of the normal 8000 pounds of TNT) to deliver to a dying ten pound patient.

Upon arrival, Klieg lights lit the tarmac as an ambulance, along a police escort with blazing lights and piercing sirens, raced to the hospital and the waiting doctor and patients.

Need I add to this purple-prosed drama that, thoughtfully, the local press had been notified well ahead of time ?

Quickly Army bombers were even on far more perilous missions of mercy, dangerously new cross-ocean flights, from places like San Francisco  all the way to Brisbane Australia or from New York to Havana, --- to save dying children.

In 1943, Martin Henry Dawson was dying ,but not quite dead yet, not by a long shot...

Life-saving penicillin had moved 180 degrees from being censored and rationed to being the subject of  radio, newsreel and pamphlet propaganda as an example - the example - of the better things ahead if only all joined in to hasten the Allied Cause.

Neutrals could reassure themselves that just like with dying babies and Martin Henry Dawson's useless-mouthed SBE patients, the Allies would do right by all, as they were doing so now for the least of these.

The Allied battle for the world's hearts and minds, had been won (unexpectedly) by the proponents of social medicine - thanks largely to the example of Martin Henry Dawson.

And decades before Joni Mitchell and Woodstock, the American Army Air Force itself turned its shotgun bombers into butterflies, above a wondering nation and world....

Dawson long been obsessed with SBE ? Show me ! 'Cause I'm from Missouri ...

Dawson & SBE ?! well I'm from MISSOURI

Even Gladys Hobby says so.

And God Knows, she should know almost better than anyone but Dawson himself.


In her book on penicillin, "Meeting the Challenge", she claims that Dawson had become "especially interested in subacute bacterial endocarditis" (SBE , a heart valve disease).

But no dates when and no specifics. All other writers repeat her claim and again offer no specifics.

I have always been skeptical.

Dawson's day job was running an outpatient clinic in chronic arthritis .

This , at a pre-war large research hospital where discipline borders were heavily policed and where there was a distinct pecking order , from live-saving surgery at the top and outpatient clinics at the bottom.

It still remains true today that dentists don't do open heart surgery and outpatient clinic directors don't handle heart valve diseases.

It is admitably true that in his course of Dawson's job, which consisted in handling the arthritis ( joint inflammation) aspects of every single sort of disease that offers it (and virtually every disease imaginable can offer arthritis pain, if only in a few patients and only transiently) , he would on occasion come across patients with a potential for endocarditis.

But normally a patient who actually had endocarditis in the 1930s was someone with a 99% certainty of a quick death and their arthritis issues were hardly a priority.

In his subsection of his overall department (Internal Medicine) there were people who did work on Rheumatic Fever (RF) and RF frequently ends in SBE, but they specifically tasked not to share RF research with Dawson's clinic.

(They surely exchanged insights and gossips, but only informally.)

During the hospital Grand Rounds, Dawson would definitely come across SBE patients as it was a heart-breakingly common disease to be seen at big hospitals in those days.

But so would every doctor in every big hospital on Earth in 1940 --- so why didn't  hundreds of other doctors  also take up the chance to try the new penicillin on SBE ?

Instead of SBE, Dawson had many other diseases to interest himself in that were closer to the nominal limits of his clinic.

To give but one example of alternate diseases Dawson could have branched into, Dawson did frequently work with patients who had gonorrhea (VD/the clap) because a very common aspect of their disease was arthritis problems.

So, for example, he was one of the first to use the new sulfa diseases on patients with gonorrheal arthritis, starting in March 1937.

But he did not, as a result of this frequent and work-related contact with patients with venereal disease, decide to try Meyer's experimental penicillin on syphilis --- that bold experiment was left to others years later.

So we circle around the issue again : why SBE, a disease so far away from his job definition that him getting involved could only rankle all-powerful senior doctors across the entire hospital?

And if Dawson had a long interest in endocarditis ,where was the proof ?

I am not aware of any published articles by Dawson*, between 1926 -1940,  that even mentioned SBE .

His many recorded comments at conferences in those years also fail to include words involving SBE.

In that same period, Dawson wrote various chapters in medical handbooks (Nelson's Loose Leaf and Cecil's) that involved many aspects of oral strep bacteria , an area where he was considered a world expert, but again nothing on endocarditis, even though SBE originates with the actions of two varieties of oral strep bacteria.

He could have waxed widely here, without raising too many hackles - but again nothing. (By contrast, his young co-worker Thomas H Hunter did write the chapter on SBE in both these textbooks, after Dawson's premature death.)

No specifically medical or scientific explanation for Dawson's sudden and overwhelming interest in SBE

The strong possibility remains - in my studied view - that his sudden and permanent interest in curing SBE with penicillin even at the cost of his own life, has to be set, instead,  against Fall 1940's political and military background in still-neutral America.

We might have to look at why and how Dawson finally got involved in a tremendous effort in WWI , to suggest why and how Dawson choose to get involved in a parallel tremendous effort in WWII.

Substitute WWII Belgium for SBE and Dawson's actions start to become clearer....

* I am unable to find any articles by his three co-workers on the SBE-penicillin project that reference endocarditis, even in passing.

I may be wrong on all this : but show me !

Aktion 47% : saving the 4Fs in a time of the 1As , putting them back to work and paying taxes : the OTHER Manhattan project

Romneycare DEATH PANELS for the 47%

In 1941, penicillin was lying about in the gutter, part of the medical world's unfit 47%.

Also in the 1941 medical gutter were the "4Fs of the 4Fs", those young men dying of invariable fatal SBE, seen as consuming precious medical resources at a time when many in the medical elite thought that the sole medical priority should be war medicine for the fit 1As.

Think of today's Mitt Romney as 1941's Dr Romney, if you aren't getting the picture yet.

But somebody - a nobody - in Manhattan had a different idea.

He thought both "unfits" (penicillin and the SBEs) could be redeemed, pulled out of that illusionary gutter, and put back to work combatting the Nazi evil.

For the Nazi evil included not just tanks and subs but also Aktion 4T : a scheme to kill all Germans ( and later everybody) who were judged not productive enough to bother having around .

Romneycare "death panels"

 It is hard to tell just how many people would have ultimately have ended up dead in Romneycare styled "death panels",  if the demands of the war for all forms of labour hadn't intervened.

 Who knows , perhaps as many as 47%.

The nobody's plan was a sort of Aktion 4F.

It was to be a rebuttal to the Nazi Aktion T-4 .

And a rebuttal as well as to his own 1A eugenically obsessed colleagues, like Dr Foster Kennedy who suggested killing the unfit young in that same year, 1941, to a wide round of applause.

Think of it as "the other wartime Manhattan Project" : saving the 4Fs of the 4Fs at the very height of an all out obsession with 1As.

Think of it, perhaps, as the most profound rebuttal to everything Hitler stood for : it said, even in war, we Allies care ( or should care) about the least of the these, as well as the wise and the mighty.

So that nobody - Dr Martin Henry Dawson - put penicillin to work and soon his medical notes happily recorded that many of his SBE  patients had indeed gotten up from their deathbeds and had gone back to work , paying taxes.

Hitler preferred killing people with such diseases outright ( see Martin Bader for an example) while the American medical elite in the 1940s and the American political elite in the 2010s, prefers to let them die quietly offstage, by neglect. The outcome is broadly the same.

Morally, it is only a short slippery slide from a fundraiser in Boca Raton to the death camps at Auschwitz....

"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.....

Nova Scotian-born Dr Henry Dawson and the "Invention" of systemic - natural - penicillin

The "Invention" of systemic - natural - penicillin

Discovery vs Invention

Many substances were "discovered" many years (sometimes centuries) before they were (re) "invented" as having a highly useful medical effect.

It is only since Aug 1945 (and the ascendancy of Physics over Chemistry as the Queen of Science) that we have devoted all our adulation to "discovery" , rather than "invention" in medicine.

Carbolic acid and sulfa's both had early dates of discovery (versus their much later first medical use) .

Alexander Fleming is - wrongly - credited with discovering the penicillin we have used since 1940 - but what did he actually do ?

 Fleming in fact thought his penicillin would be useful as a sort of "Plan B" antiseptic -- and only if pure and synthetic.

Howard Florey - ten years later - thought his penicillin would be a useful "Plan B" back-up systemic to Sulfa -- but again, only if pure and synthetic.

By contrast, right from the start and until his death, Martin Henry Dawson thought that natural (even if impure) systemic penicillin would be the "Plan A" choice to cure the incurable, to save the unsavable --- starting with those dying of invariable fatal SBE.

Only two people in New York worked with penicillin in 1940, despite a war (with millions soon to be dying of infections) raging the world over.

 One doctor published a conventional article in JBC, reminding bacteriologists how useful crude penicillin could be as an agent to clear common throat bacteria from suspected specimens of influenza bacteria.

That was about all that penicillin was in (semi-) common use for, in 1940. Just as carbolic acid had its various non-clinical uses in the days before Lister "re-invented" it as a life-saver.

The other doctor, Dawson,  saw crude penicillin as the most likely cure for SBE.

NOT because it was a super-killer of bacteria, but for some less sexy but rather more "useful" characteristics: it combined nearly-limitless non-toxicity with an extraordinary diffusion ability.

He could thickly saturate the blood stream with penicillin without killing the patient, and hope some would still diffuse in past the thick vegetations (bio-films) of SBE, as that saturated blood rushed past the diseased heart valves at breakneck speed.

Some modern SBE patients have needed as much as a kilo of pure penicillin over many months - that's 1.67 BILLION units of penicillin - but have beaten the disease.

Still while penicillin - and only penicillin - could save an SBE in the 1940s, SBE was a prodigious user of then very scarce penicillin, so Dawson also had to morally kick start ("invent") an entire "natural penicillin" industry into existence, to deliver the amount of penicillin needed for his SBE patients.

(As a by-product, the rest of the world soon got as much penicillin as anyone could need - so much so it was soon feed to cattle as a growth stimulator, partly to absorb some of the production.)

I say his "invention" was by moral argument, because the scientific and commercial consensus then was that only synthetic (patentable) penicillin could do the trick.

But only when Dawson morally convinced the head of Pfizer, John l Smith, to take a very great financial risk and go against the consensus of his industry, did the miracle of penicillin really begin to happen....