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....

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....

1940's ISOLATIONISTS abandoned Europe's 4Fs and America's 4Fs

1A =  53%

From 1938 till 1941, Europe's small and weak nations - its 4F states - were gobbled up one after another, while the majority of Americans sat on their hands and did frack-all.


Then in the Fall of 1940, these same Isolationists, using the excuse of preparing for an European war - a war that they were actually working all out to avoid - pushed for an abandonment of Social Medicine , in favour of War Medicine.

Translation of this hypocrisy ?

In Eugenics-speak, this meant abandoning efforts to provide medical care to both the well-to-do 1As and the poorer 4Fs, in favour of research on making the 1As into better fighters.

Rooseveltcare as unpopular then as Obamacare is today

Actually, the Isolationists had high hopes that America's 1As would never have to fight : this was all just an excuse to roll back the clock on providing care for the 47% in 1940s America.

Rooseveltcare was no more popular then among the well-to-do than Obamacare is today. (Or Romneycare was in Boston a few years ago - but that is another story altogether isn't Mitt ?)

It was this Isolationist hypocrisy that I believe pushed Martin Henry Dawson over the edge into his all out effort to rescue some American 4Fs (his equivalent of 1915's Belgians), with 4F natural - impure- penicillin,  as his rebuke to uncaring America.....