Patient ONE of the Antibiotics Era : how the saving of Charlie Aronson changed our world

During his lifetime, Dr Henry Dawson only gave penicillin to several dozen endocarditis patients, Charlie Aronson first among them ; only saved several dozen lives, Charlie among them.

Dawson's pioneering effort to inject Charlie with penicillin on October 16th and 17th 1940 (Dies Miribilis) certainly didn't directly save many lives.

But the moral fact that Dawson cared enough in the first place about Charlie-the-person, to pioneer in making and to giving him penicillin, has certainly saved tens and tens of millions of lives ever since Dawson's premature death in 1945.

If  only the greater cultural milieu surrounding Dawson and Charlie had been as willing - nay as eager - to save Charlie 'the 4F of the 4Fs' as Dawson was, it might also have been as willing - nay eager - to save the Jews of Europe as well.

Immaterial that Charlie was almost certainly Jewish as well : the point to Dawson was that Charlie was a fellow human being, end of story.

Social medicine, Dawson's domain, says that medicine is not just the narrow manipulating of bio-chemical activities to save lives.

It holds instead the view that most people die prematurely, not because their bodies failed or because medicines failed, but because the world around them see them as not worth much, so not worthy of much effort, time and expense to try to save them.

Doctors who challenge these utilitarian views by their voices and their actions indirectly save far more lives than do their equally competent colleagues who may directly save more lives, but who are content to only save the lives their culture deems worthy of saving.

The Allies (rather like the Axis, differing only in degree not in kind) divided the world of World War Two into three parts, like Gaul.

There were the enemy-oriented people and the allies-oriented people : themselves further divided into 1A allies and 4F allies.

Until June 1943, only enough American resources were going to be devoted to penicillin to ensure that the needs of the 1A allies would be met.

Then the American WPB (Wartime Production Board) made its most surprising decision ever : that a considerable portion of America's bomb and bullet making potential would be diverted instead to making lifesavers - penicillin lifesavers enough to save soldier and civilian alike.

This was not a decision followed by Britain , Canada and Australia.

They decided to divert only enough of their country's resources to penicillin-making to fill the needs of their armed forces at a minimal level.

Winston Churchill and his Tory-dominant government took the lead on this decision, by their broad hints and inaction (if nothing else), and the other Commonwealth nations chose to follow his lead rather than that of the WPB.

A single additional Lancaster bomber squadron is about three million pounds in 1943 money,(about a million pounds in planes , plus two million pound  more for the 500 members of the squadron , hangers, armaments, fuel etc).

This amount would have paid for enough new penicillin production facilities such that by early 1944 , Britain's could have supplied its civilians as well as its soldiers.

Ie, match the Americans' penicillin output, despite using a lower level of technology.

We know well enough the costs of a Lancaster squadron and  the costs of Glaxo's low tech but highly efficiently run bottle-penicillin factories , to be able to make this claim with a great deal of certainty.

Churchill, however, chose 'LANCs over PEN' and paid for it in the surprising election results of June 1945 ; the inequalities of  wartime health care provision being the number one reason most people chose the egalitarian Labour Party over the war-winning Tories.

America's super abundance of wartime penicillin allowed it to use penicillin as a tool of diplomacy , replacing British influence with that of the Americans at every turn : replacing Pax Britannica with Pax Americana,  again causing Churchill to "win the war but lose the world".

Dawson did not force the WPB to make the decision it did, though certainly his uniquely civilian oriented approach to penicillin treatment, starting way back in September 1940, must have played a part.

But the WPB pledge was just that : a pledge - it was up to industry to carry it out.

Industry was willing - even eager - to build high tech buildings out of extremely scarce materials now suddenly obtainable thanks to top-of-the-drawer allocation quotas for would-be penicillin producers.

Postwar, those buildings would give them an early lead on their competitors.

But they weren't so willing to make biological penicillin in those shiny new buildings, not with rumours than synthetic penicillin was just months away.

Dante Colitti forced their hand.

In August 1943, the junior staffer, a surgical resident at a small hospital a mile from Henry Dawson's hospital,  was about to get married and go on a honeymoon. He didn't have to go poke his nose into the affairs of a patient in the non-surgical part of the hospital.

But he did.

He was moved by what he had heard about the dying Henry Dawson a mile away being willing to steal government penicillin to save the weak and the small.

 And perhaps because Colitti himself was a lifelong "cripple", suffering from TB of the spine.

Dante decided to risk his own career by intervening over the other more senior doctors' heads on a patient that wasn't even his --- urging the patient's parents to call the Hearst newspaper chain directly, to ask them to help obtain the tightly rationed penicillin needed to save the baby's life.

The resulting day by day heart-rendering accounts and photos of the life-saving efforts for little Patty Malone finally - albeit 15 years late - put a human face on penicillin.

Suddenly the population woke up to the fact that they wanted/  needed  penicillin -right now ! - and what was their Congressman doing to see that it happened ?

Doctor Mom, in high dudgeon , can provoke fear even in generals, industrialists and Presidents and soon John L Smith, boss of the biggest potential penicillin producer (Pfizer) got the moral message as well.

The chain reaction : Dawson + Charlie : Dante Colitti and Patty Malone:  John L and Mae Smith and memories of their own dead daughter  + Pfizer : tons of and tons of penicillin by April 1944,  is clear enough .

Also clear enough is an ageless message : one person, even if they are dying, can indeed make a world-quaking difference .....

"Pax Penicillia" : how Churchill's Britain won the war and lost the peace

The decision by Winston Churchill's (Tory) Minister of Supply (MoS) not to divert the money for one additional Lancaster squadron, used to bomb civilians in Europe, towards providing enough penicillin for British (and European) civilians resulted in Churchill's Tories winning the war for Britain --- but at the cost of losing the peace.

By contrast, when the (left-leaning) War Production Board (WPB) decided to greatly up the production level of American penicillin from the miserably niggardly amounts proposed by the (right-leaning) OSRD , the resulting surplus provided State Department diplomats with the amazing opportunity to wrestle Victory's moral  authority from Britain (which claimed - somewhat incorrectly - to have stood alone against Hitler) to the tardy latecomers Americans.

Forget Chewing Gum and Coca Cola, or even the A-Bomb , the single best means for American diplomats to win friends for America was by providing the gift of life to people dying of sulfa-resistant infections all over the world.

And thus, American "Pax Penicillia" replaced the "Pax Britannica"...

Penicillin's "Bengali Famine Years" : 1943-1944

It was not America and Britain, it was not even the British and American governments ,that made the momentous decision, between late 1942 and early 1943, not to divert tax money just a little away from bombs and towards penicillin production instead.

This decision led, over the period of 1943-1944,  to a Bengali Famine-like situation among the Allies over shortages of live-saving drugs for civilians.

It was only one government agency in each country that made that decision ; albeit all-powerful agencies in the middle of a war.

But I do not believe they acted contrary to the informally expressed sentiments of their country's war cabinets.

Let the record note their names : Vannevar Bush's weapon-developing agency known as the OSRD in America and the Ministry of (Army) Supply (MoS) in Britain, with the common link urging them into this course being Sir Howard Florey.

By contrast, diverting even a tiny tiny amount of the government's war resources to the issuing of firm standing orders for penicillin purchases could have provided adequate semi-purified natural penicillin to treat all cases (civilian and military) of patients dying from blood poisoning that were resistant to the only life-saving alternative, the sulpha drugs.

Let me make it perfectly, morally, clear : the fundamental issue was not that penicillin was in short supply : it was that any method of saving those dying of sulpha-resistant blood poisoning was in desperately short supply.

These diverted resources , expressed as firm government orders for penicillin at currently profitably prices ,would have stimulated private capital to make good use of current technology and of idle rural factories that had closed because of the war , as well as unskilled rural labour also left idle because of the war.

As models that this could have and in fact did work in practise, one only needs, in the case of Britain, to point to Glaxo's first low tech but efficient penicillin factories cobbled out of bits of unused space in other people's factories.

And in the American case, to point to an enterprising rural mushroom farmer called Raymond Rettew who briefly became the world's biggest penicillin producer, in the late spring of 1943.

FDR's party did not lose the 1944 election over this issue , because another part of his American government (the WPB, War Production Board) chose to totally reversed this decision, and in spades.

But Churchill's party did ultimately pay the full price for this decision made by the MoS (led by his fellow Tory, Sir Andrew Duncan) not to push for enough penicillin production resources to help civilian as well as soldier, later in the war.

That was when his party overwhelmingly lost the general election it was supposed to romp home in, July 2nd 1945 .

Churchill's equally callous decision not to stop the wartime Bengali Famine in which four million people died ( "If there really is a famine, why hasn't Gandhi died?" he sneered) probably also sealed the chances of Churchill's Britain holding onto the Indian Empire.

If Florey had been even moderately left wing rather than very right wing, he might have gone to other more left wing oriented agencies of the British and American governments and the wartime penicillin story could have been very different .

If the wartime history of Civil War Era America was written as historians write the Pollyanna story of wartime penicillin, there would be only one America and one government ,with no sense at all of conflict between different parts of America.

My work on wartime penicillin will make it very clear that two agencies of the American government, the OSRD and the WPB were not in agreement on penicillin production levels and methods but in conflict.

 Just as in the UK,  Howard Florey/MoS and Harry Jephcott/Glaxo were not in agreement on these same issues but in conflict.

And I will make it clear that there were no technical reasons why civilians could not have penicillin in 1943-1944 , rather it was the result of a political and moral decision not to produce one less bomber squadron if that was the cost of bring penicillin to dying civilians.

For these were penicillin famines by government fiat : Bengal-on-the-Potomac and Bengal-on-the-Thames.....

OPRD and Dawson vs OSRD and Florey : social or war penicillin ?

If America was to win the war for the Allies by being becoming a ponderous and relentlessly-slow grinding mill of the gods ( a veritable "Arsenal of Democracy" as President Roosevelt proclaimed) than sometimes Vannevar Bush's OSRD (Office of Scientific Research and Development) worked hard against that objective, never more so than with Penicillin (and DDT).

In Total War, attrition (greater weight of arms and men) rather than generalship (the better use of the elements of secrecy and surprise) is felt to be - in the long run - the truly dominant factor.

The OSRD obviously disagreed, as did Hitler's High Command and the Japanese War Cabinet.

These three agreed amongst themselves that it didn't really matter that both sides shared the same 105mm howitzer and that so the side with the best rate of production of that artillery piece and its ammunition would win in the long run.

That was so old-school, so World War One style thinking.

No, the OSRD would win a quick clean war, by speed and secrecy of new weapon invention and by taking the offensive role at every turn in the war of new weapon invention : as the British would say, WWII was to be a war between sciences : a Boffin's war, not a foot soldier's war like WWI.

But you could also see this as classic "chicken hawk" style thinking  : stoutly favouring bold offensive operations, albeit from the cosy safety of an comfy armchair.

Because seemingly the only requirement for rising in the OSRD hierarchy was that you had successfully avoided combat when you were young and fit enough to do so, but now that you were now old and fat and balding and safely beyond the age of conscription your bellicosity had returned full on.

The German, Japanese and British military agreed with the OSRD - preferring to invent more truly new and superior - secret- weapons even when they knew this meant that fewer units of existing conventional weapons would be produced.

(By contrast, the Russians tended to want to produce greater numbers of a far fewer and far less technically sophisticated range of weapons - working in some minor incremental improvements over long, long production runs.)

So if the OSRD "took up" the development of Penicillin and DDT it would come with some heavy and hidden costs : for these two would now be developed strictly be for use as  secret and new "instruments of war" (weapons).

How we "almost lost penicillin" : it got captured by the OSRD

Penicillin being "captured" by the OSRD in the summer of 1941 when Howard Florey took it to his old pal ( OSRD heavyweight Dr A N Richards) wasn't as bad as being captured by the Gestapo , but it was a close run thing.

By contrast, the War Production Board (WPB) and its OPRD (Office of Production Research and Development) took a more sophisticated view of war work in a Total War situation : understanding completely that if civilians don't eat or are home sick, both old-fashioned howitzers and new-fashioned atomic bombs don't get built.

So if the epidemic of lung infections in America in the winter of 1944 among war workers had become a pandemic and shell production had been cut in half, just when the Battle of the Bulge needed more 105 mmm shells not less, the OPRD would have been ready, with massive amounts of civilian penicillin for ailing war plant workers.

But the OSRD would be left touting its claim that fewer of our wounded men in the Ardennes were languishing in hospital beds than in the case of the Germans, thanks to our Allied frontline military hospitals having most of the world's scarce supply of natural penicillin.

Artificially scarce , by government fiat, only because the OSRD and its British counterpart were STILL working on trying to make top secret synthetic penicillin and didn't want to warn the Germans of penicillin's potential by letting civilian doctors use it and then talk up miracle cures.

Dawson's unexpected SBE cures with stolen government penicillin leading to dying Baby Patricia Malone's widely publicized 'stealing' of penicillin beyond the OSRD's direct jurisdiction, brought the public and the OPRD into the picture and finally got us wartime penicillin en masse : for frontline Ardennes soldier and home front civilian alike .....