WWII: the horrific medical 'Triaging' of New York Jews and Blacks

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

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

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

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

Patient One , A and B

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

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

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

Heart valves damaged earlier by RF (Rheumatic Fever).

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

The Polio of the Poor

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

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

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

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

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

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

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

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

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

Delay meant Death

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Antibiotics arrives, despite doctors' best efforts

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

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

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

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

Enter Charles Aronson

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

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

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

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

Several reasons.

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

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

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

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

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

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

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

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

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

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

Dawson hated Triage

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Cynical, clinical, trials

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

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

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

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

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

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

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

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

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

The tiny amounts moral dilemma

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

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

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

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

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

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

Carefully applied, triage can be highly moral.

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

William Osler's take on the whole affair ?

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

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

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

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

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

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 ....

On a day when most other youth got America's first peacetime draft card, Aaron & Charlie got History's first needle of antibiotics : Dies Mirabilis ,October 16 1940

When the possibility of  your nation joining a world wide war looms, getting your first ever draft registration card must feel just like getting the kiss of death, to a young man on the campus of Columbia University.

But when you are a young man on another part of Columbia's campus who has been written off  'as soon to die from an invariably fatal disease', getting instead History's first ever needle of antibiotics, must feel just like getting the kiss of life.

Hence the spooky Janus-like nature of Dies Mirabilis , October 16th 1940.....

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 ....

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 .....

Penicillin's four most famous patients shouldn't have been PATIENTS... according to the research protocol

When anal-retentive children grow up, if indeed they ever grow up, they either became clients of Madame X the Dominatrix... or they become medical research scientists devoted to extremely strict and rigid clinical trials with firm protocols and hard-fast deadlines.

So it was with wartime penicillin and a group of such anally-oriented researchers swore to devote whatever scarce natural penicillin they could produce to test on cases of staph (and gas gangrene) infections.

After all, the various patented and chemically synthesized  sulfa drugs could be relied upon to look after the far more common and more deadly strep infections, couldn't they ?

Or maybe not.

Let us look at those famous four early cases.

By chronology , the first was Charles Aronson ,dying of SBE (subacute bacterial endocarditis) caused by strep viridans in October 1940.

Dr Henry Dawson gave him a tiny amount of penicillin (to boost his morale) and a whole lot of sulfa to help his body defences and he unexpectedly survived this invariably fatal disease.

Case One : success one.

(About his fellow SBE patient, Aaron Alston, little is known for certain,  only that he received the exactly same tiny dosage of penicillin as Aronson at first and later got some additional slightly larger doses of penicillin.

It is implied that he died of his disease early in 1941: but then this is also said to be true of Aronson and that claim is definitely wrong.)

Case Two.

That famous policeman dying from the prick of a rose : Albert Alexander of Oxford would have lived, should have lived, if only Howard Florey hadn't polished the apple so long testing penicillin on healthy animals (his forte) rather than on dying humans.

That and stopping the course of antibiotics too soon (today a widely known elementary error but something I can't really blame Florey's team for back in February 1941.)

Alexander had a mixed infection of strep and staph that had gradually consumed most of his face and was now threatening his brain. At the stage of his disease when he first met penicillin, conventional wisdom was that he was a definite goner.

 It was second miracle that he recovered from this --- until the penicillin needed to totally clear up his infection was given to someone else who were not dying of their infection.

Case Three : Anne Miller.

The OSRD/CMR and the NAS/COC (the medical war lords of Washington, to adapt Bruce Catton's famous phrase) had agreed, along with the only two (out of over 200) drug companies in America that agreed to join in their restrictive government effort on penicillin, that the first priority on investigating the healing powers of penicillin was to look at staph infections.

In addition the two drug companies, Merck and Squibb , felt would be at least mid-1942 before any of this government-sanctioned penicillin would be released for clinical trials.

But strings were pulled to save the live of Florey's best friend, John Fulton, a top member of America's medical research elite --- by claiming the badly needed penicillin was actually for his fellow patient Anne Miller, dying of strep infection after a miscarriage.

So in March 1942, her life, too, was saved, in a dramatic fashion and post-the-awkward-fact that this totally broke all the agreed-upon protocols, the OSRD and NAS began touted Miller as the first patient treated in America.

 (Obviously not true, but "embedded historians", ie historians who do most of their research in the lush gardens of the self-selected "official" archives of the OSRD and NAS, have generally fallen for this hook and sinker.)

Case Four : Harry Lambert.

Lambert was an employee of Fleming Brothers, a very successful optical wholesale firm run by Alexander Fleming's family.

When his strep infection wasn't helped by sulfa, Alexander was pressured by his family to try some of his wonderful penicillin on the case.

Awkward that : cause Fleming claimed he didn't have any and never did have any of his miracle drug.

Fact was, Fleming was still totally repugnant to putting his own "crude" penicillin into the temple of a human body. So he went cap in hand to Florey to get some "refined" penicillin.

Florey, to his credit, gave him as much as he had - pulled from experiments in purification and synthesis of penicillin.

(Florey's penicillin was still 75% junk, just as Fleming's penicillin was 99% junk , but it had been manipulated by a real live chemist, so that made it alright to put in a body !)

Lambert's life was saved, partly by Florey's penicillin and partially by Fleming's surgeon manque skill in injecting it into Lambert's spine.

As a result, Fleming overnight became a true believer in his own medicine's systemic healing powers ,14 years after he first discovered it.

Sulfa-resistant strep was a leading cause of death by 1942...

Four cases, among many, where the first wonder drug , the sulfa family of medicines, were not working and where only penicillin saved a life.

But still a great reluctance (except from Henry Dawson) to say this aloud in front of the customers : that a mold-medicine was beaten the pants off a man-made synthetic and was not merely a supplement to sulfa for frontline staph wounds, but an all-around better life-saver and needed to be mass produced, like yesterday.....

"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.....

Leonard Colebrook is CENTRAL CASTING's penicillin hero

Time to wake up.

This isn't Hollywood.

"This Reality talking: Put your hands in the air and move slowly away from the World of Fiction".

In the World of Reality, Leonard Colebrook actually did bugger-all to advance the development of penicillin.

But Hollywood isn't totally wrong - he should have been the one to make penicillin a world wide success by 1932 or so.

He actually did do so in 1936 with a later - and lesser - 'miracle drug' : the sulfa family of drugs.

He did it by using some of the first commercially available sulfa to reduce childbed fever deaths to a very low figure - a feat that alone should have earned him immortality from grateful young mothers and families.

Childbed fever - actually commensal GAS strep bacteria (long term residents of the throats of the many attending doctors and nurses) settling in on the huge wound that is every new mother's uterus - is a particularly dreaded form of infectious death.

The death itself is often very painful. By definition the patient is relatively young (ie in her child-bearing years) . The death leaves a new born baby to be raised alone by a grieving young father and his young family.

Next Colebrook went on to pioneer new techniques to combat other forms of cross-infections that frequently develop in hospitals - starting with World War Two burn victims.

Even in retirement he led yet another crusade to modify the ubiquitous space heater so they all had clothing guards installed by law. Until this law was in place, thousands of people a year - in the UK alone - got severely burned or died, when their night clothing got set alight when it got entangled on the bare heating element.

His parents had raised him to be a Non Conformist missionary and reformer. In the event,Colebrook did as many would-be missionaries did at the turn of the last century - he channelled his missionary impulses into the field of medicine.

His highly moral impulse remained as intense as ever in everything he did.

He joined the Territorial (Reserve) Army and when he was called up in 1914, was prepared to go to the front as an infantry officer, not as a doctor.

But he was judged too valuable as a medical researcher to remain on the front lines - he spent the rest of the war in the rear echelons, with Fleming and Wright.

But at least- and unlike Fleming or Florey - he was willing to go to the Front.

In World War Two, he was again at the front, in a medical military capacity - teaching medical teams how to use sulfa powder in new war wounds ( he knew little more they did !) - and as the Front Line dissolved and became meaningless in the Battle for France he had a number of very close escapes.

He was 57 years old - and still at the front,  still in the thick of it, trying to save lives 'right here, right now'.

Colebrook was the near-perfect example of  the type of doctor I call the ward-doctor type.

This type of doctor may suffer from EED (Empathy Excess Disorder), in that they care too much for the patient, feel too much of their pain.

When they see patients dying needlessly around them, they are inclined to throw themselves even deeper into the battle at the bedside level - trying to use any or all of the best available techniques as best they can, as hard as they can.

What they can not see themselves doing, is beating what they'd call 'a cowardly retreat' to the quiet of a laboratory to 'study' the disease at its most fundamental level, hoping to find a cure - 'sure ,in about 6 years time'.

JV Duhig, Robert Pulvertaft, RH Boots, Perrin Long, Frank C Queen and even Karl Meyer are all doctors in the penicillin saga that fit this type.

There is a totally different type of doctor I will call a lab doctor. They probably suffer, to some extent, from EDD (Empathy Deficiency Disorder).

 They too find it very hard to see patients dying needlessly, but they reject 'simply'  providing 'band aid' palliative care for those who are dying without a cure in sight.

They spend their careers in the laboratory seeking the fundamentals of a disease and its cure in the universalities of chemistry and physics - as far as possible away from living, breathing, capricious individual human beings.

They may serve - if they must - in the military but they contrive that it is done in the rear echelons.

 However, once over draftable age, they frequently display a newly bellicose attitude to war service that one rarely find among the ex-veterans who actually faced death on the front lines.

I am thinking of Fleming, Florey, Keefer, Richards, and their ilk.

Now they may have something to offer society as scientists, despite the negative picture I paint of them.

They are no more quitters in the lab than the clinician doctors are on the ward.

They might have the skills to grow something as difficult as penicillium and the strength to hang in there when their first ten months of efforts are marked by nothing but failure.

One could see Florey and Colebrook as the perfect combination of two men who are incomplete as individuals, when it comes to successfully developing penicillin.

Colebrook would be too focused on 'saving this patient - today'  to ever set aside the months of time needed for the effort in the lab to learn how to grow penicillin.

 Florey ,on his own, would be too focused on purifying penicillin to 100% pure to remember that there is a war on and patients dying while he fiddles.

But Florey and Colebrook had nothing in common, in terms of their personalities---- I couldn't see it ever happening.

Colebrook, by contrast, had worked successfully for years with Fleming at St Mary's but the relationship had soured when Fleming moved to displace Colebrook in Wright's affections.

Colebrook regarded Wright as his second father and could never forgive Fleming for this.

Besides, Fleming clearly lacked the drive to do hard work for months on end, needed if a hospital lab was to produce enough penicillin for human trials.

Colebrook succeeded with sulfa where he failed with penicillin because sulfa was abundantly and cheaply available in a stable form, ready to have any nurse give the patient as a pill as scheduled.

Penicillin had to be grown by the doctor determined to use it - as no drug company was really that willing to help.

He or she would have to concentrate and purify it and then preserved this highly labile drug long enough for it to make it to the patient's arm. It had to be given IV, and hence by doctor,likely themselves in fact ,a needle every three hours around the clock for weeks at a time.

Few doctors - even of the heroic cast like Colebrook or his American counterpart Perrin Long - were up for this.

Only Martin Henry Dawson combined the rare strengths of Fleming/Florey and Colebrook /Long in just one person.

That is why 70 years ago this week ,it was he - and him alone - that gave that long awaited first ever needle of penicillin, that sent a young boy named Charles Aronson home from his expected deathbed.....