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....

Henry Dawson puts the Allied treatment of the weak and the strong to the "Acid Test"

This was Henry Dawson's Acid Test : during World War Two, did the treatment of the weak and the strong by the nations that ultimately made up the Allies differ in kind or only in degree from that of the Axis nations?

Any single individual - let alone a single dying individual - could not pose that question across a broad spectrum of issues and expect to force a response.

But in focussing tightly upon the Allies' differential medical treatment of the lightly wounded combat soldier and of his high school pal back home dying of endocarditis, Dawson did manage to hit a sore spot among the Allies --- across America and Britain in particular.

In late 1943 , Henry Dawson was able to make the Allied public realize that , on this issue,  their elite leaders differed far less in kind from the "the weak must die so the strong can flourish" philosophy of the Axis that anyone could have comfortably imagined back in 1939.

When the Allied public forced their leaders to alter course and provide penicillin, during wartime, for endocarditis patients, the whole of civilized thought shifted course --- permanently.

No mean response for a persistent little team locked away in a ward, a lab and a doctor's office ......

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

If my claim be wrong : show me the money !

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

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

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

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

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

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

Dr Martin Henry Dawson and the MORAL INVENTION of 4F penicillin ---- during a 1A war (PART 1)

Thalidomide has had 9 lives...

Is it truly unfair that only Paul Gelmo initially invented Sulfa-the-(useless)-chemical, but is was Gerhard Domagk , 25 years later, who won the Nobel prize for Sulfa?


Not in the eyes of  99.9999999% of contemporary (and very grateful) observers.  Because what Domagk invented was something called Sulfa-the-lifesaving-miracle.

Though you'd never notice from our "initial discovery" obsessed journalists, many, many important things were invented several times over.

Thalidomide is a particularly spectacular example : it had already had several medical applications ( with good successes but also very severe side effects that were kept secret) before it was promoted to cure morning sickness.

We all know the results that that particular application caused.

But, believe it or not, it is still in use - for forms of leprosy in particular, - and still being investigated for its ability to inhibit some tumours: new uses still being invented for an old "initial invention" .

AZT and carbolic acid were both much later "re-invented" when they were dragged out of the medical gutter and first used for the uses we best know them for today.

We don't - but we should - most highly honor those people who first put a product to its highest use, rather than merely honoring those who first invent or discover it as a mere substance.

Those who only honor  those who initially discover or invent something are unconscious devote disciples of Auguste Comte and his dogma of Positivism.

That school of thought, if it can be called that, sometimes assumes that the mere act of discovering or inventing something will also instantly inform that inventor/discoverer as to its many self-evident uses and to its self-evident highest possible use.

Anyone else who later does put it to such uses, in this view, was merely taking advantage of information that is open to all that gaze up the substance---- and hence not worthy of any honor.

Put like that, Positivism use in this case does seem childishly ridiculous - as many unstated assumptions often are - when they are more closely examined.

Most re-inventions are of a technological nature : something long thought capable of merely reducing the pain of leprosy turns out to actually - and unexpectedly - reduce the advance of the disease. ( In this case, the drug in question is thalidomide.)

But probably the most famous medicine and science story of all time also saw a substance re-evaluated for a new use , but for moral reasons.

A doctor's moral anger drove him to break a whole bunch of rules and norms to stick the first ever needle of (dirty) penicillin in a dying patient's arm : and the patient lived.

There had never been any technological barriers to putting Alexander Fleming's penicillium juice in a needle and sticking it in a patient's arm to save their life.

Not even to sticking penicillin into someone's arm to save them from invariably fatal Subacute Bacterial Endocarditis (the dreaded SBE).

Doctors and Scientists' objections to natural (impure) systemic penicillin were only ones of an aesthetic nature

The objections had only been quasi-aesthetic : in a modern scientific age, was it worth the risk to the dignity of the medical profession, to be seen sticking something seen as mostly dirt into the human bloodstream, even if it was in a worthy attempt to save the life of someone otherwise facing immediate death?

Many doctors, faced with lots of patients dying of an invariably fatal disease, will indeed throw a kitchen sink of oddball medical treatments at them, in the hope one will stick. SBE saw many such attempts.

But from September 1928 till October 1940, no doctor in the world ever stuck penicillin in someone's arm, to see if it might save their life --- for any disease. Amazing but true.

Since 2004, I have lived and breathed and dreamt why this might be so - and why the unlikely doctor who finally did so , Martin Henry Dawson, chose to break that mental barrier.

It matters because it is only his Penicillin (Penicillin-the-natural-systemic) that the world has used since 1940 - not Alexander Fleming's Penicillin-the-synthetic-antispetic or Howard Florey's Penicillin-the-synthetic-systemic.

It is his penicillin - and his penicillin only - that we use, but it was those two who got the Nobel Prizes for penicillin.

Dawson probably backed his way into penicillin - driven by his anger over the way that the "4F" in society were so quickly abandoned at the first opportunity --- in this case, in preparing to fight a war using the best "1As" in society.

His special area of interest - Rheumatic Fever (RF) - was mostly a disease of the poor, so the well-off donors to the cause of RF were largely motivated by pure altruism.

But it had been recently replaced (by the Fall of 1940) by Polio as the number one child health "Cause" for America's well off .

Polio deaths were far ,far outnumbered by RF deaths, but polio was a disease of the well off mainly, and this was the first evidence of a now common organization : the patients (families) self-help group : mothers going to door to door to find a cure for a disease that might hit their own children.

We generally think this is a good thing, but it is also another example of a society of individuals increasingly looking out for Number One.

In 1940,mighty  America collectively looked out for itself as Number One and did not come to the aid of about a dozen of Europe's small weak nations : Czechs, Poles, Danes , Belgians etc etc.

Dawson who had gone to war to help the people of little Belgium in 1915, was in agony - too old to fight, but also too principled to just sit back.

When he arrived in the Fall of 1940 back at his employer (Columbia University Medical School), he found that the research and teaching efforts were to be dialled back in social medicine (medicine to help the poor) and put into war medicine (making the armed forces better fighters).

By sheer coincidence, his fellow researcher, German Jewish refuge (and potential internment camp alien) Dr Karl Meyer, wanted to revenge himself upon another biochemist who he felt had downplayed Meyer's successes. This biochemist was also a German Jewish refuge and potential alien in an internment camp), Ernst Chain.

Both men were not evil or naive : they simply knew the best way to be kept out of a miserable internment camp in the event of war, was to be judged very useful by their anti-semitic hosts. So they were holding nothing back to avoid an internment camp for themselves and their families.

Meyer thought he was a far better biochemist than Chain (very true !) and could more quickly and easily synthesize penicillin  than Chain (very untrue !)

Would his friend, Dawson the bacteriologist and clinician, help out by testing the resulting product ?

Dawson read up on what little there was on penicillin and noticed its unique combination of extreme non-toxicity and extreme diffusiveness could possibly be the best shot in a long time to cure SBE.

Now SBE was usually a matter for the heart specialists (an elite in every hospital) and Dawson's main job was in an arthritis out-patient clinic (at the low end of  any hospital's pecking order).

Moreover, some people had made SBE their primary lifelong research and clinical interest and Dawson had never - as far as I can tell - written or spoken on SBE.

To barge into their area of expertise would be a disaster.

I can only presume that Dawson first suggested his idea to SBE and heart experts and then to his contacts at the big Drug Companies.

Only when none responded positively and he had two dying SBE patients in front of him, did he act.

Because he felt that penicillin might save their lives, he pulled out all stops and broke all the rules and norms, to try and save their lives --- with this urgency additionally fueled by his anger at how the 4Fs of society were now being treated.

SBEs, in a month of the first ever peacetime Draft registration ( an entire nation trying to find all the 1As in society), were everyone's 4Fs of the 4Fs : about the most useless to the war effort young males imaginable.

Many medical staff felt they'd only consume precious medical attention for months and then invariably die anyway.

So, when Dawson stuck that first ever penicillin needle into an SBE's arm on that first ever peacetime Draft Registration Day, I feel sure his first finger was cocked in the air while the other four were wrapped around the needle.

"Down goes the needle - and 'up yours' !!!!! " .....

NYC medical community , August 1943: Martin Henry Dawson's OPEN SECRET ...

Nothing does more to lower the normally high social prestige of all doctors, than a disease that is 100% incurably fatal.

You could argue that no disease is 100% incurable, technically ----
but you would be wrong. Wrong, wrong: dead wrong.

Yes, there is always a tiny number of people who survive even the worst diseases -- but they not 'cured' --- these people survived even if they never saw a hospital or a doctor.

They survived , yes.

But they were not 'cured' by human agency.

Give the credit to God or Mother Nature instead.

No doctor or nurse likes to have to tell patients and their families that there is nothing medically one can do and they should prepare for a tragic death.

Death is painful for all of us - but for medical professionals to have to admit to others that they are powerless and useless adds an extra sting to the unpleasant task.

Normally they get to say "Its Stage Four - the prognosis is very guarded but we will try radiation."

 The patient still dies but the family respects the doctor for at least trying.

SBE  (Subacute Bacterial Endocarditis) was one such invariably fatal and uncurable disease during the war years.

In fact, it was the most common invariably fatal disease in the western world in those years - the invariably fatal form of brain tumors ran a very distant second.

It could hit anyone: anyone can get strep throat anytime in their life, and get it over and over --- from that they could get RF ((Rheumatic Fever) at any time in their life, and get it over and over.

That greatly increased, in turn, their chances of getting SBE, at any time in their life, - and get it over and over, if by some real Miracle, they survived the first bout.

Every medical single doctor came across cases of fatal SBE in their career in those days --- they hated it for what it did to patients and families (  particularly because SBE patients were on the younger side of life usually) and because it made doctors feel powerless.

Now: cue August 1943, and the medical community of greater New York City.

Throw in SBE researchers, ordinary ward nurses, SBE patients, their families and friends, - heck throw in all the patients and families of people with past bouts of RF, just waiting to be told they now have SBE.

On one hand, the government - your government - has publicly and officially said that regrettably Penicillin does not cure SBE.

But this is wartime - who totally trusts the government and media?

The wartime medical slash patient grapevine throughout greater New York City area is alive with a different story: a doctor named Martin Henry Dawson has gotten half a dozen cures off of penicillin for SBE .

"One patient got his SBE back in August 1940, that's three long years ago. And he's still alive !!!!"

Dawson's success, he tells all who ask, is only limited by the tiny amount of penicillin he can steal - that's right - STEAL from the government supplies, to give to his SBE patients.

Doctors from all over the area are visiting him, asking him to help with their SBE patients, promising to steal additional penicillin if he will only help.

Heavens ! One of them is even the President's personal doctor, yes FDR himself !!!!!

Mysterious bottles of bootleg penicillin keep on turning up at doctors' doors, provided by ladies in white --- taken presumably from the city's one pharma plant that is producing penicillin.

None of this is being reported in the local or national media ---strangely a cone of silence has descended on this good news story in the wartime media, which could use a little relief from having to report years of bad news stories.

That is until a young hunchback doctor named Dante Colitti and the purple-paged Hearst flagship newspaper decide to blow the story wide open.

In theory, its just a local NYC story --- but there is an old,old saying in the music biz : "In NYC, there is no such thing as a regional breakout: if a song is breaking in New York, its breaking wide stateside...."

Within days the story is all over North America - and then all over the world - even into wartime Germany and Japan.

I have always been very interested in the differences between knowledge that is private, that which is public and that which is popular.

For example, the Nazi Hunger Plan to kill 30 million Slavs during WWII to free up food was private during the war , the killing of 3 million Polish jews was publicly known during the war while the Nazi killing of 300 people in the little Czech village of Lidice was popularly known during the war.

Open Secrets are an unusual hybrid of the private and the popular - bypassing the public (aka the official/conventional/ mainstream media).

Lots of Nova Scotians (my estimate was 5%)  knew, from gossip, the private knowledge that a high public official in Nova Scotia 'couldn't keep his pecker in his pants' when it came to women (particularly young women, unwilling young women).

About one person in twenty could tell me detailed details of the crime when I asked.

That may not sound like much, but I bet fewer than 5% of any given population could tell you much about the top news story in the land, despite it receiving wall to wall coverage in the conventional media.

So it was private, yet popular, yet not public - none of the semi-official media in Nova Scotia (aka the CBC, CTV and the Herald newspaper) had reported anything on it.

The stones may have cried out over the injustice, but no opposition politician, or theologian, professor of ethics, feminist group or police department had gotten exercised over the scandal.

This had a corrosive effect on how ordinary Nova Scotians viewed their supposed moral leadership when the population knew a crime but their leaders did nothing.

I often wonder what led young Dante Colitti to do what he did ---I can't help feeling he wanted to prick this cone of official secrecy as much as he wanted to help save the life of the baby girl in his care...

1941-1950: Friedberg revises SBE deathwatch

In 1950 Dr Charles Friedberg told the readers of JAMA, one of the world's leading medical journals for frontline doctors, not to forget that SBE was now the easiest of the common heart diseases to cure.

They listened.

 Friedberg had quite literally wrote the book on SBE, back in 1941.

The, ahem, old book on SBE.

In that 1941 book, Friedberg and chief co-author Emanuel Libman had carefully surveyed 1200 cases of SBE in detail and said 'no cures' - at least no cures by the efforts of doctors.

 However three percent might expect a spontaneous cure.

Until the next and the next attack -  for SBE was a repeater disease and so really inevitably fatal - over the short medium term period.

Another researcher at the time was even less hopeful - finding  out of 249 of his SBE patients, maybe one had a temporary cure.

But now in 1950,Friedberg's 'invariable fatal SBE' had become Friedberg's 'the most curable common heart disease' !

The reason for this amazing turn about, Dr Martin Henry Dawson, had died a little earlier, back in April 1945.

But these amazing 1950 conclusions were due to his pioneering 1940-1945 efforts to prove up penicillin as an anti-biofilmic agent , able to penetrate SBE vegetations and kill the bacteria without killing the patient.

It was a mission carried on and brought to a spectacular conclusion by his assistant Thomas H Hunter, after the war.

DOCTOR MOM  now had one Sword of Damocles removed from over her head --- thanks to a doctor from Columbia University.

Just in time too.

Because another doctor from Columbia university, Harold Urey, PhD, had just given her a new Sword of Damocles.

During World War II, in one part of Columbia,
the former Lt Dawson,(winner of the Military Cross with Citation),was busy(illegally) curing "4F" SBE patients.

 Meanwhile, in another part of Columbia, Urey-The-Pacifist, with his crew of war-exempt healthy, young "1A" scientists, was busy inventing the Cold War's most fearsome weapon: the gaseous diffusion process for the extraction of uranium for the mass production of nuclear weapons.

As a result, 1950s kids, of which I was one, were the healthiest and the most scared generation of kids ever raised.

Thank you, Columbia.....