In the end, finding out about the Patient Zero I knew the least about, Aaron Alston, turned out to be by far the easiest.
But first I had to make all sorts of naive mistakes.
I knew that if an acute case of Rheumatic Fever attacks a young child's heart, they can quickly die, without prompt and appropriate medical intervention.
But if they don't die, most of the attacked heart tissue will more or less heal - unless the area attacked is the very delicate and extremely vital heart valves.
You can literally hear damaged heart valves.
Many people have harmless heart murmurs but these particular stethoscope sounds tell a doctor that the valves are damaged and the entire heart is straining in overtime, to pump blood through these only partially closed/open doors.
So doctors will then strongly advise the parents to not tax this particular child's heart.
So no strenuous sports - later on, no vigorous dancing, no passionate sex acts, pregnancies are very dangerous, chasing after toddlers is too stressful, etc.
While my brother Bruce had childhood Rheumatic Fever and was left with a heart murmur and damaged valves, ironically enough he was the only athletic member of our extended family !
Though small, he was eager to try out for high school football and was a city level long distance running champion.
So you'd think I would have known better about Rheumatic Heart Disease (RHD) and young athletes.
In my defence, I had just assumed that the heart valves of Rheumatic Fever patients who go on to develop life-ending subacute bacterial endocarditis (SBE) were far more damaged than most RHD patients - so obviously far less capable of championship level athletics.
But this simply isn't so - SBE, like cancer, has a pronounced stochastic (for PhDs) or random (for ordinary folk) nature to it : sheer bad luck as well as bad valves plays a part.
Dawson treated patients who got SBE fifty or more years after their childhood heart valves were first damaged and some who got SBE only a year or two after first getting Rheumatic Fever.
But most patients get SBE ten or twenty years after their valves are first attacked.
Still, when I did find an Aaron Alston finishing in the top level in NYC wide races in 1930, ten years before my Aaron Alston first got SBE, I dismissed that it might be him.
I also got search results for A. Alston too : an A. Leroy Alston also winning athletic events.
I just felt I had got nowhere with Alston - the lack of his birthdate was so crippling.
As I described in an earlier blog, knowing first and last name, residence in greater NYC area in 1940, and birthdate, usually means that 140 million possible American patients is reduced down to one or two.
Without a birthdate, it goes up to at least a hundred possible names.
But in 2014, I suddenly realized I probably did have a death date on him as well.
For his brief medical history made it clear he was going to get all the penicillin Dr Dawson's team had (they were making themselves) but suddenly all the penicillin was switched to another patient.
Alston had obviously died, died in mid January 1941, and almost certainly while undergoing treatment in Dawson's hospital, ie in the borough of Manhattan.
Now a search for an index of NYC death certificates seemed easier.
Well, thanks to many tireless volunteers, it certainly was.
I din't really need a specific borough or specific day or month - a volunteer-run online death index for NYC in the first half of the twentith century, didn't show tons of deceased Aaron Alstons in all of 1941 in all boroughs - just him !
With his death certificate number in hand and because he had died before 1948, I a white stranger from Canada could order up the death certificate of someone who was probably a black man from Harlem.
When the certificate copy arrived, it wasn't as detailed as many death certificates I had seen - but his mother's maiden last name Glaze was one I had never seen - rare maybe enough to find her on on Google Search ?
I kept typing in Louise Glaze Harlem or variations thereof and presto one evening, a website came up of her nephew talking about her - i had found one of Aaron's living cousins !
I phoned him (Claude Jay of Harlem My Love) and first I astounded him and then he astounded me --- because he knew of Aaron as Leroy - or more formally as A. Leroy Alston.
He said he was a big athlete.
A person who used his middle name and not his first name - well who would have thought ?!
Well, my wife's huge family has many who do just that - and Dr Martin Henry Dawson was alway Henry - from birth.
Armed with this unexpected information, I soon found tons of material on Aaron Leroy Alston - some in his own voice.
And Claude made it clear Aaron had hundreds of living relatives all over the US.
I astounded Claude again - discovering Aaron Leroy wasn't widowed as his mom said on the death certificate - Claude thought he was always single.
Instead Leroy and Charlotte Lee had been married in the good times of 1930 but the couple were living back with their separate mothers in 1940 when Leroy was too sick to provide an income.
(Both families, once doing okay, were unbelievably poor in 1940 thanks to the Great Depression, racism and early deaths/severe illness of breadwinners.)
I gave all my information to Claude and tried not to research too much further.
I don't feel, as a white Canadian, that I should tell the story of a black man from Harlem - Claude is a relative, journalist, activist and author - he'll tell the full story well I am sure.
Now I turned my hand to another named SBE patient of Dawson - known only as Mr Conant.
(I came to assume that the highly unusual use of that word Mr meant he probably wasn't a young black or Jewish charity case but that he was a private patient, middle class,middle aged and white, from outside NYC)and treated in January 1941.
I searched for a middle aged dead Mr Conant, Manhattan, early 1941, in the NYC death index and up came George M Conant.
Google gave me him in spades - his small town daily describing his SBE illness and his treatment at Columbia Presbyterian at the right dates.
I found Dawson's death certificate and that of little Patty Malone as well - but no Charles Aronson.
That was because he had survived into 1949 at least and NYC death certificates after that date were hard to locate and even harder to gain a legal right to access...
Now read Antibiotics' Patients zero, part 3
Showing posts with label antibiotics' patients zero. Show all posts
Showing posts with label antibiotics' patients zero. Show all posts
Sunday, April 5, 2015
Antibiotics' Patients Zero , part 1
When I began the search for Antibiotics' Patients Zero ten years ago, I very naively thought like a historian, not a genealogist, and as a result, I got precisely nowhere for ten wasted years.
Professional historians are taught to distrust family oral histories and to put all their faith in official paper documents.
Professional genealogists tell their clients to do exactly the opposite: don't quickly dismiss old family tales as myths and legends and never simply take the evidence of official documents at face value.
I also made a fundamental error in math which I suspect you and 99% of the world would do at first try.
If about all you knew about a missing antibiotics' patient zero was that they were 31 in 1944, quickly, what year do you think they were born ?
1913, of course.
And if they were born on January 1st 1913, that fact is always true, no matter when in 1944 the question is raised.
But what if, like my sister Margo, they were born on December 27th ?
Strictly speaking, wouldn't she also be 31 for 99% of 1944, though born in 1912 ?
I had also assumed wrongly, for ten years, that the doctor (Martin Henry Dawson) making this statement about his patient's age was calculating it from late 1944, as he was finalizing the submission of an very important scientific article on this man and others.
But doctors are very busy people and the only time they tend to ask you your age is on admission.
This man (Charles Aronson) was admitted in April 1944 but his birthday was in June 1912, as it turns out.
Further mistake : I took on faith the claim made by many (without any backing evidence - whatsoever) that this patient's doctor long had an overwhelming interest in curing patients with invariably fatal SBE (a form of endocarditis brought about by Rheumatic Fever.)
The strongest claim about this was made by his closest colleague, a colleague for almost all of his scientific career : so a claim hard to dismiss.
But as Google Search got better and as I gathered up all of this doctor's public utterances in articles, at conferences, in textbooks etc, in 2014 I was suddenly struck by the fact that he never once talked about endocarditis -- despite having considerable freedom to do so.
I also now knew that his first antibiotics efforts with patients came just after he had finally moved up from assistant attending physician at a huge research and teaching hospital (aka dogsbody) to associate attending physician, in charge (more or less) of one public charity ward.
Admitting patients to world class teaching hospitals is never easy for 99.9% of doctors - patients themselves are never the priority, to put it bluntly but truthfully.
In a 24 hours a day, seven days a week teaching hospital, most patients are considered for admission when any particular doctor is at home or busy working in another part of the hospital.
The priority for the admitting doctor - a medical student of a sort themselves - is always, 'do my teachers need a patient with this condition - right now - to fit in with the teaching schedule for us medical students' ?
Followed by, 'or would this sort of patient and illness fit in with the research work of the more senior and powerful teacher-researchers here', people who can make or break my future career?
The known wishes of the thus usually absent Dr Dawson, being in charge of a world class outpatient clinic for people with arthritis - would have had considerable sway in the admission process of (private or charity) patients with rare forms of arthritis but that is all.
The only SBE cases he would have any say over occurred whereever seriously ill people simply arrive at the hospital doorstep and basically had to be admitted right away,regardless, for humanitarian reasons.
If they arrived at the one charity ward Dawson was mostly in command of, he not their lowly GP, would have the most say of their medical care.
After all, the patient and their GP were not paying the medical piper.
And I now knew that Depression Era patients seeking admission to Manhattan hospital charity wards almost always came from just a few convenient miles away by bus, subway or even foot - their families were too poor to own a car and worked at tiring physical jobs.
Their frequent, easy, presence at the hospital was a key emotional asset in the patients' speedy recovery --- or in their last days on earth.
Only when a poor person, with an unique set of medical conditions, in a distant community came to the attention of a powerful doctor with good personal and professional connections with the top doctors at a big teaching hospital in Manhattan, could they secure admission on that hospital's charity ward, regardless of the opinion of the ward's attending physician in charge.
And then, be assured, that attending physician would have little say in their treatment : the various Drs Big from outside and inside the hospital would take over !
I now sensed that unless the available evidence suggested otherwise , as it did with history's third antibiotics' patient, the first two patients zero probably came from about a three mile radius around Dawson's hospital (the world famous Columbia Presbyterian Medical Centre in upper Manhattan.)
His hospital had no shortage of very poor people near by in 1940 - blacks in Harlem and Jews in South Bronx.
Research and teaching hospitals can really only thrive if large supplies of poor patients are near by.
These poor, in return for advanced medical care for free, agree to be constantly examined and probed by huge numbers of strangers and agree to submit to new, scary and painful treatments.
Almost all I knew about Dawson's Patient Zeros was their names : Aaron Alston and Charles Aronson.
Alston was/is a common black name in Harlem New York, ditto Aronson was then a common Jewish name in South Bronx --- both places just two or three miles from Dawson's hospital.
But Google provided too many Aaron Alstons (I had no birthdate on him) to narrow my search easily and only one Charles Aronson born in 1913 in the whole USA.
Dawson's Aronson had spent so much of his young life in hospitals fighting off death so many times that I doubted he could have lived too many years past 1945.
(In his last known illness known to me, he had such a severe stroke that he was left paralyzed on one side and speechless as well.)
But when I tracked down the sons of one American Charles Aronson born in 1913 and they said he had been healthy as a horse, all his very long life, and was not in a hospital in NYC in 1940 or 1944.
By this time, some American census results came up in Google search : a Charles Aronson in the Bronx in 1940, but with a birthdate of 1915 not 1913.
But it was close enough for me - because it soon became clear that in all of 1940 USA and searching very generously for birthdates between 1908 and 1918 ,there was only three Charles Aronsons, period - two far from NYC and one in the Bronx.
But the historian in me soon drew a blank .....
See part two
Professional historians are taught to distrust family oral histories and to put all their faith in official paper documents.
Professional genealogists tell their clients to do exactly the opposite: don't quickly dismiss old family tales as myths and legends and never simply take the evidence of official documents at face value.
I also made a fundamental error in math which I suspect you and 99% of the world would do at first try.
If about all you knew about a missing antibiotics' patient zero was that they were 31 in 1944, quickly, what year do you think they were born ?
1913, of course.
And if they were born on January 1st 1913, that fact is always true, no matter when in 1944 the question is raised.
But what if, like my sister Margo, they were born on December 27th ?
Strictly speaking, wouldn't she also be 31 for 99% of 1944, though born in 1912 ?
I had also assumed wrongly, for ten years, that the doctor (Martin Henry Dawson) making this statement about his patient's age was calculating it from late 1944, as he was finalizing the submission of an very important scientific article on this man and others.
But doctors are very busy people and the only time they tend to ask you your age is on admission.
This man (Charles Aronson) was admitted in April 1944 but his birthday was in June 1912, as it turns out.
Further mistake : I took on faith the claim made by many (without any backing evidence - whatsoever) that this patient's doctor long had an overwhelming interest in curing patients with invariably fatal SBE (a form of endocarditis brought about by Rheumatic Fever.)
The strongest claim about this was made by his closest colleague, a colleague for almost all of his scientific career : so a claim hard to dismiss.
But as Google Search got better and as I gathered up all of this doctor's public utterances in articles, at conferences, in textbooks etc, in 2014 I was suddenly struck by the fact that he never once talked about endocarditis -- despite having considerable freedom to do so.
I also now knew that his first antibiotics efforts with patients came just after he had finally moved up from assistant attending physician at a huge research and teaching hospital (aka dogsbody) to associate attending physician, in charge (more or less) of one public charity ward.
Admitting patients to world class teaching hospitals is never easy for 99.9% of doctors - patients themselves are never the priority, to put it bluntly but truthfully.
In a 24 hours a day, seven days a week teaching hospital, most patients are considered for admission when any particular doctor is at home or busy working in another part of the hospital.
The priority for the admitting doctor - a medical student of a sort themselves - is always, 'do my teachers need a patient with this condition - right now - to fit in with the teaching schedule for us medical students' ?
Followed by, 'or would this sort of patient and illness fit in with the research work of the more senior and powerful teacher-researchers here', people who can make or break my future career?
The known wishes of the thus usually absent Dr Dawson, being in charge of a world class outpatient clinic for people with arthritis - would have had considerable sway in the admission process of (private or charity) patients with rare forms of arthritis but that is all.
The only SBE cases he would have any say over occurred whereever seriously ill people simply arrive at the hospital doorstep and basically had to be admitted right away,regardless, for humanitarian reasons.
If they arrived at the one charity ward Dawson was mostly in command of, he not their lowly GP, would have the most say of their medical care.
After all, the patient and their GP were not paying the medical piper.
And I now knew that Depression Era patients seeking admission to Manhattan hospital charity wards almost always came from just a few convenient miles away by bus, subway or even foot - their families were too poor to own a car and worked at tiring physical jobs.
Their frequent, easy, presence at the hospital was a key emotional asset in the patients' speedy recovery --- or in their last days on earth.
Only when a poor person, with an unique set of medical conditions, in a distant community came to the attention of a powerful doctor with good personal and professional connections with the top doctors at a big teaching hospital in Manhattan, could they secure admission on that hospital's charity ward, regardless of the opinion of the ward's attending physician in charge.
And then, be assured, that attending physician would have little say in their treatment : the various Drs Big from outside and inside the hospital would take over !
I now sensed that unless the available evidence suggested otherwise , as it did with history's third antibiotics' patient, the first two patients zero probably came from about a three mile radius around Dawson's hospital (the world famous Columbia Presbyterian Medical Centre in upper Manhattan.)
His hospital had no shortage of very poor people near by in 1940 - blacks in Harlem and Jews in South Bronx.
Research and teaching hospitals can really only thrive if large supplies of poor patients are near by.
These poor, in return for advanced medical care for free, agree to be constantly examined and probed by huge numbers of strangers and agree to submit to new, scary and painful treatments.
Almost all I knew about Dawson's Patient Zeros was their names : Aaron Alston and Charles Aronson.
Alston was/is a common black name in Harlem New York, ditto Aronson was then a common Jewish name in South Bronx --- both places just two or three miles from Dawson's hospital.
But Google provided too many Aaron Alstons (I had no birthdate on him) to narrow my search easily and only one Charles Aronson born in 1913 in the whole USA.
Dawson's Aronson had spent so much of his young life in hospitals fighting off death so many times that I doubted he could have lived too many years past 1945.
(In his last known illness known to me, he had such a severe stroke that he was left paralyzed on one side and speechless as well.)
But when I tracked down the sons of one American Charles Aronson born in 1913 and they said he had been healthy as a horse, all his very long life, and was not in a hospital in NYC in 1940 or 1944.
By this time, some American census results came up in Google search : a Charles Aronson in the Bronx in 1940, but with a birthdate of 1915 not 1913.
But it was close enough for me - because it soon became clear that in all of 1940 USA and searching very generously for birthdates between 1908 and 1918 ,there was only three Charles Aronsons, period - two far from NYC and one in the Bronx.
But the historian in me soon drew a blank .....
See part two
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