Allies reluctant to help the small and weak - even more reluctant to let them help

Dawson offered 'hope for all' --- with 'help from all'

The WASP patricians (FDR and Churchill among many) running the Allied show during WWII could find it embarrassingly hard at times to bend down to help small and weak peoples in desperate need.

Dead nations never rise again? Hitler and Longfellow certainly felt so about Zion (Emma Lazarus disagreed, as did Henry Dawson regarding the 'certain' deaths of his Jewish SBEs)

When Emma Lazarus read Longfellow's otherwise moving poem about the old Jewish cemetery in Newport, Rhone Island, she hated the concluding line that - with Social Darwinistic finality - flatly stated that dead nations (ie Zion) never rise again.

Dawson's Smalls

A small team of just four, working with small penicillium fungoid growths helpers, all to heal some small patients, working class SBE youths, the very "4Fs of the 4Fs".

Dr Henry Dawson seemed to have kept his team deliberately small, not just to maximize his freedom from the people and institutions who wanted to financially shut him down, but also to make a point of the continuing abilities of small science and small science teams to still do major work.

Again, he deliberately chose to rub the fur of Allied medical science the wrong way when he decided to break a worldwide medical taboo, and after only all five weeks into his project, inject the raw penicillin made from the dismissed-as-too-primitive penicillium mold into his patients' blood stream.

This, rather than wait years or decades for Big Pharma and Big Medicine to painstakingly and slowly bring mass clinically tested synthetic penicillin to market.

Fundamentally, Henry Dawson did it all for 'the little ones'

Henry Dawson's other Manhattan Project wasn't really to advance the cause of penicillin, to aid the Allied military effort or even to save the SBEs : rather he did it all for 'the little ones', to persuade Humanity to build a "Big Tent" that included everyone.

For with rare exceptions (perhaps the early days of the Communist revolutions in some countries) a Big Tent doesn't need to invite the big and the powerful inside - for they are already there.

Instead a Big Tent always newly invites in the small, the weak, those traditionally judged unworthy and unfit.

If small science is beautiful and bountiful then no smaller (or better) example exists then the tiny penicillium factories that produced penicillin when the biggest factories of Man could not

In the Fall of 1940, Dr Henry Dawson set out to embarrass the Allies to actually do something concrete to match their high sounding (but actually empty) Atlantic Charter style rhetoric about protecting the rights of the small in the war against Big Evil.

So he deliberately recruited some very small (and very overlooked) individuals into his "Big Tent Coalition of All the Talents" that came to be the other Manhattan Project.

"4Fs, Slime and a Cracked Pot"

Re-reading Hotchkiss and Dubos's various 1940 era papers on their quick "small science" success at extracting, crystallizing and analyzing high yields of gramicidin, an early (unfortunately deadly) antibiotic exuded by microbes, one is struck by the apparent ease of the whole project.

By contrast, penicillin, another antibiotic exuded by another microbe, was extremely difficult to successfully handle - in every single aspect of it --- from growing the microbe to the ultimate failure to commercially synthesize penicillin itself.

This despite a multi-nation effort that eventually rivalled the Manhattan atomic Project for "Big Science" funding and skilled manpower levels.

But biochemist Dr Karl Meyer was not to know this in September 1940 when he recruited his co-worker, bacteriologist Dr Martin Henry Dawson, to "just" grow a little bit of the fungus microbe, for a "little while".

A seemingly small request, for a short period of time, that cost Dawson his life but also ended up changing our entire world, for the better, forever.

In the darkest weeks of the war, a quixotic project is launched in Manhattan, directed not against the wars' bullies, but against its bystanders...

On Saturday September 7th seventy five years ago, church bells rang out all over Eastern England, signalling both the start of both the softening-up Blitz and the expected Nazi sea invasion of Britain.

It was a bit of a false alarm, but everybody in the know realized that the invasion would have to begin in the next few weeks, before the start of the annual (and terrible) English Channel storms of late September.

With the expected fall of the aircraft carrier Britain, now all alone against the might of a loose coalition of Germany, Russia, Italy and Japan, these remain the darkest two weeks of the entire war for the cause of freedom and peace.

Dr Martin Henry Dawson had spent time, during his military service in WWI, hiking along the very short route the German tanks would take from Kent's sandy beaches to the southern suburbs of London.

He knew how it could be all over in a day or two's fighting.

Dawson was now too old to be effective at the fighting end of this war but his fighting spirit still hadn't left him.

Bu what on earth could a middle aged top notch medical researcher, albeit in the non-military area of chronic arthritis, actually do now to help the cause ?

Yesterday's lie: all wealth created by the rich ; today's lie: all created by the middle class

The truth is, at least in today's ideological culture, it takes big people's wealth and decisions, the middle people's managing the carrying out of these decisions and the back breaking labour of the smallest people, all to create new wealth.

(And I say all this as a left-leaning Green.)

The fact is that successful wealth creation, like everything else truly successful on Earth, requires a 'coalition of all talents' to come about, has always been true.

The why of Dawson's "small" penicillin

Life, if we but let it, is a 'Coalition of All Talents', containing not just Plan A but also all other Plans right up to Plan Z, and is never more useful then in a crisis situation.

If, instead, one instantly consigning all the small to the category of 'useless' and then start doing the same to all women and to all non-WASP populations etc, that is rather like sending more than half of your army home ---- on indefinite leave.

Not a smart move in any war --- particularly not in a war that you are already losing.

Way out of his comfort zone

I was not truly 'surprised' that the normally highly diffident Dr Martin Henry Dawson broke his own team protocol and became the first person in history to inject an antibiotic (dirty natural penicillin) into a patient, 75 years ago this October 16th.

For the diffident Dawson had done something similar at least once before, pushing on with his equally pioneering research into the horizontal transfer of DNA between microbes, against the express orders of his boss at NYC's Rockefeller Institute.

That totally ruined his career prospects at the world's most attractive centre for doing medical research --- so this new decision to merely jump his own tiny team's protocol would have far less dire career consequences.

But what did surprise me - and did so for a very long time (years and years and years in fact) - was his twin decisions made the month earlier.

Fungus growing - and starving - on a massive scale

First was his decision to grow massive amounts of the fungus mold, penicillium n.

Massive as in obtaining 50 US gallons of penicillium liquid per run - the very size of a typical drug industry pilot plant project.

Like most ambitious bacteriologists, Dawson was extremely narrowly focused on learning all he could about just one tiny segment of the bacteria world and so he gave only a glance at all the other bacteria - and tried to ignore viruses and fungus, etc,etc completely.

In his case, he had focused on the then deadliest of all microbe families - the streps (which included the s. pneumococcus).

He had grown massive amounts of the various streps successfully and routinely but massive fungus growing for clinical not lab work would be much different.

Firstly, it would all have to be done with an eye to making penicillin economically on a long term basis, particularly when set against penicillin's cheap and abundant competitors, the sulfa drug family.

Occasionally growing small amounts of pathogens like pneumococcus for some personal science experiments is one thing - 'costs versus sale returns' don't really come into it.

It is far different when one grows de-natured pathogens to supply a huge public market demanding equal and cheap access to vaccines, as Alexander Fleming well knew, because he ran such a business in his London hospital.

His hard earned knowledge of costs versus profits may have lessened the willingness of Fleming and his huge drug company partner (Parke Davis) to grow large amounts of 'his' penicillium, considering how small the amounts of penicillin produced as a result.

Unlike his naturally made - and very profitable - vaccines, Fleming always insisted his penicillin would only come into clinical use when it was made artificially by chemists.

Secondly, Dawson would be growing massive amounts of penicillium fungus to an effort to scale up tiny amounts of an infrequently produced and highly fragile distinctly second rate secondary metabolite.

Why is that so noteworthy ?

Because all bacteriologists, like all farmers, work to make as much biomass as possible, as cheaply, quickly and easily as possible.

As many big viable bacteria/apples/pigs as quickly, cheaply and routinely as possible.

It was a piece of cake to get the penicillium n. to bulk up quickly and cheaply but when they did so, they produced no penicillin at all !

It seemed to everyone that penicillin was sort of like green poop in humans - a rare waste product produced when a body ate a food it didn't like and got very sick as a result .

Learning to grow penicillium n. so as to make lots of penicillin routinely and economically went on after the war as well as during it and it involved at least as much scientific manpower hours as did the entire nuclear Manhattan Project.

And - a distinct rarity - most scientists thought this might be the case, right from the start, and this is why Fleming and Howard Florey and almost all the others differed from Dawson and focused totally on man-made synthetic penicillin making efforts.

I can't really explain Dawson's decision to get involved in mass fungus making except to say that his career had been devoted to demonstrating how smart the supposedly stupid microbe really was.

He certainly thought the penicillium might be damed good at making penicillin, merely by dint of hundreds of millions of years of trying.

Perhaps then it was the overweening hubris of the 'synthetic penicillin' crowd that might have perversely pushed him much further into mass making of fungus than his own personal inclinations would have done.

SBE rather than septic arthritis

Dawson ran a day clinic for chronic arthritic patients, people who normally who returned to their home and daily work afterwards.

About as low on the totem pole in status at a world famous research-oriented teaching hospital as one can go.

SBE, sub-acute bacterial endocarditis, is today seen as a dire medical emergency disease, likely to be fatal even with the best and extremely extensive treatment, and something managed by the top heart specialists and heart surgeons.

A disease near the top of the status world of big hospitals.

Not to be handled by the guy in the basement running a day clinic for little old ladies with badly bent fingers.

If it was an impossibly long stretch for Dawson to focus on SBE we must ask why he did not focus on septic arthritis instead.

This (surgically oriented) disease of dangerously infected joints was still a bit of a stretch for a day clinic director but it was a form of arthritis, his speciality after all, and like SBE it also a disease likely to prove fatal and one that would only be cured by penicillin.

Now, Dawson certainly did deal with septic arthritis cases in his wartime penicillin work but he didn't really focus on them.

As a result of his wondering off his own arthritis estate onto the faraway property of the SBE experts, Dawson greatly aroused a lot of anger from his colleagues.

He may have intended just that.

I have found no indication that the efforts by medical conservatives to use "war preparation" as an excuse to roll back Social Medicine ever evoked septic arthritis as a disease and patient type to be abandoned and left to die.

But that definitely turned out to be the case with SBE - I suspect Dawson saw this plan coming early on and for this reason, and this reason alone, he focused on the SBE patient rather than the septic arthritic patients....

October 1940 : purifying or preserving the Gene Pool of 'useless' penicillium & SBE genes

Is the world safer by minimizing or maximizing the Gene Pool ? 

In the Fall of 1940, American Science renewed its century long efforts at triaging and then discarding much of the world's gene pool; this time under the new guise of a sudden need for "American Military Medicine Preparedness".

It was a movement, ironically enough, that was mostly led by conservative Isolationists among the scientists, men who had long opposed military intervention to help the little peoples of Europe from the evil axis of Hitler, Mussolini and Stalin.

These conservative Isolationists had long opposed intervening to help the little peoples of America as well (opposing Social Medicine for example) so they could not be accused of inconsistency, merely of heartlessness.

That Fall, they gave off plenty of indications that the stripping down for military preparedness meant the final death of Social Medicine.

No good news for the young patients suffering from then invariably fatal SBE.

The conservative isolationists considered that even if the SBEs survived one bout, eventually another would certainly kill them.

Meanwhile the SBEs just consumed lots of scarce medical resources without any prospects they would recover enough to become useful servicemen or do productive work in war industries.

With many conservative doctors believing that SBE, along with most diseases afflicting the poor and minorities, were highly genetically based, it could even be asked why even bother keeping them alive long enough for them to breed and pass on their defective genes to another generation of the collective human gene pool ?

Weren't the SBEs' genes something rather to purify and discard out of the human gene pool ,by a strict policy of deliberate government neglect, and wasn't the excuse of a planning for a Total War the best time to start doing so ?

Even lower on the conservatives' scale of genes worth retaining than those of the SBEs were the genes of that common household pest, the blue green penicillium mold.

If obtaining adequate amounts of lifesaving penicillin meant keeping the genes alive of the slimey mold that originally made penicillin, many were against it.

Better that human chemists, the smartest in the universe, quickly bested the slimey little chemists and made better penicillin cheaper and faster and far more predictably.

Synthetic man-made penicillin in this war or no penicillin, said Howard Florey, while Alexander Fleming and the Allied medical establishment cheered assent.

Dr Martin Henry Dawson strongly disagreed.

He felt the world would be better off, enriched even, if SBE patients like Bobby Darin was allowed to live, perhaps even to sing, dance and act, rather than to squalidly die from deliberate government neglect.

And his entire scientific career had been devoted to proving up his belief that the small and the weak and the useless 'gene carriers' all had something to bring to the commensal table of global Life.

Dawson had demonstrated more than enough examples showing that the microbe chemists were far far smarter than anyone had ever imagined.

He was not at all sure that the penicillium chemists hadn't polished the production of penicillin to a fine velvet sheen over hundreds of millions of years of trying -- and that the smartest chemists in the universe mightn't be able to beat them in a few frantic months of trying.

No matter how much money and labs and bombast was thrown at the problem.

So on October 16th 1940, a day the nation specifically set aside to triage all the 1A young men in America, Dr Dawson injected natural, freshly squeezed, orange colored penicillium juice into two 4Fs of the 4Fs patients, SBE sufferers Negro Aaron Leroy Alston and Jew Charles Aronson.

A product from rejected microbe genes injected to save some rejected human genes, as Dawson sought (against the grain of 1940s thinking on the topic) to preserve and protest the existing gene pool, not purify it and shrink it.

So began our present Age of Antibiotics - in a wartime scientific dispute over whether it was better to reduce or preserve the world's gene pool.

Dawson and Florey certainly weren't the only ones to dispute this issue : on the wider stage, Hitler certainly had his own take, as did Europe's Jews.

But, as is well known, the Dawson-Florey dispute was the only one that ended happily for humanity ....

Why was Marie Barker's actual death sentence praised while Harry Lime's fictional murders so condemned : a story of two Teddy Bears ...

The 1943 real life Allied decision to deny penicillin to Marie Barker (the only medicine that could save the life of this young teenager and SBE patient) on the (unstated) grounds that her disease was 'not a military priority', has generally been praised by historians of science - then and now.

It was also acquiesced in - at the very least - by most lay people back then.

Even when that public saw newspaper photos of still just a teenager Marie breaking into a smile of delight at the sight of one of her 'stuffies' (a teddy bear) that her Canadian-born mother Hermance had brought to her bedside.

By contrast the needless, painful but fictional deaths caused by Harry Lime denying penicillin to children in 1949 Vienna only six years later has been strongly condemned by most of those same academics and by the public generally.

Okay ---- perhaps the professors did not condemn it in actual peer reviewed articles, but almost certainly, like the public, they did so in casual water cooler talk and during post-movie-watching 'pillow talk' between spouses.

I can claim this with some certainty because it is known that countless audience members discussing the moral issues raised by Harry Lime's unspeakable actions around helpless children and penicillin was what helped lift THE THIRD MAN from being just another run of the mill B&W 'quota flick' to among the top films of all time.

How the casual upending of a child's teddy bear helped change us for good

In just six short years, we went from praising the decision to cold bloodedly and publicly kill Marie Barker & her teddy bear by baneful neglect ------- to blanching at the mere fleeting sight of a nurse silently putting the teddy bear of of one of Harry Lime's victims upside down on a waste basin.

I hold that to be a hugely momentous moral upending, as dramatic in its own way as was the totally unexpected upending of the best in civilized technology by primitive penicillin...

A 'second rate' doctor (Dawson) treating 'second rate' wartime patients (the SBEs) with medicine from a 'second rate' drug producer (the penicillium slime) and in the process, upending simplistic notions of linear Progress

When Jesus talked of "the first being last and the last being first", this sort of 'upending' talk was really one more of his famous hard sayings, designed usually to abruptly awake the intellectually smug and sleepy, rather than being offered as a serious description of His Father's world.

Equally, any idea that simply upending the current state of affairs in industry by replacing capitalist factory bosses with worker factory bosses would really improve things on the shop floor has been revealed to be, over and over, mere eyewash.

The hungriest of workers are just as capable of deceit and greed directed against others as the fattest of fat cats.

A more subtle and yet more probing claim is to insist that the smart aren't always smart and the dumb aren't always dump - that we all have qualities and weaknesses.

To accept all the assumptions of the usually smart without question is as dangerous as quickly dismissing all the qualities of the usually dumb as useless, without examining them all more carefully.

This was the implicit claim of a scientist from the second tier (Martin Henry Dawson) who lacked either the ability or the urge to talk scientific rhetoric about his insights - who preferred muchly to show, rather than to simply tell ...

Dawson's opponents, not Dawson, had special concern about SBE patients in September 1940

Pity the poor historian ( like me !) trying to recover the substance of the visual glances,the brief shoulder shrugs,  the sotto voce verbal hints and half finished sentences, all very typical of conversation within small cliques in a small staff room, when the group is divided up into various opposing factions of colleagues, who must still at least pretend to get along at work.

I believe that in September 1940, upon his return to medical school and hospital, Dr Martin Henry Dawson half overheard some conversations between members of a group of his colleagues who not well disposed to social medicine, even in peacetime.

The Fall of France had happened and many Americans believed the Fall of Britain was soon to follow.

The American medical elite, made up mostly of  conservatives not in favour of medical intervention towards the weak at home or abroad, were now all claiming to be preparing for a possible war.

Maybe they were - in part.

But for many of them, talk of war preparation allowed them to reduce the alarming amount of social medicine (treating the poor dying like the rich dying) being practised.

They insisted they were only seeking to reduce medical intervention among the domestic weak and small because all existing resources (and more) were needed for possible future medical intervention in support of Europe's weak and small nations.

Reducing domestic comfort and aid because of possible foreign intervention ---- which they were still strongly opposed to !

I call that classic 'Bad Faith' and template Orwellian Double Talk.

I think it was these colleagues who mentioned the SBE patients as the classic sort of 'bed waster' that a war medicine hospital could no longer afford.

We know there was already some existing consensus on ignoring the SBEs under war conditions because there was almost no resistance from doctors in America in the Fall of 1942, when the disease was declared by the NAS 'death panels' to be of no military value and so denied penicillin - the only medicine that could save its patients' lives.

This censenus was also found among doctors in Canada, the Uk and Australia as the NAS ban on the use of wartime penicillin for dying SBE patients was extended by the medical establishment in those countries again without almost any controversy.

But Dawson himself had never before spoken or written or researched on SBE and its patients.

His sudden concern in September 1940 to make the 4F SBEs the focus of his wartime natural penicillin crusade, I believe, came from him half overhearing his conservative colleagues dismissing them as worthy of equal treatment to the war wounded 1As.

Dawson's empathy for the unjustly neglected simply kicked in ....

Was WWII's battle over Penicillin a microcosm or a macrocosm of that horrific war ?

WWII was far too big for one mind to encompass and far too horrific for one stomach to handle.

The even longer but much smaller battle over penicillin production and delivery seems easier to handle and to stomach.

But just like the war itself, many, many people died because of decisions taken over the course of the twenty year long battle over just how penicillin should be made and to whom it should be given to.

True : all these people were deadly ill, by definition.

So possibly many would died anyway, with or without penicillin, though probability suggests that in fact most would have lived, if given enough penicillin early enough.

Unfair premature death is still unfair premature death, but their slow deaths from disease, caused by not so benign neglect, lacks the visceral horror of thinking about mothers and babies being murdered in a field with a bullet to the face, Einsatzgruppen style.

Preventable death due to lack of should-have-been-readily-available penicillin was still death on a massive scale.

But it remains deniable because it is only viewable, faintly and through the softest of gauze*.

Guilty

So yes, I plead guilty - I want to have it both ways.

I want to discuss the biggest, most horrific, issues of the war but also to sugar coat them.

To reduce them to closeups of the lives of a mere handful of individuals, most who don't die and even of those few who did die, didn't die violently.

But I also want readers to think back, back behind these few representatives.

To think of the literally tens of millions of people, unnamed and un-described, who died needlessly throughout the world because cheap abundant penicillin-for-all was delayed so long.

(Delayed for up to fifteen years for a few lucky ones and up to twenty five years for many, depending on your class, race, gender and where you lived.)

That is a death toll that approaches that of WWII itself.

So it really should never have been so casually dismissed, as it has been, all these years....

* I know of only one death among those tens of millions - that of Marie Barker of Chicago in September 1943 - that happened with enough detail provided day by relentless day to the reading public as to still bruise our collective conscience.

Social Penicillin : the story of 'Penicillin-For-All'

Was October 16th 1940 the date of the world's first ever injections of social penicillin ?

Well, first, let us consider this question :

Can a hospital system actually make citizens feel sick or feel well, even if they never ever visit in their entire lives ?

On the surface, that seems a very ridiculous question - what earthly good are hospitals if they don't actively try to make sick people better?

But I argue to the contrary.

That, perhaps, over all people and over all their lifetimes, a hospital's greatest value or damage is the sort of moral values it radiates forth, on behalf of the society around it.

If it has a great reputation for serving all equally, regardless of their income, ethnicity, gender or age, if it says 'everyone is valued' - it raises everyone's self esteem.

And it is medical fact that high self esteem, all by itself, is a powerful, cheap and non-toxic preventive and curative medicine.

Or perhaps the hospital is best known for first testing your financial worth before it even tests your blood pressure and is also well known for ill-treating patients, even if they have sufficient income, if they are of the wrong ethnicity, gender or age group.

That sentiment is damaging to the self esteem of the people in those unfortunate groups.

Again, it is a medical fact that the stress of lifelong low self esteem acts to lower our immune response --- indirectly making us, if not actually 'sick', a whole lot 'sicker' whenever we do fall ill.

I believe that History's first ever injections of penicillin, ushering in the Age of Antibiotics, offered no drug-induced clinical value whatsoever to the patients receiving them and that the doctor giving those injections (Henry Dawson) well knew that.

These injections then were not of penicillin-the-chemical-drug but rather shots of 'social penicillin', a phrase I have coined in homage to 'social medicine' .

The very real clinical value these injections represented was in the uplift in spirits it gave to these two young patients and to all others suffering from their disease.

For SBE (heart valve endocarditis caused by Rheumatic Fever) - was a disease their families were always being told was invariably fatal.

And totally resistant to all known treatments, in fact the very Mount Everest or Gold Standard of resistant infectious disease.

Abandon hope, all ye that enter here.

But Dr Dawson believed that three combined characteristics of penicillin ( with only the last being totally unique) would beat the unique set of difficulties presented by this dreaded disease and finally conquer infection's Mount Everest.

That is he knew that (a) penicillin killed strep bacteria readily(b) was small & highly diffusible and (c) was totally non-toxic, even if given in enormous amounts.

Only a recently acquired medical community revulsion against injected crude fungus slime into the human bloodstream had denied this lifesaver to tens of millions of dying patients over the previous twelve years.

Dawson resolved to break that medical taboo, a taboo perhaps even held by the other members in the tiny four person team working with penicillin at his hospital.

Dawson, as a busy ward clinician, was actually the junior member of the team, at least in the beginning.

Karl Meyer, gifted biochemist, together with his chemist assistant Evelyn Chaffee, would destructively analyze the fungus penicillin grown mostly by microbiologist Gladys Hobby and then chemically synthesize artificial penicillin.

Hobby would confirm that both the natural and artificial penicillin indeed had biological activity - testing it on killing microbes.

In the beginning, Dawson would mostly run interference with the hospital authorities, above all in securing rare permission to deliberately grow gallons of fungus, with all their highly mobile spores, in a normally highly antiseptic hospital setting.

Only a planned four months after the beginnings of the project would Dawson take centre stage, when he injected synthetic penicillin into actual patients assigned to 'his' ward.

Now Dawson knew that chemically either natural or synthetic penicillin were equally good at defeating SBE.

But defeating SBE required more than just an effective bug-killing medication ---- SBE uniquely needed simply enormous amounts of medicine, particularly to kill such relatively small amounts of a very fragile bacteria.

SBE bacteria live on the heart's Rheumatic Fever damaged valves, sheltered behind a tough but semi-porous barrier of biofilm (then known as vegetation).

Normally medications diffuse gently and slowly into and around the individual cells of an organ via the incredibly tiny blood capillaries.

And like a lobster trap, once in around the cells it is not that easy for the medication to leave, and the molecules of the drug have a long time to work their magic.

But like ear lobes, the valves of the heart have virtually no capillaries. Yes, they are literally bathed in blood all the time, but the blood surges by them at an incredibly fast pace, as measured in terms of the motion of molecules.

The chances of a molecule successfully diffusing (aka moving via random thermal motion) its way over to the biofilm and finding its way in by the rare small opening in the biofilm, in the millisecond it pulses over the valve surfaces, is near zero.

About as likely as U235 separating from U238 simply by their varying rate of diffusion through tiny holes.

And we all know the trillions it has cost the world to make that diffusion technology work !

But in both cases, brute force technology will indeed slowly win through.

For penicillin, that meant about a thousand steady hours of the constant pulsings of trillions of tiny penicillin molecules a second bouncing their way past the biofilm surface.

The laws of probability would eventually ensure enough made their way into the biofilm's rare tiny holes to kill the bacteria within and end the infection.

In plain english, while a single unit of penicillin might cure an infant from lifelong blindness caused by a meningitis eye infection, easily over a billion units of penicillin today might be needed to cure a particularly stubborn case of SBE.

That a seriously ill patient can receive that much of any medication without any ill effects is why doctors still call penicillin magic.

In October 1940, Dawson could only guess at the ultimate amount of the SBE medication needed for a permanent cure.

But he did know the small amount of penicillin the team had grown in the five weeks since they started the project and its relative strength, by weight, against number of bacteria per a unit of mouse body weight.

He could even compare his figures against similar calculations performed by Howard Florey's team in Oxford a few months earlier.

And as a very experienced bacteriologist and clinician, Dawson was particularly good at converting lab mouse cures rates per weight of medicine into their effective impact on adult sick humans weighing two thousand times as much.

But that was actually for infections by highly virulent bacteria, but in readily accessible organs.

SBE involved very weak bacteria but in very inaccessible locations - perhaps the two conditions could thus be crudely equated.

Still no matter how he sliced it, the penicillin at hand was far far too small an amount and far too weak in strength to really combat SBE.

But on this day, it wasn't really the SBE bugs that Dawson was seeking to combat - but rather it was the moral values of the society around him.

He didn't like the values his hospital and his society was radiating to a world at war - and he sought to change it.....

October 15 1940 : a Fighting 69er fights SBE instead ?

Almost everyone dimly recalls hearing about New York's famous "Fighting 69ers" / "the Fighting Irish" - an infantry regiment more formally known as the 165th (infantry) Regiment, New York State National Guard,--- part of New York State's 27th Division.

Though a state regiment, it in fact recruited exclusively from NY City.

On October 15th 1940, the day before America's first ever peacetime draft registration, the day before History's first ever antibiotic shots, it was 'federalized' and began moving to the US Army's Fort McClellan in Alabama.

And there by hangs yet another intriguing tale in the wartime penicillin saga.

For at the very beginning of 1932 (January 4th), an eighteen year New Yorker old named Charles Aronson joined its Company K - which recruited from the eastern part of the city.

The extreme earliness of this date in the year means statistically he was almost certain to be born in 1913.

That recruitment area and the age of this recruit makes him very likely to be my "dying of heart disease" Charles Aronson.

My Charles Aronson was a young man who had just survived a series of life threatening diseases that left him with a permanently weakened heart but not too weak to work - first as a office boy and then as a teletype operator in a newspaper office.

I no longer doubt - just because of his past illnesses - that he couldn't possibly join an infantry unit.

Not after my refusing for years to believe that a top champion athlete named Aaron Alston could possibly be my "dying of heart disease" Aaron Alston - except that he was.

So - possibly - Charles Aronson had to hear on the radio of his old unit leaving to possible fight for America, just as he was fighting for his own life and about to enter history as one of the two people who were the first ever to receive an antibiotic (penicillin).

So on October 16th 1940, the very next day, as he was supposedly just about to die and receiving an historic - and desperate -  first ever shot of penicillin, the draft registration team visiting his ward probably mentally marked him down as 4F, in fact a 4F of the 4Fs.

But for the grace of an accidental and recent infusion of tooth bacteria into his bloodstream however, tooth bacteria perhaps received from brushing his teeth too vigorously, he would never been fighting this fatal disease in October 1940.

Instead he would have been regarded as a 1A member of the federalized National Guard ---- bad heart and all.

Life is funny isn't it?

Because later in the war, the united Allied scientific and medical elite, taking a leaf out of the Nazi playbook, decided that young people like Charles and Aaron were useless because they couldn't possible fight.

They then ruled them as 'lives unworthy of lifesaving penicillin' and so sentenced them to a death as certain as any trip to Auschwitz.

It didn't really matter to their doctor, Dr Martin Henry Dawson, whether or not they had been infantry soldiers, champion athletes or lifelong invalids - to Dawson all people was worthy of lifesaving penicillin.

Charlie beat this first bout of invariably fatal SBE endocarditis and did so again in 1944, with Dawson's penicillin, He survived the war too - living at least into the 1950s.

Meanwhile Dawson gave up his own life in his belief in the worthiness of all human life ---and finally won his point, just before his own premature death in April 1945 ....

When the upward causation of 'invariably fatal' SBE meets the downward causation of Dawson's agape penicillin

Let us accept - for the sake of the argument - the unproven assumption that many kids could even get SBE disease out there in the Social Darwinists' belovedly savage "Nature" that existed before Christian compassion peed on their picnic.

Then, yes, the SBEs' premature death out there in early Nature does seem assured - even 'invariable'.

A clear case of what philosophic reductionists (such as Adolf Hitler) liked to call "upward causation", mandated from the virile little bacteria at the bottom to the big - damaged - heart valves at the top.

Seemingly, end of story.

But remember, even when the evolutionary upward causation of tiny mutating genes throw ups three headed horses, the varying reproductive odds out there in the big eternal environment also get to have their say.

And to date, those reproductive odds has shown a decided preference for horses with only one head.

A clear example of Evolution's "downward causation" (from the top big to the bottom small) having its two cent say on the final results.

In September 1940, the upward causation of Aaron (Leroy) Alston's inevitably death from SBE (subacute bacterial endocarditis - the disease that made Rheumatic Fever the number one killer of kids for 50 years) hit a speed bump.

Inspired by Alston's black activist spunk, a middle aged doctor (Martin Henry Dawson) decided to strike his own personal blow for freedom during WWII by trying to stop Social Darwinists in America from doing to SBE patients what Hitler was already doing to their counterparts in Germany under the Aktion T4 program.

Despite Dawson's best efforts with his historic home-brewed antibiotic injections, Alston did not survive in the end, but Dawson's efforts ultimately ensured that ten billion of us - so far - have led longer happier healthier years.

Seventy five years later, the downward causation of Dawson's agape penicillin is still working itself out in all its complex manifestations, all over our world.

Try and reduce that .....

75 years ago, on a day supposedly devoted to 1As, two New York City 4Fs made medical history instead

It is an irony beyond all measure that on America's first ever peacetime Draft Registration Day, October 16th 1940, a day designed to separate the 1A sheep from the 4F goats, two 4Fs (a black man from Harlem and a Jew from the Bronx) instead made medical history by ushering in our current Age of Antibiotics !

And they made history not by accident of sheer coincidence either.

For their doctor, Martin Henry Dawson of Columbia University's Presbyterian medical campus,was incensed that his colleagues were using the move to a War Medicine footing (of which the separating of valued 1As from unvalued 4Fs was but one part) as an excuse to drop Social Medicine - the extending of life-saving medical care to those in need, regardless of their income, color or origins.

Dawson felt that a Double V Victory was needed to defeat the hold that Fascist values held among much of the world's Neutral nations - both a military defeat and a moral defeat.

Abandoning America's weakest and the smallest to medical benign neglect, just as the Nazis were currently doing with their own weak and small, was no way to win the 'hearts and minds' of the neutral nations.

These two young New York City boys, famed athlete Aaron Leroy Alston of St Nicholas Avenue and teletype operator Charles Aronson of Vyse Avenue, were dying of then invariably fatal subacute bacterial endocarditis, known to all as SBE, the disease that made Rheumatic Fever the most feared and fatal of all school age children's diseases.

It was also known as "The Polio of the Poor", which gives an indication that minorities , immigrants and the poor were the hardest hit by it.

For these two reasons, people with it were judged, by a medical establishment echoing the Manhattan of Gordon Gekko, to be of no value to the military or to hard-slog war-factory work ---- and so best left to die.

But Dawson, perhaps channelling the spirit of Manhattan's equally famous Emma Lazarus, saw the pair as worth saving and their disease as curable if only.

If only, twelve long years after penicillin's non toxic and bacteria killing nature were first discovered, some doctor plucked up enough courage to test its toxicity in the human blood stream.

Dawson did that crucial test - injecting it in himself.

Convinced it was safe, he then injected his team's home made penicillin into the pair and quietly, off stage in all that day's media splash, made history.

For journalistic hindsight is always 20/20, but back then it seemed clear that reporting upon possible student resistance (on the same Columbia campus) to the draft registration process was a far,far bigger story.

Hopefully, this time around, on the October 16th 2015 seventy fifth anniversary of those historic pair of antibiotic injections,  the NYC area media will run with the ball ...

Mostly poor people ALL OVER THE WORLD denied life --- by wartime's Republican-dominated NAS death panel

American doctor-run death panels did exist and they did sentence people to an inevitable death based on mostly eugenic driven considerations.

It happened during WWII.

The patients denied access to penicillin (that was the only thing that could save their lives) were all suffering from subacute bacterial endocarditis (SBE) that was then a leading cause of death for poor, minority and immigrant youths - the final deadly stage of childhood attacks of rheumatic fever.

Actually the entire spectrum of possible ways to die from rheumatic fever (known as Rheumatic Heart Disease or RHD) was the leading cause of death for school age children and youths in all of the industrialized world - far far more than polio for example - and would remain so till the 1960s.

But you won't know this unless you were very poor ; it wasn't a middle class disease.

Now this story of the wartime bureaucratic denial of penicillin to SBE patients isn't totally unknown to students of the history of wartime penicillin - but most think that this diktat was limited to American patients only.

But I have been tracing how the same American-originated list of diseases to be treated (or not) by GPs using this new penicillin kept re-appearing world wide, always with virtually the same wording.

So far I have traced the publication of this diktat (intended to apply to all GPs) in journals or newspapers in Canada, Britain, Australia , and now New Zealand.

The New Zealand newspaper report in June 1944 was franker than most - the nation wasn't making its own penicillin but was wholly dependent on penicillin given to it (via Australia) by America.

But the report indicated that the penicillin gift came with strings - the Kiwis had to agree to refrain from using the medication on diseases that were being ignored in America and in all the other Allied nations.

The disease the Kiwis and all the others were specifically told to ignore was SBE.

The NAS panel headed up by Dr Chester Keefer - himself an expert on SBE - was in a dispute with Dr Martin Henry Dawson and his supporters who was insistent their numerous patient cures indicated that penicillin and only penicillin could cure SBE and do so completely.

(Dawson and his supporters were 100% right by the way !)

If news came to American SBE patient families that in New Zealand SBEs were being treated and cured by penicillin, Dawson would have a further ammunition to inadvertently embarrass Keefer.

Inadvertent because while Dawson was a rank amateur on SBE until he started in with penicillin (and was anyone never one to be mean to fellow scientists),  Keefer had made SBE's cure his life's work.

But Keefer had backed the wrong horse as to the best drug to cure SBE and wasn't willingly to publicly back down and grant that Dawson was right.

Keefer had other more public excuses for his denying penicillin to SBEs , but this was the real reason ...