wartime penicillin's Progressives vs Naturalists

The Progressives (people such as Sir Howard Florey, the OSRD and Merck) literally intended to RE-FORM things, wholesale - the human body in particular.

They advocated a sort of 'synthetic autarky' with Man replacing everything that came from Mother Nature with a better and cheaper & quicker to make artificial form.

But such re-forming, in practise, often broke down the very old fashioned farming practise of culling out whatever was regarded as 'unfit' and selecting and favouring whatever was regarded as the 'fittest'.

(Here cue the word : Eugenics.)

But with eyes only for the future, no Progressive would ever publicly admit to using such old fashioned farming techniques.

Clinging to such vestiges of the past were supposed to be the preserves of their opponents, the Naturalists, people such as Florey's opponent, Dr Martin Henry Dawson, the OPRD and Pfizer.

But all efforts - by  hundreds of the smartest chemists in the universe with money to burn- to synthesize commercial penicillin failed.

Instead, a few Naturalists, with very little resources, patiently picked the best of the best of the best of the best penicillin producing penicillium molds to greatly up penicillin yields at the point of the cow's utter rather than in improving the machinery in the milk factory.

Only near the end of the war, did a scientist finally get the chance to set a $20 UV heat lamp (bog ordinary variety !) upon a sample of the naturally best penicillin producing molds.

All this to deliberate fry the poor penicillium's DNA with UV rays, in the hope that among the dead and living dead offspring, a few fully alive cells' DNA might be altered (re-formed) to produce even more penicillin.

He indeed found these winners by the old fashioned farmers' method of patiently picking the most likely big producers and putting them to it - the proof was in the penicillin they did produce.

Against the Progressives' 'terrible simplicities', my brief account shows the unexpected wartime success of natural penicillin was a bit more complicated than might be expected ----- as usual ....

History's first ever antibiotics injections were expected to be of pure synthetic penicillin

Back at the start of the 1940s, two highly skilled biochemists (Karl Meyer and Ernst Chain) both confidently expected to quickly synthesize artificial penicillin, as they knew natural penicillin was a relatively small biological molecule of only about 350 Daltons.

After 100 weeks of hearing this reoccurring promise of quick results from Chain, his imperious boss, Howard Florey, reluctantly decided to inject his first human patients in February 12th 1941 with still-impure natural penicillin.

Henry Dawson, normally the most diffident of men, changed his mind about waiting till  co-worker Meyer's synthetic penicillin arrived in January 1941, and after only five weeks into their joint penicillin efforts and without so much as a backward glance, injected his first patients with impure natural penicillin on October 16th 1940.

Why did Dawson uncharacteristically proceed to Plan B so very much quicker than Florey?

Partially it was because Dawson was so angry on his return to his medicine school from his vacation in September 1940 to discover that all American medicine was using the excuse of preparing for war medicine to drop their feeble efforts at social medicine aimed at improving the health care of the poor and the weak.

But it also seems from Dawson's own words that it was a civil rights activist and dying SBE patient, Aaron Leroy Alston from Harlem, whose angry eloquence on this neglect of the poor and minorities that so moved Dawson.

Moved him to defiantly thumb his nose at an uncharitable world by deliberately treating two 4F SBE patients with this historical first ever injected antibiotics, on the very day when all of the rest of America was focused only upon its 1A population ...

First injection of penicillin into patients : October 16th 1940 New York

The first penicillin needle into a patient, ushering in our present Era of Antibiotics, was one of the most signal events in all medical history and it happened exactly 75 years ago this Fall.

Yet, until this present article, even the barest of its bare facts have never been publicly reported accurately - not even by the three key team leaders that first performed them !

Here is how it went, based on cross-checking the various published report by the three team leaders against public records and newspaper accounts:

On October 15th 1940, after a hectic six weeks learning from scratch just where to find the right strain of penicillium and then how to coax the temperamental  fungus to produce raw penicillin juice, the three key members of the tiny team at New York's Columbia Presbyterian Medical Centre were finally ready.

The team leader (Nova Scotia born and raised Dr Martin Henry Dawson) would inject the penicillin into himself, a healthy volunteer, to test whether the never-before injected drug was dangerous to human life once in the bloodstream.

If he survived unharmed, the team planned to use the free time provided the next day by the university's registration of students and young staff in America's very first peacetime Draft to inject some penicillin into two young male patients dying of then invariably fatal SBE.

More formally known as subacute bacterial endocarditis, SBE was the then common disease that made Rheumatic Fever the leading killer of the young.

So only October 16th (in between the two dying boys being registered for the Draft) and once again on October 17th 1940, Dr Dawson injected some of the team's hospital brewed penicillin into the two young men.

One was a young black star athlete , Aaron Leroy Alston born 1910 and residing on St Nicholas Avenue in Harlem and the other was a deathly-sick-all-his-life young Jewish man, Charles Aronson, born 1913 and residing on Vyse Avenue in the Bronx.

Next, the two young men got a much longer and and a much larger regime of oral Sulfa drugs.

Unexpectedly, the Sulfa worked on the sickly Aronson and he went home apparently cured, on a maintenance dose of Sulfa, in late December.

His cure held and he survived alright for three and a half years until another bout of SBE brought him back to Dawson.

This time Dawson had plenty of penicillin to cure SBE reliably and he did so again with Aronson.

Unfortunately, star athlete Alston did not respond to Sulfa drugs (more accurately his particular strain of SBE-causing Viridans Strep didn't respond) and Dawson started him again on a larger and longer regime of stronger injected penicillin on December 31st 1940.

He died mid-treatment in mid January 1941 and his tragically short sports career was celebrated and mourned by many sports fans across the city.

The penicillin brewed for him but not used was given to a third patient, a young middle class salesman in his thirties from upstate New York - Middletown to be precise ; his name George Milton Conant.

He got at least one course of Dawson's penicillin in late January.

He died on May 31st 1941 -nearly a month after Dawson gave a cautious report May 5th on his treatment of four SBE patients with penicillin , delivered before a huge convention of medical researchers at Atlantic City and given extraordinary wide coverage in the news media.

I (and even the team itself) know nothing of the fourth patient - but Dawson's May 5th report specifically says four were treated ( thus treated between between October 16th 1940 and late April 1941).

(It is is worth remarking, given the canonical status and wide circulation of this newspaper, that The New York Times' science correspondent William L Laurence (who wrote the famous eye-witness account of the first atomic explosion ,"Dawn Over Zero") reported the next day that he had heard  Dawson saying that he had treated 4 patients suffering from SBE with his penicillin.)

As of the May 5th date, we know for sure that only one patient had definitely died but Dawson refused to crow about his small successes ---- or give specifics of just when the first injections were given and to how many patients.

Dawson later referred , in his 1944 JAMA article, to treating five SBE patients with early hospital brewed penicillin, of a potency not stated.

This allows us to assume that the fifth patient was probably treated very early in the Fall of 1941.

Because that was before Dawson had been introduced, after a visit from Norman Heatley, to the idea of calibrating the biological activity of penicillin by using Oxford units - as we still do to this day.

(The team seems to have stopped making penicillin during the high summer months because the temperature in the hospital, anywhere than in a bottom basement room, was far too high to successfully grow penicillium that would give off penicillin juice.)

Later he and his fellow team mates bacteriologist Dr Gladys Hobby and chemist Dr Karl Meyer would all give partially accurate and incomplete public accounts of those early (clearly non-dramatic) days - so who could blame the lay press or science historians for repeating their errors and adding some of their own ?

Synthetic Howard Florey vs Natural Martin Henry Dawson

The untold scandal of the Anglo-American pharmaceuticals "CODE SLOWING" natural penicillin production in the crucial months before D-Day

Howard Florey seems to have contacted every major pharmaceutical firm and governmental scientific organization in the UK , Canada and America but clicked with only a very few.

Martin Henry Dawson's project was known by most of the same organizations - but he clicked with even fewer.

But both men eventually found institutional supporters of the same like mind as themselves - so it probably didn't matter how many rejected them.

Both men were relatively inflexible as to their ultimate objectives.

 Florey sought a perfect chemical synthetic solution, no matter how long it took and was unwilling to settle for anything less .

By contrast, Dawson wanted any sort of solution to the penicillin supply issue - as long as it happened now ! - and that it provided an abundance of inexpensive wartime penicillin.

Florey found similarly chemically minded executives at Merck, ICI and in A. N. Richards the head of the medical division of the American OSRD (where the ultimate boss, Vannevar Bush was notorious for never ever hiring biologists.)

Dawson found a kindred soul in John L Smith of Pfizer (albeit prodded by his wife Mae) who decided to risk all by going the all-natural route when the industry consensus was to "Code Slow" natural penicillin production until perfect synthetic penicillin was invented.

And like Dawson, Smith's vision was for lots and lots and lots of penicillin - now !

Suddenly - a crucial month before D-Day - the race between the two competing visions was all over.

Not a drop of synth pen in the pipeline to Kansas City Kansas and then onto the waiting military hospital units in the south of England - instead tens of billions of units of natural penicillin were in that pipeline , almost all from Pfizer.

Florey stormed and the dying Dawson permitted himself a rare - wall-to-wall - grin .....

Specialist - in depth - beat reporters - or just cheerleaders, captured by their sources ?

In August 1941, Howard Florey published a gripping human interest drama in the pages of the world's leading medical journal, THE LANCET, complete with dramatic before and after photos of little kiddies rescued from certain death.

Yet no reporter in Great Britain's highly competitive newspaper world ever published a single word about it !

Why not ?

I think it is because the general reporters who would have published such a gripping human interest story in a shot never heard of it from their "filtering" colleagues, the beat specialists.

Otherwise, general reporters only write such stories if they had had a personal approach - say by the parents of one of the boys in question.

But general reporters do not generally scan endless numbers of highly specialist publications like THE LANCET looking for likely stories and exclusives - that "filtering" job is the role of their papers' specialist or beat reporters.

These beat specialists cover only Parliament, or only The City.

 (Or perhaps only the labour scene, or medicine and science , or the police courts, sports etc.)

During WWII , effective if informal censorship existed for all the Allies' scientific and technical publications.

A word to the wise to a few key technical-scientific editors about subjects to be low-balled generally worked better than a legal (and hence highly public) censorship notice detailing all the subjects these publications could not talk about.

For that method had the paradoxical effect that it only alerted everybody on the specific scientific areas the military was most concerned about !

I think that almost* all the beat reporters covering medicine and science for the general media during WWII got too close to their sources and too far away from the readers who paid their wages .

They thus failed - for but one example - to ask why such a good news story - already published globally, during a world war, in THE LANCET - couldn't also be read by the millions of downmarket readers of the UK's DAILY MIRROR ?

William L Laurence - the New York Times  science reporter who shilled under the table for the Manhattan Project - is the best known example of this process of being morally captured by the sources you are supposed to cover objectively for readers outside that field.

But surely , he can't be the only one....

* One key exception : James McKeen Cattell , publisher of the giant scientific journal SCIENCE, who went to bat with great courage in the darkest days of early 1942 , against censoring Dawson and his Penicillin-for-All proposal.

Penicillin in wartime: an alphabet soup of organizations passing the buck then hogging the credit

I am still not fully recovered from the disaster of my first public talk on wartime penicillin before Dalhousie University's  Medical History Society.

I was given a very generous amount of time by the Society's Jock Murray and Allan Marble to state my case but it didn't help : my choice for a title slide in my powerpoint presentation simply covered far too big a subject and left me no 'on the spot' wiggle room.

" Wartime Penicillin : from secret 'war weapon' to widely publicized 'beacon of hope' " is not a topic line easy to compress.

 (Though last night's blog entry on the Janus Month of March 1943 would have been a good attempt at compression.)

Within a minute or two into the talk, I felt like crawling into a hole  and disappearing forever --- I could see by the faces of the audience that I was giving far too much unknown information far too quickly.

Any two or three of my powerpoint slides, from the forty two I had actually come with, could have formed the basis of an interesting talk and a lively amount of discussion afterwards.

Eight and a half years of research has finally made me more or less comfortable with the vast array of sound-alike organizations involved in wartime penicillin,  and their activities are just as important as the individual stories of individuals like  Fleming, Florey and Dawson.

But trying to establish what the OSRD and OPRD were in the first place, even before trying to show how much at odds these two similar sounding government agencies really were on penicillin is a month's work - not a small part of a 40 minute talk.

It is entirely my fault - because the night before the lecture I had noticed that even a well known expert on the history of wartime penicillin (name omitted !) still managed to badly confuse the two in an major article in a digitalized book I found on the internet.

And when a printed work is digitalized and put on the internet, an error is forever and eternity --- and visible to all, worldwide.

That is why my penicillin work  will remain electronically fluid on this blog and in website e-books.

 My errors of fact and interpretation (and I expect and even hope to make many) will be instantly correctable as new information comes to light or savvy readers spot errors and typos.)

And another thing about individuals and institutions when Cinderella unexpectedly turns into the Queen of the Ball.

 After passing the buck for years, they now suddenly tack hard right and start clawing each other to take all the credit .

Sorting who actually did what when, not what they claimed ,after the war ,in expensive official histories, that they did, is  itself a work of many lifetimes...

First person to ever read Fleming's 1929 penicillin article, REALLY READ IT, was Henry Dawson, in October 1940...

Very early in his investigation of  the antibacterial qualities of the liquid beneath a penicillium mold , probably by October 1928, Alexander Fleming came to a truly startling conclusion.

And it is not what you - or he - or any other doctor or scientist might have expected.

Finding unknown substances that kill bacteria was and is a commonplace.

Finding a substance that kills bacteria without also killing the patient is a distinct rarity.

But the chances of finding a unknown substance that kills bacteria  while (a) not killing the patient AND (b) while being a part of about two dozen other unknown compounds in a bath of 97% water ?

Well, sir, that simply is an event that has mathematic odds well beyond the calculating.

Let us label the Alec Fleming of this startling conclusion, "Fleming I" , because six months later he had - confusingly - become both Fleming I and "Fleming II", depending on his mood.

Fleming II consistently insisted, for the next fifteen years, that penicillin would not become a useful medication until chemists had purified it, discovered its chemical structure and recreated it as an artificial synthetic. Even then, it would only be good as an external antiseptic.

Talk about a parent praising their latest offspring with faint dams !

But while Fleming II's team had actually started down the chemists' path  and had produced a much more concentrated (and semi-purified) material, he totally and abruptly abandoned this effort and never wrote it up in his seminal 1929 article.

He never even used this highly concentrated material  (a thousand times more concentrated than original his liquid mixture) in any biological experiment.

It could just be that the businessman-bacteriologist Alexander Fleming, a frugal Scot, had more native arithmetic in him than almost all the doctors and scientists who followed him into penicillin - certainly more native arithmetic ability than almost all the writers I have read on the penicillin saga.

Because the two dozen unknown compounds swirling about together hadn't eliminated the anti-bacterial activity or caused a toxic reaction, removing them by purification was a 50/50 shot at  improving- or reducing - those two valuable qualities.

Remember that : let me repeat it : purification might actually reduce the bacterial activity or increase toxicity. Synergy, working together, does many mysterious things.

In fact, Dawson's co-worker, Gladys Hobby ten long years later was only one of many who were convinced that crude impure penicillin worked better than the equivalent amount of units of pure penicillin did all by itself.

Balancing these unknowns, it wasn't mathematically likely that purifying penicillin 100% was actually going to make it a better medicine.

In fact, since with 1929 levels of original mold juice and the then current state of extraction technology, 100% pure penicillin was probably going to require losing 99% or more of the original anti-bacterial substance, 99 patients would now die so that 1 might receive 100% pure penicillin.


Let me go further, and recall some of the economics lesson professor John Graham taught me too many years ago.

Graham had a way of bringing economic jargon down to ground level, perhaps never more so than in explaining the term  "opportunity cost".

I'd like to think that this is the way he'd explain Fleming I's decision to refute Fleming II's progress :

It is not just that purifying the penicillin juice to 100% results in so little penicillin output that 99 potential patients must die so one patient can be treated with 100% penicillin - that has no more medical efficacy than the original un-purified juice.

Because devoting all of your incredible amounts of labour, stress, time, expense, lab space to this purification effort, means your team can't find the time and space to simply produce more absolute units of the original penicillin, with the production technology they already have.

Nor can they find the time, energy and money to improve the biological yield of that original strain of penicillium mold.

In the real world of limited time and resources, when you open one door, you close many others.

Now Fleming II didn't actually go very far down the path of this (pointless) path of purification.

But his team did find success in the much easier and much more potentially useful concentration of penicillin juice ; aka simply removing most of the harmless water, as we do with concentrated orange juice.

If water is the one compound in the mixture known to be harmless, why bother ?

Fleming's strain of penicillium was actually a very potent producer of penicillin on (not in) water : eventually it produced 200 units of activity per ml of liquid in painstaking experiments in the lab, and routinely got at least 40 units in day to day industrial efforts.

But Fleming didn't know how to grow penicillium right to produce its potential in penicillin - and why should be ?

But he also didn't bother to try to find out, from other fungus farmers, how to grow it better.

He was a medical bacteriologist and he grew it as if it was a medically important bacteria.

The results were a disaster : he was lucky to get one unit of activity per ml of liquid.

But even the most careful technique of safely injecting large amounts of liquid by IV drip wasn't going to find a way to get anti-bacterial activity that diluted into the blood stream to cure really life threatening blood poisoning.

Success by this method, as several bold and brave doctors discovered in 1943-1944, wasn't actually that far off : in those early days, even massive infusions of 10 units per ml of liquid would save lives ,and at 40 units per ml of liquid all but the toughest infections could be beat back then.

So if Fleming II concentrated his original liquid down to a thick syrup, he'd have concentrated it enough to inject into patients --- without losing too much of the original scant penicillin in the process  OR consuming all his team's limited energy, time and money in the process.

But at this point, another set of experiments convinced Fleming II completely (and totally wrongly) that penicillin would not work at all as a systemic - concentrated, purified or not.

If only he had injected his syrup, mixed with a little bit of saline solution, into a dying mouse, the mouse would lived.

 And penicillin would have been in wide clinical use by December 1929, repeating the rapid pattern of Banting's insulin, but this time in spades.

However, Fleming I never put Fleming II's work or conclusions into his 1929 paper - only repeating his conclusions in private conversations , if pushed.

He found, (and so told hundreds of hospital bacteriologists all over the world) , that easy to make, 100% recovery , liquid penicillin worked well as a routine lab clearing agent and for use as an a non-toxic human antiseptic.

Now to October of 1940 , exactly 12 years after Fleming's original startling discovery about 'the non toxicity of impurity'.

 Henry Dawson is waiting impatiently for his co-worker Karl Meyer to purify some of Fleming's penicillin up to what the team imagined was the level of purity acceptable to their famous teaching hospital's quality standards.

And to the level they imagined the deliberately vague but purity-obsessed Howard Florey had claimed he had achieved before safely injecting his penicillin into infected mice in the summer of 1940, saving their lives.

Suddenly, while impatiently waiting and pacing the floor, Dawson was presented with a truly Solomon's Dilemma.

He had expected to treat a single patient with SBE, provided the young man didn't die of the invariably fatal disease before Meyer had purified the penicillin to an acceptable level.

Now he suddenly had two young men dying of SBE.

Re-reading Fleming's original article gave him his solution : if purifying merely lent losing half or more (much more) of the limited material available, without making the resulting medicine any less toxic, why bother ?

Merely quickly concentrate the liquid penicillin, so most of the harmless impurities are left in, while the harmless but burdensome excess of water was left out - and you would be quickly left with enough penicillin to treat two patients - and all this could happen before the two men died.

So the spirit of Fleming I , not Fleming II, was guiding Dawson's hand when he injected the world's very first antibiotics , months ahead of schedule, into BOTH Aaron Alston AND Charles Aronson on October 16th 1940.

Fittingly, in this act of inspired charity, Matthew 20:16 was again fulfilled as the Last became the First to receive this healing balm.

(Alston was almost certainly black and Aronson almost certainly Jewish and in 1940s America both were hardly among the truly favoured peoples.)

After Dawson, a few others others would re-read Fleming's paper as if for the first time, and decided to prefer large amounts - today ! - of highly impure but non toxic penicillin, over small amounts of highly purified but no more non toxic penicillin, maybe, tomorrow.

I suspect their grateful patients, plucked back from the grave, more than agreed with their re-reading of Fleming 1929.

A case of Jam Today , indeed .....

Wartime penicillin was "A Genie of Universal Healing", trapped by Florey in a military bottle...

... a Genie intended to remain secret, military and patented for the duration of the war, until others --- led by Henry Dawson --- fought to set it free to benefit all humanity.

Like the war itself, wartime penicillin was not a single event, as we tend to treat it today, but a six year long, world-wide process - a conflict in fact.

A conflict between the much more powerful and much more numerous Hares, led by Florey, who sought to seal off penicillin in many different senses of that phrase.

The small band of Tortoises , led by Dawson, sought to make penicillin free to mix , again in many different senses of that phrase.

The Hares had all the early running from 1939 till 1944, when the Tortoises suddenly appeared out of the dust , like the US Seventh Cavalry, to save the medical establishment's bacon just moments before the D-Day beaches became red with blood .....

Fleming's seminal 1929 article on penicillin is missing two words : impurities and crude

Fleming, in this extremely famous article, defines his "penicillin" as consisting of  one or more soluble solid active ingredients in a liquid nutritional  broth, no more and no less.

He makes it clear that "penicillin" is merely a useful shorthand for that cumbersome longer phrase.

He never once uses the word impurities or impure or crude: to him his active ingredient is perhaps ALL  of the soluble solids left behind when the water is evaporated .

Fleming says that this (mixture) of soluble solids and nutritional broth is non-toxic to the extent that it can be injected in a mass of one fortieth of body weight without harm.

(That is, this liquid mixture appears to be safely injectable in a mouse and a rabbit to the equivalent of  a single bolus of 1500 to 2000 cc into an average adult human.)

And Fleming isn't the only one never to use impurities or crude in describing penicillin in a scientific report, in the twelve years between 1928 and 1940.

Clutterbuck & Raistrick in 1932 do not use the words impurities or crude, nor does Roger Reid in 1934, or Elizabeth Pickering at Squibb in 1937 or Siegbert Bornstein in 1939.

But Howard Florey, the chemist manque , the anti-clinician, he sure does in 1940.

He might even ask his potential readers, "Purity : how many ways do you want it ?"

Despite being a very short article - almost more of a scientific note  in the style of letters to the journal Nature - Florey manages to inject the words "purify" , "not a pure substance", "impure" and "impurities" and talks constantly of his "penicillin preparations" as if they are something quite different and advanced from Fleming's liquid penicillin.

But, in fact, Florey has merely concentrated all the soluble solids by evaporating away the water, so that 4 tiny units of anti-bacterial activity are no longer in a gram of water and solubles, but in a milligram of solubles.

But two thirds of the scarce anti-bacterial activity has been lost in this totally unnecessary and expensive and complex effort : and in any case, this dry powder has to have water added back into it, to inject it for use !

Dawson, Pulvertaft, Duhig, Yermolieva , Berger (among a mere handful of all the world's doctors ---- maybe just .01% of them  thought this way) seemed to have picked up on Fleming's crucial point.

A point he quickly missed, because he publicly always said that the substance would have to be synthesized pure by chemists before it might be a useful antiseptic .

But his original point was true, nevertheless.

It was this : that regardless of whatever was the compound(s) with that mixture of soluble solids that had the anti-bacterial powers, the water and other solids had no harmful effect and needn't be laboriously purified out - or even concentrated by evaporation - at a tremendous loss of the anti-bacterial matter.

Dawson is at pains to introduce the word "crude" repeatedly in his 1941 article, but with a much different point that Florey's article a few months earlier.

Dawson wants to hammer home that despite the crudity of this mixture of the anti-bacterial activity and the other soluble solids, it was still non-toxic even when injected ( finally) into the human blood stream : life-saving does not have to wait until the chemist's apple has been polished to a 't' .

Dawson is , in a sense , "The James Lind of Penicillin".

Put in another way, James Lind said we don't know which compound (later determined to be vitamin c) it is in limes that prevents scurvy but that shouldn't stop us from using it - NOW ! - to save lives.

Almost two hundred years later, another Scottish (Canadian) doctor (Henry Dawson) said pretty much the same thing.

The lesson might be this : chemists, let the sleeping dogs of chemical perfection lie -----  while we clinicians get on with saving lives.....

January 1943 : that penicillin cured the incurable SBE is a military secret, but penicillin's chemical formula is not !

The American scientific journal "The Journal of Bacteriology" is a top journal in its field, read - at least in peacetime - by workers in that field the world over.

Yet in January 1943, it is revealing that one of the earliest and most persistent researchers as to the chemical structure of penicillin , Karl Meyer, is still free to publish his informed opinion on the formula for penicillin : C14H19NO6 or C14H17NO5 + H2O.

His co-author, clinician Henry Dawson, by way of contrast, is NOT free to reveal that he has achieved a truly spectacular medical event : curing the incurable, invariably fatal SBE with penicillin , still the acid test of all infectious diseases.

His first penicillin success with this disease, a young woman known to us only as Miss HH , had just gone home cured - in time for Christmas - just days before Dawson team member Gladys Hobby was due to deliver this paper in Columbus Ohio in late December 1942.

Few members of the January 1943 public, falling by chance upon this journal were likely to care about the chemical formula of a largely unknown new drug - but curing SBE - Oh My, oh my !

Now that was a good news story, with legs.

The OSRD hated good news not of their own making ...

Which is precisely why it was banned  ---- and the chemical formula was not.

The very last way the OSRD wanted the public to first hear about penicillin a full year and a half before D-Day, was in the context of a widely publicized civilian miracle cure.

Dropping the miracle-work of D-Day penicillin on a surprised German Army medical corps was not going to work, if the Germans had first heard rumours of miracle cures with penicillin coming from every local American newspaper some two years earlier and had time to grow their own penicillin.

If the price for Dawson continuing to receive penicillin, once his hitherto semi-independent supplier Pfizer joined the OSRD cartel in the Fall of 1942, was to became a OSRD "principal investigator" (aka COC "accredited investigator") then he had to take an extraordinary oath not to reveal anything to anyone, without full OSRD approval.

So nothing public on the success penicillin was having in pulling bodies back from the grave : but if the Germans wished to make penicillin ; well then here is the formula.......

George Redmayne Murray : moral predecessor to Dawson,Duhig & Pulvertaft's penicillin efforts

moral predecessor to Henry Dawson

Dr George Redmayne Murray is no longer a name that trips off the lips of scientists and doctors, but he still has moral lessons to teach us today.


Thyroid conditions in his day, the 1890s, were started to being treated by grafting new thyroid glands from animals into the bodies of people with diseased ones.

It sort of worked - heroic medicine indeed.

This concept was more or less how Banting originally planned to cure diabetes.

But when Murray read of one such effort is Lisbon, he noted the results came far too immediately -  the same day in fact - for new blood vessels to have had time to grow for the organ to spread the juice of the gland into the body.

The juice must have diffused outward from the new organ, on its own.

In which case, the juice alone, from ground-up animal organs, might work - without the need for an expensive and dangerous major operation to insert the organ itself.

(And let us not go into rejection problems !)

And here is where the application to chivalrous penicillin came in : he immediately extracted the juice of animal thyroid, added a little of a bog-common preservative to the juice to kill off any bacteria within, and injected it cautiously, just under the skin, into a patient with thyroid disease.

It worked -- she recovered her strength- and the first ever successful hormone deficiency treatment had happened for the price of a hot dinner, and in about the same time period it takes to eat a hot dinner !

Insight and drive - not money - more often than not, really drives medical advances

Dawson, Duhig, Pulvertaft also injected their crude substance (penicillin juice) via this method : cautiously just under the skin ( the safest form of injection) and with a simple common preservative to kill any potential pathogens.

Advances in medicine don't always require armies of the ambitious (more eager to produce endless papers than to help patients) and factories full of equipment.

It sometimes just takes deep insight and a moral drive : Murray , like Dawson, clearly had both....

WWII : penicillin as punishment for self-inflicted wounds - or for saving lives ?

In WWII, they used PENICILLIN , instead....

Dr Howard Florey's deep and sharp (fundamental) differences with Dr Henry Dawson on the appropriate application of wartime penicillin were not over matters narrowly "scientific" or "medical" but rather were differences in philosophy and ethics.


Were the Allies to devote a limited amount of resources to producing just enough penicillin to use as a punishment in cases of self-inflicted wounds such as VD , as Florey and his mentor Dr AN Richards acquiesced in or advocated ?

 Or were the Allies to devote resources to produce enough penicillin - not in spite of it being wartime, but particularly because it was wartime - to treat all people dying of disease (regardless of income, race or gender) as a highly popular and public example of the ethical nature of Allied War Aims, as advocated and practised by Henry Dawson ?

Penicillin only became popular among the military elite of Britain, Canada and America in 1943, when it became apparent that combat troops in the European Theatre, fearing the worst against the tough Germans, were deliberately infecting themselves with VD, in hopes of a two month treatment away from the upcoming invasion of Sicily.

Deliberately getting VD, by not using Army-provided free condoms was considered a Self-Inflicted Wound, SIW, and during WWI made a Capital Offense punishable by death by firing squad.

Even during the Second World War, it could mean being sent to the dreaded Glasshouse military prisons, where the policy was to inflict punishment so severe that potential death at the front was considered a better alternative.

Unfortunately from the senior officers' point of view, many still preferred the Glasshouse, so punishment for VD cases of SIW was considered counter-productive, as it led to severely deplete ranks among the combat elite forces who faced the highest chances of dying in the invasion of Sicily.

If these combat troops were out of action, other men's sons ( like their own) would simply be 'called up' in their place and so using penicillin as a punishment was wildly popular among the officer class in the rear echelons of wartime reality.

Rather than waste penicillin on saving the lives of men so seriously wounded they would never return to fight and who - if they survived - would simply become 'useless mouths' consuming medical resources and pension funds, divert the penicillin to rapidly curing non-fatal cases of gonorrhoea among the elite combat troops.

A two day cure ( with painful penicillin shots) and they'd be back in the Front.

Why bother to waste bullets on an Allied firing squad for the offense of SIW : why not let German combat bullets do the job instead ?

We must never forget that both sides practised the policy of death for 'useless mouths' : the Allies made it "death by neglect", the Nazis "death by deliberate murder".

Deliberately limiting resources for the production of wartime penicillin was the Allies' Aktion T4

To Dawson, and to me,  the notion of killing of the weak because they are considered useless as war workers and just a burden on the wartime economy is simply wrong, no  matter how it happens.

Death is death.....

2011: creation of clash of 1840s darwin/dalton versus 1940s dirac/dawson

The "Four Ds" are not "The Four Divas" but two groups of conflicting scientists who laid the ground for the world most of us are destined to live , reproduce and die in - the 21st century.

John Dalton and Charles Darwin, scientists from the 19th century, still bulk out 21st science education for most of us, thanks to the ego issues of the teaching class, who can not accept that the world is not fully composed of definite answers to definite questions.

But our century is actually the dialectic result of the WWII clash between the scientific certitudes of Darwin and Dalton colliding with the scientific uncertitudes promoted by Paul Dirac and Henry Dawson, scientists definitely of the 20th century.

Plenty of irony in the latter pair.

Dirac's QUANTUM PHYSICS said the behavior of a billion radioactive atoms are predictable in true Daltonian fashion, but  the activities of any one individual radioactive atom is not.

In contrast, Dawson's QUORUM BIOLOGY agreed that a single individual bacteria was as dumb as Darwin said all the"primitive races" were, but that collectively a billion bacteria were collectively (and unpredictably) smart in ways we are only beginning to comprehend.

Both agreed that the smallest entities of matter and life were not as stable and as dumbly inert as civilized man had assumed.

Conversely, WWII itself seemed proof enough that civilized man was not as smart as he had thought.

From above, such Phaetons as Albert Einstein fell back earthward, while from inside the ground itself, Penicillium rose up in our esteem to meet Einstein midway to dine with him at Life's commensal table...

*In ferrum pro libertate rueban

It is thin comfort when you lose your dad or husband at an young age to note that his death had its poetic dimensions to it.

But just as Dr Martin Henry Dawson began his independent career with his work on the dagger shaped S pneumococcus, so those bacteria also brought his career to an end.

 These sword-shaped bacteria - 'the old man's friend' - hastened his end when a final Myasthenia Gravis Crisis, two and a half years after his initial diagnosis, led to aspiration pneumonia which developed into full blown bacterial pneumonia.

This was the usual time period - and manner - in which people with severe MG died , before changes in emergency crisis treatment in the late 1950s greatly reduced fatal outcomes from 80% to 5%  (and that 5% usually from the severely ill elderly with MG.)

A further poetic dimension to Dawson's life and death is that the man spent his whole scientific career focused on mucus -  strep bacterial mucus to be exact.

(From the lifetime he spent plowing this narrow, boring-seeming furrow, Dawson nevertheless spun off HGT and Recombinant DNA, Q-sensing, Molecular Mimicry induced Autoimmune disease, and Biofilm colonies destroyed by Systemic Natural penicillin - basically the entire field of  current bio medicine.)

Not bad !

But in the end, it was his own thickened mucus that his MG crisis produced but that his weak gag reflex could not expectorate that led to the aspiration pneumonia that resulted in his death.

Dawson lived for his (bacterial) mucus and he died by his (own) mucus...

* "For Freedom, They Rushed the Sword" : Virgil's AENEID

Laconia: DELIBERATE friendly fire is modernist utilitarianism

I do not find it at all impossible to comprend why so many Germans found it easy to cold-bloodedly murder millions of 'useless' outsiders, whom they hated and feared, after learning that they first killed hundreds of thousands of their 'own kind of people', kinfolk that they regarded as 'useless mouths' impeding an all-out total war effort.

While these numbers killed dwarf any other killings during the last War, they do not seem to me to plump the depths of the evil that modernist utilitarianism proved capable of during Modernism's big war.

As just one example,German soldiers east of Berlin, near the end of the war, followed orders to blow up a river bridge to stop the Russians coming over it, despite the fact that the bridge was loaded with hundreds of German civilians.

I call this 'deliberate friendly fire' (and I do not consider fragging as friendly fire at all).

My definition of deliberate friendly fire : "you know there are people from your side - soldiers or civilians - in the very small area you are accurately aiming your weapons at, and you fire away anyway and kill many of your own side while attempting to kill the enemy".

It is fairly well known that naval escorts were routinely under orders to never stop to pick up convoy survivors in the freezing North Atlantic waters but rather to abandon them (to likely die), while they chased subs instead.

Sometimes they had to be even more brutal - dropping depth charges in among survivors ,knowing many would die from the blast.

In September 1942, the converted Cunard liner LACONIA, which had frequently docked in Halifax during the war,
was sunk by a U-boat off Africa.

She was an armed warship, so this was fully allowed under the rules of war, though the U boat thought she was a troop carrier, not an  armed naval vessel.

The U boat captain got a shock when he heard the survivors in the water speak Italian and learned that there were 1500 Italian POWs on board, along with Allied women and children.

He told Berlin he was going to signal his position in clear language and try and arrange a rescue trip, under the flag of the Red Cross, to a neutral (Vichy) port.

The British ,suspecting a trap, didn't fully inform a near by
American fighter bomber base, who decided to bomb the U-boat, even though it would mean the death of many near-by allied sailors and families - as it did.

The ultimate decision was apparently made by one plane's bomb sighter's adamant eagerness to drop bombs on civilians, if needed to record a u-boat kill.

His personal decision led first the Germans and then the US to create a formal and public "sink everything without warning or rescue"  submarine policy worldwide - leading to hundreds of thousands of extra civilian deaths - many of them being innocent people 'from their own side'.

My partner Rebecca, without giving it much thought, said things like this happen - 'sometimes you must kill a few to save the many' .

I told her I rejected utilitarianism absolutely and decided to write this blog entry to try and explain why to her.

World War Two was many kinds of war.

After all, it was the same war that saw Americans unwilling to send healthy young fathers off to fight till forced to in late 1943.

They also rejected using the one in ten Americans who were black in combat roles and they rejected a wider use of women to replace men to go off and fight.

They objected to almost every rationing rule with real bite.

This unwillingness to fully engage their national resources, if doing so led to inconveniencing civilian lifestyles and upsetting prewar civilian norms, meant that America couldn't put up enough military resources to stop the relatively small number of U boats wrecking havoc all over the Atlantic.

This, in turn, led to these brutal 'kill our own side if need be to kill the enemy' orders as Allied commanders tried everything to try and keep the U boats from winning the war on their own.

Everything? Did I say that ?

I didn't mean that Allied commanders were willing to put a serious number of their longest range bombers on U-boat patrol - the one thing needed to stop the U boats cold.

No, those were saved for the glamorous (but mostly useless) high tech bomber war against Germany itself - not the boring but useful patrols over the Atlantic.

I say that utilitarianism is never moral - even if we ( literally all of we - from child to grandmom) all agreed to draw straws.

Straws to see who goes off to die in the infantry and who gets to stay home.

This total utilitarianism without limits would end up consuming itself until we, on all sides, would literally fight to the last person.

But we haven't seen - Thank God ! - this kind of utilitarianism - yet.

What we got in World War Two was selective use of total utilitarianism, almost always invoked by the higher-ups and almost always inflicted upon those lower down.

In 1942-1943,during the same time as the Laconia Incident, thsat same US government also decided to deny penicillin to the SBEs that Dawson championed.

The small supply of penicillin would go instead to quickly cure GIs in Italy who had deliberately incurred cases of VD to get out of the constant killing zone that was the American front line.

Once quickly cured in a day or two by penicillin, (the old protocol took months to get a full cure), they could be ordered back to fight - to fight until they died thanks to the American 'no rotation' rule'.

This was all decided so that American civilians back home won't have to be called up to fill out their depleted ranks.

This penicillin decision likely meant death for both SBE and GI.

A selective, lethal, slice of 'total war' was applied there, on these few people, so that a less lethal slice of total war did not have to be applied here, among many people.

I find it a horrifically cynical policy but it has its defenders, even today.

The right policy would have been to issue the threat of a government factory to supply this miracle drug, if the private drug companies proved too slow.

The fear that a Democrat government factory would have ended up getting the credit for "supplying the miracle", rather than private enterprise, would have lit a fire under the backside of Republicans like George W Merck as nothing else could.....

the epic triumph of DEMAND SIDE penicillin

All penicillin histories - to date - have been about what I call "SUPPLY SIDE" penicillin.

"Brilliant scientists, working day and night in the 15 years since September 1928, once again totally surprised humble but ever grateful lay people all over the world."

"They did so by dropping the new miracle cure penicillin  upon them, out of the blue, in September 1943."

This version of the saga says penicillin is best told in two competing stories or parts.

 But both parts are united in being all about active scientists --- with no role what so ever for us, the totally passive and inert citizenry, or in our roles as patients and patients' families.

Part One ,(1928-1937), features Dr Fleming - discoverer of penicillin - with far too many pages devoted to the mysteries of that discovery and with too few of the rest devoted to his efforts to bring his penicillin juice forward to the point of actually saving lives -----when used as an antiseptic.

Part Two, (1937-1940), features Dr Florey of Oxford University (all bow) and his years of wartime work on the chemistry of penicillin - all about his troubles extracting and purifying and synthesizing penicillin.

My book will be about Part Three, (1940-1943), the era of "DEMAND SIDE" penicillin. It will be all about the life-saving done by early penicillin doctors (not scientists), on the rare occasions when penicillin was diverted to the ward bedside and away from the synthetic chemists.

 It will focus on Dr Dawson - the patient. Yes, the patient.

Dawson was not unique in deciding to become a doctor after months spent in a hospital - Dr Colitti ( of Patty-Malone-and-penicillin fame) resolved to become a doctor after his own childhood bouts in hospital dealing with his spinal TB that left him a permanent hunchback.

For Dawson, his insights as a doctor dealing with chronically and terminally ill SBE patients could only have deepened when he himself became a chronically and terminally ill MG patient at about the same time.

Actually I will focus on Dawson, on his first penicillin cure Charlie Aronson, on Baby Patricia Malone's family and on the mother of a dead child he never got to save - Mae Smith, wife of Pfizer chief John L Smith.

In August 1943,Dr  Dante Colitti - inspired by Dawson's illegal SBE successes (an early example of ACTING UP) at another hospital a mile away, got Mr and Mrs Malone to also 'ACT UP' and publicly demand penicillin for their dying child.

Soon hundreds of families were doing the same all over North America and when enough Doctor Moms kicked up a fuss, even the stupidest men in Washington or Brooklyn listened - penicillin production really got moving, after 15 years of male excuses for 'not taking out the trash'.

CHRONICALLY ILL are always 4F

Med Schools in that era - and perhaps even today - hated the chronically ill because they refused to die or get better, within the only school term that could be devoted to that particular form of illness.

The chronically ills' failure to get better 'put paid' to the notion that Science was always successful.

And Society in general packed the chronically ill of low income families away in large impersonal institutions with too many patients and too little money.

It got worse in wartime - a lot worse. A lot of people feel free to unleash their inner evilness in wartime and the helpless are a safe target.

In Hitler's Germany, the chronically ill were actively gassed - particularly those 'useless mouths' type patients like the SBEs (Charlie) and MGs (Dawson) who needed lots of repeated interventions of  high tech medical care without any hope they would eventually recover and start back at productive war work.

In Vichy France or in the US, it was more subtle - the eugenics of benign neglect.

Budgets were cut for the chronically ills day to day living expenses so more money could go to the war, or simply back to the well to do taxpayer when no one was able to complain.

Many chronically ill in institutions died of hunger-induced  infections while the budget-cutters' consciences could remain unsullied.

 Chronic illness research efforts were re-directed away from these useless mouths 4Fs towards the 1As and war medicine.

 Many patients were conscripted,without their informed consent, in some very dangerous experiments for the war - humans being as badly and baldly treated and cast off as laboratory white mice usually are.

Dawson and his supporters rejected the artificial divide between Social Medicine and War medicine, between social penicillin and war penicillin.

They said , against Hitler and Tojo, social medicine was war medicine,in fact the best kind of war medicine.

They said are we fighting Hitler simply because he took raw materials and markets we once regarded as ours or rather because we detest his values with all our hearts?

If it truly was the latter - FDR's Four Freedoms -  we should contrast how we treat our old and weak against how Hitler treated his.

For we will all become old and weak someday.

By 1943-1944, a lot of people saw that Dawson was right - and penicillin's promise was held out to people in the occupied ,enemy, allied and neutral nations as a symbol of the rightness of the Allied Cause.

Until then it had been treated as one of the Allies' best war weapons - a strange term for a life-saver .

 Yes, Dr Dawson probably did 'go a little native' when he got MG and became a perpetually ill patient as well as life-saving doctor -----but Thank God for that !

In January 1945, when AMA boss Morris Fishbein, the American medical censor, finally let Dawson tell American GPs about his five years of successfully curing SBE with penicillin, Dawson could reflect he hadn't done too badly for a chronically ill 4F.

Most histories of penicillin - to date - act like Dawson withdrew to a shadow world of chronic illness and inactivity after he got his MG diagnosis around May 1941, so the authors can return to focus on his rival Florey.

But in the Spring of 1945, Dawson could say, like a lot of chronically ill people who kept on being highly productive despite the pain, "*I'm Still Here - and so is my penicillin !"

Partially because of Dawson and Colitti's ACTING UP, patients today are much more likely to demand quick relief rather than simply waiting for the desultory scientists to get it all perfect and pure before dropping it into our grateful little hands - and Thank God for that, too....

* "I'm Still Here !" is a copyrighted expression and used with the kind permission of the late copyright holder, Margo Takacs Marshall, 1928-2010

Florey,Dawson's clashing business models

Florey and his many scientific supporters have always said that his interest in penicillin, beginning in early 1938, was the fact that it killed staph bacteria while the sulfa drugs did not.

Staph was not a big killer back then - not like strep bacteria - at least not in peacetime.

It tended to do its worst when it settled deep into big bones that weren't well supplied with blood - making it hard for white blood cells and sulfa molecules to get at the bacteria.

This condition is called acute or chronic osteomyelitis and it was rampant among the young children of the poor - in peacetime.

In wartime, surviving victims of war wounds - or the surviving wounded from the Blitz - often had huge deep wounds that involved their leg bones - a hard-to-get-at location that was ideal for staph bacteria to settle in for a long stay.

Patients affected went back and forth from convalescence bed to hospital bed while doctors and nurses strived to prevent the patient from getting worse in the hope the body would eventually seal off the infection without crippling the patient in the process.

Often they survived but were left crippled - other times the patient's resistance weakened and the staph spread widely till the patient died of general blood poisoning.

In war time, deep bone wounds infected by staph represented a massive cost to the military medical system - consuming resources for years while the affected soldier was unlikely to ever to return to full service. Blitz victims similarly taxed the overworked civilian medical system.

So Florey's business model for "war penicillin" - penicillin as a mere supplement for the sulfas, its wartime use to be strictly limited to healing military patients with deeply set staph infections of the bones and limbs - how did it sell ?

It didn't.

There is no record in all his biographies that any military medical types ever visited him until 1943 - nor is it recorded anywhere that he visited military doctors and was turned down.

Curious - the Navy, Air Force, 8th Army in North Africa, the Blitz victims - they had no end of deep staph infections of the bones to treat from September 2nd 1939 to September 2nd 1942 (three years - half of the entire war) but they avoided penicillin like it was plagued.

Florey was set up to supply an non-existent market.

By contrast,from 1940 to 1942, Dawson's main market had more customers than he could hope to fill.

Florey,Fleming, Heatley, Merck, Dawson of course, they all got requests (from around the world) for penicillin to treat SBE after Dawson announced that he had hopes to cure SBE with the new drug.

Dawson's business model for penicillin could not have been more different from Florey's.His Social Penicillinhe wanted to be made by a government factory and made available to all ( civilians and soldiers) in quantity and at a reasonable price - and made available like yesterday.

He thought penicillin could replace sulfa, not just supplement it, and used to kill all bacteria that was sensitive to it - not just staph.

Florey didn't directly treat any cases - he had no hospital rights unlike Dawson.

But the twenty serious systemic cases he
indirectly treated were almost all staph infected - so he kept to his business model in his own practise.

Similarly, Dawson had about 125 serious systemic cases that he directly dealt with and he too kept to his business model.

Those cases included all the types of bacteria that penicillin could kill---with about a third of them SBE cases.

Penicillin was promised to the military in mid-1943 after they finally decided that they wanted it ,by seeing it work well in military staph wounds in early 1943.

Score one for Florey.

But it only actually got delivered to the military and to the civilians when Dawson's
SBE success produced a patients' revolt across America and Canada ----inspiring Pfizer to go for broke.

Credit that to Dawson's business model--- and lets recall that by 1950 penicillin had completely replaced ,not supplemented, the mighty sulfas.....

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.....

why MUCOID mattered: Henry Dawson and Rheumatic Fever

Recently having had a sore throat or tonsillitis - when it is caused by our normally throat and nose inhabiting (commensal) strep bacteria- is the only way you can get Rheumatic Fever.

There has never been a confirmed incident when huge life-threatening amounts of virulent strep bacteria rolling about in a gaping wound (the type of dramatic situation that makes strep the most feared word in the medical lexicon) has ever caused a single case of life-threatening Rheumatic Fever.

Rheumatic Fever (RF) is (and was) a very serious and very common disease, yet it begins with the quietest possible onset - one third of all its victims can't even remember having had a recent sore throat.

'Sore throat', undefined, is so common throughout all our lives, that we find it hard to tell those ones that were caused by strep bacteria from those that weren't.

The safest rule is if the sore throat hurts much and hangs on more than a day or two - run to a doctor and ask for a swab test.

If we are very unwell and have had endless rounds of sore throats and even previous bouts of RF, probably almost any strain of strep can cause another round of RF.

But for most of us that are healthy and well fed, being in an stressful new situation in an enclosed space for weeks at a time with a particularly virulent strain of strep running from person to person back to person, is our only way to get it.

I mean a wartime military recruit camp - the best possible natural laboratory we have ever had to see just how many people can get RF if the conditions are perfect.

The observed percentages are high enough, often enough, to put real fear into that doctors that do statistics and are paid to keep an eye on epidemics ---this despite the fact that RF is almost totally gone in the western world.

(It is still common in third world countries that until fairly recently historically never saw a case of it.)

We still don't know enough about it, to be terribly confident that it will remain beaten here in the western world.

Currently, the biggest focus of research effort is something that Martin Henry Dawson would not have found surprising : it is the fact that it is the most heavily mucoid of hemo strep colonies that seem to cause RF among populations normally felt to be at least risk.

Mucoid heavy strains of hemo strep turn RF from a social disease affecting the poor mostly, to something that could kill any or all of us.

A deep interest in raising the awareness of the virulence of Mucoid colonies of GAS strep generally (along with his pioneer use of penicillin to cure RF's final effect, SBE) was Dawson's particular contribution to the world wide effort to explain and prevent RF from the 1920s to the 1960s.

I do not believe that Dawson had actually pinpointed mucoid strains of hemolytic strep as the leading agents of the most deadly versions of RF - he simply knew that mucoid colonies were usually the most deadly agents in all of the dozens of serious diseases that strep deals out to us humans - and in the 1930s, RF was the most important hemo strep disease around.

Having his thesis proven in the case of acute RF wouldn't have surprised Dawson - but it would have pleased him.

 His 1930s mucoid work, sandwiched as it was between his pioneering work on recombinant DNA in the 1920s and his pioneering penicillin work in the 1940s has naturally been overshadowed by these two, the two biggest medical stories of the entire 20th century and beyond.

But to explain how in 1940 that an arthritis 'aspirin doctor' ended up in the area of endocarditis, today the domain of heart surgeons, we need to see this intellectual connection between mucoid hemo strep causing RF, which in turn led to SBE.......

Sir Robertson's curious letter and curiouser claim

Late August and early September 1942 saw a furious burst of letters to the editor directed at The Times of London, provoked by an August 27th editorial in paper concerning penicillin.

The three hundred word effort echoed an earlier editorial from The Lancet , and supported their claim that the drug was non toxic and more active than sulfa drugs and that its production should be greatly expanded and quickly.

Since penicillin looked to be a real comer with much 'moral capital' accruing to the companies or institutions that best claimed the laurels for first developing it, naturally all the major bodies involved had to elbow their way forward to stake their claim -  the current 'all-for-one' war effort not withstanding.

(A note to errant historians and authors: the drug companies' penicillin research arm, the TRC,were actually the first to gave themselves credit. Only then did St Mary's Hospital step in to also seek some glory.)

Sir Robert Robertson, the world famous Oxford chemist , spoke for the Oxford team.

Some of what he claimed were mere weasel words.

Dawson published the results of his treatment of 12 patients by May 1941, Florey his results on ten patients in August 1941.

Both were admirably cautious in assessing what if anything penicillin had done for their patients.

Dawson was actually the first to treat a patient and see that patient go home from his deathbed --- so Robertson was content to use weasel words that Florey was the first to "demonstrate the value
(of penicillin) clinically."

'Demonstrate' is a subjective term - in the eyes of the beholder - and Robertson knew it.

So, he had as well admitted that Fleming discovered penicillin and that Dawson had been the first to use it clinically as a life-saving systemic antibiotic.

What credit left for Oxford?

Robertson then told the bare-faced lie that toxic materials were produced by the penicillium mold, along with penicillin.

 Florey was therefore to be praised for being the first to separate the unsafe impurities from the safe pure penicillin so that it could be at last safely used on humans. (But wasn't, not by Florey - at least not right away ...!)

Nobody who ever worked with penicillin-producing penicillium , starting with Fleming in 1928 and carrying right on through twenty years later, ever saw enough of anything harmful, at levels enough to be toxic.


All made a point to note that the raw penicillin juice was not toxic even when injected in huge quantities by normal medical standards.

Foremost among these supporters of the use of  semi-purified or raw penicillin was one Howard Florey.

He publicly marveled that in hundreds of IM injections, no damage was ever seen at the site of the needle - not even in babies. The impure preparations he rated at 10% pure at the max (actually 3% pure) yet their impurities ( 97% of the dose) were non toxic - even when given in huge dosages.

It is hard to imagine a better test for proving the impurities were NOT toxic --- I can not,myself, imagine one.

What was going on then - in the mind of Professor Robertson and his chemist-manque Dr Florey ?

If Robertson and Florey had made any headway on synthesizing penicillin, I am sure this would have been their sole claim to glory.

But they hadn't.

So what can chemists do?

They can separate substances, even if they can't synthesize them, and even if the substances didn't need separating !

A nice meal does not improve when a chemist burns it all and then pours acid over the remains, to separate it into its constitute elements.

Penicillin juice - as Australian Dr James Vincent Duhig demonstrated in Brisbane in the Fall of 1943, doesn't need to be separated from its impurities at all, in order to save lives safely.

When it comes to questions of health, trust Duhig,MD over chemist Robertson PhD.

I don't expect Oxford University's academics to ever set the scholastic record straight about what Oxford did and didn't do with penicillin.

Claiming a leading role in developing the best lifesaver the world will ever know is simply too much of a money spinner for Oxford and the entire Thames Valley community.....