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

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

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

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

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

Patient One , A and B

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

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

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

Heart valves damaged earlier by RF (Rheumatic Fever).

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

The Polio of the Poor

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

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

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

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

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

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

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

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

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

Delay meant Death

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Antibiotics arrives, despite doctors' best efforts

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

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

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

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

Enter Charles Aronson

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

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

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

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

Several reasons.

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

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

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

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

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

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

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

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

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

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

Dawson hated Triage

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Cynical, clinical, trials

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

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

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

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

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

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

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

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

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

The tiny amounts moral dilemma

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

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

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

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

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

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

Carefully applied, triage can be highly moral.

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

William Osler's take on the whole affair ?

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

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

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

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

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

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

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

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

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

The Cure for Auschwitz Disease : "Dawson's Crude" : .56% penicillin ...and 99 and 44/100ths pure love

Pray there comes a day when most premature deaths really are 'Acts of God', when even the best of money and the best of medical care could not result in a happy ending.

But until that happier day, most premature deaths in the world - in peace as in war - are 'Acts of Humanity' , or rather 'Acts of Lack of Humanity'.

Sins of Omission : premature death caused because the people dying are not judged (by others more fortunate) as worthy of devoting much money or effort towards saving.

In war, comparatively few people die as soldiers dying of mortal wounds gained in combat.

The Nazis' behavior provides a particularly clear example of this.

They fed and cared for  the captured POWs and enemy civilians of some nations (the Dutch for example) but for other (Russians and Poles for example) many or most of these people were shot after battle or left to starve and die of disease from lack of food, medical care and shelter.

The food and fuel saved as a result meant that no German citizen went hungry or cold.

The right kind of German civilian anyway.

Using the war as excuse, the Nazis killed many German civilians, those judged 'life unworthy of life' , to free up food and hospitals for other Germans.

In another well known example of  WWII's Sins of Omission, Winston Churchill ignored the pleas of his top British officials in India and let four million poor Bengali civilians needlessly starve to death in 1943-1944 ,rather than divert some food and some shipping from  Allied peoples he judged more worthy of receiving them.

Even the different death rates from wounds gained in combat  , among the so called "modern" nations engaged in World War Two is revealing.

The Americans and British generally devoted more resources to saving their wounded compared to the Germans, Japanese, Russians and Italians.

 As a result,more western Allied troops survived the same severity of wound as experienced by troops of these other nations.

'Of course', I hear you say, 'they were richer nations, it was easy for them !'

But no : they had a choice, because the extra money devoted to this extraordinary care of the wounded could have been allocated elsewhere: to more and better anti-tank artillery, for example.

An extraordinary effort to produce the best anti-tank artillery ever made was , in fact, probably the cheapest way for the Western Allies to have ended the war against Germany at least a year earlier than it did, saving millions of lives all around.

I raise the genuine issue of better earlier anti-tank artillery versus the best possible military health care to remind us that even total war still leaves us with genuine moral choices.

More Lancaster bombers versus more 17 pounder anti-tank guns versus raising everyone's morale by generously providing penicillin enough for all people were some of the choices - part political, part moral, part economical - that leaders had to make in WWII.

Making the wrong ones meant the war dragged on longer than it had to, costing more lives lost.

It is not enough to say Churchill won the war in 1945 ; better to ask, could he have won the war in 1943 ?

In 1940, Henry Dawson was battling a near universal mindset among the world's research-oriented doctors of that time : that a medical researcher's only task was to determine that disease A was caused by bug B and that bug B was killed by compound C.

Then, like sleeping under a bridge, the researchers considered that the cure for disease A was open to rich and poor alike : pay for three weeks of needles at $10 a shot: together with doctors fees, say $250 in total.

When the annual wages of the working poor, if they found work, was very lucky to be $750 in 1940, that was a cure well beyond their reach.

Besides the fact that their disease might be far harder to cure than that of someone well off, due to the cumulative affect of their lack of good nutritious food for years and years.

Or that fact that living, as they did, in poor and crowded housing, disease A was more likely to come back again, even after an impossibly expensive cure.

Now what if disease A is something one gets from having open wounds - such as the open wounds all civilian mothers have after childbirth, or the open wounds that soldiers get after exposure to shell fire in battle.

How do we judge western Allied governments unwilling to provide the only life saver for disease A , either to any civilian moms (except those personally known to lead disease A researchers) or to any soldiers with wounds so severe they will be discharged and pensioned off, if they live ?

And how do we judge these governments when at the same time, they are gladly willing to provide live-saving compound C  (totally free !) to men who had either very high and very low peacetime incomes, just as long as their war wounds (by sheer luck) are only moderately severe and they can be expected to return soon to combat duty ?

Is this attitude not different in kind from that of the Nazis, but merely different in degree ?

Dawson had no realistic expectations that a few small injections of a very crude penicillin powder, hastily made in a few weeks, would cure such an incurable invariably fatal disease as subacute bacterial endocarditis, (SBE), then as now the acid test of all infectious diseases.

His powder had only about 8 to 9 units of penicillin per mg in it ; ie it was only about .56% pure.

The rest (the remaining 99 and 44/100ths worth),was in many researchers' minds, "junk".

Rather as they later described most of our DNA : "junk".

I believe Dawson considered his little bit of brown powder to be .56% penicillin and 99.44% pure love.

99.44% pure care, concern, caring.

For Dawson was judging his attempt to save Aaron Alston and Charlie Aronson by a much different - and much more moral - acid test.

To Dawson, SBE in the Fall of 1940 was not the acid test of infectious disease, but rather the acid test of pernicious morality.

These SBE patients were be judged to be 1940 America's "4Fs of the 4Fs", suffering from the militarily most useless disease on earth and not worthy of wasting any precious medical resources upon.

Now a doctor named Francis Peabody that Dawson had hoped to train with (but who died of cancer before that could occur) had earlier and famously said that the care of the patient begins (only begins in fact ) if the doctor first cares about the patient.

A single doctor can't hope to directly save everyone dying in a big war.

But by setting a very public example about caring for the least of these, those judged "unworthy of life", even in the midst of a war , they can hope to begin to still the trigger fingers of those all too willing to kill prisoners  just because 'it is too much bother to bring them back to our own lines'.

Only when the world is willing to care about "useless" others, even in the midst of wars, can we expect to begin to see war deaths reduced to combat mortal wounds, and then to ultimately see lesser and shorter and less brutal wars.

Only in a world where ordinary people care about others judged "useless", can we expect to still the hand that dropped the pellets at Auschwitz .

Which is why I earnestly claim that Dawson's Crude was the best and only cure for the Auschwitz Disease ....

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

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

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

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

Or maybe not.

Let us look at those famous four early cases.

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

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

Case One : success one.

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

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

Case Two.

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

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

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

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

Case Three : Anne Miller.

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

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

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

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

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

Case Four : Harry Lambert.

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

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

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

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

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

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

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

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

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

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

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

"Little Belgium" : Floor "G" Columbia Presbyterian Hospital , Oct 16th 1940 - Feb 4th 1945

"LITTLE BELGIUM"

On October 16th 1940, the first day of registration for America's WWII Draft, Belgium was well past defending from the Boche.

Like Czechoslavia, Poland, Denmark, the Netherlands, Luxenbourg and Norway, Belgium was one of many small nations of Europe that had already fallen to Nazi Germany, without America so much as putting up a squeak.

WWII was not like WWI - if the Great War had been dominated by Victoria sentimentalism - WWII was Victorian social darwinism's war : a cold, hard-faced, ruthless war.

No "poor bleeding Belgium" this time - no "poor bleeding Poland" either.

Belgium was not an area of vital political or economic interest to America and so 'sentiment be damned' : America was not about to waste money and lives defending the small and the weak on the basis of mere humanitarian sentiment : 'we're living in the Modern Age, not the Victorian Era'.

But Dr Martin Henry Dawson had earlier felt much differently.

As a very young man, he abandoned his promising university career to join up the same day (October 16th 1915) that he first read in the North American newspapers that Edith Cavell had been executed for aiding the Belgians.

That meant that today marked his 25th year in Medicine, because he had initially joined up for a year in the medical corps, despite being a non-medical student.

Then, later, as first an infantryman and then as an artilleryman, he had spent most of the rest of the war in and out of hospital because he had twice been seriously wounded and won the Military Cross with Citation for bravery for his efforts while wounded.

Now, giving up his established career and family in still neutral America to get a Canadian Medical Corps desk job in England (as a middle aged/ middlingly healthy bacteriologist that was all he could hope for) didn't seem to be much in the way of help for Belgium and all the other small poor weak people being stomped upon by the Mighty and the Powerful .

Besides, the poor and the weak here at home in America were once again be stomped upon by the Mighty and Powerful of their own nation using the pending threat of war as an excuse to do so.

"We can't afford to waste scarce medical resources on Nature's 4Fs : eugenics teaches us that we need to preserve our best and that means our 1A fighting men".

So the few timid attempts at what was then called Social Medicine were halted and the money re-directed into War Medicine : research on the unique problems and diseases of fighting a modern world-wide war.

Social Medicine had its origins in the ferment around the Great Depression and the New Deal .

It combined directing more money on traditional public health measures aimed at the poorest citizens together with discussions on how best to ensure working class and middle class people had insurance against major medical emergencies.

All the powerful - from the AMA leadership on down - saw this as a giant intellectual threat to individualism and unfettered business enterprise.

The universities, then Republican Party hotbeds, led the charge against Social Medicine : and Columbia University-Presbyterian Hospital loyally signed up in the Fall of 1940 : directing its School of Medicine to put more teaching dollars into War Medicine courses without offering any new dollars to pay for it.

Guess what was hinted could be usefully cut,  to pay for the new courses ?

So the dawn of October 16th 1940 and all eyes of the media were on Columbia University's two campuses on Manhattan.

Columbia  was widely seen as a bellweather on whether American students, who had earlier talked about refusing to fight anymore wars, would obey their elders and register for the Draft.

To ensure all did, the university closed the two campuses and cancelled all classes for the day. Almost all the students and professors of young enough age, did indeed march off obediently to register before the lights and motion cameras of the newsreel crews.

(Including undergrad Jack Kerouac, who took time off from hefting big mysterious blocks of something or other for Fermi and Szilard's Atomic Pile in the basement of the Physics building.)

On October 16th 1940 and until the Actual Belgium's total liberation on February 4th 1945, Floor G became a defacto "Little Belgium"

But in Dawson's tiny team on Floor G of the Presbyterian building , no member had to go register : two (Hobby and Chaffee) were the right age and health, but as women were not valued as potential draftees.

Karl Meyer, like Dawson, was a Great War veteran but was now overage : Dawson was not only overage, his war wounds made him even more unattractive, even as a potential volunteer recruit.

The team's two patients (Aronson and Alston) were young men of the right age, so had to be registered in theory , despite being universally regarded as terminally ill.

I think that the draft officials might well have regarded it as a waste of time and needlessly cruel to register the two clearly dying boys , only to send 4F notices to their grieving parents two months later.

But I suspect Dawson would have urged the draft officials to register the two lads, because he believed that hope - along with his untried penicillin - was the best possible cure for their "invariably fatal" SBE.

"Register the boys - please - because I intend to have them up and in fighting trim in no time !"

(Those would have to be words for the boys' ears only, because no army ever knowingly took anyone with damaged heart valves , "cured" or not.)

SBEs, to be brutally frank, were the world's 4Fs of the 4Fs, probably the first victims of any rollback of Social Medicine .

To start their cure on the very day that North America's eyes were all focussed on War medicine's much touted 1As , had to be Dawson's silent rebuke to a nation and a medical community eager to overlook the poor and weak , in Poland, in Belgium and at home.

Morever, Dawson was rebuking Big Pharma's focus on the big as well, because they saw no reason to help Dawson and his foolish crusade to inject crude natural penicillin into humans.

So his medicine was not made in any huge factory by man-made techniques, but produced by billions of tiny fungus factories at the bottom of a handful of flasks in Dawson's own lab.

Verily, the weak and the foolish would have to come to the aid of the small and the weak, if the Mighty and the Wise were unwilling.

So it was on Day One of the start of the Age of Antibiotics.

And as Dawson abruptly lifted the needle into the air before sinking it gently along the skin of the boys' arm, the Italian in us might have seen it as a medical "up yours !".

And looking back from almost 75 years later, would we be so wrong.....