" Crude is more than 'good enough' ...

... if it can save lives right now ! "

Lifesaving's perpetual understudy , Penicillin, unexpectedly made her long overdue debut in a medical theatre in uptown Manhattan on October 16th 1940 .

Albeit more than a dozen years after the best lifesaver ever known was first discovered.

the Good , as well as the Bad , gets intensified under the pressures of wartime

In her time - during and after WWI  - nurse Edith Cavell was as famous as Oscar Schindler, Raoul Wallenberg and all the other WWII "Righteous Among the Nations" combined.

She devoted her life to nursing, mostly in Belgium though she was British herself, and didn't see why WWI should interrupt her practise of trying to save all patients, regardless of whether they were German, Belgian or Allied.

She was shoot however , by a German firing squad, for the war crime of helping Allied soldiers to escape the brutal German occupation forces enslaving Belgium.

Britain has claimed it had gone to war precisely to defend the right of neutral little Belgium not to be over run and then brutally enslaved by her bigger neighbours.

But many in her political and military elite thought it was right and just for the Germans to shoot her - they would have done the same - in fact did the same to Mata Hari.

World public opinion decidedly thought otherwise and her death became a big factor in turning neutral America to the Allied cause and for inspiring tens of thousands of youth in all the Allied countries to immediately join up as medical workers or soldiers.

News of her execution hit North American newspaper readers October 16th 1915.

It immediately inspired Martin Henry Dawson to become a medical orderly oversea.

He subsequently changed his life career plans and became a doctor.

On October 16th 1940, exactly 25 years later to the day he entered the medical world, Dawson ushered in one of those sort of earth-shaking events that only happens once every few centuries.

He gave two dying young men some of that elixir of life, natural penicillin, and so began our present Age of Antibiotics.

Neither man was Belgian, but for Dawson the principal was still the same : the small were being crushed beneath the interests of the big and he was as determined to fight that outrage as hard in WWII as he had in WWI.

These two men were being neglected by a medical community and drug company industry that had become focused on profitably war medicine for the 1As of the world , not on 'socialistic' social medicine to aid the 4Fs of the 4Fs.

Dawson saw that solely a military effort to defeat the Nazis or the Huns was never going to be enough, not if there was no moral battle behind it.

Sinking to the level of the Prussian military mindset, in WWI London or in WWII New York  he saw was no way to win the hearts and minds of neutral nations - or even for retaining the loyalty of one's own citizens.

So, no Dawson did not go forth into battle on behalf of Mars in this second world war as he had eventually in the first.

He stayed home and treated only people too '4F' to ever be useful for military duty or even for the fast pace and long hours of munitions factory work.

He worked on the Venus side of Manhattan exclusively and his direct war impact was limited to filling the hearts of people all over the world with renewed hope.

But i believe that his efforts saved far more lives ,and probably won the war quicker, than The Bomb ever did.....

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.....

Patient ONE of the Antibiotics Era : how the saving of Charlie Aronson changed our world

During his lifetime, Dr Henry Dawson only gave penicillin to several dozen endocarditis patients, Charlie Aronson first among them ; only saved several dozen lives, Charlie among them.

Dawson's pioneering effort to inject Charlie with penicillin on October 16th and 17th 1940 (Dies Miribilis) certainly didn't directly save many lives.

But the moral fact that Dawson cared enough in the first place about Charlie-the-person, to pioneer in making and to giving him penicillin, has certainly saved tens and tens of millions of lives ever since Dawson's premature death in 1945.

If  only the greater cultural milieu surrounding Dawson and Charlie had been as willing - nay as eager - to save Charlie 'the 4F of the 4Fs' as Dawson was, it might also have been as willing - nay eager - to save the Jews of Europe as well.

Immaterial that Charlie was almost certainly Jewish as well : the point to Dawson was that Charlie was a fellow human being, end of story.

Social medicine, Dawson's domain, says that medicine is not just the narrow manipulating of bio-chemical activities to save lives.

It holds instead the view that most people die prematurely, not because their bodies failed or because medicines failed, but because the world around them see them as not worth much, so not worthy of much effort, time and expense to try to save them.

Doctors who challenge these utilitarian views by their voices and their actions indirectly save far more lives than do their equally competent colleagues who may directly save more lives, but who are content to only save the lives their culture deems worthy of saving.

The Allies (rather like the Axis, differing only in degree not in kind) divided the world of World War Two into three parts, like Gaul.

There were the enemy-oriented people and the allies-oriented people : themselves further divided into 1A allies and 4F allies.

Until June 1943, only enough American resources were going to be devoted to penicillin to ensure that the needs of the 1A allies would be met.

Then the American WPB (Wartime Production Board) made its most surprising decision ever : that a considerable portion of America's bomb and bullet making potential would be diverted instead to making lifesavers - penicillin lifesavers enough to save soldier and civilian alike.

This was not a decision followed by Britain , Canada and Australia.

They decided to divert only enough of their country's resources to penicillin-making to fill the needs of their armed forces at a minimal level.

Winston Churchill and his Tory-dominant government took the lead on this decision, by their broad hints and inaction (if nothing else), and the other Commonwealth nations chose to follow his lead rather than that of the WPB.

A single additional Lancaster bomber squadron is about three million pounds in 1943 money,(about a million pounds in planes , plus two million pound  more for the 500 members of the squadron , hangers, armaments, fuel etc).

This amount would have paid for enough new penicillin production facilities such that by early 1944 , Britain's could have supplied its civilians as well as its soldiers.

Ie, match the Americans' penicillin output, despite using a lower level of technology.

We know well enough the costs of a Lancaster squadron and  the costs of Glaxo's low tech but highly efficiently run bottle-penicillin factories , to be able to make this claim with a great deal of certainty.

Churchill, however, chose 'LANCs over PEN' and paid for it in the surprising election results of June 1945 ; the inequalities of  wartime health care provision being the number one reason most people chose the egalitarian Labour Party over the war-winning Tories.

America's super abundance of wartime penicillin allowed it to use penicillin as a tool of diplomacy , replacing British influence with that of the Americans at every turn : replacing Pax Britannica with Pax Americana,  again causing Churchill to "win the war but lose the world".

Dawson did not force the WPB to make the decision it did, though certainly his uniquely civilian oriented approach to penicillin treatment, starting way back in September 1940, must have played a part.

But the WPB pledge was just that : a pledge - it was up to industry to carry it out.

Industry was willing - even eager - to build high tech buildings out of extremely scarce materials now suddenly obtainable thanks to top-of-the-drawer allocation quotas for would-be penicillin producers.

Postwar, those buildings would give them an early lead on their competitors.

But they weren't so willing to make biological penicillin in those shiny new buildings, not with rumours than synthetic penicillin was just months away.

Dante Colitti forced their hand.

In August 1943, the junior staffer, a surgical resident at a small hospital a mile from Henry Dawson's hospital,  was about to get married and go on a honeymoon. He didn't have to go poke his nose into the affairs of a patient in the non-surgical part of the hospital.

But he did.

He was moved by what he had heard about the dying Henry Dawson a mile away being willing to steal government penicillin to save the weak and the small.

 And perhaps because Colitti himself was a lifelong "cripple", suffering from TB of the spine.

Dante decided to risk his own career by intervening over the other more senior doctors' heads on a patient that wasn't even his --- urging the patient's parents to call the Hearst newspaper chain directly, to ask them to help obtain the tightly rationed penicillin needed to save the baby's life.

The resulting day by day heart-rendering accounts and photos of the life-saving efforts for little Patty Malone finally - albeit 15 years late - put a human face on penicillin.

Suddenly the population woke up to the fact that they wanted/  needed  penicillin -right now ! - and what was their Congressman doing to see that it happened ?

Doctor Mom, in high dudgeon , can provoke fear even in generals, industrialists and Presidents and soon John L Smith, boss of the biggest potential penicillin producer (Pfizer) got the moral message as well.

The chain reaction : Dawson + Charlie : Dante Colitti and Patty Malone:  John L and Mae Smith and memories of their own dead daughter  + Pfizer : tons of and tons of penicillin by April 1944,  is clear enough .

Also clear enough is an ageless message : one person, even if they are dying, can indeed make a world-quaking difference .....

Re-setting the Allies' moral compass : the acid test of penicillin for wartime endocarditis

Please correct me : but in all my research I could find no indication that in his 15 years of medical research before October 16th 1940, (and he was a world-class expert in the area of strep bacteria) Henry Dawson had never written or spoken one peep - not one peep - on the subject of endocarditis, a very common and deadly disease, usually caused then by a variant of strep bacteria.

Dawson was a scientist who spoke and wrote a lot , so his silence , until October 16th 1940, was surely hardly from lack of opportunity.

Nor was it bureaucratically and professionally easy, in October 1940 anymore than it would be today, to go from being the director of an outpatients' clinic on chronic arthritis to suddenly becoming the lead doctor on a totally new treatment of such an acute cardiac illness as subacute bacterial endocarditis (SBE).

At least not in a big teaching hospital, with all boundary-conscious specialists rigidly defined in each area.

So we are still left with the puzzle explaining why Dawson literally gave his life to suddenly treat and cure this hitherto incurable disease, endocarditis.

It helps to recall that as a paid up member on the side of Social medicine at a time when War medicine was in the ascendancy in the corridors of Columbia Presbyterian Medical Centre that Fall, Dawson's ears must have zeroed in on the disease quickly voted "the absolutely lowest priority disease in all War medicine" : and that SBE.

The overall consensus that that the SBEs consumed endless amounts of medical care, generally only to quickly die anyway.

Or if they did by some weird chance recover - this time - they couldn't much useful war work with their weakened heart and anyway would surely succumb to a second bout of SBE.

Dawson might even have agreed with this assessment , albeit reluctantly, before October 1940 : nothing, not even the much vaunted brand new sulfa drugs, did anything to extend the SBEs' chances.

But to Dawson, if not to any one else in the world,  the written claims about this new , as yet untested, drug penicillin seemed to offer a way out.

It promised activity against SBE's green strep bacteria, good diffusibility and above all , near absolute non-toxicity.

The latter was critical because ("Blood, blood everywhere and not a drop to drink") ironically the heart's values have almost no internal blood supply and must be 'dabbed' by a drug filling the entire blood supply, as it whistles past the heart valves at break neck speed.

An internal "antiseptic" as it were.

Any drug strong enough to instantly push its way through the thick vegetation on the heart valves and quickly kill the strep within , as it rushed on by at 'breaking the speed limit speeds' was also strong enough to be toxic to the entire human body.

SBE was a "disease designed by a committee" : a committee of Devils creating a disease so devilish as to even frustrate God Himself.

SBE seemed an impossible cure -- surely a quick death following upon benign neglect was the most merciful choice ?

But none of the SBE experts seemed to feel as he felt ; none was willing to do the sort of heroic medicine required to at least give crude penicillin and SBE  the old school try.

Did Dawson begin to feel that this indifference to the possibility of curing SBE, "the polio of the poor", was just an excuse?

Did he not buy the claim that the difficulties of preparing penicillin together with all the preparations for war medicine and  for prioritizing medicine for the 1A fit  was the real reason for inactivity on SBE ?

Or was it really just an excuse to roll back New Deal efforts to do something medically for the poorest and weakest (the 4Fs) among us ?

Were there not strong rumours about that the Nazis were also abandoning the poorest and the weakest among the German patients, also using the necessities of war to justify their actions ?

Whatever ethical speculation led him to his decision, it is a fact that on October 16th 1940, Henry Dawson made the wartime treatment of the weakest of the weak, the 4Fs of the 4Fs, the ultimate acid test for the moral compass of the Allied cause.

It took him years - and cost him his life - but he got that moral compass set right, right in the middle of a bloody war.

Finally, treating the SBEs, the least of these, as we would want ourselves to be treated, became the practise of the Allies, not just another plank in their hollow public rhetoric....

Dies Mirabilis : October 16th 1940 : the first ever peacetime 1A Draft and the first ever 4F penicillin needle

Oh, to be there , just to see the Janus-like faces of Columbia University's campus on dies mirabilis, October 16th 1940.

Over in one corner, led by blustery University President Butler himself, most of the campus was busily and very publicly (cue the news reel cameras) engaged in the nation's first ever peacetime draft registration process : busy triaging the best 1A youth away from the 4F rejects.

Over in another corner of the campus, a tiny band of four individuals was just as busily triaging away in the opposition direction.

Led by two world war one frontline military veterans, they had deliberately - almost provocatively - picked this, of all sacred days in WASPish America's calendar - to usher in the Age of Antibiotics.

Their choice of the first ever patients was equally provocative, not merely that one was Black and the other one was Jewish, but because both were SBEs : the 4Fs of the 4Fs, in Draft Registration terms.

 Both were dying from the disease rated as about "one hundred and ten" on a priority list running from one to one hundred on diseases of military priority.

Later on (by 1943), Columbia's campus again resumed a Janus-like cast, as one part beavered away at The Bomb, determined to se it at working ,killing, before peace broke out , while in another part of the campus, our tiny team was at work trying to see penicillin in high production, before death and pestilence broke out in the occupied lands.

But I like to think we will never again see such a contrasting day in such a small place, as we did on October 16th 1940 at Columbia University ....

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 .....

"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.....