Tuesday, December 4, 2012

Scots wha hae wartime penicillin : chase Fleming's synthetic chimera or save lives with Dawson's shovel-ready ?

Dawson vs Fleming decided wartime PENICILLIN 
The battle over the direction of wartime penicillin can be presented, semi-accurately, as a showdown between two Scots with widely different concepts of the continuing value of chivalry in a Modernist Age.


By unlikely coincidence , our two Scots, Alexander Fleming and Henry Dawson, were both born on August 6th, albeit 15 years apart (1881 and 1896).

Fleming was 18 when the Boer War broke out but refused to go and fight - he loved being in the London Scottish Rifles and was a keen marksman but was not really up for dying and discomfort and all that real chivalry stuff.

Dawson was also 18 when WWI broke out but only joined up in October 1915, after nurse Edith Cavell was murdered by the Germans in Belgium.

Dawson started off in the medical corps as a private and orderly  but became a junior officer in the infantry and trench mortar artillery, was wounded twice and got the MC with citation for displaying bravery, chivalry and command despite being badly wounded.

Now it is widely claimed that Modernity repudiated Chivalry, after the horrors of the battles of Somme and Arras during World War One.

Modernity repudiates Chivalry : Chivalry repudiates Modernity right back


But a few writers - like Raymond Chandler and Howard Koch - claim that in World War Two, Chivalry repudiated Modernity and this is a thesis that I also hold - pointing to the Henry Dawson and Patty Malone stories as my prime examples of proof.

Fleming and his ilk : Florey, the NAS/OSRD/MRC et al , were seemingly contend between 1928 and 1945 to keep on polishing a turd, to still chase the chimera of synthetic penicillin for a few years more, while the world all around them burned.

Dawson passionately believed that if impure natural penicillin could save lives now , he had a moral duty to do so - Now !

His penicillin might be quick and dirty and a pain in the butt* for doctors and hospitals to keep in supply but it was shovel-ready, with its sleeves rolled up, ready to save lives : anyone, anywhere, anytime.

Fleming's synthetic chimera won all the early innings but Dawson's shovel-ready came from behind to win the race , in the late months of 1943.

Just as Chandler's Big Sleep had proved an unexpectedly massive hit with the general public and voters, so had Howard Koch's Casablanca and Henry Dawson's shovel-ready attitude of using existing natural - albeit impure - penicillin to save lives of 4F civilians today !

Chivalry - it turns out - was far from dead....

* and often , a literal 'pain the butt' for the patients too !

1942's key question : not can penicillin save lives but can SULFA still save lives ...

wartime PENICILLIN's unlikely saviour
Popular and academic historians alike continue to treat the histories of wartime penicillin and wartime sulfa as if they existed on separate universes, when, in fact , they were fierce, close competitors.


The biggest sin of Allied medical planning bureaucrats and their political masters was not in ignoring the life-saving potential of natural penicillin in mid-1942, but rather in ignoring the awkward fact that their chemical wunderkind sulfa was increasingly starting to fail to save lives.

They could claim that one can hardly go about searching - in the midst of a Total War - for some new knight on a shiny horse, until one knows for sure that the old knight is fading fast.

But in fact the signs were all there - in more and more anguished published reports from frontline clinicians, on the Home Front and in battlefield hospitals - but the planners deliberately ignored them.

They felt they had no choice, because they felt they had to button down some hard medical choices and stick with them regardless, in the reasonable expectation of a late 1942/ early 1943 invasion of Occupied Europe.

The supply chain and taught protocols for frontline medicine for ten million soldiers is not something stopped, started and reversed on a dime.

However, this does not excuse them for not placing lots of large, firm orders (aka big $$$$$$$)  for natural penicillin, as it existed in 1942, for use in Home Front hospitals and rear echelon base hospitals.

People were dying from sulfa being no longer always effective - dying by the tens and hundreds of thousands world wide.

But , true to the tenets of heartless war medicine - the bureaucrats stuck to their chemical dogmas and mantras, regardless of new evidence.

Dawson's shovel-ready penicillin vs Fleming's synthetic chimera penicillin


It was probably only the Casablanca Conference's decision, in January 1943, to postpone the planned invasion for at least a year (together with the timely replacing of hidebound American Army Surgeon General James Magee) that ensured that penicillin became a big wartime success (rather than a small post-war success).

This, as much as anything Dawson's shovel-ready penicillin or Fleming's synthetic chimera penicillin did or didn't do......

Sunday, December 2, 2012

Were Stalin's COMMIES the best at making crude penicillin ? Say it ain't so, Joe !

Here is what Howard Florey, normally the most hostile critic of crude penicillin, found in his analysis of the crude Russian penicillin liquids in early 1944: 30 to 40 Oxford units per cc/ml.

Amazing !


It had taken years of hard work from the best American and British researchers, lots of expensive equipment and the best strains of penicillium to get those sort of levels from their own surface production of penicillium juice on an routine factory level.

Ruskies outdid even Aussie Duhig !


Apparently, the Russians  (a la Dr Duhig) kept things real simple and real efficient : they quickly ran the raw juice through the customary Seitz filter and into 10cc ampoules and then right into the patients' arms -routinely curing serious blood poisoning situations.

When you have 30 plus units of penicillin per cc, a 300 cc drip IV of raw penicillium juice delivers 10,000 units of serious infection-fighting power.

When your juice only has 1.5 units plus of penicillin per cc, ( which is closer to what Dawson and Florey got off their raw juice) 300 cc only gives 500 units in total per IV drip and that only fights very small infections with highly sensitive bacteria.

Not a common situation and also not the sort of situation where the attending doctor would normally even ask for an experimental drug's help.

The strain the Russians used (which they said was a variant of penicillium crustosum) was from basement wall slime they had found in a dark, dank, damp air-raid shelter ......


The Allied governments and Henry Dawson had a serious disagreement on the Allied war aims : but I happen to think that Dawson won the argument...

Superficially ,WWII came down to a physical battle between a democracy that lynched Negroes in Georgia (America) and a dictatorship that hoped to lynch Jews in Georgia ( USSR).

 But really it was much more than that.

The bigger, more permanent, conflict was the battle for the hearts and minds of the whole world, fought between the eugenic forces of modernity and the commensality forces of an emerging post-modernity.


Patient-oriented penicillin vs war-oriented penicillin


If the Allies started out talking a noble rhetoric but acting out a sort of muted Nazi "me too-ism" , by the war's end they had moved much further towards Henry Dawson's September 1940 position.

His patient-oriented penicillin was as much a moral and cultural force as it was a scientific affair...

Like Germany, Howard Florey effortlessly won all the tactical battles, losing only the strategic war to Henry Dawson

Eugenics was on the side of the Big Battalions...
Howard Florey was a WWII chicken-hawk, so it little surprises that his chosen hobby-horse, Allied war medicine, was vigorously and publicly 'On the Side of the Big Battalions'.

That meant making a virtue of denying aid to dying 4Fs, to give it instead to healthy 1As.

 But as Hitler had earlier found out to his cost, this was not a position designed to win over the small battalions of the world's hearts and minds.


Dawson's Folly


Dr Dawson's 'folly' - by contrast - was to give up his own life, during a Total War against the Ultimate Evil, trying to save the lives of the 4Fs of the 4Fs, those 'useless mouths' young people with SBE.

His folly was near-universally damned by those in America's scientific and medical elite who knew of it.

Only those who the British call "the punters" : ie, the housewives, the customers and the voters all over the world, approved his idea.

They chose not to judge the Allied Cause by when it ventured into Nazi like behavior (denying aid to the weakest) but only in its better moments, as when it changed its mind and came to the aid of the SBEs' small battalions, aiding the least of these.

A small gesture perhaps, but in the end, more than enough ....

The Allied battle for the world's 'hearts and minds' : NS-born Henry Dawson's patient-penicillin vs OSRD war-penicillin

Army is - wrongly - blamed for her SBE death
The idea that successful American governments need first to win over the 'hearts and minds' of people, before they rush to impose their objectives by legal and military fiat is an old, old , old one.

Presidents John Adams used the phrase "hearts and mind" in this sense early in the 19th century, long before Presidents FDR, Kennedy and Johnson made it famous in the 20th century - and before recent presidents George W Bush and Obama dragged it out of the archives to use in this century.

(And to share the blame around, their wartime Ally Britain also used the phrase during its 1950s war in Malaysia.)

When American finally joined The Coalition of the Willing  (December 1941), many of the world's nations still remained strictly neutral in the battle against Nazi evil , or were, at best,  nominal friends but in reality merely laying back on the oars.

The world's largest, richest, most militarily-advanced economies in the world (America and the British Commonwealth) had a real job on their hands trying to convince the neutrals (all much smaller and weaker than these two superpowers) that their interests would not be subsumed before the interests of these global colossus.

Unhelpfully, America and Britain's scientific and medical elite - centred in the American National Academy of Science (NAS) and the British Medical Research Council (MRC)  made the job much harder.

Reactionaries of all stripes (from Germany to America) had been determined to roll back the1930s move to Social Medicine (the claim that more poor people got sick than rich people because they were too poor to pay for adequate housing, food or routine medical care).

However, the dire effects of the Great Depression had put wind behind Social Medicine's sails and confounded the reactionaries.

Now - Thank God ! - war, or even just the possibility of war, gave the reactionaries new hope.

 Hitler killed off his first "useless feeder" the same week that he declared war on the Poles and soon his Aktion T4 program was killing Germany's weakest and smallest members by the tens of thousands.

In America, people like Dr Lewis Weed (a mid-level medical researcher) dropped his unsuccessful research to become a war-medicine advocate at the NAS and its action-oriented NRC (National Research Council).

War medicine wins opening rounds against social medicine


He locked horns with Dr Thomas Parran, the American Surgeon General from 1936 to 1948, who was a strong (and powerfully-positioned) advocate of social medicine.

A war medicine proponent advocates that any nation at war - even the richest, least attacked nation at war - needs to divert resources normally assigned to civilian medicine towards making bullets instead.

 In addition, much more money would have to be spent providing for the high medical requirements of an activity (war) whose stated aim is maiming and killing people on muddy fields miles away from the nearest hospital.

Limited research dollars would have to focus on war-related  medical needs ( such as finding new ways to keep factory workers and bomber pilots alert for long hours) and put before finding  new ways to keep elderly retirees alive) .

War medicine is, in a very real sense, 'eugenics in uniform' : the best citizens (those that are tested and rated physically and mentally to be A1) end up in the military and get top notch medical care at no cost.

Those citizens who fail these tests and end up as 4F, are second rate eugenically and get second rate medical care during the war.

Proudly promote this concept to the outside world - and America's still relatively free press during WWII did just that - and it comes across quite differently in those neutral nations still sitting on the fence with regards to whole-heartedly backing the Allied cause.

As individuals, the elites in these neutral nations could see themselves as A1s  --- but as nationalistically minded citizens they could only see their nations as 4Fs in America's eyes : mere inconvenient dirt beneath their advancing wheels.

When the Patty Malone vs Marie Barker debate broke in the United States media (basically, scarce penicillin for dying civilians : yes or no ?) , it broke even bigger overseas, as worried American and British diplomats noted.

Heartless or caring : the public image of the Allied cause had reached past the unimportant front pages and onto the most important page of any newspaper or magazine --- the women's page : home to Doctor Mom.

It suddenly mattered what the mothers and parents and grandparents from neutral nations thought of America and Britain's harsh dictates on penicillin.

Put your small neutral nation, say Eire or Turkey, in the place of the unfortunate Marie Barker and then ask yourself, how would you feel to just be Marie Barker-like 'incidental collateral damage' , on the pathway to the ultimate Allied Victory ?

And the Home Front within the Allied nations was just as caustic about their own governments' inactions : 'penicillin the miracle cure' had been around for 15 years and still no one in charge had bothered making enough of it for all ?

Don't the bosses know "there's a war on" ???!!!

And let us set this debate (occurring between the late Summer of 1943 and the early Spring of 1944) in its full context.

The western Allies still hadn't invaded Europe and left the heavy lifting of killing German soldiers to the beleaguered Russians.

Instead they were busy bombing Europe into rubble : busily killing civilians from both Axis and neutral nations alike.

The Germans and Allies had co-operated on censoring the results of the fire-bombing of Hamburg of July 1943, (right before the story of little Patty Malone broke) but on-site reports from neutral Swedish journalists had laid the whole horrific affair out on the newspaper pages of the world.

It had led to considerable unease - in neutral country and allied country alike.

Hadn't FDR himself raged that the bombing of civilians was a crime against all humanity and now weren't the Americans and British far out-doing the earlier Nazi efforts to bomb enemy and neutral civilians ?

Allied fire bombing of  innocent babies in occupied Europe - denying life-saving penicillin to innocent young moms in America so that their unfaithful husbands in Italy could be get a quicker ( via penicillin) cure for the Clap - it all didn't seem morally right.

Perhaps surprisingly, the American Army revealed far greater political and cultural savvy on this matter than American doctors and scientists were capable of.

The Army was sick and tired of being blamed for hogging all the penicillin and refusing to give any to the nation's dying babies.

'For Christ's Sake', they could rightfully protest, 'we can't get anywhere enough penicillin for our own dying boys, and we hadn't even heard of this stuff penicillin till a few months ago --- you ask the drug companies and the doctors what they were doing with the stuff for the last 15 years !'

Somewhere in the American Army Air Force some bright mind (s) decided to solve both PR problems (the fire bombing uproar and the penicillin uproar) at one stroke.

(And before you ask, no .)

No academic historian has yet brought us the true story behind this highly imaginative response: I see a great PhD thesis for some bright light.)

Soon, American Army "heavy" bombers were pulled off their bombing practises and were sent out on a still risky flight (because at top speed and at night) "pounding" across country with a tiny 8 grams of penicillin (instead of the normal 8000 pounds of TNT) to deliver to a dying ten pound patient.

Upon arrival, Klieg lights lit the tarmac as an ambulance, along a police escort with blazing lights and piercing sirens, raced to the hospital and the waiting doctor and patients.

Need I add to this purple-prosed drama that, thoughtfully, the local press had been notified well ahead of time ?

Quickly Army bombers were even on far more perilous missions of mercy, dangerously new cross-ocean flights, from places like San Francisco  all the way to Brisbane Australia or from New York to Havana, --- to save dying children.

In 1943, Martin Henry Dawson was dying ,but not quite dead yet, not by a long shot...


Life-saving penicillin had moved 180 degrees from being censored and rationed to being the subject of  radio, newsreel and pamphlet propaganda as an example - the example - of the better things ahead if only all joined in to hasten the Allied Cause.

Neutrals could reassure themselves that just like with dying babies and Martin Henry Dawson's useless-mouthed SBE patients, the Allies would do right by all, as they were doing so now for the least of these.

The Allied battle for the world's hearts and minds, had been won (unexpectedly) by the proponents of social medicine - thanks largely to the example of Martin Henry Dawson.

And decades before Joni Mitchell and Woodstock, the American Army Air Force itself turned its shotgun bombers into butterflies, above a wondering nation and world....

Saturday, December 1, 2012

Florey vs Dawson : penicillin to be perfect & a war medicine OR an imperfect but universal medicine ?

patricia (Patty) Malone penicillin breakthrough september 1943
Baby Patty Malone helped the whole world discover penicillin 
As should be well known, penicillin-the-molecule and penicillin-the-lifesaver were discovered September 1943 by the whole world, (not in September 1928 by Alexander Fleming) while natural-penicillin-the-universal-livesaver was invented on October 16th 1940 by Henry Dawson.


Penicillin-the-molecule was ignored in June 1929, firstly by Alexander Fleming himself and secondly by the world.

This was because Fleming on that date indirectly denied any possibility of penicillin ever becoming a lifesaver, ie a systemic ( spread through the blood system) medication.

As a result, Fleming - and the world - yawned.

Contrast this with Banting team's excited, animated, passionate announcement --- at a Boxing Day medical conference just a few years earlier  -- that it was  just two weeks away from injecting insulin-the-lifesaver into a dying patient.

(What a Boxing Day present for millions of diabetics and their familes !)

You can just bet that insulin-the-lifesaver and insulin-the-molecule were discovered together, by the entire world, at that moment.

What about Howard Florey then ? Didn't he play some role in penicillin ?

Yes, some role.

But Florey ,along with Fleming, and along with the British and American governments together with the leading firms in the pharmaceutical world, was convinced that penicillin first must be perfected (100% pure, industry-made, probably synthetic, tested-onto-death) before being used on humans .

 And even then 'humans'  really meant 1A military personnel only, at least during the war.

In addition, they all only saw penicillin as an useful supplement to the existing sulfa drugs - mostly for use in sulfa-resistant staph infections.

Truly a perfectionist and limited vision of wartime penicillin.

One can only begin to imagine the high prices that would be charged governments and patients for such perfect material.

Chain deserved less credit for his chemistry and more for his pushiness , in forwarding the penicillin story to a happy conclusion...


By way of total contrast, only five weeks after learning of penicillin's lifesaving potential (and here Florey and above all Chain deserve the credit) , Dawson was injecting life-saving penicillin into 4F civilians ( Negroes ! Jews !) dying from a strep infection (SBE) , using imperfect , impure, hospital-made, natural, penicillin made by slimey molds.

Yes, like Banting's first insulin injections, Dawson's first penicillin injections 'stung like a bee', from natural impurities still in it. The stings, in both cases, did no permanent (or even temporary) harm.

To Dawson (and to Banting, his model) saving dying patients today with imperfect, impure medication was preferable to letting them die so we can maybe save dying patients, years from now, with a perfected pure medication.

These clashing visions of penicillin ran throughout the war with Florey's vision overwhelming dominant until Dawson's success with -stolen - government issue penicillin on SBE patients inspired another local doctor (Dante Colitti) to jump over the traces for his dying patient as well.

The resulting  heart-stirring story of baby Patty Malone ( late August - early September 1943) broke the media floodgates and the entire civilian world began to "ACT UP" and demand Dawson-style penicillin - now !

By 1944, the Allied governments, dragging the still reluctant Big Pharma firms along with them, had caved.

Semi-purifed, semi-perfect - CHEAP- natural penicillin was being mass produced and being made available for all, as fast as that was humanly possible.

And not just Allied civilians as well as Allied military personnel , but for Axis POWs , Neutral nation civilians and ultimately even Axis civilians.

Canadians Banting and Dawson and Canadian Medicare : there is a pattern here :  a strong belief in medical care that is universal in theory as to who is permitted to receive it (everyone, anywhere) and universal in practise (as a result of being very inexpensive).

But it wasn't something simply discovered and instantly received with acclaim by everyone - as science historians want you to believe how science works : as a totally bloodless affair.

 Instead, it was invented by some humans and contested fiercely by some other humans until finally most humans accepted it.

Invented by people like Banting, Dawson and Douglas ...