One of the most historic of meetings and dates in the whole extended penicillin saga occurred on September 25 1942 at Portland House in London England .
In fact one key participant at the meeting sensed this so greatly that he even whispered that history was going to view it that way, into the ear of the chairman as the meeting broke up.
In many ways, this meeting was very odd as well as being very historic.
Mostly because who called it and who it asked to attend.
It was called by one of the powerful of the many British wartime Ministries, the Ministry of Supply (MoS), which actually only supplied the Army (and perhaps in few things , the other two armed services as well) - but never ever supplied civilian needs.
Ronald Clark in his biography of Ernst Chain says this meeting was proceeded by the Ministers of (army) Supply and (civilian) Health, Sir Andrew Duncan and Ernest Brown, jointly "taking the idea of the immediate mass production of penicillin to the War Cabinet".
If so, it was possibly informally done via a Ministry "Minute" to the War Cabinet as neither gentlemen were ever members of the small War Cabinet : even in peacetime many many British politicians become ministers, without ever being becoming cabinet ministers.
And significantly, no one from Brown's civilian-oriented department was at this historical meeting.
This is a very important matter to resolve definitely, in part because the peculiar nature of this crucial meeting spelt the doom of Winston Churchill and his party in the election of June-July 1945.
How on earth did penicillin the universal lifesaver ever come be re-jigged as something only useful to the combat needs of the British Army ?
None of the drug firms summoned to this meeting (which did NOT include the very politically powerful firm of ICI ) had any real political or military influence - they didn't push for the meeting to take place but merely came when they were called.
But two of the four scientists had the meeting certainly did have good credentials with the Army ( but not Navy or Air Force) medical authorities and were of the correct Tory stamp: Howard Florey and Alec Fleming.
They had pushed for this meeting with the Army's supply department.
So, the army-oriented MoS was there in full force with six top officials along with two top officials from the Army Medical Branch charged with drug procurement for frontline casualties.
Missing in action at this meeting - by design - was the Navy, Air Force and any officials representing the Civilian interest in penicillin production.
Florey and Fleming both strongly saw penicillin as basically a useful supplement to the cheap abundant and systemically-oriented oral sulfas, with penicillin to be used primarily as in "local applications" for frontline combat wounds.
True, the Navy and Air force casualties were more often treated at large hospitals (and more often simply died in action) than in the case of the Army.
The Army had to deal with the fact that more of its casualties emerged as alive but wounded ,compared to the other services, which was the good news ---- but the bad news was that their wounds were usually about to get badly infected as a result of the primitive conditions at the front line.
A highly concentrated anti-bacterial drug with a long storage life and stable under almost any conditions as a dry powder (ie highly pure as well as highly concentrated) seemed essential.
Then and only then could it be suitable to sprinkle on open wounds immediately as they occurred on the front lines by barely trained medics or ordinary soldiers themselves.
Or for a busy front line doctor in am ambulance tent to inject, with a little sterile water, in or around those open wounds, within hours of the wounding.
Chemically, sulfa was born fulfilling these requirements - but penicillin didn't really meet them until after the six years of war was long over.
But unfortunately, no thorough controlled clinical trials of this claim that a frontline local application anti-bacterial medication would be essential for wounded survival was ever done.
At war's end, the general assessment was that, in fact, the frontline powders and needlefuls of these "local" penicillin and sulfa (ie applied directly into the wound) were not essential.
Instead, the wonderfully low rate of death from wounds (versus either the much worse record of WWI or of WWII Germany) was felt to be more due to the Allies' quick thorough debridement (removal) of dead wounded flesh , front line blood transfusions and policy of rapid evacuations of wounded soldiers to clean, quiet ,well equipped base hospitals .
That ---- and the general good health of wounded Allied troops, because they had been kept well fed and lived in warm sanitary conditions in the months before being wounded.
In the military base hospitals and civilian general hospitals, wartime sulfas and penicillin did prove to be reliable life savers when given as a systemic, if and when blood poisoning was suspected.
In fact, "crude" liquid penicillin (totally un-concentrated and totally un-purified) injected by needle and prepared in the hospital daily by Dr Duhig, saved lives as a systemic at a Brisbane general hospital --- and could have done so in the military equivalent.
Ooops ! It did do so, at Cairo's largest military hospital, where Dr Pulvertaft treated patients with liquid systemic crude penicillin he made daily in the hospital.
How did the Navy, RAF and the public, along with those politicians sworn to protect these groups of humans beings, react to the idea that penicillin was to be made under the control of the Army and for war casualties only ?
Seemingly with initial indifference - though by the Spring of 1943, a freelancing Navy Surgeon Commander had converted the Admiralty's under-producing vaccine operation to a huge penicillin factory supplying all of the Royal Navy's penicillin needs.
The Admiralty had always 'looked after its own', had always produced its own vaccines and serums so it didn't take long before the Navy medical brass had a look around at the penicillin factory and beam approval.
(Unlike the Army and Air Force, they had won the battle to retain the supplying of their needs by a naval units controlled directly by the Admiralty itself.)
For some rather sad reasons, the Air Force had relatively few wounded, for its size, and for other reasons, the treating of the wounded and returning them to battle was not an operational priority.
Over the course of the whole war, each of the British armed service got about one third of the money spent on the war. But in terms of manpower, of five people in uniform there were three in the army versus one in the RAF and one in the Navy/Merchant Marine.
This is because the RAF and RN/Merchant Marine had lots of big expensive machines that if "taken out of action" usually resulted in a 100% loss (aka "sunk" or "crashed"), while except in disastrous retreats, this rarely happened to the Army and its smaller cheaper machines.
The Allied Armies proved very much better, for example, at recovering even badly damaged tanks , as compared to the Germans.
In terms of personnel killed, the story is more complex.
Most of the RAF were never in real danger of dying but among those that flew, rather than maintained aircraft on the ground, the death rate was very high -often as much from operational accidents as enemy fire.
In Bomber Command, 55 of 100 fliers died before finishing their tour of duty.
Again there were relatively few wounded fliers versus a high rate of deaths - with the relatively few that survived their plane being hit only doing so by remaining out of the war, as German POWS.
People losses anyway and quite frankly , were not a big concern to the RAF : it never had a shortage of qualified recruits.
The RAF was seen as very glamorous to those determined to be very brave and seen a very secure place to spend the war to those with peacetime technical and engineering skills and no urge to be brave.
Manpower sustaining by speeding the recovery of the wounded was never a critical issue for any of WWII's air forces.
Replacing lost machines ( and frequently the training of new flier recruits) was always their obsession instead.
The world's navies were almost as attractive as the air forces, and rarely suffered from manpower worries and wounded recovery worries.
Instead, the sudden loss of entire town-sized machines (battleships or aircraft carriers) with all two thousand on board dead at one stroke, from a single torpedo or bomb, was their admirals more realistic nightmare.
In addition, while the Merchant Marine had particularly high losses of lives, against the relatively small number of its personnel, the merchant marine crews' relatively high pay and lack of onerous military discipline kept manpower replacement issues at bay.
When all factors are combined, at a gross figure level, the three armed services all lost about the same percentage of dead against the total number enlisted in each service, though as I have shown, the chance of death in service fell very unevenly.
In the case of the Army, it fell hardest on the infantry, followed by the tank crews and often the combat engineers.
Because almost no one wanted to join the infantry, it had few volunteers and generally the infantry got those conscripted recruits so totally lacking in useful education and technical skills that no other section of the Army wanted them.
To combine metaphors : incredibly enough, in all the Allied military , the very pointy end of the offensive stick came from the very bottom of the barrel.
In a nutshell, this is why the Germans and Japanese proved so very hard to defeat.
Over the whole war, the death rate varied greatly among the three services - the Navy death rate actually went down as the war progressed, the RAF's deaths peaked in 1943-1944, while in the case of the Army it was expected to rise suddenly and sharply to WWI Western Front levels, following the invasion of Europe.
The Army faced a short sharp period of potentially huge casualties - most wounded and infected but in Allied hands, not POWS.
If they weren't too badly wounded and the right anti-bacterial medication was at hand, the Army might be able to get most of the wounded back into battle formations before the war ended.
Just as well ,as there were no new men hustling to enter the infantry replacement pipeline at the other end.
At the very least, the thought that if and when they got wounded, the Army could heal most of them, would make the infantry less reluctant to rise up and advance against deadly Mortar and Machine Gun fire.
Or so the Army brass fondly believed.
I have tried to make the Fall of 1942 case for the British Army making penicillin just for itself seem as sensible as possible.
But in fact, it was a case going around with its nose full of Coke and Ecstasy.
In the fall of 1942, the really big medical story wasn't the rise of penicillin ; it was the decline of the previous wonder slash miracle drug : the Sulfas.
After five years of ever newer, better sulfas coming on market, that pipeline had died.
It was a double whammy of disaster, because now the current sulfas were proving less useful as more and more bacteria were becoming resistant to them.
Either a disease's bacteria totally failed to respond to sulfa and the patient died, or so large a dose need to be given that some patients again died from sulfa's toxicity at high dose levels.
This was not some sort of a Army front line versus RAF or Navy base hospital versus civilian home GP issue --- the stuff just didn't work as well as it used to ---- anywhere : in the UK , in battlefields world wide, in Germany and in Russia.
Full stop.
Sulfa's improved replacement - and it might be penicillin, who can tell ? - would face immense pressure to made in sufficient quantities to fulfill all needs all over the world, in civilian systemic use as well as front line local antiseptic use.
This was Florey and Fleming's greatest intellectual failure : the inability to see this.
Now neither of them were conceptual thinkers, as even their most ardent supporters admit in print - they were uniquely tied to the concrete and conventional here and now rather than to abstract speculation.
By contrast, Rene Dubos didn't have their success in finding a useful anti-bacterial medicine from microbes, (his luck was bad) but he could clearly see the Big Picture issues in ways those two could never hope to.
I do not know where Dawson stood for sure on this conceptual versus concrete issue since we have no personal papers of his - but the fact that Dubos always felt highly of him suggests a hint.
Certainly if deeds are better than mere words, Dawson never acted at all as if penicillin had to be first weaponized before it could become useful to humanity.
He was the first to give the world a patient successfully treated by a life-saving antibiotic because he saw semi-crude penicillin as more than good enough to inject safely into a human being : Dies Mirabilis, October 16th 1940.....
Friday, February 15, 2013
Wednesday, February 13, 2013
The first - and internally fatal - Tory response to the Beveridge Report : the Ministry of Supply takes over Penicillin ...
To make sense of this claim, we need to clear as to what the role of Britain's powerful wartime Ministry of Supply actually was.
The Ministry of Supply (the MoS) was never the British equivalent of the American War Production Board (WPB), no matter how many times this claim is offered up.
In fact, it was very much closer in spirit to Vannevar Bush's powerful Office of Scientific Research and Development (the OSRD) per the role set out for both under statute , than it was to the statutory role set out for the WPB.
Britain's Ministry of Supply strived to supply the military's needs - period. Unlike the WPB, it did not try to arbitrate between the conflicting demands of civilian and military claims upon scarce material and manpower.
Equally, the OSRD did NOT deal with all of America's wartime science and research efforts , a point that no doubt Jesus Christ himself will have to repeat again and again to academics on Judgement Day and on into all Eternity.
It only dealt with that amount of science and research that involved the designing of (but not the production of) new weapons that could come into use, during the current war.
Bush was very very careful to sharply limit the parameters of his organization, all to make it more dominant within its narrow but vital sphere.
So when Howard Florey went to both the OSRD and to the Ministry of Supply to help in the production of penicillin - rather than going instead to ask help from the American Public Health Service and the British Ministry of Health, he had already made it very clear where his penicillin priority lay.
He wanted additional penicillin production yes --- but only sufficient to supply the armed forces, period.
Florey was strongly conservative, as were all the key individuals within the Minister of Supply and the OSRD : Big Government to them was abhorrent.
Thus the sudden willingness, eagerness even, of the Ministry of Supply in the Fall of 1942 to go all out and seize control of all of the British commercial penicillin production has to be seen as ideologically surprising.
Unless it can (and should) be seen as the opening conservative counter-attack against the rumoured radical notions of the Beveridge Report.
A preemptive move to ensure that the Ministry of Health (also run by a Tory minister but with wider than just military responsibilities) didn't dominate penicillin production.
If is often claimed that the Ministry of Supply took over all of penicillin production because the Scottish-born minister was an old pal of fellow Scot, Alec Fleming, who asked him to do so.
Politicians - grant us at least this - do not spontaneously fall upon old friends and their requests with open arms --- not unless it suits us.
In September and October 1942, Fleming's request much suited Duncan and the British Tories.
In late September and October 1942, the tenor of the Beveridge report, though as yet unreleased, was well known within the top officials of Whitehall.
It called for a placing the values of equality and egalitarianism at the core of the British government - a notion intensely hostile to Tory values.
For penicillin, all this Beveridge "equality" talk could only mean one of two things.
It might mean divvying inadequate amounts of penicillin equally between dying civilians and dying soldiers - when Tories felt the most vital hope of penicillin was that it would help maintain current front line troop levels without the need to "call up" middle class men (their voters) now at home engaged in war work.
Or it might mean diverting the cost of one additional Lancaster squadron (three million pounds) away from the all-out bombing of civilian Germany , towards creating more penicillin factories on the successful Glaxo model.
Glaxo had taken up space in bits of idle factories and by using local cheap and plentiful unskilled labour,( aka women) , had cheaply but efficiently produced a lot of penicillin with current low technology methods and equipment.
(Basically making penicillin as if it was a milk product , using the very abundant modern dairy equipment existing everywhere thanks to the 1920s civilized world's mania over pure milk.)
A lot of similar factories could be quickly brought up to speed, supplying a good deal of penicillin, without requiring too much vital material like stainless steel, already in desperately short supply.
If all this sounds very familiar, that is because this solution is what Britain in the end was forced to do - but very late and only under intense public pressure.
If it had been done wholeheartedly in the Fall of 1942, there would have been no highly public late 1944 civilian penicillin famine crisis.
But the Conservative bits and bob of the Coalition Government wanted no part of equality and penicillin was just the first of many counterattacks against the threat of Beveridge.
They were unsuccessful in the extreme, blowing what had to seem to them (and to Labour !), a sure electoral victory at war's end.
"Unfair distribution of a vital commodity in short supply" , to quote The Times (of all people !) referencing an earlier debate over Hugh Dalton's fuel rationing proposals , was totally anathema to the British public.
In June 1945, what little polling type information we have suggests it was the unfair rationing of medical services that moved people to Labour .
The most current example of that unfair medical rationing had to be rationing difficulties with life saving penicillin.
Let me repeat that : "life saving". This was not just temporary unfairness in allocating housing or clothing : this was the unfair allocation of life itself.
You can't get a more "vital commodity" than life itself : to switch from the specialized language of the economist to that of the political scientist trying to account for a surprise pattern of vote changing, "life" is a very salient issue.
If so, the unexpected and total defeat of Churchill's Tories in June 1945 can be seen as having its origins in the Fall of 1942, when the Ministry of Supply (and Howard Florey) successfully re-defined the shortage of penicillin (contra Beveridge), as a shortage of military penicillin, civilians be damned.....
The Ministry of Supply (the MoS) was never the British equivalent of the American War Production Board (WPB), no matter how many times this claim is offered up.
In fact, it was very much closer in spirit to Vannevar Bush's powerful Office of Scientific Research and Development (the OSRD) per the role set out for both under statute , than it was to the statutory role set out for the WPB.
Britain's Ministry of Supply strived to supply the military's needs - period. Unlike the WPB, it did not try to arbitrate between the conflicting demands of civilian and military claims upon scarce material and manpower.
Equally, the OSRD did NOT deal with all of America's wartime science and research efforts , a point that no doubt Jesus Christ himself will have to repeat again and again to academics on Judgement Day and on into all Eternity.
It only dealt with that amount of science and research that involved the designing of (but not the production of) new weapons that could come into use, during the current war.
Bush was very very careful to sharply limit the parameters of his organization, all to make it more dominant within its narrow but vital sphere.
So when Howard Florey went to both the OSRD and to the Ministry of Supply to help in the production of penicillin - rather than going instead to ask help from the American Public Health Service and the British Ministry of Health, he had already made it very clear where his penicillin priority lay.
He wanted additional penicillin production yes --- but only sufficient to supply the armed forces, period.
Florey was strongly conservative, as were all the key individuals within the Minister of Supply and the OSRD : Big Government to them was abhorrent.
Thus the sudden willingness, eagerness even, of the Ministry of Supply in the Fall of 1942 to go all out and seize control of all of the British commercial penicillin production has to be seen as ideologically surprising.
Unless it can (and should) be seen as the opening conservative counter-attack against the rumoured radical notions of the Beveridge Report.
A preemptive move to ensure that the Ministry of Health (also run by a Tory minister but with wider than just military responsibilities) didn't dominate penicillin production.
If is often claimed that the Ministry of Supply took over all of penicillin production because the Scottish-born minister was an old pal of fellow Scot, Alec Fleming, who asked him to do so.
Politicians - grant us at least this - do not spontaneously fall upon old friends and their requests with open arms --- not unless it suits us.
In September and October 1942, Fleming's request much suited Duncan and the British Tories.
In late September and October 1942, the tenor of the Beveridge report, though as yet unreleased, was well known within the top officials of Whitehall.
It called for a placing the values of equality and egalitarianism at the core of the British government - a notion intensely hostile to Tory values.
For penicillin, all this Beveridge "equality" talk could only mean one of two things.
It might mean divvying inadequate amounts of penicillin equally between dying civilians and dying soldiers - when Tories felt the most vital hope of penicillin was that it would help maintain current front line troop levels without the need to "call up" middle class men (their voters) now at home engaged in war work.
Or it might mean diverting the cost of one additional Lancaster squadron (three million pounds) away from the all-out bombing of civilian Germany , towards creating more penicillin factories on the successful Glaxo model.
Glaxo had taken up space in bits of idle factories and by using local cheap and plentiful unskilled labour,( aka women) , had cheaply but efficiently produced a lot of penicillin with current low technology methods and equipment.
(Basically making penicillin as if it was a milk product , using the very abundant modern dairy equipment existing everywhere thanks to the 1920s civilized world's mania over pure milk.)
A lot of similar factories could be quickly brought up to speed, supplying a good deal of penicillin, without requiring too much vital material like stainless steel, already in desperately short supply.
If all this sounds very familiar, that is because this solution is what Britain in the end was forced to do - but very late and only under intense public pressure.
If it had been done wholeheartedly in the Fall of 1942, there would have been no highly public late 1944 civilian penicillin famine crisis.
But the Conservative bits and bob of the Coalition Government wanted no part of equality and penicillin was just the first of many counterattacks against the threat of Beveridge.
They were unsuccessful in the extreme, blowing what had to seem to them (and to Labour !), a sure electoral victory at war's end.
"Unfair distribution of a vital commodity in short supply" , to quote The Times (of all people !) referencing an earlier debate over Hugh Dalton's fuel rationing proposals , was totally anathema to the British public.
In June 1945, what little polling type information we have suggests it was the unfair rationing of medical services that moved people to Labour .
The most current example of that unfair medical rationing had to be rationing difficulties with life saving penicillin.
Let me repeat that : "life saving". This was not just temporary unfairness in allocating housing or clothing : this was the unfair allocation of life itself.
You can't get a more "vital commodity" than life itself : to switch from the specialized language of the economist to that of the political scientist trying to account for a surprise pattern of vote changing, "life" is a very salient issue.
If so, the unexpected and total defeat of Churchill's Tories in June 1945 can be seen as having its origins in the Fall of 1942, when the Ministry of Supply (and Howard Florey) successfully re-defined the shortage of penicillin (contra Beveridge), as a shortage of military penicillin, civilians be damned.....
Tuesday, February 12, 2013
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 .....
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 .....
Sunday, February 10, 2013
Penicillin : biologic 1929-1939 , chemotherapeutic 1939-1949
In 1944, Frank M Berger ( later creator of the post-war drug Miltown but then just a worker in a local municipal public health lab in the remotes of northern England) came up with an unique way of making and using penicillin.
On second thoughts, his method might well have been done first by Alexander Fleming's Wright-Fleming vaccine institute and their pharmaceutical distributor Parke-Davis about 15 years earlier : Penicillin the Biologic.
On further further reflection : should have been done first by Alec Fleming.
Berger's penicillin was only concentrated and purified to the point that not too much penicillin was lost or too much scarce labour and expensive equipment used to create and extract it.
This biological penicillin, Berger claimed, was safe, potent and cheap ---and liquid.
Liquid --- and stored cold in the hospital that made it, ( not usually stored more than a week at most), until the next life-threatening case of blood poisoning in that same hospital was cured by its systemic (ie by needle) application.
The immediate use of whole liquid blood (another biologic dismissed earlier in the war) right at the front lines of combat was/is vital for survival of the badly wounded soldier.
But immediately pouring penicillin or sulfa into the man's dirty wound (ie via "local" application) - counter-intutively - is not.
Quickly getting him back to a hospital-like setting where penicillin or sulfa can be given him systemically, and under more carefully monitored conditions, was still useful.
But, it proved not essential to do so immediately even there ; often the staff could afford to wait to first see if signs of systemic infection were present (usually via a temperature rise.)
Ie, Howard Florey's 1939 claim that penicillin was only useful if made into a dry powder that remained stable at room temperature for months at a time was totally in error --- if life-saving was to be its main (wartime) role.
Berger's efforts were merely the best thought out among the number of doctors advocating biologic penicillin, not by any means the first (Dawson) or the most stunning (Duhig) .
By contrast, Florey was the chief high priest of Penicillin the Chemotherapeutic, (pure,dry,powdery), from first to last its leading advocate....
On second thoughts, his method might well have been done first by Alexander Fleming's Wright-Fleming vaccine institute and their pharmaceutical distributor Parke-Davis about 15 years earlier : Penicillin the Biologic.
On further further reflection : should have been done first by Alec Fleming.
Berger's penicillin was only concentrated and purified to the point that not too much penicillin was lost or too much scarce labour and expensive equipment used to create and extract it.
This biological penicillin, Berger claimed, was safe, potent and cheap ---and liquid.
Liquid --- and stored cold in the hospital that made it, ( not usually stored more than a week at most), until the next life-threatening case of blood poisoning in that same hospital was cured by its systemic (ie by needle) application.
The immediate use of whole liquid blood (another biologic dismissed earlier in the war) right at the front lines of combat was/is vital for survival of the badly wounded soldier.
But immediately pouring penicillin or sulfa into the man's dirty wound (ie via "local" application) - counter-intutively - is not.
Quickly getting him back to a hospital-like setting where penicillin or sulfa can be given him systemically, and under more carefully monitored conditions, was still useful.
But, it proved not essential to do so immediately even there ; often the staff could afford to wait to first see if signs of systemic infection were present (usually via a temperature rise.)
Ie, Howard Florey's 1939 claim that penicillin was only useful if made into a dry powder that remained stable at room temperature for months at a time was totally in error --- if life-saving was to be its main (wartime) role.
Berger's efforts were merely the best thought out among the number of doctors advocating biologic penicillin, not by any means the first (Dawson) or the most stunning (Duhig) .
By contrast, Florey was the chief high priest of Penicillin the Chemotherapeutic, (pure,dry,powdery), from first to last its leading advocate....
Howard Florey saw potential enemies everywhere, but with "friends" like A N Richards and Robert Coghill, he hardly need bother looking any further
Howard Florey's correspondence twice notes that he has just received a higher yielding strain of penicillium from America.
The first, in November 1941 ,was obtained from Dr Rake at Squibb - a higher producing mutant from Fleming's original strain.
The second time in November 1943, some un-named strains were obtained from Robert Coghill of the NRRL , while he was visiting Oxford .
But in the two crucial years in between ?
I see bugger all evidence that Florey got the latest improvements in penicillium strains as they emerged at Peoria. (Prove me wrong, please) .
The mycologists at the NRRL research centre in Peoria had steadily improved and improved and improved again Rake's variant and their final version, NRRL 1249.B21 produced - via surface cultivation - most of the world's wartime penicillin until quite late in the war.
At that point, submerged strain NRRL 832, from a non-Fleming strain first found in Belgium, took over.
I believe that Merck's chief consultant and OSRD medical chief ( giant conflict of interest alert !) A N Richards, supposedly Florey's second closest American friend, using as an excuse that America was now at war, deliberately held back the giving these improved strains to Florey.
All to further America's ( sorry ! Merck's) post-war commercial opportunities.
Nicolas Rasmussen, in his article "Of 'Small Men', Big Science and Bigger Business", looks much closer than most historians at the day to day workings of the medical wing of the famous OSRD.
He points to several examples where Richards authorizes the further spending of taxpayers' money, supposedly only for war weapons, on drug research that no longer had an obvious military use, because he claimed that keeping American's edge in their development would definitely benefit the nation.
If not in this war, or any war, how would the drug's successful development benefit a nation at war - supposedly the sole purpose of the OSRD, whose mandate was set up to expire the moment peace was declared ?
Richards doesn't say.
So let me suggest a more sinister purpose , because Rasmussen does not.
I note that the two examples that Rasmussen gives where the OSRD spends taxpayers money on projects that no longer seemed to have a military need were pet projects of Merck, the firm that Richards advised.
The first was the chemical synthesis work on penicillin , carried on well past the point (say June 1944) when biological penicillin was being produced en masse and cheaply.
The other was after mid 1943, when it was clear that cortisone would not help pilots fly higher longer - an important advantage for any nation's air force if proven so.
Merck got nothing for all the money it spent on synthetic penicillin but its finally successful efforts on cortisone was and is one of its biggest successes for both its scientific reputation and its pocketbook (the two of course being closely related).
First success with Cortisone would be an advantage to America as well as Merck, over European (Swiss) competitors --- but synthetic penicillin's success could only have come by crushing fellow American firm Pfizer and given the field to Merck.
How then would that serve America's interests, rather than merely Merck's?
Because Europe wasn't even in the running on biological penicillin in 1944.
Perhaps Richards, already a pensioner when he took on the job of heading the OSRD medical wing and with the rigidity of old age, still believed synthetic penicillin would better Pfizer's penicillin in price and yield.
Then Merck would beat their only European synthetic penicillin rival : Florey !
Normally, Vannevar Bush's OSRD - as in denying the British to atomic energy research - did a better job of using taxpayers' military-assigned money to screw America's European Allies' commercial chances after the war , without favouring any one American firm.
Richard's willingness to screw Pfizer and even his friend Florey, shows just how much further he was prepared to go to aid Merck.
But he needed pliant helpers to succeed.
Luckily for him, the NRRL's Robert Coghill seemed to have had a hard time accepting that research paid for by his employer , the US Department of Agriculture and ultimately the American public, belonged to the USDA.
And that this research shouldn't only go where a different agency's chief bureaucrat, A N Richards, wanted it to go - though he hadn't paid for it and had no statutory (legal) control over it.
However , I see Coghill, a misplaced chemist running a biological program, wanted in so badly on a "technically sweet" chemical problem (the synthesis of penicillin) that he sold out the farmers he had sworn to help.
Synthetic penicillin would only negate the ready market for hundreds of thousands of tons of farm waste corn steep liquor, farm waste whey and farm waste crude brown sugar, all used in the natural fermentation of penicillin and other antibiotics coming along in the pipeline.
Coghill did publicly announce that he was giving the top two commercial strains of penicillium (presumably NRRL 1249.B21 and 832) to the entire world in November 1943, about the same time as Florey first mentions having them.
Why ?
I can only suspect because they were about to become obsolete, as synthetic penicillin seemed only months away.
By April 1944, that no longer seemed so and Coghill was back on the side of the biological angels, publicly praising Pfizer's biological penicillin and modestly claiming a role in their success.
Coghill's talents seemed rather wasted in democratic America - I can see him as the ultimate bureaucratic survivor in Stalin's Russia, adroitly changing sides as the situation shifted, moment by moment.....
The first, in November 1941 ,was obtained from Dr Rake at Squibb - a higher producing mutant from Fleming's original strain.
The second time in November 1943, some un-named strains were obtained from Robert Coghill of the NRRL , while he was visiting Oxford .
But in the two crucial years in between ?
I see bugger all evidence that Florey got the latest improvements in penicillium strains as they emerged at Peoria. (Prove me wrong, please) .
The mycologists at the NRRL research centre in Peoria had steadily improved and improved and improved again Rake's variant and their final version, NRRL 1249.B21 produced - via surface cultivation - most of the world's wartime penicillin until quite late in the war.
At that point, submerged strain NRRL 832, from a non-Fleming strain first found in Belgium, took over.
I believe that Merck's chief consultant and OSRD medical chief ( giant conflict of interest alert !) A N Richards, supposedly Florey's second closest American friend, using as an excuse that America was now at war, deliberately held back the giving these improved strains to Florey.
All to further America's ( sorry ! Merck's) post-war commercial opportunities.
Nicolas Rasmussen, in his article "Of 'Small Men', Big Science and Bigger Business", looks much closer than most historians at the day to day workings of the medical wing of the famous OSRD.
He points to several examples where Richards authorizes the further spending of taxpayers' money, supposedly only for war weapons, on drug research that no longer had an obvious military use, because he claimed that keeping American's edge in their development would definitely benefit the nation.
If not in this war, or any war, how would the drug's successful development benefit a nation at war - supposedly the sole purpose of the OSRD, whose mandate was set up to expire the moment peace was declared ?
Richards doesn't say.
So let me suggest a more sinister purpose , because Rasmussen does not.
I note that the two examples that Rasmussen gives where the OSRD spends taxpayers money on projects that no longer seemed to have a military need were pet projects of Merck, the firm that Richards advised.
The first was the chemical synthesis work on penicillin , carried on well past the point (say June 1944) when biological penicillin was being produced en masse and cheaply.
The other was after mid 1943, when it was clear that cortisone would not help pilots fly higher longer - an important advantage for any nation's air force if proven so.
Merck got nothing for all the money it spent on synthetic penicillin but its finally successful efforts on cortisone was and is one of its biggest successes for both its scientific reputation and its pocketbook (the two of course being closely related).
First success with Cortisone would be an advantage to America as well as Merck, over European (Swiss) competitors --- but synthetic penicillin's success could only have come by crushing fellow American firm Pfizer and given the field to Merck.
How then would that serve America's interests, rather than merely Merck's?
Because Europe wasn't even in the running on biological penicillin in 1944.
Perhaps Richards, already a pensioner when he took on the job of heading the OSRD medical wing and with the rigidity of old age, still believed synthetic penicillin would better Pfizer's penicillin in price and yield.
Then Merck would beat their only European synthetic penicillin rival : Florey !
Normally, Vannevar Bush's OSRD - as in denying the British to atomic energy research - did a better job of using taxpayers' military-assigned money to screw America's European Allies' commercial chances after the war , without favouring any one American firm.
Richard's willingness to screw Pfizer and even his friend Florey, shows just how much further he was prepared to go to aid Merck.
But he needed pliant helpers to succeed.
Luckily for him, the NRRL's Robert Coghill seemed to have had a hard time accepting that research paid for by his employer , the US Department of Agriculture and ultimately the American public, belonged to the USDA.
And that this research shouldn't only go where a different agency's chief bureaucrat, A N Richards, wanted it to go - though he hadn't paid for it and had no statutory (legal) control over it.
However , I see Coghill, a misplaced chemist running a biological program, wanted in so badly on a "technically sweet" chemical problem (the synthesis of penicillin) that he sold out the farmers he had sworn to help.
Synthetic penicillin would only negate the ready market for hundreds of thousands of tons of farm waste corn steep liquor, farm waste whey and farm waste crude brown sugar, all used in the natural fermentation of penicillin and other antibiotics coming along in the pipeline.
Coghill did publicly announce that he was giving the top two commercial strains of penicillium (presumably NRRL 1249.B21 and 832) to the entire world in November 1943, about the same time as Florey first mentions having them.
Why ?
I can only suspect because they were about to become obsolete, as synthetic penicillin seemed only months away.
By April 1944, that no longer seemed so and Coghill was back on the side of the biological angels, publicly praising Pfizer's biological penicillin and modestly claiming a role in their success.
Coghill's talents seemed rather wasted in democratic America - I can see him as the ultimate bureaucratic survivor in Stalin's Russia, adroitly changing sides as the situation shifted, moment by moment.....
Friday, February 8, 2013
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....
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....
two is a coincidence, three is a pattern : the OSRD on the weak and the strong
It is a commonplace to note that Vannevar Bush's wartime agency the OSRD, the biggest of Washington's many wartime scientific bureaucracies, favoured the strongest companies and the strongest universities.
Coincidence, say many.
But the fact that the OSRD, the strongest companies and the strongest universities all ganged up together to deny penicillin to America's weakest of the weakest seems more than a long stream of coincidences : it betrays a pattern......
Coincidence, say many.
But the fact that the OSRD, the strongest companies and the strongest universities all ganged up together to deny penicillin to America's weakest of the weakest seems more than a long stream of coincidences : it betrays a pattern......
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