Monday, December 31, 2012

The re-invention of a military-only antiseptic into "bedside penicillin for all" creates a global beacon of hope for a world at war

the tiny stone the builders rejected
Despite the self-centred claims of physicists, the greatest benefits to humanity have generally been ardently pursued (invented), not accidentally stumbled upon (discovered).

DNA was discovered in 1860s by an Swiss doctor, but for most of us, it was really only discovered 125 years later in the late 1980s.

That was when it began to first be successfully used to solve unsolved criminal cases, when British researcher Alec Jeffries re-invented 'DNA' as a means to definitely identify biological evidence left at the scene of a crime.

The great medical pioneer Joseph Lister clearly re-invented carbolic acid, when he took it from just one of many industrial solvents and turning it into a global life-saver.

Paul Gelmo "invented" sulfa as man-made chemical in Vienna in 1908 and it was routinely patented in 1909 by Bayer the chemical giant hoping it might yet be a useful chemical intermediate reagent.

But not until Gerhard Domagk , also of Bayer, who systemically tested every one of his firm's new chemical creations for its medical potential, was its life-saving abilities "discovered".

But I still hold this to be a case of re-invention.

 It took an awful lot of grit and determination during the Great Depression to waste scarce company money by systemically and thoroughly testing every one of the thousands of chemicals Bayer made, on then very remote possibility one might have medical applications.

The Nobel committee obviously agreed with me - giving Domagk the inventor and not Gelmo the discoverer the Nobel Prize for sulfa.

Alexander Fleming accidentally discovered penicillin in1928 and "discovered" it was only useful as a military-style antiseptic.

In 1940, Florey and Chain accidentally discovered that penicillin also might work as a systemic.

But like Fleming (by 1940) ,they still choose to emphasize its rather limited application against combat wounds infected by staph bacteria : a tiny, tiny, TINY proportion of all the deaths caused by WWII.

They were hardly alone : I was amazed to discover in my research that I could find no penicillin-making researcher between 1928 and 1945 who first put their penicillin to work as a human systemic life-saver, before they also tried it on localized wounds.

With one crucial exception: Henry Dawson.

In October 1940, months ahead of the schedule that he and his three fellow researchers had already worked out, he choose to inject systemic penicillin into two young men suffering from invariably fatal endocarditis.

At least one of the men - unexpectedly - lived.

It wasn't because of Dawson's penicillin : at an estimated 8 units per mg, it was about .56% pure.

Useless Junk ? Or Love, Hope and Charity ?

The rest (99.44%) was junk - or as I like to emphasis : "99 and 44 100ths percent pure love....hope... and charity" -- bedside penicillin.

A good bedside manner has probably saved more lives throughout history than all but a tiny handful of medications.

I contend that Dawson deliberately used his tiny amounts of home-made penicillin as part of his traditional clinician's bedside manner, to rally his patients' own body defences against their disease.

As prove, I offer up Gladys Hobby, a fellow member of his tiny team, who said she daily walked through Henry Dawson's wards, showing the patients the growing penicillium in flasks, hoping their rising interests in their treatment might rally their psychic resources.

Dawson was not content to reserve his invention of "bedside penicillin" to the handful of endocarditis patients that his small home-made supply could hope to treat.

So Dawson quickly told a convention of his colleagues (the world's top clinical researchers) that natural penicillin had "unlimited possibilities", thousands times stronger than the then acclaimed synthetic sulfas, but without their toxic side effects and inability to work well in blood and pus.

These researchers took his claims home to their labs all over the world.

Meanwhile popular media, like the New York Times , Newsweek and the wire services, spread his gospel throughout North America.

He tried to get the American government - in 1941 -(and by extension all Allied governments) to take over the production of penicillin form Big Pharma and mass produce it themselves in quantity.

Instead, wartime government bureaucrats, who were themselves paid consultants to Big Pharma , censored Dawson's conventional scientific methods to spread his good news - by restricting his access to scientific journals and restricting what he could say at scientific conferences.

But in wartime, person-to-person gossip becomes the new telegraph.

So Dawson was able to keep on spreading the word until most all of the doctors in metropolitan New York and beyond had heard of his unexpected successes with systemic natural penicillin, curing incurable endocarditis , the "Gold Standard" of infectious diseases.

Penicillin , he said, didn't have only a limited wartime role, limited to just being applied to local staph infections in combat wounds or to cure self-inflicted military VD cases.

He said it  had unlimited possibilities and could cure many of the diseases that plague a peacetime nation or a multi-million man wartime military --- if only government bureaucrats opened their eyes, their hearts and their pockets and gave it a "fair go" .

When the world's general populace, after the story of Baby Patricia broke worldwide, catch Dawson's "vision thing" , governments were forced to play catch up in the production of actual penicillin.

Meanwhile, they too caught Dawson's "vision thing" and governments all over the world turned their propaganda machine full blast to tout penicillin as a beacon of future health and hope for all , if only the Allies win this war.

The key change in the Allied governments' approach was that "for all" as it became clear that the voters did not agree with an Allied war effort that deliberately limited the supply of life-saving medicine and then triaged the world into the people worth saving and those not worth saving.

That - they said - sounded awfully familiar : wasn't that also Hitler's line ?

Well it was certainly Modernity's line : the  methods of instrumental rationality ruled all the modern nations from America to Germany.

By contrast, Dawson's general systemic was 'general' in the widest sense of that word.

 He thought it was particularly important in a Total War against Absolute Evil to give - and be seen giving - life-saving health care and food & shelter to all : it  was the best single reason why people should be willing to fight and die for the Allies' cause.

And seventy five odd years later, was he not right ?

Penicillin has a powerful mystique that tens of thousands of other useful medications ,combined, can't hope to match.

Dawson's crusade to make his inexpensive, abundant, safe "bedside penicillin" a commonplace at hospital beds the world over , in war and in peace , is the major reason we grant penicillin that mystique....

Saturday, December 29, 2012

1939-1945 : the modern Allies's real opponent was not Berlin anti-modernity but Manhattan ante-modernity ...

Conventionally , the Nazis were said to be anti-modern, though many of us feel they were the ultimate in hyper-modernity.

No, we think modernity in 1945 was defeated by ante- (or post-) modernity, of the Manhattan variety.

Henry Dawson, where ever you might be, take a bow .....

Even during Total War, its "who you know" not "what you know" : Richards, Queen and penicillin

Penicillin was not "reserved for military use only during WWII", as the cosy myth about wartime penicillin claims.

It was instead reserved as a plaything for medical researchers who would have quite happily have gone on polishing perfection until Judgement Day, if left to their own devices.

Consider how the American military finally got a look-see into penicillin, in early 1943 (remember the shooting war began back in the Fall of 1939).

A civilian pathologist-bacteriologist named Frank B Queen is now serving in the wartime army as a major and lab director in a large army hospital in an obscure part of Utah.

 (Needless to say, that is about as far off the beaten path in American 1940s medical science as one can possible be !)

Queen has started making his own hospital-grown penicillin, as he was sick and tired of seeing his patients with chronically infected deep bone wounds linger near death after months of useless sulfa treatment.

(The details of his home-grown efforts can be found in his July 1944 article in the journal, Northwest Medicine , under the title "Penicillin and its therapeutic uses".)

He writes Chester Keefer, who heads the NAS committee charged with wasting a few years research to see whether penicillin is as good as Henry Dawson has been saying it is.

(It is.)

Queen wants help on how to learn to grow penicillin better.

Keefer and his boss, A N Richards at the medical wing of the OSRD, have routinely told anyone from the Army requesting penicillin that it is still under review.

But two things about this request as different : the first was that the possibility of the Army growing its own penicillin because it couldn't get any any other way threatened the prestige of the medical research community.

 (And threatened the prestige and profits of the lack-luster American drug industry even more so!)

Secondly, Frank B Queen , it turned out, was a former student of AN Richards working with him and Howard Florey on a pioneering kidney project years earlier.

Merit and open competitions rarely entered into the mindset of American medical elites in those days : given the task of selecting members for a new committee you tended to appoint only from among your own university colleagues you knew you could rely upon - or on some of your former students.

Richards felt he could control Queen if he sent in one of Keefer's own men and a supply of OSRD-sanctioned penicillin, so Queen got the American military's first penicillin.

The rest, as they say, is history.

But the myth of wartime penicillin totally neglects to tell the real truth : that Queen was trying to make his own 'home-made penicillin', not obtain 'official penicillin' via the OSRD-Merck-Squibb cartel.

Thanks to David J Rothman, whose book, "Strangers at the Bedside" brought this fact to light (Page 40) ....

Friday, December 28, 2012

Penicillin : from Modern to ante-Modern in six bloody years

The biggest battle of WWII was NOT Stalingrad ( physically huge but intellectually a mere bun fight between History's worst dictators) but rather the battle over wartime penicillin : who makes it and who receives it.

For WWII definitely had a 'war within a war' aspect to it .

The billions of individuals who made up the modern global civilization of 1939 had six long - bloody  - years to re-evaluate whether the core values of their culture were really worth dying for, or were they only good for starting aggressive wars  - but not the sort of values for ending aggressive wars and securing permanent peace.

The New York World's Fair of 1939 promised a total world of man-made-ness but in the case of penicillin, man-made-ness ended in abject failure and it was Mother Nature that brought us this wonder drug when Man proved to be 'not up for the job'.

The world of 1939 eugenically exalted the Big and the Mighty and denigrated the weak and the small : penicillin (once it was a perfectly pure crystal shining brighter than a thousand suns) would be distributed on strictly Darwinian lines.

It would not be made in such quantities that would require the Allies to make one less bomber or battleship : so it would have to be rationed and so would go only to the eugenically 1A people .

(Be they fighting in foreign combat lines or winning the war behind some important desk in London or Washington.)

But by 1945, those same bombers were being pulled off their jobs of riding shotgun over the NRA nation and converted into butterflies to deliver life-saving grams of Nature-made penicillin to the dying all over the world : regardless of age, color, gender and economic status.

1945 was indeed the year that baby "Baby Boomers" started entering a very new , ante-Modern world......

Thursday, December 27, 2012

America sure loves its minutemen and riflemen - except during wartime

MOS 745 (circa 1780)
Do you accept - or do you deny - gun control and climate change?

Do you think that wartime penicillin should just be for healthy young  scallywags who cheat on their wives but are still fully combat-ready or do you think it should be "wasted" on the dying of all nations, races and creeds ?

Some things never change and the skygods and earthlings still mix it up to oppose each other as much today on gun control and climate change as they did back almost 75 years ago on the best uses for wartime penicillin.

Skygods sure love their guns and sure believe in an America where every man had a gun handy, to defend his family or his nation at a minute's notice.

One can't see much American culture without noticing the omnipresence of two very old symbols from yesterday in this land of tomorrow : the Revolutionary Era Minuteman and the post-Civil War Western rifleman.

It was much the same during WWII, where ads and movie iconography always focused on the modern day minuteman cum rifleman : the Army MOS 745 , the infantry trade of rifleman.

But reality spoke quite differently.

Any one moment in time, only about one American in one thousand (that's about 150,000 people) were actually up in the combat lines, fighting, as MOS 745s.

A few more were in the pipeline waiting their turn, while the vast bulk of America was - in the most profound sense - merely holding the rifleman's cloak.

Nobody much , in reality, actually wanted to be a real life rifleman or minuteman in good old WWII.

Dressing up and playing a Minuteman was lots of fun

As a result, the few MOS 745s America could obtain were almost all conscripts : generally those who were the poorest in life skills and formal education and often (a real shocker !) smaller and thinner than the non-combat boys in the rear echelons of the war.

This is why so much of the Allied debate over wartime penicillin involved these MOS 745s : they were so very few in number.

And so if the one-in-a-thousand American who was a MOS 745 was out of combat-readiness only temporarily because of something that penicillin could quickly fix, then the other 999 out of a 1000 Americans who weren't riflemen and didn't want to be riflemen, were much in favour of giving him scarce penicillin.

That was much better than "wasting it" (to use Winston Churchill's own infamous words) on some gravely wounded MOS 475 who was never was going to be able to fight again - even if he did survive his infection.

They call that rational instrumentality, and it was the hallmark of the Age of Modernity :' use 'em and then toss 'em aside like a used condom, the minute they are of no further use to you'.

Pretty sickening isn't , what granddad and grandma were up to  (morally speaking) back between 1939 and 1945: doesn't it make you want to just go off somewhere and wash your hands till they bleed with some good strong soap ?

Very last files UK National Archives plans to digitalize : FO 370/926, futile appeals from abroad for British penicillin

The very last files that the UK National Archives plans to digitalize and put on line won't be the ultra-secret Ultra files . Trust me : Ultra was a success.

No the very last files, if ever, to be digitalized and put on line will be the series FO (Foreign Office) 370/926 : requests from aboard , 1944-1945, for that wonderful British invention , penicillin.

That's because what should have been the greatest success for the UK in WWII turned out to be their worst total balls-up disaster.

The British didn't have any penicillin : not really enough for their own troops and civilians, let alone to address distressing appeals coming from the dying all over the world.

What should have been a signal triumph as Britons freely gave to the word the greatest medical boon it had ever known - would ever know - instead became an opportunity for America to practise "penicillin diplomacy" and replace Pax Britannia with Pax Americana.

The British Empire actually fell, not in early 1942 with "The Fall of Singapore" , but in early 1944, with "The Penicillin Shortfall Crisis".

The cause of the failure was the usual one : leaving policy in the hands of scientists, instead of the politicians.

Stupid and venal as the politicians often are, they know a political  minefield when they see one - but by the time they saw this one, it was just too late.

Just as the families overseas were forced to bury their dead when the British failed to help - so too, the PRO and UK archivists will bury these embarrassing files : but good....

Did Atlee - or PENICILLIN - defeat Churchill in July 1945 ?

In retrospective, the shock defeat of Winston Churchill's National Government in the General Election of July 1945 could have been foreseen in the Fall of 1944.

All that Fall, a long series of indignant Parliamentary questions were raised - and un-comforting answers were given - about the national government's refusal to find penicillin for UK civilians dying of endocarditis while Britain found the means to supply the same medicine to "Germans, Finnish Prime Ministers and Swiss footballers".

Germany and Finland were in the Axis and most Britons saw Switzerland as at least a fellow traveller.

Henry Dawson was long buried by the time the ballots were being counted in the UK, but I doubt whether he would have been as surprised by the Labour win as the world media so obviously was.

Dawson had long known that refusing penicillin to save those dying of endocarditis, a disease that came to those suffering "The Polio of the Poor" (RF -Rheumatic Fever), would be widely unpopular among working class voters, to whom RF and endocarditis were familiar dreaded diseases.

The refusal to supply government or commercial penicillin to those dying of subacute bacterial endocarditis in West Riding Yorkshire had even led the enterprising local government council there to see that its own health lab made and distributed  penicillin.

Yes , a promise to bring in National Health did give Mr Atlee and his Labour party a surprise massive win : but what was the catalyst to this largely underground groundswell of support ?

I believe the example of penicillin and how unevenly it was distributed stood as a contrasting example to a promise to provide adequate health care to all, regardless of class, age, gender, religion or color ....

Tuesday, December 25, 2012

For a medicine Modernity reserved for the military, penicillin sure missed a lot of battles ...

The USSR had at least 3 million life-threatening cases of bacterial infection between August 1940 and August 1945 that penicillin could have successfully treated.

It is not well known that Russia did make it its own penicillin and did treat some serious infections with it and saved some lives as a result during those five war years.

Sort of.

Soviet doctors treated 300 cases with their penicillin over those five years : out of at least 3 million life-threatening cases.

Not surprisingly, the Miracle of Penicillin does not loom highly in Russian historical accounts of the Great Patriotic War.

This too might easily have been the fate of wartime penicillin in the Allied West as well.

A few thousand cases treated in all, a few hundred in life-threatening situations, a few dozen front line military casualties.

Out of tens of millions of potentially life-threatening infections among the Western Allies that it was fully capable of curing.

For a medicine supposedly denied civilian use because it was needed at the battlefront, penicillin was decidedly gun-shy.

Between May 1940 and May 1941, it was proven up as a potentially unique life-saver and government fiat could have directed a gradually scaling up of production of penicillin, using the technology known at the time.

The government could have monitored the success or failure of penicillin at the Home-Front based military hospitals , which routinely treat every know disease , not just those gained in combat.

The military all by itself, at least in wartime , holds an enormous proportion of a nation's population : all ages from 17 to 67, mostly male but some female.

It can become the clinical lab, all by itself, to prove up or fail a new medication - without going anywhere near the rugged conditions at the front - rightly judged unsuitable for most experimental drugs.

Open-wound-oriented antiseptics are mostly useful on the battlefield itself, but general systemics are best used in rear base hospitals.

I suggest it was the obsession of a group of chicken-hawk medical bureaucrats , who had successfully avoided WWI when young and fit, which kept the definition of a successful medication limited to its battlefront use.

Ironically, they lacked the knowledge that real front line veterans like Henry Dawson already knew : that most military medicine is done well behind battle lines.

No Prime Minister or President, no Cabinet or Cabinet minister, no Parliament or Congress ever passed any statute or proclamation that limited the scarce wartime resources devoted to penicillin during the first four or five years of a six year war to almost nothing.

Un-elected, un-representative doctor-bureaucrats made that decision : they must bear the moral burden of explaining that signal failure of professionals swore to save lives, failing to save lives
on the most massive scale ever known to humanity......

Monday, December 24, 2012

The war began with Modern penicillin and ended with Postmodern penicillin

The war began with Modern penicillin and ended - quite unexpectedly - with Postmodern penicillin.

Began with micro-grams of Modern penicillin and ended, quite unexpectedly, with kilo-tonnes of Postmodern penicillin.

In fact we began WWII itself with Modernity at its very apogee and ended it - also quite unexpectedly - with the birth pangs of Postmodernity.

And penicillin was at the very heart of that fundamental change in world views.

The differences were the two world views  were differences over who made penicillin and who got penicillin.

Modern penicillin was first to be made perfectly pure and totally Man-made and totally synthetic (and made in huge ultra-modern factories)  before it was  deemed to to be fit enough to release for general use : and if that meant not until after the war was over, so be it.

Modern penicillin was of the sort that made for beautiful academic chemistry papers and created by new methods of total synthesis that won the admiration of all  your fellow academic chemists.

(Howard Florey, after all, was an academic chemist manque.)

By contrast, Postmodern penicillin was rough and ready, 'good enough penicillin' , shovel-ready : propelled forward by engineer manques and their production & process thinking :

Will it get the job done, quickly and cheaply ? If so, then let's get going.

(For while Henry Dawson was no engineer , his two brothers were, and Iron Ring thinking it was in the family genome.)

If tiny green basement slime can do the job, in a rural converted unused milk plant employing unemployed females from the countryside with Grade Six educations, great - let's get on with it.
Doesn't anyone realize there is a war on ?

As General Groves said about the OTHER Manhattan Project: if left to their own devices, those PhD academics would polish this job forever, till long after the war --- or at least until the grants ran out.

Now who was to get the different penicillins ?

Modernity was never revealed to be more brutal and callous and instrumentality-oriented in its thinking, than in Winston Churchill's written-in-green-ink attitude as to who should get the limited British penicillin available in North Africa.

(Limited, let us not forget, only because middle level bureaucrats in his same government had willed it to be limited.)

The severely wounded war heroes dying in Cairo hospitals had been judged once as eugenically 1A or they would have never have ended in in combat units and thus in position to be severely wounded in battle.

Judged 1A yesterday - but this is today : even if we wasted ( Churchill's chilling own words) precious penicillin on them and they survived as a result, they would be discharged as unfit for further service and remain a drain on the middle class taxpayers
until their natural deaths.

Heroes yes, but eugenically, now just 4F 'defectives'.

By contrast, the still-healthy paratroopers who cheated on their wive and deliberately got a dose of the Clap so as to avoid becoming a shot-up 'Hero' in battle, could be cured in two days by penicillin and still get his opportunity to die in battle, so my son won't have to.

He was still 1A and he - and he alone -should get the limited penicillin we have now.

And he alone deserves the moderate amounts of A1 penicillin we'll soon be making, as long as this war lasts.

Postmodern penicillin, by contrast, was for everyone - now : all those dying of infections it could cure: be they 'useless' war hero wounded, 4F civilians back home or in newly liberated territories, or even enemy POWs.

Then after the dyings' needs had been met, it was for all those who had infections it could cure.

Wartime penicillin for all was not a rain on war resources but the best means we have to win the world's hearts and minds.

So Postmodern penicillin was to be made and distributed in the spirit of a bye gone sentiment : Chivalry....

Friday, December 21, 2012

During the Ultimate Battle against the Nazi Evil, most of the world spent it parked in NEUTRAL

Only one nation group ( the British Commonwealth) was an combatant during the entire six years of WWII (September 1939 to September 1945) : even the original aggressor, Germany, ceased to be a combatant with its surrender early in 1945.

Every other nation on Earth - bar none - was neutral in the battle against Hitler and the Nazi Evil : for some, most or all of World War Two.

The sad fact is that most of the world's independent nations 'dog-danced' around the greatest moral crisis Humanity has ever faced.

Many independent nations were at first neutral, then supported the Axis, and then finally the Allies : depending whatever material advantage they thought they would gain moment by moment, rather than reflecting on the morality of the conflict and joining the side whose values they closest supported.

Again the British Commonwealth was the exception and it never wavered : it was opposed to Germany's invasion of its neighbours from beginning to end.

Many countries were further divided into two main camps : either over neutrality versus support for combat or between those opposed and pro the Axis.

Many of these nations had citizens fighting in organized groups both for and against the Nazis: so their nation was undergoing an form of  Civil War during the greater world war.

Some even divided like Gaul - in fact very like modern day Gaul.

In 1941, France's public divided into three parts: those who supported Vichy's official "neutrality", those who joined the French SS troops that fought for Hitler, and those members of the Free French Forces who fought against Hitler.

My math suggests that the when you divide the six years of war into the world's population of  independent states (those nations who had the power to decide for themselves whether or not they went to war), the largest lump of "people times days" was for neutrality rather than for combat on one side or the other !

The Good War ? Give me a large break !

The Korean War or the First Gulf War were good wars, where many nations promptly committed real lives and real money to quickly stop a nation from further invading its neighbour.

Parked in neutral during the most important moral conflict ever

By contrast, WWII as a Bad War - particularly in view of the moral stakes involved : which everyone agrees were the highest in all history.

Most people in the world, most of the time, did nothing to stop Hitler from invading Poland and executing its civilians (and did nothing to help all the other nations he subsequently invaded ,s beginning ten months later).

Prove me wrong : note the populations of all the independent states existing in September 1939, and then note how many days each of these independent nations were engaged in combat or parked in neutral.

(For example : Great Britain , 50 million in combat for 6 years. The United States, 135 million, in combat for 3 1/2 years. Turkey, 18 million in combat for zero years and so on.)

Ignore colonies with no real choice whether to fight or stay neutral - like India.

And deal only with nations that make a formal declaration of war, followed by a population-proportional commitment of troops into combat.

I think you will be shocked : how on earth could the Official Story of WWII be at such variance with the cold hard facts ????

Thursday, December 20, 2012

Fleming vs Wright 1929: local surgeon vs general immunologist ?

It is not generally accepted that Alexander Fleming actually did fight hard with his nominal boss, Sir Almroth Wright, to ensure the inclusion of a brief paragraph in his 1929 article that introduced penicillin to the world - the one that said it might have antiseptic applications.

Many researchers are skeptical about the idea of an undocumented fight.

They fear Fleming and his supporters are merely using it as an excuse to shift the blame onto Wright for Fleming's 15 year failure to put the world's best ever germ killer to work saving lives.

I do think there was a fight and that the disagreement , in a sense, flatters Wright and diminishes a part of Fleming's current reputation (though I haste to add , Fleming himself never ever fostered this part of his reputation.)

Fleming trained as a surgeon, but never practised (supposedly).

But I think he did act and think like a surgeon, and this surgeon manque side of him coloured his whole medical career.

A surgeon's personality is drawn to the concrete and the here and now : it is specific and local by nature.

This patient is dying because of a lesion right here, not there or there or 'we don't know where or why' : let me cut it out - now ! - and they will live.

By contrast, an intellectual like Wright was a generalist, a universalizer and systematizer.

In his medical career, he focused on giving body-wide vaccines : general systemics .

He was an immunologist.

We don't ordinarily think of getting a needle in the arm of BG vaccine to prevent TB as protecting us throughout our whole body : TB hits the only lungs doesn't it ?

But TB actually hits the whole body and a vaccine against it does protect the entire body.

Fleming made his living - a very good living indeed - running Wright's highly profitably vaccine factory, but his personal scientific interests certainly display a life-long interest in locally (directly) applied antiseptics for locally-situated diseases.

His needle or sprayer he welded like a surgeon welds a scalpel.

So, back to 1929.

Perhaps Wright was merely skeptical that anything delivered merely locally to an infection will have enough oomph to kill the germs : the whole body needs to push its weight.

Wright doesn't oppose penicillin as a possible antiseptic : he merely questions the worth of any antiseptic !

(And Penicillin did turn out to be most effective as a general systemic, though simultaneous local application and even local surgery often helped as well.)

Fleming has an exalted (aka surgically-minded) and very interventionist sense of how to use antiseptics : one does not dab it gingerly around the outer edges of a wound : one gets a big needleful and drills down into the lesion just below the surface, to deliver the germ killer directly.

So in 1929, he feels penicillin might work not just by being applied to areas with germs but also may have to be injected into those areas to do its work.

One of Fleming's main competitors, Howard Florey, had wanted to be a chemist, but ended up a physiologist : he spent his entire life cutting into and cutting up animals.

It is noteworthy that he, too, found delivering penicillin as a general systemic incredibly boring and always drifted to penicillin cases where there was a surgical aspect to grab his attention.

Similarly, fifteen years later when Fleming does start using penicillin to save lives, it is this sort of work  that holds his interest - not merely the putting of a needle ,every four hours, into a patient's butt to deliver a general systemic .

general internist vs local surgeons

By way of final contrast, Fleming's second main competitor, Henry Dawson, was going to be a law professor but ended up as a bacteriologist (though his main day job was as a rheumatologist ).

He was actually that rarity : a clinical investigator.

While Fleming and Florey generally never went near a patient if they could help it, Dawson was an internist, an attending physician at a big general teaching hospital.

He spent half of his day in a back room lab, like Florey and Fleming, but the other half of each day was spent on the wards, dealing with real life people with real life medical conditions.

An internist aka clinician is less focused on specific diseases as fundamental researchers tend to be.

 She or he must deal with real patients who do have a specific disease, but along with this, they have a whole pile of other medical or mental conditions that greatly reduce or increase the impact of the specific disease.

Internist are biased to general systemics (and biased against locally-minded surgeons ?) such as maintaining the overall morale of the patient (aka 'a good bedside manner') and tend to view systemic medications like penicillin as perfectly in keeping with the internist's craft.

I suggest that the differing attitudes between Florey/Fleming and Dawson regarding the urgency to use penicillin as a general systemic might have been predicted from their career-long proclivities......

Wednesday, December 19, 2012

Alexander Fleming : surgeon manque ?

It is not well known that Alexander Fleming the bacteriologist actually trained to be a surgeon but never practised and apparently didn't mind the missed opportunity.

Or did he ?

I think he did, in fact, long to use a surgeon's lancet - albeit on a tiny/micro scale.

 But if so, that would be perfectly consistent with his equally tiny/micro bacteriological techniques - it reflected his basic personality.

I think his surgeon manque nature is evident in his lifelong focus on antiseptics used in local applications.

I am defining local illnesses as situation where the germs and their damages are limited to just a part of the body and that part is 'somewhat' directly approachable by external means.

(If I seem vague in my definition, blame the doctors. Treating meningitis by injecting through the skin directly into the spinal cavity is local, but injecting directly through the skin into the kidneys is usually considered not to be local.)

And his "local" desire so distorted the fate of penicillin , that it didn't come into "general" (systemic) use until 15 years after its discovery.

If this interest in matters surgical were not immediately apparent to people who knew Fleming, there is an explanation.

Fleming, by all accounts, was effective enough in face to face conservations : his comments were terse, pithy and somewhat 'in your face'.

But as a public speaker, he was truly dreadful.

The volume of his voice was inadequate because he not only didn't project over and into the crowd, he also totally failed to modulate and shade his voice : to pitch his key points more strongly.

His flat low monotone left his listeners unable to make sense of whatever it was he was saying: to separate his wheat from his chaff.

But if his lecture was later printed and read, it surprisingly revealed a lucid and limpid writer.

His prose is brisk and confident , never diffident, scarcely bothering to conceal the man's considerable ego.

It is thus quite different from his adversary Henry Dawson, whose articles are delivered in a tone that is one part scientifically objective and one part cautiously diffident.

By way of further contrast, Dawson was seemingly an effective public speaker, combining earnest humility with earnest conviction.

If we examine Fleming's little known Campbell Lecture (Oration), delivered in mid-1944 in Belfast, just after he had been knighted and just when he is starting to believe that he is about to become very, very famous indeed, we see something of Fleming we aren't normally permitted to see.

He is dismissive of systemic medication as being easy ( a nurse can give sulfa pills - a resident or intern the penicillin needles) but says local applications (real local applications - not just a dab on the skin near the lesion) is a job requiring real skill : real surgical skill.

He is thus separating local from topical - the two are often confused, with good cause, because they frequently shade into each other.

The outermost layer of most of our skin are tough dead cells : an extremely toxic chemical dabbed on them (topically) can still be medically useful.

If carefully enough done, it will kill any germs there that might migrate into the open would right next to that skin but won't itself migrate far enough to kill any living cells inside the open wound.

But dropping an antiseptic into the eye socket to cure an eye infection is both topical ( on the surface) and local (the disease is restrained to the eye socket area).

But because the skin of the eye socket is much more delicate than that on the bottom of our feet (more membrane like) the antiseptic must be much more non-toxic.

Fleming, in his campbell lecture, says that even the most diffusible chemical agents have their limits in diffusion ( this is a harsh dig at systemics which diffuse throughout the body from the blood supply).

No, to get the microbes killed for sure,  he feels that the chemical must be brought right to where the microbes are, particularly if they are luring in areas far from a good blood supply.

Bring the drug in directly, one kills the bugs cleanly and quickly ---AND --- one uses as little medication as possible.

By contrast, general systemics (casting their charms all over the body when only the left ear bone is infected) are so wasteful, so very un-Scottishly un-thrifty.

He then proceeds to give a very active -interventionist sounding -micro surgical history of the cases he has treated.

Clearly the big Harley Street consulting surgeons who long ignored him from 1922 to 1942, had to stand back (helpless - oh sweet !) while he demonstrated how a real precise scalpel-like needle could reach into just the right place in a bone or spinal cavity to kill the germ without killing the patient.

It brings up a question never asked about Fleming as far as I recall : why did he train as a surgeon and then never practise ?

I have no doubt that Fleming would eventally made a perfectly adequate living as a surgeon in some larger mining or engineering works sort of town, somewhere in Wales or Northern England.

But he very much wanted to stay close to his tightly knit family of transplanted Scots - in London.

And London, capital to an empire, the world's largest or second largest city, was home to some very skilled surgeons.

Surgeons skilled with the knife and more importantly skilled with social graces and social connections and possessing a big self-confident physical presence and charisma.

Fleming had none of this : in fact, he felt awkward even around other Scots, as his was an extremely rural childhood with his family living all alone on top of a big isolated moor, miles from even the nearest small village.

But Fleming always felt he had the physical chops for the surgeon's job, at least a certain kind of surgeon's job.

His needle skills in administrating the easily-fatal Salvarsan (VD ) shots had made him wealthy and admired before the Great War.

Fleming wanted to be a surgeon - hence his life long interest in local (surface wound) infections and antiseptics, not the pill pushing systemics sought by your average busy garden-variety GP.

But he was wrong - dead wrong.

Because penicillin, for its first 35 or so years, couldn't be delivered as a pill.

Now the ordinary GP could reach into his black bag at the rural farm cottage and give a needleful of penicillin G himself, arresting a fatal case of spinal meningitis before the patient even reached all those big shot specialists at the big city hospital.

GP Power Rules ! Over life and death !  Oh sweet !

The phallic symbolism of the frequently reproduced image of the needle held high up in the air at a 45 degree angle, just before the GP plunged into the patient below to save a life is almost too obvious to mention - but there you go - I said it.

Systemics like Penicillin G that must be delivered by needle, not by pill, would have given the short, homely and shy Mitty'esque Fleming all the glory he so obviously craved - if only he had  been the first to use the needle with gusto in 1928, not among the last to use it avidly in 1943......

Tuesday, December 18, 2012

Penicillin, age 13, meets her first lover : Henry Dawson

Mad, is he ??
It was frequently said of Dr Henry Dawson (as it was of General James Wolfe) that he was quite mad.

But what can one say in response, that George II hasn't already said much better over two hundred and fifty years earlier ?

It is true that Henry Dawson was quite mad , mad on the subject of the "unlimited potential" of penicillin , at a time (1941) when almost all ignored it and even its own 'supporters' damned it with veiled praise.

It was the Philadelphia Bulletin, at the time America's largest evening newspaper, that quotes him as saying ( May 5th 1941) that penicillin has "unlimited possibilities."

The New York Times' headline the next day, quotes him as describing penicillin as a Giant Germicide, non-toxic to a marked degree (unlike the then standard sulfa drugs) and "the most powerful germ killer ever discovered" : thousands of times more potent than any sulfa drug.

Hundreds of the world's top doctors heard Dawson's presentation on penicillin and many doctors described it as "opening a new chapter" on the medical fight against the deadly gram-positive bacteria.

Dawson was judged as "uncritically enthusiastic"

No wonder with such gushiness that a powerful member of the American medical establishment , Stanhope Bayne-Jones , snifflingly dismissed Dawson to (later Baron) Howard Florey, as "uncritically enthusiastic".

But was there ever (will there ever be) a better life-saver to be "uncritically enthusiastic" over than penicillin ?

Mad is he ? Well, I wish he'd bite my other doctors.....

Fleming's non-toxic antiseptic was useless (and was called penicillin)

Toxic - but effective - antiseptic
An extremely non-toxic ,wide-spectrum (for its time)  germ-killer that can be used as a huge-dose, long term, systemic (ie something we safely introduce into the bloodstream), is a very rare indeed.

And highly valuable, even priceless, whenever our body faces massive body-wide infections that can kill us.

By contrast, what Alexander Fleming claimed to offer between the Fall of 1928 and the Fall of 1942, was a slow acting, non-toxic, wide-spectrum antiseptic (externally applied) germ-killer that was in very short supply and very unstable.

Forget, for the moment, most of Fleming's 'claims'.

The main point his listeners would take away was that this was a non-toxic antiseptic and as such, not particularly valuable.

Non-toxic and yet not particularly valuable ??!!

Yes, even fairly toxic systemics can sometimes be useful.

And as for antiseptic use, even very toxic substances can still be totally useful.

This confusion comes about because even doctors are frequently far too loose as to what they actually mean when they say a drug is toxic.

Toxic usually means - when you dig into the subject - it kills  tender cells, in our interiors , and when delivered via the blood supply.

But toxic chemicals poured into body cavities and wounds without access to the internal blood supply (aka antiseptics) can end up doing very little damage in the overall scheme of things.

Even if they kill our body's cells at lower levels of the drug than the level needed to kill bacteria cells, they still can be useful : the wound at first might be a mess of already dead human cells acting as a food source for deadly bacteria.

Later after the bacteria are dead and the dead human cells are flushed away, the toxic antiseptic can be withdrawn before it starts killing new living human cells.

So antiseptics don't really need to be non-toxic, to be effective.

But they do need to be cheap, abundant, have long term stability and non-complicated storage requirements : everything that Fleming's offering (Penicillin) lacked.

Limited visions indeed : comparing penicillin to gramicidin

Something that Gramicidin, its chief rival from 1939 to 1943, did offer in spades. (Gramicidin was highly dangerous if taken internally but quite useful if poured into open wounds.)

But even the act of medically comparing penicillin to gramicidin , as many  medical researchers did in those years, gives us a rare insight into their personal 'war aims'.

They saw the many different sulfa drugs as essential for all forms of infections, internal and external, military and civilian : and so scarce resources must be diverted to their mass production.

But the fact that they only saw penicillin as an antiseptic , meant they saw its use limited to wound-type infections - ie mostly for military personnel and even there, only for trauma infections.

This limited estimation of the worth of penicillin contrasts vividly with penicillin's biggest booster, Henry Dawson.

Quite simply, he said in 1941 that he saw penicillin has having "unlimited possibilities" and that "the government" should mass produce it for all , rather than wait for Big Pharma to get its act together.

If Dawson saw it first and foremost as a systemic (and most deadly infections are systemic), Fleming had spent the last dozen years flatly telling all his face-to-face listeners that penicillin would never ever work as a systemic.

He said this beginning  in 1928 and he clung to this fatally incorrect "belief" until at least 1942 or 1943.

Yes, Alexander Fleming should be honoured as the father of penicillin, but he should also be condemned as the father who also trying his hardest to kill his own child for 15 years....

Was there a Parran-Hearst Telegram ? (You provide the penicillin, I'll provide the pictures)

"Operator, get me Washington, tell 'em I'm from Hearst..."
There is no firm evidence that Citizen Hearst ever sent that infamous telegram to the famous war artist Frederic Remington in Cuba.

We all know which telegram:  the one where Remington is sent out to illustrate the ongoing civil war in Cuba, but finds all is quiet and begs to go home.

Hearst supposedly telegraphs him to stay : "(If) you furnish the pictures, I'll furnish the war."

Hearst proceeds to puff up the accidental explosion on board the battleship The Maine as an act of sneaky warfare by the Spanish, ("Remember Pearl Harbour" 50 years ahead of schedule) and the rest is history: Yellow Journalism's finest moment.

Or is it ?

For a start, that particular telegram was apparently never sent.

But did the aging Hearst later intervene with US Surgeon General Thomas Parran in August 1943, to get penicillin to a dying baby girl in Manhattan ?

Was this Yellow Journalism's finest moment ?

The Pulitzer Committee apparently felt so - and it is worth noting that Pulitzer and Hearst were the most bitter of bitter enemies.

Consider what we know (or think we know).

Supposedly the whole thing started with a phone call from the distraught father (Lawrence J Malone) of a dying two year old girl called Patricia Malone, made to the city desk editor of the Hearst media empire's flagship newspaper, the New York Journal-American.

Actually Malone quickly fades back into the wallpaper , as do the nominal doctors for the baby girl.

Because in fact, Malone was set up for the call by a crippled Italian-American surgical resident named Dante Colitti, then working at the tiny Lutheran Hospital in upper Manhattan, about a mile from pioneering penicillin doctor Henry Dawson's hospital, Columbia Presbyterian.

The little girl was dying of blood poisoning and normally a surgical staffer - a mere resident at that - has no place in treatment decisions for that sort of illness.

But Colitti was raised right, with a good moral education and he couldn't stand by and let her die, when he knew that not a mile away, Henry Dawson was dragging babies like her back from the grave with his Floor G penicillin.

And Colitti had no cause to love the New York medical establishment which supported the limiting of penicillin to curing VD cases among the unfaithful husbands and boyfriends of the combat corps.

In the 1930s, he had been rejected from attending any New York medical school, by an informal quota system designed to keep out Catholics and Italians.

 (And Jews and Blacks and Asians and Women. Colitti's parents were recent immigrants to America).

Colitti had a permanently bent spine as a result of childhood TB and had to use crutches so it was probably the excuse given him for his rejection.

But Colitti knew that Henry Dawson, just a mile north of him, was working with a doctor who used crutches thanks to polio and another doctor who was missing an arm.

The only real difference was that these were Protestant men, with native-born parents.

Colitti paid a private medical college in Massachusetts to get his MD degree but no New York hospital would recognize any degree not granted by one of the quota-oriented establishment schools.

It was a closed loop.

But WWII led to a desperate shortage of medical staff and even New York's medical establishment had to let people like Colitti in to do the lowest medical jobs, at least until the war was over.

But the highly morally minded Colitti felt that if they had displayed no charity towards a cripple, that did not mean he would follow suit.

Hence his setting up of the phone call to the Hearst paper : he knew exactly who would cause the most noise.

The Journal-American photo-journalists were then world famous for their large, vivid, gripping front page photographs and a dying baby story was just made for their skills.

The Hearst editor got no where ( says the AP press agency) with the OSRD's Dr Richards or with the NAS Committee on Chemical Therapeutics.

But somehow or other the newspaper knew of the ongoing conflict between those who felt we could best win the war ("Hearts & Minds") through well publicized Social Medicine versus those that felt that secretive and rationed War Medicine would save more scarce resources for "Guns & Bullets".

Because the newspaper ultimately got the penicillin it needed from that supply reserved for the US Public Health Services (at that time, it only had a tiny amount of penicillin and it was only normally used for treating cases of VD among merchant seamen.)

Released by drug company Squibb upon the direct order of Thomas Parran, US Surgeon General and head of the US Public Health Services (then a relatively small and powerless body compared to its status today.)

Parran versus Weed over the fate of wartime penicillin

Parran was the de facto head of the Social Medicine forces, while the NAS's Lewis Weed was the voice of War Medicine.

Did Hearst or his senior staff know of this ongoing debate and approach Parran directly, dismissing his concerns about tackling the all-powerful OSRD and NAS by reminding him he had no love for the NAS's Weed anyway , and that if he would only provide the penicillin vials, Hearst photographers would provide the poignant pictures.

Yellow Journalism and the Yellow Magic then proceeded to make beautiful music together : because the Patty Malone Story ultimately spelled the end to the Age of Modernity ...

Politics as the authoritative "prioritizing" of values

A Canadian (but not Canada) morally defines wartime penicillin
There is a broad academic consensus as to the best way to differentiate political bargaining from economic bargaining.

That consensus says that "prices" are used to come to an informal economic agreement as to the allocating of scarce resources between alternative uses.

But politics authoritatively allocates (rations/triages) scarce resources between alternative uses.

Politics does formally what economics does informally : it passes a laws that directs that the allocating will be done by fiat and force, if need be.

But this consensus explanation merely says how the two different forms of allocation will be done.

(Either by voluntary agreement as to how one chooses to spend one's own money, or by resources being allocated at the point of a government gun if need be.)

If does not say why the government has made its allocation decisions it has made.

(We already know that Economics has made its bargains based on the differing economic values the various differing players assign to various differing goods and services.)

So normally, the consensus view has to add that politics has made its decisions and bargains based on values.

This hardly settles much : I believe it needs to be said that the political values in question are ALL moral values - albeit often expressed in terms of economic values.

And it almost goes without saying that in the political bargaining process, various bodies of political players place differing weight on different moral values and that these bodies of political players have quite different political bargaining power.

Some are large in number but have little wealth, valuable skills or organizing cohesion.

Others are very small in number, but are very wealthy, articulate, skilled in influencing governments/public opinion, and are very united in their position vis vis certain valued vales.

Most bodies of political voters fall somewhere in the middle of these positions and in fact their political bargaining strength varies widely over time and over various issues.

In addition, all these bodies agree - albeit reluctantly - they they need the others, if society and the economy are going to keep on working : thus their bargaining positions are not absolute but will settle  - if need be - for half a loaf.

This is why I say the real hard bargaining in politics occurs over the priority we as collections of political bodies give to different moral values.

Politics is always and only about winning over 'Hearts and Minds'.

And in an earlier post, I suggested why such hard political bargaining gets more - not less - intense during times of Total War.

So, to recap that earlier blog post, some of us value very highly the giving of scarce penicillin to paratroopers with a case of the Clap, so they can go back 'on strength' in two days and possibly die in the next big battle, so our own son won't have to be 'called up' in their place.

Others of us feel that a severely wounded and infected soldier who has already fought bravely in battle is more worthy of the scarce penicillin than some paratrooper deliberately cheating on his wife without a condom in some Naples brothel, hoping thus to avoid dying in an upcoming battle by being in hospital for two months with the traditional VD treatment.

We value this severely wounded hero's contribution greatly and admit we had made a tacit bargain with him to say we stay-at-homes would give him the best possible medical care if he should be wounded while defending us stay-at-homes somewhere overseas.

So we feel we must honour that bargain, despite the fact that even if our severely wounded hero is cured of his infection and lives, he will be quickly released from the army and given a small pension for life (paid for by us staying safely at home), as he will remain too permanently injured to be a good soldier or even a good factory worker.

This in a nutshell and without a lick of exaggeration , was the moral values that the Allied world debated over in the summer of 1943 - at first, solely among the well-to-do fat old men running the war and then later - post Baby Patricia - among the entire Allied population.

As the moral value of wartime penicillin went, so went Modernity - and post Modernity

In the end, it was Henry Dawson, Robert Pulvertaft, Rudy Schullinger and Dante Colitti 's chivalrous values that were prioritized, not the modern values of Winston Churchill, Howard Florey, Alfred Richards and Lewis Weeds.

And in doing so, our world quietly slipped out of the Age of Modernity and into the post Modernity Age....

Monday, December 17, 2012

The FAILURE of fiat during Total War

I insist that the truism that all politics is about the authoritative allocation of scarce resources is never less true than during Total War.

My claim is that this paradox is true because the successful waging of Total War is not really about gathering enough scarce physical resources but rather more about rallying all the possible psychic resources that your nation's citizenry possesses.

The demands of Total War are never ending and even the relatively simple task of commanding by fiat of 110% of all possible physical resources is never enough.

Fiat - the big stick with the bayonet at the end - will never makes your citizens do more than their dutiful duty (when the guards are watching).

Fiat command of psychic resources - such as Stalin employed during the Great Terror of the late 1930s, will be sufficient - in peacetime - to ensure everyone gets the minimum of food and comfort needed to keep working, while allowing a bit extra to pamper the elite and pay for a few Show Projects.

But under Total War, the bullet in the back of the head is never enough incentive to get people to give their 110%.

Stalin needed  all the physical and manpower resources of peacetime USSR to , at a minimum, defends the USSR from being conquered by the forces of germany.

But he had, instead, lost a lot of those physical resources and manpower to German conquest and the most developed portions of his remaining territory was being bombed and burned.

Despite this, Stalin repulsed the Germans and then swept into Germany itself, because he made up for a loss of half of the most developed parts of USSR by drawing on three or four times the psychic energy of the Russian peoples compared to what he had drawn in 1937.

In WWII, even Stalin found that the threats of bullets in the back of the head were not enough

The Great Patriotic War, from mid 1941 to mid 1945 ,inspired virtually all Russians to work and fight with a fury and with a great imaginative drive.

Much the same thing happened in Britain from mid1940 to late 1942.

As did Germany from late 1942 to  mid1945 and Japan during the same period.

When all of a nation's citizens are convinced that they face imminent torture and death, they will resist with all their will and energy :  all their government's propaganda efforts are hardly needed to ensure that.

But these four major combatants only made up about 1/6th of the world's population during the war and even for them, their periods of intense psychic efforts only existed during the periods when they were under direct death threat.

For the rest of the world , governments could perhaps command a lot ( but by no means all) of their nation's scarce physical resources but only some of their scarce psychic resources by fiat alone.

As Henry Dawson personally knew from the First World War and foresaw would be needed again in the Second World War , such nations needs a "poor bleeding little Belgium" and an Edith Cavell to fight and die for --- they needed a high moral cause to draw out all the psychic energy from it citizens.

For Dawson, his personal little Belgium was diverting some scarce physical resources away from making bullets and towards making enough penicillin for all people needing it : all Allied soldiers, all Allied citizens, all Neutrals, all Axis POWS.

Divert resources away from bullets towards penicillin, not in spite of Total War, but because of Total War.

Dawson's promotion of this version of Social Medicine during Total War, was actually a sophisticated example of Indirect War Medicine, rather like rationing food equally for all or the decision to fortify all citizens' bread with vitamins during the war, without regard for their ability to pay for it.

All such measures indirectly helped the war economy and the military war, by ensuring the nation's psychic engine was firing in all six cylinders.....

Thursday, December 13, 2012

Raymond Chandler biographers' alert : his entire war records posted online

Sgt Ray Chandler, SIR !!
Perhaps a fan of Raymond Chandler at the Public Archives of Canada, exasperated beyond measure by all the bosh written by Chandler biographers about his war record in the Canadian Army in WWI, has decided to set the record straight by posting all his military records online, free for the downloading.

Since "1940s Chivalry" (what an oxymoron !) is the most important meme in my book de-bunking the current myth of wartime penicillin, I am deeply interested myself in Chandler's WWI experiences in the Canadian infantry.

Down the mean corridors of wartime medicine....

This is because Chandler, alone and along with the subject my wartime penicillin book (Dr Henry Dawson) , was about the only public proponent of chivalry during WWII.

("The Big Sleep" and all of the Philip Marlowe series.)

And yes, Dawson too served in the Canadian Army Infantry about the same time as Chandler and he too implied it was the most formative event in his life.

Conventionally it is said that chivalry died in the aftermath of the millions of moderns who experienced the inhumanity and machine-like nature of modern war on the Western front.

These two men did experience warfare there at its harshest but came away perhaps more on fire for chivalry than before.

Something isn't adding up and I aim to ferret the truth out....

Wednesday, December 12, 2012

Well-intentioned PhD supervisors are the death of good History writing : particularly in writing about wartime penicillin

Many a well-intentioned PhD supervisor, hoping to help their student across the mine-field of a PhD thesis which casts its net too widely, steers the student to a subject that has an existing treasure trove of unexamined (or under-examined) archival material.

But taken too far, this attitude kills good history stone dead.

Extensive archive materials for an individual often suggest a subject who was inordinately vain (or whose spouse is determined to burnish their light after death).

The ability to retain (and store) a lifetime of records for an individual suggests someone who was wealthy enough to afford a big home, someone who didn't move much and had the work space and the secretarial assistance needed to maintain work files.

Everything about such a person suggests "elite" : far more likely to find such materials for a long time department head than a brilliant but controversial scholar who drifted from one to another non-tenured jobs from continent to continent.

But that footloose scholar might have tossed off a totally new paradigm while the other department head just produced reams  and reams of humdrum "normal" science .

What sort of institution has hundreds of shelving feet of records - and what sort does not ?

Again  on that is wealthy and secure in its funding and elite support, versus a group of young firebrands operating on pennies out of shoebox offices in ghetto storefronts.

But again, their long term historical importance may not match the influence both had when in existence.

How then to write about the sub-surface paradigm breakers and makers, when your kindly supervisor steers you to the 'usual suspects' with well funded, well maintained archives all neatly gathered up for you in one spot ?

And does the supervisor consider whether potential archival material have been so thoroughly pre-vetted by an earlier elite of that institution to remove all material that casts a darker light on their activities as to render it particularly suspect as a source to write good history ?

I like the prefaces to two contemporary historians' best known books, because they have been particularly frank in stating important subjects aren't always neatly enveloped in a few "official archives".

Aaron Bobrow-Strain has complied his social history of the store-bought white bread loaf from the oddest nocks and crannies of life.

 While he doesn't make this explicit , he could only do so because he had the time, money and authority of being an established author,expert and tenured professor  in the general area of food to spend years going all over the world and receiving warm helpful assistance from librarians and archivists everywhere.

Any 25 year old PhD candidate will tell you it rarely works that way with them.

Christina Cogdell ("Eugenic Design") tied her can to an even wilder alley cat : she tried to find hints of deep eugenic thinking in the behaviour of ordinary citizens who could truthfully say they had barely read anything on formal eugenics.

She speculated widely in tying hints in all sots of material to a wide claim indeed : that far from declining in the years between 1925 and 1945, eugenics became part of the general thinking of white middle class people throughout America.

I had always felt this to be the case, in a vague sort of 'back of the mind' feeling, so I was an easy sell.

But I can't imagine the resistance of others, who felt more comfortable with work like that of Daniel Kelves, who did pioneering work in the history of American Eugenics by the conventional route - burying himself for years in the record rooms of the elite eugenic bodies.

By their own standards - their own harshest critic ! - these eugenic organizations felt they had badly failed.

Cogdell, by contrast, felt they had succeeded far more than they knew.

I can argue that she came to this conclusion being being forced to consult wider sources - as opposed to becoming simply another "embedded historian".

I think of an "embedded historian" as being one who spends years mining one powerful institution's massive but unexploited archives, not quite believing their luck that no one more senior hasn't been there first, but who in the process, starts absorbing that institution's
archival 'rhetoric'.

No collection of important archival material from important people and institutions is ever just a neutral collection : "the facts and nothing but the facts".

It has always been culled carefully before being 'archived', in a manner to flatter the current powers-to-be , be they the original individual, their surviving family, or the institutional powerful at the time the archives were created.

Lots of things slip by - no one has a perfect record at predicting what future audiences will view as evidence of unflattering behaviour on the part of the people whose work is in the archives.

But , to point to an example in the field of penicillin , Vanevar Bush, Alfred Richards and Chester Keefer , all from the OSRD ,left plenty of evidence that they carefully stage managed the release of information - during and after the war - on the role (if any !) the OSRD had in its final, unexpected, wartime success.

They turned the biggest failure of the OSRD (the five year American failure to make synthetic penicillin) into the OSRD's biggest success : mass produced un-synthetic penicillin, by carefully massaging the truth.

They could have had little expectation that their distortions would survive them years after their own deaths.

But thanks to the embedded nature of most academic and popular writing on penicillin, it has done so.

Mostly this is because these embedded historians haven't seen themselves in that light at all : they feel they are busy correcting historical distortions.

To put it in over simple terms, they feel that either Fleming or Florey (or one of their co-worlers or supporting institutions) has been ill-served by the writing done to date and wish to correct the situation.

They have all succeeded in their stated aims, but they are really just nibbling at the edges.

For none - has refuted or even thought of refuting - the central claim of the wartime penicillin myth , that it was the OSRD intervention that led to the final success of wartime penicillin.

Peter Neushul thus stands unique because he has (in "Science, Government and Penicillin") undercut the myth of the OSRD being vital, but without actually putting the knife in decisively.

But we all owe him a great credit for the detective work he did do when he ventured off the well trodden path to the usual suspect archives on wartime penicillin ...

Tuesday, December 11, 2012

Illinois credits CORN liquor, Wisconsin DAIRY sugar for success of wartime penicillin

Call me cynical, but if Florey had been steered to the University of  Wisconsin in Madison in 1941 instead of to the USDA lab in Peoria , we might have gotten wartime penicillin in serious production a whole lot quicker.

Albeit with only one (ahem) drawback: we'd all be deaf hearing  how it was the addition of lactose than finally made penicillin production commercially viable - and hear virtually nothing about the addition of corn steep liquor to the happy mix !

The Peoria team was backed by a Washington scientific organization (the OSRD) whose research was so so but whose postwar PR efforts were first class.

Peoria boss Robert Coghill had spent much of the war backing the wrong (synthesis) approach to penicillin, then deserted that sinking ship and began touting corn steep liquor....

By contrast, Madison was also hooked up with a Washington scientific body (the OPRD) whose science was A1, but who lost out badly in that always crucial press-agency side of serious, fundamental ,science.

In applied science, a process or machine either works or it doesn't.

But in fundamental science, the theories only grow on their listeners if well supplied with plenty of bullshit.

Or steep corn liquor......

Illinois has a few houses and peolpe but otherwise is mostly tens of thousands of square miles of corn fields (and pig barns).

Wisconsin , by contrast, is all grass and cows.....

ROP on this penicillin milch cow is beyond astounding : and it is all down to lactose intolerance !

Ironic isn't it ? Hundreds of millions of people have enjoyed longer lives thanks to the lactose intolerance of some slimy little mold.

That mold makes penicillin : in the beginning, very little,  only converting about one millionth of the war-rationed sugar that was so lovingly fed into penicillin.

Turns out that was the biggest part of our problem : we were feeding it far too well, on easy-to-digest sugars and so it failed to produce any penicillin.

But as soon as we learned to starve it slowly, by giving it milk sugar, (lactose) a sugar it didn't exactly live to eat , it started into giving us tons of penicillin.

Lactose stresses the diets of molds something wicked and when they get food-stressed, but not to the point of actual starvation, they play defence .

The penicillin they start making kills and keeps at bay possible bacteria competitors for what little suitable food the mold can lay its threads upon.

But actually starve a mold (and early researchers often accidentally did that), and they started to rapidly self-suicide themselves in despair.

But feed it lousy lactose, just at the right time, just after its had a day or two of easy living on some nice sugar and protein, and it will produce tons of penicillin.

Literally : annual penicillin product induced by human industry is now at least 20,000 metric tonnes a year.

In 1928, it was about one micro-gram. That's about what Fleming saw in the bottom of his petri dish and it was about as much penicillin as was used in its first cure : curing a newborn baby of a lifetime of blindness , in 1930.

A micro gram is 1 millionth of a gram , so there are a billion of these tiny micro grams in a kilogram of penicillin ( ie about 2 pounds of penicillin). And a trillion of them in a metric tonne of penicillin ( ie about 2000 pounds of penicillin if you are old school.)

So we now produce 20,000 thousand trillion times as much penicillin today as we did 85 years ago.

Fleming's particular penicillium mold was actually very good producer - seemingly the best in the world for 15 years, but only produced one micro gram of penicillin in every gram of liquid medium.

That is a million parts junk to one part money ratio, unbelievably dismal in comparison to every other fermentation process in commercial use at the time.

Today, we get 50 milligrams of penicillin per gram of medium : that is 50,000 times better.

That is a 5,000,000 percent improvement in about 50 years.

Think your grandfather's prize milk cow had an outstanding ROP improvement ?

Try this rapid a percentage improvement on for size !

The main reason why we didn't see this sort of improvement for almost 20 years after Fleming found his mold is because we let chemistry guide our thinking ; trying hard to extract ever more of the penicillin we did manage to produce.

But as I used to say to the CUPE picketeers whenever the Gerry Regan government boasted of the size of its final, final, contract offer : " ten percent of nothing is .... still nothing" .

Only by learning to starve penicillium molds, which we had done by late 1944, did we begin to see enough penicillin to make the stuff a paying proposition , not a charity case, for Big Pharma.

But you can read all the best known books on war time penicillin - and I believe I have - and yet never read one word said about starvation of the molds.

The same goes for present day articles from historians and social scientist about wartime penicillin.

Only articles and books from physical scientists actually working in the fermentation industries routinely mention starvation stress in regards to being essential to penicillin production but even they seem to quote articles from the early 1950s as being the first to signal this fact.

But what then to make of little gem from July 26th 1941 from a letter from Norman Heatley to Howard Florey, just three weeks into Florey's effort to get American Big Pharma to make penicillin on at least a pilot plant scale?

Heatley is at a spanking brand new research facility in Peoria, set up by the US Department of Agriculture to find new uses for farm surpluses - particularly surpluses of low value farm wastes.

He is working with Andrew Moyer : one part mold genius to two parts paranoid nutter.

Already, just ten days after looking at penicillin for the first time, Moyer hazards a guess that penicillin production might be dependent on a starvation metabolism.

If Moyer had only been listened to - and there is no sign that any scientist or bureaucrat then - or historian since - ever did, we might have had commercial penicillin flowing by the Fall of 1941 not the Fall of 1944.....

Between Wartime Penicillin's initial failure ( Chemistry) and its final success (Biology) stood a third party : the humanitarians

When I call Henry Dawson "Penicillin's Third Man", I am being more than ordinarily facetious.

Penicilin's problem was chemistry-besotted biologists, the solution was  biologically-pragmatic chemists and the connecting threat were a tiny group of humanitarian-minded clinicians.

I mean that penicillin's main problem was - dating from September 1928 - was that its initial (biological) investigators  -names like Fleming,Florey and Richards spring to mind - tacitly accepted penicillium production levels of one microgram of penicillin per gram of medium as a given.

 As a result, they sought - blinker-eyed - only one possible solution : the total chemical synthesis of penicillin.

By contrast, it was chemist Larry Elder who finally pushed mycologists into doing their jobs like people on a mission, not people politely going through the motions.

And it was Larry who sought out "farmer-minded" scientists from any and all fields to up penicillium yields the old-fashioned way, the way farmers had successfully done so with other species for thousands of years : trial and error selective breeding.

But before people like Larry could be called in on the file, the public in September 1943 had to be outraged, ("its been 15 years since penicillin was discovered and  its still in desperately short supply !") and demanding that the authorities put new people on the job to finally start making this stuff - now - and in bulk.

Elder, Colitti, Queen, Hearst never get the credit they deserve

The humanitarians like Henry Dawson, Robert Pulvertaft, Rudy Schulinger , Frank Queen and Dante Colitti all pushed the civil and military powers to be to make penicillin available for all who are dying - now !

And when the purple-toned slash yellow press of Citizen Hearst picked up on their efforts, all the pieces fell into place.

In less than six months, the government of America was pulling a little bit of its money out from making nuclear bombs and germ warfare and towards saving lives and the job was done.

 America - and soon the world - would be awash with cheap naturally-breed penicillium-made penicillin....

Sunday, December 9, 2012

For the middle class of the Modernist Age, being double-dipped for their daily bread was a honor not a curse : hence their horror of hospital-made penicillin

Hard to believe that our grandparents were glad to be first soaked by milling corporations for the firms' processing away of life-giving vitamins from their flour and bread and then soaked a second time when the millers' added expensive man-made processed vitamins back in again.

It was called "Progress" and it was good.

Mom's home-made bread, prepared right in front of her kids in the kitchen, just had to be crawling with lethal germs  might even be made with (horrors) healthy vitamin-rich whole wheat flour), so it was much wiser to buy some factory-made white trash at the store.

Likewise, what family would allow their own family doctor to safely make penicillin up ( by themselves !) , to inject into a dying patient they had treated faithful for 35 years ?

Hoisted on their own modernist cum pharmaceutical petard, middle class patients between 1928 and 1943 didn't want hospital-made penicillin, even if they wound die without it ....

To a hammer, everything is a nail - to a thermometer everything is fever: but was penicillin fever BAD ??

Fever is closely associated with virtually any and every kind of illness - but does it make the disease worse or is it one of its cures ?

After the introduction of clinical thermometers in the 1870s, this fundamental question became moot.

Doctors and nurses took up this new hammer with great enthusiasm and soon saw nails everywhere.

They couldn't actually do much for most illnesses but now the carefully kept temperature chart's hills and valleys allowed them to semi-accurately predict that the patient was going to get better or go downhill.

A few doctors actually tried to raise a fever for a therapeutic purpose ,with mixed results, but most felt honour-bound to keep it down at normal at all costs.

Any drug they introduced into a patient that raised their temperature, even if only a few degrees for a few hours, made most medical staff recoil in horror.

But did it actually harm the patient ?

No one knew and no one cared to find out.

Few asked if a bacteria infection or a foreign protein (introduced accidentally along with a pneumonia serum for example) was the instigator of a temperature change, why then was fever itself always created by the body ?

Created for its own reasons - perhaps even its own good reasons.

The claim that any "non-store-bought" penicillin (rather like mom's home-made bread) was potentially lethal, was all down to reports that a sometimes a patient's temperature went up a few degrees for a hour or so, after an injection with hospital-made penicillin.

(And very often with store-bought industrial penicillin as well, in point of fact !)

This sort of minor side effect was not uncommon with many drugs and penicillin patients could in fact count themselves lucky.

There is no drug without side effects - never has been, never will be.

These side effects - often far more lethal than a short sharp temp rise - must always be judged as to their absolute danger and frequency.

And then also weighed, relatively speaking, against the alternative choices - which could be the untreated condition rapidly sliding into death.

Fever was just an excuse

"Penicillin Fever" was just an excuse, an excuse for hundreds of thousands of doctors world-wide between 1928 to 1943 to explain away why they choose not to inject un-refined hospital-made penicillin into their dying patients.

But I rather doubt that the doctor St Luke and his boss will buy that sort of excuse....

Dawson,Humphrey & Chisholm : the three Canadians who helped formulate the final Allied 'war aims'

Dawson, Humphrey & Chisholm sounds like - to Atlantic Canadians of a certain age - more like a small town firm of accountants or insurance agents than a trio of 1940s Canadians who changed the world as we know it very much for the better.

Henry Dawson
Nova Scotia born Henry Dawson is surely no stranger to the pages of this blog.

His October 1940 war aims (that the single best way to beat the Nazis was in contrasting publicly how we treated our least and weakest members with their ruthlessness towards the weak)  had by October 1943 started to become a solid part of the Allied Nations' new war aims.

John Humphrey
John Humphrey, bullied as a kid in New Brunswick, grew up determined to never see anyone else bullied - and his draft of his ideas became the United Nations' Human Rights Declaration.

Brock Chisholm
G Brock Chisholm , Ontario born, was like Dawson a WWI veteran and a lifelong strong advocate of Social Medicine (as was Dawson and Humphrey) and got to put his ideas into the very genome of the World Health Organization (WHO) as its first director-general.

Canadians weren't really key to winning  WWII , but they sure were prominent in winning the peace 

Canada wasn't as important in winning WWII as it was in winning WWI, but with these three Canadians' individual efforts, it had a great role in securing the peace....

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

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

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

It sort of worked - heroic medicine indeed.

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

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

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

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

(And let us not go into rejection problems !)

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

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

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

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

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

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

Saturday, December 8, 2012

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Death is death.....