Manhattan's OTHER project : how seven lives 'unworthy of life' improved the lives of seven billion of us ...

WWII as a triumph of small science

Conventional accounts of the atomic Manhattan Project and of the development of wartime penicillin strongly emphasize that they were the first of what has come to be called Big Science  --- something that is taken as the norm for today's science.

But in fact much of the science of the atomic bomb and atomic energy was actually done by very small teams working with very little money and home made equipment - it was the engineering aspects that were the truly massive part of that particular project.

With regards to wartime penicillin it was much the same : small science ,  not Big Science.

One must remember that wartime penicillin's powerful impact came not merely from its unique scientific characteristics --- ie that it was first (and to some extent, the last) broad spectrum but non-toxic bacterial killer.

Its biggest impact really came from the fact that wartime penicillin G was unexpectedly inexpensive and and unexpectedly widely available for such a potent lifesaver.

This is because a very cheap and abundant (because it was non-patented) lifesaver could save far more lives than any very expensive patent-limited lifesaver could ever do.

And then we all benefit.

Because by a sort of a global herd immunity when even the poorest people living in the most remote places on Earth are cured of killer strains of disease, we in wealthier places tend also to never see those diseases again.

This is because such diseases have been around seemingly for ever as endemic diseases  --- all by surviving in geographic cum cultural pockets, among those considered too poor or too worthless to treat properly medically.

So the true miracle of wartime penicillin was more moral than scientific in nature.

Its miracle lay in the unexpected success of a small band of seven physically challenged individuals in convincing the American public that penicillin should be made available to all Americans who need it to survive.

Convincing them that their Allied leaders should not just producing a small amount of penicillin as secretively as possible, just so they could use it as a weapon of war to give D-Day's front line Allied commanders an advantage over their Nazi counterparts.

The Allies had - because of dysgenic fears - far too few infantrymen to really defeat the Nazis or the Japanese in a hard fight.

(And the few infantrymen they did have were more 4F than 1A, in comparison to the average military serviceman !)

The Allies instead hoped to quickly re-use most of their relatively small forces of infantry when they got moderately severely wounded - by employing advanced medical efforts - so their frontline rifleman could get a second and third crack at being killed in combat.

(As a member member of an reserve infantry unit, may I quickly say ---- "Oh joy !!")

If these medical efforts failed , it meant many more 'decent, middle class, white, Protestant men' would end up dying in the PBI (Poor Bloody Infantry) and this was seen as an eugenic mistake that the Allied cultural elite was not about to repeat from WWI.

If their scheme worked, they would keep the best of their breed safe from the trenches and still have a big advantage over the enemy.

Because , by contrast, they figured the average German infantry, when moderately severely wounded , was out for half a year - while the average Japanese under such circumstances simply died of their wounds.

Their thinking was that that much bigger Axis armies, with much of their troops in hospital beds, couldn't defeat assaults from much smaller Allied Corps , if the Corps had most of their troops in fighting trim.

Because the medically convincing details of the lifesaving results of penicillin were only known by the Allied medical establishment , the  hard pressed Nazis and Japanese hadn't given the development of penicillin (which they had read about in the public scientific literature) much of a priority.

If these lifesaving successes could continue to be kept out of the medical and public media until D-Day , only the Allies would have abundant patented (secret) penicillin to return their wounded to combat much quickly than had traditionally been the case.

D-Day would spill the beans soon enough , but long before the Germans and Japanese chemists had broken the penicillin patent and gone into mass production,  the war would be over.

The Seven Crips

The seven argued - by contrast - that the war to defeat Hitler was as much moral as military.

Germany was the moderately big schoolyard bully and Poland was the moderately small schoolyard victim.

Hitler had gotten away with his bullying because the rest of the world - which vastly out-numbered and out-gunned him, had not intervened against his bullying but instead talked up the virtues of non-intervention in European 'schoolyard squabbles'.

Not my words - rather the shameful words of endless newspaper editorials and 'statesmen' the world over in the early 1940s.

The seven said we must not just talk The Atlantic Charter talk (the Allied declaration that said all - even the smallest and weakest and most valueless - had an absolute right to life and security).

The seven said we must make sure our own Allied actions don't echo the Nazi's counterclaims.

(That the strongest are morally justified in denying the weakest and smallest the right of life and succour.)

But instead the Allies were actually and openly "Code Slowing" tens of thousands of mostly young, mostly poor and minority people.

People with the SBE version of endocarditis - SBE being the final - hitherto terminal - disease that made childhood Rheumatic Fever such a terror.

The SBEs were considered to be so useless that they couldn't even be recruited to work in the war industries , let alone be in the military.

So no wartime penicillin was to be wasted on them and they were to be left to die --- for two reasons.

The unimportant reason was that currently penicillin was still in limited supply and the SBE were below the lowest in priority, particularly as some cases of SBE did consume extremely large amounts of that limited penicillin.

The important reason was that SBE was regarded as the "Gold Standard" of intractable infections.

Any evidence that this new fangled 'penicillin' stuff could actually cure this famously most incurable of infectious diseases would tend to break the whole story of wartime penicillin wide open in the American news media.

And nothing (to paraphrase an old old adage of the pop music business) only 'breaks local' in America .

A big news story in America becomes a big news story worldwide - including in Japan and Germany, via friendly neutral diplomats in Washington.

The seven may have realized that while the Allied medical establishment won't easily bend on the issue of SBE and penicillin, it was also a hard position for the Allied elite to sustain publicly.

Letting young kids die needlessly merely on account of being judged 'life unworthy of life' would be a hard moral sell for the Allies warring against evil governments that basically did exactly the same thing.

Dr Dawson, the leader of the seven , decided to liberate ie 'steal' government controlled penicillin to successfully save five young women dying of SBE but his success was written out of the official report indicated penicillin test results.

And there it might of ended.

But for the fact that his successes and how this most unlikely of heroes was driven to steal to save lives had become the stuff of legend in New York's wartime-strengthened gossip grapevine among it tens of thousands of medical staffers.

A former patient of his, a fellow crip and fellow doctor named Dante Colitti , decided to emulate Dawson and saw to it that the fount of Yellow Journalism, Citizen Hearst's newspaper empire , covered his efforts from gavel to gavel.

The story - involving a terminally ill and terminally cute two year old toddler named Patty Malone - broke wide , broke stateside, broke worldwide.

Soon defeated in the court of public opinion by the formidable Doctor Mom, the Allies really opened the penicillin floodgates wide when Dawson's friend among Big Pharma , John L Smith of Pfizer , took up his cause and started producing it at levels a million times higher than Pfizer had done earlier.

Small science ?

Well the seven cripples had no government grants, had strong enemies rather than warm friends in high places and were - obviously - in poor physical vigour.

That they nevertheless brought the massed Allied governments - during a Total War - to their knees shows us all what sheer raw moral courage can do.

And that when we see those physically and mentally challenged as 'lives useless of life', they are anything but ....

I propose to a (book) editor.... in an elevator

Clutching my manuscript to my heaving chest (insert bodice here) I got down on one knee and said to her , "This Manhattan Project is from Venus ---- and so are most of your customers."

"So enough already on any more books about Manhattan Projects that kill. This wartime Manhattan P. saved lives : its all about life and love and the whole nine months."

"Listen to your mother, she says you won't even be here if it wasn't for penicillin : cheap, abundant, natural, non-patented penicillin."

"Now does that sound like how Big Pharma normally operates ?

Yeah, exactly --- this time, despite America being at war, Doctor Mom was in charge and she saw to it that it was done up right."

"If this book proposal has legs - and I think it does , try to think of those legs as being shapely, shaved and belong to an avid reader of character-driven narratives ."

"Besides, market-wise, isn't it long overdue for a Good News Story to come out of WWII's Bad News War ?"

"Give it a read and then get back to me before the bidding war gets heavy -----  'cause, baby, this here book project is all about peace, love and understanding...."

By 1945, Martin Henry Dawson's 1940 war aim had become OUR war aim too

Baby, dank Harry Lime, werden nicht neeeding Teddy

In September 1940 , at the height of the Battle of Britain, war hero Martin Henry Dawson decided against rejoining the Canadian Army to help fight Hitler.

He would fight Hitler instead by saving the lives of the very people that Hitler (and a lot of Dawson's medical colleagues) judged to be "lives unworthy of life" --- particularly in wartime.

In five short weeks, he grew and then injected penicillin into two working class youths, a Negro and a Jew , both dying of invariably fatal SBE.

 In many eyes, they were judged to be the 4Fs of the 4Fs, and definitely not a priority for life-saving during a Total War.

But Dawson instinctively felt that this was something that would definitely separate the Allies from the Axis , proving that the Allies believed in saving all lives - in particular even the smallest and the weakest, "the least of these", as it were.

The Allied government-scientific-military-commercial establishment disagreed, saving penicillin only for the 1As of the 1As, the frontline combat soldiers away from the killing zone due to a non-fatal dose of the clap they had picked up.

They banned the use of penicillin to save SBEs , sentencing them to a certain death.

Dawson, himself dying from a terminal disease, defied the authorities and stole some government-issued penicillin to give to the SBEs , later getting secret supplies from a sympathetic CEO at a Big Pharma corporation.

His misdeeds inspired others, the story broke, Doctor Mom sided with Dawson's ideas and the males in the establishment reluctantly fell in line.

But very soon they saw the virtue in Dawson's ideas, and warplanes were soon flying about, dropping not bombs but penicillin for dying children in both Allied countries and in Neutral nations.

Penicillin-the-lifesaver-of-all-civilian-lives had become a very public weapon in the battle to win the hearts and minds of the world for the Allied cause.

So much so, in fact, that by 1949 erstwhile 'citizen of an Allied nation' Harry Lime was judged one of fiction's all time villains mostly because he had dared to water down the penicillin intended for dying children.  Dying Axis children.

It is this viewpoint, only 4 years after the war, that I thinks allows us to claim "The Third Man" as one of the first postmodern films.

Dawson was four years dead by that point, but I think he would have be proud to think how far his war aims had become our war aims.....

Thanks to DOCTOR MOM, "he (and she) will be coming home!"

Most wartime GIs who drank too much Schenley whiskey and ran their jeeps off the road and woke up in the hospital with a penicillin drip in their arm, never realized that not only did Schenley sell them the bite of a snake but they also sold them the cure.

That wartime penicillin might have come from Schenley Labs.

Their whiskey is still here  - but their penicillin is long gone.

But Schenley did have the satisfaction for having produced the most iconic image of the entire saga of early penicillin.

Printed in rich vivid glossy magazine color, this ad featured the realistic style painting of a medic putting penicillin in the arm of a wounded Marine in a place that looks to be Tawara, as photographed by Marine photographer Norman Hatch.

 Seventy years later, Hatch's photos remain the gold standard of 'you are there' combat photography.

This famous island battle first brought home to America just how bloody this war was going to be - particularly because of the casualty count.

 But mostly because Hatch's grim photographs were deliberately released, rather than censored, to toughen up Americans at home to the mounting death toll that lay ahead.

So the ad's painting immediately conjured up a grim backdrop to any magazine readers in 1943-1945.

But the cutline below was pure uplift : "Thanks to PENICILLIN...
he will come home !"

Often rendered in the retelling as "Thanks to Penicillin, he will be coming home !"

The combination of image and cutline basically assures home viewers worried about their relative overseas that "Despite the vicious fighting and the terrible jungle conditions, thanks to penicillin, he WILL be coming home !"

This ad went totally unremarked upon during the war.

 But in the 65 years since, it has grown by leaps and bounds in importance as almost every scholar today finds it to be the best single wartime expression of the sheer hope that grew in a world (bone tired of 15 years of Depression and War) that something good must lie ahead.

Usually, their subtext when recalling this ad is "Thanks to Big Science bringing us Penicillin, he will be coming home !"

I don't think this is true at all.

I believe that if left to their own devices (along with scads of our tax dollars) it would have been 1946 or later before enough penicillin would had been produced to help the soldier at the front , let alone the patient back home.

I think there were two competing strategies to speed up the production of wartime penicillin.

One was develop scientific evidence on a very wide and deep front ("Big Science") to convince scientists in universities, hospitals, corporate research labs and in bureaucratic offices that a small shift in international wartime priorities was justified to produce large amounts of penicillin as a supplement to the sulfa drugs for illnesses resistant to sulfa like those caused by staph bacteria.

But that only enough penicillin needed to be produced to aid the fighting men, at least until the war was finally won.

I hope you sense the contrast between a massive effort of "means" to secure a limited "end".

This was Howard Florey and his supporters' thesis.

The other strategy was proposed by just one man - a soon-to-be dying man - in  September 1940 and maintained by him until his death in April 1945.

Martin Henry Dawson.

He said penicillin had already been privately discovered, in 1928 by Fleming, but no one had been roused and no lives had been saved.

Penicillin had also been publicly discovered,( ie published in the scientific media) in 1929 by Fleming and again in 1940 by Florey but no one had really been roused and no lives had been saved.

Dawson proposed instead to have penicillin popularly discovered - by Doctor Mom.

It was a Man's World back in 1940 .

(It mostly still is, but not as bad as back then !)

But even in 1940 women voted, bought much of the family's purchases and they were the daughters, mothers, sisters and spouses of the prominent men who ultimately ran things.

If they got on the case of the men to bring them penicillin and they stayed on the case (as women are very good at doing - some dare call it 'persistent nagging') , even reluctant men will eventually give in and get moving.

So Dawson persuaded Meyer and Hobby and Chaffee, his entire team of 'little science', to refocus their primary aim of their newborn penicillin pilot project.

He said they should immediately and narrowly focus on curing  a single disease, Rheumatic Fever-induced Subacute Bacterial Endocarditis.

This disease was the one that all parents in the western world regarded as a constant Sword of Damocles over their heads ,at least until all their children had gotten safely into their early twenties.

Tuberculous might be the disease feared more by the poorest families and Diphtheria and Scarlet Fever  might have been feared more in grandma's day, but from about 1910 to 1960, Rheumatic Fever (RF) was the number one killer of school age kids .

In addition, the invariably fatal subacute bacterial endocarditis (SBE) it brought to many Rheumatic Fever 'survivors' was a big killer of youth and adults all along life's journey.

But the main point of the myth of The Sword of Damocles was not the pain of the instant the sword actually did fall and kill you but rather that the situation made you afraid all of your life, just waiting for the day the sword might fall.

Most parents never experienced their children getting RF or SBE but all dreaded it might happen someday.

RF starts with a child getting a sore throat or tonsillitis from strep bacteria.

Think about it - what child doesn't get tons of those, even today with antibiotics?

Before antibiotics, the kids might cure themselves.

But one attack did not bring immunity.Your children got them again and again  - like the common cold they were common, endemic ,ubiquitous.

Always the fear was that this strep throat attack will lead to something worse. Many kinds of worse, but the deadliest and the most common was Rheumatic Fever (RF).

Most times, nothing happened. But like Russian Roulette, for no good reason one strep throat attack or tonsillitis attack could lead to RF.

Now RF could kill your child outright, during the very first attack.

But in most cases, the child lived, even emerged unharmed.

But again it did not bring immunity.

Far from it, one incident of RF made a child more vulnerable to another and more severe attack of RF and so on and so on, ever downhill.

Now suppose the child survived all those severe repeater attacks but with a damaged heart - particularly damaged heart valves.

Now in their teens, the child was less likely to see RF ever again, but instead they faced the fact that ordinarily harmless tooth bacteria, swept into their blood stream by a single vigorous tooth brushing, could settle in on their damaged heart valves and lead to an 'invariably fatal' case of SBE.

They might , nevertheless, fight off a single bout of SBE - as perhaps as many as 10 to 20% did.

(The near 100% death rate for SBE as normally reported, was biased by only counting cases sick enough to end up in hospitals. But autopsy work often revealed hints of healed SBE scars on the valves of young traffic accident victims.)

But again, and I know I am a broken record, one cure of SBE did not prevent those tooth bacteria from settling in again on your valves - and the second bout was fatal.

RF induced SBE was a chronic ,invariably fatal, disease.

Dawson treated patients as young as 10 and as old as 60. After penicillin, patients were found to dying of RF mediated SBE into their seventies - deaths often disguised as a 'stroke' .

More bad news : the kind of strep throat bacteria that gives you RF grow more virulent by being passed back and forth repeatedly between humans in close contact.

If you had lots of children,  that meant that your chances that several would get RF and SBE was higher than the statistical average, even when corrected for the number of children you had.

That is if you had six kids and a small house, their chances that one
of them would get RF should be six times 3.3 per 100,000 ( ie 1 in 5,000) but in fact it was much higher than this - more like 1 in a 1,000.

Small houses and big families being more common among poorer families, they got hit the hardest, resulting in it being called The Polio of the Poor.

But no family was really immune.

Dawson knew that a report of a cure for either RF or SBE would grab the attention of every single DOCTOR MOM in the world.

And Doctor Mom, not Dad (in charge of the bread winning), was the person in charge of the entire family's health -- if she wanted penicillin , now, she would get it - or governments (even wartime governments) would tremble.

Drug companies would rush in to take her money.

This was Dawson's thesis.

He had a small crew - four people, no government or foundation funding, with curing a single disease as its sole thrust. But against those small 'means', look at its broad 'ends'.

Doctor Mom, said Dawson, would see to it that her entire family all got lots of penicillin, now, not after the war - penicillin enough for  both Frank on the battlefield on Tarawa and for little Susie in the Rhemuatic Fever ward in America.

Was he right - or did Florey's view prevail?

I will 'tell all' - on October 16th this year - in my e-book "MO goes PO".....

Fleming versus Dawson on Endocarditis

Hardly dueling Scots, though.

Fleming's  Cheadle Prize winning medical essay "DIAGNOSIS OF ACUTE BACTERIAL INFECTIONS" (the only time I know of that he seriously engaged the subject of endocarditis) was written in 1909 and published in the ST MARYS HOSPITAL GAZETTE (volume15 , pages 67-69,72-77).

Most biographers of Fleming felt this early essay nevertheless set out the course of his life's work - which extended for another 45 years - so it is well worth a close reading.

Dawson confounded the essay's conclusions on intravenous injections to treat endocarditis in March 1942, with his first success in reducing bacterial colonies in endocarditis patient's blood.

Critics of vaccines said endocarditis's constant shedding of small amounts of bacteria directly into the bloodstream should lead to a natural immunity against them but instead actually only led to death.

Fleming dosed himself with a staphylococcic vaccine via an intravenous injection directly into the bloodstream.

 (Staph was then a far less virulent bacteria than it is today.)

He lived, having only a slight headache and fever, but gained no increased resistance to staph.

Intravenous injections of vaccines gave maximum infectious effects and minimal increases in natural antibodies said Fleming.

Despite the fact that all of Fleming's considerable wealth came from his great skill in injecting the very dangerous drug Salvarsan directly into veins, he seemed dubious on 'systemic' or intravenous medications in general.

I think this is partially why he never tested penicillin as a systemic medicine in humans - or animals.

Not till 1940 did Dawson do so for humans and Florey for animals...

Dawson, Florey and the multiple suppliers

Dawson first turned down Pfizer and then a month later accepted their offer of penicillin extracts, at the same time his co-worker Meyer was working with a potential competitor of Pfizer called Schering and Co, while at same time  Dawson, Meyer, Hobby and Chaffee were producing their very own penicillin !

This was not unique.

Florey produced his own penicillin and was willing to ask for penicillin from any commercial firm and got commercial supllies from at least Merck, ICI and Kimball and Bishops, the latter two on a regular basis.

Why ?

And how were conflict of interests avoided?

I believe none of the commercial firms had a problem if a doctor wished to stick their penicillin (and that of all their competitors,) into patients.

 Even if the doctor(s) first concentrated the commercial liquid
extracts up to a minimal level necessary for therapy - say to a dried state of 30-50 units per mg.

None of this would affect the commercial interests of the firms.

But it would be unfair if a doctor used commercial extracts to improve extraction processes or to do chemical synthesis work on the firms' offerings.

The firms were spending lots of money on these sorts of activities and hoped to eventually profit from it.

They won't want the doctor get to the patent office first or pass on the information on to their favorite commercial firm.

So Dawson, who cared not for the chemical synthesis of penicillin, could treat patients with Pfizer penicillin, while Meyer the chemist used his own penicillin or that of Schering to do chemical studies.

Everybody happy.

Florey did likewise - using mostly ICI penicillin on his famous second series of treatments of patients but not using any of it for chemical studies, while his own team's penicillin mostly went to the team chemists to be destroyed in chemical studies.

It hardly jibs with the heroic image of either group now does it?

I can only say that very quickly, Meyer dropped synthesis studies and shifted to chemically altering penicillin into an ester so it worked better (ie worked slooooower) inside patients.

Morally, it is hard to fault this sort of chemical work.

Oxford claimed (ala LADs' PEN) that it produced 500 litres of penicillin a week between the Fall of 1940 till May 1944.

That is 400 million units of useful, injectable penicillin, in Duhig Units.

J V (James Vincent)  DUHIG

I feel sure than Duhig's first reaction would be the same as mine: "Bull feathers".

I bet a check of the published records will show that only 4 million units of Oxford-created penicillin ended up being used for patients in that period.

(To keep things in perspective, in 2010, 4 million units - 4 MegaUnits - is what you might receive as a daily dose, for an average serious infection. But in 1942, it should be enough to treat 40 patients with life-threatening illnesses.)

Gladys Hobby, quoting a ICI report on Oxford's efforts, says in 1941 they were producing 2 grams a week at 16-32 units a mg, ie 15,000 to 30,000 units a week or a maximum of 1 to 2 million units a penicillin a year at the outside best.

I have seen an estimated figure of 13 million units produced in total between 1938 till 1944, coming - it seems - from Norman Heatley, and that seems to match this report fairly well.

Trevor I Williams, in probably the best single book on the Oxford team ,"HOWARD FLOREY", says that even in 1942, half of the final Oxford penicillin went to the chemists.

I believe all, or almost all, went to the chemists from 1943 onwards.

Doctor Mom has a right to be skeptical about the Lads....

MARJORIE DAWSON , 

still in widow's weeds in 1946, at a film industry meeting

Meyer to Durack: I started penicillin to get back at Chain

In 1981 Harcourt Brace Jovanovich published "Treatment of Infective Endocarditis" ,edited by Alan L Bisno.

You can read it on the stacks at your closest medical school library.

I suppose the most cited article is the first, a "Review of  Early Experiences in Treatment of Bacterial Endocarditis, 1940-1955", by David T Durack, M.B., D Phil.

 I first read it very early in 2005.

Durack is from Australia, came to Oxford as a Rhodes Scholar, and was soon regarded as one of the best young doctors around anywhere.

He did a very through review of his chosen subject, reading through the early articles closely.

 Quickly he saw something in Dawson's and Hunter's first article on SBE patients treated by penicillin that others writing about penicillin or endocarditis hadn't fully sensed .

The disease of endocarditis was in fact the very first disease to ever be treated by an antibiotic, in the modern sense of that word.

(And even perhaps cured by an antibiotic, if you want to go out on a limb - others have - but I hesitate.)

(In any case, an event that happened on October 16th 1940 - an anniversary seventy years old this year - hence my urgency in trying to finish this book as soon as I can.)

An antibiotic in the modern or common sense meaning of that word is a medication produced by microbes that is taken internally and that can save lives.

(By contrast, antiseptics are often man-made chemicals and are applied externally and are intended as a band-aid solutions for minor cuts and bruises.)

To doctors, this means an antibiotic is a systemic medication and in the case of the original penicillin (aka Penicillin G), one administrated by needle - ie parenterally.

All this fully met by Dawson's first needle of penicillin stuck into a dying patient seventy years ago next month.

Durack managed to personally contact the three key surviving members of Dawson's team and I feel he must have asked some very probing questions.

Hunter and Hobby added interesting tidbits to the historical record, but Karl Meyer dropped the biggest bombshell.

Well it was a bombshell to me anyway, because I have this thing  (call me a stickler) for exact dates and figures.

Hobby and Hunter weren't at Columbia in early September 1940 when the decision to begin the penicillin project was taken and Dawson never publicly spoke how it came about.

Karl Meyer had never publicly spoke out about his motives either---- until 1981, when he was 83.

 I rather doubt he ever told Dawson,Chaffee or Hobby about his motives back in 1940-1945.

His personal motives hardly seemed to mount a high moral plane that might bring others in help out.

Meyer had recently been incensed, says Durack, by an article from Ernst Chain on lysozyme that slighted Meyer's earlier work (in 1933-1936) on lysozyme.

Durack quotes Meyers as saying that when he read, in August 1940, the first Oxford article in LANCET on penicillin, he determined to quickly purify penicillin, before Chain could, to pay him back.

Durack then moves on to the matters more pertinent to the actual subject of his review.

I, on the other hand, had a much greater interest in this particular matter and as a result I had available a greater variety of other information to try and make sense of this 'claim' of Meyer.

First, I doubted that Meyer in New York could have read a copy of Lancet with a cover date of August 24th, much earlier than about September 7th in peacetime, let alone when Britain was at war.

Secondly, in an 1990s oral interview with Meyer's boss in 1940, (Phillips Thygeson), Dr. Thygeson describes Meyer as a rather typical type of chemist who is (rightfully) worried that others will steal their data.

In old fashioned mystery books circa 1880 to 1940s, the 'formula' stolen from the safe was always chemical--- not math or physics or biology.

Only in chemistry is something extremely valuable to the world outside Science reducible to a page or two of formulas and symbols.

The most famous modern chemist of them all, Robert Burns Woodward, liked to make public his total synthesis of yet another impossible-to-synthesis natural material in a brief announcement of not more than a page or two.

It was as a sort of 'guy thing' type bravado, common in male chemists involved in scientific pissing contests --- but it does mean than valuable chemical results are easily stealable.

I knew Meyer and Chain had known each other since their student days in Berlin and that both were young German Jewish emigres
 very insecure about their ability to avoid a wartime internment camp --- very eager to garner citation credits, if only for the sakes of their families.

And by mischance, both were interested in the same very ,very, very narrow area of science and so bound to trip over each others' feet.

A rivalry seemed a distinct possibility.

Only one problem ---a very very big one --- Chain only published one article on lysozyme, and it didn't even get submitted to the British editors till October 28th 1940, let alone get published and find it way to America.

The Columbia penicillin effort was begun about September 9th 1940, months before this ----so could Meyer read into the future?!

I had to put Meyer's 'claim' on the mental back burner.

Then in early 2010, I read Ronald Bentley's "Leslie A (Epstein) Falk, 1915-2004, and Penicillin production at Oxford", published in the JOURNAL OF MEDICAL BIOGRAPHY, Volume 15, May 2007.

Bentley mentions that in Chain's sole article on lysozyme (of which Epstein, not Chain, is the lead author), Epstein (LE) thanks "Dr K Meyer" for lab space and assistance.

So sometime between June 10th 1940 (Epstein's return to New York) and early October 1940, Epstein was in Meyer's lab and presumably mentioned (a) how Epstein planned to dis-credit Meyer's early work and (b) that Chain was now working on penicillin and that work was very,very fruitful and would soon be published.

Alerted and incensed about (a), Meyer was also alerted about (b) so as to watch all ports for an article---- and to start attracting Dawson and Hobby to see the virtues of penicillin as a research subject.

Meyer, Chaffee and Hobby would probably have remained content to just grow enough penicillin to try and purify it.

But Dawson saw its capabilities as a possible ABF agent (anti bio-filmic agent) and the rest...... is history.

Seven flasks became seven hundred flasks, etc....

Pearl Harbour Saves Florey?

As long as America was at peace ,America's businesses could compete against each other relatively freely without the ability of the "dollar a year men" in Washington to make use of  " the emergency " to misuse government's wartime muscle to restrain competition, so as to favor the firms they represented in peacetime.

If Japan's attack on Pearl Harbour hadn't happened, America would have probably remained a neutral at least throughout the first half of 1942 - long enough for Pfizer and Dawson to be free to fully publicize the life-saving powers of naturally-brewed penicillin in the national media.

This would have been enough, in peacetime, to create an overwhelming public demand for its immediate mass production.

Penicillin would then become just another in a series of remarkable drug discoveries that first emerged as a small but notable success and just kept on growing in importance.

Sulfa drugs started that way - they really had no immediate or dramatic success to introduce themselves to the world.

Rather it was a series of notable successes, among a number of different years and a number of different continents that gradually made them famous.

Newer and newer sulfa variants kept on being discovered and were then put to work curing additional diseases.

Likewise,Penicillin's initial success would have focused attention on the possibility of ever more drugs from molds and bacteria - as of course happened from about 1947 onwards to today, but in a non-dramatic ,and above all, industry-directed fashion .

85 years after sulfa and penicillin first emerged in the lab (around 1928), only one drug has got any kind of universal dramatic legend attached to it and this is penicillin.

The deleterious effect of the American declaration of war on what should have been its normal emergence from lab to drug company to its acceptance by GP and patient is the reason why.

Without Pearl Harbour happening in December 1941, Florey and Merck would have been free to pursue their synthetic penicillin mirage while Dawson and Pfizer would have been equaly free to introduce natural penicillin - first grown in large trays and then from deep tanks.

The winner would have been the same (Pfizer) but they just might have emerged in May 1942 rather than be delayed until May 1944.

Ie, it would be as if the dramatic events of May 1941 to May 1944 never ever happened.

Let us go to a concrete example:

J. Chem. Educ., 1941, 18 (12), p 552

DOI: 10.1021/ed018p552.2

Publication Date: December 1941

This is a monthly publication of the American Chemical Society.

 In 1941, when the public heard the word scientist, they thought only of chemists - chemistry was the Queen of the Sciences back then to an extent we can't begin to imagine ,unless we were living back then.... before 1945 (Physics) and 1953 (Biology).

This journal was directed towards chemistry teachers and undergraduates in North America's high schools and universities--- a huge audience well beyond more prominent chemistry journals with a select but tiny audience.

This particular column was a monthly roundup of news from the popular press that had a chemical industry aspect to them.

Just reading the column in its entirety makes it clear that "WHAT"S BEEN GOING ON" for December 1941 was written and released before Pearl Harbour.

Using language from The New York Times's description of Dawson's work on penicillin back in May of 1941, the paragraph seems a little out of date to fit this speedy "up to the minute" news digest column's style.

It credits Fleming with discovering penicillin in 1929, but says nothing happened to it until Dawson at Columbia proved it up.

I admit it - I love it !!!

No mention of Oxford nor Florey no Merck no OSRD nor of the NRRL and COC.

I think it reflects a little quiet PR spin that Pfizer put behind on its corporate decision to seriously help Dawson use Pfizer-brewed NATURAL penicillin on clinical cases.

That brewing, and that corporate decision, happened in mid October 1941, a date much closer to the date the column would normally have been researched and written --- rather than about events from way back on May 5th 1941.

A Merck-oriented paragraph on penicillin in this same time period would have credited Florey and ignored Dawson totally.

Merck never had to do that media-spinning, not after Pearl Harbour.

One wartime government agency,the OSRD-CMR, run by Merck men, now controlled almost all of the news on penicillin and they spun it to focus exclusively on Florey and hence indirectly on Merck.

But they forgot to put a muzzle on Dante Colitti  (and Doctor Mom) and penicillin became a legend despite the best efforts of  OSRD,Merck and Florey....

How to tell a lie - and prosper

On February 1st 1964, the journal NATURE ran a long feature article by Dr A N Richards, a foreign member of the Royal Society, a professor emeritus in pharmacology at the University of Pennsylvania and the head of the medical section of America's all powerful science agency, the OSRD......


(Blogger ate about 1000 words right about here - I'll re-type it when my temper cools down - I have learned to print my blog posts out as PDFs right away since this 'incident' - ARRRGH !!!!!!)

 ......Fulton had been out in Central California investigating aviation medicine for the military and had wandered into a lab where a fungi researcher was working with this fungi ,without proper modern precautions, and Fulton was soon stricken onto death.

(Or he simply got it during the days he spent on a military base deep in this valley - the more likely explanation but a lot less colorful story...)

The disease was worked up by the American Military during the Cold War to use as a possible Germ Warfare weapon but in fact it was usually not fatal even if not treated.

But if it spreads from your lungs to everywhere else in your body, it was and is usually fatal.

Fulton eventually knew he was very sick from this fungus but he also knew he was also getting the best possible care one of the best medical schools in the world would naturally give to one of its most senior doctors - he wasn't excessively worried.

Nor where his doctors, until they took a routine swab from a unrelated boil he had on his abdomen to type it for sulfa treatment. Unfortunately, to their shock, it was filled with the fungus --- it seemed he was a goner and all kinds of "heroic' ( ie risky, foolhardy) medical interventions were suggested, as he seemed likely to die anyway.

Fulton had been telling his main doctors that his very best friend Howard Florey was  working with a totally new substance,  penicillin ---- produced by another fungus --- and finding it could kill an ever-widening array of microbes.

These doctors decided not to tell Fulton that his boil meant he likely faced a painful death and instead enlisted him to pull strings to get some penicillin for  a fellow patient, Anne Miller.

They secretly would divert a bit of it, to see if killed off rival fungus and so save Fulton.

This was good peacetime science - but in wartime, the medical establishment tended to say, if it isn't a common military disease, let the man die - we need the penicillin more elsewhere.

Luckily for Fulton, the military had lots of bases in this valley and military men were getting sick and dying from this fungus - so a military need could be evoked - in a stretch.

Merck, the OSRD,and the COC had all gotten pitiful pleas for penicillin before the phone calls from John Fulton---- and turned them all down.

The calls usually involved SBE, an almost always fatal form of endocarditis that - in those days - usually stricken young teens and young adults.

These kids were considered by the medical establishment as the $Fs of the $Fs, as people not worth wasting penicillin on during an all out total war.

Martin Henry Dawson had said since 1940 that he felt that penicillin could cure SBE - war or no war - and they should be saved.

No other doctor in the world believed strongly that they should - at the time.

Most still didn't feel SBEs could be cured or were a priority, even at the time of his death in 1945 - by which time he had about three dozen cures - some cured for as long as three years with a repeat bout.

Norman Heatley of Florey's Oxford University penicillin team was working for Merck and reporting everything back to Florey in England.

He had already recorded in his diary, in November 5 1941 and December 3 1941, receiving pleas to provide penicillin to individuals dying of SBE, while visiting labs in Canada, Dawson's home country.

Merck, the ORSD, the COC hadn't helped young Joan Murray with her SBE then, so why help Anne Miller now ?

(Heatley, not a medical doctor, seems to have felt in his 1942 diary that Miller might have SBE.)

Let us, for a moment, return to Richards.

The thesis of  Richards and  all the other medical bureaucrats in charge of wartime penicillin was simple - "give us lots of taxpayers' money, leave us alone away from taxpayer scruntiny, and we will produce penicillin quickly and cheaply and distribute it objectively and absolutely without favouritism."

In fact, the very first case the OSRD/COC and Merck was involved in was a blatant case of favoring the mighty and the wise over the weak and foolish.

Once it was secretly told to a very few people - perhaps only Richards - that the penicillin for Miller was also going to go to help save Fulton, it made it likely that penicillin would be forthcoming.

In his own right, Fulton was considered a valuable part of the medical brains that America felt it needed to husband if it was to win the war --- he and his own doctor, Francis Blake, were high up in the war medicine committees deciding American health priorities.

The scientists found that even the politicians, the military and the business elite (and perhaps the general public as well) agreed that healthy, fit 1A  scientists shouldn't be drafted - too valuable to the war effort.

The same thinking said penicillin was wisely used if it saved Fulton --- unwisely used if it merely went to save 4F useless SBE kids..

More importantly, Fulton was the very best friend of Florey, a man with few really close friends.

The other closest friend that Florey had in America was Richards himself.

Richards and Merck needed Florey on their side if they were to convert a largely British effort into a profitable venture for Merck in America.

While Blake secretly pulled strings for Fulton and Fulton openly pulled strings for Miller, the key person, I believe, was Richards.

The OSRD and CMR, the COC ,the NRRL,the British MRC and TRC, Merck and other drug firms , the NRC-NAS, the military Surgeons General, basically every official and semi official body connected to wartime penicillin all reveal a long paper trail of documents showing they usually bowed to Richards' dictates.

Luckily for Fulton, while the penicillin didn't do anything for his strain of fungus, careful nursing care kept him alive till his own body pulled him through.

He apparently never knew how he had been 'used' to help save his own life.

Anne Miller's case was not the first one involving penicillin in North America.

Dawson and Meyer's homebrew penicillin and Pfizer penicillin had treated at least 15 cases by March 14th 1942, the day Anne Miller got her famous first needle.

One had gotten penicillin - in fact history's very first needle of penicillin - and been cured - but not by penicillin.

Some had been cured by Dawson's penicillin - but the penicillin hadn't been injected internally as an antibiotic only dropped into an eye as an antiseptic.

A few cases of Dawson's had already been treated by the first commercial penicillin used clinically in North America - Pfizer lot number 696, first injected March 5th 1942, according to his co-worker, Gladys Hobby,in her lab records and correspondence file, as recounted in her 1985 book, PENICILLIN - MEETING THE CHALLENGE.

Because Pfizer wasn't in the OSRD-COC-Merck-Squibb agreement, its commercial penicillin wasn't counted by Richards and the OSRD when it came to proclaiming Anne Miller the first patient cured by penicillin in America.

Nor was Abbott or Eli Lilly, both huge drug companies back then, soon to do their own independent-of-the-OSRD/COC clinical trials.

But interestingly, the OSRD/COC were glad to add Dawson's cases, produced from this invisible Pfizer penicillin, to their total of the first 100 cases treated by penicillin in America.

AND Hobby says that Richards knew and personally approved Pfizer sending this commercially-produced penicillin to Dawson to use clinicallly , though Pfizer was not bound to listen to Richards at all.

A few of the most careful historians today say that Anne Miller was the first person cured by penicillin provided by the OSRD and I think this is exactly right.

But there was a vast world of penicillin activity around the globe between 1938-1945 and much of it was not directed by the OSRD or any OSRD-bodies in other countries - it was the work of individuals who like Dawson merely thought they could do something right now, not perfect or big, that might help save a few lives around them.

Ironically once those agape scientists and amateurs got to Doctor Mom, she lit the fire under Richards' ass that finally got us penicillin en masse,overnight, 15 years after it was first discovered...

addendum : I just discovered that TV  megastar Dr Gregory House did reference Fulton's rare fungus disease in one of his episodes....