Why Charlie ? Why Miss "H" ?

Between September 1940 and April 1945, pioneering penicillin doctor Martin Henry Dawson treated about three dozen patients with subacute bacterial endocarditis (SBE) or acute bacterial endocarditis (ABE).

So out of those three dozen patients , why on earth did I decide to focus on just two - one young man (Charles Aronson) and one young woman (Miss H H) ?

One reason was to simply add continuity and coherence to my narrative, particularly my libretto narrative.

Charlie was there, on-site, in Dawson's ward at the very beginning and at the very end of the narrative arc - something you just invent in a work of fiction but something you rarely find in real life.

(Charlie had the extremely rare good luck to survive his first bout of SBE and the extremely bad luck to get a second bout of SBE and then to survive a severe stroke while recovering from that second bout .)

The arrival of Miss "H" provoked the crucial turning point in the narrative arc and her prolonged recovery from the side effects of her SBE ensured she was in many scenes - including the climatic one , along with Charlie.

Again a real life boon rarely granted the author of narrative non-fiction !

But my main reason for including these two in Dawson's team of seven key 'unfits' is because I sense these two , out of all the three dozen patients, were more 'actors' than 'acted upon' (which is the normal role for patients in such doctor-oriented stories).

The first period of extensive penicillium growing and penicillin extraction was originally planned to occur at the end of the first term (December) at Dawson and co-team leader Meyer's medical school.

But Dawson suddenly decided to give the first (tiny) historic injections of penicillin just 5 weeks into the 16 week process - seemingly right after Charlie unexpectedly joined the team's first SBE patient, Aaron Alston.

Dawson did write Ernst Chain at that time that he had a patient of whom he was unusually interested in - and admittedly that could have been either Aaron or Charlie.

But Charlie, he later noted, had an unusually complicated medical history - all revolving around surviving repeated brushes of death with oral commensal strep.

And nothing in life - nothing - interested Dawson more than oral commensal strep .

And Charlie was a repeated 'survivor' , probably with the characteristic survivor's buoyancy.

This alone might have inspired Dawson onward to also do his very best.

Much the same for Miss "H" - after all, for her, the very honest and modest Dawson 'stole' incredibly scarce government-controlled penicillin in the middle of an all-out Total War  !

Her earlier medical history indicated she had survived a life-threatening bout of Rheumatic Fever with 'endocarditis' involvement (probably actually severe pancarditis) .

 She went on to survive her SBE thanks to Dawson's penicillin (the first case in history ever cured by penicillin) and then to endure years of serious infections caused by infected matter from her damaged heart valve infecting other parts of her body - she lost one eye and her womb in the process.

But like Charlie, she survived them all - she was a born survivor , probably with a similar characteristic buoyancy.

So : two real-life 'larger-than-life' characters just crying out to be portrayed on stage by first class actors yearning to stretch their craft .

What's there not to like ???!!!!

Aaron Alston , penicillin's first SBE patient but second to get the historical injection

The known published facts are few

All the contemporary (1945 era) newspaper and book accounts - written by (or coming second hand from) participant eyewitnesses to the events themselves - make it clear that Martin Henry Dawson's first SBE/penicillin patient was a "negro" "man".

And that his name was"Aaron Alston" and that he subsequently "died".

The available record of the amounts and dates that Aaron received Dawson's penicillin - as published by key Dawson team member Dr Gladys L Hobby in her 1985 book on penicillin , Penicillin : Meeting the Challenge , ceases near the end of January 1941.

And that is all the published accounts show.

But now for new research and reasoned suppositions...

We can say that 1940s medical statistics indicate that Alston was a more likely than not a young adult when he entered the hospital with SBE .

It is clear from the census that the names Aaron and Alston is a combination found in a fair number of men in America in the first half century of the 29th century.

However , the censuses generally indicates they are usually negro and that their residences seem centred in the South - from rural Carolina into urban black centres like Washington and Baltimore.

But in the critical 1940 census , there is no Aaron Alston recorded in New York City or in nearby New Jersey and Connecticut.

Now the first SBE patients that Dawson dealt with in the public wards of his upper Manhattan Columbia University Presbyterian Hospital were simply there because they were poor and his hospital happened to be close to where their family lived or close to where they lived when they took ill.

They were not drawn there from great distances because Dawson was then a famous and successful expert in this nearly 100% invariably fatal disease.

Far from it , he hadn't in fact handled any SBE cases up to then as the lead doctor.

Alston almost certainly had to be residing within a three or four miles circle of the Presbyterian hospital, at most , at the time he took ill. But the census does not show this.

He may have moved to New York City after April 1940 and before September 1940 : because southern blacks were still coming north to the unofficial American black capital of Harlem , though there was rarely gold for them at the end of its tattered rainbow.

Harlem is well within the catchment area for the Presbyterian's public wards.

We seemed to have failed to find out anything more about Mr Alston.

But as it happens, the New York City individual death records up to 1948 have been hand indexed on computer by many volunteers and made available via Ancestry.com.

They show an Aaron Alston , born about 1911 , (that is about age 29 on date of his admission to the hospital in September-October 1940) has having died on Jan 25th 1941 in Manhattan.

I am not sure that the original  death record will reveal more more - but perhaps a last address in New York and the name of next of kin and their home town , but I feel 100% certain this is our Mr Alston.

All we have really confirmed so far is that he was indeed a young man at time of his admission , as expected.

Why first patient but second to get the historic penicillin injection

Now while I am certain that Mr Alston was first SBE patient Dawson intended to treat with penicillin, I think he got it moments after Charles Aronson , the other SBE patient to get the historic penicillin injections on October 16th 1940.

Dawson's first major paper on penicillin and SBE was significantly the first penicillin paper not written by him with the help of the very reticent (as he himself was !) Dr Gladys Hobby, his lab chief.

Co-written instead with young Dr Thomas H Hunter, it positively gushes - for Dawson anyway - in giving forth the ages, initials of their name, gender, ethnicity,  dates of treatment, medical condition etc of all the SBE patients that Dawson had treated.

This was a style that Dawson had never shown before in 20 years of writing many, many medical articles.

Some doctors ("clinicians") simply tend to write articles that minutely detail the very 'grain' of  one (person's) case - while others ("researchers") prefer to report on the general conclusions drawn from treating one hundred similar cases.

(Both are valuable to doctors and scientists - but biographers won't be human if they didn't prefer the intimate details of the first type of articles !)

Dawson gets a chance in mid April 1944 to treat Charles Aronson a second time with penicillin for SBE .

This was because the little penicillin Charles had gotten in October 1940 had helped him survive his first bout of SBE.

He thus became that rare successful SBE case (about one in a hundred) that did so , back then.

Dawson indicates  in 1945 , that Charles had first entered the Presbyterian three and a half years earlier - ie mid October 1940 , confirming the common assumption that he was a very late addition to Dawson's Penicillin SBE program.

(Dawson knew he had too little penicillin to even treat Alston adequately, but he kind-heartedly treated both.

He was hoping perhaps that any small sign of a clinical response from either one of them might move Big Pharma to step up to the plate and mass produce the stuff --- for Aaron, Charlie and everyone else.)

Literally : the last shall be first 

But did Dawson really add Charlie at the last minute out of kind-heartedness alone ?

I believe the real reason was because Charlie was such a late addition to his ward's SBE patients.

When a new patient arrived with suspected SBE - a relatively slow killer, first a number of blood tests over a number of days must show the continued and not merely transitory presence of green strep in the blood stream to match all the other classic clinical signs of SBE,.

Then the ethical response is to immediately start treatment with the newest miracle drug , sulfa, and pray.

This is what happened to Aaron, who had been in the ward about a month when he first got his penicillin.

But because Charlie was such a late addition, there hadn't been time to start treatment with sulfa drugs .

So if Charles was treated with penicillin alone and did show a clinical improvement, Dawson's sulfa worshipping naysayers (and their lineup began around the block) could not say it was all due to their established sulfa , not his new penicillin.

(Remember that a lot of middle-aged doctors , the same age as Dawson , had first made their mark as early sulfa drug pioneers - any new miracle drug meant their acclaim was over. )

Behind the polite rancour of academic/scientific 'critiques' is often a lot of half-hidden ego and income concerns.

Dawson recalled, in his 1945 article , that the 1940 Charles was treated with penicillin on October 16 and 17th and then immediately (first) "started" on sulfa on October 22 and that he responded so well that he was released in December and was illness free for three plus years.

Ethically, Dawson would never have wasted half of his tiny amount of penicillin he intended for Aaron on Charles --- if he was already responding well to sulfa.

I think the reason it became so urgent to treat Aaron in mid-October (well in advance of the Dawson team's own original timetable for starting clinical trials) was because he had already been treated with sulfa and it had failed.

And maybe even made him extremely sick  because allergies to sulfa are common and serious.

But treating Aaron alone risked having any penicillin success disputed by the pro-sulfa lobby and this would only forestall drug company involvement - hurting Aaron as well as all others.

Hence Charlie not only getting treatment but getting treated ahead of Aaron , if only by moments.

Ask anyone : nothing starts off a (soon to be citation classic) medical article quite like an opening sentence like this one ---

"The first patient  ever treated with systemic penicillin had (then invariably fatal) SBE , but had not yet had time to start a sulfa treatment, however he responded so well to the penicillin that he has now been home fully recovered for over six months months."

In fact Dawson saw no clinical response at all between cases of endocarditis and penicillin for one and a half long years and he didn't save anyone with the disease purely on penicillin alone until two years later.

But Charles's recovery might have been helped by the morale uplifting affect of simply knowing that he was Patient One of a touted new Miracle drug .

I can only hope that my research efforts eventually help Aaron Alston's relatives to gain some comfort from his short life.

They will learn that he helped bring penicillin into this world and that while it didn't help him personally, it has directly and indirectly helped ten billion of us in the seventy five years since he first received it.....