Sunday, April 5, 2015

Antibiotics' Patients Zero , part 1

When I began the search for Antibiotics' Patients Zero ten years ago, I very naively thought like a historian, not a genealogist, and as a result, I got precisely nowhere for ten wasted years.

Professional historians are taught to distrust family oral histories and to put all their faith in official paper documents.

Professional genealogists tell their clients to do exactly the opposite: don't quickly dismiss old family tales as myths and legends and never simply take the evidence of official documents at face value.

I also made a fundamental error in math which I suspect you and 99% of the world would do at first try.

If about all you knew about a missing antibiotics' patient zero was that they were 31 in 1944, quickly, what year do you think they were born ?

1913, of course.

And if they were born on January 1st 1913, that fact is always true, no matter when in 1944 the question is raised.

But what if, like my sister Margo, they were born on December 27th ?

Strictly speaking, wouldn't she also be 31 for 99% of 1944, though born in 1912 ?

I had also assumed wrongly, for ten years, that the doctor (Martin Henry Dawson) making this statement about his patient's age was calculating it from late 1944, as he was finalizing the submission of an very important scientific article on this man and others.

But doctors are very busy people and the only time they tend to ask you your age is on admission.

This man (Charles Aronson) was admitted in April 1944 but his birthday was in June 1912, as it turns out.

Further mistake : I took on faith the claim made by many (without any backing evidence - whatsoever) that this patient's doctor long had an overwhelming interest in curing patients with invariably fatal SBE (a form of endocarditis brought about by Rheumatic Fever.)

The strongest claim about this was made by his closest colleague, a colleague for almost all of his scientific career : so a claim hard to dismiss.

But as Google Search got better and as I gathered up all of this doctor's public utterances in articles, at conferences, in textbooks etc, in 2014 I was suddenly struck by the fact that he never once talked about endocarditis -- despite having considerable freedom to do so.

I also now knew that his first antibiotics efforts with patients came just after he had finally moved up from assistant attending physician at a huge research and teaching hospital (aka dogsbody) to associate attending physician, in charge (more or less) of one public charity ward.

Admitting patients to world class teaching hospitals is never easy for 99.9% of doctors - patients themselves are never the priority, to put it bluntly but truthfully.

In a 24 hours a day, seven days a week teaching hospital, most patients are considered for admission when any particular doctor is at home or busy working in another part of the hospital.

The priority for the admitting doctor - a medical student of a sort themselves - is always, 'do my teachers need a patient with this condition - right now - to fit in with the teaching schedule for us medical students' ?

Followed by, 'or would this sort of patient and illness fit in with the research work of the more senior and powerful teacher-researchers here', people who can make or break my future career?

The known wishes of the thus usually absent Dr Dawson, being in charge of a world class outpatient clinic for people with arthritis - would have had considerable sway in the admission process of (private or charity) patients with rare forms of arthritis but that is all.

The only SBE cases he would have any say over occurred whereever seriously ill people simply arrive at the hospital doorstep and basically had to be admitted right away,regardless, for humanitarian reasons.

If they arrived at the one charity ward Dawson was mostly in command of, he not their lowly GP, would have the most say of their medical care.

After all, the patient and their GP were not paying the medical piper.

And I now knew that Depression Era patients seeking admission to Manhattan hospital charity wards almost always came from just a few convenient miles away by bus, subway or even foot - their families were too poor to own a car and worked at tiring physical jobs.

Their frequent, easy, presence at the hospital was a key emotional asset in the patients' speedy recovery --- or in their last days on earth.

Only when a poor person, with an unique set of medical conditions, in a distant community came to the attention of a powerful doctor with good personal and professional connections with the top doctors at a big teaching hospital in Manhattan, could they secure admission on that hospital's charity ward, regardless of the opinion of the ward's attending physician in charge.

And then, be assured, that attending physician would have little say in their treatment : the various Drs Big from outside and inside the hospital would take over !

I now sensed that unless the available evidence suggested otherwise , as it did with history's third antibiotics' patient, the first two patients zero probably came from about a three mile radius around Dawson's hospital (the world famous Columbia Presbyterian Medical Centre in upper Manhattan.)

His hospital had no shortage of very poor people near by in 1940 - blacks in Harlem and Jews in South Bronx.

Research and teaching hospitals can really only thrive if large supplies of poor patients are near by.

These poor, in return for advanced medical care for free, agree to be constantly examined and probed by huge numbers of strangers and agree to submit to new, scary and painful treatments.

Almost all I knew about Dawson's Patient Zeros was their names : Aaron Alston and Charles Aronson.

Alston was/is a common black name in Harlem New York, ditto Aronson was then a common Jewish name in South Bronx --- both places just two or three miles from Dawson's hospital.

But Google provided too many Aaron Alstons (I had no birthdate on him) to narrow my search easily and only one Charles Aronson born in 1913 in the whole USA.

Dawson's Aronson had spent so much of his young life in hospitals fighting off death so many times that I doubted he could have lived too many years past 1945.

(In his last known illness known to me, he had such a severe stroke that he was left paralyzed on one side and speechless as well.)

But when I tracked down the sons of one American Charles Aronson born in 1913 and they said he had been healthy as a horse, all his very long life, and was not in a hospital in NYC in 1940 or 1944.

By this time, some American census results came up in Google search : a Charles Aronson in the Bronx in 1940, but with a birthdate of 1915 not 1913.

But it was close enough for me - because it soon became clear that in all of 1940 USA and searching very generously for birthdates between 1908 and 1918 ,there was only three Charles Aronsons, period - two far from NYC and one in the Bronx.

But the historian in me soon drew a blank .....

See part two

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