That 'ever-climbing' Aussie Howard Florey: year by year his listed degrees got longer and longer

While we all know the differences between a BA, MA and PhD , few of us can fathom the distinctions between a BM/MB, and DM/M.D. in the field of medicine --- even when our life literally depends on it.

Most of us today, particularly in North America, tend to regard as the only real medical doctor someone who not merely has a degree of some sort from a medical school, but who has also passed an internship at a hospital (if not a residency), in addition to passing a local medical society's entry exams and gaining some hospital admitting privileges.

We tend to think , in other words, that the only real medical doctor is a full MD in the lay sense of that technical term, who is licensed to deal directly with acutely ill patients , giving them all forms of narcotics and IV needles,  can perform minor outpatient operations and is able to admit them to nearby large general hospitals.

In the British Commonwealth (outside of Canada), rather than a doctorate in medicine (M.D.) being the first medical degree, it is one reserved for medical researchers doing a PhD thesis in medicine. (DM=PhD in medicine= MD.)

One gets an initial BM/BS (BM=MB) and then goes off for various internships, residencies, local medical society and or speciality society exams, hospital admitting privileges etc just as brand new MDs do in North America.

Interestingly, none of the many people included in the Oxford team that Howard Florey assembled to develop penicillin were full MDs, in that lay sense of the word, including Florey himself.

(So Dr Florey was licensed, but only to do  operations on research animals but not licensed to deal with humans in the local general hospital..... Dr Chain wasn't even licensed to give needles to research animals !)

But in 1944, his old university in Adelaide gave Florey an honorary M.D. degree and he used it for the rest of his life with pride, as he did all of his honorary degrees.... without indicating their honorary nature.

His first well-known article (on penicillin) in 1940, lists him only as having a M.B.

By 1941 with his second article on penicillin, he could and did add a FRS to that.

By 1949 he is listed ,as chief author of the two volume history called simply "Antibiotics", with a MA, MD, PhD and FRS : that old oddball MB is forgotten history.

By, contrast Henry Dawson's rival penicillin effort had a much smaller team of just four people, but both he and Dr Meyer had M.D.s ---- an important distinction in 1940s American research hospitals, where by contrast with today, the PhD was a low degree indeed.

(His other team members ? Hobby had a PhD in bacteriology and Chaffee a BSc in chemistry.)

Obscure degrees, in author listings DO matter ...

Florey's team was oriented by their training and hence personal inclination , to fundamental research on on the nature of penicillin and away from saving individual lives.

Dawson's team was dominated, by training and hence personal inclination, to saving individual lives with therapeutic penicillin .

This matter of obscure degrees after researchers' names then turns out to matter greatly ...

was I too harsh on Eric Lax ?

Some have worried that I was.

But I don't agree and I hope that even Eric Lax will see why I argued as I did.

Almost anyone reading Lax's book on penicillin, "The Mold in Dr Florey's Coat", is struck by the fact that the emotional climax of the book is well forward in the overall Penicillin Saga - occurring in May 1940.

 I would have set the emotional climax much later - in August/September 1943 or in May/August 1944.

Lax's book builds steadily up to the (supposedly) crucial animal protection tests that Lax and almost all other penicillin authors chide Fleming for failing to perform in the Fall of 1928.

A check of Lax's own indexing confirms the large number of pages (in a shortish book) that are devoted to animal testing and the mouse protection tests.

He is also that rarity among the many penicillin authors in deciding to quote at length from John Fulton's letter to the Nobel Committee ,in which Fulton says that Florey deserves the Nobel because of his animal experiments with penicillin.

Surely an, ahem, unique viewpoint.

But in a perverse sort of way it does show some truth - Fulton and Florey loved to experiment on the bodies of animals far more than they did anything else in life.

Lax sets up the animal protection tests of May 1940 as the moral high ground of the entire penicillin story.

He even highlights the story of the Florey team deciding to smear their coats with the most widely available 'rare' mold on Planet Earth (thanks to Fleming !), all to keep it from the Nazis.

I merely say that what is good for the goose is even better for the gander.

Yes, Fleming should have needled the mouse back in '28, but why didn't Florey do the bog simple mouse test in early 1938, when peacetime drug firms might have been able to produce commercial penicillin, even before Hitler overran Poland ?

The usual biographer's apology for Florey waiting from Spring 1938 till Spring 1940 to test penicillin against an artificial illness (and until Spring 1941 before testing against a real human illness) is that he needed purified dry penicillin before he could do an injection.

Fleming's rebuttal would be "that since I never obtained any dry purified penicillin - according to Florey" - "then I was under no moral obligation to do the mouse protection test".

"Or if I should have done so anyway with wet penicillin in 1928,then Florey should have done ditto in 1938."

Duhig from Brisbane could also chime in with that blunt Australian manner, with "Look, Florey, I saved large adults from terminal illnesses with injections of weak,wet, penicillin - surely you could cure a diseased mouse with some of your 1938 wet penicillin if you had only tried ..."

In support of Duhig, Heatley says that the first penicillin used by Chain in March 1940 ( in a sort of toxicity test) had between 2 to 5 units of anti-bacterial activity per mg and that
a 20 gram mouse got 40 mgs - that is about 4,000 to 10,000 units per kg of body weight.

For a 80 kg adult human male that is the equivalent of a single dose of 320,000 to 800,000 units of injected penicillin - even today that is 'heroic medicine'  -and as a single dose in a series for animal protection it is about one hundred times too big.

But is also the liquid penicillin you would obtain, even in 1928 or 1938, from a single medium sized lab flask  - not exactly hard work to gather up.

But it is 40 mls of liquid penicillin to inject into a mouse - far too much even if done as a slow drip.

However, injecting .5 or 1.0 ml of raw crude wet penicillin at a time into a twenty gram mouse, as part of a series of injections, would be perfectly safe.

It would give , in human adult male equivalent terms, a single dose of about 4,000 to 16,000 units - which is about what a wartime adult male penicillin patient did get in a single dose in a series of shots (usually receiving 4 to 8 such shots in a twenty four hour day).

The technical claims against using crude wet penicillin in animal protection tests fails to stand up - but fails for Florey as well as for Fleming.

In talking about (Duhig's) raw, totally non-concentrated penicillin as being suitable for animal protection tests, I am deliberately worsening the case against Fleming.

In fact, while in 1940 Florey had a dry brown powder with 2-5 units of activity per mg, in 1929, Fleming had a brown gooey toffee with 2-5 units of activity per mg - once re-wetted with distilled water to inject into a mouse, both were as equal as can be.

 Neither were pure.

But both had been concentrated successfully enough to be highly useful therapeutic penicillin - if only that pair had had the guts to 'do the clinical' .

That was something that Dawson did , and did in a ' New York minute' .

Harsh on Eric Lax ?

I don't think so...

FLOREY's biggest mistake : Spring 1938-May 1940

Two wrongs can never make a right.

Millions of lives, literally, might have been saved if Alexander Fleming had only run a quick animal protection test with a mouse, a bit of staph bacteria and a needle full of his wet penicillin juice , back in October 1928.

It wasn't until about ten years later that sulfa drugs began to be universally available and regularly used - and even then they didn't work as well as penicillin.

The lives needlessly lost in that period have to be laid at Fleming's door.

Howard Florey and his entire Oxford University team never stopped criticizing Fleming for this elemental failure - as most people would have a full right to do.

But Florey and his team do not have that right.

For they failed to do the same thing they criticized Fleming for not doing,that bog simple animal protection test with wet penicillin juice, something they neglected to do from early Spring 1938 till May 1940.

They had the wet penicillin, the mice and the skill to do the test.

If they had done that test, we might have seen penicillin development work started in earnest by British drug firms in 1938, before the Munich Crisis, long before the fall of France in June 1940.

In which case the exciting wartime penicillin story might have ended happily before it even began.

Not until they had accomplished their  real goal - concentrating Fleming's impure 2-5 units per mg penicillin sticky brown toffee into a 2-5 units per mg dry brown powder - and claiming it was highly purified penicillin, did the Oxford University think about the all important animal protection test.

All the evidence is that while Ernest Chain was anxious to do it, Florey didn't think they had gone far enough along the so called purification route to move into stage two animal trials.

Chain had to force the issue - making Florey so angry that Chain never ever regained Florey's trust.

Here was Britain about to be invaded, civilization tottering in the balance and Florey was plodding through every scientific experiment in his rulebook, instead of cutting to the chase on a drug that might save many Britons lives.

He was thinking like a scientist ,not like a patriot - fair enough - a common failing among scientists - even during a war crisis.

But most scientists who think like that don't have the nerve to turn around and very publicly blame a colleague for failing to do what they themselves also failed to do.

It is things like this that make it very hard for me to stomach Howard Florey as a whole - though there are many things I do admire about the man.

And don't think I let Florey's many admiring biographers off any more lightly - how in the name of all that is holy do they justify admiring Florey for delaying that critical wet penicillin animal protection test  for more than two years?

The recent British television movie on Florey criticizes Fleming for never doing the animal test, but remains silent on why on earth Florey waited until well into the Battle of Britain crisis to 'poke the mouse'.

Fleming deserves to be blamed for some of his failings.

Fair enough.

But Florey needs to be held to the same high standard - I only wish Eric Lax and others had done so....