How a Deadly Fire Gave Birth to Modern Medicine
On the evening of November 28, 1942, more than 1,000 revelers from the Boston College-Holy Cross football game jammed into the Cocoanut Grove, Boston's oldest nightclub. When a spark from faulty wiring accidently ignited an artificial palm tree, the packed nightspot, which was only designed to accommodate about 500 people, was quickly engulfed in flames. In the ensuing panic, hundreds of people were trapped inside, with most exit doors locked. Bodies piled up by the only open entrance, jamming the exits, and 490 people ultimately died in the worst fire in the country in forty years.
"People couldn't get out," says Dr. Kenneth Marshall, a retired plastic surgeon in Boston and president of the Cocoanut Grove Memorial Committee. "It was a tragedy of mammoth proportions."
Within a half an hour of the start of the blaze, the Red Cross mobilized more than five hundred volunteers in what one newspaper called a "Rehearsal for Possible Blitz." The mayor of Boston imposed martial law. More than 300 victims—many of whom subsequently died--were taken to Boston City Hospital in one hour, averaging one victim every eleven seconds, while Massachusetts General Hospital admitted 114 victims in two hours. In the hospitals, 220 victims clung precariously to life, in agonizing pain from massive burns, their bodies ravaged by infection.
The scene of the fire.
Boston Public Library
Tragic Losses Prompted Revolutionary Leaps
But there is a silver lining: this horrific disaster prompted dramatic changes in safety regulations to prevent another catastrophe of this magnitude and led to the development of medical techniques that eventually saved millions of lives. It transformed burn care treatment and the use of plasma on burn victims, but most importantly, it introduced to the public a new wonder drug that revolutionized medicine, midwifed the birth of the modern pharmaceutical industry, and nearly doubled life expectancy, from 48 years at the turn of the 20th century to 78 years in the post-World War II years.
The devastating grief of the survivors also led to the first published study of post-traumatic stress disorder by pioneering psychiatrist Alexandra Adler, daughter of famed Viennese psychoanalyst Alfred Adler, who was a student of Freud. Dr. Adler studied the anxiety and depression that followed this catastrophe, according to the New York Times, and "later applied her findings to the treatment World War II veterans."
Dr. Ken Marshall is intimately familiar with the lingering psychological trauma of enduring such a disaster. His mother, an Irish immigrant and a nurse in the surgical wards at Boston City Hospital, was on duty that cold Thanksgiving weekend night, and didn't come home for four days. "For years afterward, she'd wake up screaming in the middle of the night," recalls Dr. Marshall, who was four years old at the time. "Seeing all those bodies lined up in neat rows across the City Hospital's parking lot, still in their evening clothes. It was always on her mind and memories of the horrors plagued her for the rest of her life."
The sheer magnitude of casualties prompted overwhelmed physicians to try experimental new procedures that were later successfully used to treat thousands of battlefield casualties. Instead of cutting off blisters and using dyes and tannic acid to treat burned tissues, which can harden the skin, they applied gauze coated with petroleum jelly. Doctors also refined the formula for using plasma--the fluid portion of blood and a medical technology that was just four years old--to replenish bodily liquids that evaporated because of the loss of the protective covering of skin.
"Every war has given us a new medical advance. And penicillin was the great scientific advance of World War II."
"The initial insult with burns is a loss of fluids and patients can die of shock," says Dr. Ken Marshall. "The scientific progress that was made by the two institutions revolutionized fluid management and topical management of burn care forever."
Still, they could not halt the staph infections that kill most burn victims—which prompted the first civilian use of a miracle elixir that was being secretly developed in government-sponsored labs and that ultimately ushered in a new age in therapeutics. Military officials quickly realized this disaster could provide an excellent natural laboratory to test the effectiveness of this drug and see if it could be used to treat the acute traumas of combat in this unfortunate civilian approximation of battlefield conditions. At the time, the very existence of this wondrous medicine—penicillin—was a closely guarded military secret.
From Forgotten Lab Experiment to Wonder Drug
In 1928, Alexander Fleming discovered the curative powers of penicillin, which promised to eradicate infectious pathogens that killed millions every year. But the road to mass producing enough of the highly unstable mold was littered with seemingly unsurmountable obstacles and it remained a forgotten laboratory curiosity for over a decade. But Fleming never gave up and penicillin's eventual rescue from obscurity was a landmark in scientific history.
In 1940, a group at Oxford University, funded in part by the Rockefeller Foundation, isolated enough penicillin to test it on twenty-five mice, which had been infected with lethal doses of streptococci. Its therapeutic effects were miraculous—the untreated mice died within hours, while the treated ones played merrily in their cages, undisturbed. Subsequent tests on a handful of patients, who were brought back from the brink of death, confirmed that penicillin was indeed a wonder drug. But Britain was then being ravaged by the German Luftwaffe during the Blitz, and there were simply no resources to devote to penicillin during the Nazi onslaught.
In June of 1941, two of the Oxford researchers, Howard Florey and Ernst Chain, embarked on a clandestine mission to enlist American aid. Samples of the temperamental mold were stored in their coats. By October, the Roosevelt Administration had recruited four companies—Merck, Squibb, Pfizer and Lederle—to team up in a massive, top-secret development program. Merck, which had more experience with fermentation procedures, swiftly pulled away from the pack and every milligram they produced was zealously hoarded.
After the nightclub fire, the government ordered Merck to dispatch to Boston whatever supplies of penicillin that they could spare and to refine any crude penicillin broth brewing in Merck's fermentation vats. After working in round-the-clock relays over the course of three days, on the evening of December 1st, 1942, a refrigerated truck containing thirty-two liters of injectable penicillin left Merck's Rahway, New Jersey plant. It was accompanied by a convoy of police escorts through four states before arriving in the pre-dawn hours at Massachusetts General Hospital. Dozens of people were rescued from near-certain death in the first public demonstration of the powers of the antibiotic, and the existence of penicillin could no longer be kept secret from inquisitive reporters and an exultant public. The next day, the Boston Globe called it "priceless" and Time magazine dubbed it a "wonder drug."
Within fourteen months, penicillin production escalated exponentially, churning out enough to save the lives of thousands of soldiers, including many from the Normandy invasion. And in October 1945, just weeks after the Japanese surrender ended World War II, Alexander Fleming, Howard Florey and Ernst Chain were awarded the Nobel Prize in medicine. But penicillin didn't just save lives—it helped build some of the most innovative medical and scientific companies in history, including Merck, Pfizer, Glaxo and Sandoz.
"Every war has given us a new medical advance," concludes Marshall. "And penicillin was the great scientific advance of World War II."
Steven Pinker: Data Shows That Life Today Is Better Than Ever
The government shutdown. A volatile stock market. Climate change.
It's so easy to get discouraged by the latest headlines, argues Steven Pinker, that we lose sight of the bigger picture: life today is actually improving.
"To appreciate the world, we've got to look at numbers and trends."
Pinker, a cognitive psychologist from Harvard, says in his book "Enlightenment Now" that we're living at the greatest moment of progress in history, thanks to reason, science, and humanism. But today, he says, these ideals are under-appreciated, and we ignore them at our peril.
So he set out to provide a vigorous moral defense of the values of the Enlightenment by examining the evidence for their effectiveness. Across a range of categories from happiness and health to peace and safety, Pinker examines the data and reassures readers that this is a pretty great time to be alive. As we kick off the new year, he's hopeful that our embrace of science and reason will lead to an even more prosperous future. But political and cultural hurdles must still be overcome before the heroic story of human progress can continue to unfold.
Pinker spoke with our Editor-in-Chief Kira Peikoff in advance of the book's paperback release, which hits stores next Tuesday. This interview has been edited and condensed for clarity.
One anecdote you describe in the book was particularly striking: how the public reacted when the polio vaccine was announced. People took the day off work to celebrate, they smiled at each other in the streets, they offered to throw parades. Today, it's hard to imagine such prevalent enthusiasm for a new advance. How can we bring back a culture of respect and gratitude for science?
That's such a good question. And I wish I knew the answer. My contribution is just to remind people of how much progress we've made. It's easy to ignore if your view of the world comes from headlines, but there are some built-in biases in journalism that we have to counteract. Most things that happen all of a sudden are bad things: wars break out, terrorists attack, rampage shootings occur, whereas a lot of the things that make us better off creep up by stealth. But we have to become better aware of them.
It's unlikely that we're going to have replications of the great Salk event, which happened on a particular day, but I think we have to take lessons from cognitive science, from the work of people like Daniel Kahneman and Amos Tversky, showing how misled we can be by images and narratives and that to appreciate the world, we've got to look at numbers and trends.
The cover of "Enlightenment Now," which comes out in paperback next week.
You mention that the President's Bioethics Council under Bush was appointed to deal with "the looming threat of biomedical advances." Do you think that professional bioethicists are more of a hindrance than a help when it comes to creating truly enlightened science policy?
I do. I think that there are some problems in the culture of bioethics. And of course, I would not argue against that the concept of bioethics. Obviously, we have to do biomedical research and applications conscientiously and ethically. But the field called Bioethics tends to specialize in exotic thought experiments that tend to imagine the worst possible things that can happen, and often mire research in red tape that results in a net decrease in human welfare, whereas the goal of bioethics should be to enhance human welfare.
In an op-ed that I published in the Boston Globe a few years ago, I said, deliberately provocatively, that the main moral imperative of bioethics is to get out of the way since there's so much suffering that humans endure from degenerative diseases, from cancer, from heart disease and stroke. The potential for increasing happiness and well-being from biomedical research is just stupendous. So before we start to drag out Brave New World for the umpteenth time, or compare every advance in genetics to the Nazis, we should remember the costs of people dying prematurely from postponing advances in biomedical research.
Later in the book, you mention how much more efficient the production of food has become due to high-tech agriculture. But so many people today are leery of advances in the food industry, like GMOs. And we will have to feed 10 billion people in 2050. Are you concerned about how we will meet that challenge?
Yes, I think anyone has to be, and all the more reason we should be clear about what is simultaneously best for humans and for the planet, which is to grow as much food on this planet as possible. That ideal of density -- the less farmland the better -- runs up against the ideal of the organic farming and natural farming, which use lots of land. So genetically modified organisms and precision agriculture of the kind that is sometimes associated with Israel -- putting every last drop of water to use, delivering it when it's needed, using the minimum amount of fertilizer -- all of these technologically driven developments are going to be necessary to meet that need.
"The potential for increasing happiness and well-being from biomedical research is just stupendous."
You also mention "sustainability" as this big buzz word that you say is based on a flawed assumption that we will run out of resources rather than pivot to ingenious alternatives. What's the most important thing we can do as a culture to encourage innovation?
It has to be an ideal. We have restore it as what we need to encourage, to glorify in order to meet the needs of humanity. Governments have to play a role because lots of innovation is just too risky with benefits that are too widely diffuse for private companies and individuals to pursue. International cooperation has to play a role. And also, we need to change our environmental philosophy from a reflexive rejection of technology to an acknowledgement that it will be technology that is our best hope for staving off environmental problems.
And yet innovation and technology today are so often viewed fearfully by the public -- just look at AI and gene editing. If we need science and technology to solve our biggest challenges, how do we overcome this disconnect?
Part of it is simply making the argument that is challenging the ideology and untested assumptions behind traditional Greenism. Also, on the part of the promoters of technology themselves, it's crucial to make it not just clear, but to make it a reality that technology is going to be deployed to enhance human welfare.
That of course means an acknowledgement of the possible harms and limitations of technology. The fact that the first widely used genetically modified crop was soybeans that were resistant to herbicides, to Roundup -- that was at the very least a public relations disaster for genetically modified organisms. As opposed to say, highlighting crops that require less insecticide, less chemical fertilizers, less water level. The poster children for technology should really be cases that quite obviously benefit humanity.
"One of the surprises from 'Enlightenment Now' was how much moral progress depends on economic progress."
Finally, what is one emerging innovation that you're excited about for 2019?
I would say 4th generation nuclear power. Small modular reactors. Because everything depends on energy. For poor countries to get rich, they are going to have to consume far more energy than they do now and if they do it via fossil fuels, especially coal, that could spell disaster. Zero-carbon energy will allow poor countries to get richer -- and rich countries to stay rich without catastrophic environmental damage.
One of the surprises from "Enlightenment Now" was how much moral progress depends on economic progress. Rich countries not only allow the citizens to have cool gadgets, but all kinds of good things happen when a country gets rich, like Norway, Netherlands, Switzerland. Countries that are richer on average are more democratic, are less likely that to fight wars, are more feminist, are more environmentally conscientious, are smarter -- that is, they have a greater increase in IQ. So anything that makes a country get richer, and that's going to include a bunch of energy, is going to make humanity better off.
Kira Peikoff was the editor-in-chief of Leaps.org from 2017 to 2021. As a journalist, her work has appeared in The New York Times, Newsweek, Nautilus, Popular Mechanics, The New York Academy of Sciences, and other outlets. She is also the author of four suspense novels that explore controversial issues arising from scientific innovation: Living Proof, No Time to Die, Die Again Tomorrow, and Mother Knows Best. Peikoff holds a B.A. in Journalism from New York University and an M.S. in Bioethics from Columbia University. She lives in New Jersey with her husband and two young sons. Follow her on Twitter @KiraPeikoff.
Shoot for the Moon: Its Surface Contains a Pot of Gold
Here's a riddle: What do the Moon, nuclear weapons, clean energy of the future, terrorism, and lung disease all have in common?
One goal of India's upcoming space probe is to locate deposits of helium-3 that are worth trillions of dollars.
The answer is helium-3, a gas that's extremely rare on Earth but 100 million times more abundant on the Moon. This past October, the Lockheed Martin corporation announced a concept for a lunar landing craft that may return humans to the Moon in the coming decade, and yesterday China successfully landed the Change-4 probe on the far side of the Moon. Landing inside the Moon's deepest crater, the Chinese achieved a first in space exploration history.
Meanwhile, later this month, India's Chandrayaan-2 space probe will also land on the lunar surface. One of its goals is to locate deposits of helium-3 that are worth trillions of dollars, because it could be a fuel for nuclear fusion energy to generate electricity or propel a rocket.
The standard way that nuclear engineers are trying to achieve sustainable fusion uses fuels that are more plentiful on Earth: deuterium and tritium. But MIT researchers have found that adding small amounts of helium-3 to the mix could make it much more efficient, and thus a viable energy source much sooner that once thought.
Even if fusion is proven practical tomorrow, any kind of nuclear energy involves long waits for power plant construction measured in decades. However, mining helium-3 could be useful now, because of its non-energy applications. A major one is its ability to detect neutrons coming from plutonium that could be used in terrorist attacks. Here's how it works: a small amount of helium-3 is contained within a forensic instrument. When a neutron hits an atom of helium-3, the reaction produces tritium, a proton, and an electrical charge, alerting investigators to the possibility that plutonium is nearby.
Ironically, as global concern about a potential for hidden nuclear material increased in the early 2000s, so did the supply of helium-3 on Earth. That's because helium-3 comes from the decay of tritium, used in thermonuclear warheads (H-bombs). Thousands of such weapons have been dismantled from U.S. and Russian arsenals, making helium-3 available for plutonium detection, research, and other applications--including in the world of healthcare.
Helium-3 can help doctors diagnose lung diseases, since it enables imaging of the lungs in real time.
Helium-3 dramatically improves the ability of doctors to image the lungs in a range of diseases including asthma, chronic obstructive pulmonary disease and emphysema, cystic fibrosis, and bronchopulmonary dysplasia, which happens particularly in premature infants. Specifically, helium-3 is useful in magnetic resonance imaging (MRI), a procedure that creates images from within the body for diagnostic purposes.
But while a standard MRI allows doctors to visualize parts of the body like the heart or brain, it's useless for seeing the lungs. Because lungs are filled with air, which is much less dense than water or fat, effectively no signals are produced that would enable imaging.
To compensate for this problem, a patient can inhale gas that is hyperpolarized –meaning enhanced with special procedures so that the magnetic resonance signals from the lungs are finally readable. This gas is safe to breathe when mixed with enough oxygen to support life. Helium-3 is one such gas that can be hyperpolarized; since it produces such a strong signal, the MRI can literally see the air inside the lungs and in all of the airways, revealing intricate details of the bronchopulmonary tree. And it can do this in real time
The capability to show anatomic details of the lungs and airways, and the ability to display functional imaging as a patient breathes, makes helium-3 MRI far better than the standard method of testing lung function. Called spirometry, this method tells physicians how the lungs function overall, but does not home in on particular areas that may be causing a problem. Plus, spirometry requires patients to follow instructions and hold their breath, so it is not great for testing young children with pulmonary disease.
In recent years, the cost of helium-3 on Earth has skyrocketed.
Over the past several years, researchers have been developing MRI for lung testing using other hyperpolarized gases. The main alternative to helium-3 is xenon-129. Over the years, researchers have learned to overcome certain disadvantages of the latter, such as its potential to put patients to sleep. Since helium-3 provides the strongest signal, though, it is still the best gas for MRI studies in many lung conditions.
But the supply of helium-3 on Earth has been decreasing in recent years, due to the declining rate of dismantling of warheads, just as the Department of Homeland Security has required more and more of the gas for neutron detection. As a result, the cost of the gas has skyrocketed. Less is available now for medical uses – unless, of course, we begin mining it on the moon.
The question is: Are the benefits worth the 239,000-mile trip?