I'm somewhat embarrassed that it took me until about half-way through the book to think “you know, this is really just about this one guy!”, where, had I paid closer attention to the subtitle of Thomas Hager's The Demon Under the Microscope: From Battlefield Hospitals to Nazi Labs, One Doctor's Heroic Search for the World's First Miracle Drug, I'd have possibly noted the “One Doctor's” part. Instead, I launched into this thinking it was a general overview of the development of antibiotics.
Of course, the book is about the development of antibiotics, and it's pretty amazing to realize just how recent these have come along. I was familiar with the story of Ignaz Semmelweis, a Hungarian doctor who in the 1850's introduced the idea of antiseptics to a medical community that really didn't want to hear it (at that time, surgeons wore their bloody smocks, patient to patient, as something as a badge of honor), but he, at one hospital in Vienna, was able to reverse the numbers which had three times the deaths of mothers in obstetric wards staffed by doctors verses those being run by midwives, eventually pushing mortality rates to under 1% of patients. Since there was no “germ theory” at the time, and despite his successes, Semmelweis was decreed to be mad and died in an asylum!
The Demon Under the Microscope, however, primarily follows the work of Gerhard Domagk, who had been a medical student prior to WWI, volunteered for the German army, was wounded, and served the rest of the war as a medic. The book goes into a great deal of detail about how most deaths in WWI came not from initial damage from gunshots, shrapnel, etc., but from the infections following. While by this time the use of antiseptics had become accepted (although hard to maintain on the battlefield), there still wasn't much that could be done. Diseases, especially the dreaded Streptococcus, would quickly do in those with any but the most minor injuries.
As most folks reading this will understand, this came as a bit of a shock. In the West, in the past half century, “strep” is a bothersome throat infection that will occasionally run through a school, but be quickly put down with antibiotics … it's something one gets one's kids tested for if they have a throat infection … but it's never been something that I had any idea was so horribly lethal. And yet, in the years before the Second World War, it was pretty much a death sentence, and a strep infection could take a young, otherwise healthy, person in a matter of days. Hager notes:
To illustrate this point he walks the reader through the sad tale of Calvin Coolidge Jr., who was a teen in his father's White House. One day he went out and played tennis in sneakers without socks, and got a blister on his toe … two days later he was weak and feverish, a couple of more days later he was transferred to Walter Reed Hospital, being attended by the finest physicians, and, a week after getting the blister, the boy was dead.Strep might seem an odd choice today when the only strep disease most people ever experience is a bad sore throat. In the 1920s, however, it was one of the most feared killers on earth. No one was safe from strep.
A dozen years later, another Presidential son, Franklin Delano Roosevelt Jr., fell ill with a sinus infection, which turned into a fast-spreading strep infection. Near to death, his family approves the use of a brand new drug out of Europe … Sulfa-based drugs from Bayer … and the patient had a fast, full, and nearly miraculous recovery.
The sulfa drugs were discovered by Domagk and his predecessors almost by accident. Most of their research followed the discovery that certain dyes had properties that stopped certain diseases (first discovered when using dyes for staining slides) … with an early success being an azo dye that cured “sleeping sickness”, a significant threat to the European colonial powers in Africa. Once this initial drug was on the market, the dye manufactures launched research programs with their chemists creating molecule after molecule that would form the basis of tests on animals that had been infected with a number of diseases. At one point a sulfa compound had been added to a dye and they suddenly saw remarkable survival rates in their strep test animals. As it turned out, the sulfa was the key ingredient (much to Bayer's dismay, as it was cheap, easy to manufacture, and not patentable like their dye-based products).
Of course, in the 20's and 30's, drugs were hardly controlled, and there was a long history of “patent medicines”:
Unfortunately, once the idea of sulfa caught on in the US, there were hundreds of companies making products based on this, including one, Massengill, which produced an “elixir” that was sweet, raspberry flavored, and based on the industrial solvent diethyline glycol – a substance sometime used in salves and lotions – one of the few things in which the sulfa compounds would dissolve. Very quickly after its introduction, reports of deaths started to come in, from kids taking it for sore throats to folks trying to treat VD, they were drinking the “elixir” and dropping dead. The government and medical establishment quickly tried to halt distribution, but over a hundred people had died. This was not “good press”, and many people suspected the “new German drug” sulfa, rather than the toxic delivery system.Patent medicines in the early part of the twentieth century were as firmly established a part of American culture as jazz or baseball. Americans were accustomed to medicating themselves, deciding on their own treatments, and buying their own drugs. It went against the grain to have some doctor or federal agency telling Americans how to cure themselves.
The coming of WW2 was, however, the heyday for sufla, and it ended up being in the personal kits of most of the allied soldiers, causing many fewer post-engagement casualties than in any previous war, but it was also quickly eclipsed by the development of penicillin in the late 30's. Domagk had been awarded the Nobel Prize for his work in 1939, but had been prevented from accepting it by the Nazi regime, yet he survived the war, and was able to receive the honor afterwards.
The Demon Under the Microscope is an engaging read, and a real eye-opener (as noted) at how recent much of the medical resources we have today were developed. It is part medical history, part military history, and an interesting look at how haphazard much of scientific advances are, frequently coming from something that wasn't being specifically looked for, but arising out of fortuitous accidents. The edition I have is the 2006 hardback, found at the dollar store, and there is a more recent paperback version as well ... which appears to be the only one actually in print at this point. The online big boys have the paperback at a bit off its very reasonable cover price, but the new/used guys have copies of the hardcover for as little as 1¢ (plus shipping). If you have an interest in the various types of history that pull together here, or of medical stuff in general, you'll probably enjoy this, and given how reasonable it would be to score a copy, I'd recommend you take a chance on it.