Ernie's Reviews > The Demon Under the Microscope: From Battlefield Hospitals to Nazi Labs, One Doctor's Heroic Search for the World's First Miracle Drug

The Demon Under the Microscope by Thomas Hager
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Mar 20, 2012

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Read in March, 2012

This is an excellent book, effectively combining history and science in a discussion of the discovery and impact of sulfa antibiotics. The author does an excellent job describing the motivations and actions of scientists. The historical period and events make amazing backdrops. The discoverer of Sulfa antibacterial drugs was Gerhard Domagk, inspired to discover a cure for gas gangrene by service as a medic in the Germand Army in WWI. He becomes a physician and a scientist, working for IG Farben, a company famous for making chemical dyes. (Later infamous for employing slave labor under the Nazis) The inspiration for using chemical dyes came from Paul Erlich's use to stain cells under the microscope. The observation that different dyes stained different structures led to the inspiration that if a dye could attach specifically to a bacteria, then it could be coupled with a poison to kill the bacteria.... Erhlichs "magic ball"... later stylized as the "magic bullet". The book is wide ranging and amazing in the diversity of topics it treats.

Domagk's work, following the examples of Koch and Erhlich, led to a methodical approach, working with chemists, to assay the effects of drugs... a scientific method with controls and repetitions.

In the early 1900s, medicine was the domain of patent medicine. Battles were fought in American Congress when the insipient FDA wanted to regulate the safety of drugs. The power of the patent medicine lobby and its rhetoric was frightenlying similar to the powers arrayed against goverment sponsored health care today. The lobbiests were staunch defenders of Americans' rights to self medicate. Patent medicine producers could make claims based on supposition and without evidence. It was up to the FDA, for example, to prove that a drug promoted as a cancer cure did not actually have cancer curing properties.... a proposition making such investigations pointless. Sulfa came and had a powerful effect. Everyone hopped on the bandwagon. But one unfortunate formulation killed 100 people. This led people to consider whether regulation of medicines by government might be a good thing.

With instructions from congress, the safety and efficacy of drugs were evaluated methodically using controls and repetition. Up until then, only narcotics were controlled. People were free to kill themselves with ineffective medicines or poisons.

Effective treatments transformed medicine. Physicians became less comforters of the sick and transformed into diagnisticians and the source of curative medicines. Decreasing the dangers of infection from surgeries made the operations more effective.

WWII came. Curiously Hitler did not approve of experiments on animals. Later, his lieutenants conducted experiments on humans, including experiments with sulfa drugs. Domagk was awarded the Nobel prize, but directed not to accept. Hitler was angry because the peace prize had previously been awarded to one of his German opponents.

Lots of other interesting stories.... The author ties them together well.

The impact of sulfa on disease was amazing. I grew up in the age of antibiotics and think little of strep throat. I recall hearing that people died of it. I know lots of kids who got it but no one died. Times change.

There were other interesting aspects. Domagk, actually missed the boat on the action of the drug. The dye had little to do with it. Initially it was only effective with Strep. Later formulations were effective with other drugs. The early reports were couched with scientific understatement and obscure descriptions. This delayed appreciation of the work. Celebrity cures paved the way to more widespread us.

In the background, two things were happening. Resistance was developing. Happily, pennicillin and other antibiotics were developed.

Fascinating book. Fascinating story. Well written. I recommend it.


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