Demon under the Microscope: From Battlefield Hospitals to Nazi Labs, One Doctor's Heroic Search for the World's First Miracle Drug by Thomas Hager

From Barnes & Noble

In the history of medicine, sulfa was just a short blip: The antibiotic achieved wide distribution in the mid-1930s; a decade later, it had all but disappeared. But during its short lifetime, this miracle drug saved millions of lives; helped shape the course of WWII; and set the stage for the transformation of pharmaceutical research and medical practice. Thomas Hager's The Demon Under the Microscope is a fast-paced, fact-filled chronicle of a drug that changed the world by changing microscopic bacteria.

From the Publisher

Fast-paced, suspenseful, and utterly satisfying, The Demon Under the Microscope is a sweeping history of the discovery of the first antibiotic and its dramatic effect on the world of medicine and beyond.

Publishers Weekly

Modern bacteriology was born on the battlefields of WWI, where bacteria-rich trenches added to the toll of millions of soldiers killed. Not coincidentally, the search for anything that would significantly diminish the deadly power of disease largely occurred between the world wars, mostly in Germany. Gerhard Domagk and his colleagues at Bayer (a subsidiary of I.G. Farben) worked feverishly to identify which microscopic squiggles might render humankind forever safe from malaria and tuberculosis. The answer, discovered in 1932, turned out to be sulfa drugs, the precursors to modern antibiotics. Hager, a biographer of Linus Pauling, does a remarkable job of transforming material fit for a biology graduate seminar into highly entertaining reading. He knows that lay readers need plenty of personality and local color, and his story is rich with both. This yarn prefigures the modern rush for corporate pharma patents; it is testament to Hager's skill that the inherently unsexy process of finding the chemicals that might help conquer strep is as exciting as an account of the hunt for a Russian submarine. (Sept.) Copyright 2006 Reed Business Information.

Library Journal

The "demon" in the title refers to the disease-causing bacteria that killed off innumerable human populations before the advent of modern drugs. In this fascinating and highly readable account, science and medical writer Hager narrates the story of the race to find the "magic bullet" to eliminate diseases such as pneumonia, childbed fever, and gonorrhea. He details the primitive state of medicine during World War I, when more soldiers (and civilians) died from infection than from wounds received during combat. The war itself spurred scientists to research the causes of bacterial infections and search for a cure, which spawned fierce competition between German and French companies. Hager connects early innovations in medicine to the fortuitous and intuitive leaps that allowed early 20th-century researchers to create sulfa, the first antibiotic. Hager also documents the first abuse of antibiotics: physicians using patients as guinea pigs, guessing wildly about correct dosing, and prescribing sulfa for every perceived malady. One is left with a sense of gratitude for the relative safety of modern medical practices. Highly recommended.-Janet M. Schneider, James A. Haley Veterans' Hosp. Lib., Tampa, FL Copyright 2006 Reed Business Information.

School Library Journal

Adult/High School-An exciting, fast-paced read, Demon opens with a grisly scene at Tripler General Hospital in Hawaii as ambulances, trucks, and private cars drop off the injured from Pearl Harbor. Men who were wounded, dismembered, and literally roasted in the harbor oil fires from exploding ships were tended to on the lawns outside the hospital and in three operating rooms that ran continuously for 11 hours. Not a single patient died due to infection, in dramatic contrast to World War I, when it was estimated that more soldiers died of infection than in combat. What was the difference? Sulfa drugs-antibiotics. The story of their discovery reads much like a suspense novel, set against the backdrop of World War I trench warfare and political intrigue in Europe leading up to World War II. The scientific leaders in medical research, Gerhard Domagk at Bayer, Sir Almroth Wright's group "The Lords," and Ernest Fourneau at the Pasteur Institute, conducted meticulous work and experienced accidental discoveries that advanced medical procedures and determined the protocols for drug testing. Great reading both for curriculum support and general interest.-Brigeen Radoicich, Fresno County Office of Education, CA Copyright 2006 Reed Business Information.

Kirkus Reviews

The fascinating story of the world's first antibiotic. Science-writer Hager (Force of Nature: The Life of Linus Pauling, 1995) asserts that sulfa, which was eventually displaced as a miracle drug by penicillin, holds a unique place in the history of medical science. It banished the notion, widely held among doctors, that chemicals would never be able to cure most diseases; it established the research methods for finding new drugs; and it created the business model for developing them. Hager's account opens on the battlefields of World War II, where wound infection was a gruesome killer, then moves to postwar Germany, where industrial chemists manipulating azo dye molecules discovered that the addition of sulfanilamide (sulfa) created a chemical with bacteria-fighting properties. In England, doctors tried the new dye-based German wonder drug Prontosil on hospital patients; in France, researchers found that sulfa alone was the effective agent; and in the U.S., great quantities of sulfa-containing patent medicines were soon developed and marketed. The author enlivens his tale with a host of personalities, including German industrialist Carl Duisberg, head of the Bayer company; Heinrich Horlein, who ran Bayer's pharmaceutical division; researcher Gerhard Domagk, whose work won him a Nobel Prize, which the Nazis would not permit him to accept; and French chemist Ernest Fourneau, whose discovery of the power of sulfa on its own greatly dismayed the German makers of Prontosil. Hager also provides a vivid picture of Germany at the peak of its prestige in the international scientific community and of a very different country under the Nazis. Of special interest is the cautionary tale of theMassengill Company's Elixir Sulfanilamide, which contained an industrial solvent and killed more than 100 people in the U.S. This disaster led to an overhaul of the nation's drug laws, including passage of the 1938 Federal Food, Drug and Cosmetic Act. It put an end, the author states, to the era of patent medicines and launched the age of antibiotics. A rousing, valuable contribution to the history of medicine.

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The Demon Under the Microscope

Harmony

Chapter One

The blow to his head did not change Domagk's mind about the war. He, like most of his fellow university students, had been infected and rendered mildly delirious during the epidemic of patriotic fever that swept Germany in the summer of 1914. The tall, thin boy volunteered for service with more than a dozen of his classmates and friends soon after war was declared. They were inducted as a group into the Leibgrenadier Regiment of Frankfort on the Oder, a unit specializing in the use of grenades. They were given a few weeks of cursory training. Then they were loaded onto a train for Flanders.

They were young and full of energy, eager to join Germany's march, giddy with visions of a short, glorious war. Domagk, the son of a village schoolmaster, was eighteen years old and ready for adventure. He was also a young gentleman who brought his lute to training camp and played folk tunes around the campfire. He wanted to take the instrument with him to the front. When his officers told him that regulations forbade it, he dismantled it, sent the body back to his parents, and kept the neck attached to his knapsack as a memento. Inside the knapsack he carried a photo of his village sweetheart dressed in her white Communion gown.

Now, months later, he was beginning to miss his home, Lagow in the lake country of far eastern Germany. Picturesque and quiet, Lagow became the source of ever-sunnier memories the longer he spent in the army: cannonballing into the river below the mill; a swarm of children flying out of school at the end of the day; a group of friends concocting homemade gunpowder; sneaking his first cigar; the taste of a ripe pear in late summer. He spent his nineteenth birthday in the trenches of Flanders under fire from British ships, huddled in the dirt, "the heavens lit," he wrote his parents, "from burning villages." The glory of war began to fade. He and his comrades were soaked by freezing autumn rains, exhausted, starving, their uniforms caked with muck. Once while digging for drinking water, they broke open an abscess in the earth, a cache of rotting French soldiers, men killed and buried, he figured, by his own unit's grenades.

The Germans were dug in near the Belgian coastal town of Nieuport, where in late October the Leibgrenadier Regiment of Frankfort on the Oder was ordered to participate in a massive attack. Their officers told them that following a 4:00 a.m. German artillery barrage they would charge forward from their trenches and drive the enemy from their trenches. The young men synchronized their watches. They wrote last letters home and put them in their pockets, promising each other that the living would deliver them for the dead. They waited for what seemed a very long time in the dark, listening to shells screaming overhead, watching the flashes.

When the barrage stopped, the young German soldiers struggled and slipped out of their holes. They slogged through a football field's length of mud before they started falling, then heard the chattering of machine guns at short range, each one firing as many bullets as 250 rifle-equipped soldiers. Most of the boys Domagk had joined with were dead within a few seconds. The rest ran. Domagk later figured that only he and two or three others out of his group of fifteen student volunteers survived the battle alive and unwounded. They learned later that their charge was part of a huge failed offensive in which the Germans lost 135,000 soldiers, many of them recent university students, in the course of four weeks of fierce fighting. The British called it the First Battle of Ypres. The Germans called it Kindermord: "The Massacre of the Innocents."

Too ripped up to fight any longer in Flanders, Domagk and what remained of the Leibgrenadiers were transferred to the Eastern Front. A few weeks later, he lost his helmet near the Polish farmhouse. When he began to gather his senses about him in a Berlin hospital room, he discovered that his knapsack was gone, along with the neck of his lute and the photo of his sweetheart. All he now had of his childhood were memories. He remembered his father sitting at the window, waiting for the lamp man. The gas streetlights in Lagow were lit every evening by the lamp man, who came came by with his white horse. Then one day the man stopped coming. When Gerhard's father explained to him that the lamp man had been delayed because his horse was sick, the young boy was stricken by the idea. "I said at the end of the evening prayer with my mother, 'Good God, please make the lamp man come again,'" he remembered. "'Make his horse better again.'"

The German army hospital administration in Berlin, on reviewing their records, found that wounded Leibgrenadier Gerhard Domagk had attended a bit of medical school. It was decided that rather than send him back to the front lines, they would set him to the task of providing medical care for the wounded. Domagk was placed in a training program for medical assistants, one of hundreds of novices hastily pressed into service. After a few weeks of first-aid training, he was sent back to the Eastern Front, through Krakow to a field hospital in the Ukraine. He was fascinated by his trip through "the culture of the East," as he called it, the lands of Germany's destiny, the "beautiful but dirty streets," the Jews with "caftans reaching over their long boots and their corkscrew-like curls hanging down from their temples." He was especially impressed by the architecture he saw.

Flanders had been bad, but the Eastern Front was in many ways worse, especially when it came to medical care. The German casualties were just as heavy, but the hospitals were cruder, doctors fewer, supplies scarcer. The field hospital to which Domagk was assigned was stark, a farm in the middle of the woods roughly converted into a care facility with tents for wards and a barn for an operating room. Every day a miscellany of ambulances, cars, trucks, and farm carts arrived, disgorged their loads of quiet, white-faced wounded, and left for more. There was a constant, deep rumble from big guns a few miles away.

They were seeing wounds no one had ever seen before, thanks to the advance of military and industrial science. Newly deployed and unprecedentedly powerful weapons-artillery that could shoot shells 120 kilometers, high-explosive shells like the giant "Jack Johnsons" that geysered black earth a hundred feet in the air, airplanes and aerial bombs, tanks and poison gas-were slaughtering men at a rate and in ways unimaginable a few years earlier. In previous wars men had been shot or stabbed. Now they were blown to bits. The new weapons changed both the manner of fighting-more trenches, fewer cavalry charges-and what happened after. Because of the new weapons, the number of dead and wounded on both sides was staggering. During the entire Franco-Prussian War in the 1870s, a total of a quarter of a million men were killed and wounded on both sides over ten months of battle-roughly the same total number of killed and wounded at the First Battle of Ypres alone. Military leaders realized within a few months of the war's start that they needed to quickly expand their medical services. Anyone with any medical ability was pressed into service in the rapidly growing network of hospitals. That was how Domagk ended up in the woods of the Ukraine.

One of his jobs was to sort the new arrivals, separating the obvious infectious cases, cholera especially, and moving them out of camp as quickly as possible; setting aside those whose wounds were least severe, those with the best chance of recovery, and sending them immediately into the queue for surgery; then arranging for the remainder, the severely wounded, those with parts of their heads blown away, the cases with burst intestines, those no longer responsive. The worst were put under the straw. Comforted as much as possible, of course, given water, told their turn would come, to keep up their spirits, that the straw would keep them warm. They were generally in shock anyway, pulses thready, color graying, skin growing cold. They would last a night or two at most. Another of his jobs was to go out in the morning, pull the straw away, and make a final sorting. The living were reexamined. The dead went into that day's mass grave.

With the grisly morning chore out of the way, aides like Domagk were often given strip-and-clean duty. The wounded arrived filthy, their shredded uniforms crusted with dried blood and dirt. Some had been wounded for days, lying in water pooled in the bottom of bomb craters. Many were infested with lice. The young aides cut away the uniforms, peeled them off and burned them, then tried to wash the men as well as they could, working around the open wounds and broken bones. Most of the men were surprisingly silent and stoic, showing their strength. Others moaned or sometimes screamed.

That done, Domagk was often called to help in the operating room. The surgeons worked in shifts twenty-four hours a day, the operating theaters in the barn, lit with hissing carbide lamps at night, or in tents. Everything was in short supply-morphine, anesthetic, sterilization equipment, surgical instruments. It was impossible to keep the area clean. Gowning and masking were rare; assistants like Domagk worked bare-handed in their uniforms. "We could hardly keep the flies away," he remembered. All the medical staff were dizzy from exhaustion and from breathing the ether and chloroform they dripped onto pads and held over the mouths and noses of the wounded. The physicians and aides fled the operating areas whenever they could, napping outside even in the rain to get away from the insects and the fumes. Get what sleep you can; sort the new arrivals; strip and clean; pull the bodies from the straw; assist in surgery; fall into bed; get what sleep you can; sort the new arrivals.... This was Domagk's life for two years.

He was smart, young, and strong, he followed orders and worked hard. He earned a reputation as a reliable, steady man. And he was unusually observant. Some people had a feeling for medicine, a caring personality, or-like the surgeons-a combination of hand-eye coordination and steady nerves. Domagk had the ability to see. He watched everything, noted slight variations, quietly filed it all away. He witnessed more operations in two years than many surgeons see in a lifetime; helped set compound fractures, the bones bristling through the skin; used magnets to search for pieces of shrapnel; watched the surgeons run their fingers down the insides of intestines, probing for holes; assisted with countless amputations; threw the severed arms and legs onto a growing pile in a side room. The physicians came to trust him as he spent more and more time in the operating room.

Domagk for his part came to have a profound respect for what could be learned by cutting through the skin. He saw what lay beneath, saw what could be fixed with knives and thread and what could not. He saw that surgery could sometimes work miracles, and he learned about other things in medicine that did not work. Infectious disease was the bane of every military facility. Cholera was an especially severe problem in close-packed military camps. Around a campfire one evening, an old officer serving in Domagk's hospital told the young assistants about an epidemic of cholera that had raced through Hamburg fifteen years earlier, killing thousands in the city; a terrible disease, he said, the man still unsettled by the scope and swiftness of the contagion he had witnessed. He then told the young aides a bit of folk wisdom: Alcohol, he said, generously imbibed, could ward off cholera. The only thing they had in camp, apart from the pure alcohol sequestered to clean wounds, was red wine, so all the young men started drinking as much as they could get. Then, a few evenings after he was told the story, Domagk remembered, the old officer started complaining of a pain in his calves. A few hours after that, the older man was dead-from cholera. Folk wisdom, Domagk learned, was little protection against disease.

The most important thing that Domagk observed in the Ukraine was that even the most heroic and seemingly successful surgeries could go completely wrong a few days later. A soldier could wake one morning to find his carefully closed incisions, which had been fine the day before, now swollen, red, and painful. The edges, perhaps, had started to split open. Sometimes a foul-smelling, dark liquid oozed out. The skin around the wound began to take on a "a curious half-jellified, half-mummified look," as one physician described it. These were signs of what military physicians feared most in their postoperative cases: Gasbrand, the Germans called it. Gas gangrene. The doctors knew what caused Gasbrand-an infection by bacteria-and they knew how it progressed, the microscopic invaders eating away and essentially rotting the muscle tissue, releasing as they went both toxins that poisoned the patient and a gas that ballooned his wounds.

(Continues...)

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