The First Miracle Drugs: How the Sulfa Drugs Transformed Medicine (review)
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The First Miracle Drugs: How the Sulfa Drugs Transformed Medicine. By John E. Lesch. Oxford: Oxford Univ. Press, 2007. Pp. 364. $59.50.

We are fortunate to be living in what has been termed the "Golden Age of Antibiotics," 60 or so years when most bacterial infections have been treatable with the aid of antibiotics. While this golden age is currently being threatened by the widespread appearance of antibiotic resistance, there remains considerable hope that new antibiotics (or entirely new approaches to antibacterial therapy) will be developed to save us from a return to pre-antibiotic days. When the antibiotic revolution occurred, in the shape of penicillin (gramicidin arrived first, but this proved of limited medical use), antibiotics were rightly heralded as miracle drugs.

The story of how this golden age came about has been well documented, both in scholarly articles and books aimed at the popular science market (Wainwright 1990). In all such popular accounts, penicillin is shown to have arrived miraculously from nowhere to transform medicine. Examples are generally given of where patients (to increase the emotional drama these are often children) are snatched from the jaws of death by penicillin. The miraculous image of penicillin owes much to the fact that it helped the Allies win the Second World War. [End Page 639]

We should not be too dismissive of these popularist accounts; penicillin was indeed a miracle drug and it did much to transform medicine. On the negative side, American penicillin almost certainly saved Hitler's life after the Stauffenberg assassination attempt of 1944: miracle drugs lack discrimination when it comes to their ability to save lives (Wainwright 2004). The Germans and their Axis allies, strangely, never developed penicillin in large quantities for use on wounded troops of civilians, despite setting up a number of number of research programs with this aim both in Germany and in occupied countries such as Holland. This deficiency is particularly surprising since the initial information on penicillin was freely available in the medical literature, and the Germans had no problems obtaining a penicillin-producing strain of Penicillium notatum; attempts to develop penicillin in occupied countries were doubtless hindered by occult sabotage. Germany and her allies, having no penicillin in quantity, had to rely instead on other antibacterial agents, namely the sulfonamides. This, by a circuitous route, brings me to the subject of the book under review.

The First Miracle Drugs, by Berkeley Professor of History John E.Lesch, is a fascinating and comprehensive account of the discovery and use of these first widely available, commercially produced, antibacterial agents, commonly called the sulfa drugs. Lesch provides us with the full story and shows how a collection of wonder dugs have been largely overlooked in the shadow of the "penicillin miracle" and the subsequent development of other antibiotics.

The sulfonamides are not of course antibiotics, a term defined by Selman Waksman to refer to medically useful antibacterial agents that are produced by other microorganisms (the definition has since been extended to include antibacterial agents from plants and animals). Sulfonamides are not of biological origin but are synthesized in the laboratory. Lesch provides an excellent and full account of how the German chemist Gerhard Domagk came to discover the effectiveness of these agents in combating bacterial infections. As with discovery of penicillin, there was an element of serendipity in the story, since the first of these compounds, Prontosil (sulfamidochrysoidine), was not antibacterial in vitro but only killed pathogenic bacteria when injected into infected mice. Fortunately, Domagk routinely used mice, thereby providing an excellent example of how a group of drugs would have been missed had vivisection been outlawed and Domagk's animal work banned. Which brings us neatly to one of the numerous interesting side stores in the book, an account of how Hitler and the Nazis did in fact ban vivisection as part of a kind of primitive folk culture aimed at promoting all things natural. The fact that the sulfonamides were chemical agents meant that, in this Nazi fantasy world, their development was nearly stillborn. The book contains other similarly fascinating anecdotes, such as the well-dumented story of how a sulfonamide (M & B 693, or perhaps...