Review of The Demon Under the Microscope by Thomas Hager (Three Rivers Press, 2006)

The demon the title refers to are bacteria, which when present in wounds can often lead to death when not treated by antibiotics. Prior to the 1930s there were no effective cures for many forms of bacterial infection, such as strep, staph, meningitis, pneumonia, gonorrhoea, gangrene and tuberculosis, other than to hope the body’s own defences managed to fight back and overcome the invaders. That meant high rates of death from infected wounds for soldiers and for women giving childbirth, but also that what seemed like fairly innocuous cuts could lead to death within a few days. After serving as a medic in the First World War and seeing thousands of men have limps amputated to try and stop the spread of infection or die from their wounds, Gerhard Domagk wanted to change that. After training as a doctor he moved in to pathology research, first in a university team, then in the industrial giant, Bayer. If Bayer could produce a chemical solution to bacterial infections, it could reap a vast fortune. Domagk headed up the research lab to identify an effective drug, working with chemists to create and test on mice hundreds of new synthetic compounds. They hit on a line of research that linked sulphur to azo dyes, discovering that a few of their new concoctions worked, enabling mice infected with strep to fight back and remain well. So was born a whole family of sulfa drugs, the first antibiotics, which massively improved survival rates from bacterial infections.

Hager tells the story of the invention of sulfa, predominately by focusing on the life and work of Gerhard Domagk, though there are plenty of sidebars where other parts of the tale are filled in. The result is a book that is not told in a linear fashion. Indeed, the book pings around the calendar like a pinball machine in the first half in particular. It starts, quite oddly, at December 1941 and the attack on Pearl Harbour (presumably to orientate the book for an American audience), then swaps to 1914-18, then the 1920s interspersed with 1084, the seventeenth century, the 1870s, the eighteenth century, nineteenth century, and also travelling from Germany to France, England, Scotland, the Netherlands, the US. From around page 70 it starts to settle down into a more linear narrative, progressing from the late 1920s through to late 1930s, mostly located in Germany, with a few forays to England, France and the US. The story also starts to diversify from Domagk and medical tales to the wider political economy of the pharmaceutical industry and science, as not only did sulfa products lead to a revolution in treatment, but also how the drugs were developed, tested and approved, after one particular drug had catastrophic effects. Prior to sulfa, pretty much anyone could create and market a health product without highly regulated testing or naming ingredients or side effects. Indeed, Hager goes as far as to argue that the nature of health care was fundamentally changed, with physicians moving from being caregivers to technicians, and the predominant site of care moving from home to hospital. Having been forced to reject his Nobel prize by the Nazis in 1938, Domagk finally received it in 1947. Despite the fractured narrative, created by trying to centre the story on Domagk when it is really a multi-threaded tale, Hager tells a fascinating history in an engaging voice.