The sulpha drugs, together with penicillin and the other antibiotics that followed, had a massive effect on medicine, saving countless lives in peace and war, as well as making possible many of the medical advances we now take for granted.

By the time WWII began in Europe the sulphonamides were well established as life-saving drugs. Discovered by Domagk, as Prontosil, the new drugs had been further developed and were showing their worthin treating childbed fever, pneumonia and septic wounds. Sulphonamides were used to great effect to treat the wounded at Pearl Harbor and continued to be used in the Pacific and, alongside penicillin, throughout the War.

One type of sulphonamide produced in England by May and Baker undoubtedly saved the life of Winston Churchill and thereby had a spectacular effect on the outcome of the War, and civilization in general. Late in 1943, at the height of the War, Churchill made a trip to the Middle East, meeting Chang Kaishek in Cairo, Stalin in Tehran and then on his return to Cairo, Roosevelt. Early in the morning of 11 December, he boarded a flight to Tunisia to spend a while relaxing at Eisenhower’s villa in Carthage. But things began to go wrong from the start. Off course, the plane was forced to make an unscheduled stop some 40 miles from Carthage. Churchill was left stranded in a cold wind, sitting on his luggage, for more than an hour. In the evening, he complained of a sore throat and bad headache and soon developed a temperature of 101 F. His personal physician, Lord Moran, was called and he used a portable X-ray machine to show that Churchill had a shadowon his lung that indicated only one thing; the Prime Minister had pneumonia. Moran immediately prescribed a new, British developed sulpha drug (sulphapyridine), commonly referred to as M&B, after its manufacturers. Churchill’s condition got worse, however, and he developed heart disease. The lungs of the 69-year-old Prime Minister became congested and his condition deteriorated rapidly. Then, miraculously, under the influence of the new drug, Churchill began to improve, and by Christmas he was working again. At the end of December he was transferred to Marrakesh to convalesce and was able to return to England by early January 1944. M&B 693 undoubtedly saved Churchill’s life in 1943, and, by allowing him to return to work on plans for the Anzio invasion of Italy and the Normandy invasion, affected the course of WWII. We obviously have no idea what would have happened if Churchill had not been saved by M&B. Perhaps his successor would have taken a completely different approach when it came, for example, to supporting Tito in Yugoslavia, to the aerial bombing of Germany or relations between Stalin and the Allies. What is not in doubt however,

is that without M&B the outcome of WWII would, for better or worse, have been very different.

Hitler’s escape from death

Antibacterial agents, of course do not discriminate – they save the wicked as well as the righteous. The next story provides a perfect example of the former, showing how, in all likelihood, penicillin, the antibiotic that has reduced mortality and relieved so much suffering, also saved the life of Adolf Hitler. Hitler lived a charmed life, so much so that one might believe the Fates were, for a long time, on his side. He survived wounding in the First World War, life in Munich during the interwar years, and then numerous near misses and assassination attempts as he rose to power, even while he was Führer. One assassination attempt that almost succeeded involved Count Claus von Stauffenberg. In 1944 von Stauffenberg smuggled a briefcase containing a bomb into Hitler’s briefing hut at the Wolf’s Lair in East Prussia. As he made his hasty exit, he heard an enormous explosion, which he assumed must have killed everyone in the hut, including Hitler.

Unfortunately he was wrong; Fate had once again smiled on Hitler. Soon after von Stauffenberg placed the bomb, one of Hitler’s adjutants moved it behind a thick wooden table leg. This helped dampen the blast, leaving Hitler alive, although badly injured. von Stauffenberg, his family and co-conspirators were not so lucky; some committed suicide, while most were hunted down by the Gestapo and the SS, tortured and then brutally murdered. Hitler’s personal physician, Theodor Morell, arrived almost immediately on the bomb scene and began administering first aid. It was clear, however, that Hitler’s life hung on a thread. Morell is usually portrayed as a quack who did more harm than good to his principal patient. Despite the fact that he kept Hitler high on drugs, Morell also did some surprisingly imaginative work on a novel probiotic called Mutaflor, which he prescribed to ease Hitler’s long-term stomach problems. Morell probably began treating Hitler with sulpha drugs after the explosion, but he had a small supply of a much better drug, penicillin, in his arsenal.

The Germans and their allies had been remarkably slow in developing their own penicillin so, by the time of von Stauffenberg’s assassination attempt, they had only small amounts of Axis-produced penicillin. Doubtless these meagre supplies would have been available to Morell for use in treating Hitler and his criminal henchmen. Fortunately for the Führer, Morell had access to the more potent American and British penicillin. The Americans, in particular, had decided to supply their field doctors with penicillin, and fighter and bomber pilots carried a supply when they flew over Germany. Penicillin was also sent through the Red Cross to prisoner-of-war camps. Morell clearly would have had access to some of this Allied penicillin; Adolf Hitler would naturally have been the first person to receive it. My own recent researches in fact leave little doubt that Morell used Allied penicillin to help save Hitler’s life in 1944. A Germany at war without Hitler in 1944 would have been very different. Perhaps the Germans would have continued to fight under a new Führer. Conversely, a German Army without Hitler’s meddling may have done better at Stalingrad and on D-Day; we shall never know. Maybe the Germans would have sued for peace and all those who died in the war and the concentration camps, from 1943 onwards, would have survived; the speculation is endless.

For good or for worse, antimicrobial agents have dramatically changed the course of history. Although we usually emphasize their positive effects in saving lives, these two stories show that history is never simple and that antimicrobials have had a complex impact on our modern world.

 

Prof. Milton Wainwright

This article was published in “Microbiology Today” Magazine vol34|feb2007