The Dawn of the Sulfa Drugs

THE DAWN OF THE SULFA DRUGS

The "Sulfa" Drugs

Infectious diseases had no truly effective agents for treatment available until the 1930s, when sulfonamides were developed as the first systemic drugs effectively used to fight the major killers of the twentieth century. The first of the sulfa drugs, Prontosil, was discovered by the German physician and chemist Gerhard Domagk. In 1932 he noticed that Prontosil, a red azo dye used in the laboratories of the dye industry, cured streptococcal infections in his laboratory mice. Domagk was awarded the 1939 Nobel Prize for medicine or physiology for his research, but the Nazis forced him to decline it. Workers at the Pasteur Institute (Paris) found that the active component of the dye was sulfanilamide, and the dawn of the modern era of antibacterial chemotherapy truly began.

American Contributors

American scientists Perrin H. Long and Eleanor A. Bliss brought Prontosil to the United States and used it in clinical applications at the Johns Hopkins Hospital beginning in 1936. Their invitro experiments and experimentation on mice led them to conclude, "the careful clinical use of para-amino-benzene-sulfonamide and its derivatives in the treatment of human beings ill with infections due to beta-hemolytic streptococci is warranted." Another major contributor to the modern age of chemotherapy was E. Kennerly Marshall Jr., a professor of pharmacology at Johns Hopkins, who created a process for determining the amount of sulfanilamide in the blood of patients receiving it. Clinical experience proved the drug was effective in streptococcus and other bacterial organisms such as meningococcus and gonococcus.

The Beginning of the Revolution

The sulfonamides soon offered a more hopeful outlook for sufferers of gonorrhea and streptococci infections, but there were certain drawbacks. The drugs often created serious side effects such as kidney failure. Other patients showed such allergic reactions as rashes and fever. Strains of bacteria, especially gonococci, developed a resistance to the sulfonamides, and the drugs had a relatively narrow range of activity since many infectious diseases were not affected by their action, The greatest development of the sulfa drugs came in the decade of the 1940s when the needs of the war promoted their research and development. They later came to be overshadowed by the development of newer antibiotics such as penicillin and tetracycline. But the 1930s marked the real beginning of the revolution of the management of many important infectious diseases, and the sulfonamides continue to be widely used today.

DOCTORS AND THE DEPRESSION

When incomes fell after the stock market crash of 1929, Americans were forced to make choices between paying for food or paying their medical bills. A 1933 government survey of unpaid bills found the delinquency percentage to be 8.9 percent for department stores, 24.7 percent for grocery stores, 45.1 percent for landlords, 55.6 percent for dentists, and 66.6 percent for physicians. In addition, Americans, especially the poor, used medical services less. All this meant lower incomes for doctors. In California, for example, the average net income of doctors fell from about $6,700 in 1929 to $3,600 in 1933. Nationally, private practitioners lost 47 percent of their 1929 incomes by 1933.

Source:

Paul Starr, The Social Transformation of American Medicine (New York: Basic Books, 1982), p. 270.

Sources:

James Bordley and A. McGehee Harvey, Two Centuries of American Medicine/1776-1976 (Philadelphia: W. B. Saunders, 1976), pp. 447-448;

Theodore L. Sourkes, Nobel Prize Winners in Medicine and Physiology, 1901-1965 (London: Abelard-Schuman, 1966), pp. 214-215, 219.