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The White Plague in the City of Angels

Caroline Luce, Author

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Scientific Discovery of streptomycin - 1946

The idea that tuberculosis and other infectious diseases could be cured with “chemicals” had first been proposed by a colleague of Dr. Robert Koch’s named Paul Ehrlich. Dr. Ehrlich had helped Dr. Koch perfect his chemical staining technique, and worked for decades to develop similar chemical serums that could be used to treat a variety of diseases, including syphillis. Ehrlich successfully developed a toxin-based treatment known as "the magic bullet" for which he was later awarded a Nobel Prize. An additional advancement came in 1928 when a Scottish scientist named Alexander Fleming discovered a type of mould called penicillium that could be purified and used to treat bacterial infections in the body. He called his discovery penicillin, and it is widely recognized as the first modern antibiotic.

The theories of Ehrlich and Fleming informed the work of Selman Waksman, whose research on soil microbiology ultimately lead to the discovery of streptomycin, an antibiotic to treat tuberculosis. Waksman (nee Zolman Abraham Waksman) was born to Jewish parents in Priluka (Ukraine) in 1888 and studied biology in Odessa before coming to the United States in 1910. After earning degrees from Rutgers and University of California Berkeley, Waksman headed a soil microbiology laboratory at Rutgers where he mentored graduate students including Rene Dubos, H. Boyd Woodruff, and Albert Schatz. Schatz isolated a soil-based bacterium named streptomyces grisens, believing that, if isolated and purified, it could provide a more powerful antibiotic for infections resistant to Fleming’s penicillin. By the end of 1943, he and his mentor Waksman had successfully refined streptomycin, Schatz published his dissertation on the topic, and pharmaceutical company Merck & Co. signed on to fund clinical trials for the new antibiotic.

Meanwhile, another cure for tuberculosis was being developed at the very same time in Copenhagen by a Danish biochemist named Jorgen Lehmann. Lehmann had being working on vitamin extraction and, influenced in part by Dr. Ehrlich’s “magic bullet,” began developing a chemical solution that would target and kill bacterial infections. He developed a substance called para-amino-salicylic acid (PAS), and began testing it on patients just as the Second World War began to flare up in his country and across Europe. Due to the chaos and tumult of the war, Lehmann was not aware of the efforts of Waksman and Schatz, and did not publish his results until after they had announced their discovery of streptomycin, by which point his trials had proven PAS’s success in treating tuberculosis.

Both groups of scientists soon realized that neither of their “cures” was entirely effective in treating tuberculosis. Patients quickly developed resistance to the drugs and each drug failed to stop the spread of the disease in many cases. But after the war, doctors and scientists working with streptomycin in New Jersey and those working with PAS in Europe began corresponding more closely and collaborating. By 1948, after rounds of trials on two continents, they realized that the most effective treatment for tuberculosis was to offer the two drugs in combination. They developed a combination therapy called isoniazid that, if given for several months, cured patients of tuberculosis completely.

The introduction of isoniazid had an immediate impact on the tuberculosis epidemic across the world. For decades, hundreds of thousands of cases had been reported every year, but by 1953, only 84,000 new cases of tuberculosis were reported in the United States. The death rates associated with the disease also dropped off precipitously: while in 1930, 70 out of every 100,000 people in the United States died from the disease, by 1954 only 10 out of every 100,000 did. [1] The advent of a cure greatly reduced the fears surrounding the disease and virtually ended the Sanatorium movement

In 1952, Waksman was awarded the Nobel Prize in Physiology in Medicine for his work to develop streptomycin. But all of his collaborators, including Albert Schatz, Jorgen Lehmann, and his other students, were denied the honor, leaving their contributions overlooked.

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