The Demon Under the Microscope, page 21
Long and Bliss might not have been the first in the United States to use the new drug, but Johns Hopkins was by far the biggest, most enthusiastic, most influential U.S. center using it in 1936. Hopkins was respected around the world. Hopkins researchers published their work in leading journals. Hopkins did more than any other center in seeking to solve the mystery of how the drug worked. In addition to Long and Bliss’s clinical and animal results, for instance, E. K. Marshall at Hopkins discovered a simple way to measure the concentration of the drug in body fluids, leading to more effective ways to relate dosage to effect. By the fall of 1936, Hopkins researchers were in the middle of a detailed comparison of Prontosil with pure sulfa, confirming in a more carefully quantified way from metabolic and toxicological studies what the French were saying: Both worked.
Sulfa was such a hit at Hopkins that other physicians started joking about it, saying that if you went to see a doctor there, you were immediately put on sulfa; if you were not well after a week, they might give you a physical exam. Long got calls from physicians pretending to be famous people asking for miracle cures. One day he was with a colleague when his phone rang. The other physician answered and heard a woman’s voice on the other end ask for Dr. Long. He gave Long the phone and heard him say, “You can’t fool me this time. I know you’re not Eleanor Roosevelt.” Then Long hung up. The phone rang again a few seconds later. This time Long answered himself. After a moment he said, meekly, “Yes, Mrs. Roosevelt, this is Dr. Long.”
CHAPTER FIFTEEN
FRANKLIN DELANO ROOSEVELT JR. was having second thoughts about his engagement.
Not about the girl. His fiancée, Ethel du Pont, was lovely and wealthy, the favored daughter of one of the most powerful men in America. Franklin Jr. and Ethel had been carrying on a romance ever since her coming-out party. It had been a very private courtship. Their families, one rock-ribbed Republican, the other ultraliberal Democrat, were, to put it mildly, at political odds, and neither wanted the publicity. Eventually, of course, the newspapers found out that FDR Jr. loved Ethel du Pont.
Tonight he was unhappy. It was November 20, 1936, just weeks after his father’s reelection as president of the United States, and here he was at the geographic center of Rhode Island Republicanism, the Hock Popo Ski Club at the Agawam Hunt, dressed in a ridiculous outfit, in the middle of a costume ball given by some of the richest people in the nation. The hall was full of the sort of plutocrats and industrialists who thought his father’s “New Deal” was something akin to a socialist revolution. Here he was, the president’s son, wearing leather lederhosen, a bolero jacket, and a green Tyrolean hat with feather, Ethel in a peasant dirndl skirt, straw hat, and puffed-sleeve blouse trimmed with edelweiss—cartoon Germans at a time when his father was beginning to take on Hitler in public speeches.
The week since their engagement announcement had been stressful, a string of cocktail parties and formal dinners, starting with a glittering bash thrown by the du Ponts at Owl’s Nest, the family estate in Delaware. There was endless and endlessly tiresome press attention, most often presented in the form of Romeo-and-Juliet stories featuring attractive young lovers from warring families.
Now, to top it off, he was not feeling well. Maybe he was catching a cold. He was accustomed to good health—strapping and handsome Harvard senior and crew member that he was—but in the past few days he had begun to feel run-down. His head felt like it was full of concrete. His throat was sore. Still, Ethel was having a good time, so they stayed a respectable amount of time, drinking and dancing.
Five days later, the day before Thanksgiving 1936, FDR Jr. was admitted to Massachusetts General Hospital in Boston. His admission papers listed the reason as an acute sinus infection. That was the beginning.
WHEN SHE HEARD about her son, Eleanor Roosevelt made certain, first of all, that he was installed in Phillips House, the section of Mass General that was more like an exclusive hotel than a hospital. Then she canceled Thanksgiving plans at the White House. The diagnosis did not sound dire, but no son of hers would spend a holiday in a hospital alone. President Roosevelt, on a goodwill trip to South America aboard the USS Indianapolis, wrote her, “Dearest Babs . . . I’m sorry about Franklin’s sinus. I hope it will clear up quickly and think it will if he will go to bed early for a week.” She rushed to spend the holiday in Boston, where the attending physicians assured her that she had nothing to worry about. Sinus infections generally resolved themselves in a few days. If he got his rest, it was more than likely that FDR Jr. would be released no later than the following Monday. She telegraphed the president, FRANKLIN JR MUCH BETTER THINK HE CAN LEAVE FOR SOUTH IN A FEW DAYS.
Then she flew home. There was little more she could do, and she was needed at the White House. In any case Ethel du Pont was on her way to stay with the patient. All, it seemed, would be well.
Five days later the First Lady rushed back to Boston, this time by car, through a pouring rain. Something had gone wrong. FDR Jr. was not getting better. His fever was reaching dangerously high levels. After a restless night, he seemed to rally, and the next day the hospital physicians again assured the First Lady that he was going to be fine. It was just a small setback. He would be released shortly. Again Mrs. Roosevelt returned to Washington.
But her son was not released. Publicly, a stream of recurring, reassuring public statements continued to flow from hospital administrators and appeared in newspapers on an almost daily basis. Privately, the patient’s condition continued to deteriorate.
After another week with no improvement, Mrs. Roosevelt took charge. She consulted her friends in the Boston area and arranged to bring in the best ear, nose, and throat man in the Northeast, Dr. George Loring Tobey Jr., as her son’s personal physician. Tobey was fifty-five years old and at the peak of his skills. He was of the wrong political persuasion—a staunch Republican with a love of expensive suits, a blueblood who could trace his lineage back well before the American Revolution—but he was also a fine physician, a “fashionable and crackerjack Boston ear, nose, and throat specialist” as a journalist of the day put it. He was well trained, well respected, well connected, and highly recommended.
After examining the president’s son, Tobey ordered immediate changes in his care. He was concerned about a tender spot forming under FDR Jr.’s right cheek; Tobey thought it was likely to be a pocket of infection, a small but growing abscess, perhaps an important part of the reason the young man was not getting better. He suspected strep because of the throat but ordered lab tests to see exactly what sort of organism was causing the problem. Then he asked the First Lady’s permission to perform an operation to drain it.
Suddenly things began to go seriously wrong. Before Tobey could operate, FDR Jr.’s throat began to close, making it difficult to breathe. His fever spiked to an even more dangerous level. He began coughing up blood. It appeared that he was hemorrhaging from the throat.
Tobey made some fast decisions. The lab tests, when they came back, showed that FDR Jr.’s abscess and throat infection were caused, as he had suspected, by strep. This worried Tobey deeply. The strep had gotten into FDR Jr.’s sinuses. The bleeding in the throat could mean that strep was destroying the tissue there, possibly opening a passageway to an infection of the bloodstream. A blood infection with this particular germ would make everything up to this point look mild. A strep blood infection, after all, had killed the son of another president just twelve years earlier.
The wild card was the bacterium itself. Strep was very bad, as Tobey well knew, the cause of millions of deaths. Some strains of strep, however, were far worse than others. There are factors in our favor, he told Mrs. Roosevelt. Your son is strong, young, and physically fit, and the staff at Massachusetts General is giving him the best possible care. He then advised Mrs. Roosevelt to return to Boston as quickly as possible.
In addition to his other attributes, Tobey read the medical literature voraciously, keeping up with all the latest developments. Unlike many physicians, he was not afraid to try something new. He had heard about Prontosil and had been among the first in the United States to try it on a few patients with severe strep infections. He had seen good results. He knew, too, about the spate of recent work by Long, Bliss, and the others at Hopkins. It was increasingly clear that sulfa could work in advanced cases. It was still unproven in his view, still experimental, and it went against the grain to try an experimental drug on the president’s son, but he was running out of options.
He and Mrs. Roosevelt talked about Prontosil. Before she would approve its use, she wanted to hear more about it. She called Perrin Long to find out firsthand about his experience with the drug, its side effects, and how it might relate to her son’s case. She hesitated about using her son, as she wrote later, as a “guinea pig,” but after talking with Long and finding out that the side effects he was seeing were very mild, she gave Tobey permission to try it.
PRONTOSIL SOLUBILE was a beautiful drug. In this liquid form, it had a vibrant, rich color that physicians described as port red or ruby red; in a glass vial or syringe, it caught the light deep inside and shone. It was the color of blood, but with a clarity, a purity that real blood never had. In mid-December, during FDR Jr.’s third week in the hospital, Tobey administered the first injections. Dosage was still a question mark; given the patient’s deteriorating condition, Tobey erred on the side of aggressive therapy and dispensed generous doses, injecting the red liquid and managing to get down his patient’s throat some of the white pills he had obtained from Bayer’s U.S. arm, which was getting ready to sell them under the trade name Prontylin.
There was little change in the first hours. Reporters now knew there was a story here, and they began asking Tobey questions. On December 13 he told them he was waiting for FDR Jr.’s fever to lower; it was still too high to allow the operation he wanted to do for the sinuses. The press asked if the young Roosevelt would make it home for the holidays. Tobey said he was “dubious.”
Both Ethel du Pont and Mrs. Roosevelt were at his side now. “We still continue to spend a great many hours at the hospital just waiting around,” she wrote, “for I never knew the time when hospital routine worked out exactly as it was scheduled to work. I look back over a rather long life, and waiting around is one of the things which are inevitable where illness is concerned. So you want to keep some occupation handy which you can pick up whenever you are told politely to step out of the room, or just to wait until something or other is done. The really busy people are the nurses and the doctors, so you are glad enough to wait patiently and store up energy for the time when you may need it.” Eleanor Roosevelt spent her waiting time on a chair in the corridor outside her son’s room, answering piles of correspondence.
The injections were tingeing Franklin Jr.’s skin red, a sign that the drug was working, Tobey told her. His skin would soon return to its normal shade. Tobey was waking the patient to give more medicine every hour, taking blood samples and tracking his temperature. During the first long night, there was still little change. At least he was not getting worse.
Then, finally, on the fourteenth, FDR Jr.’s fever began to subside. Tobey noted that the swelling in his throat was easing. By the middle of the day, he was sleeping more easily and seemed to have more energy when he woke. The infected area in his cheek was no longer as inflamed or tender. His temperature dropped to normal in the space of a few hours. He woke up hungry. Tobey told reporters that evening that the patient was “very much improved”—so much so that an operation was no longer needed.
In fact, there was a complete turnaround. FDR Jr. felt so much better so quickly that Tobey had to enforce an unusual rule: In order to prevent damage to the healing throat tissue, the patient was forbidden to laugh.
WHAT HAPPENED WITH FDR Jr. was not as important as what happened next. A team of reporters from the New York Times kept after Tobey and soon got him to talk about Prontosil. They broke the story on December 17 under a front-page headline that read YOUNG ROOSEVELT SAVED BY NEW DRUG. The story caught the imagination of the nation, went out over the newswires, and was widely reprinted in both the United States and leading newspapers worldwide. During the next weeks, it made it into the newsweeklies, onto the radio, and into monthly magazine features. It was an enormous story for a short time, the first most of the public had heard about Prontosil and the other sulfa drugs. It was a positive story, a medical triumph, a welcome relief from the endless string of dark stories about the tribulations of the Depression. It was the spark that would ignite worldwide demand for the drug. After reading about the Roosevelt cure, people began writing Mass General, Tobey, FDR Jr., even the White House, asking for the drug, demanding to know more, and offering free advice. Several young women, apparently unaware of Ethel du Pont’s presence, proposed marriage. One man asked Mrs. Roosevelt why FDR Jr. wasn’t being cared for at the White House so that the money saved on his hospitalization could be sent to him or some other needy person. Many of the inquiries were from sufferers of chronic sinus infections; Tobey had to make public statements trying to distinguish between that condition (which could be caused by a number of different bacteria or viruses, many of which did not respond to the new drug) and strep infections. The demand for Prontosil and its derivatives in the U.S. soared.
Prontosil saved FDR Jr.’s life, but he continued to suffer from a severe sinus infection. He was so weakened that he spent not only Thanksgiving but Christmas in Phillips House. At Christmastime, Mrs. Roosevelt wrote in her daily syndicated newspaper column, “I hated to leave [Washington], but we couldn’t any of us bear to think of Franklin Jr. alone by himself, so here I am in Boston.” Her trip had a second purpose: She was, she wrote in a private letter, “weary and depressed” from the work of getting her husband’s second term rolling and “exhausted” by the “painful and perilous” illness of her son. Going to Boston allowed her an escape from the elaborate formal rituals of the season. While FDR Jr. slept, she could read and relax.
By now, FDR Jr.’s case did not require vigilant attention from members of the family. He would eventually fight off his sinus infection and in June would marry Ethel du Pont (the first of what would eventually total five marriages). He would serve and be decorated in World War II. He would be elected to three terms as a U.S. congressman. But nothing he did would equal the impact of his illness and recovery. Linking the most famous name in America to the curative powers of Prontosil kicked off America’s great sulfa boom.
CHAPTER SIXTEEN
SULFA WAS SLOW coming to America. By the end of 1936, when FDR Jr.’s case first hit the newspapers and the U.S. public was introduced to the new medicine, sulfa was already well known and becoming widely used in Germany, France, and Great Britain. Following the publication of Colebrook and Kenny’s first study of the drug’s astounding effect on childbed fever victims in the summer of 1936, the medical community awoke to the fact that Prontosil was more than just another overhyped German chemical cure. This was a breakthrough. After a quarter century of pessimism, chemicals were suddenly the talk of medicine again. “The whole field is one of the most fascinating that has been presented for some considerable time alike to the clinician, the chemist, and the bacteriologist,” enthused a British biochemist after the childbed fever numbers were published. Prontosil in its various forms—including the pure sulfas, Prontosil album (the German version), and Septazine (the French)—was rapidly adopted by maternity hospitals and everywhere that strep diseases were treated. It was cheap, it was lifesaving, it had few side effects, so why not give it to everyone? Its use spread rapidly—to some observers, alarmingly. When Colebrook found that obstetricians were prescribing sulfa not only for childbed fever patients but as a preventive medicine given to every woman who arrived to give birth, he felt compelled to write a strong letter to The Lancet. In it he reminded everyone that his studies did not indicate that the drug should be given to otherwise healthy pregnant women in hopes that it might stave off a possible infection. He then noted that the drug was not without side effects—nausea, changes in blood chemistry, some disquieting effects on kidney function in rare cases, a few reports of allergic reactions—and that practitioners would see more side effects the more they used sulfa. In other words, sulfa was not to be handed out like candy.
