Who’s ready for more World War Two science?
No? No one?
Well, this story is about all kinds of badness,
yes—but also a lot of incredible goodness.
The history of science up until the Cold War
is often overshadowed by the Manhattan Project.
But today we are going to talk about advances
in biomedicine, or healthcare based on a biological
understanding of human bodies and diseases.
[Intro Music Plays]
Many biomedical breakthroughs, like antibiotics,
were developed in the twentieth century, but
a few are much older.
The original wonder drug is a natural pain-relief
compound of the opiate class that is still
widely used today—morphine.
A German pharmacist’s assistant named Friedrich
Sertürner isolated it around 1804.
Morphine induces relaxation and sleepiness,
and too much can kill you. Aaaaand it’s
super addictive. But very effective and relatively
cheap!
Soon, a German company called Merck began
selling it. And in the 1850s, the hypodermic
needle was introduced.
Now, the last time we talked about medicine,
exciting things were happening: namely, germs!
Most diseases are caused by germs.
So, with a germ theory—not to mention a
cell theory, and vaccines, and beer—the
life sciences in the late 1800s looked pretty
great.
But… vaccines are slow, so if you’re dying
right now—maybe due to an infected war-wound—they
don’t work well.
And, they only work on certain diseases. Also,
there just weren’t that many vaccines, and
there were a lot of diseases. In fact, even
reliable diagnoses were a problem.
So what the life sciences had gained in theories
and models, they still lacked in applications.
Advances came in the form of chemical compounds
that had specific effects on specific physiological
systems.
In 1907, the lab of German chemist Paul Ehrlich
created an arsenic compound sold under the
name Salvarsan that was antimicrobial but
not toxic to humans.
Ehrlich used Salvarsan to effectively treat
syphilis, which was a huge deal: the first
modern chemical therapeutic could treat one
of the biggest public health problems!
But Salvarsan didn’t work on late-stage
syphilis patients who suffered from general
paresis of the insane, or GPI. Which had very
serious symptoms, including delusions, and
was fatal.
But in 1917, Austrian physician Julius Wagner-Jauregg
developed an effective therapy… which involved
infecting them with malaria. While weird,
malaria-fever treatment for GPI gave hope
to people suffering terribly, and Wagner-Jauregg
won a Nobel for his efforts.
Another psychiatric discovery, in 1933, was
insulin shock therapy to treat schizophrenia
and other mental disorders: patients were
dosed with the hormone insulin, causing them
to go into shock and then a coma. It became
common in the 1940s and 50s. But this method
of inducing shock wasn’t alone; there were
several.
The most famous, invented in the 1930s, was
electroconvulsive treatment or ECT. Many people
have objected to ECT over the years, and the
exact way it’s been used has changed. But
today, as a treatment for severe depression,
it’s considered safe.
One pre-World War Two treatment that is no
longer used is lobotomy, or surgically cutting
connections in the brain’s prefrontal cortex.
This left patients with reduced responsiveness
and awareness. They had literal brain damage,
which could help control severe symptoms of
mental disorder.
Lobotomies became common around 1935, first
in Europe, then in the United States. Initially,
they were typical psychosurgeries, performed
in hospitals.
But in 1945, neuropsychiatrist Walter Freeman
figured out how to perform lobotomies using
an icepick. He practiced on a grapefruit at
home. And then he went on the road, popularizing
his much faster transorbital technique.
In the United States, 40,000 people were lobotomized.
Were they all suffering from severe mental
disorders, and did they enjoy better lives
after the surgery? Some probably did.
But, unfortunately, in many cases, lobotomies
were used to make patients easier to manage,
or for even worse reasons. In 1977, Congress
investigated the history of the lobotomy,
concluding that it had often been used to
harm minorities.
The biggest advancement in biomedicine at
the time was the development of antimicrobial
compounds, like Salvarsan.
In 1931, German chemists developed an effective
anti-malaria drug, mepacrine.
Allowing medics to treat soldiers with malaria
helped open up much of the world’s equatorial
regions to combat during World War Two.
Even more revolutionary, Gerhard Domagk
—a researcher working in the
same lab that synthesized mepacrine—discovered
sulfanilamide,
the first drug that broadly treated a whole
bunch of diseases caused by bacteria. He was
awarded the Nobel in 1939… which he was
forced to give back, because Nazis.
Sulfanilamide was only the first of a whole
class of antibacterial drugs, the sulfonamides,
or sulfas. These were the first antibiotics.
With them, doctors could quickly and cheaply
help thousands of patients—treating everything
from meningitis to gonorrhea to burns.
But most people today don’t go to the doctor
and ask for sulfas.
Because in 1928, in the basement laboratory
of St. Mary’s hospital in London, Scottish
physician and microbiologist Alexander Fleming
noticed, quite by accident, that some mold
growing in his lab seemed to kill some harmful
bacteria.
He cultured it and started experimenting.
Fleming discovered a whole new class of antibiotic
drugs—the penicillins—derived from that
mold, penicillium.
Alas—at first, his colleagues didn’t understand.
Fleming wasn’t great at explaining his work,
and it took him years to convince them. A
few doctors used penicillin in the 1930s.
But it wasn’t until nearly ten years later
that penicillin became a “wonder drug.”
Again, Merck scaled up production, followed
by Pfizer. And again, World War Two drove
demand.
The penicillins pretty much replaced the sulfas
during World War two, treating sexually transmitted
diseases, burns, heart infections, scarlet
fever, pneumonia, and infections of the skin,
mouth, and throat. Whole categories of disease
that had once been deadly became manageable.
This is good news for me by the way because I am allergic to sulfas as I found out
when I took one and became a giant puff.
Later drugs created based on the penicillins,
starting with ampicillin in 1961, were even
more effective against more diseases.
Fleming won the Nobel in 1945, sharing it
with two other scientists who had figured
out how to scale up production of the mold
to industrial levels—English pharmacologist
Howard Florey and German biochemist Ernst
Chain. They were all knighted.
So yay, more treatments for more diseases,
and doctors being knights. Unfortunately,
one medical pioneer was definitely not treated
with this respect. Introduce us, ThoughtBubble:
African-American surgeon Charles Drew showed
enormous promise. He graduated from medical
school at McGill University in Montreal, Canada,
in 1933 and became an instructor at Howard
University in Washington, D.C., in 1935. A
year later, he became a surgical resident
at Freedmen’s Hospital.
And in 1938, Drew earned a Rockefeller Fellowship
to study at Columbia University and work at
Presbyterian Hospital. There, he became the
first African-American doctor of medical science.
His doctoral thesis, “Banked Blood,” revolutionized
medicine.
Drew realized that blood plasma—the clear
part, without cells—lasts a lot longer than
whole blood. He worked out how to bank, or
store plasma for longer periods of time. He
also discovered that plasma can be dried and
rehydrated as needed.
Anticipating terrible casualties, and drawing
on lessons from the first World War, New York’s
Blood Transfusion Betterment Association met
with British physician John Scudder to formulate
a plan. Scudder had heard of Drew’s work
on plasma and hired him as soon as he earned
his doctorate, in 1940.
Drew’s new job was to coordinate Blood for
Britain. His team collected and processed
blood plasma from different hospitals in New
York, shipping it overseas to save Allied
lives.
A year later, Drew led another large-scale
blood project, this time for the American
Red Cross and the U.S. military. But there
was a catch: the military wanted Drew to segregate
the blood donated by African Americans from
that donated by whites. Understandably outraged,
Drew resigned after only a few months.
By the end of 1941, when Drew returned to
Howard, he had created two of the first large
blood banks. But he was not a knight, and
his country was still so deeply racist that
even its official supply of lifesaving biomaterials
was segregated.====
In 1950, Drew died in a car accident. He was
only forty five years old.
Thanks, Thoughtbubble. But this was far from
the worst offense in World War Two. The Nazis
also undertook systematic research on human
biology and medicine—all within the paradigm
of Rassenhygiene, or racial hygiene.
This was German eugenics: the application
of a distorted understanding of Darwinian
evolution to human society.
The Nazis believed that certain human groups
were better than others, and that biology—not
nurture—determined everything. But they
wanted proof.
In the 1920s, the racial hygienists had to
wait around. But with the Nazi takeover in
1933, they had the research material they
needed to understand the human body at a deep
level, in the form of Jewish people and others
whom the Nazi state didn’t consider fully
human.
During World War Two, Nazi scientists such
as Josef Mengele performed experiments on
humans in concentration camps. Among other
atrocities, Mengele conducted studies of genetics,
including twin studies, but killed subjects
afterwards, sending tissue samples back to
Berlin for further analysis.
Like the Allies, the Nazis developed drugs.
But the Nazis weren’t sure if they should
focus on antibiotics, which kill bacteria,
or on homeopathic remedies, which are based
on the idea that a substance that causes disease
in a healthy person can cure similar symptoms
in a sick person.
To conduct their tests, the Nazis simulated
brutal war injuries on concentration camp
prisoners and then tried to prevent infections
using different agents.
Finally, the Nazis developed a robust euthanasia
program, or way of testing the cheapest, fastest
ways to kill the most people without causing
them to riot.
Meanwhile, in occupied China, an infamous
group of biologists and chemists within the
Imperial Japanese Army called Unit 731 carried
out some similarly horrifying research.
They cut patients open while they were still
alive, without anesthesia. They tested new
biological weapons. They tested the limits
of human resistance to hypothermia, or frostbite.
It gets worse, but you get the idea.
When the war ended, the United States government
discovered the atrocities committed by the
Imperial Japanese doctors… And they cut
a deal: the U.S. would grant certain war criminals
immunity in exchange for their data.
So where’s the goodness I talked about at the beginning of the episode? Well, after
World War Two, more drugs, medical technologies,
and novel procedures emerged. For example,
in the 1950s, Jonas Salk and A. B. Sabin created
a polio vaccine, which was very good!
But the deeper point is that medicine—now
a global institution—had a long look at
itself. The vast majority of doctors and government
officials were absolutely sickened by the
revelations of the Doctors’ Trial of the
Nazis.
Doctors convened and created a new way of
handling medical research with human subjects,
the Nuremberg Code of medical ethics. In fact,
a whole new branch of philosophy, bioethics
was born.
On the policy side, all human subjects research
in the U.S. now has to be approved by institutional
review boards or IRBs. It’s a long process
in which scientists and regulators scrutinize
what will or won’t be done in the name of
medicine, to whom, for what purpose. And it’s
one of the greatest, quietest moral wins in
the history of science.
Next time—we finally bring together Darwin
and Mendel in an intellectual super-group
called the Modern Synthesis. Don’t miss
it!
Crash Course History of Science is filmed
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