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BOOK REVIEW : Curing TB: A Victory Declared Too Soon : THE FORGOTTEN PLAGUE: How the Battle Against Tuberculosis Was Won--and Lost by Frank Ryan, M.D. ; Little, Brown and Company $24.95; 460 pp.

August 03, 1993|BETTYANN KEVLES | SPECIAL TO THE TIMES

Only recently, tuberculosis had acquired an antique Bohemian luster.

It was the classy disease suffered by Thomas Mann's characters in "The Magic Mountain" as well as by real artists like Keats and Chopin. After X-ray diagnosis and powerful antibiotics seemed to have conquered it by the 1970s, TB's research funds dwindled to pennies; every year between 1981 and 1986 the Reagan Administration tried to end the federal TB eradication program altogether.

But TB was never classy. It is an ugly, painful disease that attacks every organ in the body, especially the lungs. And it was never totally wiped out, not even after an array of antibiotics were found to battle it. Like malaria, another scourge that had only recently seemed on the brink of eradication, TB has returned, invigorated by mutant strains and impoverished standards of living.

When the British gastroenterologist Frank Ryan began investigating the intricate tale of the sleuths who set out to find a cure, he thought he would be telling a story with a triumphant finale. Instead he discovered that Mycobacterium tuberculosis-- the TB germ--had found a diabolical partner in the AIDS virus. Today new drug-resistant strains of TB are wreaking havoc in epidemic proportions.

The numbers speak for themselves. In the last 200 years, tuberculosis has killed more than a billion people. After World War I, TB, which thrives when immune systems are weakened, was responsible for more deaths than influenza or battle injuries. As recently as 1962, blood-borne tuberculosis killed the Presidential widow, Eleanor Roosevelt.

Ryan narrates "The Forgotten Plague" as if broadcasting a horse race. Following by turns the careers of three major researchers, as well as those of some contributing players, he shows how personality, timing, and sheer luck had a lot to do with how the race to find a cure was run, and who got credit for the victory.

Playing the United States against Europe, he tells us about Selman Waksman, a Russian immigrant who arrived in New Jersey in 1910, where happenstance and penury led him to study agricultural science at neighboring Rutgers rather than medicine at Columbia University in New York. Waksman believed that soil, rich in bacterial life, held many organisms that could be used to fight infection. In 1943, with the help of a graduate student, Albert Schatz, Waksman developed streptomycin from soil-nurtured bacteria to kill the tuberculosis bacterium and, in the process, coined the word antibiotic .

Ryan takes us to Germany where a contemporary of Waksman, Gerhard Johannes Paul Domagk, who had studied medicine after having fought in the First World War, was working with the dread Staphylococcus bacterium. Peering into a microscope, Domagk learned how the body defends itself against invading bacteria in the bloodstream. That insight led him, as a researcher for the Bayer company, a subsidiary of IG Farben, to fabricate Protonsil, a sulfa drug that kills Streptococcus in laboratory mice, and in people.

Ryan's account of Domagk's perseverance during the '30s casts an interesting light on life in Hitler's Germany. When Domagk received word in 1939 that he had been awarded the Nobel Prize, he was prevented from accepting it because Hitler had declared the Nobel off-limits after the Peace Prize had been awarded to a German pacifist in 1935. Domagk continued his research in Berlin throughout World War II, watching his assistants vanish as the city collapsed in rubble around him.

Ryan also takes us to Sweden where a Danish physician, Jorgen Lehmann, was approaching the tuberculosis puzzle theoretically, rearranging the molecules of the familiar drug aspirin into a new medication known as PAS.

When streptomycin turned out to boomerang in protracted cases, allowing a more lethal mutant bacterium to develop that literally thrived on streptomycin, the medical community discovered that streptomycin, in combination with PAS, was a successful treatment.

Word leaked out early in 1952 that the Nobel Committee was going to award the prize in physiology or medicine for the conquest of tuberculosis. The many players assumed there would be some division of acclaim. They were wrong. Waksman won the prize alone, and the bitterness and disappointment that followed, almost as much as the idiosyncratic methodology of each researcher, demonstrate the very human nature of scientists and scientific research.

Reading like a thriller, "The Forgotten Plague" shows how medical research really works. Ryan explains the key role of mentors, the good and the bad (it was Waksman's student Shatz who publicly demanded a share of his Nobel), the contributions and misjudgments of many talented scientists, and how all were helped by intuition, obsession, and the vagaries of chance.

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