The name Paul Ehrlich is largely forgotten today except by those who have a medical school diploma or sit up half the night watching old movies on cable TV.
Yet Ehrlich was one of the world's most celebrated medical scientists less than 100 years ago. In 1908, he won the Nobel prize for medicine for his work in immunology. He also was a pioneer in hematology, the founder of modern chemotherapy and the discoverer of salvarsan, the first specific and effective cure for syphilis. Indeed, salvarsan might have won him a second Nobel prize (he was twice nominated) had it not been for the long controversy that followed the drug's general release in 1910.
"Dr. Ehrlich's Magic Bullet" was Hollywood's tribute to the man, and it still runs at absurd times overnight on cable. Released in 1940 with Edward G. Robinson in the title role, it takes considerable dramatic license with events and gives the impression that Ehrlich spent more time fighting battles with bureaucrats than he did with disease-bearing microbes. Unfortunately, he was never able to devise a "magic bullet" for his critics.
The movie gives short shrift to the real drama of Ehrlich's life--his four-year struggle to deal with the problems that followed the release of salvarsan. Although his discovery achieved instant acceptance in the medical community at large, it created a small group of dissenters who pronounced salvarsan a dangerous drug. They also accused Ehrlich of charlatanism, profiteering, ruthless experimentation and even stealing the credit for his discovery from one of his researchers. Friends maintained that this "Salvarsan War" undermined Ehrlich's health and led to his death in 1915 at the age of 61.
Born in Prussian Silesia in 1854, Ehrlich received his medical degree from the University of Leipzig in 1878. His doctoral thesis dealt with "histological staining," which helped to create the modern science of hematology. He demonstrated that blood cells and granules within cells have an affinity for specific organic dyes, which allowed their classification by color. This concept of selective affinity also would become the central theme of his later work with drugs and chemicals.
In 1891, he joined the new Institute for Infectious Diseases in Berlin. Primarily because of his work in developing effective antitoxins and standardizing dosages, his reputation continued to grow and in 1899 an Institute of Experimental Therapy was created for him in Frankfurt.
Concentrating on chemotherapy soon after the move to Frankfurt, Ehrlich noted that many infectious diseases did not seem to respond to antitoxin or serum. His answer was to develop chemotherapeutic drugs that would act as what he called "magic bullets." By invoking the principle of selective affinity, they would seek out and destroy specific bacteria without harming the rest of the body.
These efforts culminated in the discovery of a synthetic arsenical compound originally known as "606" because it was the 606th preparation in a series of experiments. Even after it was named salvarsan, many still preferred 606 because, as the Ehrlich film character notes, it had a kind of "magical" sound to it.
When Ehrlich announced in April 1910 that 606 had proved effective in treating syphilis in animals as well as in clinical trials on humans, it set off an uncontrollable demand for the new "wonder drug."
Ehrlich contracted with the Hochst Chemical Works to produce salvarsan. Hochst began marketing the drug in December 1910, backed by public assurances from Ehrlich that salvarsan had been tested in 20,000 to 30,000 cases and that he was "certain that it is one of the most powerful specific remedies for syphilis."
Not everyone agreed. The attacks on salvarsan began almost immediately, with a 40-year old Berlin physician named Richard Dreuw firing the first salvo. He told a Berlin medical group that 606 had not been adequately tested and warned of the dangers of its widespread use.
Salvarsan encountered other problems as well. It was difficult to manufacture and administer. Routes of injection and dosages were largely empirical. It also produced toxic side effects, some resulting from the drug's imperfections and others from poor preparation and injection techniques. Although some patients died in treatment, the number of and reasons for these fatalities were always debated.
Ehrlich fought a continuing battle with physicians to standardize treatment and eliminate carelessness. "You can not have any idea what sort of blockheads one has to deal with," his biographer quotes him as telling a colleague. "Those wretched scoundrels are really going to ruin salvarsan entirely because they will not pay attention to any of my instructions."
Meanwhile, Dreuw continued his attacks and was joined by an eccentric Frankfurt journalist named Karl Wassmann, who mounted a strident campaign on behalf of the local prostitutes. Wassmann charged that these women were being given salvarsan against their will at the Frankfurt hospital, resulting in the death of some and "severe and lasting damage" to many others.
In response to Wassmann's articles, the hospital sued for libel. The trial opened in a circus atmosphere as Wassmann did his best to disrupt proceedings with the help of a contingent of the city's prostitutes and pimps. The hospital director denied any salvarsan deaths at his facility or any cases of salvarsan-related blindness or paralysis. However, other testimony showed that some 1,200 Frankfurt prostitutes had been treated with the drug and not all had been volunteers.
Ehrlich had opposed the court action, feeling it would give Wassmann undue attention, and friends said he was shaken by the whole experience. He vented his anger in a newspaper article, describing those involved in the trial as "naturopaths, anti-injectionists, quacks, anti-vivisectionists and antisemites." He charged that this "rabble" had banded together "to blacken my name and weave a veritable web of the most abusive and glaring lies."
Wassmann's conviction and the outbreak of World War I effectively terminated the extreme attacks on salvarsan. But Ehrlich had only one more year to live, his constitution undoubtedly undermined by the long ordeal and his neglect of his health. Friends noted that he was a workaholic who subsisted mainly on "mineral water and strong cigars."
Ehrlich died of a stroke on Aug. 19, 1915. But his work lived on in the most practical ways, such as the continued use of salvarsan for treating syphilis until it was replaced by penicillin in the early 1940s. We still honor the Ehrlich legacy in many ways; it's only his name that seems to have slipped our minds.
John G. Leyden is a writer living in Davidsonville, Md.