Consumption, as it was then
widely known, was a pervasive and enduring near world-wide epidemic
that had no identifiable beginning
or foreseeable end. It brought slow, sure death to millions. Most
pervasive among the urban poor crowded
together in fetid slums and the lowest levels of the rural peasantry whose large, multi-generational families often lived
together in crowded hovels.
But
consumption was no respecter of class privilege. Those who read biographies of notables from the 17th to early 20th Centuries
as well as literature from the same
period are struck by the frequent
references to the White Plague
and its devastating effects. Take, for instance, just the highly educated and largely affluent literary elite of Boston and the New England Renaissance. Ralph Waldo Emerson saw a beloved
brother, his child bride Ellen
Louisa, and other friends and relatives succumb to the disease. Theodore
Parker was just one of several other leading
figures of the Transcendentalist
movement that died of it. It was suspected
to run in families—we would call it hereditary today—largely because devoted family members would tenderly nurse stricken kin giving them the long,
close exposure we now know is necessary to transmit the disease.
The
very memory of the disease haunted people even after it was on its
way to being controlled. Every movie goer knew that a cough
in the first reel was certain foreshadowing of a tragic death bed scene in the last.
Consumption
was commonly assumed to rise spontaneously, be caused by miasmas or foul air—and thus be treatable
by exposure to clean, fresh air
in sanitariums away from the
city—or, as noted, be hereditary.
Dr. Robert Koch at work. |
On
March 24, 1884 Dr. Robert Heinrich
Herman Koch, Germany’s most distinguished physician and the Father of Microbiology published a paper sweeping away all of those suppositions and rendering them mere superstitions
and as outdated in medicine as bleeding.
Consumption, or as he called it tuberculosis,
was caused by a bacterium which he
had isolated and named Mycobacterium
tuberculosis.
Dr.
Koch, of course, could not offer a cure
for the dread disease, but by proving that it was a communicable infectious disease he laid the groundwork for eventual effective public health preventative measures and eventually treatment. Infection
rates began to decline in Europe
and North America after World War I. But it wasn’t until the development of the antibiotic
streptomycin in 1948 that an effective
treatment of the active illness was achieved. That was followed by other effective antibiotics.
The
development of a Tubercular skin test led
to the discovery that many more people carry the infection in a latent,
but communicable form. Only 10-15% of those with latent infection
get the active disease, generally when the immune
system has been weakened by other
illness, injury, and infection, or due to chronic malnutrition.
By
the turn of the 21st Century rates
of active tuberculosis infections in the advanced
industrialized nations had plummeted
to near zero. Most new
reported cases involved immigrants and
visitors. Even high
rates of infection in the Third
World were coming down, albeit slowly.
Then in 2007 international rates
began a sharp increase, particularly
in sub-Saharan Africa and much of Asia.
Increases are blamed on the rapid
development of anti-biotic resistant
strains, tuberculosis as a secondary
infection in those with HIV/AIDS, over
whelmed and underfunded public
health services in desperately poor
and often politically unstable
countries. Drug resistance has even
caused rates to begin to creep up in
Europe and the U.S.
Internationally
there were in 2012 8.6 million active
chronic cases were, 8.8 million new
cases diagnosed, and 1.20–1.45 million deaths, most of these occurring in
developing countries. Of these about 350
thousand occurred in those also infected with HIV. That means that tuberculosis today is far
more deadly than the widely reported
panic infections of recent years.
But
back to Dr. Koch. His breakthrough discovery, for which he
was honored with the Nobel Prize for Medicine in 1905, was
the result of years of work in
microbiology and the development of his famous Four Postulates—four
conditions, all of which must be met,
that prove any disease is directly caused by an identifiable microbe.
Robert
Koch was born in Clausthal, Hanover, Germany to a middle class
family on December 11, 1843. A very
bright child, he reportedly taught
himself to read from his parent’s
books and magazines before he entered school in 1848. At gymnasium—the
equivalent of high school but with higher academic standards than in America—he excelled in math and science.
Koch entered the University of
Göttingen at age 19 where he studied natural
science for two years before switching to medicine.
Even
as an undergraduate Koch’s proclivity for research and laboratory work
drew notice. He was asked to assist Jacob Henle, a noted anatomist who had published a pioneering theory
of contagion in 1840, to participate in his research project on uterine
nerve structure. The next year he
was conducting independent research
into succinic acid secretion at the Physiological Institute culminating in
his lauded dissertation. Koch graduated medical school in January
1866 with the highest honors and a bright future ahead of him.
In
the summer of 1867 Koch married Emma Adolfine
Josephine Fraatz
and they had a daughter, Gertrude,
the following year. In 1870 he was
called away from his established medical
practice and family to serve as a surgeon
in the Franco-Prussian War.
Dr. Rober Koch about the time he gained fame for his breakthrough identification of the anthrax pathogen, |
After
the war Koch turned his attention to research in various plagues which he was
convinced were communicable diseases.
His first break through came with anthrax,
the deadly disease that annually did major
economic damage by infecting herds
of cattle and other domestic
ruminants. He identified the cause,
the bacteria Bacillus anthracis. He also discovered that spores of
the bacteria could remain dormant
for long periods of time and become activated under optimal circumstances. Koch used microscopy, including dyeing
his samples for examination on a slide,
and identifying agar as an ideal culture medium in which to grow specimens for examination. These became the standard techniques for microbiological
research to follow.
Even more important was his development of the Four Postulates based on his experience
with anthrax. The postulates are
1)
The
organism must always be present, in
every case of the disease.
2)
The
organism must be isolated from a host
containing the disease and grown in
a pure culture.
3)
Samples
of the organism taken from pure culture must cause the same disease when inoculated into a healthy, susceptible
animal in the laboratory.
4)
The
organism must be isolated from the
inoculated animal and must be identified
as the same original organism first isolated from the originally diseased host.
Even
using more advanced equipment and techniques than Koch had available,
modern epidemiologists employ these
same criteria and methods.
The
isolation of Bacillus anthracis
was the first time in history a specific
microbe had been identified as the cause of a disease and thus gave strong support to the still controversial germ theory and was a nail in the coffin of outdated ideas like spontaneous generation.
Koch was widely acclaimed for his discovery and it
led to his appointment as a professor of
medicine
and an administrator at Berlin University.
He
next turned his attention to a disease that regularly erupted, especially in semi-tropical and tropical regions in devastating epidemics—Cholera. Koch collected
samples and did field research during epidemics in Egypt and India. He isolated and identified Vibrio cholera. It turned out that in 1854 Italian
anatomist Fillipo Pacini had
isolated the same bug but had not widely
published his findings nor definitively
identified it as the cause of Cholera.
On
the strength of these achievements
Koch was recruited as an advisor to
the Imperial Department of Health in
the newly consolidated German Empire. It was during this time that he performed
his research on tuberculosis and published his result in 1882. It was the
apex of a brilliant career. Not only
would he be awarded the Nobel Prize for this discovery but also the Prussian Order of Merit in 1906. In 1908 with support of a gift of 500,000 gold marks from American philanthropist Andrew
Carnegie the Robert Koch Medal and
Award was established to be awarded annually to the scientist who does the most to advance research and discovery in microbiology. The criteria of the judges is said to be, “What would Robert Koch be working on if he
was alive today?”
In
1893 he ended his 25 year marriage
to his wife Emma after becoming involved
with a beautiful and much younger actress, Hedwig Freiberg who he had been seeing
as early as 1889. Indeed his scandalous involvement with her may
have led to a not entirely voluntary
retirement from Berlin University in 1890.
Koch married Hedwig, or Emma after his divorce.
Had
it not been for the scandal Koch might have been as celebrated in America as
his contemporary, the Frenchman Louis Pasteur. Certainly
their accomplishments and advancement of modern medicine were at
least comparable. But the deep Puritanical strain of Americans would never allow that level of
adoration for an open and unapologetic adulterer.
Their
story is said to have inspired the
1930 German film Der blaue Engel—shot simultaneously in an English version, The
Blue Ange--and released
by Paramount in the U.S. The movie
featured the fall of a distinguished professor played by Emile Jannings when he becomes
infatuated by night club singer Marlene Dietrich in the memorable role
that made her an international star. The movie was based on Heinrich Mann’s novel Professor Unrat published in 1905 when Koch’s scandal was
still in people’s minds.
Ironically Jannings would go on to portray Koch is
a German 1939 bio-pic. The Nazi-era
film was a propaganda piece celebrating
the achievements of good Aryan science.
Luckily Koch’s fall
was not as complete or lethal as the professor in the book and
movie. He accepted his major awards with Hedwig at his side. She remained there until he died on May 22,
1910 as the health spa of Baden-Baden of a heart attack at 66 years of age.
He had been in declining health
for years.
You should watch 'Charite' a new German show on Netflix. Robert Koch is a big feature of the show.
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