Dr. Robert Koch at work in his laboratory.
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 who 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 to be treatable
by exposure to clean, fresh air
in sanitariums away from the
city—or, as noted, be hereditary.
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and rendering them mere superstitions and as outdated in medicine as bleeding.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 until the Coronaviris struck down 2.7 million over the last 18 months.
Deadly Tuberculosis bacteria first isolated and identified by Dr, Kosh
using the techniques and protocols that he invented and which are still
the standard for microbiological research.
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. Koch examining a sheep for anthrax.
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.
Dr. Koch about the time he gained fame for his breakthrough identification of the anthrax pathogen,
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?”
Dr. Koch created a scandal when he divorced his wife of 25 years to
marry his much younger mistress, actress Emma Hedwig Freiberg.
In
1893 he ended his 25 year marriage
to 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 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.
In the 1930 film classic The Blue Angel, nightclub singer
Lola Lola--Marlena Dietrich--was the cause of the downfall and ruin of a
distinguished professor--Emile Jannings--said to be modeled on Dr,
Koch.
Their story is said to have inspired the 1930 German film Der blaue Engel—shot simultaneously in an English version,
The Blue Angel—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.
