[From Erastus: Varia Opuscula Medica. Francofurdi, 1590.] ANNALS OF MEDICAL HISTORY

New Ser ie s , Volu me VII Mar ch , 1935 Numb er 2 (1843-1910)

AN AMERICAN TRIBUTE

Par t I

By LAWRASON BROWN, M.D.

SARANAC LAKE, N. Y. IT seems fitting in In 1876 at the head of the Botanical our busy lives to Institute in Breslau was Ferdinand pause this year *Cohn, the greatest figure in bacteri- (1932) to do hom- ology before Koch, who had worked age to the memory out the first morphological classifica- of one of the im- tion of , putting bacteria in mortals of this the vegetable kingdom, and had found earth, Robert spores in Bacillus subtilus, for up to Koch, discoverer this time bacteria were still con- of the use of solid sidered a part of Botany. The work of media in , discoverer of Schroeder on pigment bacteria, done the method of obtaining pure cultures under Cohn, is still a classic. of bacteria, discoverer of the methods On April 22, 1876, Cohn received a of sterilization against bacteria (thus letter from Wollstein in Posen. “Es- making modern [aseptic] surgery pos- teemed Herr Professor,” it began . . . sible), discoverer of tuberculin, dis- coverer among other bacteria of the Stimulated by your work on bacteria tubercle bacillus, just fifty years ago; published in Contributions to the Biology in fact the Father of scientific bacteri- of Plants, I have for some time been at work on investigations of anthrax con- ology. He takes his place with Pasteur and Lister among the great benefactors * Called “ Pflanzen-Cohn ” to separate him of mankind. from “Augen-Cohn” (H. L.). tagium, as I was able to secure the neces- butter and cheese only at night, white sary material. After many vain attempts, bread Sunday morning and meat twice I have finally been successful in discover- a week. He knew such luxuries as ing the process of development of the coffee, sugar, tea, only by name. He Bacillus anthracis. After many experi- received poor instruction in the local ments, I believe to be able to state the Gymnasium where discipline was such results of these researches with sufficient certainty. Before I bring this into the that the teachers and not the pupils open I respectfully appeal to you, es- were at times chastised. Though he teemed Herr Professor, as the foremost had announced that he would study authority on bacteria, to give me your philology, later he decided upon a judgment regarding this discovery. Un- mercantile career as he loved to travel. fortunately I am unable to prove this by The family were ultimately able finan- means of preparations containing the cially to send him to the University of individual stages of development as the Goettingen, where finally he studied attempt to conserve the bacteria in the medicine under Henle, Hasse and respective fluids has failed. I would, Meissner. His industry won for him a therefore, respectfully request you to place in the pathological museum and, permit me to show you, within the next signing an essay on the “Ganglion few days, in the Botanical Institute, the essential experiments. Should you, Cells of the Nerves of the Uterus” highly esteemed Professor, be willing to with the phrase, Nunquam otiosus, grant my humble request, will you never at leisure, he won a prize. His kindly appoint the time when I may graduation thesis was on the origin of come to Breslau? With the highest succinic acid in the body and in its esteem, Yours Respectfully, R. Koch, preparation he succeeded in upsetting District Physician. his own stomach. Graduating in 1866 at nineteen, But who was this Robert Koch? And after a short interneship in the general why was Cohn so interested in his hospital in Hamburg, he accepted a work? position as externe in a hospital for His Ear ly Year s the insane at Langenhagen, near Han- over, and began private practice with Born in 1843 at Clausthal, on the western or Hanover Slope of the the purchase of a riding horse. Shortly Harz Mountains, a “perfect epitome after graduating, when he still had of mineralogy,” one of the elder of plans to become a ship’s surgeon in thirteen children, the third child and order to see the world, he had become one of the eleven boys, son of a engaged, by promising to give up such ideas, to a boyhood sweetheart, Emmy Bergrat, a scientific superintendent of Adolphine Josephine Fraatz, also of *mines, Robert Hermann Heinrich Clausthal, daughter of a Lutheran Koch was frugally reared on black minister. They were now (1867) mar- bread, sweet and butter milk, legumes, ried and in 1868 Koch’s only child, a * The German miner of these times, where daughter, Gertrude, was born. He skill and art were required, had been con- made little headway financially, and sidered not long before a servant of God, resigned and moved to Niemegk, but combating demons of the subterranean deep, a member of a mystic craft. With these men, fared no better and considered emi- young Koch spent much time collecting grating to America where he had two specimens of minerals. or three brothers. Moving again in July 1869 to Posen, he settled in finally collected, no doubt in an old Rakwitz, where he soon had a satis- stein, a fund sufficient to make him a factory practice and could afford to present on his birthday of a new micro- buy some experimental animals. Pre- scope, such as he desired. viously rejected on account of his Koch had studied medicine for the nearsightedness, he voluntarily en- reason that by doing so he might listed for the short Franco-Prussian indulge in his hobby for natural war. On his return, after five months’ history. He always found time to do experience in field surgery, his practice some microscopic work and was espe- increased and in 1872 he was ap- cially interested in algae. At this time pointed at a yearly salary of 900 marks anthrax was decimating the herds of District Physician to Wollstein, a cattle and the flocks of sheep of a nearby town of 4000 inhabitants, large part of Europe, and when he where he already enjoyed what con- had a little leisure he worked con- sultation practice there was. stantly upon this disease for, as he says, it was at hand. He had to

Life at Wol lst ei n devise all his implements; but with his ingenuity this apparently caused Posen was the most benighted prov- him little difficulty. For example, he ince of , more Polish than inoculated his mice from one to German, and to eke out a restricted another, with little slivers of wood. living, he spent many a long Polish Now Ferdinand Cohn himself had winter night jogging on horseback worked unsuccessfully on the problem over rough roads to see a child with of attempting to isolate a pure strain croup, to usher into the unknown the of bacteria for he realized that until soul of some expiring peasant or into this was done little advance could be this stormy known the child of another, expected. I have no doubt he was and all this for small fees, counting as delighted to receive such a letter but I successful the day when he made as also feel sure that on account of pre- much as five or six dollars. Near- vious disappointments he dared not sighted, rather slender, full bearded, let his hopes rise too high. somewhat brusque, little given to society, a man of few words except to Bac ter io lo gy be for e Koc h intimates, respected for his ability but hardly loved by his fellow citizens To grasp what all this really meant who saw little of him (he was the to Cohn it is necessary to go back a busiest physician in the village), he century to the time when Leeuwenhoek worked in his little laboratory formed improved the microscope, when was by curtaining off a portion of his revealed to man for the first time a private office. I doubt if the corner of new world, so confused, so puzzling, any private office has ever meant as that the findings were grouped by much to the suffering world. Here he Linnaeus, the botanist, under the head placed a microtome, a home-made of “Chaos.” The germ theory of incubator built by himself, and an old disease was not new for Plenciz had fashioned microscope. He was unable believed in a contagium vivum, putre- to buy a modern microscope but his faction was said to be caused by living good wife by scrimping and saving organisms (Spallanzani, Schultze), and the inoculation into the thigh of pus A little later Lister, unaware of Le- from a syphilitic chancre had pro- maire’s work, developed brilliantly duced a pustule containing the same his antiseptic technique for surgery. vibrios as were found in the chancre About the middle of the nineteenth (Donne, 1837). century PoIIender as the first, and a In 1837, the small round bodies little later Davaine and Delafond, noted previously in beer were seen to proved conclusively that anthrax ba- grow as the fermentation increased, cilli occurred in every case of anthrax and were considered to be living plants, but did not prove it to be alive or called by Turpin, Torula cerevisiae. even the cause of the disease for At this same time Bassi showed that another substance, living or dead, muscadine, a contagious disease of might be transferred with the sus- the silk worm, was due also to a pected organism and so prove later to minute plant. These discoveries opened be the cause of the disease. Hallier had the flood gates of wild and reckless attempted to overcome this difficulty speculation which were closed only and others no doubt described detritus when Jacob Henle wrote in 1840: of organic and inorganic material, fat, “Before microscopic forms can be re- crystals, etc., as living microorganisms garded as the cause of contagion in and as the cause of the disease. Von man they must be found constantly Recklinghausen in 1871 had proved, in the contagious material, they must by use of alkalies, by acetic acid and be isolated from it and their strength glycerine, that certain bodies found tested.” This, however, did not imply in certain diseases were organic; Wal- necessarily that the contagious ma- deyer had demonstrated bacteria in terial was living. Remember that this the heart in pyemia and in the kidney was almost forty years before Koch in pyelonephritis; Weigert similar announced his postulates. bodies in the skin in smallpox; and Between 1857 and 1870, Pasteur had Klebs in wounds, fistulae, diseased demolished spontaneous generation, bone marrow, , etc. Klebs had proved organic decomposition due and Billroth, however, had made to germs capable of self-regeneration, matters worse by declaring that many had demonstrated that fermentations different diseases were due to the same resulting in lactic, acetic and butyric microorganism, a coccobacterium. acids, as well as diseases of wine, were Up to this time, none of the modern caused also by minute organisms methods of investigating bacteria had differing in shape and characteristic been developed. The methods for from each other, and had further shown obtaining pure cultures were highly that pebrine, a disease of the silk unsatisfactory, for example; by dilu- worm, was due to a parasite, and had tion (Pasteur and his predecessor, F. suggested how to control it. Pasteur, Cohn); by “fractional cultures” however, did not attempt to isolate (Klebs); and by a capillary pipette pure cultures nor engage in morpho- method (Salomonson). Cultures on logical studies. Lemaire, an apothecary, solid media (potato) had been used, experimenting with carbolic acid, dis- (Fresenius, Hoffman, Schroter). covered that living microscopic plants Several had suggested the use of gela- were prevented by it from growing, tine (Vittadini, Brefeld, Klebs) but while true ferments continued to act. none had used it to obtain pure cul- tures, a method Koch was about to stration of the relationship of a micro- show Cohn and his associates. organism to an infectious disease. His And now we can readily see why audience was delighted, and Koch Cohn was so delighted to get Koch’s hurried to Berlin to submit his find- letter and to hear that Koch was ings to Virchow, but the great man willing to demonstrate and to prove received him coolly, which naturally his assertions. depressed Koch. The article of forty pages, breaking Koch’s silence of ten Ant hr ax , th e Fir st Unr av elle d years, appeared in Cohn’s Beitrage Inf ec tio us Dise ase zur Biologie der Pflanzen, and stands Cohn spoke to a number of pro- today as one of the classics of medi- fessors at Breslau about the matter cine. After over half a century the and so on April 30, 1876 he gathered facts remain as Koch presented them. together Leopold Auerbruch, the phys- Do not forget that all this came out of iologist, Julius Cohnheim, the pa- the office of a man in private practice, thologist (to whom Ludwig sent Welch where he must needs see patients, when Welch had planned to go to where for the first time a practical Virchow), his assistant Karl Weigert, method for obtaining germs in pure , Weigert’s cousin,Traube, culture was worked out, furnishing and others. Cohnheim, delighted with really the key to unlock the problem such a three day demonstration said, of the infectious diseases. “ It leaves nothing more to be proved. He was probably never happy away I regard it as the greatest discovery from his corner laboratory and Nun- ever made with bacteria and I believe quam otiosus, never at leisure, placed that this is not the last time that this on his prize essay, could be used for young Robert Koch will surprise and the rule of his life. In November, 1877, shame us by the brilliancy of his he again appeared in print. In this investigations.” Saying this he rushed article he emphasized the value of off to his own laboratory, called his photography in the description of assistants together, told them to drop bacteria (his uncle in Hamburg being everything and hasten to hear Koch. an expert photographer), described Bringing with him some prepara- how to make films of bacteria on cover- tions and his own apparatus, Koch slips, borrowing the fundamental idea had cultivated before them the anthrax from Ehrlich, how to stain them with bacilli in pure culture, stained them Weigert’s aniline dyes, and how to with Weigert’s dyes (discovered in stain flagellae, thus proving their 1871, 1875), demonstrated the bacilli previously disputed existence. developing from spores in the aqueous Welch recalls the frequent visits of humor of the eye of an ox (see Corner), Koch to Cohnheim’s laboratory in the and growing into long chains, inocu- summer semester of 1877, and the lated animals and, in the words of insistence of Koch upon the use of Henle, demonstrated the bacilli con- photography to replace description of stantly in the contagious material, bacteria. Welch and Salomonson were isolated them from it and tested their the only foreign students, and while strength. In this way he traced for the Welch worked on edema, Cohnheim first time the life cycle of a bacterium had Salomonson inject tuberculous and made the first conclusive demon- material into the anterior chamber of the eye of rabbits, an experiment now for him the position of city physician, classical. * paying him 1800 marks a year, Koch About this time Paul Bert opposed moved his family to Breslau but the conclusions of Koch but Pasteur, remained only three months due, the grandfather of bacteriology, at- possibly, some say to too little practice tracted by Koch’s work on anthrax, and too small funds, and probably to himself, as he said, a stranger to too little time for study and experi- human infectious diseases, repeated mentation. His position at Wollstein, Koch’s work, confirming it in every paying him annually but 900 marks, particular. Pasteur had himself ob- had been held open and his old friends tained one organism in pure culture and patients received him with open from a septicemia in animals for it arms. was in pure culture in the blood. He lived in Wollstein in a ground floor apartment, consisting of four Fur th er Wor k in Bac te ri ol ogy spacious rooms, a kitchen and a hall The following year (1878), Koch used as a waiting room. His large published his third important com- office was divided by a curtain, and munication, dealing with wound infec- part used as his laboratory, for he tion in animals, analogous to surgical never lost his interest in natural wounds in man, in which he reviewed history. He used a closet as his dark the previous knowledge of the condi- room and on a table were found the tion, describing how he produced in glass vessels for the experimental animals conditions analogous to septi- animals and his photographic appa- cemia, pyemia, gangrene, erysipelas ratus. His wife, three years younger and finding them always due to micro- than he, an excellent housekeeper, organisms, noting that the various helped him in his social duties and in animals differed in their susceptibility his practice, receiving and questioning to different germs, demonstrating that the patients before letting them see one of the best ways to obtain pure Koch, and aiding him in an under- cultures was by repeated animal inocu- standing manner in his researches, lation and showing what great aid directing the light for photographs, the Stevenson oil immersion lens and feeding, caring for the living and Abbe condenser contributed in such burning the dead animals in the stove work. In 1878 he attacked the views in the room. Their only child, a of Naegeli, who believed in the insta- daughter, Gertrude, born in 1868, bility of bacteria both in regard to their Koch loved tenderly. He would play pathogenic properties and to their with her and her little friends, at morphology. At this time Koch began times pretending to be a lion, crouch- to long for a larger laboratory, for ing on all fours and roaring. Later he he was a born experimenter and needed would answer patiently all her ques- expensive apparatus to carry on his tions, have her sit by his desk and various researches. help her with her studies or go walking In 1879, his friends having procured with the family and the dachshund. A letter in a light vein to her on her * A delightful description of that summer semester was written by Salomonson for eighth birthday tells her how delighted Ehrlich’s Festschrift. See Berl. klin. he is to hear she is doing so well, that Wchnscbr., 51: 485-490, 1914. he expects her soon to help him in his work, to relieve her mother, so that dish where it cooled and hardened. before long they can sit resting in their Simple as this now seems to us none chairs while she does everything for up to that time had been able by any them. It was with a heavy heart that simple method to get a pure culture he left Wollstein and his friends in from mixtures save as Koch had shown 1880 to go to Berlin where he felt a by animal inoculation. It is said that field of wider usefulness lay before him. Koch got the idea from observing on a piece of cut potato, left by accident on The Imper ia l Heal th Office in Ber lin the laboratory table over night, many In July, 1880, Koch began work different colored specks which on with the Imperial Health Office in examination proved to be pure cul- Berlin, where for some time bacteri- tures of germs; but what is more ology had been at a low ebb. He had likely is that he simply changed the assigned him such associates as Gaffky older method of dilution by adding and Loeffler. He had always worked enough gelatine to the culture media alone and greeted the two young to solidify it on cooling. Cultures on military physicians who were to be potato were also described. This his associates with inborn shyness. method of obtaining pure cultures He had, at first, little for them to do has never been improved, and only but they were fine chaps after his own the complicated method of Prof. Bar- heart, industrious, conscientious, loyal, ber of Kansas, who picked up single as eager for work as he. He could not germs and then grew them, has ever resist them and soon they worked added anything to the problem. Im- closely together while Koch astonished munity problems, disinfection, steri- them almost daily with new bacterial lization, sanitary control of milk and revelations. Later surrounded also meat were also discussed. Indeed this, by Gaertner, Proskauer, Wolffhuegel, with the second volume, might be Huppe, B. Fischer, he began what we called the cornerstone of the science of might call the Golden Age of Bacteri- bacteriology. It laid also the founda- ology. Koch himself referred to it as a tion for aseptic surgery. But even at period when the gold lay upon the this time, Koch had clearly in mind surface, and all that one had to do was that some diseases might be due to to pick it up, but one had to dis- microorganisms other than bacteria. tinguish what was gold. In September, This publication marks the close of 1881, fourteen months after his arrival the first period of Koch’s scientific in Berlin, appeared the first volume work, at the beginning of which he of the Communications from the Im- found bacteriology in a chaotic condi- perial Health Office in which Koch tion and at the end (1881) left it, made what is considered by many to largely through his efforts alone, a be his greatest contribution to bacteri- well-organized science, based in part ology, his poured-plate method of upon his four postulates for connect- obtaining pure cultures from mix- ing etiologically any bacterium with a tures of germs. Gelatine, containing certain disease. Not only the broad meat-infusion, which solidified on cool- principles, settling once for all time ing, was gently heated until liquid, the germ theory of disease but also inoculated with the mixture and then, the little details of technique, the after shaking, poured into a sterile knacks which change failure into sue- cess, were largely due to Koch’s great edema, gonorrhea, relapsing fever, ingenuity. The first four years of his leprosy, , typhoid, glanders residence in Berlin were almost the and staphylococci, streptococci, and greatest in the history of infectious the malarial plasmodium had all been diseases (Welch). A master had arisen discovered. You will recall that Joseph and bacteriology was now a medical Leidy of Philadelphia in 1849 had science. placed bacteria among the plants and that Prof. John K. Mitchell, father of Wor k on Tub er cu losi s Weir Mitchell, had been one of those All those who knew Koch intimately who believed in the germ theory of were aware that no subject interested disease. But the germ theory at this him as much as . Cholera, time maintained that the germ was bubonic plague and other pestilences, not superimposed upon the patient he said, carried off their hundreds, and independent of him; it was some- even thousands, but tuberculosis thing belonging to him and borrowing claimed as victims in all civilized from him a sort of pathological vitality countries its ten thousands. His prac- and ability to transport it elsewhere. tice in Posen had taught him that few The idea of a living virus, capable of families escaped. In fact, he was so being cultivated and modified out- impressed with the importance of side the body was new with Pasteur. tuberculosis that throughout his life, No work relative to obtaining a even to the very end, he let no good milk supply had yet been under- opportunity escape to work upon this taken. That flies could transport an- problem. Koch was ever intensely thrax germs had been shown but their practical, always keeping clearly be- relation to other diseases had not been fore him the practical application of suggested. Filtration of water was used his discoveries. This tendency no in America by 30,000 persons in 1880 doubt had much influence in determin- and today the number must be nearly ing what problems he would investi- 50,000,000. The first hygienic insti- gate. Once, in reply to a direct tute, that of Pettenkofer in Munich, question why he did not take up the opened in 1878; the first in America in study of cancer, he said, “I must 1884 at Bellevue Hospital where Welch protect myself, There is nothing in it.” had inaugurated his bacteriological In the summer (August) of 1881 laboratory in 1878, while Prudden with the first volume of the Com- began his at the College of Physicians munications safely through the press, and Surgeons in New York a year he turned his attention to tuberculosis later. Both had been pupils of Koch. stimulated by the many failures of the The bogey of carbonic acid gas in leading scientists of the world. regard to ventilation was still at this time in the minds of many sani- Tub er cu lo si s an d Hygi en e be for e Koc h tarians, and most houses were heated It is necessary, in order for us to by stoves and hot-air furnaces. grasp the significance of Koch’s work It is Koch’s work on tuberculosis to know something of the ideas in that interests us chiefly, and for us to existence at that time concerning grasp its significance we must know hygiene and tuberculosis. something of the ideas in existence at The germs of anthrax, malignant that time concerning tuberculosis. Jerome Fracastor, the founder of the Niemeyer even went so far as to say germ theory of disease, in 1546, wrote: that the worst thing that could happen to a consumptive was that he might Nothing further than contagion is become tuberculous. Virchow opposed necessary for the origin of phthisis, which may attack a person who has all specificity in disease. The influence never had catarrh, who has not ruptured of Broussais, not Laennec, was strong a blood vessel, or has an ulcer about the in Germany. Heredity at this time chest, or who has not had a pleurisy or was considered the most important any other malady, but has been per- factor in tuberculosis and in such fectly well. He may contract it by unfortunates cold, humidity, dust, habitual intercourse or a life in common among other things, might bring about with a phthisical patient, or by fomites the disease. But no germ had yet been (contaminated objects). For it is aston- proved to cause the disease though ishing how tenacious and for what a many accepted such a view. In a few long time the virus will live in fomites; years, however (1865 and 1868), Vil- we have seen the clothes which a con- Iemin proved that “tuberculosis is the sumptive had worn to give the contagion after two years; indeed, the bedrooms, effect of a specific causal agent, of a the beds and the flats (?) in which the virus,” and that dried sputum was patients have died, may do the same. important as a source of the disease. His book is a model of scientific The Italians and the Spanish were writing, but none is so difficult to both convinced in the eighteenth convince as the self satisfied, and even century of the contagiousness of phthi- the definite proof of Villemin’s con- sis and required that the bed and tention, brought forward by Chauveau, belongings of anyone dying of the Edwin Klebs, Gerlach and Cohnheim, disease should be burnt. Morgagni failed to settle the problem for such refused to perform autopsies on doubters as Colin, Chatin, Virchow. phthisical persons. But in the north Cohnheim predicted, however, that such views did not hold. You may soon someone would find “tubercle recall that Sauvages in France de- particles,” as he called them, in the scribed twenty varieties of phthisis tubercles and in the cheesy matter. and Morton in England sixteen but Stimulated by this, many set out at that Laennec preached the unity of once to work on the problem, and in phthisis, and believed that all the 1877 Klebs announced that he had changes in the lungs in pulmonary found the cause of tuberculosis; Tous- tuberculosis arose from the tubercle. saint and Aufrecht did the same in Louis upheld Laennec. Klencke later, 1881; and Baumgarten in 1882 made in 1843, showed that tuberculosis a similar claim. While it is probable might be transmitted by cow’s milk. that Baumgarten did really see the But many combatted these ideas, and tubercle bacillus, he was unable to among them none was more com- stain it or to produce convincing proof manding than the great Virchow who of his belief. At this time Bodington held that tubercles had no connection had passed into forgetfulness and with the cheesy matter so common in Brehmer and Dettweiler had ushered pulmonary tuberculosis (caseous tuber- the treatment of pulmonary tuber- culosis), and that the cheesy degenera- culosis into the sanatorium period. tion might follow a variety of causes. There was as yet no sanatorium in America but shortly Trudeau was to demonstration in the afternoon but lay the foundation of his on a bleak had not come. The large central hillside. As the question of con- table about which the chairs were tagiousness was not settled, no san- gathered was covered with specimens itarian dared suggest any sanitary (some say 200) and microscopes. The regulations concerning tuberculosis. room filled. There was a hushed There was no fumigation, no steriliza- expectancy. Greetings were whispered. tion, no spitting ordinances, no tuber- DuBois-Reymond sat chatting with culin for diagnosis. Brehmer was still Helmholtz. The opposing factions were exercising the “small hearts” of his present, those who believed in the patients, and Dettweiler was advocat- infectiousness of phthisis and those ing rest in the open. All was still who did not; those few who followed empirical. Forlanini had begun to Laennec, those many who held with think of artificial pneumothorax but Broussais. Some recalled how Vir- had not yet dared to practice it. The chow, the professor of professors, had diagnosis of pulmonary tuberculosis remarked upon the youthfulness of had not advanced much beyond the the work emanating from the Health state that Louis left it in the early Office. Koch meanwhile played with part of the century. Epidemiology the micrometer screws of the micro- and prophylaxis were unborn. scope. Then du Bois-Reymond who presided, opened the meeting. Koch The Disc ov er y of th e Tub er cl e Bac il lu s came forward, adjusted his papers and You will recall that Koch was said began his address in a manner sug- to have really begun his attack upon gesting some nervousness, some em- tuberculosis as a public health problem barrassment, for here in his maiden in the summer, probably in August, of speech in Berlin, he had to face the 1881, and when spring was but three greatest in medicine in Berlin. After days old in March (24) 1882, six a short time he regained control of months later, he had satisfied himself himself and was then the cool experi- that he had solved the problem. Up menter as always. His voice as he to this time he had been his own proceeded raised in pitch, his face severest critic. On March the 24th, became red, and his favorite expres- a damp, cheerless evening, he pre- sion “no loose ends” came to his sented his data and conclusions before mind. The audience listened with the Berlin Physiological Society, a breathless excitement and when to- small but influential body, where wards the end he began to draw frank discussion was the rule and practical inferences concerning anti- rising ambition was often none too tuberculosis work they recognized his gently treated. The society met in sober common sense. They saw come du Bois-Reymond’s physiological lab- true the dream of Henle, the predic- oratory, in a room now shown with tion of Cohnheim. That night when just pride to visitors. This proud the speaker, flanked by Gaffky and marble building on the banks of the Loeffler, finished reading his devastat- Spree was the scientific home of two ing communication, all eyes sought the of the great lights of the University, great Virchow who had combatted Helmholtz"and du Bois-Reymond. Vir- the idea that caseation might be due chow had been invited to a private to tuberculosis; but like some of the other leaders in medicine and surgery Though time and again he had he was absent. “That evening remains found these tiny rods he recalled his graven in my memory,” wrote Ehrlich teacher Henle’s requisite, what is later, “as the most majestic scientific necessary to connect in a causative event in which I have ever partici- way a germ with a disease, he at- pated.” Koch’s picture, with those of tempted to grow them on various the Kaiser, of Bismark, of Moltke, substances (media) but failed until he was printed on red handkerchiefs of coagulated the blood serum of cattle which 100,000 were sold. Verses were and used it for growing germs. I can written to the “bacillus-father” Koch see him going morning after morning and printed in Kladderdatscb. to the incubator, five days, six days, Koch’s paper* was published Mon- seven days, nine days and still no day, April 10, 1882, in the Berliner growth as he examines with his lens kliniscbe Wocbenschrift, seventeen days the many tubes he has inoculated and after it was presented. returns them disappointedly to the Now Koch immediately began look- thermostat. And then on the tenth ing for the cause of the disease in day, possibly as rumor has it on the tuberculous tissue, the usual method fifteenth to the twentieth day when of procedure, employing the ordinary he is ready to discard them as showing stains or dyes, but he failed. Then, no growth, I can picture him going to remembering that some bacteria the incubator with grim determination stained better when the dye was and I can see his face light up. What slightly alkaline, he added potash to are these little specks and white his methylene blue and saw, after scales? Koch was never a demonstra- counterstaining with vesuvin, a brown tive person, and yet an expression of dye which decolorized everything save pleasure and triumph must have spread the bacilli, very thin rods still blue over his face as he saw what he felt in color, 1/10,000 of an inch long and sure were the growing tubercle bacilli. one third as wide. I can picture Koch He had at last grown the germ, and he with hands colored like a rainbow, carried them later through seventy shriveled from acids, as hour after generations. With the germ so to hour he stains coverslip after cover- speak in hand, he attempted to “test slip, 100,150, and then only was he its strength,” as his old teacher Henle able to show Gaffky, who possibly said was necessary. Again and again timidly entered the room to announce he reproduced the disease in all types that Frau Koch was awaiting the of animals. He finally grew the germs Master, some long, thin blue rods. again from the animals and he had He imagined that they were the bacilli. fulfilled all the conditions necessary. Efforts were redoubled. Hospitals, To accomplish such an amount of slaughter-houses, zoological gardens, work in such a short time as six or were haunted, and finally Koch was seven months, especially when the satisfied. He had found the tubercle slow growth of the tubercle bacillus bacillus and had proved as much as he is taken into consideration, seems could by staining. incredible, and Theobald Smith and * A translation by the Pinners has recently Petroff frankly think it highly unlikely. been published by the American Review of There is a limit to the length of any Tuberculosis, 1932. article prepared for presentation to any society and I have often wondered describing how a German had dis- whether this was not the cause of the covered the cause of consumption. omission of the names of some workers And so Koch the scientist became from whom Koch borrowed ideas. Koch the world figure. However this may be, in this article The Atlantic cable to America had he traced for the first time the been in existence for nearly thirty etiology of tuberculosis and if he were years and yet the first news of a a little dogmatic in doing so, I beg of discovery, far more important for you to think of the dogmatism of some mankind than any political news, of his hearers. Possibly it was Vir- reached New York only on April 3, chow’s influence which forced Koch to ten days after Koch had read his present his paper before a physiological paper which, however, was not pub- instead of before a pathological society lished in the Berliner klinische Wocben- where it belonged. It is possible, of scbrift until April 10. It appears, course, that Virchow, opposing the however, that Koch had sent a copy of idea of the specificity of disease and his paper to in London realizing that any paper presented who recognized at once its significance before a society over which he pre- and wrote a letter calling attention sided might be inferred to have his to it in the London Times which was sanction, suggested that as Koch re- published on April 2. A cable announc- placed a physiologist in the Health ing the discovery was published in the Office it would be more fitting for his New York World on April 3, and it paper to be presented where it was. was this paper which Flint waved How the news of the discovery came before Welch. Probably the first men- to America is interesting. Very early tion of it in an American medical on the morning of April 3, 1882, a journal was an editorial notice in the very much excited elderly man with Medical News of April 20 (Landis). greying hair and the sideburns typical Sternberg, later Surgeon-General of of the practitioner of those days, the U. S. Army, demonstrated and rushed into the bedroom of a much photographed in 1882 at Fort Mason younger man, a great student, a in California the tubercle bacillus but reader into the wee hours of the night, it is certain that both Welch and and awakened him waving the morn- Prudden had stained it previously ing paper and shouting, “I knew it, (early in May, 1882) in New York I knew it, I knew it!” In this way City. Prof. Welch writes: Austin Flint, probably the greatest clinical student of tuberculosis that As soon as Koch’s method of staining America has yet produced, a firm and the tubercle bacillus reached this coun- one of the few believers in the con- try, I applied it successfully and demon- tagiousness of phthisis in America, strated the bacillus to Austin Flint and others and taught it to the class. This informed Professor William H. Welch could not have been later than early in of the discovery of the tubercle bacil- May, 1882. Ehrlich’s method which was lus. On that same morning my earliest published not long after Koch’s paper, medical recollection takes me back to was a great improvement and I used a dining room where I heard the this and later Ziehl’s carbol-fuchsin, as family discuss and read in the Sun everyone else did, in preference to Koch’s. paper the headlines of the cablegram I think Prudden was doing the same thing at his laboratory at “P and S.” I classes just after the publication of do not know that any one else preceded Koch’s classical work on the Etiology us in staining the tubercle bacillus and of Tuberculosis. In his most lucid and demonstrating them to others in this fascinating manner he told us of this country. Sternberg in California could great work and of its significance in the not have learned the method earlier than future development of medicine. He Prudden and I on the Atlantic Coast. It showed us the methods of staining was no great trick to stain the bacilli and sputum and demonstrated the tubercle I had many visitors to my laboratory at bacillus. Bellevue who came to see them. Landsteiner told me recently that Austin Flint at this time “wished to Ehrlich’s tubercle bacilli stain was already institute a systematic examination of in use by Ehrlich for Mastzellen before the sputum of all cases of tuberculosis Koch’s paper was published on April the which came to the hospital. I was tenth. It was always a mystery how junior assistant at the time,” writes Ehrlich came out so quickly with his Biggs, “ but fortunately for me, neither method and Landsteiner’s statement ex- the house physician nor the senior plained the mystery. assistant could find time for this work and it fell to my lot to do it.” H. M. Biggs wrote in his graduation They concluded that when the tubercle thesis presented before Cornell Univer- bacillus was present it meant pulmo- sity in June, 1882: nary tuberculosis but its absence on Within the last month there has come one occasion meant little. The report to us across the waters from Germany of the Committee on Practical Medi- the announcement of what promises to cine and Epidemiology of the Illinois be the grandest discovery of the age, State Medical Society concluded that the discovery of a parasite as the cause of the tubercle bacillus was probably tuberculosis by Dr. Koch of Berlin. only one of the mere accompaniments Professor Tyndall in an article upon this of certain deteriorative changes in says, “if the seriousness of the malady organic matter and possessed no be measured by the number of victims, causative relation to tuberculosis what- then the most dreaded pests that have ever, basing their opinion on the ravaged the world—plague and cholera included—must stand far behind the one asserted fact that physicians and now under consideration. nurses caring for the tuberculous suffer no greater mortality from tuberculosis Biggs had completed his undergradu- than others. Consequently, they con- ate work at Cornell in two and a half tinued, it is unnecessary to quarantine years and had gone to New York to the victim of tuberculosis, to dis- begin his study of medicine. He later infect his sputum or to hope by the writes: use of germicide to cure him. Loomis refused to accept Koch’s discovery How clearly I recall the incident which at the College of Physicians and directed my thought to bacteriology and tuberculosis. I was in the last year of the Surgeons in New York but Austin medical school. Our beloved friend, Dr. Flint, who had written, “The doctrine Welch, was professor of at of the contagion of the disease has now Bellevue and was conducting a private as hitherto its advocates, but the class in normal and pathological his- general belief is in its non-communica- tology. I was a member of one of those bility,” accepted it immediately. persons; but Gaffky could not confirm

Repl ie s to Dou bte rs the observation and it was possible that Cramer did not decolorize his prep- It is difficult for us to comprehend arations properly. Schottelius found how any one could doubt Koch’s tubercles in the lungs after the inhala- logical and convincing conclusions in tion of many different substances but regard to the etiology of tuberculosis, did not try further injections of these but some did, and in 1883 we find tubercles which of course were foreign Koch answering sarcastically some of particle tubercles. Dettweiler found his critics. He deals first with the tubercle bacillus in the sputum of the American skeptics, mentioning eighty-seven patients almost without Ephraim Cutter, who thought the exception, but held them to be an tubercle bacilli were “babies” of the accompaniment and not the cause of acetic acid bacteria; R. R. Gregg, who tuberculosis. Injection of these bacilli suggested as an explanation of Koch’s into animals never produced such “mistake” that the supposed bacilli lesions as he saw in his patients but were bits of fibrin formed in the always a miliary lesion, and so he tubercle; Schmidt of Chicago, who inferred they might not be the cause could not stain the bacilli and so of the disease in man, while other and thought no one else could; Formad of various bacteria which he saw in the Philadelphia who thought the tubercle lesions he suggested might be the bacilli were superfluous as he could causal factor. Koch asked why he had diagnose tuberculosis from the scrofu- his patients spit into a solution of lous tissue; Sternberg who at first corrosive sublimate, and Dettweiler could not find the bacillus and who, answered, to satisfy the over squeam- Koch hoped, would soon recover from ish. Koch called to his attention how his error. He is more surprised at his the malignant pustule of anthrax in German critics. Beneke got similar man differed from the disease in bodies when he treated blood cells animals. Spina attempted to repeat with an alcohol-ether solution and Koch’s work but failed and Koch stained them. Cramer claimed to have doubted if he ever worked with pure found bacilli staining like tubercle cultures. bacilli in the stools of twenty sound [To Be Continued]