Twentieth Century History of Findlay and Hancock County, Ohio, and Representative Citizens, Part 168

Author: Jacob Anthony Kimmell
Publication date: 1910
Publisher:
Number of Pages: 1189

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XII .- No. 250.]

BALTIMORE, DECEMBER, 1911.

[Price, 25 Cents

CONTENTS.

PAGE

and Work of Robert Koch. WILLIAM W. FORD, M. D., D. P. H. 415

och. (December 11, 1843-May 27, 1910.) The Father of Modern Science of Tuberculosis. (Illustrated.) S. ADOLPHUS KNOPF, M. D. 425

The Blood Picture in Tuberculosis. (Illustrated.)

By MARGARET REED LEWIS 428

Notes on New Books .

434

Books Received

439

Index

. 441

THE LIFE AND WORK OF ROBERT KOCH.

By WILLIAM W. FORD, M. D., D. P. H., Associate Professor of Hygiene and Bacteriology, The Johns Hopkins University.

Ehrlich, possibly the greatest mind in modern medical y, certainly the most prolific investigator in those Medical Science in which his path has lain, said when ed that our entire knowledge of the infectious diseases various related branches of learning rests upon the ons which he established ; that he devised the methods ave science the posibility of solving the problems in y on an exact experimental basis, the problems of y which Pasteur for the first time freed from the con- : pure empiricism : and that even in the realm of ex- al therapy Koch holds the first place, since he taught 1 how to transmit the infectious diseases artificially mal to animal, thus enabling us to apply therapeutic experimentally.

raise by Ehrlich seems at first an extravagant tribute ition for a devoted friend and an honored colleague; we remember that every well-trained physician and f the present generation uses in his daily work the which came from the investigations of Koch; that perly organized medical school and hospital has a founded on the methods which Koch devised and itus which he invented; that every municipality in Against the great pestilences of the world, cholera, 3, typhoid fever, diphtheria, and in the efforts to its citizens milk, water, and food which cannot e vehicle of infection, depends for its preventive on the doctrines which Koch proved; when we re- Il modern bacteriology has been made possible by

the discoveries of Robert Koch, then we are minded to regard Ehrlich's tribute as expressing even less than the truth.

Let us inquire into the circumstances of Koch's life and study for a moment his early publications to try and determine why he occupies such a pre-eminent place in medical science. Robert Koch was born in Klausthal in the province of Hanover on December 11, 1843. According to Gaffky, who has given us the most intimate account of his teacher and predecessor at the Institut für Infecktions-Krankheiten, Koch's family had lived in Klausthal for a number of generations, and had been for some years in the employ of the government. His father was a man of considerable scientific attainment, whose reputation spread beyond the little district in which his activi- ties were centered, and who was honored by the Prussian gov- ernment with the title of Bergrath, or as we may say expert mining engineer. Koch himself was one of thirteen children, two daughters and eleven sons. Two brothers dying in infancy left him among the eldest of the sons. His mother was a hard- working woman, whose domestic cares and responsibilities pre- vented her from devoting much attention to the rearing of her numerous progeny, and his father from the nature of his work was compelled to absent himself from the home for much of his time. Koch was thus left to grow up in a crowd of wild and untrained boys. He attended the Klausthal Gymnasium, in which, contemporary accounts tell us, the instruction was poor and discipline lax. He took an active part in the school life, was an excellent athlete, was a member of a school society known as Concordia, and sang, but without great success, in

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a choral union, or as we would express it, was a member of the Glee Club. During his school life his chief outside occupation was with his father, whom he accompanied on long rides and walks over the hills and valleys of the surrounding Harz country. He early showed a passion for natural science and made numerous collections of minerals, plants, and small animals. His reading along the lines of geology, zoology and botany was extensive and during his entire life and work he kept up this active interest in the branches of learning collat- eral to the science of medicine. Koch thus enjoyed in his early youth the free out-door life of a boy brought up in the country, developing a rugged physique and great powers of endurance.

He was intended by his father for a merchant, the rapidly growing commercial cities of northern Germany like Hamburg and Bremen with their world-wide commerce offering the sons of Government officials peculiar advantages for a practical ca- reer. About the year 1860, however, the worldly condition of the father was greatly improved-we do not know the exact source of this enhancement of income and he was enabled to offer the son a University training. We thus find Koch in 1862 leaving the Klausthal Gymnasium, wending his way to Göttingen and entering upon the study of medicine. His idea at that time seems to have been to train himself to be a ship- surgeon.

At the time Koch entered the University of Göttingen the faculty there included a number of men who left their marks on science. The senior among them was the chemist Friedrich Woehler, who in 1828 had accomplished the synthesis of urea. Others were the pathologist Wilhelm Krause and the physiolo- gist George Meissner. By far the most important man in Göttingen, however, was the anatomist Jacob Henle, whose scientific work and mental grasp were so wide that his writings covered the field of physiology and pathology as well as an- atomy. It is interesting and important to note that Koch came into intimate relationship with Henle, who evidently made a strong impression upon him.

In the year 1865, the medical faculty offered a prize for the best dissertation upon the structure of the uterine nerves. In the competition which resulted, two prizes were awarded, one to Robert Koch for a thesis which bore the title Ueber das Vorkommen von Ganglienzellen an den Nerven des Uterus and was inscribed with the Latin motto, Nunquam otiosus; a second prize going to a fellow-landsman of Koch's, Adolf Polle. Four weeks later, on July 18, 1865, Koch was appointed assist- ant in the Pathological Museum of which Krause was the director. This appointment offered him the opportunity of acquiring a thorough training in pathological and microscopi- cal technique, a training which gave him afterwards the ability to guide his early footsteps groping in the dark maze of microorganisms by the true light of pathological anatomy. At the same time that Koch served as assistant in pathology he was engaged in original work in the Physiological Institute under the direction of Meissner. He made a study of the ex- cretion of succinic acid in animals fed exclusively on meat and "h was unwilling to limit his observations to the lower

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animals but endeavored to work out the problem by taz himself the subject of experimentation. He ate half ap: of butter daily and estimated his output of succinic acid. !: fortunately he undertook these experiments in the hot or- summer and after five administrations of this fat-rich : his stomach revolted, he developed a violent attack of : catarrh and was compelled to finish his work upon the es .. sitive animals.

In January, 1866, Koch finished his academie career. ;. the examen rigorosum with the mark eximia cum ko ... .. three days later was given his doctor's degree on whit .. sion he delivered in Latin an address on the subject " do. Acid in the Human Body." Owing probably to his pr. thesis on the ganglion cells of the uterus, he was not et .: to present a thesis on taking his degree. In March of the 6: year Koch passed the state examination in Hanover. .. spent the intervening time in postgraduate study in Berlin. . then became an assistant in the General Hospital in Hac: for a short term of three months and in October tork a: as physician to the Asylum for Idiots in Langenhagen : the city of Hanover, where he remained until July, 1% practiced for a short time in the little town of Niemet 1869 moved to Rakwitz in the Province of Posen. Fra. witz he enlisted as a surgeon in the Franco-Prussian Wie . after his return in 1872 secured the position of Fra- or district physician in the town of Wollstein.

Here in Wollstein Koch remained for years busily .. in a general country practice of medicine. He was. to take long rides over rough country roads by day .. night, and minister to the needs of a people in the tr- circumstances. He was out of touch with University! which he loved. He was outside the circle of intelle" tivity, the stimulus to great endeavor. And yet from :. of Koch's arrival in Wollstein, we know that he occurie !. self unceasingly in attempts to solve the most impora." tions in medicine of his day and generation. We know .. fitted up for himself a laboratory, setting aside a p his consulting room for this purpose. We know - mediately after his arrival there he purchased & nes : scope and a microtome and that in his improvised l: he installed a piece of apparatus, the use of whit: learned in the Physiological Institute at Göttingen, 83 : tor or thermostat which could be kept at the body tempe" We know that Koch devoted all his spare time to the st .: disease of animals widely spread in the district where ?. anthrax or splenic fever, and that he carried out al. . experiments in his study of this disease. We do not ka .. Koch did not lapse into the respectable mediocrity #: position in life and his professional attainments made :" the line of least resistance. Something of his youth. chief pleasure was the amateur collection and dis. plants and animals, something of the influences with: : was surrounded in the years at Göttingen, possibly the. tion of his teacher and master Henle, something it "." kept Robert Koch from degenerating. Something I. Google

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-pww wwwo wurunt ne coura snaten from cting duties of a country practice. During the first ars of this period Koch seems to have said nothing of k and only in the year 1876 when he was thirty-three Id, and ten years after his graduation from Göttingen · inkling of his results reach the scientific world.

nderstand the significance of Koch's first publication t glance for a moment at the bacteriological work which d it. For 100 years after the discovery of the micro- y Athanasius Kircher and the improvement in lenses uwenhoek, which revealed to the astonished eye the ss structures belonging to a finer world, the attention of ators was centered upon these minute bodies and specu- zas rife as to the possible rôle they might play in nature. fused were the ideas of scientists, nevertheless, and so g were the findings of the microscope that the great t Linnæus grouped all the microscopic living forms ne division which he named " chaos." Gradually, how- ore and more definite conclusions could be drawn from ny observations. Plenciz, for instance, in an accurate ; of the symptoms of disease brought forward convinc- uments for the doctrine of " contagium vivum." Spal- and later Schultze pointed out that the development g organisms was the cause of putrefaction and Müller trenberg by exact morphological studies demonstrated itence of constant differences in the various bodies seen e microscope. The year 1837 was especially fruitful in tions of permanent scientific value. In this year Donné d for the first time living microorganisms in patholog- ditions. In pus from a syphilitic chancre he found forms which he termed vibrios, and with material con- these vibrios he inoculated the skin of the thigh in his patients. On the following day he noted the ap- e of a typical pustule containing a sero-purulent fluid h vibrios like the original were to be found. Despite that Donne obtained these vibrios from cases of typical and showed that they contained infectious material, not convinced that they were the cause of the disease. , in 1844, he announced that the vibrios previously e in all probability accidentally present on the surface iancre. In the year 1837 also Cagniard-Latour and each made independently the observation that the und bodies first found by Leeuwenhoek in beer and Id be seen to increase and multiply step by step as the tion of the beer and wine advanced.>> They suggested e bodies were minute plants and the cause of the fer- n, Turpin later giving them the name Torula cere- he idea that disease and fermentation were similar was by no means new to medicine and if the one to the growth of microorganisms, the other might je to this factor. In the year 1837, we thus have the : formulation of the germ theory of disease which on any definite observations. This year also saw the by Bassi that muscardine, the contagious disease of

gave instant confirmation to the theories of Latour and Schwann. Soon all sorts of microscopic forms were described in diseased conditions and their etiological relationship to these conditions accepted without question, but the resulting confus- ion was so great and the bar to further progress so strong that Jacob Henle, then a Privat-docent in the University of Berlin, was stimulated to challenge the claims of the many investiga- tors who attributed disease to bacteria. In 1840 in his Patho- logische Untersuchungen, in an essay entitled Von den Mias- men und Contagien und von den miasmatisch-contagiösen Krankheiten, he called attention to the various conditions which had to be established in order to show that bacteria were the cause of disease. " Before microscopic forms," said Henle, " can be regarded as the cause of contagion in man they must be found constantly in the contagious material, they must be isolated from it and their strength tested." The postulates of Henle seem so near the truth as we see it today, that we are apt to transfer them directly from the science of 1840 to the science of 1900, forgetting that the state of knowledge at the time Henle wrote could give him no adequate conception of the morphological and physiological properties of bacteria as at present understood.

Nevertheless the rigid proof demanded by Henle, made the most profound impression upon the thought of his day. The wild and reckless speculation ceased. Fortunately the work went on and the observations continued. During the next decade a host of parasites was described, many of them be- longing, we now know, to the higher fungi, and to this period we owe such terms as oïdium, aspergillus, trichophyton, and leptothrix.

In the year 1857 Pasteur following the lead of Spallanzani and Schultze, by his demonstration of the special resistance to heat of certain bacterial structures which we now recognize as spores, dispelled from the world the fascinating doctrine of spontaneous generation. He next showed that as Latour and Schwann had taught for beer and wine, the fermentation which resulted in lactic, acetic, and butyric acid was also occasioned by microorganisms which differed from each other in morpho- logical and biological characteristics and that the diseases of wine and beer were accompanied by other forms than those found under normal conditions. He thus established on a firm basis the doctrine of the existence of definite kinds of micro- organisms having definite physiological properties. Pasteur, however, was interested largely in the study of microscopic organisms in bulk, and in determining the effects brought about by the development of these organisms under different conditions. He had little or no interest in morphological studies and the necessity of obtaining pure cultures and of studying the action of isolated species apparently was not clearly faced by him.

These observations upon fermentation were confirmed almost at once, but in an indirect way, by the apothecary Lemaire who for years had busied himself with the study of carbolic acid. Lemaire showed that the addition of minute traces of this acid

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to fluids fermenting from the development of microorganisms stopped this action while the addition of the same material to solutions containing diastase or similar substances was with- out effect. The carbolic, according to Lemaire, inhibited the development of the living plants but could not stop the chemi- cal changes superinduced by the presence of the true ferments. The importance of this observation did not escape Lemaire, who suggested that the suppuration of wounds might be prevented also by the addition of carbolic acid, if the suppuration were really due to living parasites. Shortly after, the brilliant young English surgeon, Joseph Lister, thoroughly imbued with Pasteur's ideas on fermentation and its relation to dis- ease, began his wonderful experiments upon the healing of wounds. He seems to have been unfamiliar with Lemaire's observations, gaining his first idea as to the efficacy of carbolic acid in the destruction of microorganisms from the work which was done with this acid in the disposal of sewage near the little town of Carlisle. The observations of Lister, by means of which he developed his antiseptic technique, form one of the great chapters in surgery as well as in bacteriology and we all know how far-reaching the influence of this work has been. Lister was actuated in his experiments, however, mainly by the idea that the poisonous germs were in the air and that their access to the wounds must be prevented, a point of view which we now recognize to have been based upon insufficient knowledge as to the etiology of infections. At no time did he offer any evidence to show that a definite pathological con- dition was due to the development of a particular bacterial species.

The first observation of a characteristic microorganism in a definite disease is apparently that of Pollender, who, in 1849, found the bacillus of anthrax in the blood of an animal dead of splenic fever. The following year this was confirmed by Davaine, and in the decade from 1850-1860 the presence of these organisms in anthrax blood was testified to by a number of observers. In the year 1860 Delafond found the parasite not only in affected cattle but also in the blood of animals inoculated with material taken from the natural disease, and three years later Davaine, impressed by the work of Pasteur on fermentation, carried out still more convincing experi- ments. Side by side he inoculated animals with blood contain- ing the bacteria and blood free from them, observing the development of anthrax only in those animals which had re ceived the material containing the organism. Nevertheless, in all these experiments, some virus in the blood and not the organisms visible under the microscope might be the cause of the disease. The proof that the bacteria seen first by Pol- lender and Davaine were the infectious agent of splenic fever had not yet been brought and could not be brought until the organism was cultivated artificially outside the animal body, and successful inoculations carried out with such a culture freed from any virus or poison.

The first attempt to devise a method for the separation of microorganisms from mixtures is probably seen in the ex- . nts of Hallier in 1866. His apparatus, however, did

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not permit the isolation of individual species, and si : different kinds of organisms appeared that Hallier was : the doctrine of pleomorphism, the doctrine that miche. isms could change their size and shape, developing ‹ : another. Faulty as was the method of Hallier and vo: were his conclusions, he nevertheless again drew attet: the occurence of bacteria in various pathological condi: in measles, syphilis, gonorrhea, glanders and diphtheria presence of bacteria in morbid processes was about the= further demonstrated by some of the most reliable inrec; tors of the day, among whom must be mentioned W .: Cohn, Oertel, Eberth, Klebs, Rindfleisch, von Recklingr. and Waldeyer. In most of the observations at this time: : ever, various cells, cellular detritus of organic and in co. nature, particles of fat and different crystals were together as living organisms. In 1871 von Recklingha found, in the organs and tissues of individuals dead of prr. puerperal fever, typhoid fever, and rheumatism, smel ;. with a definite structure which were not dissolved by al: by acetic acid or by glycerine. Such bodies were clax ganic in nature. During the same year Waldeyer demir:" aggregations of minute forms which were evidently be in the heart muscle in pyæmia and in the pelvis of the in pyelonephritis, and a little later Weigert found bydi. . the reaction described by von Recklinghausen in the cor . cases of hemorrhagic smallpox. Klebs also in IS:i}" scribed his microsporon septicum in gun-shot wicz- granulation tissue, in fistula, in diseased bone-marnr. cartilages of the joints in arthritis, and in diphther : devised methods for the isolation of organisms in pure c. the so-called fractional cultivation, but had no succes observations of so many competent observers that baxter. constantly present in diseased conditions coupled with :- ure to demonstrate organisms in the normal tissues, 0: be explained on the theory that they were the cat- pathological change. The whole question was involved : obscurity, however, since no proof had been brought cz particular variety of organism seen with the micress derived from a previously existing organism of the &: and shape and with the same properties. The obsc=" rendered more dense moreover by the contentions d' :. servers as Bilroth and Klebs, that the same mich ... could be the cause of the most diverse pathological (" pyæmia, septicemia, puerperal fever, phthisis, smallpin theria, and cholera. The etiology of infections com. cleared up by the demonstration of specific different. many bacterial forms found in diseased organs and tis -

About this time the Botanical Institute of Ferdins: in Breslau became the seat of active and illuminati: gations upon microorganisms. The Monas prod's: previously been discovered in a red discoloration ez Ehrenberg and its cultivation accomplished by Fres. Erdmann on potato. The pigment produced by this .: enabled the observer to follow the growth from getans generation, and cast aside as contaminations all the Google

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" of media in Cohn's Institute. He was unable to sepa- mixtures of organisms into their constituent elements. er, and in consequence could not be sure his colonies t contain extraneous species having the same morphology microorganism which produced the pigment. The cry- cessity was for a method which would bring about the tion of one organism from another and enable the ob- to test the properties of isolated species. No one ap- ed this necessity more than Cohn himself, who clearly at until the different bacteria could be isolated, in pure 2, and observed over long periods of time, no certainty xist as to the origin of any one particular organism from existing organism of the same size and shape. Neverthe- 1 the ground of the various investigations relating to the ology and the physiological properties of bacteria, Cohn toroughly convinced of the correctness of the doctrine ifferent species of microorganisms existed in nature, ng from each other in form, in biological reactions, and mentative activity. The proof for this thesis, which regarded as the key-note to the whole science of bac- gy, had not yet been brought. Cohn had himself dis- 1 the sporulation in the bacilli and had predicted that would be found in the organism of splenic fever. As self tells us, he was greatly delighted to receive a letter on 22, 1876, from a young country physician in Wollstein, Koch, stating that he had succeeded in working out the te life-history of the anthrax bacillus and that the na- id distribution of the disease could be fully explained by de in which the organisms developed and especially by porulation, the sporulation which Cohn had predicted hich he himself had observed under the microscope. expressed his willingness to carry out the necessary ex- its to prove these claims in Cohn's own Institute and his o obtain Cohn's judgment of their value. Cohn at once Koch to come to Breslau and on April 30, 1876, Koch, three-day demonstration before Cohn in the Botanical e. He brought with him many of his preparations and out a number of fundamental experiments. He showed ow he could cultivate the anthrax bacillus in sterile rum or in the aqueous humor of a bullock's eyes, and vent through a definite phase of development. During se of this development the short rods originally present lood of animals dead of splenic fever grew out into long or chains of bacilli in each of which a spore appeared. pores became free from the organisms which disinte- nd disappeared, and under proper conditions of tem- and moisture underwent certain peculiar changes. As of these changes, projecting from each spore there I the short rod, characteristic of the bacillus of anthrax red in the blood of infected animals. Thus the com- e cycle of the anthrax bacillus was established, the plete life cycle to be described for any of the bacteria. rther showed Cohn how the inoculation of animals

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Twentieth Century History of Findlay and Hancock County, Ohio, and Representative Citizens, Part 168

Author: Jacob Anthony Kimmell Publication date: 1910 Publisher: Number of Pages: 1189

Author: Jacob Anthony Kimmell
Publication date: 1910
Publisher:
Number of Pages: 1189