Robert Heinrich Herman Koch

Abstract

German physician and bacteriologist who identified the tubercle bacillus as the cause of tuberculosis and is credited with founding the specialty of medical bacteriology. Born in Clausthal, Germany, on Dec 11, 1843, he died on May 27, 1910, aged 66 years.Robert Koch had an unremarkable start in life. Born the son of a mining engineer, Koch excelled in science and maths at school, and went on to study medicine at the University of Göttingen, Germany. After he graduated in 1866, Koch worked as a physician in several provincial towns, including Hamburg. He then served in the Franco-Prussian War (1870–71), before becoming a district medical officer in the town of Wollstein (now Wolsztyn in Poland). “Koch had an inconspicuous career as a countryside doctor until the early 1870s”, explains Christoph Gradmann (Wellcome Unit for the History of Medicine, University of Oxford, UK). However, he did write a medical diary during his time in Wollstein, which documented his growing fascination with bacteriology.Anthrax was prevalent in farm animals at that time and, in a makeshift laboratory in his own home, Koch set out to prove that the anthrax bacillus was the cause of anthrax. Koch followed the methods of the renowned botanist Ferdinand Cohn, growing the anthrax bacillus for several generations, demonstrating its spore stage, and injecting it into healthy animals to prove it caused the disease. Koch presented his work to Cohn at the University of Breslau, who was so impressed that he published Koch's study in his botanical journal in 1876.In 1880, Koch moved to the Imperial Health Office in Berlin, taking with him the methods that he learnt from Cohn and the pathologist Julius Cohnheim. Koch began to work on tuberculosis, developing new staining techniques and methods of culturing bacteria on solid materials (such as agar), and taking photomicrographs of bacteria. On March 24, 1882, Koch presented his findings to the Berlin Physiological Society, confirming that the tubercle bacillus was the cause of tuberculosis. Allegedly, Koch's audience were stunned into silence by the thoroughness of his methods. “Koch and his colleagues had developed the methodologies required to pure culture one of the most difficult bacterial pathogens”, comments Stefan Kaufmann (Max Planck Institute for Infection Biology, Berlin, Germany). “This was an enormous breakthrough for the whole of medical microbiology and marks the birth of this discipline.”In 1883, the Prussian state dispatched Koch to Egypt, and subsequently India, to identify the cause of the cholera outbreaks in these countries. These expeditions established Koch in the public eye—the microbe hunter was transformed into a crusader against epidemics. They “also made Koch a player in health politics”, says Gradmann, and he was appointed Professor of Hygiene at the University of Berlin in 1885. “At the beginning of the 1880s, medical bacteriology was a breakthrough science, but by the end of that decade, it was becoming an important and powerful discipline”, Gradmann adds.Koch then turned his attention to finding a treatment for tuberculosis, announcing in 1890 that he had discovered an inoculum—tuberculin—that cured the disease. “Koch wanted something that even today is considered impossible—to use immunotherapy to cure active disease”, explains Kaufmann. Unfortunately, Koch overstated the therapeutic potential of tuberculin. “In 1891, the official report was published, which concluded that the vast majority of tuberculosis of endogenous organs (such as the lung) was not successfully cured by tuberculin”, Kaufmann comments. Koch had dreamt of founding his own tuberculin research institute, and of making his fortune by producing tuberculin. Although Koch was appointed director of the Berlin Institute for Infectious Diseases (which now bears his name) in 1891, after the failure of tuberculin, he was forced by the Prussian state to agree to work on infectious disease generally and not just on tuberculin as Koch had envisaged. “Koch was—unsurprisingly—not enthusiastic about being the director of an institute that was very different to the one he had dreamed of, and he began to take an interest in tropical medicine”, notes Gradmann.Koch went on many expeditions to Africa and India, studying malaria, sleeping sickness, and diseases of cattle such as rinderpest. While working on typhoid in 1902, Koch proposed the idea of the healthy carrier. Koch realised that an epidemic was not simply a chain of infection, but could arise from a seemingly healthy person or animal who was a carrier of disease.His companion on many of his expeditions was his second wife, Hedwig Freiberg. Koch's first marriage to Emma Fraatz, with whom he had a daughter, had ended in 1893. Later that year Koch married Freiberg, an artist who was Koch's junior by at least 30 years. Although his second marriage was the subject of much speculation, Freiberg was devoted to Koch and showed a keen interest in his work.In 1905, 5 years before he died, Koch was awarded the Nobel Prize for his work on tuberculosis. Although honoured, he felt this accolade was long overdue, and was sour that the first Nobel Prize in Physiology or Medicine in 1901 had been given to his former assistant, Emil von Behring. Koch cherished loyalty, and felt that he had been deserted by Behring. The two famously disagreed about whether bovine and human tuberculosis were caused by the same pathogen.Although Koch is undoubtedly most famous for his discovery of the tubercle bacillus, it was his painstaking work to develop research methods and techniques—eg, solid cultures and new bacteria-specific stains—that is his lasting gift to medical science. In this way, Koch laid the foundations for modern-day medical microbiology. Although Koch did not develop a cure for tuberculosis, tuberculin was subsequently used in a diagnostic test to show the true burden of tuberculosis. Moreover, Koch's work on tuberculin inspired others, such as Paul Ehrlich, to harness the host immune response by developing vaccines to protect against infectious diseases. More than 130 years since Koch's first presentation on the tubercle bacillus, his legacy is still evident as scientists and clinicians work on strategies to reduce the number of deaths caused by tuberculosis every year. German physician and bacteriologist who identified the tubercle bacillus as the cause of tuberculosis and is credited with founding the specialty of medical bacteriology. Born in Clausthal, Germany, on Dec 11, 1843, he died on May 27, 1910, aged 66 years. Robert Koch had an unremarkable start in life. Born the son of a mining engineer, Koch excelled in science and maths at school, and went on to study medicine at the University of Göttingen, Germany. After he graduated in 1866, Koch worked as a physician in several provincial towns, including Hamburg. He then served in the Franco-Prussian War (1870–71), before becoming a district medical officer in the town of Wollstein (now Wolsztyn in Poland). “Koch had an inconspicuous career as a countryside doctor until the early 1870s”, explains Christoph Gradmann (Wellcome Unit for the History of Medicine, University of Oxford, UK). However, he did write a medical diary during his time in Wollstein, which documented his growing fascination with bacteriology. Anthrax was prevalent in farm animals at that time and, in a makeshift laboratory in his own home, Koch set out to prove that the anthrax bacillus was the cause of anthrax. Koch followed the methods of the renowned botanist Ferdinand Cohn, growing the anthrax bacillus for several generations, demonstrating its spore stage, and injecting it into healthy animals to prove it caused the disease. Koch presented his work to Cohn at the University of Breslau, who was so impressed that he published Koch's study in his botanical journal in 1876. In 1880, Koch moved to the Imperial Health Office in Berlin, taking with him the methods that he learnt from Cohn and the pathologist Julius Cohnheim. Koch began to work on tuberculosis, developing new staining techniques and methods of culturing bacteria on solid materials (such as agar), and taking photomicrographs of bacteria. On March 24, 1882, Koch presented his findings to the Berlin Physiological Society, confirming that the tubercle bacillus was the cause of tuberculosis. Allegedly, Koch's audience were stunned into silence by the thoroughness of his methods. “Koch and his colleagues had developed the methodologies required to pure culture one of the most difficult bacterial pathogens”, comments Stefan Kaufmann (Max Planck Institute for Infection Biology, Berlin, Germany). “This was an enormous breakthrough for the whole of medical microbiology and marks the birth of this discipline.” In 1883, the Prussian state dispatched Koch to Egypt, and subsequently India, to identify the cause of the cholera outbreaks in these countries. These expeditions established Koch in the public eye—the microbe hunter was transformed into a crusader against epidemics. They “also made Koch a player in health politics”, says Gradmann, and he was appointed Professor of Hygiene at the University of Berlin in 1885. “At the beginning of the 1880s, medical bacteriology was a breakthrough science, but by the end of that decade, it was becoming an important and powerful discipline”, Gradmann adds. Koch then turned his attention to finding a treatment for tuberculosis, announcing in 1890 that he had discovered an inoculum—tuberculin—that cured the disease. “Koch wanted something that even today is considered impossible—to use immunotherapy to cure active disease”, explains Kaufmann. Unfortunately, Koch overstated the therapeutic potential of tuberculin. “In 1891, the official report was published, which concluded that the vast majority of tuberculosis of endogenous organs (such as the lung) was not successfully cured by tuberculin”, Kaufmann comments. Koch had dreamt of founding his own tuberculin research institute, and of making his fortune by producing tuberculin. Although Koch was appointed director of the Berlin Institute for Infectious Diseases (which now bears his name) in 1891, after the failure of tuberculin, he was forced by the Prussian state to agree to work on infectious disease generally and not just on tuberculin as Koch had envisaged. “Koch was—unsurprisingly—not enthusiastic about being the director of an institute that was very different to the one he had dreamed of, and he began to take an interest in tropical medicine”, notes Gradmann. Koch went on many expeditions to Africa and India, studying malaria, sleeping sickness, and diseases of cattle such as rinderpest. While working on typhoid in 1902, Koch proposed the idea of the healthy carrier. Koch realised that an epidemic was not simply a chain of infection, but could arise from a seemingly healthy person or animal who was a carrier of disease. His companion on many of his expeditions was his second wife, Hedwig Freiberg. Koch's first marriage to Emma Fraatz, with whom he had a daughter, had ended in 1893. Later that year Koch married Freiberg, an artist who was Koch's junior by at least 30 years. Although his second marriage was the subject of much speculation, Freiberg was devoted to Koch and showed a keen interest in his work. In 1905, 5 years before he died, Koch was awarded the Nobel Prize for his work on tuberculosis. Although honoured, he felt this accolade was long overdue, and was sour that the first Nobel Prize in Physiology or Medicine in 1901 had been given to his former assistant, Emil von Behring. Koch cherished loyalty, and felt that he had been deserted by Behring. The two famously disagreed about whether bovine and human tuberculosis were caused by the same pathogen. Although Koch is undoubtedly most famous for his discovery of the tubercle bacillus, it was his painstaking work to develop research methods and techniques—eg, solid cultures and new bacteria-specific stains—that is his lasting gift to medical science. In this way, Koch laid the foundations for modern-day medical microbiology. Although Koch did not develop a cure for tuberculosis, tuberculin was subsequently used in a diagnostic test to show the true burden of tuberculosis. Moreover, Koch's work on tuberculin inspired others, such as Paul Ehrlich, to harness the host immune response by developing vaccines to protect against infectious diseases. More than 130 years since Koch's first presentation on the tubercle bacillus, his legacy is still evident as scientists and clinicians work on strategies to reduce the number of deaths caused by tuberculosis every year. An infectious narrativeBack in the 1840s, a Hungarian doctor named Ignaz Semmelweis had his medical students disinfect their hands after doing autopsies. Previously they had gone from handling the dead to delivering babies, and the mortality rate in the Viennese maternity ward reflected the atrocious practice. Deaths fell sharply after his instructions were enacted. But the adherents of germ theory were revolutionaries; they sought to overthrow the medical orthodoxy that had prevailed since time immemorial. The hospital authorities wanted no part of it. Full-Text PDF