The German Genius

of the small intestine in ten bodies that had died of cholera. He found the same again in about twenty cholera patients. Though promising, this organism failed to induce cholera when fed to or injected into monkeys and other animals. However, Koch’s observations in Egypt were confirmed in Bengal, where his commission traveled next, and where cholera was endemic. In the spring of 1884 he identified village ponds, used for drinking water and all other domestic purposes, as the sources of why cholera was endemic in Bengal. He had, he said, observed cholera bacilli in one such pond. 13
    Although Koch and his work caught the eye (and continue to do so), the bacilli of swine erysipelas, glanders (an infectious disease of horses), and diphtheria were isolated by Loeffler, and the typhoid bacillus by Gaffky. 14 Advances were being made at such a rate that additional institutes of public health were established in Prussia, and in 1885 Koch was appointed to the new chair of hygiene at the University of Berlin. There was a hiccup when Koch announced he had developed a substance which prevented the growth of the tubercle bacilli, a substance which, it was subsequently found, didn’t always work and sometimes had toxic side effects. 15 It emerged in this way that dosage was all-important. This hiccup strained relations between Virchow and Koch but, over Virchow’s objections, an Institute for Infectious Diseases went ahead as planned in Berlin. The circle around Koch was by now more impressive than that around Virchow and included Paul Ehrlich and August von Wasserman. 16 As a result of Koch’s work, a communicable diseases control law was passed in 1900, the year in which his institute moved to larger quarters, adjoining the Rudolf Virchow Hospital, making it the most famous medical complex in the world.
    Koch achieved a level of fame for a doctor that has probably never been equaled, not even now. Toward the end of his life, he was in demand all over the world—South Africa, where he investigated rinderpest, Bombay (plague; he identified rats as the source but overlooked fleas as the vector), St. Petersburg (typhus), and Dar-es-Salaam (malaria and blackwater fever). He eventually isolated four types of malaria. 17
    In 1905 he received the ultimate accolade, the Nobel Prize for Physiology or Medicine. He died of angina on April 9, 1910. “Addicted” to chess and a great admirer of Goethe, Robert Koch probably benefited mankind—and the poor as well as the better off—more than anyone else to that point, and maybe since.
    T HE D ISCOVERY OF A NTIBIOTICS AND THE H UMAN I MMUNE R ESPONSE
     
    Despite the stirring achievements of Virchow and Koch, which would take time to work through their effects, at the beginning of the twentieth century people’s health was still dominated by a “savage trinity” of diseases that disfigured the developed world: tuberculosis, alcoholism, and syphilis. TB lent itself to drama and fiction. It afflicted the young as well as the old, the well-off as well as the poor, and it was for the most part a slow, lingering death: as consumption it features in La Bohème , La Traviata , Der Tod in Venedig ( Death in Venice ), and Der Zauberberg ( The Magic Mountain ). Anton Chekhov, Katherine Mansfield, and Franz Kafka all died of the disease. 18
    The fear and moral disapproval surrounding syphilis a century ago mingled so much that despite the extent of the problem it was scarcely talked about. Despite this, in Brussels in 1899, Dr. Alfred Fournier established the medical speciality of syphilology, using epidemiological and statistical techniques to underline the fact that the disease affected not just the “demi-monde” but all levels of society, that women caught it earlier than men, and that it was “overwhelming” among girls whose poor back-ground forced them into prostitution. This paved the way for clinical research, and in March 1905 Fritz Schaudinn, a zoologist from Roseningen in East Prussia, noticed under the microscope “a very small spirochaete, mobile and very difficult to study” in a blood sample taken from a syphilitic. 19 A week later Schaudinn and Eric Achille Hoffmann, a bacteriologist originally from Pomerania, and a professor at Halle and Bonn, observed the same spirochaete in samples taken from different parts of the body of a patient who only later developed roseolae, the purple patches that disfigure the skin of syphilitics. Difficult as it was to study, because it