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Rockets and MCAT’s
In the last days of July 2006, as Hezbollah rockets landed outside an operating theatre at the Rambam Medical Center in Haifa, a surgeon continued with his operation and the web-site of Haifa University announced that "This week no exams will be held, Neither will lectures be given" (1
, 2)
. On the same day, while a lighthouse near the American University of Beirut was hit by Israeli bombs, its provost left the country and the University posted the news that "We regret, for many reasons, being unable to administer the August 2006 MCAT examination in Beirut" (3)
.
That’s the immediate outlook for our young colleagues in the Middle East: cancelled biochemistry exams in Haifa, pre-meds blocked from the U.S. Medical College Aptitude test in Beirut. The two groups of students share the common language of biomedical science: each had been prepped on the Krebs cycle, DNA repair, and G proteins. Sadly, each was hunkered down at home with textbooks in hand, the issue in doubt, and death waiting around the corner. Despite their common language, they were separated by a wide gap in social history, a gap filled by hirsute zealots who care more for their scriptures than for their children.
As Galileo and Darwin learned, the culture of science rests on fragile ground. Sweet reason is distrusted, even in the most languid of venues—look at the story of evolution in Kansas. But, let slip the dogs of war and common ground crumbles under the Katyushas. It is at times like these that we and our colleagues in the Middle East must continue to speak to each other in the collegial voices of skeptical reason. When the shooting stops, when the rockets are grounded, when blame is allotted, we ought to be sure that, as scientists, we have remained true to the charge that unites us: the search for, not the worship of, Veritas. I am pleased to note that within the past year, The FASEB Journal has received and reviewed and published submissions from universities in Iraq, Sudan, Jordan, Lebanon, Israel, and the Islamic Republic of Iran. Our contributors are our brothers and sisters in the republic of science, and we stand with them as the horsemen pass by.
The Franco-Prussian War on Cholera
The Middle East was the setting for an exemplary tale of collegiality in the midst of a bitter scientific competition between two nation states.
Up to now twenty-two cholera victims and seventeen cholera patients have been examined in Calcutta, with the help of both the microscope and gelatin cultures. In all cases, the comma bacillus has been found. These results, taken together with those obtained in Egypt, prove that we have found the pathogen responsible for cholera (4)
So wrote Koch from India on February 4, 1884, reporting on the success of the German Cholera Commission to his supervisors in Berlin. In July of 1883, cholera had entered Egypt from India and the Arabian peninsula along the recently opened Suez Canal. Quarantine facilities were set up at major ports and at way stations for pilgrims returning from Mecca, to which Muslims from India had brought the disease. The caliphate appealed to Europe for help, rightly supposing that the century-long rivalry in science between France and Germany would prompt both countries to send the best and brightest of their new microbe hunters. National honor and human lives were both at stake and national honor was clearly paramount. In 1870, the Prussians had humiliated the French on the battlefield and had succeeded in besieging Paris, the inhabitants of which were reduced to eating rats. Altruism was a secondary motive; if the disease could be halted in Egypt before it spread to the West, the fifth pandemic of Asiatic cholera might be prevented.
By mid-August 1884, the two contending teams of French and German scientists were on site in Alexandria seeking to be first to isolate the cholera agent. The French team, which was hand-picked by Pasteur himself, consisted of the internist Isador Straus, the veterinarian Edmond Nocard, and two of Pasteur’s most valued assistants, Emile Roux and Louis Thuillier. Together with several Italian colleagues, they were quartered at the Hôpital Européen. The Germans were led by Koch, fresh from his triumphant discovery of the tubercle bacillus (for which he would be awarded the Nobel Prize in 1905). He was assisted by the chemist Ludwig Treskow and the bacteriologists Georg Gaffky and Bernhard Fischer—they were housed in the Greek Hospital across town from the French team. (These days, we remember Roux, Gaffky and Nocard as names of bacteria we studied in microbiology. Their fame is shared by a dirty village stopover for pilgrims on the Suez Canal; El Tor is now simply the technical name for a bad strain of the cholera vibrio.)
The French struck pay dirt soon after arrival. They found strange new microscopic structures in stained blood smears of patients with cholera. Excitement mounted, and news of the possible identification of the cholera agent spread around town. But before their preliminary finding could be confirmed, tragedy struck the French camp. Thuillier, at the age of twenty-seven the youngest of the team, succumbed within 36 hours to an explosive bout of cholera. As Roux reported to Le Temps,
Straus and I were obliged to hold him up to prevent his fainting. From this moment everything passed involuntarily; and, in spite of the most energetic treatment, at eight o’clock he was already moribund ... We employed strong frictions (rubbing of the limbs). All the French and Italian doctors were present. Iced champagne and subcutaneous injections of ether were given freely. In short, everything that could be devised was done to prevent a fatal issue (4)
The champagne was useless as friction and the issue was fatal. At Thuillier’s funeral, Robert Koch and the other German scientists showed up with two wreaths for their fallen competitor. "They are only a small token, but they are of laurel and most fitting for him, who deserves such glory" said Koch, who helped to carry the coffin. Myth and legend have arisen around this episode. For it turned out that the strange new particles discovered by the French group were nothing but fractured blood platelets with altered staining properties. Koch is said to have realized that the French discovery must be an artifact and suspected that the real culprit was a novel microbe that resembled a punctuation mark: "ein Komma bazillus."
In the legend, Koch was called out in the middle of the night by a visit from the distraught Roux. The two erstwhile rivals rushed through the dark, disease-ridden town to the bedside of the dying Thuillier, whom Koch had known since the young man visited him in Berlin. Thuillier looked up at the master and weakly asked his evaluation of the new "organisms" the French had spotted in the blood. "Have we found it?" asked the moribund youth. Koch wished his colleague to die a happy man: "Yes, you have found it (5)
."
Cholera in India: the oriental card
In reality—as opposed to this legend from de Kruif’s Microbe Hunters—neither the French nor German teams made the conclusive discovery in Alexandria. Perhaps because of strict quarantine measures, perhaps because the epidemic wound down naturally with the end of hot weather, Thuillier’s death was almost the last from cholera that season. The French went home with their samples and Koch proceeded to Calcutta. There the disease was still rampant, and it was in India that Koch isolated pure cultures of the cholera vibrio for the first time. He spelled out its local epidemiology and finally proved that it is spread via contaminated water. By rigorous bacteriological means, he showed that John Snow had been correct in 1854 when he concluded that water from the Broad Street pump spread the disease. Koch and the Europeans were entertained at clubs in the British Raj from which native Indians (called "wogs" for "worthy oriental gentleman") were excluded.
Once the Egyptians learned that cholera was carried by pilgrims returning from Mecca, strong sanitary measures combined with enforced quarantine along the Suez Canal stopped this route from becoming a chronic portal of entry. But the road from Mecca continued to stir the Western imagination by combining sanitary fear with religious chauvinism. In Microbe Hunters (1926) Paul de Kruif played the oriental card in the popular prose of his generation:
It is thanks to these bold searchings of Robert Koch that Europe and America no longer dread the devastating raids of these puny but terrible little murderers from the Orient—and their complete elimination from the world waits only upon the civilization and sanitation of India (6)
The microbe hunters of the nineteenth century were certain that once the causative organism of a disease was identified and its mode of spread appreciated, sanitary measures would suffice to eliminate it. And if those who carried it were the immigrant, the poor, the mad, the Gyppo (Egyptian), the Indian, or Jew—well, so be it. The needs of public health came first and the rights of "lesser breeds without the law" a distant second. We get more than a whiff of this from Paul de Kruif. Indeed, I’d guess that strife in today’s Middle East owes not a little to Western contempt for the ignorant, unsanitary "oriental."
Ironically, a good number of my students over the last few years have been led to read de Kruif’s Arrowsmith because someone told them that the name of the rock group "Aerosmith" was taken from a "doctor book." They’ve found it quaint, dated, and totally inspiring. Martin Arrowsmith, in turn, was inspired by Koch, Roux and Thuillier. Sinclair Lewis has Martin Arrowsmith resolve that if he had to be "a small town doctor he would be such a small town doctor as Robert Koch." Unlike Aerosmith’s grungy millionaires, however. Arrowsmith leaves riches not for rags but for science. His picaresque career blends the biographies of Paul de Kruif and Sinclair Lewis’s father: research in a bacteriology lab in Michigan, a small-town doctor’s life in Wisconsin, work at the Rockefeller Institute, the temptations of money and the flesh. Eventually Martin and his wife travel to a Caribbean island to stop an outbreak of the pneumonic plague by means of a bacteriophage he has developed. On that plague-ridden island, Martin’s Swedish colleague is killed by the epidemic they have been fighting—his death is the heroic death of Thuillier:
"What is it? What is it?" "I t’ink—it’s got me. Some flea got me. Yes," in a shaky but extremely interested manner, "I was yoost thinking I will go and quarantine myself. I have fever all right and adenitis ... O my God, Martin, I am so weak! Not scared ... It hurts some, but life was a good game. And—I am a pious agnostic. Oh, Martin, give my people the phage! Save all of them— (7)
Our new millennium has been racked by the fevers of piety, pride and national petulance; it seems longer than a short century ago that the armies of health and reason wore the same uniform. Whatever their differences, whatever their flaws, Roux and Koch, Frenchman and German, marched together under the white ensign of sanitation. Under that banner, science went on to conquer anthrax and typhoid, diphtheria and plague. It has had less luck with unreason.
Jacques Loeb—the model for Dr. Gottlieb in Arrowsmith—numbered Robert Koch among the men of reason, among the philosophes who "dared to follow the consequences of a mechanistic science, incomplete as it then was, to the rules of human conduct, and who thereby laid the foundations of tolerance, justice and gentleness which was the hope of our civilization until it was buried under the wave of homicidal emotion which swept through the world in 1914 (8)
." It could be said that the dream of Enlightenment reason was interrupted in 1914 by the Guns of August to become a nightmare awaiting Judgment at Nuremberg. The Katyushas in Haifa and bombs in Beirut are keeping our brothers and sisters awake in the new age of Endarkenment.
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FOOTNOTES
The opinions expressed in editorials, essays, letters to the editor, and other articles comprising the Up Front section are those of the authors and do not necessarily reflect the opinions of FASEB or its constituent societies. The FASEB Journal welcomes all points of view and many voices. We look forward to hearing these in the form of op-ed pieces and/or letters from its readers addressed to journals{at}faseb.org
REFERENCES
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