History of Medicine

 THEODOR ESCHERICH AND HIS BACTERIUM

 

         Last month the CDC reported on an outbreak of diarrhea due to a strain of Escherichia coli, thought to be associated with the consumption of romaine lettuce. Certain strains of this bacterium frequently cause diarrheal illness while others are innocuous inhabitants of the lower intestinal tract. This tongue-twister of a name derives from its discoverer, Theodor Escherich, a pioneering pediatrician who originally called the organism Bacterium coli. 

  

Theodor Escherich (Wikipedia)

       Escherich was born in 1857 in Ansbach, Germany. His father was a district health officer, concerned with health of the poor and high infant mortality rates, passing these concerns on to his son. Theodor completed his medical education in different German cities, as was the custom at the time, served briefly in the military, and became an assistant to Prof. Karl Gerhardt in Würzburg. Although Gerhardt was an internist, he was interested in pediatrics and eventually wrote a large, sixteen-volume work on the subject.
Inspired by Gerhardt and by the newly developing science of bacteriology, Escherich studied further at the St. Anna Children’s Hospital in Vienna, where he attended lectures by Hermann von Widerhofer, who held the city’s first Chair of Pediatrics at the University of Vienna. After a brief time in Paris, he moved to Munich where he learned bacteriology skills from a former student of Robert Koch. He learned well, and focused his efforts on

Hermann von Widerhofer

examining the intestinal bacteria of the newborn. He characterized two distinct new bacteria that he called Bacterium coli commune (now known as Escherichia coli) and Bacterium lactis aërogenes (now called Klebsiella pneumoniae). He determined that at birth the intestinal canal was sterile but acquired these and other bacteria almost immediately. His thesis paper on the subject was published and a translated version eventually saw print in the U.S in 1988.

         In 1890, at age 33, he moved to the St. Anna Children’s Hospital in Graz, as a professor of pediatrics, soon being elevated to a full professor and director of the hospital. In this capacity he supervised an expansion of the hospital, including laboratories and incubator rooms. He and a colleague demonstrated antitoxin in children recovering from diphtheria, he promoted Emil von Behring’s diphtheria antitoxin treatment, and he wrote a book on diphtheria. He also established Bacterium coli as a cause of diarrheal disease and urinary tract infections in children. After Roentgen’s discovery of X-rays, he installed an X-ray camera. He attracted numerous students, including Clemens von Pirquet and Bella Schick. These two studied and described in detail serum sickness, a complication of serum therapy. Pirquet also developed the tuberculin skin test, and Schick developed the Schick test for diphtheria, then widely used but now obsolete. 

         Escherich’s talents as a teacher, researcher, and humanitarian did not go unnoticed. After the death of his old teacher, von Widerhofer, in 1901, he accepted an offer from the University of Vienna to fill his shoes as Chair of Pediatrics and Director of the St. 
Anna Children’s Hospital (separate from the one in Graz), where he had studied 18 years previously. Escherich did not slow down in his new role. He expanded the hospital laboratories and X-ray facilities and instituted training of pediatric nurses. Infant mortality in Vienna was still high and Escherich combatted it by establishing organizations enhancing the hygiene and welfare of children, such as an infant welfare society, a Society for Children’s Research, and the Association of Pediatricians in Vienna. He continued his interest and research in infectious diseases and was considered the best pediatric bacteriologist in Europe. The Emperor Franz Joseph named him Court Counselor in 1906 and invited him to dine at court several times. 

St Anna Hospital, Vienna, 1850s (Wikimedia Commons) 

         His accomplishments in pediatrics and his connections were essential in the construction of a new Imperial Institute for Maternal and Infant Care in Vienna and the first human milk bank. Escherich’s bacteriologic studies of neonatal stool of breast-fed and non-breast-fed infants taught him the importance of breast feeding. Boston opened a similar bank the next year and as of 2017 about 500 milk banks were operating worldwide. In short, his influence was global. 

Sadly, in 1911, as he was making ward rounds, he began to uncontrollably speak in several languages. It was the first sign of a cerebrovascular accident that ended his life the next day. Numerous obituaries lamented his loss and praised his contributions to medical science and his humanity toward children. He had published several works: on infant intestinal flora, on tetanus, and on diphtheria, authored numerous articles, and trained a generation of pediatricians. 

In 1919, Drs. Castellani and Chalmers, in a text on tropical diseases, proposed that the name Escherichia coli replace Bacterium coli, but the change was not official until 1958. E coli has been a popular laboratory organism for years. Studies of the bacterium have yielded three Nobel Prizes. One was for the mechanism of transfer of genetic material, one for mechanisms of enzyme control, and one, using phages, for the replication and genetic structure of viruses. Interestingly, a sample of the original strain studied by Escherich turned up in the National Culture Type Collection in London (formerly the Lister Institute), a collection that holds strains from the beginnings of bacteriology. Theodor Escherich’s brother-in-law had sent it to a laboratory in Cambridge in 1900 and it eventually landed in the Lister Institute. Its presence was “rediscovered” in 2015.

Theodor Escherich’s work in bacteriology and pediatrics resulted in major contributions to medicine and child health. Authors of a paper in 2007 felt that he could justifiably be considered “the first pediatric infectious disease physician,” a fitting and well-deserved designation.

 

SOURCES:

Schulman, S T, et al, “Theodor Escherich: The First Pediatric Infectious Disease Physician?” 2007; Clin Infect Dis 45: 1025-9.

 

Méric, G, et al, “From Escherich to the Escherichia coli Genome.” 2016; Lancet Inf Dis 16 (6): 634-36.

 

 Friedmann, H C, “Escherich and Escherichia.” 2006; Advances Appl Microbiol 60: 133-196.

 

Escherich, Theodor, “The Foundations and Aims of Modern Pediatrics.” 1905; American Medicine 9 (2): 55-62.