Max von Pettenkofer Award

In August 1892, a cholera outbreak struck Hamburg. In just a few months, 17 000 cases of the illness were recorded resulting in 8600 deaths within a population of about 640 000 (Evans, 1987). At its peak intensity, only a few weeks after the onset, a thousand illnesses and five hundred deaths were reported daily in the city. Intense but short-lived cholera outbreaks had struck Hamburg and other European cities repeatedly through the nineteenth century. The 1892 episode was Hamburg’s most severe in terms of lives lost (Evans, 1987). It was to be the last major cholera outbreak in Western Europe. Cholera acts ferociously. After a short incubation period, ‘symptoms are generally abrupt and include watery diarrhoea and vomiting. ... In adults with severe cholera, the rate of diarrhoea may quickly reach 500–1000 ml/h, leading to severe dehydration. ... The fluid loss may be so rapid that the patient is at risk of death within a few hours after onset, and most deaths occur during the first day’ (Sack et al., 2004). Cholera has been brought under effective control in the more developed countries owing to good sanitation and water treatment practices. Improved case management relying on oral and intravenous rehydration treatment has markedly reduced cholera-associated mortality rates in less developed countries (Sack et al., 2004). Nevertheless, cholera remains a major global health issue with an estimated annual incidence rate of 3-5 million cases resulting 100 000–120 000 deaths (Ali et al., 2012). In the late 1800s, scientific controversy raged over the causes and control of cholera. At the heart of the conflict were two prominent German scientists, Robert Koch (1843–1910) and Max von Pettenkofer (1818–1901). Koch’s contagionist view of the disease focused on its microbial cause. In February 1884, Koch reported from Calcutta (where cholera is endemic): he had isolated and identified the bacterium ‘found in the intestines and stools of cholera victims [that] was the causal agent of the disease’ (HowardJones, 1984). According to Koch, ingestion of this bacterium was both necessary and sufficient to cause cholera. Effective management of outbreaks necessitated measures such as isolation, quarantine, and disinfection. Koch’s discovery was celebrated in Berlin as a matter of pride for the German empire. However, his influence was not large in Hamburg, a city-state that still had considerable independence (Evans, 1987). It also happens that Robert Koch was not the first to identify Vibrio cholerae as the bacteriological cause of cholera. The credit for that discovery, which had occurred 30 years before Koch’s achievement, belongs to Filippo Pacini of Florence (Bentivoglio and Pacini, 1995; Howard-Jones, 1984). Pacini’s achievement was not widely known in Europe in the late nineteenth century. Max Von Pettenkofer had devoted much of his prolific research career to the study of cholera. He dismissed the view that, ‘cholera is simply an infectious or contagious disease, passing from the sick and their excreta to the healthy’ (Von Pettenkofer, 1892). Von Pettenkofer argued that the contagionist’s view ‘does not satisfy the epidemiologist; for the latter knows that there are not only cholera-immune people, but also cholera-immune places, and that even in places where cholera has prevailed there are seasons when it will not spread, although introduced.’ Von Pettenkofer’s complex theory of cholera causation is well summarized by Morabia (2007). Cholera results ‘from the interaction between a postulated cholera germ and the characteristics of soils. In order to cause cholera, the cholera germ had to become a cholera miasma, but this transformation required prolonged contact of the germ with dry and porous soils when groundwater levels were low. ... Von Pettenkofer’s postulate also implied that cholerapatient quarantine or water filtration was useless to prevent and/or control cholera epidemics.’ Max von Pettenkofer (Figure 1) was of a generation older than Koch. He completed his university studies in pharmacy and medicine in 1843. He worked under renowned chemist, Justus von Liebig, at the University of Giessen. Pettenkofer was appointed to a professorship in medical chemistry at the University of Munich in 1847. In the second half of the nineteenth century, he was a highly influential scholar. He became the first chaired Professor of Hygiene at the University of Munich in 1865. ‘In 1879, the Hygienic Institute, which had been built for him, opened in Munich’ (Trout, 1977). Von Pettenkofer co-founded two successful journals: Zeitschrift für Biologie (first published in 1865) and Archiv für Hygiene (first published in 1883). In Hamburg in 1892, hygienic practices were more aligned with von Pettenkofer’s views than with Koch’s