VACCINE VISIONARIES

				EMIL ADOLF VON BEHRING: (1854-1917)
			FIGHTING DIPHTHERIA WITH SEROTHERAPY
		Awarded the Nobel Prize in Physiology or Medicine 1901 "for his work on serum therapy, especially its application against diphtheria, by which he has opened a new road in the domain of medical science and thereby placed in the hands of the physician a victorious weapon against illness and death."

Diphtheria is a respiratory tract infection. It usually affects the tonsils, pharynx, larynx and sometimes the skin. It is contagious and spreads through the droplets from the throat of the infected person when s/he coughs or sneezes. If untreated, it progressively affects the nervous system and can be fatal. Treatment consists of antitoxins (antiserum) and antibiotics.

Today, diphtheria has been eradicated in the developed world though pockets of infection continue to exist in developing countries like Afghanistan. But in the late 1880s and the early twentieth century the situation was very different. In fact, in the 1920s, there were an estimated 100,000 to 200,000 cases of diphtheria per year in the United States alone, causing 13,000 to 15,000 deaths. (Atkinson W, Hamborsky J, McIntyre L, Wolfe S.) If diphtheria has become a rare disease today, we owe it to the efforts of Emil von Behring, who discovered the antitoxin to cure diphtheria. He was awarded the Nobel Prize in 1901 for his work on serum therapy.

Emil Adolf von Behring was born on 15 March 1854 in Hansdorf, East Prussia into a large family of fifteen, which included thirteen siblings. His family was poor, and his father, who was a schoolmaster, wanted him to study theology. But destiny had planned differently. A family friend who was a military doctor persuaded Adolph to enter the Army Medical Academy in Berlin instead. He received his medical degree in 1878.

During the initial years Behring worked as an army doctor with various military units in Poznan, Eastern Germany, then joining the Pharmacological Institute in Bonn. In 1889, when he was 35 years of age, he became an assistant to Robert Koch, at the University of Berlin. When Koch moved to the Institute for Infectious Diseases, Behring moved with him, and was appointed professor. In 1894, he resigned and took up responsibilities as Professor of Hygiene at Halle and later as director at the Martburg University Institute of Hygiene.

From 1889 to 1894, Behring focused his attention on finding a cure for diphtheria. Through a series of innumerable experiments, he discovered that minute quantities of diphtheria toxin could immunize animals. He further discovered that if he injected blood serum from an immunized guinea-pig into another, the second guinea-pig also gained immunity. Further, an animal suffering from diphtheria toxin could sometimes be cured. The serum did not affect the bacilli, but it neutralized the toxin they produced. The ‘antitoxin’ (or antiserum) was directed against this poison. Animals that had survived the disease provided the serum to immunize others. His experiments contributed the concepts of serotherapy and passive immunization to modern medicine and immunology. Von Behring collected enough blood serum containing the diphtheria antitoxin to extend his trials on human beings. During the Christmas of 1891, he injected a small child lying in a Berlin hospital with the antitoxin. It worked. Further testing was done in Berlin’s Charite Hospital and later in Leipzig. Finally, in 1913, Behring developed the diphtheria vaccine, but widespread immunization using the vaccine began only in the 1920s.

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