Pioneers and milestones
2002; Elsevier BV; Volume: 109; Issue: 4 Linguagem: Inglês
10.1067/mai.2002.123049
ISSN1097-6825
AutoresMurray Dworetzky, Sheldon G. Cohen,
ResumoClemens von Pirquet, MD (1874-1929)First, the patient, second the patient, third the patient, fourth the patient, fifth the patient, and then maybe comes science. We first do everything for the patient; science can wait, research can wait.Bela Schick1Wolf IJ. Aphorisms and facetiae of Bela Schick. Knoll Pharm, Baltimore (MD)1965Google ScholarOnly in the case of an unusual physician/medical scientist who concurrently meets the totality of patients' needs-medical, emotional, social-and focuses on scientific pursuits with equally undiverted attention, dedication, and accomplishments might reason be found to qualify the above referenced tenet. Such is the story of Bela Schick's associate, research collaborator, and closest friend, Clemens von Pirquet.2Wagner R. Clemens von Pirquet: his life and work. Johns Hopkins Press, Baltimore (MD)1968Google ScholarClemens Freiherr von Pirquet was born in 1874 in Herschstetten, near Vienna, into a family of the Austrian landed aristocracy-a line of patricians who pursued professional careers in the army, commerce, and law. His mother's family of court bankers similarly moved in the uppermost fashionable circles of social prominence.Clemens' father managed his inherited family estate with its farm land and tree nursery, served as the landowners' party representative in parliament, and in a cultural outlet, wrote poetry and plays. Through his special hobbies he introduced his son to graphic analysis, chart-making, and statistics-technical skills that Clemens would use in later life in his scientific research.The religious fervor of his devoutly Catholic mother influenced Clemens to aim for the Jesuit priesthood. But after 2 years of preparatory university study of theology at Innsbruck and philosophy at Louvain and receipt of a PhB degree, he changed his preference to medicine. For his parents, it was a disappointing choice, for at that time medical practice was not considered an acceptable professional career for Austrian nobles.Clemens then successively attended classes of the Austrian faculties of medicine at Vienna, Königsberg, and Graz (MD, 1900). Through interactions with 2 eminent professors of pediatrics, he developed a primary interest in and orientation to childhood medicine and infectious diseases. At Graz he encountered Theodor Escherich, who was noted for his studies of infantile intestinal flora and his discovery of the bacillus that bears his name, Escherichia coli . After postgraduation military service, Pirquet spent time in Berlin with Otto van Heubner, who was recognized for the isolation of meningococci in cerebrospinal meningitis and the introduction of caloric feeding of infants.In 1902, Pirquet and his Graz classmate Bela Schick began a program of internship and residency training with their former professor, Escherich, who had since been brought to Vienna as Director of the Santa Anna Children's Hospital and University Kinderklinik. Concurrently, Pirquet, working at the University Serotherapeutic Institute under Rudolf Kraus (the discoverer of precipitating antibody), was introduced to immunology and the treatment of scarlet fever with newly developed antistreptococcal horse antiserum.Advanced to the position of First Clinical Assistant to Escherich and generating laboratory data, Pirquet, between 1903 and 1907, made noteworthy original contributions to new knowledge of immunity and hypersensitivity. Just 3 years out of medical school, he both correctly identified flaws in Paul Ehrlich's technique for quantifying antitoxins by biological rather than chemical methods and soundly disputed Ehrlich's side chain theory of origin of antibodies from cell receptors. His series of discoveries, descriptions, and publications, which profoundly influenced the development of the new field-for which he coined the term allergie -included studies with Schick on adverse reactions to antitoxins that defined the immunopathogenesis of serum sickness, the nature and mechanisms of immediate and accelerated vaccine reactions, the application of vaccination and vaccinoid data to explain the onset and course of smallpox lesions, the development and introduction of a simple and safe tuberculin test as a tool for the diagnosis and study of tuberculosis, and the basis for a theoretical explanation of the pathogenesis and pattern of measles exanthema.By the age of 32 (in 1908), Pirquet's widely recognized accomplishments brought 2 offers of prestigious opportunities to further his work in settings compatible with his linguistic sophistication in several languages. One offer, from Pierre Emile Roux, Director of the Institut Pasteur, involved an experimental laboratory-based position in Paris; according to the terms of the alternative offer, he would be named first Professor of a newly created independent Department of Pediatrics at the Johns Hopkins Medical School in Baltimore. The opportunity for patient contacts as Physician-in-Chief of the hospital-based clinics and the Harriet Lane Home for Invalid Children was the deciding factor in his decision to accept the latter position, orchestrated by William Henry Welch, Professor of Pathology.Fully successful though he was, he nonetheless took a leave of absence after just 1 year to return to Europe as Professor of Pediatrics at Breslau, Germany (today's Wroclaw, Poland). The next year he declined an offer to return to Johns Hopkins as the first full-time Professor of Pediatrics at an annual salary of $7,500 rather than at the $10,000 salary that he suggested. Although recommended and supported by Welch and pediatric department members who even offered to raise and contribute the requisite endowment funds, the proposal was rejected by the Board of Trustees for organizational budgetary reasons. Pertinent to Pirquet's declination was an offer from Vienna to fill the professorship opening created by the death of Escherich. His former mentor had effectively laid the attractive groundwork for the design and placement of laboratories, a school for training pediatric nurses, a model infant department, and an organization for cooperative child research by physicians and educators.Another opportunity to return to the United States came in 1923 with an offer of the chairmanship of pediatrics at the University of Minnesota Medical School. However, after a short stay in St Paul and faced realistically with the need to organize a new department and cope with limited facilities as well as with an indeterminate waiting period for construction of the teaching hospital, he returned to Vienna and the Kinderklinik.In moving his new responsibility forward in innovative and creative fashion, Pirquet molded the Kinderklinik into an integrated teaching and research institution and emphasized prevention and diagnostic recognition of infectious and contagious diseases; he constructed an isolation system, provided staff coverage in the subspecialties of hematology, metabolism, endocrinology, neurology, psychiatry, and radiology, and established a postgraduate seminar program for practicing physicians.Fig. 1Clemens von Pirquet with pediatric patients in the tuberculosis sanatorium on the roof of the Kinderklinik. (Courtesy of the National Library of Medicine)View Large Image Figure ViewerDownload Hi-res image Download (PPT)In a change of investigative focus, Pirquet turned his attention to analyses of mortality statistics and to nutrition. Evolved from the latter was his formula for calculating relationships of body measurements and nutrition and a proposed system of feeding that replaced the calorie by the “nem” as an arbitrary food unit for the nutritional equivalent of 1 cm3 of milk (0.67 calorie).As Pirquet's accomplishments moved across the scientific spectrum of bacteriology, immunology, allergy, anthropometrics, nutrition, biometry, and biostatistics, Vienna became recognized as the premier center for pediatrics. Through his warmth and extended hospitality, international students, physicians, postgraduates, visitors, and individuals to participate in cooperative projects were welcomed to learn from and share in Kinderklinik clinical activities and teaching programs.Trial applications of Pirquet's “nem” unit were worked into the post-World War I American Relief Administration's project under Herbert Hoover, when during the 1918-1923 period of food shortages he was given responsibility for the organization of a mass feeding endeavor designed to provide at least 1 meal daily for 100,000 school-age children. He subsequently worked for the League of Nations Health Service and served as founding chairman of its Committee on Child Hygiene. At the end of the 1920s, esteemed as a nationally prominent and respected figure, he was nominated for the presidency of the newly established Austrian Republic-an action that he considered to be a matter solely of intended honor, not to be taken seriously.4Neues Wiener Journal. 3 March 1929; : 62Google ScholarPirquet's qualities of strength of character are all the more remarkable in the light of the compartmentalization of his professional and personal life, as he kept what must have been the daily strains of a distressing marriage from impacting on his carriage, serenity, and productive activity and on the ambiance that he created for and within the clinic's setting. The reality of an ever-present, emotionally disturbed, and barbiturate-addicted wife (she was dismayed by her rejection by members of the Pirquet family, who were convinced that an amorous Clemens, when a hospital resident trainee, should not have married beneath his station) was contained within his private concerns. One can only conjecture about whether his not deserting his mentally ill wife was a matter of honorable obligation, commitment, sense of values, conscience, and/or a remnant of his early Catholic upbringing and marital vows.In 1929, at age 55, beloved, admired, and at the summit of his career, Pirquet and his wife died by self-administered cyanide poisoning. A brilliant, rewarding professional and scientific career and 25 years of a troubled marriage were thus abruptly and simultaneously terminated. Within the stunned pediatric community-“Theirs not to reason why”5Quotation from Tennyson's “The charge of the Light Brigade.”Google Scholar-there were unanswered questions and expressions of bewilderment. From a British colleague: “Those who have enjoyed the hospitality of the Vienna Kinderklinik will find it difficult to visualize without the gracious figure of its well-loved chief.”3Chick H. Clemens von Pirquet and his work.Lancet. 1929; 1163: 624-626Abstract Google ScholarTo this day, Pirquet's tragic ending remains unexplained. Clemens von Pirquet, MD (1874-1929)First, the patient, second the patient, third the patient, fourth the patient, fifth the patient, and then maybe comes science. We first do everything for the patient; science can wait, research can wait.Bela Schick1Wolf IJ. Aphorisms and facetiae of Bela Schick. Knoll Pharm, Baltimore (MD)1965Google ScholarOnly in the case of an unusual physician/medical scientist who concurrently meets the totality of patients' needs-medical, emotional, social-and focuses on scientific pursuits with equally undiverted attention, dedication, and accomplishments might reason be found to qualify the above referenced tenet. Such is the story of Bela Schick's associate, research collaborator, and closest friend, Clemens von Pirquet.2Wagner R. Clemens von Pirquet: his life and work. Johns Hopkins Press, Baltimore (MD)1968Google ScholarClemens Freiherr von Pirquet was born in 1874 in Herschstetten, near Vienna, into a family of the Austrian landed aristocracy-a line of patricians who pursued professional careers in the army, commerce, and law. His mother's family of court bankers similarly moved in the uppermost fashionable circles of social prominence.Clemens' father managed his inherited family estate with its farm land and tree nursery, served as the landowners' party representative in parliament, and in a cultural outlet, wrote poetry and plays. Through his special hobbies he introduced his son to graphic analysis, chart-making, and statistics-technical skills that Clemens would use in later life in his scientific research.The religious fervor of his devoutly Catholic mother influenced Clemens to aim for the Jesuit priesthood. But after 2 years of preparatory university study of theology at Innsbruck and philosophy at Louvain and receipt of a PhB degree, he changed his preference to medicine. For his parents, it was a disappointing choice, for at that time medical practice was not considered an acceptable professional career for Austrian nobles.Clemens then successively attended classes of the Austrian faculties of medicine at Vienna, Königsberg, and Graz (MD, 1900). Through interactions with 2 eminent professors of pediatrics, he developed a primary interest in and orientation to childhood medicine and infectious diseases. At Graz he encountered Theodor Escherich, who was noted for his studies of infantile intestinal flora and his discovery of the bacillus that bears his name, Escherichia coli . After postgraduation military service, Pirquet spent time in Berlin with Otto van Heubner, who was recognized for the isolation of meningococci in cerebrospinal meningitis and the introduction of caloric feeding of infants.In 1902, Pirquet and his Graz classmate Bela Schick began a program of internship and residency training with their former professor, Escherich, who had since been brought to Vienna as Director of the Santa Anna Children's Hospital and University Kinderklinik. Concurrently, Pirquet, working at the University Serotherapeutic Institute under Rudolf Kraus (the discoverer of precipitating antibody), was introduced to immunology and the treatment of scarlet fever with newly developed antistreptococcal horse antiserum.Advanced to the position of First Clinical Assistant to Escherich and generating laboratory data, Pirquet, between 1903 and 1907, made noteworthy original contributions to new knowledge of immunity and hypersensitivity. Just 3 years out of medical school, he both correctly identified flaws in Paul Ehrlich's technique for quantifying antitoxins by biological rather than chemical methods and soundly disputed Ehrlich's side chain theory of origin of antibodies from cell receptors. His series of discoveries, descriptions, and publications, which profoundly influenced the development of the new field-for which he coined the term allergie -included studies with Schick on adverse reactions to antitoxins that defined the immunopathogenesis of serum sickness, the nature and mechanisms of immediate and accelerated vaccine reactions, the application of vaccination and vaccinoid data to explain the onset and course of smallpox lesions, the development and introduction of a simple and safe tuberculin test as a tool for the diagnosis and study of tuberculosis, and the basis for a theoretical explanation of the pathogenesis and pattern of measles exanthema.By the age of 32 (in 1908), Pirquet's widely recognized accomplishments brought 2 offers of prestigious opportunities to further his work in settings compatible with his linguistic sophistication in several languages. One offer, from Pierre Emile Roux, Director of the Institut Pasteur, involved an experimental laboratory-based position in Paris; according to the terms of the alternative offer, he would be named first Professor of a newly created independent Department of Pediatrics at the Johns Hopkins Medical School in Baltimore. The opportunity for patient contacts as Physician-in-Chief of the hospital-based clinics and the Harriet Lane Home for Invalid Children was the deciding factor in his decision to accept the latter position, orchestrated by William Henry Welch, Professor of Pathology.Fully successful though he was, he nonetheless took a leave of absence after just 1 year to return to Europe as Professor of Pediatrics at Breslau, Germany (today's Wroclaw, Poland). The next year he declined an offer to return to Johns Hopkins as the first full-time Professor of Pediatrics at an annual salary of $7,500 rather than at the $10,000 salary that he suggested. Although recommended and supported by Welch and pediatric department members who even offered to raise and contribute the requisite endowment funds, the proposal was rejected by the Board of Trustees for organizational budgetary reasons. Pertinent to Pirquet's declination was an offer from Vienna to fill the professorship opening created by the death of Escherich. His former mentor had effectively laid the attractive groundwork for the design and placement of laboratories, a school for training pediatric nurses, a model infant department, and an organization for cooperative child research by physicians and educators.Another opportunity to return to the United States came in 1923 with an offer of the chairmanship of pediatrics at the University of Minnesota Medical School. However, after a short stay in St Paul and faced realistically with the need to organize a new department and cope with limited facilities as well as with an indeterminate waiting period for construction of the teaching hospital, he returned to Vienna and the Kinderklinik.In moving his new responsibility forward in innovative and creative fashion, Pirquet molded the Kinderklinik into an integrated teaching and research institution and emphasized prevention and diagnostic recognition of infectious and contagious diseases; he constructed an isolation system, provided staff coverage in the subspecialties of hematology, metabolism, endocrinology, neurology, psychiatry, and radiology, and established a postgraduate seminar program for practicing physicians.In a change of investigative focus, Pirquet turned his attention to analyses of mortality statistics and to nutrition. Evolved from the latter was his formula for calculating relationships of body measurements and nutrition and a proposed system of feeding that replaced the calorie by the “nem” as an arbitrary food unit for the nutritional equivalent of 1 cm3 of milk (0.67 calorie).As Pirquet's accomplishments moved across the scientific spectrum of bacteriology, immunology, allergy, anthropometrics, nutrition, biometry, and biostatistics, Vienna became recognized as the premier center for pediatrics. Through his warmth and extended hospitality, international students, physicians, postgraduates, visitors, and individuals to participate in cooperative projects were welcomed to learn from and share in Kinderklinik clinical activities and teaching programs.Trial applications of Pirquet's “nem” unit were worked into the post-World War I American Relief Administration's project under Herbert Hoover, when during the 1918-1923 period of food shortages he was given responsibility for the organization of a mass feeding endeavor designed to provide at least 1 meal daily for 100,000 school-age children. He subsequently worked for the League of Nations Health Service and served as founding chairman of its Committee on Child Hygiene. At the end of the 1920s, esteemed as a nationally prominent and respected figure, he was nominated for the presidency of the newly established Austrian Republic-an action that he considered to be a matter solely of intended honor, not to be taken seriously.4Neues Wiener Journal. 3 March 1929; : 62Google ScholarPirquet's qualities of strength of character are all the more remarkable in the light of the compartmentalization of his professional and personal life, as he kept what must have been the daily strains of a distressing marriage from impacting on his carriage, serenity, and productive activity and on the ambiance that he created for and within the clinic's setting. The reality of an ever-present, emotionally disturbed, and barbiturate-addicted wife (she was dismayed by her rejection by members of the Pirquet family, who were convinced that an amorous Clemens, when a hospital resident trainee, should not have married beneath his station) was contained within his private concerns. One can only conjecture about whether his not deserting his mentally ill wife was a matter of honorable obligation, commitment, sense of values, conscience, and/or a remnant of his early Catholic upbringing and marital vows.In 1929, at age 55, beloved, admired, and at the summit of his career, Pirquet and his wife died by self-administered cyanide poisoning. A brilliant, rewarding professional and scientific career and 25 years of a troubled marriage were thus abruptly and simultaneously terminated. Within the stunned pediatric community-“Theirs not to reason why”5Quotation from Tennyson's “The charge of the Light Brigade.”Google Scholar-there were unanswered questions and expressions of bewilderment. From a British colleague: “Those who have enjoyed the hospitality of the Vienna Kinderklinik will find it difficult to visualize without the gracious figure of its well-loved chief.”3Chick H. Clemens von Pirquet and his work.Lancet. 1929; 1163: 624-626Abstract Google ScholarTo this day, Pirquet's tragic ending remains unexplained. First, the patient, second the patient, third the patient, fourth the patient, fifth the patient, and then maybe comes science. We first do everything for the patient; science can wait, research can wait.Bela Schick1Wolf IJ. Aphorisms and facetiae of Bela Schick. Knoll Pharm, Baltimore (MD)1965Google Scholar Only in the case of an unusual physician/medical scientist who concurrently meets the totality of patients' needs-medical, emotional, social-and focuses on scientific pursuits with equally undiverted attention, dedication, and accomplishments might reason be found to qualify the above referenced tenet. Such is the story of Bela Schick's associate, research collaborator, and closest friend, Clemens von Pirquet.2Wagner R. Clemens von Pirquet: his life and work. Johns Hopkins Press, Baltimore (MD)1968Google Scholar Clemens Freiherr von Pirquet was born in 1874 in Herschstetten, near Vienna, into a family of the Austrian landed aristocracy-a line of patricians who pursued professional careers in the army, commerce, and law. His mother's family of court bankers similarly moved in the uppermost fashionable circles of social prominence. Clemens' father managed his inherited family estate with its farm land and tree nursery, served as the landowners' party representative in parliament, and in a cultural outlet, wrote poetry and plays. Through his special hobbies he introduced his son to graphic analysis, chart-making, and statistics-technical skills that Clemens would use in later life in his scientific research. The religious fervor of his devoutly Catholic mother influenced Clemens to aim for the Jesuit priesthood. But after 2 years of preparatory university study of theology at Innsbruck and philosophy at Louvain and receipt of a PhB degree, he changed his preference to medicine. For his parents, it was a disappointing choice, for at that time medical practice was not considered an acceptable professional career for Austrian nobles. Clemens then successively attended classes of the Austrian faculties of medicine at Vienna, Königsberg, and Graz (MD, 1900). Through interactions with 2 eminent professors of pediatrics, he developed a primary interest in and orientation to childhood medicine and infectious diseases. At Graz he encountered Theodor Escherich, who was noted for his studies of infantile intestinal flora and his discovery of the bacillus that bears his name, Escherichia coli . After postgraduation military service, Pirquet spent time in Berlin with Otto van Heubner, who was recognized for the isolation of meningococci in cerebrospinal meningitis and the introduction of caloric feeding of infants. In 1902, Pirquet and his Graz classmate Bela Schick began a program of internship and residency training with their former professor, Escherich, who had since been brought to Vienna as Director of the Santa Anna Children's Hospital and University Kinderklinik. Concurrently, Pirquet, working at the University Serotherapeutic Institute under Rudolf Kraus (the discoverer of precipitating antibody), was introduced to immunology and the treatment of scarlet fever with newly developed antistreptococcal horse antiserum. Advanced to the position of First Clinical Assistant to Escherich and generating laboratory data, Pirquet, between 1903 and 1907, made noteworthy original contributions to new knowledge of immunity and hypersensitivity. Just 3 years out of medical school, he both correctly identified flaws in Paul Ehrlich's technique for quantifying antitoxins by biological rather than chemical methods and soundly disputed Ehrlich's side chain theory of origin of antibodies from cell receptors. His series of discoveries, descriptions, and publications, which profoundly influenced the development of the new field-for which he coined the term allergie -included studies with Schick on adverse reactions to antitoxins that defined the immunopathogenesis of serum sickness, the nature and mechanisms of immediate and accelerated vaccine reactions, the application of vaccination and vaccinoid data to explain the onset and course of smallpox lesions, the development and introduction of a simple and safe tuberculin test as a tool for the diagnosis and study of tuberculosis, and the basis for a theoretical explanation of the pathogenesis and pattern of measles exanthema. By the age of 32 (in 1908), Pirquet's widely recognized accomplishments brought 2 offers of prestigious opportunities to further his work in settings compatible with his linguistic sophistication in several languages. One offer, from Pierre Emile Roux, Director of the Institut Pasteur, involved an experimental laboratory-based position in Paris; according to the terms of the alternative offer, he would be named first Professor of a newly created independent Department of Pediatrics at the Johns Hopkins Medical School in Baltimore. The opportunity for patient contacts as Physician-in-Chief of the hospital-based clinics and the Harriet Lane Home for Invalid Children was the deciding factor in his decision to accept the latter position, orchestrated by William Henry Welch, Professor of Pathology. Fully successful though he was, he nonetheless took a leave of absence after just 1 year to return to Europe as Professor of Pediatrics at Breslau, Germany (today's Wroclaw, Poland). The next year he declined an offer to return to Johns Hopkins as the first full-time Professor of Pediatrics at an annual salary of $7,500 rather than at the $10,000 salary that he suggested. Although recommended and supported by Welch and pediatric department members who even offered to raise and contribute the requisite endowment funds, the proposal was rejected by the Board of Trustees for organizational budgetary reasons. Pertinent to Pirquet's declination was an offer from Vienna to fill the professorship opening created by the death of Escherich. His former mentor had effectively laid the attractive groundwork for the design and placement of laboratories, a school for training pediatric nurses, a model infant department, and an organization for cooperative child research by physicians and educators. Another opportunity to return to the United States came in 1923 with an offer of the chairmanship of pediatrics at the University of Minnesota Medical School. However, after a short stay in St Paul and faced realistically with the need to organize a new department and cope with limited facilities as well as with an indeterminate waiting period for construction of the teaching hospital, he returned to Vienna and the Kinderklinik. In moving his new responsibility forward in innovative and creative fashion, Pirquet molded the Kinderklinik into an integrated teaching and research institution and emphasized prevention and diagnostic recognition of infectious and contagious diseases; he constructed an isolation system, provided staff coverage in the subspecialties of hematology, metabolism, endocrinology, neurology, psychiatry, and radiology, and established a postgraduate seminar program for practicing physicians. In a change of investigative focus, Pirquet turned his attention to analyses of mortality statistics and to nutrition. Evolved from the latter was his formula for calculating relationships of body measurements and nutrition and a proposed system of feeding that replaced the calorie by the “nem” as an arbitrary food unit for the nutritional equivalent of 1 cm3 of milk (0.67 calorie). As Pirquet's accomplishments moved across the scientific spectrum of bacteriology, immunology, allergy, anthropometrics, nutrition, biometry, and biostatistics, Vienna became recognized as the premier center for pediatrics. Through his warmth and extended hospitality, international students, physicians, postgraduates, visitors, and individuals to participate in cooperative projects were welcomed to learn from and share in Kinderklinik clinical activities and teaching programs. Trial applications of Pirquet's “nem” unit were worked into the post-World War I American Relief Administration's project under Herbert Hoover, when during the 1918-1923 period of food shortages he was given responsibility for the organization of a mass feeding endeavor designed to provide at least 1 meal daily for 100,000 school-age children. He subsequently worked for the League of Nations Health Service and served as founding chairman of its Committee on Child Hygiene. At the end of the 1920s, esteemed as a nationally prominent and respected figure, he was nominated for the presidency of the newly established Austrian Republic-an action that he considered to be a matter solely of int
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