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Remembering innovative paediatrician Clemens von Pirquet on the 150th anniversary of his birth

2024; Wiley; Volume: 113; Issue: 8 Linguagem: Inglês

10.1111/apa.17242

1651-2227

Nils Hansson, Daniela Angetter‐Pfeiffer,

Medical History and Research

Clemens von Pirquet (photo taken before 1906). Wikicommons. Clemens Freiherr von Pirquet was born in 1874 in Hirschstetten, now Vienna, in Austria. He was the son of politician Peter Freiherr von Pirquet (1838–1906) and his wife Flora, née Freiin von Arnstein-Pereira (1845–1912), the daughter of a Jewish Viennese banking family. After attending three reputable Viennese schools, he began studying theology at the University of Innsbruck. In 1893, he moved to Leuven to study philosophy and graduated with a Master's Degree in 1894. Pirquet started his medical studies at the University of Vienna the following year, much to the displeasure of his parents, who considered the medical profession to be inappropriate in aristocratic circles.2 It is possible that his early experiences as a volunteer at the St Anna Children's Hospital in Vienna shaped his future life and career path. To deepen his specialist knowledge, Pirquet went to work with Otto Heubner (1812–1893), sometimes referred to as the father of German paediatrics, at the Charité children's clinic in Berlin in 1901. During his internship, he met his future wife Maria Christine van Husen (1878–1929) and they married in 1904.3 Pirquet began his career as a bacteriologist and was particularly interested in infectious diseases. In 1903, he submitted his work on the theory of infectious diseases to the Academy of Sciences in Vienna. Two years later, he and Béla Schick (1877–1967) observed that people who had been immunised with the smallpox vaccine showed significantly stronger reactions when they received a repeat injection. Pirquet was also able to demonstrate that injections with diphtheria serum didn't just lead to the production of protective antibodies. They could also trigger hypersensitivity reactions, such as the now familiar symptoms of hay fever, asthma or anaphylaxis. In 1906, Pirquet established a theory on allergies and introduced this term to the scientific community.4 His name was also connected with tuberculosis research and a valuable diagnostic tool for the early detection of tuberculosis.5 When the tuberculin test was developed in 1907 it was also known as Pirquet's skin test, later named after the French physician Charles Mantoux (1877–1947) who built on the work of Robert Koch and Pirquet. In 1908, Pirquet was appointed professor of paediatrics at the Vienna Medical Faculty. Only a year later, he became a professor of paediatrics at Johns Hopkins University in Baltimore, where he also held the position of chief physician at the Harriet Lane Home for Invalid Children. After a further short period as professor of paediatrics at the University of Breslau in 1910, he returned to Vienna, where he was appointed head of the University Children's Hospital in 1911. During the same year, he established a curative education department at the University of Vienna. This was probably one of the first departments in the world to focus on clinical research into organic brain damage and behavioural disorders in children and their treatment.6 Pirquet and his staff were particularly active in this department during the First World War. He also developed the so-called nutrition element milk nutrition system, where one unit corresponded to 1 g of milk. This formed the basis for large-scale child feeding programmes at the end of the First World War and during the first years of the post-war period. Pirquet also calculated a tolerance range between the maximum and optimum food intake for infants, in order to ensure that as many infants as possible received the right amount of milk.7 One of his probably less well-known ideas was to name the teeth numerically using a two-digit tooth chart which has been the basis for an odontogram used internationally. Pirquet's 1924 model was revived in 1960 by Joachim Viohl (born 1933) and resulted in a dental chart that has been used by the World Health Organization since 1970. Pirquet's name has been closely associated with pioneering research in the fields of serum diagnostics, tuberculosis, diphtheria, measles and infant nutrition. He introduced the term allergy in 1906, to describe a general change in the reactivity of an organism, namely in time, quality and quantity.8 These topics were also mentioned in his five Nobel Prize nominations for physiology or medicine in 1914, 1920, 1926, 1928 and 1929. Hans von Haberer (1875–1958) nominated Pirquet in 1914 for the development of tuberculosis tests and allergy research. Then, in 1920 Otto Heubner (1843–1926) added his work on measles and infant nutrition to his nomination, which was the most convincing of the five. For example, he praised Piquet for how his 'deeply penetrating methodical thinking' had enabled him to develop novel views and discoveries and pioneer the use of mathematical methods in the study of biological processes.9 There are probably several reasons why Pirquet was rejected by the Nobel Committee. To date, only a few Nobel medals have been awarded to those with direct links to paediatrics. These include Emil von Behring (1854–1917), who received the award in 1901 for diphtheria research, and Hendrick Dam (1895–1976) and Edward Doisy (1893–1986) who were honoured in 1943 for their work on vitamin K. Although paediatrics was a new discipline and did not play a major role in the Nobel Committee discussions at the turn of the 20th Century, there was no shortage of nominated candidates, such as Otto Heubner and Belá Schick.10 A review of the files in the archive of the Nobel Committee reveals that Pirquet never reached the shortlists that were investigated by the jury. This could be explained by the fact that he repeatedly encountered harsh criticism of his theories and medical views. Many contemporaries viewed his nutritional theory as questionable, arguing that it could lead to considerable nutritional disorders. His theories on allergies and tuberculin reactions were not universally accepted either. Another reason why he was never shortlisted could be that he lacked a ground-breaking achievement that only he was associated with. The Nobel Prize laureates in the years that Pirquet was nominated included Robert Bárány, for the physiology and pathology of the vestibular apparatus, and Charles Nicolle for typhus research. The other ground-breaking discoveries were August Krogh, for the capillary motor regulation mechanism, Johannes Fibiger for Spiroptera carcinoma and Frederick Hopkins and Christiaan Eijkman, for the antineuritic vitamin and growth stimulation vitamin. Although the nominations for Pirquet never fully convinced the Nobel Prize juries in Stockholm, he received many other honours and prizes and was trusted with gatekeeping positions in academia. Pirquet became a member of the Supreme Medical Council for Austria, President of the Vienna Society for Paediatrics and President of the Union Internationale au Secours des Enfants in Geneva. He founded the Sisterhood of the University Children's Hospital in Vienna in 1918 and the Austrian Society for Public Health in 1927. Streets in Vienna and Perchtoldsdorf, Lower Austria, have been named after him and a 50 Euro gold coin was dedicated to him in 2010. His name also lives on in the Clemens von Pirquet Medal of the Austrian Society for Allergology and Immunology and the Clemens von Pirquet Prize of the Austrian Society for Paediatrics and Adolescent Medicine. Sadly, Pirquet was less fortunate in his private life. His wife had a mental illness and was addicted to barbiturates. They took their own lives by ingesting cyanide in February 1929. It was a tragic end to a glittering career. Nils Hansson: Conceptualization; investigation; writing – original draft; writing – review and editing. Daniela Angetter-Pfeiffer: Investigation; writing – original draft; writing – review and editing. Open Access funding enabled and organized by Projekt DEAL. None.