key: cord-0909036-lrzhnyj5
authors: Köhler, Werner
title: Killed in action: Microbiologists and clinicians as victims of their occupation Part 4: Tick-borne Relapsing Fever, Malta Fever, Glanders, SARS
date: 2006-02-15
journal: Int J Med Microbiol
DOI: 10.1016/j.ijmm.2005.04.005
sha: 01a67ebcdff08c33e7cda01649297647dc170ae4
doc_id: 909036
cord_uid: lrzhnyj5

nan

money at the disposal of this expedition. The researchers left Liverpool on September 23, and reached the Stanley Falls at the end of the year. Dutton's special interest was directed to tick-borne relapsing fever of the Central African type. He was able to infect monkeys by the bites of spirochaete-carrying soft ticks, Ornithodorus moubata. What he did not know, Philip Ross and Milne made the same experiment a few weeks before in Uganda. Dutton found also that Borrelia duttoni could pass into the eggs and larvae, and so confer infective potential on the tick of the succeeding generation (Manson-Bahr, 1951) . Robert Koch (1906) , who had no information about these results, found while he was in East Africa in 1905 that this transmission is possible up to the third generation. Christy and Dutton infected themselves with the disease, possibly at the dissection of a patient died of relapsing fever. Christy survived but Dutton died after the fourth relapse on 27th of February 1905 in Kosongo/Congo Free State. He was at the age of 31 years. The news about his death came relatively late to England because ''The journey from Kosongo to the nearest telegraph station takes 2 months'' (Anonymus, 1905) .

The ''Malta Chronicle'' of September 15, 1904, reported ''Well known for his discovery of the microbe of Mediterranean or Malta Fever Prof. Tito Carbone died in Milan from a fever contracted during scientific experiments''. The real story is another one, David Bruce discovered the microorganism, and Carbone is not so well-known in this respect. But, he was a victim of this disease.

Tito Carbone was born on 16th of July 1863 in Carbonara Scrivia (Alessandria). He studied medicine in Turin, Pavia and Florence and was graduated in 1886 in Turin. Working with C. Lombroso (psychiatric clinic)

www.elsevier.de/ijmm he was engaged in the control of a cholera epidemic in Tortona, and later worked in the pathological laboratory of G. Bizzozero. In 1888 he was assistant at the Institute of Morbid Anatomy, headed by P. Foa`, and changed in 1891 to the Laboratory of Pathological Physiology at the hospital Umberto I. at Turin. He went to Buenos Aires, and back to Italy he became a coworker of S. Belfanti at the Istituto Sieroterapia Milano. Later he followed an academic career and was appointed Professor of Morbid Anatomy in Cagliari (1897), Modena (1898) and Pisa (1903) . His main field of research was the aetiopathogenesis of infectious diseases, he published on bacterial toxins and immunity. In 1904 he dissected a patient died of Malta Fever and published the pathological findings (Carbone, 1904) . Brucella melitensis was isolated by him and transferred to experimental animals. In order to get information about the toxin production he cultivated the microorganisms, and it seems that he infected himself by this way. Carbone died on 6th of September 1904, aged 41 years (Dizionario Biografico degli Italiani, 1976) .

Glanders in humans was a rare disease, even when it was common in horses. But there have been some laboratory infections because ''probably no organism, with the possible exception of tularaemia bacillus, is as dangerous to work with as the glanders bacillus. In one laboratory, several members of staff became ill a few days after the breaking of a centrifuge tube'' (Parker, 1984) . Without giving details Bernstein and Carling (1909) mentioned: ''glanders has been assigned as the most frequent case of accidental death amongst laboratory workers''. The six patients, described by these authors, were horse keepers or horse-bus drivers. Howe and Miller (1947) reported on six cases of glanders occurring within 1 year (1944/45) in Camp Detrick, Frederick, MD. In the small laboratory a research program on glanders was performed. The first two cases occurred 2 weeks after an accident, when a technician dropped a flask containing a virulent suspension of Burkholderia mallei. The technician did not infect himself but two physicians staying in the laboratory fell ill. Two technicians became infected by routine laboratory work and the route of infection of two veterinarians was possibly aerogenic. The patients were cured by sulfadiazine.

Little is known about the course of life and the death of Georg von Hofmann-Wellenhof. He was born on 14th of May 1860 in Vienna as the third child of Paul Ferdinand Hofmann von Wellenhof and his wife Klothilde, ne´e Kraus (data from his thesis). He studied medicine in Vienna and Graz (where he was graduated), and was for some years First Assistant at the Institute of Pathology. Then he changed to the Institute of Hygiene, interrupted by some years of assistantship at the Institute of Zoology, all in Graz. As a result of his work in the Institute of Pathological Anatomy he reported on the detection of a ''pseudodiphtheria bacillus'' (later often cited as ''Hofmann-Wellenhof'scher Bacillus''); first on 20th of September 1887 at the 66th Assembly of the ''Gesellschaft Deutscher Ä rzte und Naturforscher'' in Wiesbaden, followed by the detailed publication (von Hofmann-Wellenhof, 1888; Ko¨hler, 2004) . Before 25th of September 1889 (he was since 1888 assistant at the Institute of Hygiene at Vienna) he performed ''infection experiments with the virus of glanders''. Around October 8, his temperature raised and he had pain in his left chest (pleuritic rub). For some days he improved, then he complained about ''rheumatoid discomfort''. Eight days later purulent blisters and abscesses developed, and on 22nd of the month he was hospitalized. The clinical picture was that of acute glanders, and the dissection confirmed the diagnosis. The source of infection was unclear; an aerogenic infection was supposed. Georg von Hofmann-Wellenhof died on 23rd of October 1889, aged 30 years (Anonymus, 1889) .

Deadly infections of physicians by microorganisms they were working with happened as shown in the four Dutton (from Olpp, 1932) . EDITORIAL / International Journal of Medical Microbiology 296 (2006) 1-4 parts of this article mostly at the end of the 19th up to the first quarter of the 20th century. But also recently we had to deplore the loss of a colleague who died of SARS. It was Carlo Urbani, born on 19th of October 1956 in Castelplanio/Italy. As to Oranski (2003) in Hanoi as a representative of the WHO he examined Jonny Chen, a Chinese-American businessman on February 28, 2003, and he was the first one who identified this ''new'' disease. The patient was suspected for an avian influenza infection. Urbani himself realized that he became infected on 11th of March while taking care for the patient.

About his career is known that he earned his medical degree in 1981 from the University of Ancona. For 3 years he was trained in infectious diseases at the University of Messina, and in 1990 he became deputy chief of the Department of Infectious Diseases at the General Hospital in Ancona. He worked for the WHO since 1993 and after moving to Me´decins Sans Frontie´rs in 1995 he became president of the Italian branch in 1999. His working places were in Vietnam, the Philippines and in Cambodia. On 29th of March 2003, 18 days after infection, Carlo Urbani died of SARS in Bangkok/Thailand. Some well-known bacteriologists and clinicians died of infections not connected with their professional duties (Table 1; Vierordt, 1915; Ko¨hler, 1997; Olpp, 1932; Vierhuff, 1907; Hetsch, 1935; Schloßberger, 1935) .

Many microbiologists and physicians lost their life in the battle against the disease they wanted to explore and to overcome for the welfare of mankind. A few of them were honoured by a monument of memory like Ricketts, Lazear, Noguchi, Thuillier or da Camara Pestana, others were mentioned only in a short obituary in scientific journals, or are remembered among microbiologists like E. Hailer of the Robert-Koch-Institute (Berlin) who died after a laboratory infection with anthrax bacilli in 1939 (Stefan Winkle, personal communication; Robert- Koch-Institut, 1991) . Many are unnamed like those plague doctors in the Middle Ages who did not leave their patients, or the many army surgeons who died of typhus, variola or other infectious diseases. These men are shining examples and we should stand in awe of them. -This is the bright side, but there was (and is?) also a dark one. Microbiologists and socalled ''physicians'' used their knowledge and medical skills to kill people by application of virulent microorganisms in order to prove the efficacy of bacteriological weapons (e.g. see Geißler, 2003) . We should treat them with scorn. 

Georg von Hofmann-Wellenhof

Observations on human glanders with a study of six cases and a discussion of the methods of diagnosis

Un caso di febbre di Malta

Note on a trypanosoma occurring in the blood of man

Anthrax und das Versagen der Geheimdienste

Wilhelm Kolle

Human glanders: report of six cases

Ü ber afrikanischen Recurrrens

Vor 150 Jahren: Ignaz Philipp Semmelweis fu¨hrt die Ha¨ndedesinfektion ein

Zentralblatt fu¨r Bakteriologie -100 years ago. Sleeping sickness -intoxication or infectious disease?

Zentralblatt fu¨r Bakteriologie -100 years ago. The controversy diphtheria and pseudodiphtheria bacilli versus virulent and avirulent diphtheria bacilli

Manson's Tropical Diseases

Hervorragende Tropena¨rzte in Wort und Bild

Septic infections due to Gram-negative aerobic bacilli

Wilhem Kolle

Moskauer Brief (Obituary Gabritschewsky)

Todesursachen bei namhaften Medizinern

Untersuchungen u¨ber den Klebs-Lo¨ffler'schen Bacillus der Diphtherie und seine pathogene Bedeutung