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The Father of Hygiene

München, 12/03/2018

To prove his hypothesis, Max von Pettenkofer drank a suspension of cholera bacteria. He survived the cholera cocktail, and his research on the impact of hygiene on health would revolutionize medicine and public health.

“From time to time we send our underwear to be washed – instead of taking a bath ourselves.” This Pettenkofer quote pithily describes contemporary attitudes to hygiene in the first half of the 19th century. The importance of hygiene for general health had not yet been recognized by the medical profession, let alone become common knowledge among the general public. Munich was one of the filthiest cities in Germany. Waste and fecal matter are disposed of in cesspools, or simply tossed into the street. The city stinks to high heaven. No wonder that the incidence of infectious diseases such as typhoid fever is high. In 1854, a large-scale epidemic of cholera breaks out in the Bavarian capital, claiming the lives of many – the most prominent of whom was Queen Therese. The municipal authorities turned to the 35-year-old LMU Professor Pettenkofer for help, and he took up the challenge with characteristic energy.

Failed actor or famed doctor?
Max von Pettenkofer was born 200 years ago, and grew up in humble circumstances on the family farm. However, his uncle was Apothecary to the Bavarian Court and financed his education. His young charge went on to study chemistry, pharmacy and medicine, and proved to be as gifted as he was assiduous. But at the age of 20, he lost interest in pharmacy and announced that he wanted to be an actor. – And for a year that’s what he did for a living. He was persuaded to return to science by his future wife. When he proposed to her, she told him that she would marry him only on condition that he took up a “proper” profession. He was very much in love – as witnessed by the 123 love letters addressed to her which are now in the Bavarian State Library – and he agreed to return to his studies. Pettenkofer was appointed to a professorship in Chemical Medicine at LMU at the age of 29, and he went on to become the world’s first Professor of Hygiene. A few years later, he was elected Rector of the University.

Pettenkofer’s huge project ends Munich’s recurrent public health crises
Munich was only one of the many European cities that suffered epidemics of cholera in the course of the 19th century. But for reasons that lay in the city’s history, Munich was particularly vulnerable. German cities that had been founded in Roman times had at least rudimentary sewerage systems, there were very few sewers in Munich in the 1850s, and these were distributed quite haphazardly. To learn more about the source of the 1854 epidemic, Pettenkofer began to investigate the conditions in which the city’s inhabitants lived, and it didn’t take long for him to identify a common factor: the omnipresent dirt. “We owe to Pettenkofer the recognition that environmental factors and the course of infectious diseases play a decisive role in determining whether or not outbreaks are self-limiting or develop into epidemics,” says Professor Sebastian Suerbaum, who holds the Chair of Medical Microbiology and Hospital Epidemiology and heads the Max von Pettenkofer Institute together with Professor Oliver T. Keppler, who holds the Chair of Virology, and thus one of Max von Pettenkofer’s successors.

In addition to grasping the significance of hygiene for public health, Pettenkofer was also fully aware of the economic and technological dimensions of his project. He plans to build a network of underground conduits that will crisscross the whole city, so that waste water can be disposed of safely. And he proposes that a centralized urban water supply system be set up to provide clean drinking water for all of the city’s inhabitants. The gigantic venture will require a huge investment of capital. Not all of his fellow-citizens are persuaded of its necessity. Indeed, local wits begin to refer to Professor Pettenkofer in rather less polite terms (such as ‘Scheißhäuslapostl’ and ‘Wanzendoktor’). However, Pettenkofer is undaunted by such reactions and tirelessly argues the case for his project, even visiting opponents personally to convince them of its merits. His unstinting efforts are ultimately successful. Following completion of the project, Munich is reputed to be one of the cleanest cities on the continent. Indeed the sewerage system built by Pettenkofer is still in use – in part perhaps because the multitalented Wanzendoktor himself developed a better class of cement for the task.

In fact his plans for the construction of the drainage system were so well thought out that they envisaged the addition of water-treatment systems – which were then unknown and would only be developed decades later. His practical achievements and, in particular, his pioneering research on the role of hygiene in public health, brought him to the attention of universities and urban authorities elsewhere. But he rejects lucrative job offers from abroad and remains in Munich, for he is already planning his next project.

The first Institute of Hygiene in the world
In the course of a private audience with King Ludwig II, Pettenkofer presents the monarch with an outline of his latest project: the establishment of the first Institute of Hygiene in the world. The King must have been greatly impressed, for he not only assures Pettenkofer of his support, but confers a hereditary peerage on him. The Institute opens in 1879, with Pettenkofer as its Founding Director. He himself concentrates on experimental field research, publishing 20 monographs and 200 scientific papers. Pettenkofer is effectively the founder of hygiene as a medical discipline. His Institute is the leading light in the field, attracting researchers and students from all over the world. Many of them would subsequently lead similar departments of hygiene and public health elsewhere. Among the cities that set up institutions structured along the same lines as Pettenkofer’s Institute in Munich were Rome, Chicago, Philadelphia and Berlin.

“When one takes a closer look at Pettenkofer’s work, the connections between the problems he faced and those confronting us today become obvious – as does the modernity of his scientific approach to them,” Suerbaum says. “Pettenkofer‘s dogma, namely that environmental factors play a central role in the course and dispersal of infectious diseases, remains as valid as it ever was.” The Institute that he founded, and which was later named after him, has retained its international reputation to this day. “Two centuries after his birth, we at the Max von Pettenkofer Institute are still making every effort to understand the pathogenesis of infections, to diagnose and treat them, and ultimately to prevent them,” Keppler says.

One of the most famous disputes in the history of science
Towards the end of his scientific career, Pettenkofer became something of a tragic figure. He stubbornly refused to accept that the bacterium Vibrio cholerae – identified in 1884 by his rival Robert Koch – was the sole cause of cholera. In his own work, he placed far greater emphasis on non-biological factors, such as soil type and the nature of the groundwater reservoir. This is the context in which, some years after Koch’s discovery of the real culprit, Pettenkofer drank the draught mentioned above. Fortunately, it resulted only in a violent bout of diarrhea. Most probably, he escaped more serious damage because he had been infected with V. cholerae as a child and retained sufficient immunity to the bacterium. As he got older, Pettenkofer noticed that his memory was deteriorating. In despair, he shot himself at the age of 82. His scientific legacy lives on and continues to have an impact on our lives today.