Emil von Behring

Emil von Behring: The Man Who Bought Back the Children

Until the 1890s, more than 50,000 children died of diphtheria in Germany every year. The disease strangled them slowly, from the inside, behind a grey membrane in the throat, and medicine could do nothing but watch. Then a Prussian army doctor with a talent for making enemies discovered that the blood of an immunised animal could be injected into a dying child and cure it. In 1901 the Nobel committee gave him the first prize in physiology or medicine ever awarded. Germany called him the saviour of children. His collaborators called him something else.

The Schoolmaster's Son in Uniform

Emil Adolf Behring was born on 15 March 1854 in Hansdorf, in the Prussian Kreis Rosenberg — now in Poland — one of thirteen children of a village schoolmaster. There was no money for a civilian university, so he took the route that Prussia offered a clever poor boy: the Kaiser Wilhelm Academy in Berlin, the army's medical institute, from 1874 to 1878. The state paid; the state was owed years of service in return. His doctoral work was on optociliary neurotomy, and at Poznań he studied ocular disease under Carl Ernst Schweigger and Wilhelm Uhthoff, publishing clinical observations on tumours of the eye — a first career that left no visible trace on the second.

Posted to Poland in 1878, he investigated septic disease among soldiers, and between 1881 and 1883 discharged his obligation with the Second Hussars. The septic work was noticed. In 1888 he was moved to Robert Koch's institute in Berlin, then the most productive bacteriological laboratory on earth, and the direction of his life changed.

Antitoxin

The question in Koch's laboratory was why some animals survived infections that killed others. Behring's answer, arrived at with the Japanese bacteriologist Kitasato Shibasaburō and, on the diphtheria side, with Erich Wernicke, was published in 1890 and is one of the foundational papers of immunology. Inject a sublethal dose of toxin into a guinea pig, a goat, a horse. The animal survives and acquires immunity. Now take its serum — the fluid fraction of its blood, with no cells in it — and inject that into a second animal already sick with the disease. The second animal recovers.

Something in the serum, which Behring called an antitoxin, neutralised the poison. It was transferable. Immunity, previously an obscure property of a living body, had become a substance that could be drawn off in a syringe, carried across a city and given to a stranger. This is passive immunisation, and it remains in use — the same principle underlies tetanus immunoglobulin and modern antibody therapies.

The first successful treatment of a child with diphtheria serum came in 1891. Early human trials in 1892 failed; the difficulty was not the idea but the dose, since serum of unknown strength is a guess. Behring partnered with the Hoechst pharmaceutical works from 1892, and after production and quantification were solved, commercial treatment began in 1894. He was awarded the Cameron Prize for Therapeutics.

The Quarrel Over Credit

The man who solved the quantification was Paul Ehrlich, who devised the standardisation protocols that made mass production possible. Behring, by the general account, manoeuvred to secure for himself the considerable financial rewards of the diphtheria serum, cutting Ehrlich out of the proceeds of a treatment they had developed together. Only the mediation of the ministerial official Friedrich Althoff kept the relationship from collapsing entirely; the friendship, in one assessment, never fully succumbed. Ehrlich would take his own Nobel in 1908. Kitasato was nominated for the 1901 prize and got nothing, the statutes at that time permitting only a single laureate.

Marburg

In 1895 Behring took the chair of hygiene at Philipps University in Marburg and stayed for the rest of his life. He was ennobled — the *von* — and in 1903 Kaiser Wilhelm II made him *Wirklicher Geheimer Rat*. In 1904 he founded Behringwerke to manufacture antitoxins and vaccines on his own account. In 1913 he produced T.A., a toxin–antitoxin preparation that conferred active rather than merely passive immunity to diphtheria and so lasted far longer than the serum.

Not everything worked. At the 1905 International Tuberculosis Congress he announced a substance derived from the tubercle bacillus, which he called TC; it became the basis of a bovine tuberculosis vaccine, but the human application failed.

Why Emil Is Called a Genius

The quality worth naming here is conceptual, not manual. Behring's laboratory technique was competent rather than dazzling, and he did not work alone — Kitasato, Wernicke and Ehrlich all have claims on the science. What he did was see, before almost anyone, that immunity might be a *chemical* rather than a vital property: something dissolved in blood, obeying dose-response rules, capable of being extracted, measured, bottled and sold. That reframing turned an observation into a therapy and made the pharmaceutical immunology of the next century thinkable. He also had the nerve to carry it into a child's sickroom in 1891 on evidence that would not satisfy any modern ethics board, and he was right.

The counter-case is serious and mostly concerns character. He was a ferocious protector of his own credit and money, and the record of his treatment of Ehrlich — whose standardisation was the difference between a laboratory curiosity and a manufacturable drug — is not creditable. Kitasato's exclusion from the first Nobel was the committee's doing rather than Behring's, but Behring did not much protest it. His tuberculosis work overreached and failed publicly. A fair summary is that he was a genuine original thinker with a first-rate strategic instinct for what mattered, coupled to an appetite for exclusive glory that cost his collaborators dearly.

Legacy

He married Else Spinola, daughter of the director of the Charité, on 29 December 1896, and they had six sons; one, Bernhard, was killed in action in 1918. The honeymoon was spent at Behring's villa on Capri, where Maxim Gorky later lived. Behring died in Marburg on 31 March 1917, in the middle of a war in which his tetanus serum was saving German soldiers by the thousand. The company he founded survives, through successive names, as CSL Behring, and Germany's most richly endowed medical award still carries his name. So does the principle: that what protects one body can be lent to another.

Achievements

• Nobel Prize in Physiology or Medicine — 1901
• Cameron Prize of the University of Edinburgh
• Order of the Griffon — 1895
• 2nd Class Order of the Crown — 1896
• Order of the Red Eagle 2nd Class — 1912
• Held posts at University of Marburg, Martin Luther University Halle-Wittenberg and Charité
• Fields: medicine, immunology and bacteriology