Doctor's Review: Medicine on the Move

October 18, 2017
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A shot of syphilis

Albert Neisser tried to save prostitutes from STDs, but started a scandal instead

Today we take for granted the rules that govern medical experimentation. Yet men of medicine from days gone by were governed by their own consciences rather than legal standards. So, sadly, the past is rife with atrocities, as in the case of Albert Neisser, would-be saviour of prostitutes turned purveyor of misery. The 19th-century MD totally devoted to STDs and public-health initiatives sure had a funny way of showing it.

Honoured with an STD

Albert Ludwig Sigesmund Neisser was born in Schweidnitz, Germany in 1855. His father, Moritz, was a beloved local physician and young Albert grew up sharing his father’s passion for helping others, perhaps because his mother died when he was an infant. Albert entered medical school graduating in 1877. Afterwards, he found a job under the well-known physician Oskar Simon at a dermatological clinic in Breslau. It was while studying skin complications of gonorrhea, leprosy and syphilis that Neisser’s life-long interest in STDs was formed.

Neisser was an outstanding doctor from the start. In 1879, he made the discovery for which he would become famous — the bacterium responsible for gonorrhea. For his efforts, the 21-year-old received the dubious distinction of having the bug named after him and so Neisseria gonorrhoeae was born.

Not content to rest on his laurels, Neisser turned his attention to leprosy, travelling to Norway and Spain in the early 1880s to study with some of the premier bacteriologists of the time. One of them was Gerhard Hendrik Armauer Hansen, the eminent Norwegian physician. Leprosy, aka Hansen’s Disease, might just as easily have been named for Neisser, since he was the first to provide conclusive proof that the bacillus first identified by Hansen in 1873 and known as Mycobacterium leprae was indeed responsible for causing the devastating illness. Neisser published his findings in 1880, bickered with Hansen about credit for the discovery, and then moved back home.

An eye on syphilis

Back in Germany, Neisser’s reputation had grown and, within a few years, he was awarded an assistant professorship at Breslau University. He was soon in charge of its dermatology clinic, eventually becoming director of the entire hospital. After a brief dalliance with research on lupus, Neisser turned his attention to syphilis — the sinister STD responsible for so much insanity, disfigurement and death during the 19th century.

Since the beginning of recorded medical history, syphilis was a plague affecting people worldwide, virtually exploding throughout Europe during the 15th century, with no real effective treatment until the age of antibiotics. The suffering caused by this now relatively benign STD can be hard to imagine, but it was arguably public-health-enemy number one in 19th-century Europe; medical historians estimate the mortality rate was between 20 and 40 percent.

Perhaps Neisser’s interest in the disease was personal — his old friend-turned-foe Hansen suffered from syphilis his whole life — or perhaps it developed out of a desire to cleanse the world of its biggest bacteriological enemy; either way, Neisser took the battle against the bug to heart. In fact, his efforts soon took on an obsessive and, eventually, even savage quality.

Going ape

In 1903, Neisser witnessed a demonstration by biologist Elie Metchnikoff and bacteriologist Pierre Paul Émile Roux in which they infected apes with syphilis. So impressed was he that Neisser planned a trip to the remote Indonesian island of Java to study the origins of the disease and to pick up a few apes so that he could continue to experiment. In Java, he also conducted research into the STDs spread among humans, thanks to a population of randy Dutch sailors stationed there.

Though Neisser didn’t identify Spirochaeta pallida, the bacillus responsible for the disease — zoologist Fritz Schaudinn and dermatologist Erich Hoffmann claimed that distinction in 1905 — he did help create the first serological test to diagnose it alongside his countryman and bacteriological colleague August Paul von Wassermann in 1906. Neisser was also involved in the development of the first effective drug to treat it, Salvarsan, which hit the market in 1910. If this was all he had done, Neisser surely would have been remembered only for being one of the premier bacteriologists of his day. However, this was not to be.

Bugs and drugs

By the turn of the century, Neisser had established himself as a supporter of public-health initiatives. He opposed jailing prostitutes and promoted educating them and the public about STDs, and even suggested regulating the sex trade. While many of his contemporaries were surely not as forward-thinking, Neisser’s real trouble began in 1898, when, in his blind search for a syphilis cure, he began inoculating prostitutes, some of whom were minors, by injecting them with an infected serum without their knowledge.

Inspired in part by the explosion of interest in the work of Louis Pasteur and ape-infector Roux who developed the rabies vaccine in 1885, as well as German bacteriologist Emil Von Behring’s successful inoculations against tetanus and diphtheria, Neisser theorized that the process should work equally well with syphilis. It didn’t and many of his subjects came down with the disease.

It isn’t known exactly how many patients were “inoculated” by Neisser. Four victims went to trial and caused quite a scandal, though Neisser’s colleagues mostly agreed with his practices. In 1910, he was publicly censured and forced to pay a huge fine, all of which eventually led to the adoption of moral and ethical research guidelines in Prussia — among the first such directives to be implemented by the European medical community. From that point on, it was clearly stated that informed consent had to be obtained from patients prior to any experimentation or treatment, and that children and incompetent people were unable to give such consent.

Neisser died in 1916 and will mostly be remembered for the great contributions he made to the field of bacteriology. However, his methods also serve as a cautionary tale that should not be forgotten: informed consent is required of all study participants or patients in treatment; the price of repeating the mistakes of the past is far too high.

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