Paul Ehrlich

Paul Ehrlich (born March 14, 1854, Strehlen, Silesia, Prussia [now Strzelin, Pol.]—died Aug. 20, 1915, Bad Homburg vor der Höhe, Ger.) was a German medical scientist known for his pioneering work in hematology, immunology, and chemotherapy and for his discovery of the first effective treatment for syphilis. He received the Nobel Prize for Physiology or Medicine in 1908 jointly with Élie Metchnikoff.

Early life

Ehrlich was born into a Jewish family prominent in business and industry. Although he lacked formal training in experimental chemistry and applied bacteriology, he was introduced by his mother’s cousin, the pathologist Carl Weigert, to the technique of staining cells with chemical dyes, a procedure used to view cells under the microscope. As a medical student at several universities, including Breslau, Strasbourg, Freiburg, and Leipzig, Ehrlich continued to experiment with cellular staining. The selective action of these dyes on different types of cells suggested to Ehrlich that chemical reactions were occurring in cells and that these reactions formed the basis of cellular processes. From this idea he reasoned that chemical agents could be used to heal diseased cells or to destroy infectious agents, a theory that revolutionized medical diagnostics and therapeutics.

After receiving his medical degree from the University of Leipzig in 1878, Ehrlich was offered a position as head physician at the prestigious Charité Hospital in Berlin. There he developed a new staining technique to identify the tuberculosis bacillus (a bacterium) that had been discovered by the German bacteriologist Robert Koch. Ehrlich also differentiated the numerous types of blood cells of the body and thereby laid the foundation for the field of hematology.

While developing new methods for the staining of live tissue, Ehrlich discovered the uses of methylene blue in the treatment of nervous disorders. In other diagnostic advances, he traced a specific chemical reaction in the urine of typhoid patients, tested various medications for reducing or removing fever, and made valuable suggestions for the treatment of eye diseases. Of the 37 scientific contributions that he published between 1879 and 1885, Ehrlich considered the last as the most important: Das Sauerstoff-Bedürfniss des Organismus (1885; “The Requirement of the Organism for Oxygen”). In it he established that oxygen consumption varies with different types of tissue and that these variations constitute a measure of the intensity of vital cell processes.

In 1883 Ehrlich married Hedwig Pinkus, with whom he had two daughters.

Immunity and the side-chain theory

A bout with tuberculosis forced Ehrlich to interrupt his work and seek a cure in Egypt. When he returned to Berlin in 1889, the disease had been permanently arrested. After working for some time in a tiny and primitive private laboratory, he transferred to Koch’s Institute for Infectious Diseases, where he concentrated on the problem of immunity. Very little was known at the time about the precise manner in which bacteria bring about disease, and even less was known about the body’s defenses against infection or how these immune defenses could be enhanced. The hypothesis Ehrlich developed to explain immunological phenomena was the side-chain theory, which described how antibodies—the protective proteins produced by the immune system—are formed and how they react with other substances. Delivered to the Royal Society in 1900, this theory was based on an understanding of the way in which a cell was thought to absorb and assimilate nutrients. Ehrlich postulated that each cell has on its surface a series of side chains, or receptors, that function by attaching to certain food molecules. While each side chain interacts with a specific nutrient—in the same manner as a key fits into a lock—it also can interact with other molecules, such as disease-causing toxins (antigens) produced by an infectious agent. When a toxin binds to a side chain, the interaction is irreversible and blocks subsequent binding and uptake of nutrients. The body then tries to overwhelm the obstruction by producing a great number of replacement side chains—so many that they cannot fit on the surface of the cell and instead are secreted into the circulation. According to Ehrlich’s theory, these circulating side chains are the antibodies, which are all gauged to and able to neutralize the disease-causing toxin and then remain in the circulation, thus immunizing the individual against subsequent invasions by the infectious agent.

This much-debated hypothesis, although ultimately proven to be incorrect in many particulars, had a profound influence on Ehrlich’s later work and on the work of his successors. Thus Ehrlich was able to show experimentally that rabbits subjected to a slow and measured increase of toxic matter were able to survive 5,000 times the fatal dose. In the end, he established precise quantitative patterns of immunity. These findings assumed great importance in 1890, when he met Emil von Behring, who had succeeded in creating an antitoxin against diphtheria. Behring had tried to prepare a serum that could be used in clinical practice, but it was only by adopting Ehrlich’s technique of using the blood of live horses that the preparation of a serum of optimum antitoxic effectiveness became possible. Ehrlich developed a way of measuring the effectiveness of serums that was soon adopted all over the world for the standardization of diphtheria serum. He also demonstrated, in 1892, that antibodies are passed in breast milk from mother to newborn.

On the basis of these achievements, Ehrlich was made director of a government-supported institute near Berlin, which was transferred to Frankfurt am Main in 1899 as the Royal Institute for Experimental Therapy. No restrictions of any kind were placed upon the direction of his research. While this corresponded to Ehrlich’s own talents and inclinations, it did not please Behring, who endeavoured to have his colleague specialize in immunology and serum therapy. The strained relationship between the two men was exacerbated by personality differences. Ehrlich, utterly indifferent to monetary rewards, had no ambition to become an industrialist like Behring; he was content to carry out his research.

He had by then recognized the limitations of serum therapy. Many infectious disorders, in particular those caused by protozoa rather than bacteria, failed to respond to serum treatment. The recognition of this fact marks the birth of chemotherapy. Ehrlich started experimenting with the identification and synthesis of substances, not necessarily found in nature, that could kill parasites or inhibit their growth without damaging the organism. He began with trypanosomes, a species of protozoa that he unsuccessfully attempted to control by means of coal tar dyes. There followed compounds of arsenic and benzene; other compounds proved to be too toxic. Instead of declaring himself vanquished by these difficulties, Ehrlich turned his attention to the spirochete Treponema pallidum, the causal organism of syphilis.

Syphilis studies

Ehrlich had at this time several institutes at his disposal as well as sizable research funds. He also had a staff of highly competent collaborators; in fact, his colleague Hata Sahachirō contributed much to his eventual success in combating syphilis. His preparation 606, later called Salvarsan, was extraordinarily effective and harmless despite its large arsenic content. The first tests, announced in the spring of 1910, proved to be surprisingly successful in the treatment of a whole spectrum of diseases; in the case of yaws, a tropical disease akin to syphilis, a single injection was sufficient. It seemed as if a “magic bullet,” to use a favourite expression of Ehrlich’s, had been found.

The devastation wrought by syphilis provoked worldwide demand for a new weapon against the disease. Ehrlich, however, would not yet release his discovery for general use, believing as he did that the usual few hundred clinical tests did not suffice in the case of an arsenic preparation, the injection of which required special precautions. In an unheard-of transaction, the manufacturer with whom Ehrlich had collaborated closely, Farbwerke-Hoechst, released a total of 65,000 units gratis to physicians all over the globe. Although harmful side effects remained nominal in number, some envious competitors did not hesitate to attack Ehrlich. The most libelous among them was given a jail sentence.

The greatest distinction bestowed on Ehrlich by the Prussian state was the title “Wirklicher Geheimer Rat,” or Privy Councillor, with the predicate of “Exzellenz.” Along with numerous other honours, Ehrlich was presented with honorary doctorates by the Universities of Oxford, Chicago, and Athens and an honorary citizenship by Frankfurt am Main, where the institute he founded still bears his name. Having suffered a first stroke in December 1914, Ehrlich succumbed to a second stroke in August of the following year. In its obituary the London Times acknowledged Ehrlich’s achievement in opening new doors into the unknown, saying, “The whole world is in his debt.”