Escherich, Theodor

(b. Ansbach, Germany, 29 November 1857; d. Vienna, Austria, 15 February 1911)

pediatrics.

Escherich was a pioneer pediatrician whose clinical insights and organizational abilities—linked to profound interests in bacteriology, immunology, and biochemistry—were devoted to improving child care, particularly infant hygiene and nutrition. He was born in a manufacturing town in Franconia, the younger son of Kreismedizinalrat Ferdinand Escherich, a medical statistician. His mother was Maria Sophie Frieder, daughter of Baron Carl Stromer von Reichenbach, a Bavarian army colonel. Because of his prankish tendencies in early schooldays, Escherich was sent to the great Jesuit seminary Stella Matutina, in Feldkirch, Austria. It apparently had no repressive effect upon him.

Escherich began his academic and medical education in 1876 at Strasbourg, continued at Kiel, Berlin, and Würzburg, and qualified at Munich in 1881. His doctoral dissertation was entitled “Die marantische Sinusthrombose bei Cholera infantum.” In 1882 he joined the medical clinic of the Julius Hospital, Würzburg, becoming first assistant to its director, Karl Gerhardt, a well-known internist with an outstanding knowledge of pediatrics. His interest was thus aroused in this specialty, but since Germany lacked the necessary training facilities, Escherich had to seek them elsewhere, first in Paris and then in Vienna, where he worked for some months under Hermann Widerhofer at the St. Anna Children’s Hospital. In 1885 he obtained clinical assistantships in Munich at the Children’s Polyclinic of the Reisingerianum and at the Hauner Children’s Hospital under Heinrich von Ranke. He habilitated himself at the University of Munich and became Privatdozent in pediatrics in 1886.

The increasing impact of Robert Koch’s discoveries and his own experiences as scientific assistant in the 1884 cholera epidemic at Naples (to which Gerhardt had sent him) persuaded Escherich that bacteriology could solve or illuminate many pediatric problems. Circumstances at Munich fostered this belief. Koch’s pupil, Wilhelm Frobenius, taught him pure culture techniques and methods of bacterial characterization; and he had access to Max von Pettenkofer’s hygienic institute, Otto von Bollinger’s bacteriological laboratory, Carl von Voit’s physiological institute, and Franz von Soxhlet’s dairy industry facilities. Escherich’s work on cholera had drawn his attention to the bacterial flora of the intestine in infants, and after a further year of intensive laboratory investigations he published a monograph on the relationship of intestinal bacteria to the physiology of digestion in the infant. This work, Die Darmbakterien des Säuglings und ihre Beziehungen zur Physiologie der Verdauung (1886), established its author as the leading bacteriologist in the field of pediatrics. During the ensuing years he began studies of artificial nutrition, which led him to formulate a new system of prescribing cow’s milk and to become a resolute advocate of breast-feeding for infants.

In 1890, when he was only thirty-three, Escherich was called to Graz to succeed Rudolf von Jaksch as extraordinary professor of pediatrics and director of the provincial children’s clinic. Four years later he was promoted to ordinary professor; at that time he also refused a call to Leipzig as Otto Heubner’s successor. His happiest years were spent in Graz, where he married Margaretha Pfaundler, daughter of the physicist Leopold Pfaundler. They had two children, a son and a daughter.

In Graz, Escherich instituted a broad program of clinical and laboratory researches and found scope for his organizational talents. He extended the diphtheria investigations that he had already launched in Munich and summarized the findings in two monographs, Ätiologie und Pathogenese der epidemischen Diphtherie (1892) and Diphtherie, Croup, Serumtherapie (1895). In 1890 he developed an interest in tetany of infants. He became the leading authority on this disease and in his final monograph. Die Tetanie der Kinder (1909), correctly ascribed it to parathyroid insufficiency. In 1891, one year after Koch discovered tuberculin, Escherich reported disappointing results in extensive trials of this product on tuberculous children. Thereafter problems of childhood tuberculosis remained among his chief concerns.

Escherich persuaded the Styrian government to build and maintain an infants’ division as a branch of the provincial orphanage, attached to the children’s clinic. He personally chose the furnishings and laboratory equipment for the expanded institution, designed the auditorium, founded a library, and established a diphtheria division for conducting bacteriological studies on suspected cases. The patient load trebled and a small provincial hospital was transformed into an important scientific and teaching institute.

When Widerhofer died in 1902, Escherich was appointed to his chair at Vienna. Although promised a new clinic, he himself had to draw plans, raise money, and negotiate with the government for this project, which was not completed during his lifetime. Meanwhile he renovated the venerable St. Anna Children’s Hospital, making changes whenever he could extract sufficient funds from governmental and charitable sources. In 1903, determined to reduce the capital’s infant mortality, Escherich appealed for support to the women of Vienna. The response was such that in the following year he established, with imperial patronage and civic approval, the Infants’ Care Association (Verein Säuglingsschutz).

In the St. Anna Hospital, Escherich set up an infants’ division and started an exemplary school for infant nursing. Medical students later received clinical instruction in this previously neglected field. The infant care headquarters on the hospital grounds became an educational center for mothers and a distributing point for cow’s milk preparations and breast-feeding propaganda. In 1908, the year of the Emperor Franz Joseph’s sixtieth jubilee, Escherich again drew attention to the inexcusably high national rate of infant mortality. His efforts resulted in eventual construction of the Imperial Institute for Maternal and Infant Care.

Escherich formed a pediatric section of the Viennese Society for Internal Medicine—serving indefatigably as chairman—and founded the Austrian Society for Child Research. In 1908 he was president of the German Pediatric Association. He coedited several well-known journals, held honorary membership in many foreign medical associations—including the American Pediatric Society—and was the only European pediatrician to address the International Congress of Arts and Sciences at the St. Louis World’s Fair in 1904. He received the title Hofrat in 1906.

Throughout this decade in Vienna, Escherich worked relentlessly. Consulted professionally by royal families, he attended congresses abroad, published reports on various topics, and encouraged the researches of pupils such as Clemens von Pirquet and Béla Schick, who had accompanied him from Graz. Escherich’s health deteriorated when his young son died from appendicitis. About five years later, in February 1911, a succession of cerebral attacks culminated in fatal apoplexy. The Kinderklinik, built to his plans, was officially dedicated soon afterward.

Idealism and progressiveness animated and gave purpose to Escherich’s zealous, unbounded industry. Distinguished looking and always meticulously dressed, yet genial and approachable, he disliked intrigue or spiteful gossip. To young patients he showed affection, to older ones respectful candor. His stimulating lectures stressed pathology and reflected a preventive outlook.

More than one quarter of his publications relate to bacteriology. His earliest monograph (1886) included classic descriptions of Bacterium coli commune (later eponymously designated Escherichia coli) and Bacterium coli aërogenes. Although his claims that B. coli could cause cystitis and other localized infections were undisputed, his contention that some virulent strains provoked infantile diarrhea and gastroenteritis was verified only after sixty years. He narrowly missed discovering Sonne dysentery bacilli, of which he isolated several cultures, only to discard them because they failed to produce gas in carbohydratecontaining media.

In 1889, Escherich confirmed the causal role of the Klebs-Löffler bacillus in a diphtheria epidemic. He instituted antitoxin therapy in his clinic patients in 1894 and recorded exceptionally favorable results in a subsequent monograph. Through experiments on healthy children he showed the futility of attempting to prevent the disease by oral or rectal administration of antitoxin. In Vienna, he vigorously sponsored Paul Moser’s antistreptococcus serum in scarlet fever treatment.

Escherich was intensely interested in the diagnosis, pathogenesis, and control of tuberculosis. He pioneered in X-ray detection of the disease in children. In his last years he advocated construction of sanatoria, emphasized the tuberculous nature of scrofula, and reinvestigated the Stichreaktion—the swelling and redness at the site of subcutaneous injection—observed by him during early therapeutic trials of tuberculin. The diagnostic importance of this test was effectively realized only after von Pirquet modified the technique.

The scope of Escherich’s clinical reports ranged from chorea to status lymphaticus, but his biochemical investigations focused on the physiology and pathology of infant nutrition. His breast-feeding edicts stemmed partly from recognition that improper milk formulas induced nutritional disorders, and partly from his observations that whereas healthy mother’s milk was bacteriologically sterile, cow’s milk might convey scarlet fever as well as intestinal infections. After disproving the prevailing dogma that cow’s milk casein was indigestible and showing that bowel fermentation could be influenced by withholding dietary carbohydrates, Escherich evolved new dietary formulas for infants of various ages and weights, based on volumetric intakes by breast-fed counterparts. Characteristically, he devised a sterilizing apparatus to render the mixtures safe and arranged free distribution of the treated material to needy mothers.

Escherich’s inspired common sense and technical ingenuity were directed into many channels. Thus his first building in Vienna, which housed separate laboratories for bacteriological, chemical, and X-ray activities, had a flat roof on which infants could lie or children play. The infants’ wards were equipped with many novel facilities of his design, such as fully airconditioned couveuses which were used either to protect especially vulnerable infants or to isolate infected ones. His acute social awareness and flair for innovation and coordination, combined with a bent for bacteriological and biochemical research, made Escherich the acknowledged leader of pediatrics in his day. Less versatility and longer life might have won him greater celebrity and more durable renown.

BIBLIOGRAPHY

I. Original Works. The only BIBLIOGRAPHY of Escherich’s works, listing about 170 items, is the inaccurate and incomplete one provided in an obituary by his former pupil and successor, Clemens von Pirquet (see below). Among his most important published works were four monographs, Die Darmbakterien des Säuglings und ihre Beziehungen zur Physiologie der Verdauung (Stuttgart, 1886; Ätiologie und Pathogenese der epidemischen Diphtherie. I. Der Diphtherie-bacillus (Vienna, 1892); Diphtherie, Croup, Serumtherapie nach Beobachtungen an der Universitäts-Kinderklinik in Graz (Vienna, 1895); and Die Tetanie der Kinder (Vienna, 1909). Escherich was also coauthor of a posthumous monograph, Scharlach (Vienna, 1912), written with Béla Schick; and of a long chapter on Bacterium Coli commune in W. Kolle and A. Wassermann’s Handbuch der pathogenen Mikroorganismen, II (Jena, 1903), 334–474, written with M. Pfaundler.

Many of his shorter contributions appeared in two or more journals. Among the more original and characteristic of these were “Die marantische Sinusthrombose bei Cholera infantum,”, in Jahrbuch für Kinderheilkunde, 19 (1883), 261–274; “Klinisch-therapeutische Beobachtungen aus der Cholera-Epidemie in Neapel,”, in Münchener medizinische Wochenschrift, 31 (1884), 561–564; “Bakteriologische Untersuchungen über Frauenmilch,”, in Fortschritte der Medizin, 3 (1885), 231–236;”Ueber Darmbakterien im allgemeinen and diejenigen der Säuglinge im Besonderen, sowie die Beziehungen der letzteren zur Aetiologie der Darmerkrangungen,”, in Centralblatt für Bacteriologie, 1 (1887), 705–713; “Die normale Milchverdaung des Säuglings”, in Jahrbuch für Kinderheilkunde, 27 (1888), 100–112; “Zur Reform der künstlichen Säuglingsernährung”, in Wiener klinische Wochenschrift, 2 (1889), 761–763; “Zur Aetiologie der Diphtherie”, in Centralblatt für Bakteriologie, 7 (1890), 8–13; “Ueber Milchsterilisirung zum Zwecke der Säuglingsernährung mit Demonstration eines neuen Apparates,”, in Berliner klinische Wochenschrift, 27 (1890), 1029–1033; “Idiopathische Tetanie im Kindesalter,”, in Wiener klinische Wochenschrift, 3 (1890), 769–774; “Die Resultate der Koch’schen Injektionen bei Skrofulose und Tuberculose”, in Jahrbuch für Kinderheilkunde, 33 (1891–1892), 369–426; “Ueber einen Schutzkörper im Blute der von Diphtherie geheilten Menschen,”, in Centralblatt für Bakteriologie, 13 (1893), 153–161, written with R. Klemensiewicz; “Bemerkungen über den Status lymphaticus der Kinder,”, in Berliner klinische Wochenschrift, 33 (1896), 645–450; “Begriff and Vorkommen der Tetanie im Kindesalter,”, ibid., 34 (1897), 661–866; “Versuche zur Immunisirung gegen Diphterie auf dem Wege des Verdauungstractes,”, in Wiener klinische Wochenschrift, 10 (1897), 799–801; “Kritische Stimmen zum gegenwärtigen Stande der Heilserumtherapie,” in Heilkunde (Vienna), 2 (1897–1898), 593–606; “La valeur diagnostique de la radiographie chez les enfants,” in Revue mensuelle des maladies de l’enfance, 16 (1896), 233–243; “Pyocyaneusinfectionen bei Säuglingen”, in Centralblatt für Bakteriologie25 (1899), 117–120; “Zur Aetiologie der Dysenterie,” ibid., 26 (1899), 385–389; “Zur Kenntniss der Unterschiede zwischen der naturlichen und künstlichen Ernährung des Säuglings”, in Wiener klinische Wochenschrift, 13 (1900), 1183–1186; “Die Erfolge der Serumbehandlung des Scharlach an der Universitäts-Kinderklinik in Wien,” ibid., 16 (1903),. 663–668; Bitte an die Wiener Frauen [a pamphlet] (Vienna, 1903); “Die Grundlage und Ziele der modernen Kinderheilkunde”, in Wiener klinische Wochenschrift, 17 (1904), 1025–1027; “Die neue Säuglingsabteilung im St. Anna-Kinderspital in Wien,” ibid., 18 (1905), 977–982; “Antrag auf Einsetzung eines Komitees behufs Ausarbeitung von Vorschlägen zur Förderung der Brusternährung,” ibid., 18 (1905), 572–575; “Der Verein ‘Säuglingsschutz’ auf der hygienischen Ausstellung in der Rotunde 1906,” ibid., 19 (1906), 871–875; “Zur Kenntnis der tetanoiden Zustände des Kindesalters,” in Münchener medizinische Wochenschrift, 54 (1907), 2073–2074; “Hermann Freiherr von Widerhofer 1832–1901,” in Wiener klinische Wochenschrift, 20 (1907), 1510–1513; “Die Bedeutung des Schularztes in der Prophylaxe der Infectionskrankheiten,” in Monatsschrift für Gesundheitspflege, 26 (1908), 117–130; “Was nennen wir Skrofulose?,” in Wiener klinische Wochenschrift, 22 (1909), 224–228; “Die Infektionswege der Tuberkulose, insbesondere im Säuglingsalter,” ibid., 515–522; and “Ueber Indikationen und Erfolge der Tuberkulintherapie bei der kindlichen Tuberculose,” ibid., 23 (1910), 723–730.

II. Secondary Literature. Obituaries include “Theodor Escherich, M. D.,” in Boston Medical and Surgical Journal, 164 (1911), 474–475; “Death of Professor Escherich,” in Lancet (1911), 1 , 626; H. Finkelstein, “Theodor Escherich†,” in Deutsche medizinische Wochenschrift, 37 (1911), 604–605; I. Fischer, “Escherich, Theodor,” in Biographisches Lexikon der hervorragenden Aerzte der letzten 50 Jarhe, I (Berlin-Vienna, 1932), 375; F. Hamburger, “Theodor Escherich†” in Wiener klinische Wochenschrift, 24 (1911), 263–266; W. Katner, “Theodor Escherich,” in Neue deutsche Biographie, IV (Berlin, 1959), 649–650; M. von Pfaundler, “Theodor Escherich†,” in Münchner medizinische Wochenschrift, 58 (1911), 521–523; and C. von Pirquet, “Theodor Escherich,” in Zeitschrift für Kinderkrankheiten, 1 (1910–1911), 423–441, which includes a BIBLIOGRAPHY—the same text, without BIBLIOGRAPHY, may be found in Mitheilungen der Gesellschaft für innere Medizin and Kinderheilkunde, Beilage VIII, 9 (1911), 82–93.

Other references to Escherich’s life and work are A. Gronowicz, Béla Schick and the World of Children (New York, 1954); K. Kundratitz, “Professor Dr. Theodor Escherichs Leben und Wirken,” in Wiener klinische Wochenschrift, 73 (1961), 722–725; Erna Lesky, Die Wiener medizinische Schule im 19. Jahrhundert (Graz, 1965); M. Neuberger, “Zur Geschichte der Wiener Kinderheilkunde,” in Wiener medizinische Wochenschrift, 85 (1935), 197–203, trans. by R. Rosenthal as “The History of Pediatrics in Vienna,” in Medical Record, 156 (1943), 746–751; B. Schick, “Pediatrics in Vienna at the Beginning of the Century,” in Journal of Pediatrics, 50 (1957), 114–124; L. Schönbauer, Das medizinisches Wien, 2nd ed. (Vienna, 1947); and R. Wagner, Clemens von Pirquet, His Life and Work (Baltimore, 1968).

Claude E. Dolman