I recently came upon an article by Dr. Don Nakayama, historian of the American College of Surgeons, that reminded me of Alfred Nobel’s clever ploy.
Alfred Nobel is one of those iconic humans whose legacy is associated with the most significant achievements of our recent history. His story is interesting because his main achievement is that of creating dynamite, a substance that killed and maimed thousands, if not more, humans through wars and accidents. Although Alfred Nobel was agnostic and later in his life an atheist, he worried about how he would be remembered by humanity. Alfred cleverly diverted the attention away from his homicidal reputation to one that associates the name “Nobel” with significant human accomplishments. He bought a better legacy for himself. It only cost him three BILLION dollars!
Alfred was a Swedish chemist who had a fascination with nitroglycerine, which is an oil that was invented by an Italian, Ascani Sobrero. Alfred and his family started a business in making this substance they called “blasting oil.” He had factories on both sides of the Atlantic. Alfred, while experimenting with this dangerous oil, managed to blow up several houses, including one that had his younger brother Emil in it along with four other people. After that the city of Stockholm no longer allowed him to experiment within the city limits. He took his lab to a barge on a lake outside the city. Nobel tried a variety of substances to mix with the nitroglycerine to make it more stable, and finally settled on diatomaceous earth that not only made it stable but allowed it to be molded into rods to which he attached a blasting cap to trigger it. He invented dynamite! But he continued to create many other things, including synthetic rubber, leather, and silk. By the time of his death, he had 355 patents to his name.
In 1888 another of his brothers, Ludwig, died in Cannes, France, of natural causes. Alfred happened to read the French obituary that reported on the death of Ludwig, but they got the names wrong, and instead of Ludwig the newspaper reported that it was Alfred that had died, and wrote: “Le marchand de mort est mort” (the merchant of death is dead). They went on to say, “Dr. Alfred Nobel who became rich by finding ways to kill more people faster than ever before, died yesterday.” His portrayal as a murderer deeply wounded Alfred. He made it the rest of his life’s task to change this, which he perceived to be, an unjust view of him. To add insult to injury, the French government convicted Alfred of high treason for selling explosives to Italy, and he had to move from Paris to Sanremo, Italy, in 1891. By the time of his death in 1896, his amassed fortune was more than three billion (with a “B”) dollars. He had never married and had no children, so he crafted a will that took 94% of his total worth and created the Nobel Foundation, which gave awards to the most deserving people in the fields of chemistry, physics, medicine and physiology, literature, economics, and peace. Each person received approximately $1,000,000 along with the coveted 24-carat gold medal (which now is 18 carats with 24-carat gold plating).
My interests in the Nobel prize involve the things that dealt with the sciences and especially as they affected my profession of medicine and surgery. Every year in early October, the overlords of the Swedish Academy of Sciences, with input from the Karolinska Institute for physiology and medicine, announce the winners for that year’s Nobel Laureates. Many noteworthy prizes are milestones of human accomplishments. Those stories are interesting to me and are worthy of comment, because some have changed our lives while others are just curious, historical, or heroic. As is so often true, “Truth is stranger than fiction!”
On November 8, 1895, Wilhelm Conrad Röntgen exposed his wife’s left hand on a photographic plate, to a tube with very low pressure, through which he passed an electric current. On the picture he produced, he could see the bones of her hand. The first X-Ray was taken. X-Rays revolutionized diagnosis and as a consequence, treatment of human disease processes. In 1901 he received the Nobel Prize in Medicine for this discovery.
In 1903 Madam Curie was the first woman ever to receive the Nobel Prize, which she won for physics. She was a Polish native sent by her government to study in Paris. She and her husband, Pierre, came up with two new elements, Polonium and radium. Polonium named for her native country. Unfortunately, he was no longer living, run over by a horse carriage on the Rue Dauphine during a heavy rain in Paris. She won again in 1911 for chemistry. These prizes came with a substantial sum of money. Poland supported her through grants to pursue her studies in Paris. She gave that all back and wound up giving most of the rest of it to found the Curie Institute in honor of her late husband for the research on radioactive materials, the words she actually coined. Albert Einstein said of her that she was the only human he knew that was not corrupted by money, fame, or glory. Ultimately, she gave it all, including her life, as the radioactivity destroyed her bone marrow without which she could not survive. It was Madame Curie that originated the idea that radiation could kill bacteria to sterilize surgical instruments and cancer cells in humans. During World War I she founded a brigade of trucks outfitted with X-ray machines that drove into the battlefield, risking her own life to pick up wounded soldiers. Before bringing them to the surgeons, she would X-ray their wounds to see where the shrapnel was to make it easier for the surgeon to find. Few people are more worthy of a Nobel Prize than she.
Robert Koch, a surgeon during the Franco-Prussian War and a staunch ally of Louis Pasteur, fought for the acceptance of the germ theory of disease. His four postulates of disease causation remain the standard to judge whether or not a particular agent is causative.
- The bacteria must be present in every case of the disease.
- The bacteria must be isolated from the host with the disease and grown in culture.
- The disease must be reproduced when the bacteria is inoculated into a susceptible host.
- The bacteria must be recovered from the infected host.
Robert Koch identified the causes of anthrax, cholera, and tuberculosis. He developed the skin test for tuberculosis, the PPD that is still used. He refused to patent it as he did not want to have financial reasons to hamper its use to save lives or prevent progress against the disease. It was for his work in diagnosing and treating anthrax and tuberculosis that garnered him the Nobel Prize in 1905.
Theodor Emil Kocher was one of the early greats! He came from a race of giants, Billroth, Virchow, Lister, and Langenbeck were his teachers. He, in turn, mentored, Harvey Cushing, William Halsted, and Fritz de Quervain. He did over 5000 thyroidectomies and learned how to do them right. From a mortality risk of 75%, he reduced it down to 0.5%. The Russian ideologue, and eventual leader, Vladimir Lenin entrusted his wife to Kocher when she needed a thyroidectomy. Kocher earned his Nobel Prize in 1909.
Robert Bárány was an Austro-Hungarian physician who served as a surgeon in World War I. He discovered the physiology of the vestibular system of the inner ear while he was trying to treat symptoms of vertigo and nystagmus by intermittent injecting warm or cold water into the ear canal of the patient. By circumstance, he had been turned down by Sigmund Freud for postgraduate training as Freud thought he was odd. Despite this when Barany was awarded the Nobel Prize in 1914 but did not receive it until 1916 as he was a prisoner of war. He immediately exercised his right as a laureate to nominate others for the Nobel awards. Who would you think he chose? None other than Sigmund Freud!
In the field of physics, one of the greater lapses of the Nobel Committee occurred. In 1905, a minor functionary at the Bern office of patents in Switzerland, named Albert Einstein, worked in sorting and registering new inventions. During his day job, he had time to work on his hobby, nuclear physics. He wrote two monumental papers that revolutionized physics, going back to Isaac Newton 200 years before, the Special Theory of Relativity and the General Theory of Relativity. Special Relativity relates time and space as a single entity he called spacetime. The faster you travel, the slower time passes. Also, the closer you are to a large mass (i.e. gravitational force), the slower time passes. The Special Theory further explains that mass and energy are interconvertible with the now-iconic formula E=mc2. Ten years later the General Theory of Relativity explained gravity as the distortion of spacetime.
In August of 1939, a letter drafted by Einstein and other physicists delivered to President Franklin Delano Rosevelt personally by Einstein, detailed the concern that Germany was developing a nuclear weapon. This led FDR to approve the Manhattan project that evolved to the actualization of the theoretical E=mc2 formula resulting in the vaporizing of two Japanese cities, Hiroshima and Nagasaki. This left only dust, ashes, and human agony as evidence that mass can be converted to pure energy, but did end World War II. The theory for this was all laid out by Einstein by 1915, but the Nobel Committee chose to ignore it because one of the jurors deferred his support for several consecutive nominations of Einstein. His reasoning was that he doubted Relativity would stand the test of time – so much for the wisdom of the committee. Instead, they threw the man who gave us the nuclear age, a bone, by giving him the Nobel Prize in 1922 for the photoelectric effect, a comparatively minor discovery Einstein made that electrons are released by exposing metals to specific wavelengths of light. The prize money was, however instrumental in Einstein being able to purchase a divorce from his first wife. Einstein did nevertheless keep the gold medal.
Speaking of medals, a curious story involved the medals of two laureates, Max von Laue (physics 1914), and James Franck (physics, 1925)). Both medals were housed at the Neils Bohr Institute in Copenhagen. When the German occupation posed a risk to the medals because both physicists were notoriously anti-Nazi, they were dissolved in acid and hidden from the Nazis. After the war, it was simple chemical precipitation to recover the gold and re-mint the medals. Another brush with National Socialism came with laureate Gerhard Domagk, who was not allowed, on the personal order from Adolph Hitler, to attend the 1939 Nobel Prize ceremony for his contribution to the discovery of Sulfa drugs, the first antibiotics. But Domagk did eventually get his award after Hitler bit the cyanide pill in his bunker in Berlin.
Frederick Banting was educated as an orthopedic surgeon but practiced general medicine in rural Canada. Because his practice was not very successful, he turned to academia at the University of Toronto. He and a medical student, Charles Best, did experiments in isolating a pancreatic hormone, the lack of which they thought was the cause of diabetes. They extracted this from specialized pancreatic cells found in the islets of Langerhans. The department head J.J.R. Macleod provided the lab facility as well as Banting’s assistant, Best. Because of this, Macleod, not Best, got to share the 1923 Nobel Prize for medicine in the discovery of insulin.
Alexander Fleming was a Scottish physician and microbiologist, although he did serve as a captain in the Royal Army Medical Corps and did duty in field hospitals filled with injured soldiers that required a surgeon’s skills. His talents, however, were along the lines of bacteriology. In his own words, “One sometimes finds what one is not looking for… but I suppose that is exactly what I did.” Fleming noted that one of the bacterial plates he was studying had killed the bacteria through accidental mold contamination by Penicillium notatum. He was knighted for this achievement, the discovery of Penicillin, and received the Nobel Prize in Medicine in 1945.
Charles Huggins was a Canadian-American surgeon who noted that prostate cancer could be controlled by castration and estrogen hormone administration. In 1966 he was awarded the Nobel Prize in Medicine.
Few surgeons garnered the Nobel Prize, but one Antonio Caetano de Abreu Freire Egas Moniz shared the 1949 prize with Walter Rudolf Hess. Antonio devised an operation that is now abandoned in the historic wastebasket of discredited operations, the frontal lobotomy. When I was in high school, my father, who was a physician in a mega psychiatric institution of 7000 patients in central Illinois in the 50s, would take me to operations. One of the very memorable ones was watching a neurosurgeon do a frontal lobotomy. The extraordinarily violent patient was brought in leather restraints into the operating room, and strapped to the operating table. Once the anesthetic was administered his restraints were taken off. The surgeon drilled two holes in the front of the skull just behind the now clean-shaven hairline. With a long electric cutting knife (Bovie) he made sweeping motions through both sides of the brain, disconnecting the front of the cortex from the rest of the brain. The patient was awoken.
An amazing transformation had taken place. He was a vegetable, didn’t talk, and made no intentional movement, but he would get up and walk when prompted. One of the best Hollywood movies I have ever seen was “One Flew Over the Cuckoo’s Nest” directed by Miloš Forman with Jack Nicholson in the lead role. It portrays realistically and graphically what frontal lobotomy is all about. It won all five major academy awards: best picture, best actor, best actress, best director, and best screenplay. It is considered by many to be one of the best films ever made. I sincerely believe it is a major factor that frontal lobotomy was abandoned, also calling the Nobel Committee’s decision to give Antonio a gold medal into question.
Other surgeons whose medals remain un-besmirched are: Alexis Carrel (1912) for inventing vascular surgery after being witness to the assassination of French President Marie François Said Carnot in the streets of Paris, who died of a laceration of the portal vein for which the surgeons of the time didn’t have the means or knowledge to repair. Werner Forssman and André Cournand for cardiac catheterization (1956) and Joseph Murray (1990) for the first kidney transplantation, who all need to be included.
It is surprising how many great surgeons have been left out: Alfred Blalock for his shunt that has saved thousands of infants’ lives, and C. Walton Lillehei, aptly named by his residents, the King of Hearts, for his work on correcting congenital heart disease. Also what about Michael DeBakey, who gave us coronary bypass, carotid endarterectomy, and ascending aortic dissecting aneurysm repair, not to mention his contributions to the Mobile Surgical Army Hospital (with the successful TV and movie versions of the MASH Unit). Furthermore, the first heart transplant was done by Christiaan Barnard, and Thomas Starzl did the first liver transplant.
Often at the end of a challenging operation, while teaching young surgeons to operate, there is a less tense moment while placing the last few sutures in the skin when the surgeon in training can be quizzed on surgical trivia. I liked Dr. Nakayama’s suggestion of asking them who all the surgeons are that had received the Nobel Prize. It is not a long list and, by rights, ought to be much longer. The Nobel Committee has its work cut out for them. So many more years, and so many deserving surgeons.