Theodor Bilharz
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Theodor Maximilian Bilharz (23 March 1825 – 9 May 1862) was a German
physician A physician, medical practitioner (British English), medical doctor, or simply doctor is a health professional who practices medicine, which is concerned with promoting, maintaining or restoring health through the Medical education, study, Med ...
who made pioneering discoveries in the field of
parasitology Parasitology is the study of parasites, their host (biology), hosts, and the relationship between them. As a List of biology disciplines, biological discipline, the scope of parasitology is not determined by the organism or environment in questio ...
. His contributions led to the foundation of
tropical medicine Tropical medicine is an interdisciplinary branch of medicine that deals with health issues that occur uniquely, are more widespread, or are more difficult to control in tropical and subtropical regions. Physicians in this field diagnose and tr ...
. He is best remembered as the discoverer of the blood fluke ''
Schistosoma haematobium ''Schistosoma haematobium'' (urinary blood fluke) is a species of digenetic trematode, belonging to a group (genus) of blood flukes (''Schistosoma''). It is found in Africa and the Middle East. It is the major agent of schistosomiasis, the mos ...
'', the causative parasite of bloody urine (
haematuria Hematuria or haematuria is defined as the presence of blood or red blood cells in the urine. "Gross hematuria" occurs when urine appears red, brown, or tea-colored due to the presence of blood. Hematuria may also be subtle and only detectable with ...
) known since ancient times in Egypt. The parasite, as the cause of
bladder cancer Bladder cancer is the abnormal growth of cells in the bladder. These cells can grow to form a tumor, which eventually spreads, damaging the bladder and other organs. Most people with bladder cancer are diagnosed after noticing blood in thei ...
, is declared by the
International Agency for Research on Cancer The International Agency for Research on Cancer (IARC; ) is an intergovernmental agency forming part of the World Health Organization of the United Nations. Its role is to conduct and coordinate research into the causes of cancer. It also cance ...
as Group 1 carcinogen. The infection is known by an eponymous term
bilharzia Schistosomiasis, also known as snail fever, bilharzia, and Katayama fever is a neglected tropical disease caused by parasitic flatworms called schistosomes. It affects both humans and animals. It affects the urinary tract or the intestines ...
or bilharziasis, as well as by schistosomiasis. Bilharz was born and educated in Sigmaringen,
Hohenzollern-Sigmaringen Hohenzollern-Sigmaringen () was a principality in southwestern Germany. Its rulers belonged to the junior House of Hohenzollern#Swabian branch, Swabian branch of the House of Hohenzollern. The Swabian Hohenzollerns were elevated to princes in 162 ...
, Germany. After graduating in natural science and philosophy from the Albert-Ludwigs-Universität in 1845, he earned a medical degree from the
University of Tübingen The University of Tübingen, officially the Eberhard Karl University of Tübingen (; ), is a public research university located in the city of Tübingen, Baden-Württemberg, Germany. The University of Tübingen is one of eleven German Excellenc ...
in 1849. In 1850, he followed his former teacher
Wilhelm Griesinger Wilhelm Griesinger (29 July 1817 – 26 October 1868) was a German neurologist and psychiatrist born in Stuttgart. Life and career He studied under Johann Lukas Schönlein at the University of Zurich and physiologist François Magendie in Paris ...
to Egypt to work at the Qasr El Eyni Hospital in Cairo. He became the first autopsy performer there. From autopsies of children, he observed a variety of helminth parasites and discovered the tapeworm '' Hymenolepis nana'' and the flatworm '' Heterophyes heterophyes'' in 1851''.'' Early in that year he found a male worm from a dead soldier. As a novel worm with two mouth-like suckers, he named it ''Distomum haematobium'', the description of which was published by his mentor
Karl Theodor Ernst von Siebold Prof Karl (Carl) Theodor Ernst von Siebold Royal Society of London, FRS(For) HFRSE (16 February 1804 – 7 April 1885) was a German physiologist and zoologist. He was responsible for the introduction of the taxa Arthropoda and Rhizopoda, and for d ...
in 1852. He further discovered that it was the eggs and not the flukes that caused the disease. He also unknowingly discovered another related blood fluke, later identified as '' Schistosoma mansoni,'' the most prevalent human helminth. While he was professor of anatomy at the Qasr El Eyni Medical School (now part of the
University of Cairo Cairo University () is Egypt's premier public university. Its main campus is in Giza, immediately across the Nile from Cairo. It was founded on 21 December 1908;"Brief history and development of Cairo University." Cairo University Faculty of En ...
), he contracted
typhoid fever Typhoid fever, also known simply as typhoid, is a disease caused by '' Salmonella enterica'' serotype Typhi bacteria, also called ''Salmonella'' Typhi. Symptoms vary from mild to severe, and usually begin six to 30 days after exposure. Often th ...
or
typhus Typhus, also known as typhus fever, is a group of infectious diseases that include epidemic typhus, scrub typhus, and murine typhus. Common symptoms include fever, headache, and a rash. Typically these begin one to two weeks after exposu ...
at
Massawa Massawa or Mitsiwa ( ) is a port city in the Northern Red Sea Region, Northern Red Sea region of Eritrea, located on the Red Sea at the northern end of the Gulf of Zula beside the Dahlak Archipelago. It has been a historically important port for ...
during an expedition organised by
Ernest II, Duke of Saxe-Coburg and Gotha Ernest II (; 21 June 181822 August 1893) was Duke of Saxe-Coburg and Gotha from 29 January 1844 to his death in 1893. He was born in Coburg to Ernest III, Duke of Saxe-Coburg-Saalfeld, and Princess Louise of Saxe-Gotha-Altenburg. His father be ...
. He died of it at age 37. The
United Arab Republic The United Arab Republic (UAR; ) was a sovereign state in the Middle East from 1958 to 1971. It was initially a short-lived political union between Republic of Egypt (1953–1958), Egypt (including Occupation of the Gaza Strip by the United Ara ...
established Theodor Bilharz Research Institute in his honour in 1962.


Early life and education

Theodor Bilharz was born in Sigmaringen,
Hohenzollern-Sigmaringen Hohenzollern-Sigmaringen () was a principality in southwestern Germany. Its rulers belonged to the junior House of Hohenzollern#Swabian branch, Swabian branch of the House of Hohenzollern. The Swabian Hohenzollerns were elevated to princes in 162 ...
, Germany. His father Josef Antony Bilharz (1788–1877), a councilor of the exchequer, was an advisor to the Prince Karl Anton of Hohenzollern. His mother Elisa Fehr (1800–1889) was from a Swiss family of Zollikhofer. He was the eldest of nine children, four of who died at infancy. He studied at the local school in Sigmaringen and completed his secondary education (Fürstlich Sigmaringer Gymnasium) in 1843 with the highest score. He developed keen interest in geology, biology and poetry. His surviving poem ''Die Trane des Seraphs'' (''The Travels of the Seraphs'') was composed during his school days. He scored the highest in Latin, Greek and Hebrew in his class. At age 14, he wrote a drama and translated an ancient comic epic ''Battle of the Frogs and Mice'' ('' Batrachomyomachia''). He soon developed a passion in natural science mainly from the library and specimens he inherited from his great uncle Kaspar Zollikofer von Altenklingen, a reputed Swiss biologist. In the winter semester of 1843, Bilharz entered the Albert-Ludwigs-Universität (University of Freiburg) in
Freiburg im Breisgau Freiburg im Breisgau or simply Freiburg is the List of cities in Baden-Württemberg by population, fourth-largest city of the German state of Baden-Württemberg after Stuttgart, Mannheim and Karlsruhe. Its built-up area has a population of abou ...
and took up natural science and philosophy. After completing the degree in 1845, he followed his anatomy teacher Friedrich Arnold to the
University of Tübingen The University of Tübingen, officially the Eberhard Karl University of Tübingen (; ), is a public research university located in the city of Tübingen, Baden-Württemberg, Germany. The University of Tübingen is one of eleven German Excellenc ...
where he enrolled in medicine. In 1846, he won the medical faculty's prize competition for his dissertation on topic "The microscopic characters of the blood of invertebrate animals." With the prize money he bought a compound microscope (Oberhaus microscope) that he used throughout his career. He also became closely associated with
Wilhelm Griesinger Wilhelm Griesinger (29 July 1817 – 26 October 1868) was a German neurologist and psychiatrist born in Stuttgart. Life and career He studied under Johann Lukas Schönlein at the University of Zurich and physiologist François Magendie in Paris ...
, a
neurologist Neurology (from , "string, nerve" and the suffix -logia, "study of") is the branch of medicine dealing with the diagnosis and treatment of all categories of conditions and disease involving the nervous system, which comprises the brain, the ...
and
psychiatrist A psychiatrist is a physician who specializes in psychiatry. Psychiatrists are physicians who evaluate patients to determine whether their symptoms are the result of a physical illness, a combination of physical and mental ailments or strictly ...
who was working as an internist at Tübingen at the time. Bilharz passed the state exam in 1849 to obtain a license as medical doctor. There are sources which state that he graduated in 1848, and he was awarded the medical degree without having to appear the examination because of his excellent performance throughout the course. These information may not be reliable as better biographical sources say he passed the exam in 1849. As he graduated, he immediately got an appointment as an assistant to
Karl Theodor Ernst von Siebold Prof Karl (Carl) Theodor Ernst von Siebold Royal Society of London, FRS(For) HFRSE (16 February 1804 – 7 April 1885) was a German physiologist and zoologist. He was responsible for the introduction of the taxa Arthropoda and Rhizopoda, and for d ...
at the University of Freiburg. Von Siebold became his major influence in parasitology and later discoveries. Bilharz initially planned to work in South America hoping to achieve good research in parasitology as he described: "The path to become a professor maybe shorter via America than via Tübingen." The next year, a recently appointed professor of anatomy at Freiburg, Georg Ludwig Kobelt recruited him as his prosector.


Career and achievements

In 1850, Wilhelm Griesinger, then at the
University of Kiel Kiel University, officially the Christian Albrecht University of Kiel, (, abbreviated CAU, known informally as Christiana Albertina) is a public research university in the city of Kiel, Germany. It was founded in 1665 as the ''Academia Holsator ...
, was appointed by
Abbas I of Egypt Abbas Helmy I of Egypt (also known as ''Abbas Pasha'', , 1 July 181213 July 1854) was the Wāli of Egypt and Sudan. He was a son of Tusun Pasha, the younger son of Muhammad Ali Pasha whom he succeeded as ''de facto'' ruler of Egypt and Sudan. T ...
,
Wāli ''Wāli'', ''Wā'lī'' or ''vali'' (from ''Wālī'') is an administrative title that was used in the Muslim world (including the Rashidun, Umayyad and Abbasid caliphates and the Ottoman Empire) to designate governors of administrative divis ...
(governor or viceroy) of Egypt and Sudan, to head medical services in Egypt. He responded to the Wāli that he would accept the appointment only if his former student Theodor Bilharz was appointed as his assistant. Bilharz was still waiting for his medical certificate, and recounted that he could not sleep the night he received the official appointment out of excitement. Griesinger was to hold three positions such as Director of both Qasr El Eyni Hospital and its medical school (later part of the
University of Cairo Cairo University () is Egypt's premier public university. Its main campus is in Giza, immediately across the Nile from Cairo. It was founded on 21 December 1908;"Brief history and development of Cairo University." Cairo University Faculty of En ...
), President of the Sanitary Council and personal physician to the Wāli. Von Siebold wrote of his recommendation to Bilharz’s father saying, "I can't help it to speak out the wish that the stay of your good Theodor may be a credit to him and to science... I won't believe anything else than that a longer stay in wonderful Egypt would be excellently used by your son. God may save his health." Griesinger and Bilharz left on 25 May and reached
Alexandria Alexandria ( ; ) is the List of cities and towns in Egypt#Largest cities, second largest city in Egypt and the List of coastal settlements of the Mediterranean Sea, largest city on the Mediterranean coast. It lies at the western edge of the Nile ...
on 18 June. Bilharz held the position of senior consultant for the department of internal medicine, and also enlisted in the military where he was given the rank of lieutenant colonel ( Kaimakam). As an authorised
autopsy An autopsy (also referred to as post-mortem examination, obduction, necropsy, or autopsia cadaverum) is a surgical procedure that consists of a thorough examination of a corpse by dissection to determine the cause, mode, and manner of deat ...
performer, it was an ideal assignment for Bilharz because autopsy was generally opposed by religious and traditional establishments at the time. Bilharz thereby became the first person to legally perform autopsies in Egypt as the first chief of surgery. While in charge of autopsy between 1850 and 1852, he performed more than 400 operations. In 1852, Griesinger left Egypt and Bilharz became professor of medicine in his place. The next year, Bilharz was appointed as chief surgeon of internal diseases. When Abbas I died in 1854, his successor Mohamed Sa'id Pasha, a
Francophone The Francophonie or Francophone world is the whole body of people and organisations around the world who use the French language regularly for private or public purposes. The term was coined by Onésime Reclus in 1880 and became important a ...
and a
Francophile A Francophile is a person who has a strong affinity towards any or all of the French language, History of France, French history, Culture of France, French culture and/or French people. That affinity may include France itself or its history, lang ...
, dismissed all Germans from official services. Bilharz was replaced by Antoine Clot (known in Egypt as Clot Bey) from
Marseille Marseille (; ; see #Name, below) is a city in southern France, the Prefectures in France, prefecture of the Departments of France, department of Bouches-du-Rhône and of the Provence-Alpes-Côte d'Azur Regions of France, region. Situated in the ...
. The German consul however managed to persuade the viceroy to reinstate Bilharz because of his scientific contributions. In 1856, Clot allowed Bilharz to become professor of anatomy. But he exchanged it with the position of professor of descriptive anatomy the same year. He also took charge as medico-legal adviser to the Egyptian government.


Helminthology

Bilharz in his first year in Egypt found and reported different human parasites including '' Ancylostoma duodenale'', ''
Ascaris lumbricoides ''Ascaris lumbricoides'' is a large parasitic worm, parasitic Nematoda, roundworm of the genus ''Ascaris.'' It is the most common parasitic worm in humans. An estimated 807 million–1.2 billion people are infected with ''Ascaris lumbricoides'' ...
'', ''
Trichuris trichiura ''Trichuris trichiura, Trichocephalus trichiuris'' or whipworm, is a parasitic roundworm (a type of helminth) that causes trichuriasis (a type of helminthiasis which is one of the neglected tropical diseases) when it infects a human large inte ...
,'' pinworm (''Oxyuris'')'','' pork tapeworm (''
Taenia solium ''Taenia solium'', the pork tapeworm, belongs to the cyclophyllid cestode family Taeniidae. It is found throughout the world and is most common in countries where pork is eaten. It is a tapeworm that uses humans (''Homo sapiens'') as its definit ...
''), dog tapeworm (''
Echinococcus granulosus ''Echinococcus granulosus'', also called the hydatid worm or dog tapeworm, is a cyclophyllid cestode that dwells in the small intestine of canids as an adult, but which has important intermediate hosts such as livestock and humans, where it caus ...
'')'','' hookworms ('' Ancylostoma'' and '' Necator'') and guinea-worm (''
Dracunculus medinensis ''Dracunculus medinensis'' (Guinea worm, dragon worm, fiery serpent) is a nematode that causes dracunculiasis, also known as Guinea worm disease. The disease is caused by the female which, at around in length, is among the longest nematodes ...
''). His first major discovery was that of the tapeworm '' Hymenolepis nana'' that he recovered from the small intestine of an Egyptian boy in Cairo in 1851. Von Siebold gave the original name as ''Taenia nana'' in 1852. In 1851, Bilharz also discovered a novel intestinal flatworm from an infected child in Cairo. Von Siebold named it ''Distoma heterophyes'' in 1852''.'' English biologist
Thomas Spencer Cobbold Thomas Spencer Cobbold Fellow of the Royal Society, FRS (26 May 182810 March 1886) was an English biologist. Life He was born at Ipswich, the third son of Rev. Richard Cobbold, author of the ''History of Margaret Catchpole''. After graduating ...
created a better generic name '' Heterophyes'' in 1866; thus, the parasite became '' Heterophyes heterophyes.'' Bilharz's specimen became the first known helminth in the family Heterophyidae.


Discovery of bilharzia and ''Schistosoma haematobium''

Ancient Egyptians Ancient Egypt () was a cradle of civilization concentrated along the lower reaches of the Nile River in Northeast Africa. It emerged from prehistoric Egypt around 3150BC (according to conventional Egyptian chronology), when Upper and Lower ...
had recorded urinary disease which can be attributed to ''S. haematobium'' infection. 16th-century BCE medical papyri mention the disease as ''aaa'' that indicates symptoms of urinary bilharzia.
Mummies A mummy is a dead human or an animal whose soft tissues and Organ (biology), organs have been preserved by either intentional or accidental exposure to Chemical substance, chemicals, extreme cold, very low humidity, or lack of air, so that the ...
of 5,000 years old have been found to contain the parasite eggs. The French army physician Adrien-Jacques Renoult reported the disease as haematurea (bloody urine) in 1808.
Napoleon Napoleon Bonaparte (born Napoleone di Buonaparte; 15 August 1769 – 5 May 1821), later known by his regnal name Napoleon I, was a French general and statesman who rose to prominence during the French Revolution and led Military career ...
's army in the late 18th century called Egypt as "the land of menstruating men." This is because of the high prevalence of the disease that severely affected the French army. The cause of the disease was never known. In 1851, during an autopsy, Bilharz discovered an obvious worm from the
portal vein The portal vein or hepatic portal vein (HPV) is a blood vessel that carries blood from the gastrointestinal tract, gallbladder, pancreas and spleen to the liver. This blood contains nutrients and toxins extracted from digested contents. Approxima ...
connecting the urinary tract of a dead soldier. It was the first time anyone had seen a parasitic worm that lived inside a blood vessel. Not really knowing what kind of worm it was, he wrote to his former zoology professor von Siebold at Breslau on 1 May 1851:
As helminths in general and those who attack humans in particular are concerned, I think Egypt is the best country to study them.
Nematodes The nematodes ( or ; ; ), roundworms or eelworms constitute the phylum Nematoda. Species in the phylum inhabit a broad range of environments. Most species are free-living, feeding on microorganisms, but many are parasitic. Parasitic worms (he ...
in particular populate the intestines of the indigenous population in unimaginable quantities. It is not unusual to encounter 100 individuals of ''Strongylus duodenalis'' Ancylostoma duodenale''">' Ancylostoma duodenale'' 20–40 ''
Ascaris ''Ascaris'' is a nematode genus of parasitic worms known as the "small intestinal roundworms". One species, ''Ascaris lumbricoides'', affects humans and causes the disease ascariasis. Another species, ''Ascaris suum'', typically infects pigs. O ...
'', 10–20 ''Trichocephalus'' [''
Trichuris trichiura ''Trichuris trichiura, Trichocephalus trichiuris'' or whipworm, is a parasitic roundworm (a type of helminth) that causes trichuriasis (a type of helminthiasis which is one of the neglected tropical diseases) when it infects a human large inte ...
''] and close to 1000 ''Oxyuris''. My attention soon turned to the liver and associated structures; in the blood from v. portae I found a number of long, white worms that with the naked eye appeared to be nematodes. A look in the microscope revealed an excellent ''Distomum'' with flat body and a twisted tail. These are a few leaves of a saga as wonderful as the best of '' Thousand and One Nights'' – if I succeeded in putting it all together.
He also added an identification puzzle:
thad a flat body and a spiral tail at least ten times as long as the body... The tail was a continuation of the flat body of the worm itself, rolled sideways towards the stomach surface in a half canal; the forked blind end of the intestinal canal extended into it very plainly. What then is this animal? In spite of its long tail, it probably cannot be called a cercaria fork-tailed larva of trematodes which is completely different, histologically and morphologically.
As unique among flukes, the schistosomes have two bodies – a female which is like a roundworm and a male which is curled-up fluke – that are combined permanently (a condition called ''in copula'') to make up individual adult worms. Bilharz had discovered a male fluke. He knew it has similarities to other flukes, especially the two mouth-like suckers (now called oral sucker or acetabulum and ventral sucker), for which he immediately used the name ''Distomum'', a Greek for two mouthed. But the rolled-up body made him think that it was a roundworm. At the end of May, he found a female specimen from another corpse that was all wrapped up by the same kind of worm he had discovered. It occurred to him that the worm was an extraordinary fluke, exclaiming, "Something more wonderful, a trematode with divided sex." All previously known parasitic flukes were
hermaphrodites A hermaphrodite () is a sexually reproducing organism that produces both male and female gametes. Animal species in which individuals are either male or female are gonochoric, which is the opposite of hermaphroditic. The individuals of many ...
with both male and female reproductive organs in the same individual, a condition called
gonochorism In biology, gonochorism is a sexual system where there are two Sex, sexes and each individual organism is either male or female. The term gonochorism is usually applied in animal species, the vast majority of which are gonochoric. Gonochorism con ...
. Describing his observation in a letter to von Siebold on 18 August, he wrote:
You can imagine my surprise when I saw a trematode lukeprotruding from the frontal opening of the groove and moving back and forth; it was similar in shape as the first, only much finer and more delicate... he femalewas completely enclosed in the groove-shaped half canal of the male posterior, similar to a sword in a
scabbard A scabbard is a sheath for holding a sword, dagger, knife, or similar edged weapons. Rifles and other long guns may also be stored in scabbards by horse riders for transportation. Military cavalry and cowboys had scabbards for their saddle ring ...
.
Bilharz was able to find the male fluke rolled itself up to form a canal in which the female resided, and he named the canal as gynaecophoric canal. By March 1852, Bilharz also found many eggs from the bladders of the fluke-infected individuals, indicating that those were of the parasites. He could not establish what the eggs did to cause the disease and suspected them as the cause of kidney stone (
nephrolithiasis Kidney stone disease (known as nephrolithiasis, renal calculus disease, or urolithiasis) is a crystallopathy and occurs when there are too many minerals in the urine and not enough liquid or hydration. This imbalance causes tiny pieces of cr ...
) and other kidney problems. Griesinger had thought that the fluke caused dysentery, but Bilharz found that it was responsible for urinary tract diseases including haematuria as well. He made the first vivid diagrammatic description of the worms and the eggs on 1 December 1881 in a letter to von Siebold. In it he gave the full scientific name ''Distomum haematobium''; the specific name referring to the unique habitat of the fluke in the blood vessels. Von Siebold reported the discovery in ''Zeitschrift für Wissenschaftliche Zoologie,'' the journal he edited, in 1852. Bilharz then published in the following volume of the same journal the complete description of the parasite structure and the disease it caused. He referred to the disease as "endemic haematuria of warm climates" and the "dysenterische Veränderung des Dickdarms" (dysenteric pathology of the colon). Bilharz then in early 1852 discovered the embryo (now called miracidia; singular, miracidium) developed from the egg in water, and recorded:
he miracidiumhad a long, cylindrical cone-shaped form which was thicker anteriorly and more rounded posteriorly, with a proboscis-like protuberance anteriorly. It was covered completely with rather long cilia.
Although he could not make observation on the further development of the miracidia, his discovery revealed half of the life cycle of the parasite. By then, he established that the disease (its pathology) was caused by the eggs and not the worms themselves. He reported his observations in the journal '' Wiener Medizinische Wochenschrift'' in 1856. However, the generic name was not a good choice. A closely related name ''Distoma'' had been introduced by French zoologist Marie Jules César Savigny in 1816 for other animals, the tunicates. Adding to the confusion, ''Distoma'' and ''Distomum'' had been interchangeably used to describe different species of flukes. Even ''Distomum haematobium'' was sometimes written as ''Distoma haematobium.'' In 1856, Heinrich Meckel von Hemsbach critically argued that the usage of such names was inappropriate as it was a misnomer for the flukes since these animals do not have two mouths. Writing in his book ''Mikrogeologie: Ueber die Concremente im thierischen Organismus'' (''Microgeology: About the Accumulations in the Animal Organism''), he remarked: "The genus name ''Distoma'' should not be used, but be replaced with ''Billharzia'' ouble l is the original printing mistake" The parasite thereby became ''Bilharzia haematobium'', and with it von Hemsbach introduced the name of the disease as bilharzia. Not knowing von Hemsbach's publication which had limited circulation at the time,
David Friedrich Weinland David Friedrich Weinland (30 August 1829 in Grabenstetten – 19 September 1915 in Bad Urach, Hohenwittlingen) was a German zoologist and novelist. The son of a pastor, Weinland attended the Protestant Seminary in Maulbronn from 1843 to 1847. ...
proposed the name ''Schistosoma'' (a Greek term for "split body" reflecting the separation of male and female in an individual) in 1858. After a century of debate and confusion on the name, in 1954, the
International Commission on Zoological Nomenclature The International Commission on Zoological Nomenclature (ICZN) is an organization dedicated to "achieving stability and sense in the scientific naming of animals". Founded in 1895, it currently comprises 26 commissioners from 20 countries. Orga ...
(ICZN) officially declared ''Schistosoma haematobium'' as valid on the ground of priority rule. However, if true priority was to be followed, ''Bilharzia haematobium'' should have been adopted. The disease had been known as bilharzia (or bilharziasis), after the discoverer, the term that is broadly used for all types of infections with different ''Schistosoma'' species. In 1949, the
World Health Organization The World Health Organization (WHO) is a list of specialized agencies of the United Nations, specialized agency of the United Nations which coordinates responses to international public health issues and emergencies. It is headquartered in Gen ...
adopted the name bilharzia for medical terminology. When ICZN validated the name ''Schistosoma haematobium'' in 1954, it specifically recommended that the disease be called bilharziasis. Following the valid scientific name, schistosomiasis became widely used, and the name urinary schistosomiasis is also commonly used to differentiate it from other schistosome infections.` Towards the end of the 19th century, Cobbold noted as "without question, 'S. haematobium'' isthe most dangerous f humanparasite " German anatomist,
Gustav Fritsch Gustav Theodor Fritsch (5 March 1838 – 12 June 1927) was a German anatomist, anthropologist, traveller and physiologist from Cottbus. Fritsch studied natural science and medicine in Berlin, Breslau and Heidelberg. In 1874 he became an asso ...
called it "schlimmerer feind der menschheit" ("the worse enemy of humankind"). A series of observations following the initial discovery by a British Surgeon Reginald Harrison in 1889 that ''S. haematobium'' causes
bladder cancer Bladder cancer is the abnormal growth of cells in the bladder. These cells can grow to form a tumor, which eventually spreads, damaging the bladder and other organs. Most people with bladder cancer are diagnosed after noticing blood in thei ...
, the WHO
International Agency for Research on Cancer The International Agency for Research on Cancer (IARC; ) is an intergovernmental agency forming part of the World Health Organization of the United Nations. Its role is to conduct and coordinate research into the causes of cancer. It also cance ...
(IARC) declared the fluke as Group 1 carcinogen in 2009. It became the first fully proven carcinogenic organism, and is classified among the
neglected tropical diseases Neglected tropical diseases (NTDs) are a diverse group of tropical infections that are common in low-income populations in developing regions of Africa, Asia, and the Americas. They are caused by a variety of pathogens, such as viruses, bacteri ...
.


Discovery of ''Schistosoma mansoni''

When Bilharz found parasite eggs from infected individuals in March 1852, he noted unique characteristic of schistosome eggs, as each egg has a spine, which he called "pointed appendage." He observed the spiny eggs in the bladder as well as in the intestine. He wrote to von Siebold that some of the eggs were different in having terminal spines while some had lateral spines. Bilharz also noted that the adult flukes were different in anatomy and number eggs they produced. His drawings depicted which were later identified as those of ''S. mansoni'' adults''.'' Until 1902, it was generally believed that ''S. haematobium'' produced both lateral and terminal-spine eggs. But a British physician
Patrick Manson Sir Patrick Manson (3 October 1844 – 9 April 1922) was a Scottish physician who made important discoveries in parasitology, and was a founder of the field of tropical medicine. He graduated from the University of Aberdeen with degrees in Ma ...
showed that the lateral-spine eggs were produced only by schistosomes in the intestine. The intestinal flukes were established to be a new species, which Louis Westenra Sambon named ''Schistosomum mansoni'' in 1907 in honour of Manson.


Electric organs of fish

After the discovery of bilharzia, Bilharz researched on the electric organs of the Egyptian
electric fish An electric fish is any fish that can Bioelectrogenesis, generate electric fields, whether to sense things around them, for defence, or to stun prey. Most fish able to produce shocks are also electroreceptive, meaning that they can sense electric ...
popularly known as thunderfish. Electric fishes had been well known in Egyptian history and commonly depicted in ancient
hieroglyphics Ancient Egyptian hieroglyphs ( ) were the formal writing system used in Ancient Egypt for writing the Egyptian language. Hieroglyphs combined ideographic, logographic, syllabic and alphabetic elements, with more than 1,000 distinct characters.I ...
. For this historical importance, Bilharz considered his research on electric organs more valuable than bilharzia, and published them as preliminary note in 1853 and as a full monograph in 1858. He discovered and made detailed description of the nervous system of electric fishes responsible for producing electric fields.


Later life and death

Bilharz returned to Germany in 1858 to visit his hometown and former universities, and giving lectures at Vienna. He made a brief trip to upper Egypt in the winter of 1859 around the
Red Sea The Red Sea is a sea inlet of the Indian Ocean, lying between Africa and Asia. Its connection to the ocean is in the south, through the Bab-el-Mandeb Strait and the Gulf of Aden. To its north lie the Sinai Peninsula, the Gulf of Aqaba, and th ...
, where he noticed a good research opportunity. He spent seven months there with his brother, Richard Alexander Alfons, who had just completed his medical degree at the
University of Vienna The University of Vienna (, ) is a public university, public research university in Vienna, Austria. Founded by Rudolf IV, Duke of Austria, Duke Rudolph IV in 1365, it is the oldest university in the German-speaking world and among the largest ...
. In 1861, he was transferred to the department of infectious disease (
syphilis Syphilis () is a sexually transmitted infection caused by the bacterium ''Treponema pallidum'' subspecies ''pallidum''. The signs and symptoms depend on the stage it presents: primary, secondary, latent syphilis, latent or tertiary. The prim ...
and skin infections).
Ernest II, Duke of Saxe-Coburg and Gotha Ernest II (; 21 June 181822 August 1893) was Duke of Saxe-Coburg and Gotha from 29 January 1844 to his death in 1893. He was born in Coburg to Ernest III, Duke of Saxe-Coburg-Saalfeld, and Princess Louise of Saxe-Gotha-Altenburg. His father be ...
, requested him to work as personal physician to the Duchess on an expedition around the Red Sea. With research in mind, Bilharz accompanied the Duchess in early 1862. While staying at
Massawa Massawa or Mitsiwa ( ) is a port city in the Northern Red Sea Region, Northern Red Sea region of Eritrea, located on the Red Sea at the northern end of the Gulf of Zula beside the Dahlak Archipelago. It has been a historically important port for ...
he contracted
typhoid fever Typhoid fever, also known simply as typhoid, is a disease caused by '' Salmonella enterica'' serotype Typhi bacteria, also called ''Salmonella'' Typhi. Symptoms vary from mild to severe, and usually begin six to 30 days after exposure. Often th ...
or
typhus Typhus, also known as typhus fever, is a group of infectious diseases that include epidemic typhus, scrub typhus, and murine typhus. Common symptoms include fever, headache, and a rash. Typically these begin one to two weeks after exposu ...
(reports are contradictory) and became seriously ill. When he returned to Egypt, he was in terminal condition and died on 6 May 1862, at the age of 37. British parasitologist and biographer, Harry Arnold Baylis wrote of Bilharz's death: "No one, probably, had ever been more universally or more sincerely mourned in the European colony in Cairo." Richard Alexander Alfons also lamented that "The plan or his career to further medical research by natural scientific methods, had failed." Bilharz's works and grave remained largely forgotten until the first International Congress of Tropical Medicine and Hygiene held in Cairo in 1928. The meeting revealed the importance of bilharzia and his name became at the forefront of medicine, his grave was rediscovered by a search party soon after the conference. His is in Old Cairo next to that of Hans Eisele (1912–1967), a
Nazi concentration camp From 1933 to 1945, Nazi Germany operated more than a thousand concentration camps (), including subcamp (SS), subcamps on its own territory and in parts of German-occupied Europe. The first camps were established in March 1933 immediately af ...
doctor, who was convicted by the US military court for
crime against humanity Crimes against humanity are certain serious crimes committed as part of a large-scale attack against civilians. Unlike war crimes, crimes against humanity can be committed during both peace and war and against a state's own nationals as well as ...
.


Legacy

*Bilharzia or bilharziasis is another term for
schistosomiasis Schistosomiasis, also known as snail fever, bilharzia, and Katayama fever is a neglected tropical helminthiasis, disease caused by parasitism, parasitic Schistosoma, flatworms called schistosomes. It affects both humans and animals. It affects ...
, and is still used in technical publications, as well as by official organizations like the World Health Organization and
Centers for Disease Control and Prevention The Centers for Disease Control and Prevention (CDC) is the National public health institutes, national public health agency of the United States. It is a Federal agencies of the United States, United States federal agency under the United S ...
. *The Theodor Bilharz Research Institute was established by the
United Arab Republic The United Arab Republic (UAR; ) was a sovereign state in the Middle East from 1958 to 1971. It was initially a short-lived political union between Republic of Egypt (1953–1958), Egypt (including Occupation of the Gaza Strip by the United Ara ...
in 1962 at
Giza Giza (; sometimes spelled ''Gizah, Gizeh, Geeza, Jiza''; , , ' ) is the third-largest city in Egypt by area after Cairo and Alexandria; and fourth-largest city in Africa by population after Kinshasa, Lagos, and Cairo. It is the capital of ...
. *The crater Bilharz on the
Moon The Moon is Earth's only natural satellite. It Orbit of the Moon, orbits around Earth at Lunar distance, an average distance of (; about 30 times Earth diameter, Earth's diameter). The Moon rotation, rotates, with a rotation period (lunar ...
was named after him.Bilharz
Gazetteer of Planetary Nomenclature, International Astronomical Union (IAU) Working Group for Planetary System Nomenclature (WGPSN)


References


Further reading

* * * {{DEFAULTSORT:Bilharz, Theodor German military doctors German parasitologists 1825 births 1862 deaths Qasr El Eyni Hospital German tropical physicians University of Tübingen alumni University of Freiburg alumni People from Sigmaringen