Theodor Maximilian Bilharz

Born 1825
Died 1962

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German physician and parasitologist, born March 23, 1825, Sigmaringen; died May 9, 1862, Cairo.

Biography of Theodor Maximilian Bilharz

Theodor Maximilian Bilharz was born in the picturesque town of Sigmaringen on the Danube and grew up in a typical Biedermeier environment. His father, Anton Bilharz, was a councillor (Hofkammerrat) of the exchequer, the advisor to Prince Karl Anton of Hohenzollern-Sigmaringen (1811-1885). His mother was born Elsa Fehr.

Theodor Bilharz attended the secondary school in Sigmaringen and took an early interest in nature, and particularly entomology. After having completed the Fürstlich Sigmaringer Gymnasium with good marks he studied philosophy for two years at the Albert-Ludwigs-Universität in Freiburg im Breisgau, where his disciplines were mathematics, physics, chemistry, mineralogy, botany, geology, archaeology, antique art, history, ethics and psychology.

One of his teachers at Freiburg was Friedrich Arnold (1803-1890) who influenced Bilharz to become passionately interested in medical research, particularly that of comparative anatomy. From 1845 Bilharz studied medicine at the University of Tübingen, still under Friedrich Arnold, who had accepted the chair of anatomy and physiology at Tübingen that year. Here, in 1847, he submitted a prize-winning paper on microscopic investigations on the blood of invertebrates. Another teacher who influenced Bilharz at Tübingen was Carl Theodor von Siebold (1804-1884). In 1849 he passed the state examination in Sigmaringen and the following year he received his doctorate at Tübingen.

To the land of the dead
In 1850, aged 26, Bilharz accompanied Wilhelm Griesinger (1817-1868) to Egypt on an Expedition arranged by the duke of Sachsen-Coburg-Gotha. It was the new ruler of Egypt, Abbas I, who engaged Griesinger and named him director of the Egyptian Department of Hygiene. Griesinger made it a condition that his 25 years old assistant come with him. During the previous decades Egyptian health care had been dominated by the French, who had been present in science and medicine since the time of Napoleon. Abbas' sympathies, however, went more to Germans and Austrians.

In Cairo, Griesinger and Bilharz they came to the medical school near Kasr el Aïn. This school had been established by the French physician Antoine Bartholomew Clot Bey (1793-1868), who taught according to modern European methods. This included obligatory autopsies – carried out despite heavy religious resistance.

As early as in 1851 Bilharz wrote to his former teacher Carl Siebold, who had advised him to investigate intestinal worms (entozoa):

"As helminths in general, and those who attack humans in particular are concerned, I think Egypt is the best country to study them. Nematodes in particular populate the intestines of the indigenous population in unimaginable quantities. It is not unusual to encounter 100 individuals of Strongylus duodenalis, 20-40 Ascaris, 10-20 Trichocephalus 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 a magnificent 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 night - if I succeeded in putting it all together."

In Cairo Bilharz worked as an assistant physician in various hospitals. After Griesinger's return to Germany in 1852, he was appointed physician in chief of the department of internal medicine, and in 1855 took over the chair of clinical medicine at the Kasr el Aïn in Cairo, in 1856 changing this chair for that of descriptive anatomy. He held this tenure until his death in 1862. Later he was also engaged as a forensic anatomist. In 1855 he was appointed "Bimbaschi" - major.

In 1862 Bilharz accompanied the German explorer Duke Ernst von Coburg-Gotha to Massava in Ethiopia as life physician to the duchess. During the journey Bilharz treated the duchess for typhoid fever. The duchess returned home in good health, but Bilharz died on the evening of May 9, 1862, in Cairo. He was 37 years old.

Discoveries
It was in 1851 that Bilharz discovered and described the organism which causes bilharziosis, Schistosomum haematobium. In 1853 Bilharz discovered that the worm ancylostoma caused anaemia and the disturbance called Egyptian chlorosis.

During his numerous dissections, Bilharz discovered peculiar pathological changes – white exuberances of cancerous aspect – in the mucous membranes of the bladder, intestines, ureters, and seminal glands. He found that the cause of the changes was a hitherto unknown trematode, Distomum haematobium. He described this in letters to his zoology teacher Carl Theodor von Siebold (1804-1884) between May 1851 and January 1853.

In these letters Bilharz gave not only a detailed anatomical description of the parasite and the anatomical changes produced by it, but he also supplied excellent diagrams of a pair of the copulating flatworms, which he called Distomum haematobium, and diagrams of the eggs. In these diagrams he also depicted the Schistosomum mansoni, which was not mentioned again until 1907, when Louis (Luigi) Westenra Sambon of the London School of Tropical Medicine named it for his teacher Patrick Manson (1844-1922).

The terms "bilharzia" and "bilharziosis" were coined by Heinrich Meckel von Hemsbach (1821-1856), who introduced them into scientific nomenclature in 1856, two years before David F. Weinand introduced the term "schistosoma". The name bilharzia was also suggested by Thomas Spencer Cobbold (1828-1886) in 1857.

Bilharz took his only European vacation in 1858, at which time he had the chance to report on his zoological research. In the following years he occupied himself with investigating native fauna – he gave the first description of a Nile fish, the Alestes macrolepidotus - and with anthropological and etymological activities.

In the Swedish journal Läkartidningen nr 44, volume 87, 1990, professor Olav Thulesius describes his search for the grave of Theodor Bilharz: "When I was in Cairo searching for the grave of Bilharz I asked a taxi driver for help. When I mentioned the name of Theodor Bilharz he immediately knew who I was talking about and what disease I meant. For a whole day he helped me indefatigable to locate the small and forgotten churchyard in the old town where Bilharz was buried. The disease that bears his name is still a major health risk in large parts of the world."

In Cairo the Bilharz Research Institute is named for him, and upon the hundredth anniversary of his death the Egyptian postal issued a stamp with his portrait. In Sigmaringen a school, a street and a pharmacy is named for him. Bilharz was one of the earliest founders of scientific infectology.

Theodor Maximilian Bilharz is buried in the German cemetery in Cairo - but not in the best of company. He shares the same plot with Hannes Eisele (1912-1967), a Nazi doctor whose specialty during World War II had been the injection of experimental fluids into human guinea pigs. Eisele was found guilty and sentenced to death by a US military court in Dachau, but his sentence was changed to life in prison, and eventually he was set free and escaped to Egypt.

Bilharz' younger brother, Alfons Bilharz, (2.5.1836-) was a physician and philosopher who was in charge of the Sigmaringen Hospitals from 1882 to 1907.

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