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VOLUME 41 FEBRUARY 1968 NuM 2
COMMENTARIES
BELA
SCHICK,
1877-1967
B
Scrncx was born in Bolgar,Hun-gary, on July 16, 1877. He received his medical degree from Karl Franz Uni-versity at Graz in 1900. After a period of 6
months in the Austro-Hungarian army, he
returned to Graz where he became a volun-tary assistant in the clinic of Professor Theodore Escherich. In 1902 when Profes-sor Escherich left Graz to accept the chair in pediatrics in Vienna, Dr. Schick was
in-vited to accompany him. In Vienna, Dr.
Schick was appointed volunteer to work
with Dr. Clemens von Pirquet, who was an assistant at the Children’s Clinic of the Uni-versity. A perfect life-long friendship sprang up at once between these two men
of genius. They immediately began the
studies on serum sickness which made them famous. In 1918 Dr. Schick was appointed Professor of Pediatrics at Vienna.
Dr. Schick remained in Vienna until 1923
when he came to New York to become
chief of pediatrics at The Mount Sinai Hos-pital. He was welcomed with great ‘enthu-siasm by his new staff. Close ties of friend-ship were established at once, and a happy, friendly atmosphere rapidly came into be-ing. The effect of his teaching and stimula-lion upon his colleagues and pupils was
pro-found. He immediately became an
impor-tant influence in American pediatrics.
In 1925, Dr. Schick married Catherine
Fries. Their 42 years of married life was
one of complete harmony and contentment. He continued in his post at Mount Sinai
until he reached the age of mandatory re-tirement in 1942. However, he remained an active member of the Mount Sinai staff for
many years after 1942. From 1950 until
1962 Dr. Schick served as pediatrician-in-chief at Beth El Hospital of Brooklyn. In
1955 he became visiting professor of
pedi-atrics at the Albert Einstein College of
Medicine.
Bela Schick was 25 years old in 1902
when he and Von Pirquet began their work on serum sickness. The occurrence of fever and skin rashes after injection of diphtheria antitoxin had been described by Lublinski in 1894. Their reactions were at first athTh-uted to the antitoxin in the serum, but Johannesen proved experimentally that the offending material was the horse serum it-self. He produced serum sickness by inject-ing “normal horse serum” into healthy per-sons. Schick and Von Pirquet realized that serum sickness was a model of a disease
caused by an agent which was unable to
multiply and hence might yield information
regarding pathologic physiology which
could not be obtained by the study of dis-ease caused by bacteria. Indeed, they sug-gested that the body might not respond in the same way to all invading agents and that a response which was favorable in one circumstance might be unfavorable in
380 BELA SCHICK
other. They thus broadened with one clear idea the general concept of the pathogene-sis of disease.
Von Pirquet and Schick published their monograph, Die Serutnki’anlcheit, in 1905. The book immediately brought them inter-national recognition. As Schick once wrote, what is now called allergy is based on ob-servations published in this book. All of the basic principles of allergy are clearly de-lineated in Die Serumkrankheit and its au-thors are clearly aware of the superstruc-ture which might be built upon their basic observations. Schick and Von Pirquet ex-plained serum sickness on the basis of an antigen-antibody reaction. They realized that this idea was a revolutionary one, which might be difficult for others to ac-cept. They stated:
The conception that the antibodies which should protect against disease, are also responsible for the
disease, sounds at first absurd. This has as its basis the fact that we are accustomed to see in disease only the harm done to the organism and to see in the antibodies solely antitoxic substances. One
forgets too easily that the disease represents only a stage in the development of immunity and that the organism often attains the advantage of im-munity only by means of disease.
The observations of Schick and Von
Pirquet on the immediate and the acceler-ated reactions which occur on reinjection of serum were of profound importance and led directly to their basic concepts of fin-munity, hypersensitivity, and allergy. These concepts require very little modification in the light of even the most recent discov-eries. This is clearly shown in the following
paragraphs, which are taken from the last
three pages of Die Serumkrankheit.
We possess, therefore in the immediate or ac-celerated reactivity a new criterion for the diagno-sis that a patient has formerly ‘had the same
dis-ease. This statement is not only valid for serum
sickness but as we shall see for many other toxic and infectious diseases such as tuberculosis. We
re-fer to this respect particularly to the behavior of the human to revaccination.
The accelerated reactivity is the permanent
ad-vantage the organism has acquired by having
over-come the first disease. Immediately after the
ter-mination of the disease, the organism is in the stage
of free antibodies in consequence of which we
ob-serve the immediate reactivity and
hypersensitive-ness. This phase has only a limited duration. The
free antibodies disappear, but in spite of it, the individual is inunune. But the essence of this
im-munity does not lie anymore in the immediate re-action against the infectious germ, but in an
ac-celerated reproduction of antibodies.
This ability to localize a repeated infection does
not rest on the presence of free antibodies in the body fluid but upon a property of the cells ac-quired through the first disease.
Bela Schick was clearly pleased that many of his discoveries were of direct
bene-fit to mankind. He was devoted to the
pursuit of knowledge which would find
practical
application.
He often waved aside theories which were not able to be put to direct experimental test. On the other hand, he had a keen interest in all natural phe-nomena. No deviation from the expectedescaped examination. His active mind
would not permit any unexplained happen-ing to pass without investigation. Thus, the wilting of a bunch of fresh roses which was
handled by a woman who was
menstruat-ing led him to study folklore, the Bible, and Pliny for references to taboos concerning menstruation. These studies resulted in the discovery of the menstrual toxins which cir-culate in the blood and are excreted from the skin.
Bela Schick’s unusual scientific gifts show
themselves
at
once in his writings. Hiswonderful character and personality also
were immediately apparent. An aura of
warmth and friendliness surrounded him.
He was completely open and unreserved; and strangers feeling this at once became devoted friends. He took great joy in life; he was always cheerful and gay and never gloomy or depressed. He had a wonderful sense of humor. It is characteristic that his
jokes were always kindly with not the
slightest barb. Dr. Schick, until the last few years of his life, had extraordinarily good
health. He enjoyed worldwide fame from
COMMENTARIES 381
word. He had admirers and devoted friends all over the globe. He was awarded dozens of medals, prizes, scrolls, and other tangible evidence of the world’s regard. Yet, Bela Schick remained a completely modest man.
Bela Schick is gone. But, his influence
on pediatrics and medical science will go on forever.
HoicE L. HODES, M.D.
Mount Sinai Hospital
1
East 100th StreetNew York, New York 10029
“PRECLIN
ICAL”
AND
“CLINICAL”
EVIDENCE
1L
0 of the pages in PEDIATRICs arere-lvi
served for original descriptions of a wide variety of phenomena which interest those concerned with the health of chil-dren. Advanced technics of biologic investi-gation are used increasingly to study these natural events in minute detail and at var-ious levels (often subeellular) of organiza-tion. As a result, readers are now presented with much basic (“preclinical”) evidencewhich provides the foundation for
fin-proved understanding of many outstanding problems in clinical pediatrics. Since there has been some discussion about the appor-tionment of space in PErnAmIcs between “preclinical” and “clinical” reports, it is
ap-propriate to comment on some aspects of
this particularly artificial dichotomy.
The value of seeking inspiration for the understanding of disease in the laboratory and at the bedside hardly needs emphasis; but, it must be more widely appreciated
that the fundamental methods of study
(observation and experiment) cannot be
different in the two settings. The rules which are used to judge evidence are the same whether we are describing events in cells or in the whole child. If this is not clearly recognized, there is likely to be mis-understanding about the editorial ideals of PFrnAmIcS. Reports of clinical observations
are rarely, if ever, rejected for publication solely because the topic of study is too mundane; contrarily esoteric (“predlinical”) evidence is not infrequently declined as un-interpretable when the rules of the scien-tific method have not been followed. The principal criterion for acceptance of origi-nal communications is not the subject
mat-ter-necessarily
wide
ranging
over
the
broad field of pediatrics-but rather the kind and amount of evidence presented.
