1901 Nobel Prize in Physiology or Medicine — Emil von Behring

What You Will Learn in This Article

You will learn why the first Nobel Prize in Physiology or Medicine was awarded for the discovery of the body's "defense system" rather than a "cure," and how the dedication of a single military physician paved the way for modern immunology.

Immunity is Not an Army

We often learn that the immune system is like an "army of the body." When external invaders enter, white blood cells, the soldiers, are dispatched to fight. While intuitive, this analogy overlooks the most crucial aspect of immunity. An army operates under the command of a commander, but the immune system has no central commander. Instead, it works through molecular-level pattern recognition and the exchange of authentication tokens.

This story begins with the moment humanity first discovered and utilized these authentication tokens—antibodies—for therapeutic purposes. It is the story of Emil von Behring, the first recipient of the Nobel Prize in Physiology or Medicine in 1901.

A Military Physician Encounters Bacteria on the Battlefield

Emil Adolf von Behring (1854-1917) was born in a small Prussian town as the son of a school principal. He was one of thirteen siblings, and the family was not wealthy. Just when his prospects for attending university seemed dim, he was given an opportunity by the Kaiser Wilhelm Academy (a military medical school). It came with the condition that he would serve in the military for 10 years in exchange for tuition.

After graduating in 1878, he served as a military physician and became fascinated by bacteriology, then a cutting-edge field. His mentor was Robert Koch—the discoverer of the tuberculosis bacterium and the father of bacteriology. At Koch's research institute, Behring began to fight against diphtheria, a deadly infectious disease.

Diphtheria. This disease, which we rarely hear about today, was called the "Angel of Death for Children" in 19th-century Europe. It primarily infected children's throats, obstructing their airways and destroying their hearts and nerves. It was not uncommon for dozens of children to die in a single village.

The Age of Empires — Science Was a Weapon

To understand the era in which Behring was conducting his research, we must first look at the world of 1901.

At this time, Germany was an empire under Kaiser Wilhelm II. The young emperor, having dismissed Bismarck and taken direct control, was pouring all the nation's resources into "Weltpolitik" (world policy), including colonial expansion, naval expansion, and competition with Britain for global dominance. This was the era of the partition of Africa and the deployment of German troops to suppress the Boxer Rebellion in China (1900). The powder keg that would explode into World War I thirteen years later was already being filled.

In this imperial competition, science was a measure of national strength. The German Empire did not hesitate to invest in scientific research at the national level, and institutions such as the Imperial Health Office (Kaiserliches Gesundheitsamt) and the University of Berlin were at the forefront of world science. The early list of Nobel laureates is dominated by German and German-speaking scientists, which is no coincidence. The empire actively used science as a tool of national prestige.

The fact that Behring was a graduate of the military medical academy must also be understood in this context. In late 19th-century Europe, infectious diseases were a greater enemy to armies than combat. In the Crimean War (1853-1856), ten times more soldiers died from disease than from battle. The German military sought to solve this problem through science, and the military medical academy, which provided tuition waivers to talented but impoverished students, was a pipeline for bringing talents like Behring into the military-scientific system.

If we use a computer science analogy, the German Empire was a kind of nation-state-led R&D accelerator. Military needs (responding to infectious diseases) provided the funding and talent, and the resulting products (antisera) spread to the civilian sector. This structure is similar to the early internet in Silicon Valley, which originated from DARPA (Defense Advanced Research Projects Agency). However, this analogy breaks down—DARPA opened up the technology, but German science ultimately led to the tragedy of two world wars.

Toxins Against Toxins — The Birth of Serum Therapy

By 1890, it was already known that diphtheria was caused not by the bacteria themselves, but by the toxins secreted by the bacteria. It was also known that animals injected with small amounts of this toxin became immune to diphtheria. However, no one knew why they became immune, or how this could be used for treatment.

Behring's idea was this: chemically weaken the toxin (using iodine-formol treatment) and inject it into animals. The animals' blood would then produce something that combats this toxin. The cellular components would be removed from this blood, leaving a clear liquid—serum—which would then be injected into patients, neutralizing the toxin in their bodies.

Using a software analogy, this is like pre-deploying authentication tokens to an API gateway. When a toxin (a malicious request) arrives, the antitoxin (antibody) in the serum recognizes and binds to the toxin, neutralizing it. It's like a gateway blocking requests that don't have valid authentication tokens. However, this analogy breaks down in actual immunity. An API gateway simply blocks, but antibodies physically bind to the toxin, inactivating it and simultaneously sending a signal to other immune cells to "handle this."

In December 1890, Behring's antitoxin was injected into a young girl infected with diphtheria. The girl recovered. This was the first successful serum therapy in history. He published these results jointly with Japanese bacteriologist Shibasaburo Kitazato.

Kitazato — A Forgotten Name

This is where the dark side of scientific history is revealed. The 1890 paper was co-authored by Behring and Kitazato. The tetanus antitoxin experiment was led by Kitazato, and he also made a crucial contribution to the diphtheria research. However, in 1901, Behring alone received the Nobel Prize.

Why was this? The official reason is not known. However, it is likely that a combination of factors contributed to this, including the structural biases of the European scientific community at the time (perceptions of Asian scientists), the dynamics within Koch's research institute, and the fact that Behring subsequently led the large-scale production and commercialization of diphtheria antitoxin.

Kitazato later returned to Japan and established the Institute for Infectious Diseases, becoming known as the "father of Japanese bacteriology." He is also the figure who will appear on the 2024 Japanese 1000 yen banknote.

"Savior of Children," and the Shadow of Commercialization

Diphtheria antitoxin had an immediate effect. The mortality rate from diphtheria at Berlin hospitals fell from 50% to 25%. Behring earned the nickname "Savior of Children" and received the title of nobility ("von") from the Prussian government.

However, Behring was not just a pure researcher. He quickly recognized the commercial value of the antitoxin and entered into an exclusive contract with the chemical company Hoechst (now part of Sanofi). This process damaged his relationship with Paul Ehrlich (Nobel Prize winner in 1908), his colleague and collaborator at Koch's research institute. Ehrlich developed a method for standardizing the potency of antitoxins, but Behring did not provide adequate recognition or share the profits.

The tension between scientific discovery and commercial gain. It is quite similar to the situation in which contributors to an open-source project are marginalized in the commercialization process by a company.

Why Was It the First Nobel Prize?

Alfred Nobel's will stated that the prize should be awarded to the person who made "the most important discovery in the fields of physiology or medicine." In 1901, there were actually quite a few candidates. Koch's tuberculosis research, Pavlov's work on digestive physiology, and Ramón y Cajal's work on neuroanatomy were all worthy of a Nobel Prize.

However, why Behring? The key was immediate saving of lives. Antitoxin had already saved tens of thousands of children. The Nobel Committee determined that serum therapy was the most in line with the criterion of "the greatest benefit to mankind."

This choice foreshadowed the direction of the Nobel Prize. Rather than pure scientific elegance, it focused on the actual impact on humanity. Of course, both are important, but the choice for the first Nobel Prize was a statement.

After Behring — The Door to Immunology Opens

Behring's antitoxin was the first example of passive immunity. That is, the method of acquiring immunity by receiving antibodies produced by another organism. This was a great start, but it also had limitations. The effect was temporary, and animal-derived serum could cause side effects (serum sickness).

The real revolution came with active immunity, that is, the method of inducing one's own immune system to produce antibodies, which led to vaccines. This story continued for decades with Nobel laureates such as Ehrlich (1908), Landsteiner (1930), Burnet (1960), Tonegawa (1987), and Karikó and Weissman (2023) with their mRNA vaccines.

On December 10, 1901, in Stockholm, Emil von Behring received the first Nobel Prize in Physiology or Medicine. At that moment, no one knew that this was the beginning of a great story that would span 125 years.

But now we know. Without Behring's antitoxin, the first "authentication token," the vast security system of modern immunology would not have been born.