The Nobel Prize in Medicine and the Karolinska Institute

Reviews and opinions

"The medical university Karolinska Insitute is the only university in Sweden with an exclusive focus on medicine. After the death of Alfred Nobel (1833-1896), Axel Key (1832-1901), professor in pathological anatomy, and 'the main player' in this book accomplished an important role in the association of the Karolinska Insitute with the Nobel Prize in Medicine.
The authors of this book, a professor of neurosurgery and a professor of neurology, succeed admirably in providing a wealth of well-documented history of life and work of Axel Key, Alfred Nobel and numerous other scientists who played a role in the Karolinska Institute and the activities connected with the Nobel Prize. The book, with an unparalleled layout, is brilliantly illustrated with 112 figures, 49 in color....
The reading of this book was a pleasing and educational experience. This important and unusual book is warmly recommended not only to neurologists and other neuroscientists, but also to everybody interested in the history of medicine."
J.A.M. Frederiks, Eindhoven
Clinical Neurology and Neurosurgery, Vol. 105, No. 2, April 2003

"This is a beautifully bound and printed book with numerous selected photographs, mostly in color. It is a treasure trove of information about the medicine and science of the 19th and 20th centuries. The authors are Professor Bengt Ljunggren and George Bruyn, the latter being Professor of Neurology at Leiden University in the Netherlands. Bengt Ljunggren is the maternal great-grandson of Axel Key, about whom much of this monograph is written. Dr. Ljunggren is, on his own, a world-famous Swedish neurosurgeon and an author who has researched a wealth of material of historical importance for this book…." Read more
Eben Alexander, Jr., Professor emeritus of Neurosurgery,
Wake Forest University School of Medicine, Winston-Salem, North Carolina, USA

"This magnificent volume is available at a price of $ 119.25 because of generous subsidies from several societies, funds, and foundations. As the authors state in the Foreword, " the aim of this book is to describe Axel Key and Alfred Nobel, with glimpses of the period in the history of the Karolinska Institute before and when Key devoted his life work to promote the Institute in its last phase of struggle for academic rights and full recognition, on a par with the other two Swedish universities." The authors succeed admirably, keeping this stated aim in focus, while at the same time providing an almost encyclopedic store of terse biographical notes on the many people who were participants in the ultimate success of the Karolinska Institute. After reading this book, one is led inexorably to accept the authors' conclusions: "the Karolinska Institute and the Nobel Prize in Medicine now once and forever became what it remains today - a prestigious and internationally well-recognized institute for medical research linked to an annual prize award of no comparison in the whole world."
... based on an extensive list of bibliographical material as well as the more personal treasure of Axel's letters, mainly to his wife Selma Charlotta. The story that unfolds in these letters provides an authenticity of extraordinarily contemporaneous value. I doubt that even an author of unusual and literary skill could have achieved this level of merit...."
Lycurgus M. Davey, M.D. (Yale University, New Haven, Connecticut)
Journal of Neurosurgery, Vol. 97, Dec. 2002

"[The authors] have drawn on a wealth of sources, including many obscure publications in Swedish and unpublished correspondence and speeches. The history is celebratory and antiquarian, sweetened with anecdote rather than spiced with analysis. ... The book itself - coffee-table format, with three-inch margins, more than 100 illustrations, and an understated, elegant design – is clearly intended as a specimen, not a workhorse. Nevertheless, it relates a history that will be brand-new to most readers.
... this attractive volume will grace any biomedical coffee-table and provide the browser ample conversational fodder ..." Read more
Nathaniel Comfort, PhD, Center for History of Recent Science, The George Washington University, Washington, DC
JAMA, Vol. 288 No. 10, September 11, 2002

"Die Lebenswege der beiden Protagonisten werden ausserordentlich geschickt in die Medizingeschichte der Zeit eingebettet. Stilistisch benutzen die Autoren die Mittel, welche bereits dem Buch 'Great Men with Sick Brains' zu grossem Erfolg verholfen haben, nämlich die Darstellungsweise in interessanten und leicht lesbaren Erzählungen. Diese ermöglicht es, die Lektüre des Werkes, in dem auch viel Sachwissen vermittelt wird, zu geniessen, ohne grosse eigene Anstrengung aufzubringen. Diese Querverweise sind ein besonders wertvoller Bestandteil des Buches....
Das Buch ist geschickt gegliedert und gut illlustriert. Die hervorragende Ausstattung rechtfertigt den relativ hohen Preis. Die Lektüre kann jedem an der Medizingeschichte interessierten Arzt und Historiker uneingeschränkt empfohlen werden, aber auch denjenigen, die bisher nur wenig Konfrontation mit der Medizingeschichte hatten, und hier ist besonders der Zeitraum zwischen 1850 und 1900 in Europa anschaulich und leicht lesbar dargestellt. Das Buch ist anhand eigener gründlicher Recherchen der Autoren sachlich sehr solide fundiert und enthält eine reiche Sammlung von an anderen Stellen bisher noch nicht dargestellten wissenswerten Begebenheiten."
M. Buchfelder, Göttingen
Zentralblatt für Neurochirurgie Vol. 63, Nr. 3, 2002

"...I immensely enjoyed reading this excellent book (manuscript) about the history of the Karolinska Institute in Stockholm. The authors have succeeded in drawing a vivid picture of the history of neuroscience in relation to basic sciences from a holistic perspective. Similar to physical or chemical processes, social dynamics also require a catalyst for their initiation, and Axel Key was just one of those outstanding characters who could spark off a process of change. This is perfectly illuminated in the book...."
M. Gazi Yasargil, Professor of Neurosurgery, Little Rock, Ark.

"The neurosurgeon Bengt Ljunggren and the neurologist George Bruyn here tell the story of the growth of Swedish academic medicine, and with it that of the Karolinska Institute and its association with the Nobel Prize in Physiology and Medicine. (Publication of their handsome book was timed to coincide with the centenary of the Nobel Prize). They also recount the life of Axel Key, professor of pathological anatomy and rector of the Karolinska, whose studies in morbid anatomy culminated in the first detailed description of the ventricular system and circulation of the cerebrospinal fluid in 1876, and who was one of the most influential figures in European academic medicine in the late 19th century. With Key's story the authors have interspersed events from the life of Alfred Nobel ....
I would say that Key is one of the most interesting people I have encountered for a long while, and I thoroughly enjoyed his story."
Jennian F. Geddes, Barts & The London School of Medicine and Dentistry, London
Journal of the Royal Society of Medicine, Vol. 95, No. 5, May 2002

"This book is a wonderful contribution to the history of one of the best recognised institutions in medicine in the world. It fills a void not only in the history of the institute but in the history of the Nobel Foundation and of Sweden itself. An important historical document!"
Milton Heifetz, Professor emeritus of Neurosurgery, Northstar Truckee, Calif. (USA)

"As an additional admirable enticement to the prospective reader the appendix must receive special mentioning. It provides biographical data on all the numerous scientists whose names appear in the text, data which are fascinating but more or less inaccessible for the average reader, as many of them are not recorded in current reference books. A real delight!
This important opus promises to be a welcome find for all physicians, actually for all scientists who desire a look behind the scene."
Wolfgang Zeman, Professor emeritus of Neuropathology, Lahnstein (Germany)

"This book is a delightful account both of the intertwining lives of Alfred Nobel and Axel Key and of the history of both the Nobel Prize and the Karolinska Institute. Axel Key and Gustav Retzius are known to neurosurgeons for their pioneering studies of the CSF circulation and the arachnoid granulations. Key did much in the 19th century to establish the Karolinska Institute against the opposition of the Universities of Uppsala and Lund, to foster the academic careers of women and to ensure that Nobel's wishes to establish his prizes survived the controversies over his will.
Those who have read Bengt Ljunggren's Great Men with Sick Brains and Other Essays will not be surprised by the entertaining clarity of his prose and of his scholarship, now shared with George Bruyn. The book is beautifully illustrated. The main themes are enlivened by many historical vignettes of intrigue, politics, science, medicine and misplaced passion. How many neurosurgeons now remember the courage shown by Sir Victor Horsley in the Brown Dog Affair (Bayliss versus Coleridge 1903) that temporarily destroyed the credibility and exposed the intellectual dishonesty of the antivivisection movement, the tragic love story of the world's first female Professor of Mathematics, Sonya Kovalevskaya, and the possibility that Nobel may have been the basis for the character in Peer Gynt? These are just a few of the gems in a splendid anthology of stories. A book to be recommended, read and treasured."
J.D. Pickard, Professor of Neurosurgery, Addenbrooke's Hospital, Cambridge
British Journal of Neurosurgery, Vol. 16, No. 6, 2002

"The Nobel Prizes in medicine and science are known throughout the world and recognized to represent the highest achievements of the greatest importance in both fields. The Karolinska Institute is equally well-known in neurosurgery, having been the home of famous neurosurgeons and neuroscientists and a sought after training site for most of the last century. The name Key is equally recognized, though it is probable that most neurosurgeons could not go much further than the foramina of Key and Retzius, if asked to identify Axel Key and his contribution. Thus, it is particularly appropriate that Professor Bengt Ljunggren (a distinguished founding editor of this journal) and Professor George Bruyn have combined to create a history of Axel Key, the Karolinska Institute and the importance of both in the birth of the Nobel prizes...
The historical details and brief biographies on many of the famous people of the Karolinska are of real historical value, but perhaps a bit more than most of us want to know about Swedish medicine and science. Nevertheless, the book is brief, well written, beautifully produced, and a great way to spend a few hours learning more about the Institute and its faculty who have had such an important influence upon the development of neurosciences."
Don M. Long, MD, PhD
Neurosurgery Quarterly

"The authors of this richly illustrated and story-telling book about the medical history of the Karolinska Institute in Stockholm are the neurosurgeon Professor Bengt Ljunggren and the neurologist Professor emeritus George W. Bruyn. Bengt Ljunggren (early aneurysm surgery) has gained an extraordinary reputation in the neurosurgical community for his textbooks about great medical personalities or significant medical historical events, and it is likely that ideas to this book have sparkled from visits to George W. Bruyn's secluded Haut-Languedoc property! Anyway, this book is enriched by so many well-dug and well-told anecdotes.
In spite of its title this book is not about the Nobel Prize nor is it about its founder Alfred Nobel. It is about the foundation and development of the Karolinska Institute in Stockholm and how the Karolinska Institute gained seats in the Nobel Prize Committee in front of the established and at that time the only Swedish universities in Uppsala and Lund. This interesting story is told through the life story of the remarkable personality Axel Key. Axel Key was appointed professor of pathology at the Karolinska Institute in 1862 and its Rector from 1886 to his retirement in 1897. He played a major role in the promotion of the Karolinska Institute from its rights to appoint graduates in medicine in 1873 to its delegation to the Nobel Foundation established in 1897. The Karolinska Institute gained the right to undertake full academic disputation as late as 1906 and was thereby finally brought on level with the Uppsala and Lund Universities.
It is the fortunate abundance of preserved official business documents and letters, but in particular plenty of personal letters written by Axel Key to his wife which form the rich source to this unique story ingeniously seen by the authors. The turn-key for the book and the crown jewel of Key's personal correspondence with his wife in this context is the letter dated 19 April 1893 in which he describes in detail his self-staged social visit with Alfred Nobel in San Remo on the Italian Riviera. By occasion he heard from the receptionist in his hotel that Alfred Nobel had bought a villa and settled in San Remo. Axel Key walks up to the front gate and approaches the concierge of the villa and introduces himself, walks away and is called upon in his hotel by Alfred Nobel – as he had hoped. He was given an enjoyable evening, a drive in the neighborhood and a handful of good cigars when he leaves! Alfred Nobel had already in 1890 made generous donations to the Karolinska Institute, and Key 'showed him in a convincing manner how extremely useful we found his fund'. Alfred Nobel 'lit up with a childlike happiness' and replied that he had made further provisions in his will. This was the start of the Nobel Prize!
Axel Key made novel and fine discoveries of the CSF circulation. His exhausting 'academic peregrinatio' in 1872 touring the famous medical faculties in central Europe meeting Friedrich von Recklinghausen, Ernst von Leyden, Paul Langerhans, Theodor Langhans, Jacob Henle, Rudolf Virchow, and many others are revived to us through his letters to his wife. What an epoch of medical history viewed through the window of Axel Key's life. Ingeniously seen and marvelously told by the authors. Read it."
Dr. Jens Astrup, Dept. of Neurosurgery, Aarhus Kommunehospital, Aarhus, Denmark
To be published in Acta Neurologica Scandinavica

"Medical History with Rich Portrait Gallery
The authors are Bengt Ljunggren, formerly active in Stockholm and Lund, currently Professor of Neurosurgery in the UAE, and George W. Bruyn, Professor Emeritus of Neurology, Leiden University. The foreword of the book outlines its object to describe Axel Key's fight for the academic status of the Karolinska Institute in the latter part of the nineteenth century and his contacts with Alfred Nobel. There is, furthermore, a historical overview and a description of many of the medical authorities of the day, partly as relayed by Key in his letters to his wife during his European travels.

Historical Overview
Despite the creation of Collegium Medicum in 1663, the foundation of the Seraphim Hospital and organised medical training there still did not exist any rights of examination or disputation in Stockholm, not even at the time of the creation of the Karolinska Institute by royal decree in 1810. This was still the prerogative of the Universities of Uppsala and Lund who had fought for these exclusive rights. It was to take until 1873 and 1903, respectively, before these rights were bestowed on the Karolinska Institute. One of the champions of this cause was Axel Key, professor of pathology and later principal of the Institute between 1886 and 1897. Key was also active in the creation of the Stockholm University and in defending the Institute's position in relation to Alfred Nobel's will. A number of short biographies and a rich gallery of portraits describing Swedish university history and the formation of Collegium Medicum and its rival, Societas Chirurgica are also supplied, and the political background lobbying the need for a new seat of learning in Stockholm is explained. All this led to the birth of the Karolinska Institute.

Axel Key and Alfred Nobel
Then follows an account of Axel Key's medical training under Rudolf Virchow in Berlin among others and his friendship with Theodor Billroth. Immediately after his appointment as professor at the Karolinska Institute he started a publication, "Medicinskt Arkiv" 1862, in order to raise the Institute's academic status and to stimulate the scientific ambitions of his colleagues. This was followed ten years later by a new trip around Europe, which is described in his letters to his wife. His personal circumstances are outlined as are his different civic cultural activities, including those as a Member of Parliament. One chapter is devoted to his achievements in neuro-anatomy, above all regarding the circulation of the cerebrospinal fluid. He chose Gustaf Retzius as his collaborator, and after seven years they published their big work "Studien in der Anatomie des Nervensystems und des Bindegewebes" in two extremely well illustrated volumes. It contained partly new information and was praised by, among others, Charcot and later Cushing.
During yet another foreign trip Key met Alfred Nobel in San Remo in 1893, as described in his own words in a letter home. Nobel had already donated money to the Karolinska Institute and he hinted in his talks with Key that more might be forthcoming. This was two years before Nobel wrote his will, in which it was suggested that the Karolinska Institute should choose prize winners in physiology or medicine. This was accepted and granted as a result of convincing written argumentation from Key.

A multi-facetted book
For the inquiring mind there is an extensive appendix with comments regarding the personalities mentioned in the text and the colleagues Key met during his trips. As a further complement there is an index and a bibliography. The text is very detailed but written in a light and easy-to-read fashion. The book contains a great number of illustrations that, with few exceptions, are of very high quality. It is possible to approach the book on more than one level by anyone with specialised interests without losing track of the whole. It describes imposing personalities during the time cellular pathology and somewhat later bacteriology entered medical science. You will also be able to follow the fight for the development of the Karolinska Institute, culminating with the awarding of the first Nobel prizes in 1901.
To sum up, the book gives a very initiated description of an epoch in Swedish medical history illuminated by a contemporary personality."
Sven-Göran Fransson, fellow and chief surgeon, Thorax Radiology Clinic of Linköping University Hospital, Linköping, Sweden
Journal of the Swedish Medical Association, "Läkartidningen", Vol. 99, No. 13, 2002
(Translated from the Swedish original)

Although there are richer prizes in science today, none confers celebrity, peer-envy, or the license to speak authoritatively on any subject like a Nobel. ... Scientists at the Karolinska have one of the best seminar series in the world; almost nobody turns down their invitations.
The histories of the prize, its host institutions, and its benefactor Alfred Nobel, inventor of dynamite (philanthropy is the last refuge of the scoundrel), therefore have an intrinsic, gossipy interest. Moreover, the prize turned 100 in 2001, prompting the gush of retrospectives typical around anniversaries. ... [The authors] have drawn on a wealth of sources, including many obscure publications in Swedish and unpublished correspondence and speeches. The history is celebratory and antiquarian, sweetened with anecdote rather than spiced with analysis. References, at the back, are keyed only to a given chapter, and the chapters are not numbered. The book itself coffee-table format, with three-inch margins, more than 100 illustrations, and an understated, elegant design is clearly intended as a specimen, not a workhorse. Nevertheless, it relates a history that will be brand-new to most readers.
This history ends where the main title might lead you to think it begins. It is primarily a brief biography of Axel Key (1832-1901), a neuroanatomist and head of the Karolinska Institute who brokered the establishment of the prize in medicine. Key was a long-time Karolinskan. He began medical studies there in 1853, under the distinguished anatomist Anders Retzius. In 1862, before his 30th birthday, Key returned to the Karolinska, as professor of pathological anatomy. The Karolinska was having growing pains, fighting for full academic standing and competing with older institutions in Lund and Uppsala. Key boosted his institution's reputation with his research and teaching and by founding a new journal. The institute was reorganized in 1865, with a special wing for pathological anatomy, Key's specialty.
Key studied the anatomy of the brain and its surrounding membranes. His central scientific contribution resulted from a collaboration with Retzius' son, Gustaf, between 1869 and 1876. In the midst of this research, in 1872, Key took an academic "peregrination" to central Europe, where he hobnobbed with the 19th-century scientific glitterati: Rudolf Virchow, Rudolf von Kölliker, Jakob Henle, and Darwin's bird-dog, Ernst Haeckel. In 1875 and 1876, Key and Retzius published a two-volume work on central nervous system anatomy; its most original contribution was a detailed description of the plumbing by which the cerebrospinal fluid bathes the brain and spinal cord. Retzius fils went on to a distinguished career of his own in neuroanatomy. Although I am 10 years out of neurophysiology research, I retain an affection for the millimeter-sized Retzius cell, which dwarfs all other neurons in the ganglion of the leech and so presented a welcome, easy target for my novice electrode one summer at Woods Hole.
In 1886, Key became Rector of the Karolinska Institute. In 1893, on another scientific sojourn, he met Nobel, not quite by chance, at the TNT mogul's villa in San Remo, Italy. Nobel broached his plan for giving all his money not to his family, not to his home country, but to endow in Scandinavia a series of international prizes in science, literature, and politics. Would the Karolinska be interested in being the home institution for a prize in medicine? France, playing the patriotism card, nearly succeeded in sequestering the Nobel fortune; Nobel subverted their effort by exploiting a French custom according to which wherever the deceased's carriage horses were, there the estate inventory was to be made. He moved his famed Orloff steeds to Sweden. Nobel drew up his final legacy in 1895 and died the next year. Formal approval from the Karolinska was secured in 1897, at which point Key retired. On 10 December 1901, Emil Adolf von Behring received the first prize in Physiology or Medicine, for his work on serum therapy for diphtheria. Key, who had been battling cancer for years, seemed to wait for that first prize to be awarded; he died on the 27th.
The book's organization is choppy, and the treatment is amusingly uneven. The authors provide the entire menu of a gala on 5 May 1880 at which Key gave a speech, right down to the Cos d'Estournel 1874 and orange pudding ... this attractive volume will grace any biomedical coffee-table and provide the browser ample conversational fodder with which to impress her hosts, the next time she is invited for a seminar in Stockholm.
Nathaniel Comfort, PhD, Center for History of Recent Science, The George Washington University, Washington, DC
JAMA, Vol. 288 No. 10, September 11, 2002

"This is a beautifully bound and printed book with numerous selected photographs, mostly in color. It is a treasure trove of information about the medicine and science of the 19th and 20th centuries. The authors are Professor Bengt Ljunggren and George Bruyn, the latter being Professor of Neurology at Leiden University in the Netherlands. Bengt Ljunggren is the maternal great-grandson of Axel Key, about whom much of this monograph is written. Dr. Ljunggren is, on his own, a world-famous Swedish neurosurgeon and an author who has researched a wealth of material of historical importance for this book.
Alfred Nobel and Axel Key, born a year apart in the first half of the 19th century, became close friends later in life, and each had made notable contributions to science. Key, with Retzius, had described the circulation of the spinal fluids through the veins of Retzius, and had worked assiduously to establish and make more important the Karolinska Institute in Stockholm. Axel Key had been influential in persuading Nobel to leave his fortune to the prizes in medicine, physics, and science generally, as well as peace, and later to economics.
There is a plethora of information about various scientists throughout Europe, historical material that will be invaluable to future historians. In that process, one becomes aware of certain repetitions, but they are of very little concern. Alfred Nobel, a true scientist, always restless to discover new products and methods, had managed to combine nitroglycerin and nitrocellulose with camphor and to create dynamite, smokeless gunpowder from which he had made a huge fortune. It was called ballistite. He regarded this as a peace instrument, as he wrote to Austrian pacifist Bertha Von Suttner, "My dynamite factories can put an end to war quicker than your peace congresses. On the day when two armies are drawn up against each other in the knowledge that they can annihilate each other in less than one second, then all civilised governments will shrink from the thought of war and disband the troops."
The combination in this volume of the history of Axel Key and Alfred Nobel, and of the Karolinska Institute of Stockholm, where the Nobel Prize is awarded annually, makes this book a unique contribution that will be a treasure in any library of the world."
Eben Alexander, Jr., Professor emeritus of Neurosurgery,
Wake Forest University School of Medicine, Winston-Salem, North Carolina, USA