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J R Soc Med. 2002 May; 95(5): 268–269.
PMCID: PMC1279692

The Nobel Prize in Medicine and the Karolinska Institute: the Story of Axel Key and Alfred Nobel

Reviewed by Jennian F Geddes

Bengt Ljunggren, George W Bruyn
232pp Price 98 ISBN 3-8055-7297-2 (h/b)
Basel: Karger, 2001 .

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, on the slightly tenuous grounds that Nobel and Key were exact contemporaries and spent one memorable evening together in 1893. Approximately the last quarter of the book is an authoritative and useful appendix giving short biographies of more than 150 of Key's contemporaries, and others mentioned in the text. The end result is rather a curious mixture.

Because there are so many strands, the book is not always easy reading. Much of the narrative is written in a rather staccato style, merely listing names, dates and events. Some of it is irrelevant to any of the book's themes— notably the 13 pages devoted to the life of a gifted young Russian professor of mathematics at Stockholm University, on whom Key happened to perform a necropsy after her early death from pneumonia. Nevertheless, persistence is rewarded. Nothing in the first section prepares one for the splendid account of four months Axel Key spent travelling on the Continent, at the end of 1872. Here Ljunggren and Bruyn sensibly allow Key to describe his own travels, through his letters to his wife Selma. And what letters they are! Key displays the keen observation one would expect of a morbid anatomist trained by Rudolf Virchow, coupled with a lively interest in people and places, and a facility with words. We hear about the Belgian professor of surgery with a high postoperative infection rate who didn't know the work of Joseph Lister; we discover that Louis Ranvier, a convivial companion, became unbearably chauvinistic when drunk; that Paris appeared remarkably unaffected by the Franco-Prussian war, and that the trees were growing up fast along the magnificent new boulevards. He endearingly expresses surprise at finding that Strasbourg was not a fortified city on a hill overlooking the Rhine. I was fascinated by this section on his trip round Europe— essentially a tour promoting the journal Nordiskt Medicinskt Archiv, of which he was editor in chief.

‘Close to the cathedral square is the magnificent new Galleria di Vittorio Emanuele. The light that radiates from all delightful shops in the Galleria is reinforced by two thousand gas lamps. In addition there is a tight circle of gas-jets around the cupola of glass in the centre of the gallery which are ignited by a special man on a small steam-wagon, using a paraffin lamp. Made myself comfortable at a bistro in the galleria ordering coffee and brandy. It was very relaxing.’

He could be snide:

‘the Professor in Pathological Anatomy was a well-groomed gentleman who made a somewhat blasé impression. He kindly gave me a copy of his thesis from 1863. I was discreet and didn't ask him whether he had published any paper since’,

but could laugh at himself

‘in Rome I happened to get a newspaper, “Le Touriste”, which is published in French and contains a column entitled “High Life”. Previously I have always skipped such newspaper columns on various celebrities. Well, you can imagine my surprise when I found myself depicted in this column.... It made me laugh. I will never miss a “High Life” column again but this notice cost me some money because it was clear that as a representative of “High Life” I could no longer wear the scarf I had found good enough until that moment’.

He was also generous to professional colleagues: ‘I made several new and pleasant acquaintances, of which one with the professor of pathological anatomy, Wilhelm Krause, who is right in a question where the whole world including myself had believed him to be wrong’. This long trip of Key's, to more than thirty cities in half a dozen countries, gained him a few new subscribers to his journal and a large number of important academic contacts.

After this grand tour, the book's narrative meanders rather inconsequentially until 1893, when Key, on a second European voyage, once again takes up the narrative, to describe his meeting with Alfred Nobel in San Remo. In a long letter to Selma, Key tells her how, after he had left his card at Nobel's villa, the great man returned the call, visiting him at his hotel later the same day with an invitation to dinner, after which he took Key on an extraordinary high-speed night drive down the coast. I cannot reproduce the whole letter; you will have to read it for yourself. It ends

‘This evening with Nobel has been the culmination of my journey. Nobel himself is, quite simply, an extraordinary personality and one of the most interesting acquaintances I have ever made’.

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.

Articles from Journal of the Royal Society of Medicine are provided here courtesy of Royal Society of Medicine Press