History in Medicine: (In)famous Clara Cells

by Amanda Strickland, MS1

Cell Biology class is like an extension of Anatomy because of all those names we must learn – except most of these structures are only visible through a microscope. In the Respiratory System lab, we recently learned about a set of cells in the respiratory bronchioles that make an oily fluid called surfactant. Thanks to surfactant, Clara cells help ease respiration by making lung structures more slippery and less sticky, preventing the small air-filled sacs called alveoli from collapsing.

I smiled when I first heard of these cells, thinking about the girl’s name, which comes from Latin meaning "clear and famous." As I searched for the true etymology of the structure, I was surprised to find that the name indeed had a famous – or rather infamous – past.

Clara Cells (Arrows)
Courtesy UTSW Dept of Cell Biology

The Clara cell’s namesake is Max Clara (1899-1966), an Austrian anatomist. Clara, who was appointed Chair of Anatomy at Leipzig University in 1935, was associated with the Nazi Party and Third Reich (1933-1945). He wrote his major work “Das Nervensystem des Manschen” in 1942.

Like many other Nazi scientists, Clara used the bodies of concentration camp prisoners to conduct his experiments. One of his more notable contributions was the discovery of slightly bulging cells in the bronchiolar epithelium of the respiratory tract – Clara cells.

Clara was a vocal supporter of the Nazi party, and his ethical choices made throughout his career are questionable. For example, Clara attempted to dismiss a law prohibiting dissection if relatives wanted to collect the body. He suggested that researchers should be allowed to dissect those bodies as long as they made their work unnoticeable when they were done (Winkelmann and Noack, Eur Resp J, 2010).

Clara cells have been known by this name since the 1950s, but there have been multiple calls to change the name and the controversy surrounding the name change proposal continues to this day.

Germany’s loss in World War II effectively ended Clara’s career. After being released by American forces, Clara had trouble finding a new position despite his previous scientific achievements (drenched in ethical ambiguity). Clara eventually became a professor of histology at the University of Istanbul until 1961. Clara died in Munich in 1966.

It is interesting to find that much of what we learn in medical school has a secondary story behind it. The story behind the story, or the face behind the name, gives us new insight and a different perspective of the scientific facts that we study. It also opens up another topic of discussion that we as medical students and future doctors must explore: ethics. The idea of primum non nocere, of doing no harm, stands out as Clara’s research character and methods clearly demonstrated the opposite of that.