Adolf Kussmaul (1822–1902), and the naming of “poliomyelitis”

ABSTRACT

In most parts of the developed world today, the neurological diagnosis of poliomyelitis is discussed only as a historical curiosity. For decades an epidemic cause for lameness and paralysis in infected children, reported cases of polio plummeted following the introduction of effective vaccines against the causative virus in the 1950s and 1960s. Much has been written of the trials and successes of the Global Polio Eradication Initiative, but little is generally known about how the disease was originally named. In an authoritative reference work on the History of Poliomyelitis (1971), John R. Paul attributed in passing the coining of the term “poliomyelitis” to the celebrated German clinician Adolf Kussmaul (1822–1902). Kussmaul is widely known to physicians today for several unrelated contributions, but none of his authorized biographers have mentioned his naming the disease. In this historical review article, we set out to verify the claim that Kussmaul coined the term “poliomyelitis,” surveying in the process his broader contributions to neurology and medicine.

KEYWORDS:

• Adolf Kussmaul
• history of medicine
• poliomyelitis

Acknowledgments

The authors would like to acknowledge the assistance of Lars Eriksson and his colleagues (of the University of Queensland Library) and of Karen Myers (of the Royal Australasian College of Physicians History of Medicine Library) for their valuable assistance in sourcing important historical documents during the course of this project.

Disclosure statement

No potential conflict of interest was reported by the author(s).

Notes

¹ It was not until 1875 that Wilhelm Erb (1840–1921) and Carl Westphal (1833–1890) first indicated the clinical importance of deep tendon reflexes (Louis and Louis 2002), and this is why Kussmaul did not comment on such findings in his own case. We would expect the reflexes to be diminished in this instance.

² J. R. Paul collated a variety of historically suggested medical terms used to refer to “poliomyelitis” in the past but did not look beyond Frey’s November 1874 publication when commenting on Kussmaul’s association with the name. Kussmaul’s contribution appears to have been overlooked by most authors after his death in 1902, and those few who noted the association in later years have not verified its historicity. The Ohio-based physician Harry Wain (1907–1981), for instance, wrote in 1958, “After the pathology of the disease [poliomyelitis] became established, Adolf Kussmaul of Germany named it poliomyelitis acuta anterior” (Wain 1958, 252; see also 164–65), but provided no further commentary or references to verify the same.

³ Sir William Richard Gowers (1845–1915) incorrectly attributed the naming of “poliomyelitis” to Wilhelm Erb in the first edition of his lectures on Diagnosis of Diseases of the Spinal Cord: “For anterior cornual myelitis, the term ‘tephro-myelitis’ has been proposed by Charcot, and ‘anterior polio-myelitis’ by Erb. The latter term is obtaining wide currency, but its meaning is much less obvious than that of ‘anterior cornual myelitis,’ while it does not possess the advantage of a single syllable.” (Gowers 1880, 69). Gowers promptly corrected this mistake in the second printed edition of his lectures (Gowers 1881, 75).

⁴ In one of his many highly readable historical medical vignette articles, John Pearce wrote in 2005, “And, Erb reflected this [atrophy of the anterior horns] when he coined the term ‘acute anterior poliomyelitis’ in 1875.” More recently, the Journal of Neurology published a historical review article stating, “The term ‘poliomyelitis’ was finally proposed by Wilhelm Erb (1840–1921) in 1875, a word derived from the Greek ‘polios’ (‘gray’) and ‘myelos’ (‘spinal cord’)” (Mathis et al. 2021).

⁵ There is no mention of poliomyelitis in this 1985 publication (edited by Friedrich Kluge) concerning the significance of Kussmaul’s works in internal medicine and neurology; the contributing neurologist concerned himself solely with Kussmaul’s contributions to “disturbances of speech.”

⁶ Frey referenced the 1869 edition of Hasse’s encyclopedia.

⁷ Of interest, Westphal did not use the synonym “poliomyelitis” in this volume of the encyclopedia that reviewed published works from the year 1873. He did however make remarks on “infantile spinal paralysis and the similar paralysis of adults” (Westphal 1874, 79–80).

⁸ Hammond discussed “infantile spinal paralysis” under the subtitle of “inflammation limited to the anterior tract of gray matter of the spinal cord” (Hammond 1876, 449).

⁹ Not to be confused with the identically named but more widely known English railway engineering icon, William Henry Barlow (1812–1902).

¹⁰ The term “polioencephalomalacia” was first used by veterinarians in 1956 (Adams, Griner, and Jensen 1956) and is still recognized today as a cause for cerebrocortical necrosis in thiamine deficient ruminant mammals (Personal correspondence with Dr. M. W. Shinwari, veterinary pathologist, Biosecurity Sciences Laboratory, Department of Agriculture, Fisheries and Forestry; Queensland Government, Brisbane, Australia).

¹¹ “The forms of disease summarized under the name of poliomyelitis are known to be more of a clinical term than the result of pathological anatomical observations, and the acute form of the same was known clinically under the name of infantile spinal paralysis long before it was known that disease of the gray matter was involved. When it was later possible to determine the pathological-anatomical substrate of this disease by means of autopsy findings, a corresponding naming was deemed necessary and Kussmaul then first used the name poliomyelitis, and this was soon generally accepted” (Wernicke 1881, 230).

¹² Or Sturge-Weber syndrome, named with fellow physician-dermatologist and rare diseases connoisseur, Frederick Parkes Weber (1863–1962).

¹³ Brennan’s extensive 539 item bibliography of published writings on poliomyelitis until 1917 excluded Frey’s original 1874 papers written out of Kussmaul’s Freiburg clinic.

¹⁴ Although unsigned, William Osler is credited with authoring this editorial review of Kussmaul’s second autobiographical work in Golden and Roland’s official bibliography of Osler’s publications (Golden and Roland 1988, 80, entry no. 959).

¹⁵ Kussmaul made no mention of poliomyelitis in this published account of his time as a lecturer, although Czerny appended a bibliography of Kussmaul’s extensive medical publications. Papers that were written by others but were considered to be strongly influenced or edited by Kussmaul were also included in this list. Frey’s January 1874 papers on poliomyelitis are listed on page 97.

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Funding

The authors reported there is no funding associated with the work featured in this article.