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00019616-201005000-00001MiscellaneousThe EndocrinologistThe Endocrinologist© 2010 Lippincott Williams & Wilkins, Inc.20May 2010 p 95Adolf Kussmaul1822–1902Historical NoteLoriaux, D. Lynn MD, PhDFrom the Department of Internal Medicine, Oregon Health and Sciences University, Portland, OR.Reprints: D. Lynn Loriaux, MD, PhD, Department of Internal Medicine, Oregon Health and Sciences University, L-607, 3181 S. W. Sam Jackson Park Road, Portland, OR 97201. E-mail: [email protected] Kussmaul was born February 22, 1822, in Graben Germany. His father and grandfather were both physicians. The young Kussmaul often accompanied his father on his rounds, and even occasionally into the autopsy suite. He began his medical studies in Heidelberg at the age of 18. He graduated in 1845 and went to Vienna to continue his studies.Kussmaul was a military surgeon between 1848 and 1849, and then entered private practice in Kandern, Switzerland, 1850–1853. He married Luise Amanda Wolf in 1850. They had 5 children: Helene, Luise, Eduard, Hedwig, and Ida. Two died young: Eduard drowned in the Rhone River and Ida died from tetanus.Kussmaul left private practice because of poor health and moved to Wurzburg to be in the same institution with Rudolf Virchow. He became a Doctor of Medicine there in 1855.He returned to Heidelberg in 1857 as professor of medicine, and moved again in 1859, accepting the chair of internal medicine in Erlangen. He moved to the same position at Freiburg in 1863, and again to Strassburg in 1876. He lived in Strassburg for the remainder of his life.Kussmaul worked across the breadth of internal medicine as it was in the 19th century. He made important discoveries in psychology, neurology, pathology, and pathophysiology. This can be seen from his list of eponyms: Kussmaul breathing, Kussmaul's sign, Kussmaul disease (polyarteritis nodosa), Kussmaul coma (diabetic ketoacidosis), and Kussmaul's aphasia (selective mutism). He was the first to describe “word blindness” (dyslexia), polyarteritis nodosa, progressive bulbar paralysis, and mesenteric embolism, and was the first to perform gastric lavage, thoracentisis, esophagascopy, and gastroscopy.Wilhelm Petters demonstrated the presence of acetone in the urine of diabetic patients in 1857,1 and Gerhardt demonstrated aceto-acetic acid in the urine of diabetic patients with acetonemia.2 Kussmaul proved that diabetic coma was caused by ketosis, and it was in these patients that he first described Kussmaul's respiration. He called it “diese grosse athmung” (this great breathing). He described dyspnea, indicative of air hunger, even when the patient was in diabetic coma.3 The breaths are rhythmic, deep, often sighing, and not particularly fast, but faster than would be expected for a patient at rest.Kussmaul was first to describe pulsus paradoxus, the disappearance of the peripheral pulse with inspiration in patients with constrictive pericarditis. In this same disease, he described Kussmaul's sign, the increase in the height of the jugular venous pulse with inspiration. The pathophysiology of these 2 signs is still not perfectly understood.Kussmaul made a careful study of a famous sword swallower and, by noting the position in which the sword swallower held his head, realized that it would be possible to introduce an inflexible tube through the esophagus and into the stomach. Kussmaul thus developed the first endoscope. Kussmaul developed the first ophthalmoscope. His book on aphasia remains a classic to this day.Adolf Kussmaul was one of the most creative minds in the history of medicine. He was the most prolific translational investigator of the 19th century. He died of a myocardial infarction on the morning of May 28, 1902.JOURNAL/endst/04.03/00019616-201005000-00001/figure1-1/v/2021-02-17T201932Z/r/image-tiff Adolf Kussmaul.REFERENCES1. Petters W. Untersuchungen über die Honigharnruhr, Vrtljhschr. prakt. Heilk. 1857;55:81–94.[Context Link]2. Gerhardt J. Diabetes Mellitus und Aceton, Wein. Med. Presse. 1865;6:672.[Context Link]3. Kussmaul A. Zur Lehre vom Diabetes Mellitus. Dtsch. Arch. Klin. Med. 1874;14:1–46.[Context Link] Adolf Kussmaul.Adolf Kussmaul: 1822–1902Loriaux D. Lynn MD PhDHistorical NoteHistorical Note320p 95