Emanuel Libman

Biography

• Born August 22, 1872, New York City
• 1891 – A.B. degree from the College of the City of New York
• 1894 – M.D. degree from the College of Physicians and Surgeons, Columbia University
• 1894 – Intern at Mount Sinai Hospital, New York City
• 1896 – Traveled to Europe to pursue paediatrics, where he worked with Theodor Escherich (eponymous association with Escherichia coli) in Vienna and learned bacteriological techniques.
• 1896 – Libman discovered Streptococcus enteritis (Streptococcus Libman) by isolating it from the blood of an infant with severe diarrhoea while working in Escherich’s laboratory
• 1897 – Appointed Assistant Pathologist at Mount Sinai Hospital
• 1904 – Established the department of bacteriology and serology in a new laboratory building at Mount Sinai Hospital
• 1910 – Appointed Associate Professor of Clinical Medicine at the faculty of the College of Physicians and Surgeons, Columbia University
• 1912 – Awarded the American Medical Association gold medal for a series of various endocarditis samples
• 1914-25 – Chief of a medical service at Mount Sinai Hospital
• Died June 28, 1946, New York City

Medical Eponyms

Libman-Sacks endocarditis (1924)

Libman-Sacks endocarditis, characterized by sterile, verrucous valvular lesions (Libman-Sacks vegetations) with a predisposition for the mitral and aortic valves. Libman-Sacks endocarditis is regarded as both a cardiac manifestation of systemic lupus erythematosus and, in recent years, of the antiphospholipid syndrome (APS). It is commonly complicated with embolic cerebrovascular disease.

Libman-Sacks vegetations: sterile fibrofibrinous vegetations that favor the left-sided heart valves and usually form on the ventricular surface of the mitral valve. A study of the echocardiographic findings of 342 consecutive patients with SLE found that 11% of these patients had Libman-Sacks vegetations

Other eponyms

• Streptococcus Libman (Streptococcus enteritis)
• Emanuel Libman Fellowship Fund – established in honour of Libman for his work in medical education

Key Medical Attributions

Pioneer in the fields of in bacteriology, pathology and cardiology. One of the first to advocate for the use of blood cultures to determine causative organisms in infection. Influential publications about endocarditis, especially subacute bacterial endocarditis. Discovered Streptococcus enteritis (Streptococcus Libman) as a cause of focal intenstinal infection

Published some of the first physical signs and symptoms associated with coronary thrombosis, such as the association between angina pain in essential hypertension and cardiac strain or aortic disease; and acute engorgement of the liver correlating to right coronary artery thrombosis.

Passionate teacher, researcher and philanthropist. Libman helped to establish numerous funds for medical education and research, including the Edward Gamaliel Janeway Lectureship, the William Henry Welch Lectureship, a lectureship in honour of Hideyo Noguehi at the Johns Hopkins Hospital, the Humphrey Davy Rolleston Lectureship at The Royal College of Physicians in London, the Herbert Celler Fellowship Fund, and the Henry Dazian Foundation for Medical Research.

Fun Facts

Libman had many famous patients including Gustav Mahler (1860-1911), Fanny Brice (1891-1951), Sara Bernhardt (1844-1923), Thomas Mann (1875-1955) and Albert Einstein (1879-1955)

Libman, was a student of Edward Gamaliel Janeway (1841 – 1911), and he applied the eponym ‘Janeway lesion‘ to infective endocarditis in 1906. Libman pointed out that this lesion was not tender, in contrast to the exquisitely painful Osler node.

Libman diagnosed the fatal endocarditis of Gustav Mahler on 25th February 1911. Mahler’s personal physician (Joseph Fraenkel) suspected the onset of endocarditis and called in Libman (‘the world authority and a man of monolithic certainties‘) from the Mount Sinai Hospital. The survival rate in pre-antibiotic days was almost zero. Mahler demanded to be told the truth, then asked to be taken home, to Vienna where he died 2 months later.

To the noble-minded Dr. Libman with the secret-divining eyes.

Albert Einstein 1954

Libman is medicine itself

Alexis Carrel (1873-1944; Nobel Prize 1912) In: 1932 anniversary book for Libman’s 60^th birthday

Major Publications

• Libman E. Weitere Mitteilungen über die Streptokokken-Enteritis bei. Säuglingen. Centralblatt für Bakteriologie, Parasitenkunde und Infektionskrankheiten. 1897;XXII:376-382
• Libman E. On some experience with blood-cultures in the study of bacterial infections. Johns Hopkins Hospital Bulletin. 1906; 17: 215–228 [Janeway lesions]
• Libman E, Celler HL. The Etiology of Subacute Infective Endocarditis. Table. American Journal of the Medical Sciences. 1910; 140: 516-527.
• Libman E. A Study of the Endocardial Lesions of Subacute Bacterial Endocarditis. American Journal of the Medical Sciences. 1912;144: 313-327.
• Libman E. The clinical features of subacute streptococcal (and influenzal) endocarditis in the bacterial stage. Medical Clinics of North America 1918; 2(1): 117-152
• Libman E. Some observations of thrombosis of the coronary arteries. Transactions of the Association of American Physicians. 1919; 34:138-40
• Libman E. Characterization of various forms of endocarditis. JAMA 1923; 80: 813-818
• Libman E, Sacks B. A hitherto undescribed form of valvular and mural endocarditis. Arch Intern Med. 1924;33(6): 701–737 [Libman-Sacks endocarditis]
• Libman E, Friedberg C. Subacute Bacterial Endocarditis. Oxford University Press, 1941.

References

• Geller SA. Infective endocarditis: a history of the development of its understanding. Autops Case Rep. 2013 Dec 31;3(4):5-12.
• Oppenheimer BS. In Memoriam–Emanuel Libman (1872-1946). Bull N Y Acad Med. 1947 Feb; 23(2): 116–117.
• Emanuel Libman (1872 – 1946). The Mitral Valve.
• Lebrecht N. Why Mahler?: How One Man and Ten Symphonies Changed the World. 2011 p218-219
• Emanuel Libman (1872-1946). Gustav-Mahler.eu
• Aufses AH, Niss BJ. This House of Noble Deeds. The Mount Sinai Hospital, 1852-2002. New York University Press. 2002