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Heinrich Albers-Schönberg

Heinrich Ernst Albers-Schönberg (1865-1921) 600

Heinrich Ernst Albers-Schönberg (1865-1921) was a German radiologist.

The first university professor of radiology in Germany. Co-founder of the journal ‘Fortschritte auf dem Gebiete der Röntgenstrahlen‘ and founder of ‘Deutschen Röntgengesellschaft‘ in 1905. His major textbook Die Röntgentechnik, described radiographic techniques and was translated into Italian and Russian.

His name is included on the Ehrenmal der Radiologie (Radium Martyrs of All Nations) on the grounds of the Asklepios Klinik St. Georg in Hamburg; commemorating those who died due to their work with the use of radiation, particularly X-rays, in medicine

Eponymously affiliated with autosomal dominant osteopetrosis type II (Albers-Schönberg disease) described in 1904. Albers Schönberg medal is awarded every two years in Germany to innovators in the field of radiology


Biography
  • Born on January 21, 1865 in Hamburg, Germany
  • 1891 – Graduated medicine University of Tübingen, University of Leipzig
  • 1892 – Allgemeines Krankenhaus Hamburg-Eppendorf
  • 1897 – Set up radiology practice with Georg Deycke (1865-1938) as the ‘Röntgeninstitut und Laboratorium für medizinisch hygienische Untersuchungen’ [X-ray Institute and Laboratory for Medically Hygienic Examinations]; co-founded the journal ‘Fortschritte auf dem Gebiete der Röntgenstrahlen
  • 1903 – Radiologist, Hamburg Hospital
  • 1904 – Grand Prize at the World’s Fair in St Louis for clarity in his diagnostic X-ray images
  • 1905 – Head Radiologist, Hamburg Hospital; Founded the Deutsche Röntgengesellschaft eV [Specialist society of German radiologists]
  • 1908 – Early days of radiology were dangerous. He suffered radiation-induced neoplasia in his hands, chest, and shoulder. His right middle finger and left arm were amputated
  • 1915 – Head Radiologist, Allgemeines Krankenhaus St Georg, Hamburg. Ordentlicher (first full professor of radiology), University of Hamburg
  • 1919 – Ordentlicher Professor, University of Hamburg; the first holder of the chair of X-ray science in the world.
  • Died June 6, 1921 in Hamburg, Germany.

Es wäre für die weitere Entwickelung der Röntgenologie von großem Vorteil, wenn ein reger Meinungsaustausch über die gesammelten Erfahrungen unter den Beteiligten stattfände, denn nur so kann diese noch in ihren Anfangsstadien befindliche Wissenschaft höheren Zielen und größerer Vollkommenheit entgegengeführt werden

Albers-Schönberg H, 1903

It would be of great benefit to the development of Radiology, if a discourse could be had on the opinions of the gathered experiences; for only so will this science, which is in its early stages, be steered towards higher goals and greater completeness.

Albers-Schönberg H, 1903


Medical Eponyms
Albers-Schönberg disease (1904)

Albers-Schönberg disease is the most common form of osteopetrosis, a group of conditions characterized by increased skeletal mass due to impaired bone and cartilage resorption.

In osteopetrosis there is a reduced osteoclast function which results in bones becoming more dense. However, there is also an alteration of the bones internal architecture, which makes them weaker and more brittle. This results in dense, sclerotic, fragile bones that fracture easily.

Albers-Schönberg disease is now termed autosomal dominant osteopetrosis type II (ADO II), and is the most common form of osteopetrosis. It is less severe than the autosomal recessive variant and often termed ‘benign’ or ‘adult’ osteopetrosis as most patients survive into adulthood.

Herr P., 26 Jahre alt, Kaufmann, ist das einzige Kind seiner Eltern, hereditär scheint er in keiner Weise belastet.

Infolge zweier verhältnismässig unbedeutender Unfälle hatte er beide Oberschenkel dicht unter dem Trochanter minor gebrochen.

Während man bei normalen Aufnahmen die Corticalis und Spongiosa gut differenzieren kann, erschien im vorliegenden Falle der Oberschenkel in seiner ganzen Ausdehnung wie aus Marmor gebildet ohne jede Strukturzeichnung und nur mit einer Andeutung der Markhöhle.

ALBERS-SCHÖNBERG 1907

Es handelt sich im vorliegenden Falle um eine gleichmäßige Veränderung des gesamten Skelettes, welche sich dadurch dokumentiert, dass die Spongiosa zum grossen Teil durch kompakte Knochensubstanz ersetzt worden ist, ferner, dass aller Wahrscheinlichkeit nach der Kalkgehalt der Knochen ausserordentlich zugenommen hat, wodurch seine Durchlässigkeit für Röntgenstrahlen fast ganz aufgehoben ist

Meiner Ansicht nach handelt es sich hier um eine seltene allgemeine Knochenerkrankung, welche klinisch dadurch von Bedeutung ist, dass die Knochen ausserordentlich brüchig werden.

Albers-Schönberg H. 1907

Mr. P, 26 years old, is the only child of his parents, he does not appear to be affected from hereditary matters. Following two insignificant accidents, he had broken both thighs directly under the minor trochanter

Whilst one may differentiate the corticalis and the spongiosa well in a normal projection, in this case the thigh appeared as though made of marble throughout its entire length, without any structural demarcations, and only a hint of the bone marrow.

ALBERS-SCHÖNBERG 1907

This case presents as a uniform change throughout the entire skeleton, which is characterized by the replacement of the spongiosa by compact bony substance; in all likelihood that the calcium content of the bone has increased considerably, whereby its penetrance by X-rays is almost fully effaced.

In my opinion, this is a rare, generalized bone disease, which is clinically important due to the high fragility of the bones.

Albers-Schönberg H. 1907

Albers-Schönberg disease marble bone osteopetrosis 2

Albers-Schönberg-Medaille

The Albers-Schönberg Medal was donated to the Deutschen Röntgengesellschaft (German Radiological Society) in 1932 in memory of the co-founder Heinrich Albers-Schönberg. It is awarded every two years to members who are outstandingly committed to the interests of radiology.


Key medical contributions
Die Kompressionsblende (1903)

Albers-Schönberg invented the compression diaphragm, the function of which is to intensify the object by cutting out secondary rays.


Osteopoikilosis (1915)

From the greek ποικίλος (poikilos) = spotted

In 1915, Albers-Schönberg described the case of a 22 year old male in whom roentgen examination revealed numerous minute lesions in all bones except the skull, spine, scapula, patella and clavicle. Lesions were located chiefly in the epiphyses and diaphyses and appeared as minute oval areas of condensation, usually with the long axis in the direction of the long axis of the bone. Their size varied from that of the head of a pin to that of a pea. They were sometimes so numerous as to make the bone look spotted in the roentgenogram.

Die in folgendem beschriebene eigentümliche Anomalie des Skelettes wurde zufällig bei der Röngenuntersuchung eines gesunden Soldaten gefunden. Meines Wissens ist ein ähnlicher oder gleicher Fall bisher nicht bekannt geworden. 

Soldat K., 22 Jahre alt, im Zivilberuf Emaillebrenner. 

Während des Krieges hat er bis zum heutigen Tage alle Strapazen gut überstehen können. Zur zeit ist er ins Lazarett geschickt wegen rechtsseitiger Schulterschmerzen, die so stark sind, daß er den Arm nicht ordentlich heben kann. 

Bei der Röntgenuntersuchung des Schultergelenks und Fußgelenks ergab sich kein pathologischer Befund, dagegen fiel sofort folgende Skeletteigentümlichkeit auf: 

Verteilt über die gesamten Fußknochen, mit Einschluß des unteren Teiles von Tibia und Fibula, finden sich etwa linsengroße Verdichtungsherde, ähnlich den bekannten Kompaktainseln. Diese Flecke stehen mit ihrer Längsachse stets in der Längsachse des betreffenden Skelett teiles. 

Es handelt sich wohl um eine belanglose Erscheinung, die jedenfalls niemals klinische Bedeutung gewonnen zu haben scheint. Eine Brüchigkeit der Knochen liegt trotz des vermehrten Kompaktasubstrates nicht vor 

Albers-Schönberg H. 1915

The particular anomaly of the skeleton described here was discovered incidentally  during radiological examination of a healthy soldier. To my knowledge there is no description of a similar case to date. 

Soldier K, 22 years old, metalworker in civil service. 

During the war he has thus far coped well with all efforts. He has been sent to the lazaret (hospital) because of right-sided shoulder pains, which are so strong, that he cannot lift his arm properly.

X-ray examination of the shoulder and ankle joints revealed no pathological findings, however the following skeletal particularity was immediately apparent:

Spread over the entire tarsal bones, including the lower parts of Tibia and Fibula, there are lenticular clusters of densification, similar to Enostoses. These spots are arranged such that their long axis follows the long axis of the respective bone in which they are found.

This must be an inconsequential appearance, at least one that has never merited clinical attention, it would seem. Despite the increased amount of compact substrate, there is no heightened fragility of the bones 

Albers-Schönberg H. 1915

The following year, 1916, Ledoux-Lebard, Chabaneix and Dessane published on a further such case, and coined the term Osteopoikilosis.

Une radiographie du genou faite chez un blessé en vue d’une recherche de minimes fragments métalliques nous a révélé , il y a quelque temps déjà , un aspect très curieux du squelette de cette articulation …

Il s’agit de petits ilots sombres, ovalaires ou arrondis, ayant de 1 à 8mm…et qui tranchent nettement sur la teinte de l’os environnant…

Nous avons signalé que ces taches faisaient défaut dans le squelette de la tête ainsi que dans les vertèbres proprement dites, mais nous en constatons quelque unes dans le sacrum…

Elles sont tout particulièrement abondantes dans la tête de l’humérus et du fémur, le pourtour de la cavité cotyloïde, les condyles fémoraux et l’extrémité supérieure du tibia.

Nous n’avons pu constater chez notre sujet aucun symptôme clinique anormal. Sa santé générale semble parfaite.

Seul un diagnostic radiologique semble donc possible et nous proposons pour cet aspect osseux nouveau et si curieux la désignation d’ostéo-poecilie qui a l’avantage de ne rien préjuger à sa nature et à son origine

Ledoux-Lebard et al. 1916-1917

An X-ray of a knee performed on a wounded (soldier) to search for minimal metallic fragments has revealed to us, some time ago, a most curious aspect of the skeleton of this joint.

There are small, dark islets, oval or round, measuring 1 to 8 mm… demarcated clearly on the bone which they lie on…

We have signalled that these spots are not present in the cranium or the vertebrae, though we have noticed some in the sacrum…

They are particularly abundant in the heads of the humerus and femur, around the acetabulum, the femoral condyles and the superior extremity of the tibia.

We have not been able to elicit any abnormal clinical symptom in our subject. His general health appears perfect.

It would appear that only a radiological diagnosis is possible, and we propose, for this new and curious appearance of the bone, the designation of osteopoikilosis, which has the advantage of not presuming anything with regards to its nature.

Ledoux-Lebard et al. 1916-1917

Radiographie de l'épaule droite vue par sa face postérieure 1916
Fig 2. Radiographie de l’épaule droite vue par sa face postérieure 1916

At time of publication, the French and Germans were not on speaking terms due to the outbreak of the great war. Neither Schönberg nor Ledoux-Lebard et al. knew of the others’ case. In more peaceful times, the latter were kind enough to tip their hat to Schönberg, with an endnote in their publication

Note ajoutée à la correction:
Venant d’avoir l’occasion de parcourir les fascicules de Fortschritte auf dem Gebiete der Roentgenstrahlen parus depuis la guerre, nous avons pu constater dans l’un d’eux la publication par Albers-Schönberg d’un cas absolument comparable au nôtre. Pour être rare, le cas que nous décrivons n’est donc pas isolé et il s’agit bien là non d’une simple curiosité casuistique mais d’un processus nouveau, radiologiquement détectable, ce qui en réhausse considérablement l’intérèt.

Ledoux-Lebard et al. 1916-1917

Correction note: Having had the chance to peruse the booklets of Fortschritte auf dem Gebiete der Roentgenstrahlen, which have appeared following the war, we have noted the publication by Albers-Schönberg of a case absolutely comparable to ours. Rare as it may be, the case we have presented is therefore not isolated and it is not a simple incidental curiosity, but rather a new process, radiologically detectable, which raises the interest in it considerably. 

Ledoux-Lebard et al. 1916-1917


Major Publications

References

Biography

Eponymous terms


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Resident medical officer in emergency medicine MB ChB (Uni. Dundee)  MRCS Ed. Avid traveller, yoga teacher, polylinguist with a passion for discovering cultures.

BA MA (Oxon) MBChB (Edin) FACEM FFSEM. Emergency physician, Sir Charles Gairdner Hospital.  Passion for rugby; medical history; medical education; and asynchronous learning #FOAMed evangelist. Co-founder and CTO of Life in the Fast lane | Eponyms | Books | Twitter |

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