Heinrich Quincke

Biography

• Born on August 26, 1842 in Frankfurt an der Oder, Germany
• 1858-63 – Commenced (aged 16 years) and completed medical training at Friedrich-Wilhelm-Universität in Berlin, also studying in Würzburg and Heidelberg, under some of the leaders in medicine of his day, including Virchow, Langebeck, Müller, Helmholtz, and Bunsen
• 1865 – Worked in hospitals across Europe, such as Vienna, Paris and London
• 1866 – Appointed assistant in the surgical department of the Bethanien Hospital, Berlin
• 1867-70 Assistant physician at the Charité Hospital in Berlin under Professor Friedrich Theodor von Frerichs
• 1870 – Professor and director of the department of internal medicine in Bern, Switzerland
• 1878-1908 Professor of medicine and head of internal medicine department at the University of Kiel (Christian Albrechts University), Germany
• 1900 – Appointed Rector magnificus of Kiel University
• 1908 – Retired to Frankfurt am Main and pursued further research at the Senckenberg Institute
• 1914 – Awarded honourary professor at Goethe University (Johann Wolfgang Goethe-Universität), Frankfurt am Main
• Died on May 19, 1922 in Frankfurt am Main

Medical Eponyms

Quincke’s pulse (1868)

An alternate paling and flushing of the skin at the root of the nail while pressure is applied to the tip of the nail in aortic regurgitation.

Quincke published his observation of capillary and venous pulsations aged 26 years as an assistant in the Medical Clinic in Berlin. However, as Quincke pointed out, the sign of capillary pulsation is simply a normally observable phenomenon present in most people which just happens to be especially clear in patients with aortic insufficiency…so not really that useful

As far as the capillary pulse is concerned, so can one see it best on his own finger nail, or better, on that of another, in the area between the whitish, blood-poor area and the red injected part of the capillary system of the nail-bed; in the majority of persons examined, there is, with each heart-beat, a forward and backward movement of the margin between the red and white part…

A large and rapidly falling pulse is seen especially in aortic insufficiency, and for this reason the capillary pulse is especially clear in this condition.

Quincke 1868

Quincke’s oedema (1882)

Angioneurotic edema [Quincke’s disease] was previously described by others, including Robert James Graves (1796-1853) in 1843; and John Laws Milton (1820-1898) in 1876 who described the condition as ‘giant urticaria’.

I wish to identify a skin disease which does not seem to be rare; however, only a few cases of it have been described. This disease appears as oedematous swelling of the skin and the subcutaneous tissue in localized lesions from 2 to 10 cm. or more in diameter. These swellings are most common on the buttocks and on the face, particularly on the lips and eyelids. The swollen parts of the skin are not always demarcated from the surrounding tissue which may be pale or translucent or reddened. Patients usually have a sense of tension of the skin pruritus is not common—localized swellings also appear in the gastrointestinal mucosa producing symptoms…Because of its manner of development, acute localized swelling of the skin and mucous membranes, it should be considered as an angioneurosis

Quincke 1882

• Graves RJ. Fugitive inflammation. In Clinical lectures on the practice of medicine. 1848; 1: 462-463
• Milton JL. On giant urticaria. Edinburgh medical journal, 1876; 22: 513-526
• Quincke H. Über akutes umschriebenes Hautödem. [Acute circumscribed edema of the skin]. Monatshefte für praktische Dermatologie 1882; 1: 129-131
• Bannister HM. Acute angioneurotic oedema. Journal of nervous and mental disease, 1894; 19: 627-631

Achorion of Quincke (1886)

Causative organism of ‘mouse favus’ originally described by Quincke as α-Pilz. Now taxonomically defined as the dermatophyteTrichophyton quinckeanum.

• Quincke H. Ueber Favuspilze. Archiv für experimentelle Pathologie und Pharmakologie. 1886; 22(1-2): 62–76

Quincke’s puncture (1891)

Lumbar puncture was developed by Quincke with his spinal puncture technique aimed specifically to withdraw cerebrospinal fluid in children with hydrocephalus. He had studied the formation of cerebrospinal fluid in dogs, and the communication between the arachnoid space in the brain and the spinal cord. He first presented the lumbar puncture and the diagnostic and therapeutic uses to the Congress on Internal Medicine in Wiesbaden in April 1891.

• Quincke HI. Über hydrocephalus. Verhandlung des Congress Innere medizin. 1891; X: 321-339.

Quincke’s first case of lumbar puncture was on a 12 year-old boy who died despite six punctures of the ventricles in 1888. The second case in 1890 was of a boy 1 year 9 months of age with suspected tuberculosis meningitis that recovered after undergoing three lumbar punctures with three days between each. Case three described a 25 year-old man with severe headaches and chronic hydrocephalus that resolved with lumbar puncture. Quincke’s 1891 paper described lumbar puncture in five children and five adults.

• Quincke HI. Die lumbalpunction des hydrocephalus. Berliner Klinische Wochenschrift 1891; 28: 929-933

Quincke spinal needle

This describes spinal needles with a Luer lock connection on the hub, and is designed with an A-bevel cutting sharp tip.

Mallory-Weiss syndrome (1879)

Key Medical Attributions

In addition to his important eponymous contributions, Quincke published on many other areas, including but not limited to: poikilocytosis in pernicious anemia, hemolysis of erythrocytes, hemosiderosis, caisson disease, iron salts and iron therapy, nutrition in diseases of the gastrointestinal tract, diabetic coma, surgical treatment of pulmonary abscess, the extrarenal cause of nephritic edema, amoebic dysentery and typhoid fever.

Controversies

Not…The Nobel Prize

Quincke was nominated for the 1909 Nobel Prize in Physiology or Medicine for his work on lumbar puncture, first presented in 1891. The nomination was rejected because the length of time, eighteen years, between the date of the discovery and the nomination. In 1918, a referee, who had earlier denied him the prize, now described his work on lumbar puncture as being of extraordinarily high diagnostic value and Quincke was unanimously recommended by the Nobel Committee for the Nobel Prize. However, at 76 years of age, he was considered too old for the honour (which later also affected Joseph Babinski).

Note: The Nobel rules were later changed and in 1966, Peyton Rous received the Nobel Prize in Physiology or Medicine for his work on tumour inducing viruses: at the age of 87; for a discovery that had been published 55 years earlier in 1911…

Major Publications

• Quincke H. Beobachtungen uber capillar- und venenpuls [Observations on capillary and venous pulsations]. Berliner Klinische Wochenschrift 1868; 5: 357–359. [Quincke’s pulse]
• Quincke H. Ein fall von Aneurysma der Leberarterie [A case of aneurysm of the hepatic artery]. Berliner Klinische Wochenschrift 1871; 8: 349-352
• Quincke H. Ueber Vagusreizubg beim Menschen [Vagus stimulation in man]. Berliner Klinische Wochenschrift 1875; 12: 189-191
• Quincke H. Ulcus oesophagi ex digestione. Deutsches Archiv für klinische Medicin. 1879; 24: 72-79. [Mallory-Weiss syndrome]
• Quincke H. Über akutes umschriebenes Hautödem. [Acute circumscribed edema of the skin]. Monatshefte für praktische Dermatologie 1882; 1: 129-131 [Quincke’s oedema]
• Quincke H. Ueber Favuspilze. Archiv für experimentelle Pathologie und Pharmakologie. 1886; 22(1-2): 62–76
• Quincke HI. Die lumbalpunction des hydrocephalus. Berliner Klinische Wochenschrift 1891; 28: 929-933
• Quincke HI. Lumbar puncture in hydrocephalus. Berliner Klinische Wochenschrift 1891; 28: 965-968

References

Biography

• Pagel J. Heinrich Irenaeus Quincke. Biographisches Lexikon, hervorragender Ärzte des neunzehnten Jahrhunderts. 1901.
• Editorial. Heinrich lrenaeus Quincke (1842-1922) – clinician of Kiel. JAMA 1966; 196: 1152-3
• Minagar A, Lowis GW. Dr Heinrich Irenaeus Quincke (1842-1922): clinical neurologist of Kiel. J Med Biogr. 2001 Feb;9(1):12-5.
• Göring HD. Heinrich Irenäus Quincke Aus Anlass seines 160. Geburtstages und 80. Todestages sowie seiner Beschreibung des Angioödems vor 120 Jahren [In memory of the 160(th) birthday and the 80(th) anniversary of the death of Heinrich Irenäus Quincke, as well as of his description of angioedema 120 years ago]. Hautarzt. 2002 Dec;53(12):822-5
• Cozanitis DA. Heinrich Irenaeus Quincke (1842-1922): the Nobel Prize but for the problem of age. Presse Med. 2013; 42 (4.1): 464-70.
• Bibliography. Heinrich Quincke. World Cat Identities

Eponymous terms

• Quincke H. Observations on Capillary and Venous Pulse. In: Major RH. Classic Descriptions of Disease, Springfield. 1945: 361-363.
• Balabanoff VA, Kasărov LB. On the morphology of trichophyton quinckeanum. Mycopathologia et Mycologia Applicata, 1963; 21(2): 119-128.
• Pearce J. Fragments of Neurological History Edition. Imperial College Press. 2003;203.
• Zhang G. Eponyms in Aortic Regurgitation. LITFL 2019

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