Heinrich Irenaeus Quincke

Heinrich Irenaeus Quincke was the son of the prominent physician Geheimer Medicinal-Rath Hermann Quincke who, with his family, later moved to Berlin. Here Heinrich could be seen riding every morning into the forest, impeccably dressed, ramrod straight in the saddle, accompanied by his properly liveries groom. Impressions of him were that he was a fine gentleman but a pedant: fussy, obstreperous when pressed, and most “dangerous” to get into an argument with.

He studied medicine at Heidelberg, Würzburg, and Berlin, with such celebrated teachers as Rudolf Virchow (1821-1902), Albert von Kölliker (1817-1905) and Hermann Helmholtz (1821-1894). He obtained his doctorate at Berlin in 1863. During 1865 he worked in Vienna with the physiologist Ernst Wilhelm Ritter von Brücke (1819-1892), and in 1866 he became an assistant under Robert Ferdinand Wilms (1824-1880) at Diakonissenhaus Bethanien. From 1867 to 1871 he was assistant with Friedrich Theodor von Frerichs (1819-1885) at Berlin Charité, with whom he collaborated for 6 years on the anatomy and physiology of the cerebrospinal fluid in dogs.

Quincke was habilitated for internal medicine at Berlin in 1870, and must have considerably impressed his fellow scientists. For in no other way can one account for his call to the chair of internal medicine at Bern already three years later. In 1878 he moved to the chair at Kiel where he remained until his retirement as emeritus in 1908. He then moved to Frankfurt am Main, where, as honorary professor, he gave lectures. Like his father, he held the title of Geheimer Medizinalrath.

Besides his descriptions of capillary pulsations in aortic regurgitation and angio-neurotic oedema, which others had described earlier, he was the first to advocate surgical drainage of lung abscess and position patients to enable them to cough up sputum. He was also the first person to note poikilocytosis in pernicious anaemia and reported the association with gastric cancer in a patient in 1876. With Ernst Roos (1866-) he first distinguished Entamoeba histolytica from Escherichia coli. He investigated the mechanisms of body temperature control and postulated the existence of a heat centre. He described anosmia in brain trauma and noted hypothermia occurring in lesions of the upper cervical cord and first described a patient with aneurysm of the hepatic artery in 1870.

Quincke’s most notable contribution, however, was his introduction of the lumbar puncture as a diagnostic and therapeutic technique. He arrived at this in an interesting and local fashion. Following his earlier work on the physiology of the cerebrospinal fluid he reasoned that infants with hydrocephalus might be benefited by the removal of some of the spinal fluid and thus break the over-production and/or under-absorption of liquor caused by compression of the pachonian granulations. As Friedrich Theodor von Frerichs' (1819-1885) assistant, he had studied in 1872 the anatomy and physiology related to the cerebrospinal fluid in dogs by injecting red sulphide of mercury into the spinal subarachnoid space. The knowledge gained thereby encouraged him to insert a fine needle with a stylet into the lumbar interspace of an infant, a procedure which he thought might cause slight injury to a root fibre of the cauda but would not cause paralysis.

From the first he recognized its diagnostic potential (1891) and took accurate pressure measurements at the beginning and the end of the procedure. He also measured protein and sugar values and described the low sugar occurring in the CSF in purulent meningitis. He diagnosed tuberculous meningitis by demonstrating tubercle bacilli in the CSF and was the first person to puncture the lateral ventricle to obtain CSF in infants with hydrocephalus. When he first reported the technique at the Wiesbaden Congress in 1891 it excited little comment. However, over the years he had the satisfaction of seeing it become the premier diagnostic approach in neurological disorders. Quincke died at home surrounded by his books.

Although an internist, Quincke from 1874 concerned himself extensively with lung surgery.

• Ein Fall von Aneurysma der Leberarterie.
  Berliner klinische Wochenschrift, 1871, 8: 349-352, 386.
  Quincke observed aneurysm of the hepatic artery in 1870.
• Balneologische Tafeln. Berlin, 1872.
• Zur Physiologie der Cerebrospinalflüssigket. Archiv für Anatomie, Physiologie und wissenschaftliche Medicin, Leipzig, 1872: 153-177.
• Krankheiten der Gefässe.
  In, Hugo Wilhelm von Ziemssen (1829-1902), et al: Handbuch der speziellen Therapie, Leipzig 1877-1879.
• Über perniciöse Anämie.
  [Volkmann’s] Sammlung klinischer Vorträge, Leipzig, 1876.
• Über Meningitis serosa.
  [Volkmann’s] Sammlung klinischer Vorträge. Neue Folge, Leipzig, 1893, 67.
• Ueber Amöben-Enteritis. Written with Ernst Roos (1866-).
  Berliner klinische Wochenschrift, 1893, 30: 1089-1094.
  Entamoeba histolytica distinguished from Enatamoeba coli.
  English translation in Benjamin Harrison Kean (born 1912) et al: Tropical Medicine and parasitology: Classic Investigations. 1 volume in two. Ithaca, London, Corbell University Press, 1978.
• Über Eisentherapie.
  [Volkmann’s] Sammlung klinischer Vorträge. Neue Folge No. 129. Leipzig, 1895.
• Die Krankheiten der Leber.
  Written with Georg K. F. Hoppe-Seyler (1860-), for Nothnagel’s Handbuch der speciellen Pathologie und Therapie, volume 18; Vienna 1899.
• Die Technik der Lumbalpunktion. Berlin and Vienna, 1902.
• Grundriss der Lungenchirurgie. With Carl Garré (1857-1828). Jena, 1903.
• Wandlungen der Medizin in Wissenschaft und Praxis. Berlin, 1913. 46 pages.