In 1866, Adolf Kussmaul, an internist, and Rudolf Maier, a pathologist, published the classic characterization of what eventually became known as polyarteritis nodosa.1 It was the first scientific clinical characterization of a noninfectious vasculitis. As such, it became a paradigmatic point of contrast to other types of vasculitides that were later described. Their description also provided key information about vasculitides that are still used to evaluate patients. Incorporating both precise clinical acumen and the latest in scientific technologies, the case continues to be a source of inspiration and guidance to today’s rheumatologists.
The New Scientific Era of Medicine
To understand the importance of the Kussmaul and Meier case, it is important to place it in the scientific context of the era. Eric Matteson, MD, MPH, is a professor of medicine in the divisions of rheumatology and epidemiology at the Mayo Clinic, in Rochester, Minn. One of Dr. Matteson’s interests is the history of medicine, particularly as it relates to rheumatology. “I think this medical history teaches us how we came to know what we know, and I think that’s important,” he explains. “It also shows us how difficult it is. That helps us know how medicine has advanced and was made more scientific and, ultimately, led to better understanding of the disease and its treatment.”
This was an era in which scientific medicine was first being developed. Various procedures had been performed for hundreds of years, such as removing cataracts, setting wounds, performing amputations and lancing boils. But various superstitions, dubious potions and erroneous metaphysics existed alongside these practices. The scientific basis of disease did not start to become systematically explored until the 1800s or late 1700s.