Kartagener, Manes (1897–1975)
KeywordsSitus Inversus Cystic Kidney Dermatological Clinic Clinical Triad Home Town
Date, Country, and City of Birth
January 7, 1897, Przemyśl, Poland
Date City of Death
August 5, 1975, Zürich, Switzerland
History of Life
Manes Kartagener was born in Przemyśl, Poland, in 1897, as the only son of the factory owner and rabbi Lazar Kartagener and his wife Tzluva Cluwa. He was Polish and Jewish, but the family roots went back to Spain and to the expulsion of Spanish Jewry in 1492.
Manes studied classical languages at the gymnasium in his home town and later continued his study at a gymnasium for natural sciences in Lemberg (now Ukraine, approximately 100 km away), where he graduated in 1915. He immigrated to Switzerland at the age of 18 in 1916. Here he studied medicine at the University of Zürich, where he obtained his medical qualification in 1924. Four years later he defended his doctoral thesis entitled “Ueber einen Fall von Kankroid der Schilddrüse mit peritheliomartigen Bildern” (About a case of cancroid of the thyroid with peritheliomatous features). In the same year he obtained the status of citizen of Zürich.
He gained his postgraduate experiences in Zürich and Basel. First he was resident at the Institute of Pathological Anatomy in Zürich, and then he spent some time at the Children’s Hospital and in the Dermatological Clinic. His next move was to Basel to work in the University Institute of Physiological Chemistry. His final training was in internal medicine in Zürich under Dr. Wilhelm Löffler (1887–1972), of syndrome fame, for 2 years, followed by a staff position for 8 years. During this period (1933), Kartagener wrote his landmark paper on the association of bronchiectasis with situs inversus. Wilhelm Löffler and Manes Kartagener became close friends. In 1938 Kartagener started his own practice in internal medicine in Zürich.
During the Second World War, Dr. Kartagener directed the medical section of the Swiss Army (MSA). He received the title of professor in 1950. Late in his life, he developed a polyneuropathic disease that led to his abandonment of professional activities. He died on August 5, 1975, in Zürich.
Main Achievements to Medicine/Pathology
Manes Kartagener’s name is worldwide recognized for discovering the triad of sinusitis, bronchiectasis, and situs inversus. However, the first reports describing laterality defects came already around 1600 from the Italian anatomists and surgeons Girolamo Fabrizio (Hieronymus Fabritius, 1537–1619) and Marco Aurelio Severino (1580–1656). Also the Scottish pathologist Matthew Baillie (1761–1823) described the complete mirror image reversal of the thoracic and abdominal organs in 1788.
In 1904, Dr. A.K. Siewert (also Zivert) from Kiev (Ukraine) published a case study about a patient “who since birth had the unusual combination of symptoms of bronchiectasis and situs inversus totalis.” At that time there were two conflicting theories about bronchiectasis: one asserted that bronchiectasis was a congenital disorder and the other stated that it was the result of an acquired inflammatory damage. Dr. Kartagener remained absorbed in the controversy about this topic. He wrote many papers on bronchiectasis, including his 1933 paper on the triad observed in four patients. He argued for a congenital basis, as it coexisted with abdominal situs inversus. Although the connection behind laterality disorders and the role of cilia was only found several decades after his first report, Kartagener was already thinking in the right direction. He noted that “cystic kidneys, which are often compared with congenital bronchiectasis, have been observed in combination with situs inversus.” He brilliantly recognized this clinical triad as a distinct congenital syndrome.
In the following decades, Dr. Kartagener revisited the triad many times, and in 1962 he published an exhaustive review paper about 334 additional cases, suggesting that the incidence of the syndrome is about 1:40,000. However, although he realized the autosomal recessive aspect of the triad, he never recognized the fact that the male patients with the condition never had offspring.
In the 1970s, Bjørn A. Afzelius, a Ph.D. Swedish ultrastructuralist who discovered the immotile cilia syndrome, reported cilia immotility in infertile males, some of the cases occurring in families. Half of the cases had Kartagener’s triad (Afzelius 1976). Afzelius sent two letters to Kartagener to notify him about these findings to ask him whether any of the affected males he observed had reproduced. However, Kartagener’s daughter reported him that her father had died in August 1975. It is not known if Dr. Kartagener ever saw the letters; evidently this information was never brought to his attention.
Books and Publications
- Afzelius, B. A. (1976). A human syndrome caused by immotile cilia. Science, 193, 317–319.Google Scholar
- Kartagener, M. (1933). Zur Pathogenese der Bronchiektasien. Beiträge zur Klinik der Tuberkulose und spezifischen Tuberkulose-Forschung, 83, 489–501.Google Scholar
- Kartagener, M., & Stucki, P. (1962). Bronchiectasis with situs inversus. Archives of Pediatrics, 79, 193–207.Google Scholar
- Siewert, A. (1904). Über einen Fall von Bronchiectasie bei einem Patienten mit situs inversus viscerum. Berl Klin Wochenschr, 41, 139–141.Google Scholar