Askanazy, Max (1865–1940)
KeywordsCuronian Lagoon Osteitis Fibrosa Bone Marrow Fibrosis Bence Jones Protein Oxyphilic Cell
Date, City, and Country of Birth
February 24, 1865, Stallupönen, East Prussia (now Nesterov, Russia)
Date, City, and Country of Death
October 23, 1940, Geneva, Switzerland
Early Life and Professional Work
Max Askanazy was born in the town of Stallupönen located within the Kingdom of Prussia affiliated with the German Confederation at that time. He was the son of a Jewish family. His father was Joseph Samuel and his mother was Elisabeth Maria Gerstel. He completed his high school education at the Kneiphöfsche Gymnasium in Königsberg located on the shore of the Baltic Sea of the Kingdom of Prussia and carried out his military service as a “reserve officer” in the Prussian army. Subsequently, he began his training in medicine at the University of Königsberg. He graduated here as a medical doctor in 1890.
After his graduation, Max Askanazy began to work as a resident at the Institute of Pathology. He completed his education in pathology in 1893 (Ohry 2011) and was appointed as “lecturer” in the same institute, at the time that also Ludwig Pick (1868–1944) was working there. The department head was Professor Franz Ernst Christian Neumann (1834–1918), a versatile researcher known as the “Virchow of the East” in the German pathology circles (Buzmann 2003). He had demonstrated in 1868 that the bone marrow was a site of blood formation in humans and other mammals (Neumann 1868), and he also suggested that “lymphocytes” in the bone marrow were the earliest, common precursor cells of the erythrocytes, of the granulocytes, and of the lymphocytes of the circulating blood. This “unitarian” view contrasted with the “dualist doctrine” of Paul Ehrlich (1854–1915), who assumed that the lymphocytes and leucocytes (granulocytes) originated from morphologically different precursor cells in different organs: the lymphocytes developed in lymph nodes and the spleen and the leucocytes in the bone marrow. It is likely that this versatile scientific personality of Professor Neumann had its impact on the studies conducted by Askanazy in various areas of pathology, including hematology, in the following years. As of 1894, Askanazy focused on general pathology, pathological anatomy, mycology, and parasitology. He was promoted to “titular professor” in 1903.
In 1905 he accepted the offer of the University of Geneva to become the department chair of the Institute of Pathology as successor of Prof. Friedrich Wilhelm Zahn (1845–1904). Askanazy continued to serve at this position until his retirement in 1939, one year prior to his death. However, since his student and successor Prof. Rutishauser joined the Swiss Army for border surveillance, Askanazy had to teach for some additional time. In memory of his 60th birthday, Virchows Archiv released a special edition, a “Festschrift,” for Askanazy.
In his career, he was elected as chairman of the German Society of Pathology in 1928. In 1934, he was honored with the “Marcel Benoist” award, which is the oldest science award in Switzerland and is presented each year to the person who provides the most important scientific contribution on behalf of Switzerland (Ohry 2011). In addition, he received the title of “Honorable Citizen of Geneva” in 1935.
Max Askanazy was married to Stéphanie Elisabeth Maria (born Gerstel). They had no children. He died in Geneva on October 23, 1940, following the second operation for cancer. Following his death (at least), four international journals honored him with an obituary (Rolleston 1941; Necrologia 1941; Obituary 1940, 1941).
Main Achievements in Medicine/Pathology
Askanazy was a versatile researcher who was interested in many fields of pathology resulting in many publications (probably181) on many different topics. His focus was the pathology of the hematopoietic system, bone, endocrine glands, tumors and carcinogenesis, and inflammation and the pathogenic effect of animal parasites.
His interested in hematopathology was probably stimulated by his professor Ernest Neumann in Königsberg, Askanazy was, like him, a ‘unitarian’ who claimed that “all blood cells in the bone marrow are derived from a single cell” (Askanazy 1927a). He was probably the first to report the association between amyloidosis and multiple myeloma in 1903 (Askanazy 1936), and he studied the diagnostic importance of Bence Jones proteins in the urine (Askanazy 1900). In 1914, he showed that amyloidosis could involve the choroid plexus veins in a regular and systemic manner (Askanazy 1914a). In 1904, he published a case on “Primary myelofibrosis with substantial extramedullary hematopoiesis of the liver and diffuse bone marrow fibrosis” (Askanazy 1904a). He also wrote the section on “Bone marrow and hematopoiesis” in the Handbook of Special Pathological Anatomy and Histology, edited by O. Lubarch and F. Henke, one of the most important pathology books at that time.
Parasitology was another topic of interest for Max Askanazy. When working in Königsberg, he discovered a new “liver fluke” living in the meat and liver of fish in the Curonian Lagoon extending toward the Baltic Sea, between Königsberg and Lithuania. He identified that this parasite was transmitted to humans by eating raw fish and then settled in the biliary tract where it led to inflammation; he claimed that the inflammation could gradually transform to “cholangiocarcinoma” (“Krauspe”). Other parasites that he studied included trichina and ancylostoma duodenale (Necrologia 1941). The syndrome associated with ancylostoma, anemia, dyspepsia, eosinophilia, and abdominal edema is known as the “Askanazy-Roch syndrome” (Ohry 2011). The chapter written by Askanazy in the pathology book published by Karl Aschoff in 1914 includes studies on human parasites (Askanazy 1914b).
Askanazy also studied carcinogenesis. In an article published in 1927, he demonstrated in animal studies that arsenic causes cancer. He also observed the development of benign and malignant teratomas in rat embryos that he had transplanted into the peritoneal cavities of rats drinking water containing high levels of arsenic (Askanazy 1927b). He asserted the “four-factor theory” in tumor formation, being inheritance, geographic conditions, exogenous stimuli like parasites, and endogenous (intracellular) stimuli (Necrologia 1941; Obituary 1940).
Tumor morphology, their modes of progression in the body, and tumor functions constituted the subject of many studies of Askanazy. He was the first person to refer to the association between osteitis fibrosa cystica generalisata (von Recklinghausen disease) and parathyroid tumors in 1903 (Necrologia 1941; Askanazy 1904b).
Based on his interest in geographic pathology, he established the Société Internationale de pathologie géographique (the International Society for Geographical Pathology) in Geneva in 1928. The Society held its first international meeting on cirrhosis in Geneva in 1931. The second meeting was held in Utrecht in 1934 and the topic of gastric ulcer was discussed. The third meeting, focused on anemia, was held in Stockholm in 1937. No other meeting followed because of the war. The society ceased to operate following Askanazy’s death.
Askanazy’s major misfortune regarding eponyms had to do with the discovery of Hürthle cells. These “oncocytic metaplastic thyroid follicle cells,” today widely known as “Hürthle cells,” were actually first recognized and described by Askanazy in 1898, in thyroids of patients with Basedow’s (Grave’s) disease (16). Another German pathologist, Karl Hürthle (1860–1945) (Askanazy 1898), had earlier described parafollicular C cells in the thyroid of a dog in 1894 (McCoy and Carthy 2015). It has been suggested that James Ewing (1866–1943) was responsible for the subsequent confusion and misnomer. In his book Neoplastic Diseases, published in 1919 and considered to be one of the key references in this field, Ewing mistakenly confused “oncocytic cells” with the parafollicular C cells described by Hürthle (Hürthle 1894); as a result, he introduced the oncocytic cells into the Anglo-Saxon literature under the name “Hürthle cells” (Cannon 2011). The fact that they were entirely different cells was overlooked.
Another characteristic of Askanazy was his interest in art. He organized conferences “Art and Science,” proposing to approach science from the perspective and spirit of an artist. Askanazy defined the relationship between art and science in one of these meetings as follows: “If science is called primarily to make observations, and from this to construct theories, yet the intuition is indispensable, which can be compared with the imagination of the artist.” (Huebschmann 1958).
The obituary written after Askanazy’s death was concluded with the following sentence, summarizing his approach to science: “His colleagues and students will remember him with his immediacy when confronted with the problems of science, his spontaneity, live philosophy and sincere kindheartedness”(Necrologia 1941). The British Medical Journal summarized Askanazy as follows in its obituary: “His place as a writer, teacher, and researcher, above all as an indefatigable worker in pathology, will be difficult to fill” (Obituary 1941).
References and Further Reading
- Askanazy, M. (1898). Pathologisch-anatomische Beiträge zur Kenntniss des morbus basedowii, ins besondere uber die dabei auftretende Muskelerkrankkung. Deutsches Archiv für Klinische Medicin, Leipzig, 61, 118–186.Google Scholar
- Askanazy, M. (1900). Ueber die Diagnostische Bedeutung der Ausscheidung des Bence-Jones’ schen Körpers durch den Urin. Deutsches Archiv für Klinische Medizin, 68, 34–54.Google Scholar
- Askanazy, M. (1904a). Concerning local amyloid deposition in the intestinal musculature. Verhandlungen der Deutschen Pathologie Gesellschaft, 7: 32–34. (from: Rosenblum A.H., & Kirshbaum J.D. (1936). Multiple myelomas with tumorlike amyloidosis: A clinical and pathological study. Journal of the American Medical Association, 106 (12), 988–991.Google Scholar
- Askanazy, M. (1904b). Ueber extrauterine Bildung von Blutzellen der Leber. Verhandlungen der Deutsche Gesellschaft für Pathologie, 7, 58–65.Google Scholar
- Askanazy, M. (1904c). Ueber ostitis deformans ohne osteides. Arbeiten Pathology Institute of Tubingen, 4:398–422 (from: Paieka, J.L., & Avan Heerden, J. (2014). The history of parathyroid surgery pp. 1–8. In D.J. Terris, W. Duke, & J.L. Pasieka (Ed.), Parathyroid surgery: Fundamental and advanced concepts. Plural Publishing, San Diego, CA.Google Scholar
- Askanazy, M. (1914a). Zur Physiologie und Pathologie der Plexus chorioidei. Verhandlungen der Deutschen Pathologie Gesellschaft, 17:85–103 2 (from Schröder, R., & Linke, R.P. (1999). Cerebrovascular involvement in systemic AA and AL amyloidosis: A clear haematogenic pattern. Virchows Archive, 434:551–560).Google Scholar
- Askanazy, M. (1914b). Allgemeine Ätiologie (kausale Genese) II. Äußere Krankheitsursachen zum Thema Parasiten. In: L. Aschoff: Pathologische Anatomie. Lehrbuch. 4. Auflage. Band 1, G. Fischer Verlag, Jena, S. 136–309.Google Scholar
- Askanazy, M. (1927a). The bone marrow. In F. Henke & O. Lubarsch (Eds.), Handbook of special pathological anatomy and histology (pp. 775–1082). Berlin: Springer. Part II.Google Scholar
- Askanazy, M. (1927b). Das experimentelle karzinom. Schweizerische Medicine Wochenschrift, 57, 1209. (from: Blenko V. Carcinogenic, teratogenic and mutagenic effects of arsenic. Environmental Health Perspectives, 19, 179–182, 1977.Google Scholar
- Buzmannm, C. (2003). Der Pathologe Ernst Neumann und seine Forschung auf dem Gebiet der Degeneration und Regeneration peripherer Nerven nach Kontinuitätsdurchtrennung. Medizinische Hochschule, Thesis, Hannover.Google Scholar
- Ewing, J. (1919). Neoplastic diseases: A textbook on tumors. Philadelphia, W. B. Saunders. 4th edition, 1940.Google Scholar
- Huebschmann, P. (1958). Max Askanazy. In: Ostpreußische Arztfamilie. Nr. 3, Adventsrundbrief, Teil III, Was wir immer bewahren wollen. pp. 11–12.Google Scholar
- Hürthle, K. (1894). Beitrage zur Kenntnis des Sekretionsvorgangs in der Schilddruse. Archiv der Gesamt physiologie (Pflugers), 56, 10–44.Google Scholar
- McCoy, K. L., & Carthy, S. E. (2015). Karl Hürtle (1860–1945). In J. L. Pasieka, & J. A. Lee (Eds) Surgical endocrinopathies: Clinical management and the founding figures (pp. 99–101). Springer International Publishing: Switzerland.Google Scholar
- Necrologia. (1941). Max Askanazy. Pathologie und Bakteriologie, 4, 174–176.Google Scholar
- Neumann E. (1868). Ueber die Bedeutung des Knochenmarkes für die Blutbildung, Vorläufige Mittheilung.Centralblatt für die medicinischen Wissenschaften;6(44) (from Maehle AH. Ambiguous cells: The emergence of the stem cell concept in the nineteenth and twentieth centuries). Notes and Record Royal Society of London. 2011 Dec 20; 65(4): 359–378.Google Scholar
- Obituary. (1941). Max Askanazy. The British Medical Journal, 1(4178), 178.Google Scholar