Buerger, Leo (1879–1943)
KeywordsIntermittent Claudication Mount Sinai Hospital Superficial Thrombophlebitis Thromboangiitis Obliterans Spontaneous Gangrene
Date, Country, and City of Birth
September 13, 1879, Vienna
Date and City of Death
October 6, 1943, New York City
History of Life
Leo Buerger was born in 1879 in Vienna, Austria. A year later his family emigrated to the USA where they lived in several places and he therefore attended elementary schools in New York, Chicago, and Philadelphia. At the City of New York College, he obtained a BA degree and subsequently an MA degree from Columbia University, followed by medical studies at the College of Physicians and Surgeons of Columbia University where he received his MD in 1901 at the age of 22 years.
A 3 year surgical training at Lennox Hospital and then one at Mount Sinai Hospital (both in NY), were followed by a year of surgical fellowship in Breslau (Wrocław), Poland, with study visits to Vienna and Paris. After his return to the USA with the aim to practice surgery, he instead decided first to start a pathology residency at Mount Sinai Hospital. Probably influenced by the pathologist Dr. Emanuel Libman (1872–1946, of Libman–Sacks endocarditis), Buerger immediately focused his attention on a relatively large number of amputations at that institution. This resulted already in 1908 in an accurate pathological description of the vascular disease thromboangiitis obliterans that later would be known by the eponym Buerger disease.
Buerger later became a urologist. In 1917 he was appointed as professor at the Medical Urology Outpatient Clinic New York where he worked until 1930, when he left, after a divorce and remarriage, for a similar position in Los Angeles at the present Loma Linda University. Here he worked only for 4 years. According to Friedrich Luft, “His contemporaries for the most part did not like him, most likely because reticence and humility were not among Leo Buerger’s attributes (……). In 1934, Buerger returned to New York but was not allowed back on the staff at the Mount Sinai Hospital and was forced into relative obscurity working at smaller private hospitals. Buerger died in New York in 1943. Brilliance, innovation, and flamboyance are terms that come to mind reading Buerger’s story. Clearly there is a place for such individuals, as similar stories regarding persons developing organ transplantation, percutaneous coronary interventions, and cloning of the human genome, attest. Leo Buerger belonged to these pioneers. Admiring them is great, but better at a distance”.
Main Achievements to Medicine/Pathology
Leo Buerger is especially known for the disease that still carries his name: thromboangiitis obliterans. However, the first report on this disease was probably by the German pathologist and microbiologist Carl Friedländer who published in 1876 a paper with a title Arteritis Obliterans. Three years later the disease was also described by the Austrian surgeon Felix von Winiwarter (1851–1932) in a 57-year-old man who had an unusual obliteration of the arteries and veins of his legs. He attributed this disorder to new growth of the vascular intima and proposed the name “endarteritis obliterans” for the disease.
In 1908 Leo Buerger described in detail the clinical and histopathological features of the disease that now bears his name: thromboangiitis obliterans. He starts his paper as follows: “There is an interesting group of cases characterized by typical symptoms which the Germans have described under the name ‘Spontan-Gangrän’. In 1879 von Winiwarter published the results of the pathological findings in one case, and reported an obliteration of practically all of the arteries of the leg by reason of a chronic proliferative process, due, in his opinion, to a new growth of tissue from the intima. He, therefore, proposed a new name for this condition, namely, ‘endarteritis obliterans.’ Patients afflicted with this so-called endarteritis obliterans present symptoms, which are so characteristic that the diagnosis is not difficult. I have had occasion to observe some thirty cases of this disease, and have made pathological studies on the vessels obtained from eleven amputated limbs.”
Further in his paper, he describes the details “If we dissect out the vessels in these cases, we are struck by the fact that here is an extensive obliteration of the larger arteries and veins. Besides this, we find 2 other lesions, which vary greatly in their intensity, namely, the periarteritis and the arteriosclerosis.” Later on, Buerger focuses on the nerves: “The study of the nerves in these cases is of considerable importance, both because the symptom of pain is such a constant and distressing one, and because some of the clinical features, such as the red blush of the foot in the pendent position, the transitory ischemia, and the cramp-like sensations in the calf, have all been in turn referred to some spinal or peripheral nerve disturbance. (……). We usually find it occurring in young adults between the ages of twenty and thirty-five or forty years, and it is because the gangrenous process may begin at an early age that the names presenile and juvenile gangrene have been employed.”
It occurs, although not exclusively, among the Polish and Russian Jews and is characterized by “recurrence of painful manifestations affecting lower extremities accompanied by paresthesias, Raynaud’s phenomenom, absence of peripheral pulses, superficial thrombophlebitis, difficulty in walking secondary to pain with progression to frank intermittent claudication. This constellation of signs and symptoms eventually leads to ischemic changes ranging from cyanosis to ulceration or dry gangrene of the toes, which may progress to affect one or both extremities. The devastating disease may result in amputation of the affected limb, often after periods of only weeks to months.”
In 1914 he would write “When these lesions were first referred to in 1908 their significance was not understood, although the suspicion was already aroused at that time that they were specific for the disease, and probably represented a peculiar reaction on the part of the tissues to some toxin or organism.”
Buerger also made fame in his later specialty urology. Already in 1906 he started working on a new generation cystoscope. He was the father of the universal urethroscope and a few years later of the Brown–Buerger cystoscope, a very versatile instrument that could be used as a urethroscope and as a cystoscope.
Books and Publications
Buerger, L. (1908a). Thromboangiitis obliterans: A study of the vascular lesions leading to presenile spontaneous gangrene. American Journal of the Medical Sciences, 136, 567–580. Republished in 1952: American Journal of Medicine. 1952; 13, 526–532.
Buerger, L. (1908b). The pathology of the vessels in cases of gangrene of the lower extremities due to so-called endarteritis obliterans. Proceedings New York Pathological Society, 8, 48.
Buerger L. (1914). Recent studies in the pathology of thrombo-angiitis obliterans. Journal of Medical Research, 31, 181–194.9. Free PMC Article.
Friedländer, C. (1876). Arteriitis obliterans. Zentralblatt für die medizinischen Wissenschaften. Berlin, 14.
Von Winiwarter, F. (1879). Ueber eine eigentümliche form der endarteritis und endophlebitis mit gangrän des Fusses. Arch Klin Chir, 23, 202.