The pathologists: Aschoff, Klinge and Gräff

Abstract

The article presents three pathologists who have made important contributions to the understanding of rheumatic diseases. Ludwig Aschoff's (1866-1942) work formed the foundation and was for a long time at the centre of the discussion on pathology of rheumatic diseases. Impetus was added from a rheumatological perspective by the discovery of the Aschoff nodule as an indicator of rheumatic myocarditis. Thus, newly manifested rheumatic carditis is only diagnosed when rheumatic nodules are found. Fritz Klinge (1892-1974), following in Aschoff's footsteps, broke new ground in rheumatology in Germany. From extensive animal tests at a Leipzig institute he induced inflammatory reactions, necrosis and cell proliferation which, due to repeated sensitization, lead to arthritis and periarthritis. He identified therein a relationship to human rheumatism, which he considered to be caused by an allergic (hyperergic) reaction of the mesenchyme. In his opinion, the varying manifestations of rheumatic fever and rheumatoid arthritis presented one and the same pathological event. His main achievements were to close the gap between method-related deficits in morphology and the myriad clinical observations in the field of"rheumatic" diseases and to create a pathoanatomic platform for"rheumatism". Siegfried Gräff (1899-1947) was a strong critic of Klinge. He only ever relied on individual post mortem observations and was skeptical of animal testing in a rheumatological context. He considered"rheumatism" as a symptom, refuting its status as a disease. He distinguished rheumatic fever, as characterized by the Aschoff granuloma, from a second"rheuma-symptom" disease group, namely non-specific chronic polyarthritis (rheumatoid arthritis).