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Ann Thorac Surg 2005;80:1971-1975
© 2005 The Society of Thoracic Surgeons
Department of Cardiac Surgery and Transplantology, Silesian Center for Heart Disease, Zabrze, Poland
* Address correspondence to Dr Skalski, Silesian Center for Heart Disease, 2, Szpitalna Str, Zabrze, 41-800 Poland (Email: vokedit{at}infomed.slam.katowice.pl).
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Albert Wojciech Adamkiewicz (pronounced: Adamkievitsch), pictured in Figure 1, was born in 
erków in the Duchy of Pozna
on August 11, 1850. In 1868, he received his secondary school certificate with honors. His interest in biological sciences led to an interest in medicine, a field that allowed opportunities for research and independent investigation. In the same year, Adamkiewicz commenced his medical studies at the Königsberg University and continued his education in Wroc
aw. Professor Rudolf Peter Heidenhain, who was the head of the highly acclaimed Institute of Physiology, hired the promising Adamkiewicz as his assistant [1–3].
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aw to complete his university education there and to receive his medical diploma [1, 2].
In March 1873, he left Wrocaw to become the assistant of Professor von Wittich in the Königsburg Institute of Physiology. Having spent 2 years in the Institute of Physiology, Adamkiewicz found employment in the Medical Department (ie, the Department of Internal Diseases) under Professor Naunan, where he headed the departmental laboratory. In 1876, having been promoted to assistant professor of pathophysiology at the Königsberg University, he began lecturing in pathophysiology and diagnostic management.
Several months later he relocated to Berlin to be employed as the senior assistant in Professor Carl Westphal's Department of Nervous Diseases of the Charité Hospital. In 1877 Adamkiewicz decided to once again qualify himself as assistant professor, this time in pathology and at the Berlin University. At that time his stature as an experienced researcher and academician had been already well established. In recognition of his achievements, in 1879 the Faculty of Medicine, Jagiellonian University of Cracow, appointed Adamkiewicz full professor in the Department of General and Experimental Pathology [1, 3, 6].
The long-awaited new professor took up his post and commenced lecturing in the second semester of the academic year of 1879 and 1880, residing in Cracow until 1892. At the university he developed a reputation of an excellent lecturer and teacher who was much respected by his students for the clarity and interesting manner of his presentation. His lectures were often enriched by experiments cleverly introduced as inherent elements of his classes. The number of articles, communications, and reports presented by Adamkiewicz totaled into the hundreds. He was the sole author of 43 papers and 10 monographs. This vast body of writing included large papers published in highly regarded European medical journals and communications presented at various congresses. He composed most of his reports in German and Polish, but he also wrote several articles in French and Latin. His contemporaries recognized the originality of his papers, and he received several distinctions. The body of Adamkiewicz's writings includes reports of a very high scientific value [3, 5, 7]. These papers chiefly focused on neurology, in particular the vasculature of the nervous system, as well as on histology and the theory of neoplastic tumor development.
Viewed from the perspective of a century later, the most valuable contribution of Adamkiewicz to medicine and clinical practice, we are inclined to believe, was his discovery and description of the spinal cord vascular system. His name, well known and respected in the entire modern, highly specialized world of medicine, is associated by physicians representing numerous subspecialties with the variability of spinal cord vascularization. The knowledge of the course of arteries supplying the spinal cord that were discovered by Adamkiewicz, such as the arteria radicularis anterior magna, allows for planning a surgical procedure in a way that allows for avoiding serious neurologic complications. Adamkiewicz demonstrated that blood from the radicular arteries flows upwards in the ascending branches and downwards in the descending ones (Fig. 2). He also pointed out that the anterior great spinal artery is characterized by the most stable morphology and course. Most commonly, in 60% of the general population, it branches off at the level of the ninth to twelfth thoracic segment. In 15%, at the level of the fifth to eighth segment, and in approximately 25%, at the first lumbar segment [8]. The greatest radicular artery is approximately 2.5 cm long when measuring from the point where it penetrates the spinal dura mater to the point where it reaches the medulla. Subsequently, the artery courses inferiorly and becomes progressively thinner, its total length being approximately 15 cm. It constitutes the site of origin of ascending branches and of branches that pass toward the posterior part of the spinal cord and anastomose with posterior spinal artery branches. The majority of Adamkiewicz's observations are fully confirmed by today's knowledge of the variability of the spinal cord vascular system. The variants are believed to include three anatomical types. In the first type, the anterior spinal artery, which originates in the vertebral arteries at the level of the third to fifth cervical segment, passes uninterrupted along the spinal cord, and is additionally supplied by the typical anterior great spinal artery (the so-called Adamkiewicz's artery) and by the first intercostal arteries [9]. Clamping these vessels does not deprive the spinal cord of arterial blood, but it may at times (in 5% to 15% of the cases) result in hypoperfusion of the anterior spinal artery. In the second variant, the anatomical arrangement is similar, but the spinal artery is poorly developed and potentially ischemic. In the third, which is associated with the highest risk of spinal cord ischemia, the anterior spinal artery lacks continuity (ie, it is interrupted in the majority of cases in its thoracic segment), and it constitutes the so-called risk system. Thus, in this fortunately most rare variant, clamping the thoracic aorta in the course of surgery, such as the repair of aortic coarctation or aortic aneurysm or the insertion of an intraaortic balloon [10], is associated with the highest risk of paraplegia. According to experimental data, the descending aortic pressure needs to be at least 60 mm Hg to ensure freedom from paraplegia [11].
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A series of reports describing the previous findings was published in the years 1882 to 1886. These papers constituted the culmination of the studies Adamkiewicz carried out at the laboratory supervised by Professor Teichman, Department of Anatomy, Jagiellonian University. Professor Teichman's assistant, Dr Henryk Kadyi of the same period, later professor of anatomy, was independently involved in studies of the spinal cord vascular system. In his monograph entitled "On Blood Vessels of the Human Spinal Cord," published in 1888, Kadyi described in detail the specific character of the spinal blood vascular system [3, 9]. Yet, Kadyi's papers were chiefly focused on certain aspects of the morphology of spinal cord vessel course and to a lesser degree touched upon their physiology; for example, he provided no information on the direction of blood flow (bidirectional flow) within some segments of the anterior spinal artery. Nevertheless, his reports constituted valuable contribution to the body of knowledge at the time (Fig 3). Both eminent investigators, Adamkiewicz and Kadyi, took advantage of a novel method of processing vascular preparations, for which the Cracow laboratory headed by Teichman was famous. The method consisted in injecting the vessels with putty-like substances composed of zinc white, linseed oil, ammonia, mercury sulphate, or carmine sediment (as a red, or "arterial" dye), as well as Prussian blue (for vein staining). More liquid substances used in injecting capillary vessels were enriched with paraffin oil or carbon disulphide.
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We should mention here that in 1889, Adamkiewicz described the separate nosological character of progressive hemiparesis of the cranial nerves (as a separate disease entity). The progressive cranial nerve hemiparesis syndrome was again described later, in 1927, as a new disease (the Garcin hemibasal syndrome), characteristic of connective tissue tumors of the nasopharynx. Some specific clinical features of this syndrome that are in agreement with Adamkiewicz's description support the thesis that it was Adamkiewicz who made the discovery and appropriately interpreted his observations [12].
Adamkiewicz was a colorful individual, and apart from his unquestionable achievements, he also gave rise to numerous controversies. He committed scientific errors that brought him ill fame and contributed to his decision to resign from the honorable professorship in Cracow. This brought to an end his splendid career in the field of research medicine. His major investigative blunders included the "discovery" of the so-called "nervous bodies", "cancer parasite" (coccidium sacrolytus), and "anticancer antitoxin." These "discoveries" were ruthlessly criticized by Jagiellonian University professors [2, 3, 13]. Adamkiewicz lost.
More than 30 years after Adamkiewicz published his discovery of anticancer antitoxin, the idea still had its advocates.
After a series of critical statements made by luminaries of the Cracow University, Adamkiewicz, feeling discouraged and hounded, but still unwilling to accept the criticism, decided to leave the Jagiellonian University and Cracow in 1892. He found favorable conditions for his further investigations in the field of neurology in the Vienna Department of Surgery headed by Professor Edward Albert. Gradually withdrawing from any research activities, he devoted his time solely to clinical practice, working as a physician-in-chief in the Jewish Rothschilds Hospital in Vienna. In 1900, he still published the results of his investigations on the vascularization of ganglionic neurons. Adamkiewicz remained in Vienna until his death on October 31, 1921. He was then 71 years old [4, 5, 7].
Despite several defeats, Adamkiewicz suffered in his scientific career, which at times consisted of a desperate struggle for originality of his discoveries intermingled with blundering into blind alleys of 19th century science; his unquestionable scientific achievements established him as a true searching research worker with a somewhat controversial personality. By a twist of fate it is the name of this outstanding research worker, so ferociously criticized in the Polish-speaking scientific community of Cracow, that to this very day constitutes a Polish element in the medical sciences as the eponymous term "Adamkiewicz's artery" as mentioned in all cardiac surgery textbooks of major significance. Apart from cardiac surgery, the term Adamkiewicz's artery occupies a prominent place in vascular, thoracic and pediatric surgery, traumatology, neurology, neurosurgery, and other medical subspecialties.
In spite of the previously mentioned controversies, Adamkiewicz was respected and highly valued as an international authority in medicine in his lifetime, and his reports received numerous distinctions. He was a member of several professional associations, including the Medical Societies of Königsberg, Wrocaw, and Cracow, the Association of German Internists in Wiesbaden, the Anatomical Society in Leipzig, the Medical, Neuropathological and Physiological Societies in Berlin, as well as the Paris Societé de Biologie.
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References |
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widerski G, Operacz R, widerska K. Dzieje 
ycia Alberta Wojciecha Adamkiewicza – cz
I, [The life of Albert Wojciech Adamkiewicz – part I] Chir Narz Ruchu Ortop Pol 1995;60:419-422.
ech P. Nazwisko Adamkiewicza w sownictwie medycznym w ostatnich trzech dekadach XX wieku [The name of Adamkiewicz in medical archives in the last three decades of the 20th century] Arch Hist Fil Med 2001;64:297-316.
dosz B. Katedra patologii ogòlnej i dowiadczalnej w Krakowie Nauki Medyczne w Szesetlecie Uniwersytetu Jagielloskiego [Chair of General and Experimental Pathology. In. Medical Sciences on the 600th Anniversary of the Jagiellonian University]. Volume II. Kraków: AM w Krakowie; 1964. pp. 528-529.
tnastego wieku (1801-1900) [Polish medical bibliography of the 19th century]. Vol. I. Warszawa: PZWL; 1974. pp. 10-23.
ownik Biograficzny Adamkiewicz Albert [Polish Biographic Dictionary. Adamkiewicz Albert]. Volume I. Pol Akad Umiej; 1935.
owska-Pituchowa J. Two monographs on the spinal cord vascularisation Folia Morphol Warszaw 1980;39:1-8.
aw: Zakad Narodowy im Ossoliskich, Wydawnictwo PAN; 1975. pp. 87-125.
tnoci 1872-1952. Materiay Sesji Jubileuszowej Kraków, 14.12.1972. Wrocaw-Warszawa-Kraków-Gdask: Zakad Narodowy im Ossoliskich, Wydawnictwo PAN; 1975. pp. 64-65.This article has been cited by other articles:
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  W.H. Backes and R.J. Nijenhuis Advances in Spinal Cord MR Angiography AJNR Am. J. Neuroradiol., April 1, 2008; 29(4): 619 - 631. [Abstract] [Full Text] [PDF]
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