Austrian syndrome

Editor – thank you for publishing the article about Austrian syndrome.¹

There is just one thing I would like to mention; the article ends with ‘We also propose that this syndrome should be renamed as Osler's syndrome with Osler's tetrad, in acknowledgement that Sir William Osler was the first to describe the triad of pneumonia, meningitis and endocarditis with presence of ‘micrococci’ in affected tissues and blood.’

I am aware that there is a language barrier as some really old articles are in German, but it is not the full truth that Osler was the first; Mandal et al's article does not mention Richard Heschl at all. Heschl described a case series of patients with endocarditis, pneumonia and meningitis in 1862.² If we take the historical background into account, and the fact that there was no ‘bacteriology’ in the 1860s (eg Ferdinand Julis Cohn published ‘Untersuchungen über Bakterien’ in 1872, Robert Koch described Bacillus anthracis in 1876), Heschl was as close to the pathophysiology as he could have been in the early 1860s.

I would like to propose another approach, if we have to rename the syndrome (do we have to?), then to name it Heschl syndrome, or do as with all the other syndromes and get rid of the eponymous names and call the pathophysiology something like ‘Pneumococcal multiorgan infestation syndrome affecting heart, lung and central nervous system’ as a (very long – apologies) description for the syndrome.