NOTES ON THE MEDICAL HISTORY OF VIENNA By HORACE MARSHALL KORNS, M.D.

IOWA CITY, IOWA PART II (Conclusion) * The first vaccination on the Euro- collection of valuable books, which was pean continent was performed in incorporated with the Hofbibliothek Vienna, on April 30, 1799, by Sani- after his death, bears witness to his deep tatsreferent Pascal Josef von Ferro, who interest in medicine and natural sci- used his own children for the experi- ence, and he was a no less diligent stu- ment. Ten days later, on May 10, 1799, dent of music and languages. Jean de Carro (1770-1857) inoculated Harrach’s patients were all indigent, his son with lymph obtained from the and, inasmuch as most of them were pustule on the arm of Ferro’s daughter. also incurables who had been given up Ferro was too much occupied with his by other physicians, his radiant per- official duties to pursue the matter fur- sonality and innumerable charities were ther, and it fell to the young and en- his most efficacious therapeutic weap- thusiastic de Carro, who reported 200 ons. K. F. Burdach, an eminent con- inoculations in his celebrated book temporary anatomist, said: (1801) , and extended his activities in I met him often, surrounded by a group behalf of vaccination throughout Aus- of incurables and grateful convalescents, tria, Germany, Turkey and India. He and saw with what admirable simplicity refused the 1000 guineas offered him for he bore himself towards these poor peo- his work in India, whereupon Jenner ple. In 1809 he devoted himself unceas- sent him a lock of his hair, and a silver ingly to the care of the French and Aus- snuffbox with the inscription, “ Jenner trian soldiers in Vienna, until he himself to Jean de Carro.” De Carro was a contracted typhus. He intrusted the man- Swiss, and a pupil of Cullen. agement of his case to a young physician Karl Borromaus Graf von Harrach (Staudenheim, later physician to the duke (1761-1829) was a physician whose of Reichstadt, son of Napoleon and Maria humanitarianism entitles him to a Louisa), and refused consultation. When recognition which he has never been he seemed about to die, he worried at the thought that his death might be blamed accorded by the historians. He entered on this young doctor, and to compensate first on a legal career, in the course of him for the possible loss of practice which which he rose to be Staatsanwalt in might ensue, willed him 10,000 florins Prague, but forsook law for medicine ($4800) . After he recovered he paid the because he thought he saw in it a better money anyhow, for then it seemed ridicu- opportunity to exercise his altruistic lous not to reward success at least as well instincts. After receiving his degree at as failure. Harrach’s unusual perception, Vienna (1803), where he was a pupil of broad education, and instinctive humani- Johann Peter Frank, he studied in tarianism enabled him to achieve a thor- France and England. From 1814 until oughly mature Weltanschauung. His in- the time of his death he served as Pri- numerable charities forced him to live marius at the Elizabethinerinnen. His very frugally. [He was paid the salary of a * Part I appeared in Anna ls of Medica l Histo ry , n.s. 9:345 (July) 1937. Primarius for his services to the Elizabeth- ■was appointed surgeon to the orphans’ inerinnen, but he always sent it back the home, where Josef 11 met him one day next day, together with an equal amount with the suggestion that he go abroad to from his own pocket.] It was one of his perfect himself in obstetrics, to which peculiarities that he never left the city. Boer readily assented. Before he went, The countess Dietrichstein, whose invita- the Kaiser persuaded him to change his tions to visit her at her summer home near cognominai Boogers to Boër, alleging Vienna he had always declined, sent word to him one day that she was dead, and that no Frenchman could pronounce asked him to come to her autopsy, think- such a barbarous name as Boogers. ing that this was an invitation which he I11 1785, provided with funds and let- surely could not refuse. ters of introduction, Boër left Vienna Richard Bright met Harrach in for Brussels and Ghent. In Paris the pro- Vienna during the great Congress of tection of Josef’s sister, Marie An- 1814, and spoke of him in glowing toinette, procured him entree to the terms. There is a little restaurant in the principal hospitals and the attention of Alserstrasse, close to the Allgemeines the great accoucheurs. His visit to Krankenhaus, which is known as the Madame Souchot. the patient on whom Gasthof zum goldenen Hirschen. This Jean René Sigault had performed his restaurant was mentioned in 1814 by much discussed symphysiotomy eight Karl Ernst von Baer, the great embry- years previously, convinced him that in ologist, as a rendezvous of foreign physi- this case, at least, the operation had en- cians, and to this day it is a favorite re- tailed sorry consequences, and tended sort of Americans. One who has spent to confirm his belief that it was a pro- many happy hours there likes to think cedure to be avoided. After fifteen that Richard Bright and Graf von Har- months in Paris, he went to London. rach may have drunk each other’s health He returned by way of France and Italy across one of its tables. to Vienna, where in 1789 he became A new era in obstetrics began with chief of the obstetric clinic at the Allge- the Hollander Lukas Johann Boer meines Krankenhaus. The death of his (1751-1835), (born Boogers). After patron, Josef 11 (1790) , and his bad luck studying for a time in Wurzburg under in the case of the Archduchess Eliza- the famous surgeon Carl Caspar von beth, consort of the subsequent Kaiser Siebold, he was provided with funds by Franz, who succumbed following in- a generous patron, the bishop of Wurz- strumental delivery and manual extrac- burg, and sent to Vienna (1771) , where tion of the placenta, cost him his place he promptly squandered his substance at court and much of his popularity, but in riotous living. As soon as the bishop he continued as professor until 1822. heard of his divagations from the linear In obstetrics Boër was opposed to path of rectitude, he withdrew his sup- operative interference if it could be port. Boer then made his living by avoided. He declared that pregnancy, teaching and literary work, some of parturition and the puerperium are which was proofreading, and still found physiologic processes, and that the phy- time to study medicine. In 1778 he was sician should simply play the rôle of na- granted the degree of Master of Sur- ture’s servant. He understood and de- gery, after which he studied midwifery scribed the various rotations of the fetus for two years, and became A. J. Rech- as it passes through the pelvis; portrayed berger’s assistant at St. Marx. In 1784 he the mechanism of face presentation very graphically; and opposed version in man’s life ‘from the womb to the tomb’ breech presentations and for the second —sewerage, water supply, school hy- of twin fetuses. He disapproved of spe- giene, sexual hygiene, taxation of cial beds and stools, and simply had his bachelors, and suitable benches and patients lie on the left side during de- meals for the children, as well as the livery. In one year he lost only 5 patients ideal of a scientific ‘medical police’— in 1500. In one series of 2926 cases really left little for Pettenkofer and the (1789-92) he used forceps only nine- moderns.’’ teen times. He never did a version more In 1785 Frank succeeded Tissot at than ten times in any one year. He de- Pavia, thus becoming a colleague of scribed the clinical manifestations of Scarpa and Volta. He came to Vienna in puerperal fever in great detail, empha- 1795 to take Brambilla’s place as direc- sizing his contention that it is a disease tor of the Josephinum, but instead was sui generis. These and many other con- made director of the Allgemeines Kran- tributions entitle Boer to a place in kenhaus and the medical clinic. Under obstetrics comparable to that of de his expert management many salutary Haen, Stoll and Peter Frank in medi- changes were made in the administra- cine. tion of the hospital, and important im- The incompetence of Stoll’s succes- provements were effected in the hy- sor, Jacob von Rheinlein, quickly dis- gienic conditions of the entire city. A pelled the attractions of the Vienna good clinician, an inspiring teacher, and clinic. When it was finally brought to a man of the highest intellectual hon- the notice of the government that for- esty, Frank soon restored the prestige eign students no longer came to Vienna, of the Vienna clinic, but in spite of his Rheinlein was pensioned (1795). He sterling worth, or perhaps because of was succeeded by Johann Peter Frank it, he was continually molested by the (1745-1821), the illustrious father of preposterous Stifft, Storck’s successor as modern public hygiene. While still an generalissimo of medical affairs, and undergraduate at Heidelberg Frank finally (1804) , unable any longer to en- started the great work which was to dure Stifft’s malicious meddling, he re- make him famous, and had completed signed his position in disgust and left the first volume by 1768; however, Vienna. when the printer to whom he offered Fhe impression made by Frank’s the manuscript refused to publish it, portrait12 has been well described by Frank consigned it to the flames and Rolilfs. He calls attention to the high started over. The rewriting occupied brow, and deep, even fiery, earnestness him for eleven years, during which time of Frank’s face. he travelled a great deal, and held many different positions. The first volume In his features lies a majestic calm, something deeply meditative, yet reckless, finally appeared in 1789; the treatise a prepossessing candor, yet something re- ran ultimately to six volumes, with two served. It is the face of one who knew supplementary volumes, and was not mankind, who not only recognized and completed until 1819. In spite of its im- treated disease, but understood the human perfections, it laid the foundations of a heart. One feels that this was a strong new science singlehanded. Garrison man who knew exactly what he wanted. says that Frank’s “great work on public 12 Garrison, F. H. History of Medicine. Ed. hygiene, covering the whole subject of 4, Phila., Saunders, 1929, p. 321. The touch of ironical disdain playing creating the position of prosector and about his mouth could not be taken amiss awarding it to Vetter he took the first in a physician who was reminded hourly significant steps in that direction. Frank of the transitoriness of all mortal things. had little to offer him except an un- An unusual countenance, stamped in limited opportunity to work, and Vet- every feature with originality and high in- ter’s record shows how well he availed tellectual capacity. His hair was combed himself of this opportunity. By the straight back, and the peruke which was time he was thirty-six years of age he worn almost universally in his day is miss- ing. An enemy of all that was false, he had thousands of autopsies to his credit, could not bring himself to defer to the which was an accomplishment without fashions of his age. a parallel before the nineteenth cen- Among the many obscure partici- tury. During his brief incumbency the pants in the medical life of old Vienna number of museum specimens grew are two who should be rescued from from four or five to 400. undeserved oblivion. The virtues of Vetter’s “Aphorismen zur patho- the first, Graf von Harrach, noteworthy logischen Anatomie” (1803), an im- especially for his humanitarianism, pressive monument to his untiring have already been extolled. The other, industry, extraordinary powers of obser- more notable for his scientific attain- vation, and fidelity to the truth, marks ments, is Alois Rudolf Vetter. Vetter the first scientific approach to the het- was born in 1765 in Kärnten, and erogeneous subject matter of pathologic studied medicine at Innsbruck and anatomy. Without wasting time in idle Vienna. After graduation he started flights of fancy, the author reported giving practical instruction in necropsy simply what he himself had observed, technicpie without first obtaining offi- which distinguishes the book sharply cial sanction. Storck, unable to appre- from contemporaneous treatises. As ciate either the young man’s ability or Hyrtl pointed out, Vetter towers above the importance of what he was trying to his predecessors because he was the first do, forbade him to continue, but Vet- thinker in the Held of pathologic anat- ter was undismayed and managed some- omy. Vetter appreciated fully the diffi- how to evade the injunction. It was at culties of the task which he had under- the suggestion of the eager students who taken, and entertained no illusions surrounded him that he wrote, at the concerning his achievement. In his fore- age of twenty-three, his textbook of word he said: “More able and better anatomy, which, as he said, “although trained men will arise to outline the in- not suitable for the libraries of the stitutions of pathologic anatomy, and learned, will be found useful by begin- then perhaps my earlier endeavors will ners.” His long-awaited opportunity ar- be remembered indulgently, and the rived when Peter Frank made him pro- broken pieces of this system find use sector at the Allgemeines Krankenhaus. here and there in the building of a Prior to this time there had been no stronger structure.” He described, inter effort to make systematic use of the vast alia, perforating gastric ulcer, a disease amount of available necropsy material. almost unknown before his time; spoke Frank, who was one of the first to appre- of a gastric fistula which had been uti- hend the importance of pathologic anat- lized by Helm for experiments on diges- omy, did not succeed in founding a dis- tion; declared that tuberculosis and tinct department of pathology, but in suppuration of the lungs are entirely different conditions; and called atten- After Frank, the first noteworthy tion to the importance of pathologic director of the medical clinic was Valen- chemistry, which -was then a practically tin von Hildenbrand, who is remem- virgin field. bered particularly for his clear descrip- It was not Vetter’s fault that he did tion of typhoid fever. There is much in not become the German Morgagni, a this description to indicate that Garri- destiny to which the almost unlimited son underrates it when he says that Hil- material at the Allgemeines Kranken- denbrand “had some inklings’’ of the haus seemed to call him. Instead, he was difference between typhoid and typhus. driven out by the envy of his influen- Johann von Raimann, son-in-law of tial colleagues and the petty annoyances Stifft, followed Hildenbrand. He was a of the bureaucracy. Poverty and hard good teacher and honest official who ad- work gradually affected his health, and ministered the Allgemeines Kranken- there was no place in Vienna where the haus efficiently, and increased its capac- financial return was sufficient for his ity by 500 beds. He succeeded to Stifft’s needs. In 1803 he reluctantly accepted position in 1837. a professorship of anatomy and physiol- One of the greatest surgeons that the ogy in Krakau, but returned two years Allgemeines Krankenhaus ever knew later, and died in 1808 at the age of was Johann Nepomuk Rust (1775- forty-one. Today the university of 1840) , a native of Austrian Silesia. Un- Vienna honors him as the forerunner fortunately, his skill as an operator ex- of that period in its history which was cited the envy of some of his colleagues, distinguished so gloriously by the rise and his forthright, even blunt, manner of pathologic anatomy. earned him the dislike of Stifft. Inas- The incompetent Andreas Josef von much as Rust declined to degrade him- Stifft (1760-1836), who succeeded self by stooping to the servile flattery Storck as minister of medical education, and hypocritical blandishments with was motivated principally by petty per- which second-rate men endeavor to con- sonal interests. He deserves credit for ceal their inferiority, the egregious assisting Vincenz von Kern (1760- Stifft determined to injure him at the 1829), one of Vienna’s most illustrious first opportunity. When Rust applied professors of surgery, in his farsighted for permission to lecture on operative efforts to improve the teaching of opera- surgery, Stifft not only refused to grant tive surgery, but he was responsible for it, but called on the director of the hos- the loss of Peter Frank and Johann pital for his opinion of Rust’s profes- Rust, as well as for many appointments sional qualifications. Hildenbrand re- which were unfortunate in the extreme. plied at some length, praising Rust as Kern was a clever operator, especially one of the hospital’s most industrious for stone in the bladder. In addition to and competent surgeons. This checked the provisions which he made for proper Stifft temporarily, but he soon resumed training in operative technique, he his harassing tactics, even going so far as revolutionized the treatment of wounds to have Rust’s membership in a Berlin by substituting simple moist dressings scientific society taken away from him for the nasty salves and plasters which by underhand means. Rust finally tired the young science of surgery had inher- of these petty annoyances and left ited from its itinerant and tonsorial Vienna for Berlin, where he became ancestors. successively professor at the Pepinière and Mursinna’s successor at the Charité, the universities of the monarchy, and it professor of surgery in the university of was decreed that attendance at the eye Berlin (1818), geheimer Obermedizi- clinic for two semesters and the suc- nalrat and Referent in the Prussian cessful performance of at least one ministry and surgeon general of the cataract extraction should be prerequi- Prussian army (1822). In his new en- site to the practice of ophthalmology. vironment he was extraordinarily suc- Beer, more than anyone else, placed cessful as a surgeon, writer, teacher and the teaching of clinical ophthalmology organizer. on a sound basis. Carl Ferdinand von The sadistic sense of inferiority which Graefe, Philipp Franz von Walther, manifests itself as anti-Semitism has al- Traugott Wilhelm Gustav Benedict, ways played a prominent rôle in the af- Anton von Rosas, Giovanni Battista fairs of the university of Vienna. In Quadri, Francesco Flarer, Johann 1267 the Council of Vienna forbade the Nepomuk Fischer, William Mackenzie, sick to employ Jewish physicians under Franz Reisinger and Max Josef von penalty of the ban, and similar racial or Chelius, the leading ophthalmologists religious discriminations were con- of Austria, Germany, and Italy in the stantly in effect for centuries thereafter. middle of the nineteenth century, were It was not until after the accession of his pupils. One of the most distin- Josef 11 that Jews were admitted to the guished was Friedrich Jäger von Jaxttal university. Today no Jew who declines (1784-1871) of Württemberg, who be- to affiliate with one of the more fashion- came professor of ophthalmology at the able religious denominations may be- Josephinum in 1825. Jager’s chief con- come the head of a department, no mat- tributions dealt with conjunctivitis, ter how superior his qualifications. It trichiasis, pannus, cataract, trachoma cannot be said, however, that Vienna is and the repair of ectropion. more paleolithic in this respect than Beer published important papers many other cradles of Christian culture dealing with staphyloma, cataract and in this best of all possible worlds. the production of artificial pupils. He The justly celebrated Georg Josef was the first to describe pannus cor- Beer (1763-1821), a native Viennese, rectly, and the first to observe the little was the first of his race to be graduated condylomatous nodes on the border of in Austria (1789). His decision to de- the iris in chronic progressive syphilitic vote himself to ophthalmology was iritis. Iridectomy, which was first per- formed during the years he served as formed by de Wenzel, did not become a Barth’s famulus and illustrator. As early satisfactory procedure until Beer intro- as 1793 he began to perform cataract duced a new cataract knife of his own extractions at the Allgemeines Kranken- invention (still in use) and revised the haus, where a room was set aside for his operative technique. These and many use in May and June of each year, and other scientific contributions establish patients were soon streaming in from Beer’s high rank. He and his pupils all parts of the country. In 1812 he be- initiated that important phase in the came associate professor and director of development of ophthalmology which the clinic. His appointment as professor was to reach its apogee with Albrecht followed in 1818, at which time oph- von Graefe, the greatest of all eye thalmology was made a required sub- surgeons. ject, eye clinics were established in all One of Beer’s most versatile col- leagues was Georg Prochaska (1749- the city which later became, under the 1820), a native of Lipsitz, in Mähren, leadership of Freud, the psychiatric who studied at Prague and Vienna, was capital of the world. In 1766 Franz An- graduated at Vienna, served as de ton Mesmer (1734-1815) presented to Haen’s assistant, and later became the faculty of medicine of Vienna a Dozent in anatomy. On Barth’s recom- graduating thesis which dealt prophet- mendation, he was appointed professor ically with the influence of the planets of anatomy and ophthalmology at on the human body. Thence it was but Prague in 1778. In 1786 he turned the a step to magnetic and manual influ- anatomy over to his prosector, and as- ence. His first publication on mag- sumed the professorship of physiology. netism, which appeared in 1775, at- Five years later he returned to Vienna tracted little attention, but his “cures” as professor of higher anatomy and soon became famous. He shortly found physiology. Prochaska performed more himself in difficulties with the medical than 3000 operations for cataract, and profession and the public, and in 1778 he was also an accomplished anatomist removed to Paris, where he hoped to and pathologist, but, like Sir Charles find a more appreciative clientèle. In Bell, he is remembered today chiefly this he was not disappointed; the cour- for his contributions to physiology. In tiers and aristocrats flocked to his se- 1797 he pointed out the anatomical ances, and he was offered a large pen- similarities between the minor and ma- sion if he would disclose his secrets, but jor portions of the trigeminal nerve, on when an investigating committee re- the one hand, and the anterior and pos- ported unfavorably on his activities he terior roots of the spinal nerves, on the was forced to leave France. other, later voicing the conjecture that A cleverer and more gifted charlatan the one has an efferent, the other an was Franz Josef Gall, born in 1758 and afferent, function. The proof of this graduated at Vienna, who, with his pu- theory, which was adduced many years pil Johann Caspar Spurzheim, promul- afterward by Bell, Magendie and Jo- gated the doctrine of phrenology. Gall’s hannes Müller, had far-reaching conse- fantasies attracted an enormous amount quences. Prochaska’s investigations of of attention, and were so highly es- the anatomy of the capillaries were teemed that when (1802) he was or- noteworthy, his conception of the dered to cease the public lectures he growth of bone held sway for almost a had been giving for six years, ambassa- century, and his remarkable prediction dors of foreign countries made repre- that physiologic processes would even- sentations in his behalf. Thereupon he tually be explained on physical and was permitted to resume his lectures on chemical grounds instead of by the mys- condition that only foreigners, and no terious and unknown “vital force’’ has women, might attend. Shortly after- already been substantiated to a large extent. ward he left Vienna for Germany and If it be true that mesmerism and Holland. In Berlin he was presented phrenology were in a limited sense pre- with a medal bearing the inscription: monitory of a more scientific attitude “In research keen, modest in assertion.” toward the psychogenic factors of dis- In 1807 Gall emigrated to Paris, where ease, it must have been foreordained his practice proved so lucrative that he that both of them should originate in died wealthy (1828). The k. und k. Gesellschaft der Àrzte 1805, at Pilsen, and was graduated at of Vienna owed its origin principally Vienna in 1831. After serving through to Wirer von Rettenbach, who was for a cholera epidemic in his native Bo- a long time its president. It was founded hemia, he returned to Vienna, obtained in 1838, brought out its first volume of an appointment as Secundarius at the proceedings in 1842, and began to pub- Allgemeines Krankenhaus (1833), and lish a journal in 1844. The Society lost no time in beginning his work. At maintained a reading room and library, the outset he was beset with many per- and held regular meetings at which sci- plexities. Although he was thoroughly entific papers were read and an oppor- familiar with the French literature on tunity for social intercourse provided. percussion and auscultation, the precise Its influence on the standards of medical tonal connotation of the somewhat practice was very wholesome. poetical expressions with which the The New Vienna School was in many French had clothed their observations respects the spiritual child of the scien- was exceedingly obscure, and there was tific revolution which had its origin in no one in Vienna who could help him. France during the First Empire. Bi- This forced him to reinvestigate every chat’s pioneer work in descriptive anat- phase of the entire subject, and, as omy stimulated renewed interest in Sigerist suggests, probably prompted pathology. Corvisart gave Auenbrug- his attempt to reduce the sonorous phe- ger’s percussion to the world, and nomena of physical diagnosis to simple turned his attention to organic disease and universally intelligible terms. His of the heart and great vessels. Bayle methods differed in no wise from those brought out a valuable work on tuber- of his predecessors. Diligently he cor- culosis. Bretonneau published his im- related clinical observations with ana- portant monographs on diphtheria and tomic lesions, and devised experiments typhoid fever. Rayer elucidated dis- to elucidate obscure points. He re- eases of the kidney and skin, and Brous- ported his results in a series of papers13 sais, Bouillaud, Chomel, Louis, Andral which began in 1836, and culminated and others made outstanding contribu- three years later in his “Abhandlung tions to clinical medicine. Cruveilhier über Auskultation und Perkussion,” a distinguished himself by his original book which was to serve as the starting work in pathology, and the talented point for all subsequent investigations Dupuytren was responsible for innu- in its field. Partly because of the rudi- merable advances in surgery. At the mentary state of acoustics, which was head of this brilliant list stands the yet to find its Tyndall, Helmholtz and name of the great pathologist and clini- Rayleigh, Skoda did not meet with com- cian, Réné Théophile Hyacinthe plete success in his endeavor to place Laënnec, the inventor of the stetho- all sonorous phenomena on a simple scope. It was the new auscultatory physical basis, but once the all-impor- method, the revival of percussion, and tant fact of its desirability had been the impetus given to pathology by the established, the eventual attainment French that inspired Skoda, the lead- became a foregone conclusion. ing clinician of the New Vienna School, At first little attention was paid to to dedicate his energies to the study of Skoda’s contributions. The leaseholders physical diagnosis. 13 Published in the Medizinische Jahr- Josef Skoda was born December 10, bücher des österreichischen Staates. of science proscribed him, as they had eminently fitted for the post by his mas- Auenbrugger, and the director of the tery of physical diagnosis, Skoda made Allgemeines Krankenhaus, deluged his department the high school of all with complaints from patients that they who would learn the clinical applica- were being annoyed by the too frequent tions of pathologic anatomy. His ex- examinations of Herr Secundarius ceptional powers of observation and Skoda, deprived him of visiting privi- extraordinary discernment, the pro- leges except in the psychopathic divi- found assurance with which he exam- sion. Thereafter, only the kindness of ined patients, and his command of the Primarius Josef Ratter, who opened his art of precise description and lucid wards to Skoda, made it possible for exegesis were the qualities which ex- him to continue his investigations. cited the admiration and gained the re- Worry about his future induced him at spect of his pupils. He grew more and this time to seek a place as district physi- more prominent, his practice increased cian in the provinces, but all of his ap- enormously, and his opinions came to plications were rejected. A few years be regarded as infallible. His profes- later he failed to obtain the professor- sional colleagues sought his advice in ship at Prague. In 1839 he left the All- difficult cases, and his clinics were over- gemeines Krankenhaus to become dis- run with students of all ages and nation- trict police physician in one of the alities. He was, as Rokitansky said in suburbs of Vienna. 1846, “a shining light for those who If the minister of medical education, would learn, an ideal for those who Freiherr von Turkheim, was aware of would strive, a rock for those who were the fact that Skoda’s work had begun to discouraged.” He wrote very little, but attract eager young physicians who were like Schonlein, who wrote even less, he interested in physical diagnosis, obvi- exerted a profound influence on the ously he did not consider it especially growth of scientific medicine. In 1871 important, but a brilliant diagnosis he was compelled by failing health to which Skoda made in consultation with give up his position, but it was ten years Turkheim so excited his admiration before death brought him release from that he created a new department of the misery and suffering of his last years. chest diseases at the Allgemeines Kran- Skoda has been much criticized for kenhaus, and placed Skoda in charge his therapeutic nihilism,14 his neglect of (1840). This event marked the turn of the artistic and psychic side of medicine, the tide in Skoda’s fortunes. The papers and for overemphasizing the impor- which soon began to issue from this de- tance of confirming clinical diagnoses partment attracted so much attention by postmortem examination. Such criti- that within a year Skoda was made cism does not take account of the fact Primarius and director of a division. that in Skoda’s day, to paraphrase Mar- When Franz Wilhelm Lippich died, tin Fischer’s famous epigram, diagnos- leaving the professorship vacant, Skoda ticians were the stars in the firmament, became a candidate for the position, therapists the darkness in which they but the competition of Theodor Helm, floated. The charming manners and Johannes von Oppolzer and others was 14 Neuburger has shown that therapeutic so formidable that he was awarded the nihilism was not a creation of the New place only by virtue of heroic efforts on Vienna School but an inheritance from the the part of his supporters (1846). Pre- Old. voluble ignorance of generations of into the virgin realm of pathogenesis. bedside philosophers had not succeeded His objective was virtually the same as in advancing the art of pathognomy Laennec’s, viz., to recognize pathologic beyond the gaseous stage, and it was entities by means of anatomic changes high time for a thoroughly realistic, ra- in organs, to establish these entities tional, and perhaps even somewhat clinically, preferably by objective signs ruthless, pursuit of tangibles and pon- exclusively, and to discover efficacious derables. Without minimizing in the means of destroying disease. The rich least the perennial importance of the material at his disposal afforded an un- artistic and psychic aspects of medi- paralleled opportunity to compare and cine, it may nevertheless be affirmed correlate clinical observations with ana- that contributions such as Skoda made tomic changes, and it was not long be- w’ere then, and still are, the principal fore he noticed that certain syndromes means by which clinical medicine grad- were invariably accompanied by distinc- ually replaces otherwise inevitable re- tive pathologic alterations. He began liance on art with an increasingly to feel that in these alterations the real broader foundation of applied science. nature of disease was to be sought, that It is unfortunate that an ingratiating anatomic conceptions must supplant personality does not always consort with semeiologic. His ambition was, as Wun- first-rate professional ability, but the derlich said, to transform pathologic fruits of talent, in whatever guise it pre- anatomy into anatomic pathology, and sents itself, provide all the ultimate he labored indefatigably to realize it. benefits of mankind. The substitution Some progress in this direction had al- of manner for substance has always ex- ready been made in France and Eng- erted a degrading influence on the prac- land; on German soil Rokitansky was tice of medicine. As for overemphasiz- the first to join the movement. ing the importance of correlating His preliminary papers in the clinical and anatomic diagnoses—that Medizinische Jahrbücher des öster- is quite impossible. reichischen Staates were followed by the Much as Skoda contributed, the bril- comprehensive “Handbuch der patho- liant progress which distinguished this logischen Anatomie” (1842-46), which period was to an even greater extent was to make his name known through- the achievement of Carl Rokitansky, out the entire medical world. Its rich who was born on February 19, 1804, at content of original material relating to Koniggratz in Bohemia. He began his subjects both new and old reflected studies at Prague and continued them Rokitansky’s unparalleled experience at Vienna, where he was graduated. A and grasp of the literature. He etched few years later he became Johann Wag- his verbal pictures of pathologic changes ner’s assistant at the Pathologic Insti- so vividly that the absence of illustra- tute, and in 1832 succeeded his chief. tions was scarcely noticed. Subsequent Not satisfied simply with discharging students of the subject have changed his manifold duties as instructor in little that he wrote, for as a descriptive pathology, custodian of the museum of pathologist he has had no superiors. pathology, prosector of the Allgemeines Only when his impetuous fancy and Krankenhaus, and judicial anatomist of eagerness to anticipate the unknown led Vienna, Rokitansky attempted to reach him into speculation has the judgment beyond routine pathologic anatomy of posterity gone against him. Virchow, who was a much better chemist than ship until 1875. He was honored by Rokitansky, promptly challenged and many learned societies, and created effectively demolished his nebulous doc- Freiherr von Rokitansky. His death oc- trine of erases and stases, as a result of curred on July 23, 1878. which subsequent editions of the Hand- In addition to his talents as an ob- buch were much superior to the first. server, Rokitansky possessed the rare In 1834 Rokitansky was made asso- gift of being able to evaluate his own ciate professor, and in 1844 professor, contributions in relation to the evolu- of pathologic anatomy; in the latter year tion of culture. Aided largely by his the courses in pathology and necropsy studies in philosophy, of which he was technique were made obligatory for all very fond, he succeeded in achieving an students of medicine and surgery. Large impersonal viewpoint which saved him numbers of native and foreign students from the narrow onesidedness to which soon collected around the new master, so many investigators whose activities and able assistants, including Jakob are restricted to special fields fall vic- Kolletschka and Josef Engel, were tim. It was through his efforts to over- trained under his direction. “Now one come the passive resistance offered to could learn something again in Vienna; philosophy by physicians that the chasm there were things to be seen for which between philosophy and the natural one would look in vain everywhere sciences was bridged. else,” wrote Wunderlich, who was one Dermatology, a subject to which little of the first foreigners to be attracted by attention had been paid in Vienna, was the Viennese renaissance. revived by the genial Ferdinand von Rokitansky was the recognized head Hebra (1816-80), of Brünn, in Mähren, of the nineteenth century school of de- who ranks with Rokitansky and Skoda scriptive pathologists. His high rank as a major luminary of the New Vienna professionally, the magic of his person- School. In 1841 Hebra became an as- ality, his keen understanding, which sistant in the Exanthemata Division enabled him quickly to master any sub- under Skoda. At the latter’s suggestion, ject, even when it lay far outside his he made a systematic comparison of field, his broad culture, powerful will, the plentiful material at hand with the untiring lust for work, and justifiable writings of Robert Willan, Thomas self-confidence, a trait which is common Bateman, J. L. d’Alibert, G. L. Biett, in those who have no one but them- P. F. Rayer, C. H. Fuchs and others, selves to thank for what they are, and, and in this way not only became extraor- finally, his nobility of character, were dinarily expert at differentiating skin the qualities which maintained and in- lesions, but soon discovered that many creased his influence, not only in the of them had either been missed en- medical faculty, but in all educational tirely, or only imperfectly grasped, by and public affairs. He was the first to be previous observers. When it was pro- chosen dean of the medical faculty after posed to transfer him to another de- the reorganization of 1848, and the first partment, Skoda asked that he be professor to become rector of the uni- allowed to remain, saying that “Dr. versity. In 1863 he entered the ministry, Hebra has devoted himself with so and four years later assumed the port- much zeal to the study of skin diseases folio of education, a position which he that we may well expect valuable sci- held in conjunction with his professor- entific contributions from him in this field, and dare not separate him from Isidor Neumann and Heinrich Auspitz the work which he has so well begun.” were among his pupils. In 1842 he was made Secundarius, and No one disputes Garrison’s assertion thenceforth practically directed this de- that the “greatest single achievement of partment. Three years later, when the New Vienna School was the de- Skoda gave up all control over it, termination of the true cause and pro- Hebra became physician-in-ordinary, phylaxis of puerperal fever.” All the but not until 1848 was the department credit for the discovery belongs to of dermatology organized, with Hebra Ludwig Ignaz Philipp Semmelweiss as Primarius. (1818-65), a Hungarian pupil of In 1845 Hebra initiated the second Skoda’s and Rokitansky’s. In 1847, phase in the modern development of Semmelweiss, who was serving as assist- dermatology with a classification of ant in Klein’s obstetric clinic at the skin diseases based on their pathologic Allgemeines Krankenhaus, came for- anatomy. This classification has been ward with the assertion that the high called unnecessarily complicated and incidence of puerperal fever for which artificial, but Hebra himself said of it: this clinic was infamous was due to the “Although artificial, it is not unnatural, fact that students came directly from and although not natural, it is very the dissecting room to the wards, and much like nature in that it arranges infected the pregnant and puerperal the skin diseases which belong together women by making vaginal examina- according to their nature and essential tions with contaminated hands. He character, and undertakes no arbitrary pointed out that in the second ob- separation of related evils.” It is there- stetric clinic, which was reserved for fore apparent that he devised it deliber- the instruction of midwives, the mor- ately; and subsequent developments bidity was much lower. He followed demonstrated its value. Although the the fatal puerperal cases into the nec- true nature of scabies had been dis- ropsy room, and when Kolletschka, covered many years before by Johann Rokitansky’s assistant, died of infection Ernst Wichmann (1786), it was still following a wound inflicted at the regarded as a constitutional disease pro- autopsy table, Semmelweiss noticed that duced by a dyscrasia of the body juices. the postmortem appearances were the Hebra attacked this doctrine resolutely. same as those he had seen in the women He proved that the Acarus scabiei, the who died of puerperal fever. existence of which had been known in Convinced by this experience that the disease or as an intercurrent invader his deductions were correct, he required for centuries, was not a consequence of everyone to wash his hands in a solu- the lesions, but the sole etiologic fac- tion of calcium chloride before making tor, and that the disease was therefore vaginal examinations, with the result purely local in character. Hebra was that the mortality rate soon fell from the first to describe impetigo herpeti- 18 to 3 per cent. This startling event formis, revived the use of mercury in attracted so much attention that the syphilis, and enriched the literature faculty appointed a commission to make with papers on lichen ruber, eczema an investigation. Klein, manifesting marginatum, erythema multiforme, that hatred of new ideas so characteris- pityriasis rubra, lichen scrofulosorum tic of the bigot, used his influence with and rhinoscleroma. Moritz Kaposi, the ministry to have the investigation nullified. Even the support of Rokitan- There his prodigious industry gave rise sky, Skoda and Hebra was of no avail to a flood of papers dealing with vas- against the opposition of Klein and the cular ramifications in the skin of birds pontifical disdain of such prominent and amphibians, anomalies of the veins obstetricians as Scanzoni and Carl in man, vascular anomalies important Braun. Driven from his position, finally, in surgery, the cartilages of the knee by the many mortifying discourage- joint, the musculature of the face and ments to which he was subjected, Sem- ear, including a description of the stylo- melweiss left Vienna to become profes- auricular muscle, the structure of the sor of obstetrics in Budapest (1855). inner ear in man and other mammals, His great treatise on “Die Atiologie, der the muscles of the mediastinum, the Begriff, und die Prophylaxis des Kind- mechanics of the hip joint, etc., and a bettfiebers,” and his caustic “Open textbook of human anatomy in its physi- Letters to Sundry Professors of Obstet- ologic and practical aspects (1845) rics,” a masterpiece of invective, ap- which was later translated into all mod- peared in 1861. He regarded it as a ern languages, and passed through holy mission to spread the knowledge twenty-two editions. of his discovery, for which he fought Hyrtl’s acceptance of Vienna’s invita- with phrenetic zeal; his failure embit- tion was a great triumph for the uni- tered him deeply, and gradually affected versity, and one of the principal reasons his mind. He died at the age of forty- for its subsequent period of fruitful- seven in the psychopathic hospital at ness. “Hyrtl was for thirty years the Dobling, a martyr to bigotry in its most most fascinating and popular lecturer egregious form. “Semmelweiss is . . . on anatomy in Europe”;15 the audi- the true pioneer of antisepsis in obstet- torium of the Anatomical Institute rics, and while [Oliver Wendell] could scarcely hold the crowds of en- Holmes antedated him in some details thusiastic students who came from all by five years, the superiority of his over the world. work over that of his predecessor lies His lectures were clear, concise, elo- not only in the stiff fight he put up for quent presentations of what he himself his ideas, but in the all-important fact knew, interspersed to an extraordinary de- that he recognized puerperal fever as gree with witty epigrams, classic quota- a . . . septicemia” (Garrison). tions, anecdotes, and veiled allusions of a Josef Berres (1796-1844), who be- questionable character. Hyrtl did not go came professor of anatomy in 1831, dis- in for merging his science into histology, tinguished himself by his ability to like Henle, but kept up the straight Vesa- arouse the interest of the students, by lian tradition of teaching gross or regional his microscopic and photographic tech- anatomy, and he succeeded, both as writer nique, and by his studies of the capil- and lecturer, in making a dry subject pi- quant as well as interesting. Zuckerkandl laries, arterioles and venules. He was said, “He spoke like Cicero and wrote like succeeded in 1845 by Josef Hyrtl Heine.” He made no great discoveries, (1810-94), a native of Eisenstadt in and as an independent investigator he is Hungary. In 1833, while still a stu- not in Henle’s class, but is to be regarded dent, Hyrtl became prosector in the rather as the unapproachable teacher and Anatomical Institute. He was graduated 15 This and the succeeding quotations are in 1835, and two years later was ap- from Garrison, who writes con amore of pointed professor of anatomy at Prague. Hyrtl’s scholarly attainments. technician and one of the greatest of med- When the university of Vienna cele- ical philogists, a man to whom written and brated its 500th anniversary in 1865, spoken Latin were as his mother tongue. Hyrtl enjoyed the honor of standing at The first nineteen editions of his its head as Rector magni ficus. In 1874 famous textbook had no illustrations, he resigned his position voluntarily and “the deficiency being largely supplied retired to his estate at Perchtoldsdorf, by Hyrtl’s clear, beautiful, straightfor- where he utilized his otium cum dig- ward style, closing immediately with the nitate to write “his three masterpieces subject in hand, and his wealth of his- on Hebraic and Arabic elements in toric and cultural allusions.” anatomy (1879), on anatomic termi- In 1847 Hyrtl published the nology (1880), and on old German anatomic expressions (1884). Hyrtl . . . first topographic anatomy in the Ger- ranks with Emile Littré as one of the man language, which despite its lack of il- lustrations, is doubly fascinating by rea- greatest of modern medical scholars, son of the same display of historic and and these books show him at his best philologie knowledge. His manual of dis- in a field which was his very own.” secting, published in i860, is a classic of It became apparent as early as 1820 the same rank with Virchow’s book on that the old Narrenturm was no longer post-mortem sections, and his “Corrosions- big enough to accommodate the increas- Anatomie” (1873) is a permanent me- ing numbers of psychopathic patients, mento of his unique skill in making ana- and a large new hospital was planned, tomic preparations. These, the wonder but for one reason or another the and admiration of Europe, included his project was postponed until 1848. The unrivaled collection of fish skeletons, all building of this hospital required four prepared by himself; his models of the years and cost 1,200,000 florins ($576,- human and vertebrate ear; his micro- 000). It was opened in 1853 with ac- scopic slides and the corroded prepara- commodations for 553 patients. The tions (his own invention), consisting of injections of the blood supplies of the dif- urgent need for larger general hospital ferent organs and regions, with the adja- facilities was met by a donation from cent parts eaten away by acids, to show Kaiser Franz Josef, designated as the the finest ramifications. His favorite fields Rudolf-Stiftung in honor of the birth of investigation were, in fact, the vascu- of Crown Prince Rudolf (1858), which lar and osseous systems. He discovered the made the Rudolfspital possible. Its 860 portal vein of the suprarenal capsules, the beds became available in 1865. The branchial veins of fishes, the origin of the small and unsuitable building made coronary arteries (1854), and made a col- famous by Rokitansky at the Allge- lection of hearts devoid of blood supply. meines Krankenhaus was superseded by Everything he did was stamped with orig- a commodious new Pathologic Institute, inality and self-will. He opposed Brücke’s erected at a cost of 200,000 florins theory of the autonomy of the heart with ($95,000), and opened with elaborate such harsh personalities that there came ceremonies on May 24, 1862. to be a Hyrtl faction and a Briicke faction in Vienna. Nothing delighted him more The celebrated ring wall of Vienna than to lavish praise upon the work of a remained standing until the middle of younger man, and in this unique regard the nineteenth century, although the he is like Müller and Ludwig, Virchow Turkish menace had long since ceased and Pasteur, those incomparable teachers to exist. It was used chiefly as a fashion- of youth. able promenade, and the glacis which lay beyond it, an open space 1800 feet later realized. These proposals in- wide, served as a parade ground for the cluded doing away with the lower army. While walking on the wall on courses for wound surgeons; raising February 18, 1853, the young emperor surgery to full equality with internal Franz Josef was attacked and stabbed medicine; lengthening the courses in by a would-be assassin. He was fortu- anatomy to two semesters; founding of nate enough to escape serious injury, a physiologic institute, an introductory but the incident called attention anew clinical institute, and two parallel sur- to the general uselessness and incon- gical clinics; separation of the depart- venience of the old wall and glacis, ment of pharmacology from that of which were hindering the expansion of general pathology; assignment of the the inner city, and a few years later the courses in natural science to the philo- historic bastions were removed. A sophical faculty; creation of associate superb boulevard, the Ringstrasse, was professorships in psychiatry, pediatrics laid out where the wall had been, half and comparative anatomy; instruction of the broad strip of land was sold, and in German instead of Latin; abrogation the money realized ($50,000,000) was of the rule that only certain prescribed used to construct a series of magnificent textbooks might be used; abolition of public buildings, one of which was a the annual examinations; stiffening the new home for the university. The old Rigorosen and extending them to in- university building, which had been in clude all branches of medicine; and use since 1756, was taken over in 1857 discontinuing the inaugural disputa- by the Akademie der Wissenschaften. tions and dissertations. Skoda called at- After considerable delay, the plans tention to the necessity of providing the drawn by van der Null and Siccards- university with special institutes for burg were accepted, and in 1871 the pharmacology and pharmacy; normal, work of construction was begun. The pathologic, topographic, and surgical new location was close to the clinical pathologic anatomy; medical physics, departments and the various institutes, medical chemistry and state medicine; facilitating intercourse between the and clinics for internal medicine, sur- medical faculty and its sister faculties, gery, obstetrics, ophthalmology, and and offering the members of the former syphilis and dermatology. Some of these the opportunity to avail themselves of were either wanting entirely, or were the rich resources of the university li- inadequately endowed. Physiology, es- brary more easily than ever before. pecially, had been neglected. The newer The effects of the revolution of 1848 methods of instruction and research on medical affairs in Vienna proved to which were being used so successfully be, on the whole, beneficial. Thanks to in France by Magendie, Flourens and Graf Leo Thun, the university not only Longet, and in Germany by Müller, maintained its independence during the E. H. Weber and Purkinje, had not yet period of reaction, but continued to reached Vienna. make definite progress. Many of the pro- The fourth decade of the nineteenth posals for the reform of medical educa- century witnessed tremendous advances tion which had been offered in 1845 in physiology, as well as in many other by a commission composed of Endlicher, branches of natural science. Schleiden’s Schuh, Lippich, Hyrtl, Rokitansky, fundamental work in botany, Schwann’s Kolletschka, Toltenyi and Skoda were discovery of the animal cell and of the similarities in the structure and growth the mechanism which enables the of plants and animals, and Liebig’s chameleon to change its color, the effect study of organic chemistry in its rela- of complementary colors on binocular tionship to physiology and pathology vision, demonstrated that the human opened the way for a better under- eye is not perfectly centered, made standing of the obscure processes which pioneer observations on the physiology until that time had been summed up of speech, proved that the endothelium by the designation “vital force.” Lotze, keeps blood fluid in vivo, and that sugar who attacked the belief in “vital force” may be present in the urine of normal with keen weapons, began to regard persons. His theory that the coronary general pathology and therapy from arteries fill during diastole and are the standpoint of mechanistic science, covered over by the aortic leaflets dur- but many years were yet to elapse be- ing systole was attacked viciously by fore the old doctrine was displaced by Hyrtl. Brücke continued to be active the cell theory, the great importance for more than three decades after he of which for pathology and practical came to Vienna. In 1879 he became medicine was first appreciated by rector of the university, and was raised Virchow. to the nobility in a category never be- Vienna had little part in these devel- fore attained by any of his colleagues opments until Ernst Wilhelm von except Rokitansky. Brücke (1819-92), a pupil of Johannes One of the most fortunate events in Müller, was called to the chair of physi- the long history of the university oc- ology. Brücke began his studies at curred when Theodor Billroth (1829- Berlin and Heidelberg. While still an 94) accepted the invitation to succeed undergraduate he published in Mfiller’s Franz Schuh as director of the surgi- Archiv papers dealing with such diverse cal clinic. Billroth was born at Bergen, subjects as rigor mortis and the phe- on the island of Rügen, and was edu- nomena of stereoscopic vision. As cated at Göttingen and Berlin. While Mfiller’s assistant, he was a colleague of he was still an undergraduate he at- Schwann, Henle and du Bois-Reymond. tempted difficult scientific tasks, one For years he conducted a department in of which, an investigation of the effects the journal of the Berlin Physical So- of cutting the vagus nerves, undertaken ciety. He did good work on colors, the at Traube’s suggestion, formed the sub- finer anatomy of the eye and bile chem- ject of his graduation thesis. In 1853 istry, and his studies in physiological he became Langenbeck’s assistant at optics prepared the way for Helmholtz’s Berlin, where he had abundant oppor- invention of the ophthalmoscope. In tunities to learn operative surgery, and 1848 he became professor of physiology time besides for general pathology and at Königsberg, wrhence he removed a normal and pathologic histology. His year later to Vienna. studies of the development of blood Physiology is indebted to Brücke for vessels in the area vasculosa of the chick many contributions. He studied the embryo, the normal, comparative and contractility of the gall bladder, the pathologic histology of the spleen, the mechanism of gastric digestion, the structure of polyps, the structure and finer structure of skeletal muscle (by development of tumors of the mam- means of polarized light, which showed mary and salivary glands, the structure that the cells were not homogeneous), of lymph nodes, etc., attracted so much attention that in 1858 he was offered with the help of an artificial larynx the professorship of pathology at Greifs- constructed by Karl Gussenbauer, one wald. This he declined, but two years of Billroth’s assistants, he regained his later he accepted the chair of surgery ability to speak loudly and clearly. In at Zürich. While at Zürich he investi- another case he removed the larynx and gated wound fever, resorption and nor- pharynx, together with the greater part mal growth of bone, periostitis, and of the esophagus, the upper rings of caries. the trachea and the thyroid gland. Re- Billroth’s literary activity was pro- section of the pylorus for cancer, which digious. His Handbuch of surgical had been attempted several years earlier pathology and therapy was so popular by Jules Pean, was first performed suc- by reason of its elegant and pleasing cessfully by Billroth. His fame spread form and the ease with which the dif- everywhere and many universities ficulties of presenting the subject were sought his services. While he was still overcome that a new edition was neces- at Zürich he received calls to Rostock sary almost every year. He was co- and Heidelberg; these he declined, as founder with G. A. Lücke of Deutsche he did the flattering invitation to par- Chirurgie, collaborated with Franz von ticipate in the founding of the new Pitha in the preparation of a large German university of Strassburg. He treatise on surgery, and was one of the reached the heights when he was asked most sedulous coeditors of Langen- to become the successor of his old chief, beck’s Archiv für klinische Chirurgie. the famous Bernhard von Langenbeck, His voluminous papers dealing with but fortunately for Vienna he decided almost every aspect of military surgery to remain. Billroth sought relaxation were based on his own experiences in in music, for which he had great talents. the Franco-Prussian war. Among his best known pupils were At a time when the science of bac- Alexander von Winiwarter, Johann von teriology had been conceived, but not Mikulicz-Radecki, Vincenz Czerny, An- yet born, Billroth, with his “cocco- ton Wölfler and Anton von Eiselsberg. bacteria septica,” had undoubtedly Oppolzer’s successor as director of grasped the correct conception of wound the second medical clinic was Heinrich infection. As an operator Billroth took von Bamberger (1822-88), who was high rank. His cleverness, calm cer- born at Prague, studied at Prague and tainty, and the courage and boldness Vienna, worked as assistant at Prague which he evinced in carrying out the and in Oppolzer’s clinic, and in 1854 most difficult technical procedures ex- became professor of practical medicine cited the admiration of surgeons and at Würzburg, where he remained until won him the confidence of patients. his removal to Vienna in 1872. Among Many of the most noteworthy advances his many important contributions to made by operative surgery in the last clinical medicine was his description of half of the nineteenth century are as- the Bamberger-Marie syndrome of pul- sociated with his name. He was the monary osteoarthropathy, which, inci- first to resect the larynx; the case was dentally, was known to Billroth as one of carcinoma of such a nature that Perlmutter Krankheit long before Bam- it would have been almost surely fatal berger described the first case. within a short time. The patient’s life It was due almost entirely to Bam- was prolonged by the operation, and, berger’s unselfish initiative that Her- mann Nothnagel (1841-1905) was the achievements of more recent times. selected to succeed Adalbert von Du- In 1904 Max Neuburger succeeded chek as head of the first medical clinic Theodor Puschmann as professor of (1882). Nothnagel was graduated at the history of medicine, and has dis- Berlin, became assistant to Traube and tinguished himself by many important later to von Leyden, and occupied suc- contributions. The meningococcus was cessively the professorships of medicine discovered in 1887 by Anton Weichsel- at Freiburg in Breisgau and Jena. His baum. Robert Bárány introduced a brilliant investigations in physiology, number of ingenious methods of test- experimental pathology, pharmacody- ing the equilibratory apparatus and namics and practical therapy soon elucidated Méniére’s syndrome. Carl brought him scientific recognition, and von Noorden, Nothnagel’s successor, his contributions to neurology were made important studies of metabolic among the most noteworthy accomplish- disorders. Karl Friedrich Wenckebach ments of the latter part of the nine- did outstanding work on disorders of teenth century. Westphal called his the heart beat. Anton von Eiselsberg “Topische Diagnostik der Gehirn- produced tetany experimentally in krankheiten” (1879) the best treatise 1892. Ernst Fuchs, a pupil of Briicke ever written on the subject. Nothnagel and Billroth, became the foremost is remembered today chiefly for his en- ophthalmologist of Europe. Sigmund cyclopedia of Special Pathology and Freud gave psychoanalysis to the world. Wagner von Jauregg introduced the Therapy (1894-1905), a monumental malarial treatment of general paresis. work of twenty-four volumes. He Clemens von Pirquet devised the cu- emerges from the pages of Neuburger’s taneous tuberculin test and stated the delightful biography as a charming and doctrine of allergy. And, in the minds genial man who was also courageous and hearts of thousands of students of enough to attack anti-Semitism fiercely every race and nationality throughout when it swept through the university the entire world, Jakob Erdheim, the in one of its periodic recurrences. last of the great Rokitansky school of One of the minor achievements of descriptive pathologists, has taken his the New Vienna School was the intro- place as the incomparable teacher of duction of laryngoscopy and rhinos- youth. copy. The modern laryngoscope, which In Vienna today not much remains was invented in 1855 by a Spanish sing- except the great traditions of a glorious ing teacher, Manuel Garcia, was past, but who can say that the Austrian adapted to diagnostic purposes in 1858 phoenix will not rise again to preen by Johann Czermak and Ludwig Tiirck. its feathers in the pleasant warmth of A hurried glance must suffice for a world’s admiration? Princ ipal Sou rces Baas , J. H. Outlines of the History of Medi- Neuburger , M. Das alte medizinische Wien cine. Trans, by H. E. Handerson. N. Y., in zeitgenössischen Schilderungen. Wien, Vail, 1889. Perles, 1921. Encyclopaedia Britannica. Ed. 11, 1910. Pus ch man n , T. Die Medizin in Wien wäh- Gar ris on , F. H. An Introduction to the His- tory of Medicine. Ed. 4, Phila., Saunders, rend der letzten 100 fahre. Wien, Perles, 1884. 1929- Mahan , J. A. Vienna Yesterday and Today. Tie tz e , H. Wien: Kultur, Kunst, und Ge- Ed. 2, Vienna, Halm & Goldmann, 1928. schichte. Wien, Epstein, 1931.