The History of Medicine at

JAN BROD, md, frcp Professor of Medicine, Hanover , Hanover, West Germany

The history of the oldest university north of the Alps and that they are Italian. By the same reasoning the Czechs east of Paris, in the heart of the old Czech kingdom of should not be denied the honour of their capital being the , in the city of , started with the first seat of the first university in Central . contact between the Czechs and the English on the During his years in Paris, Charles had been a student battlefield of Crecy on 26th August 1346. The blind at the Sorbonne, which he used as the model for the new Czech king, John of Luxembourg (1310-1346), and his University of Prague. From the start, there were four son Charles (1322-1378), were helping their French rela- faculties: , Law, Philosophy (Arts) and Medi- tive, Philip VI, against the English led by Edward III and cine. At first there were no proper buildings and the his son, the Black Prince. King John fell on the field and professors gave their courses in their quarters, but the three ostrich feathers on his helmet have since Charles soon bought the house of the Jew Lazarus in the adorned the coat-of-arms of the Prince of Wales. The new Old City of Prague, and it became a college with 12 king, Charles, while recovering from his wounds at the professors and housed the library. The university was Cistercian monastery at Ourchamps, had time to medi- transferred to Rotlev House, near the church of St tate on his future tasks as successor to his father, whose Gallus, in 1366, which is still the seat of the university romantic chivalrous temperament had made him partici- (Fig- 1). pate in every possible war, leaving his country in a state of chaos and poverty. Charles, known to posterity as the 'Father of his Country', planned the foundation of a Fig. 1. The Karolinum, with the original Gothic window. studium generale' a university in his capital, Prague. The plan was not new. Fifty-four years earlier, his maternal grandfather, Venceslas II (1278-1305) of the old Premysl dynasty, had thought of it but failed to raise the necessary money. Charles approached Pope Clement VI, who, as Petrus Roger, Abbot of Fecamp, had been his childhood tutor, and obtained a golden bull from him, issued in Avignon on 26th January 1347, authorising the foundation of a university in Prague whose degrees would he accepted throughout Christendom. On 7th April 1348 Charles handed over the founding bull to the first Chan- cellor of the new university, the first Archbishop of Prague, Arnost of Pardubice. In his edict Charles expressed his anxiety that 'the ^habitants of his kingdom of Bohemia?thirsting for knowledge?should not be obliged to beg for education in foreign lands but should find a table covered for them in the [Bohemian] kingdom'. (It has been repeatedly main- tained in Germany that the University of Prague was the first German institution of its kind.) Charles's edict clearly stated that the 'studium generale' was intended Primarily for the inhabitants of his own kingdom, the great majority of whom were Czechs, although students from any foreign country were welcome and would receive the same privileges, freedom and royal protection. J^he language of the university was, of course, Latin. *here were already two much older universities in the ?in Padua and Bologna?also founded by local princes. Their language was also Latin and they also attracted many students from other parts of the Holy Roman Empire and Europe, but nobody denies

Journal of the Royal College of Physicians of London Vol. 16 No. 3 July 1982 195 The officers of the university, who were elected annual- sided with the progressive cardinals who thought that ly by the academic community, were the Rector Magnifi- obedience should be refused to both the Pope in Rome cus and the Deans of the four Faculties. The students and the Pope in Avignon and that a new Pope should be were divided, according to their country of origin, into elected. At the university, whose advice and approval he four 'nations', each of which had one vote. They were: sought, however, Venceslas was out-voted by the three 1. Bohemian, comprising the Czechs and Germans living foreign 'nations'. So it was easy for Hus to persuade the in Bohemia, southern Slavs, and Hungarians. king that the voting arrangements were not in the 2. , Lithuanians, Russians and Silesians. national interest of Czechs, and on 18th January 1409, 3. Bavarians, Germans from Austria, Franconia, Swit- the king issued a decree which reversed the ratio of Czech zerland and the Rhineland, and Dutch. to foreign votes to 3 to 1. This was a Pyrrhic victory for 4. Saxons from Northern Germany and Scandinavia. the Czech cause at the university, for between 2,500 and The reason for the disparity between Czech and foreign 3,000 foreign students and Masters, mostly German, left votes was Charles's wish to attract scholars from abroad Prague and founded a German university in Leipzig in to Prague. In this disparity was the seed of the disaster 1410. With the leading scientific authorities gone, and the that befell the university sixty years later. adherents of the Roman church banned from the univer- All was peaceful in the years 1350-1360. The first sity (in 1416), the life and activities of the university were professor of medicine was the king's personal physician, paralysed and the number of Bachelors of Arts fell to Balthasar from Domazlice, and medicine was also taught three in 1414. by Master Walther, Balthasar's predecessor at the court On 6th July 1415, Hus suffered a martyr's death at the of Charles's father, King John. Medical studies lasted stake in Constance, and the same fate later befell his five years, the curriculum of the first, fourth and fifth friend and colleague, Master Hieronymus of Prague. The years including the writings of Hippocrates (Aphorisms, news of these humiliations spread like fire throughout the Prognostica), Avicenna's Canon, Ga\en's Anatomy and Sur- Bohemian kingdom and incited the masses to revolt. On gery and Gordon's De signis criticis et de phlebotomia; the 30th July 1419, a stone was thrown from the window of second and third years dealt with diet, fevers, urine and the New City Hall at a procession of Hus's followers, who the pulse, diagnosis and therapy. Medicinal plants played then broke into the Town Hall, threw seven councillors an important role in therapy. Of the prominent figures in from the window (the first defenestration of Prague) and Prague medicine during the first 100 years of the univer- appointed their own city officers. When the news reached sity, M. Sigismund Albik (1358-1427), physician to him at his hunting lodge in Kunratice, south of Prague, Charles's son Venceslas IV (1378-1419) deserves men- Venceslas IV suffered a stroke and died a fortnight later. tion. He wrote treatises on personal hygiene, rheuma- The Czechs refused to accept his younger brother Sigis- tism, and antidotes against poisons, as well as several mund as his successor, because they thought him guilty of books on plague. Hus's death, and a war, which lasted until 1434, broke Of the university students, 15 per cent were enrolled in out. University activities were suspended until 1430 and the Faculty of Medicine which in 1405 obtained a build- the Faculty of Medicine was closed in 1460. There is no ing from Venceslas IV. The degrees open to the medical record of activity for the following 150 years. During students were Master of Obstetrics, Master of Surgery, those years medicine was taught as a craft by apprentice- and Doctor of Medicine; in the third year the bachelor- ship. In spite of this, several Czech monographs were ship was obligatory. Between 1366 and 1409 the number published?on plague (Berka from Chocen, 1494-1545), of Bachelors of Arts (which included medicine, astronomy on medicinal herbs (Thaddeus Hajek, 1525-1600, physi- and law) bestowed was 3,823, and during the same period cian to King Rudolf II (1576-1611) and founder of the 844 Masters of Arts were created. The total number of Czech botanical nomenclature); on personal hygiene (A. students at any one time was up to 10,000. University life Huber, A. Rosacius), and on rules for expectant mothers was very intensive and Charles IV frequently took part in (Nicolas Klaudyan). the weekly disputations. In 1555 the first hereditary Habsburg king on the But storms lay ahead. The disorders in the Catholic Czech throne, Ferdinand I (1526-1564), founded a Jesuit church, the luxurious life of the rich clergy, the papal college in the Clementinum in Prague (Universitas Fer- schism and the selling of indulgences excited widespread dinandea), which was richly endowed. Charles Universi- criticism, particularly in the writings of the Oxford ty was reformed towards the end of the sixteenth century. philosopher and theologian, John Wycliffe. This learned At the invitation of the king's astronomer, the Dane man was a friend of Queen Anne, sister of Venceslas IV Tycho Brahe, Jan Jesenius, a German-speaking Slovak and wife of Richard II of England. After her death in nobleman educated in medicine in Leipzig and Padua, 1394, her Czech courtiers returned to Prague and they professor of surgery and anatomy in Wittenberg, carried and Czech students may have brought Wycliffe's writings out, on 6th June 1600, the first public autopsy in Prague with them. They found an ardent and eloquent apostle in before 1,000 spectators. In 1602 he moved permanently Jan Hus (1369-1415), Master of Theology and Arts, to Prague and in 1617 became a professor at Charles Rector of the university in 1402 and preacher at the University, and its Rector. At the time the conflict Bethlehem Chapel in Prague, whose passionate and between the Czech Protestants (Hussites) and the Catho- inflammatory sermons were attended by more than lic king was approaching its climax, which was reached on 10,000 people each Sunday. In the struggle between the 23rd May 1618, when the two Lords-Lieutenant and two Popes, Venceslas IV (who was also the Roman king) their secretary were thrown out of the window of their

196 Journal of the Royal College of Physicians of London Vol. 16 No. 3 July 1982 office in the castle of Prague (the second defenestration). ened sons, later Joseph II and Leopold II. Religious The Czech Estates thereupon declared the Habsburgs to tolerance was ensured by a patent, the Jesuit college in be deprived of any rights to the Czech throne and started the Clementinum was closed, and in 1784 Latin was a military action against the Habsburg emperor, which replaced by German at the Carolo-Ferdinand University. marked the beginning of the Thirty Years' War. Frederic At the same time, as a result of the influence of Maria of the Palatinate was elected Czech king, one of the Theresa's personal physician and adviser in sanitary reasons for this choice being that his wife Elisabeth was matters, the Dutchman Gerhard von Swieten (1700- the daughter of the English King James I and the Czech 1772), the General Hospital in was created and Estates hoped for his support in the ensuing conflict. But the empress ordered that by law an autopsy was to be they had completely miscalculated: all that James sent his performed on everybody dying in a university hospital of son-in-law was 30 knights who never got as far as the the Danube empire. Prague soon followed suit. In 1790 battlefield in the fatal Battle of the White Mountain at the the home for old ladies of noble birth, on the south side of western approaches to Prague on 8th November 1620, Charles Place, became part of the General Hospital, and which cost the Czechs their liberty for 300 years. Jan the building, reconstructed on innumerable occasions and Jesenius, a most eloquent defender of the Protestant quite inadequate for its present task, functions in the cause, was arrested, together with 26 other leaders of the same capacity to the present day. The lunatic asylum was Czech rebellion. He was beheaded with them on 21st also opened in 1790 and one year earlier the maternity June 1621 in the Old City Square in Prague, after his hostel next to the church of St Apollinarius. In the second tongue had been cut out. As a sign of special clemency on half of the nineteenth century, under professors Seyfert the part of his judges, the quartering of his body was and Streng, the hostel became one of the most prominent deferred until after the execution. The recently renewed schools of obstetrics in Europe, despite the fact that many activities of the medical faculty died with him. In 1623 the maternal lives were lost through its stubborn opposition Rector Troilus handed over the keys of the university to to the pioneering work of the Hungarian Semmelweis. the Jesuits. The number of professors of medicine fell to These institutions were originally intended for the two and eventually to one. Although in 1638, on the order treatment of the poor, for parentless children and for of the Archbishop of Prague, the faculties of medicine and patients suffering from 'revolting' diseases. They were law were taken out of the Clementinum, they were state owned and when, in later years, they began to be returned to the Jesuits again when, by the imperial order used for clinical teaching, the university professors and of Ferdinand III (1637-1657), the Jesuit academy was their staff acted as consultants. This dichotomy between united with the remainder of Charles University and state and university lasted until 1939. thenceforth bore the name Universitas Carolo-Ferdinan- The autopsies were carried out by medical students in dea. It was during these depressing times that William rooms reserved for this purpose in the eastern end of the Harvey, accompanying the Earl of Arundel, visited hospital, in close proximity to the wards. It was not until Prague, in 1636. He met the Professor of Medicine, 1837 that a forensic pathologist was appointed, who some Marcus Marci from Kronland, called the Hippocrates of 10 years later became the professor of pathology. A new Prague or the Czech Galileo, whose sound knowledge of pavilion was built for the Institute of Pathology in 1859. mechanics helped him with the treatment of fractures. In the early days of the emancipation of university life, Harvey explained to him the basis of his great discovery, at the turn of the eighteenth century, Prague was practi- which became the subject of a dissertation by Marci's cally a German-speaking city. Pushed by the government Pupil Jacob Forberger, 'De pulsu et eius usus'. However, in Vienna into the role of a provincial town, with the m later years the Faculty of Medicine of Prague was to Czech language eliminated from schools by the Jesuits side with the Sorbonne against Harvey's views on the and from offices by governmental decrees, the language circulation of the blood. stopped developing and was forgotten by many native In the second half of the seventeenth century the Czechs. However, its revival came towards the end of the Faculty of Medicine had four professors: eighteenth century, partly through the old Czech Ger- a professor praxaes primarius who in the first year man-speaking nobility, who saw in the revival of the taught fevers, in the second malignant diseases, in the Czech language a way towards the fulfilment of the third 'organic disease', in the fourth paediatrics and in political aspirations of the old Bohemian kingdom. A the fifth obstetrics; Czech newspaper was started, foreign literature was 2- a professor of general pathology; translated and, through the efforts of Josef Jungman, 3- a professor of physiology, pathology, hygiene and Josef Dobrovsk'y (Preceptor in the service of Count therapy; Nostic) and others, a rejuvenated Czech tongue was 4- a professor of anatomy and surgery (3 years) and heard in the first half of the nineteenth century in the botany (2 years). streets of Prague and other cities, on the stage of the However, little is known of the life of the faculty for the theatre of the Bohemian Estates (in which Mozart's Don next 150 years, during which Czech national life almost Giovanni had its world premiere on 29th October 1787) ceased to exist under the vigilant eyes of the Jesuit order and in the corridors of the university. It did not take long and the pressure of Germanisation. to penetrate the lecture halls, at first timidly, but around A change came about during the last ten years of the 1850 quite officially. of reign the Austrian empress and Czech queen, Maria At this time the greatest figure after Hus, Jan Evange- Theresa (1740-1780), due to the influence of her enlight- lista Purkinje (1787-1869) (Fig. 2), was appointed to the

Journal of the Royal College of Physicians of London Vol. 16 No. 3 July 1982 197 by the majority of the professors and students of both nations nor by the populace. In 1882 permanent conflicts eventually led to the division of the university into a Czech one and a German one. Under Austrian rule the Germans were privileged and, in addition, had the longer tradition. The German university was part of a wide- spread net of German universities with many scientific contacts and much interchange of scientists, while the Czech university was without a scientific background. It had to build up its tradition anew and was only slowly recovering from the past draining of the best brains? such as the internist Skoda and the pathologist Roki- tansky?by imperial Vienna. It is thus not surprising that in the days of Austrian rule the internationally best known names in medicine?Biedl, the founder of endo- crinology, Kohn, the discoverer of epithelial bodies, Klebs, the bacteriologist, and others?came from the German university. In 1918, amid the ruins of the Austrian empire, the Czech dream was fulfilled and the Czechoslovak Republic was born. The two universities continued their existence next to each other with no more mutual affection than in the Austrian days; witness the bitter fight that arose about the ownership of the old insignia donated by Charles IV to the university. Then came the fateful year 1938, with the Munich agreement between , Great Britain, and Germany. After illegal arms were discovered in its buildings, the German university was closed, to be re- opened six months later when the western part of Czecho- became a German In November Fig. 2. Jan Evangelista Purkinje. protectorate. 1939, the Czech university was closed and so remained until the end of the Second World War. In the restored chair of physiology newly created for him. He started his Czechoslovak Republic the German university was closed medical studies in Prague (1814-1818) but, having tried down and Charles University reopened. The Faculty of in vain to get a permanent appointment there (his Czech Medicine in Prague was split into four (general, paedia- nationalist feeling having been a thorn in the flesh of the tric, hygiene and dental schools) and further medical Austrian police), he accepted the Prussian king's invita- faculties were established in Hradec, Kralove and Pilsen. tion to found the first independent institute of physiology The foundation of the Academy of Sciences and of more } in Breslau, where he worked until 1849. The many basic than 20 institutes for medical research gave a tremendous i discoveries in most areas of physiology?nervous system, impetus to scientific life, and safeguarded Czech medicine heart, lungs, stomach, vision, skin, bone, teeth, general from the isolation and demoralisation into which the physiology of the cells and the action of a whole series of political events of 1948 and 1968 would have precipitated drugs (which he tried out on himself)?are too well known it. At Charles University the Rector (Professor Englis), to be enumerated here. Let us only recall the Purkinje was deposed and several professors who were known not cells of the cerebellum, the Purkinje fibres in the heart, to conform with the ideas of the new regime (Sekla, and the Purkinje tree. Frankenberger, Belehradek) were suspended. The uni- In his research he tried to discover the basic laws of versity staff was gradually replaced with people with well- nature and the secret of its all-pervading harmony. Most established allegiance to the Communist Party, even if of this work was done in Breslau. In Prague, he devoted they were less well qualified. There followed the introduc- himself to the restoration and reactivation of Czech tion of political schooling, censorship of all correspon- cultural life and its reincorporation into western civilisa- dence with foreign countries and of the literature, tion. He founded several journals, among them the Czech journals and daily papers read, and secret supervision of Medical Journal (1861), and the foundation of the Czech everybody, very reminiscent of the year 1620 and the Medical Society in 1860 was also his work. Purkinje was a events at the Clementinum. What the future will add to Czech patriot but, as a pupil of the Prague philosopher this confused tale cannot be foreseen. Bolzano, he saw in language only a means of self- expression. He wrote about 'Austria polyglotta', he preached reconciliation with the Germans, and in harmo- nious co-operation between the Czechs and Germans in This article is based on a lecture given as Arthur Thomson Central Europe he saw salvation from Pan-Slavism. Visiting Professor at the University of Birmingham in Septem- Unfortunately, his political views were shared neither ber 1980.

198 Journal of the Royal College of Physicians of London Vol. 16 No. 3 July 1982