Autopsy and Case Reports ISSN: 2236-1960 São Paulo, SP: Universidade de São Paulo, Hospital Universitário Ferraz de Campos, Fernando Peixoto The Dawn of Modern Pathology Autopsy and Case Reports, vol. 6, no. 1, 2016, January-March, pp. 1-5 São Paulo, SP: Universidade de São Paulo, Hospital Universitário DOI: 10.4322/acr.2016.019 Available in: http://www.redalyc.org/articulo.oa?id=576061726001 How to cite Complete issue Scientific Information System Redalyc More information about this article Network of Scientific Journals from Latin America and the Caribbean, Spain and Journal's webpage in redalyc.org Portugal Project academic non-profit, developed under the open access initiative Editorial The Dawn of Modern Pathology Fernando Peixoto Ferraz de Camposa Campos FPF. The Dawn of Modern Pathology [editorial]. Autopsy Case Rep [Internet]. 2016;6(1):1-5. http://dx.doi.org/10.4322/acr.2016.019 Karl von Rokitansky (1804-1878) The declining rate of autopsies worldwide, and age, the medical procedure of autopsy is often which has been observed in recent decades, has been considered to be unimportant and sometimes even extensively debated. Although many reasons have been worthless. suggested for the genesis of this unfortunate process, Surprisingly, in the 19th century–more than none is convincing. 200 years ago–the practice of autopsy was met with The history of medicine is far from being a linear hostility, not only from the general public but also progression of discoveries. Twists and turns occurred, from some of the medical community. It would take which, over time, completely changed the current the untiring work of a remarkable man, in Vienna, to concepts. One of these turns was based on the wealth change the future of medicine thanks to the knowledge of knowledge acquired through the observation of he gained through his determination, dedication, and thousands of autopsies. Paradoxically, in our day belief of the truth that autopsy would reveal. a Internal Medicine Division - Hospital Universitário - University of São Paulo, São Paulo/SP – Brazil. Autopsy and Case Reports. ISSN 2236-1960. Copyright © 2016. This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License which permits unrestricted non-commercial use, distribution, and reproduction in any medium provided article is properly cited. The Dawn of Modern Pathology Maria Theresa (1717-1780), sovereign of the and is part of the Czech Republic. He lost his father Austro–Hungarian Empire, started her 40-year reign early in childhood and sustained significant financial in the middle of the 18th century after the death of difficulties during that time along with his mother and her father, Emperor Charles VI (1685-1740). She ruled three siblings by the counsel of her advisors and contributed to In spite of those difficulties, he completed primary financial and educational reforms as well as promoted school at his hometown before moving to Prague greater unification of the Habsburg monarchy. where he continued his education and graduated from According to recommendations by Dr. Gerard van secondary school at the age of 14 (in 1818). He started Swieten [long-time student of Hermann Boerhaave his advanced studies in philosophy, which was the (1668-1738), brought from Leyden University – usual preliminary to a course in medicine, and was Holland, imperial personal physician], the Vienna greatly influenced by the contemporary philosophers General Hospital (The Algemeines Krankenhaus) Kant, Schopenhauer, and Schiller. In 1822, still in was rebuilt. Viennese medicine had first attained Prague, he began his medical studies, but two years international significance through its incentives. later he moved to Vienna to live with his uncle and Similarly, following van Swieten’s advice, Maria Theresa finish his medical studies there. signed a decree making it mandatory to autopsy every Highly dedicated, self-taught, and skeptical hospital death (the motivation for this decree was the of ancient medical concepts, early on Rokitansky high infant mortality in Austria, mostly in the city of focused his interest in anatomy, and was substantially Graz). This practice continued—especially for forensic influenced by the publications of Jean-Frédéric Lobstein cases—into the following century. This decree (still (1777-1835), Johann Friedrich Meckel (1781-1833), theoretically in effect in Austria, but no longer strictly and Gabriel Andral (1797-1876). He started working as followed) led to many morphologic observations that a trainee in the poorly equipped and underdeveloped contributed immeasurably to the development and pathological institute of the Vienna General Hospital. progress of modern medicine. At the age of 24 he attained a doctorate in medicine In the early part of the 19th century, the after defending a thesis dedicated to the vaccination Austro-Hungarian Empire showed many societal against smallpox (De variolide vaccinica), which had defects precipitated by the Napoleonic wars. Emperor been a plague in Europe until the end of the 18th Francis II (who succeeded his father, Leopold II, the century, when Edward Jenner’s experiment was King of Belgium, who was the son of Maria Theresa) successfully developed (the cowpox inoculation — the dissolved the Holy Roman Empire, and suffered cradle of immunology). various defeats until Napoleon’s abdication in 1815. The professional debut of Rokitansky took place in When Francis II died, his son, Ferdinand, who tried the morbid anatomy institute, which was considered as unsuccessfully to enhance the power of the throne by little better than a hut in a corner of the Vienna General leaving an heir, was depicted as feeble-minded and Hospital (described by Rokitansky as “a cabin inhabited incapable of ruling, which left the actual carrying out of by few settlers”). The young Dr. Johann Wagner, who government affairs to the austere Klemens Wenzel von found the institute entrusted to a museum servant, Metternich. Ferdinand eventually abdicated in favor of had been recently put in charge. his nephew, Franz Josef, who, somehow — and despite As assistant to Dr. Johann Wagner (1800-1832), many military disputes — proved to be a progressive he helped to perform the autopsy of Ludwig van and powerful ruler of the Austro–Hungarian Empire Beethoven (1770-1827). Aloys Rudolph Vetter during the second half of the 19th century. Metternich (1765-1806) and Lorenz Biermayer (1778-1843), and Franz Josef concentrated on military initiatives to previous physicians in charge of the morbid anatomy reinforce the Empire, while allowing society to pursue institute, had abandoned their posts of prosectors a variety of intellectual activities. many years before, because of the indifference of the In the midst of this political scenario, in 1804 profession and the opposition by many at that time. Karl von Rokitansky was born in Königgrätz, a city Adolf Kussmaul (1822-1902), in a visit to Rokitansky in Bohemia (formerly part of the Austro–Hungarian described the prosecutory as a small house, where— Empire), which is currently called Hradec Králové, besides a chamber to store the corpses — there was 2 Autopsy and Case Reports 2016;6(1):1-5 Campos FPF one room for autopsies and another for the court. such as “in most cases, the necropsy relates to the Rokitansky subsequently devoted his whole life clinical history like glasses to a blind eye; they have no to pathologic anatomy, almost entirely in Vienna, meaning for one another” (written in 1809, cited by and ultimately became one of the most important Erna Lesky); and “I set but little value on the minute physicians of his time. examination of the traces left by disease on our Wagner’s teaching led Rokitansky to develop the organs though that pursuit has been pompously styled techniques he subsequently used in the performance pathologic anatomy. The lesions found at our autopsies of as many as 30,000 autopsies. After the early death are frequently produced after death, and consequently of Wagner from tuberculosis in 1832, Rokitansky the plan hitherto followed in such inquiries is fallacious, succeeded him and in 1834 was appointed as a and can only lead to vague information and error.” temporary Professor of Pathologic Anatomy. (François Magendie’s declaration in 1839). The Viennese School of Medicine that had Unlike the practice in all other European an North flourished in the previous century was in decline, American medical centers, where dissections were and morbid anatomy had scarcely bloomed at all. restricted, Rokitansky had the unique situation of Rokitansky was also appointed Associated Professor of having endless study material since all diseases and Pathological Anatomy of the Vienna School of Medicine. cases for autopsy were referred to the Vienna General The health service was under imperial sponsorship (in a Hospital. period of constant territorial disputes), and although He developed a special technique to expedite the the general hospital was rebuilt and expanded, the old examination and dissection of many corpses brought Vienna School somewhat stagnated. daily to the autopsy room, particularly because At the beginning of the 19th century, autopsies there was neither a preservation mechanism nor any generally concentrated on one organ, typically chosen refrigeration. It has been estimated that he performed by a clinician, and, as a general rule, were carried out more than 30,000 autopsies and reviewed another without a specific methodology and left many