ANTON STOERCK, VAN SWIETEN’S SUCCESSOR, AND THE PROGRESS OF MEDICAL AFFAIRS AT VIENNA UNDER THE MANAGEMENT OF JOSEPH II.

After the death of Maria Theresa, in 1780, her son Joseph, who had previously been associated with his mother in the government of the empire, became the Emperor in the full sense of that term. Fortunately for the best interests of the science and art of medicine he had long been familiar, and fully in sympathy, with the plans and purposes of Maria Theresa; and he was therefore quite ready to advance the good work which she had begun. One of his first acts was to remove every possible disability from those officers and instructors who were non-Catholics, thus enabling them to gain all the facilities and honors which their Catholic associates had up to that time enjoyed. In their ultimate effect upon the growth and prosperity of the university these special measures undoubtedly were advantageous, but they were carried out with too great rapidity. According to Puschmann the Emperor strove to accomplish in a comparatively short period of time what required not less than a century. His efforts met with strong opposition in certain quarters, and before his death in 1790 he had the disheartening experience of witnessing the upsetting of many of his cherished plans. After his death, however, he received full credit for what he had attempted; the Viennese speaking of him as “the friend of the poor and the miserable, the upholder of justice and the champion of spiritual freedom and of education.”

Anton Stoerck and the Manner of Teaching Medicine in the University of Vienna.—Anton Stoerck, van Swieten’s successor, was the first to enjoy in large measure the fruits of the latter’s reformation of medical teaching in Vienna. His elder brother, Melchior, had already before this date been appointed Professor of Theoretical Medicine in the University; and then, in 1760, Anton himself was elevated to the important position of Court Physician. He gained his chief distinction, however, through his enthusiastic cultivation of experimental pharmacology. In this field, which had previously received very little attention, he was probably the first to appreciate the fact that the gap between theoretical medicine and actual practice could be bridged only by a resort to experimentation. Among the drugs which he tested in this manner were the following: datura stramonium, hyoscyamus niger L., clematis erecta and pulsatilla nigricans L. Van Swieten, so long as his state of health permitted, encouraged Anton to go on with his experimental work; de Haen, on the other hand, was rather skeptical about the success of his efforts.

Ultimately—after van Swieten’s death—Anton Stoerck became the leading spirit in the affairs of the Vienna medical world. The instruction in medicine was graded by him, with the Emperor’s consent, in the following manner: The medical students, before they were permitted to begin the course of instruction, were obliged to furnish satisfactory evidence of possessing adequate general scientific knowledge and of having previously attended lectures in natural history and experimental physics. In the next place, they were further obliged to attend the lectures on botany, chemistry, anatomy and physiology, and to pass a satisfactory examination in these branches before they were permitted to take up the study of pathology and materia medica. It was only after having passed a satisfactory examination in these subjects that they were allowed to receive clinical instruction. At the final examination they were called upon to make a report on a few cases of actual disease and to set forth especially the details of the treatment adopted; to write a certain number of prescriptions; and, finally, to defend publicly, in the presence of the Rector and the Chancellor of the University, the Deans of the four Faculties, and one Professor of the Medical School, a thesis on some medical doctrine. After which the formal ceremonial of conferring the degree was carried out in the presence of the same university officials. And here again, the Emperor effected a most marked reformation; he abolished all those religious ceremonies which it had been customary to observe in connection with the bestowal of the degree of M.D. and the right to practice medicine. He also adopted measures for enlarging the equipment of the University libraries, and among other things he abolished a large number of monasteries and turned over their collections of books to the libraries of the university. Recognizing, as he did, the fact that the proper training of medical men who intended to follow the career of surgeons was at that time lamentably inadequate, he instituted, at the earliest moment practicable, such changes in the teaching, in the duration of the course, in the requirements for graduation, etc., that the surgeons would thereafter be on the same level, with regard to education and practical training, as the physicians.

At first (1780), the Faculty consisted of nine professors, who gave instruction in the following branches: anatomy, physiology, natural history, chemistry and botany, general pathology and therapeutics (including pharmaceutics), internal medicine and clinical instruction, theoretical surgery, clinical surgery, and obstetrics. In addition to these there were several assistants and a prosector (demonstrator of anatomy). The Emperor Joseph II., after expressing serious doubts with regard to the “possibility of teaching the theory of surgery, bandaging and the various surgical operations in six months,” gave orders that the following scheme should be adopted:—

First Year: Anatomy and physiology, together with chemistry and botany (for physicians only) and operative work, bandaging and obstetrics (for surgeons only).

Second Year: (For physicians) Materia medica, pathology and clinical medicine.

(For surgeons) Clinical medicine, clinical surgery, and obstetrics.

Third Year: Entirely given up to practical work at the hospital and the Clinic.

At a later date the course was extended to four years; and from that time forward, according to Puschmann, surgeons were looked upon with consideration.

Hirsch, speaking of the majority of physicians of that period, says that they sought to quiet the demands of the public for satisfactory information about their maladies by employing, in their responses, the meaningless terms of Graeco-Latin terminology; and he quotes Immanuel Kant, the famous Prussian metaphysician, as having expressed the same idea when he said: “These men thought they were rendering their patients a great service when they gave them a name for their disease.”

As regards the therapeutic measures which these so-called physicians employed, Hirsch adds: “they generally consisted of pills and plasters, drugs of various kinds, clysters and repeated blood-lettings which at times produced such a degree of exhaustion that only patients with a strong constitution were able to rally from the effects of this loss of blood.... The title ‘Doctor of Medicine’ afforded no guarantee that the individual who bore it possessed the requisite degree of medical knowledge.” Fortunately for the public there were at that time in almost every community a few men to whom the description given above does not in the slightest degree apply. I have already mentioned the names of several physicians of this higher stamp, and the number of such honorable representatives of our profession rapidly increases as we approach the nineteenth century.

Reorganization of the Hospital Work in Vienna toward the End of the Eighteenth Century.—In the preceding sections mention has been made of the important changes effected by the Emperor Joseph II. in the scheme of teaching adopted by the Medical Department of the University. It now remains for me to give some account of his reorganization of the Vienna hospitals and of his founding that famous general hospital known as Das Allgemeine Krankenhaus. That there was need of reorganization in at least some of the hospitals is shown by the following anecdote which is related of Professor Boer, who held the Chair of Obstetrics. When the authorities who had special charge of the Lying-in Ward complained to him that he prescribed too liberal a diet for this class of patients, he replied somewhat impatiently that he could not feed, “with water, Epsom salts and ‘Arcanum Duplicatum’ [a secret remedy that was popularly believed to be efficacious], the women who were already a good deal weakened by their pregnant state as well as by sorrow, anxiety and insufficient nourishment; for a liberally supplied kitchen and a good wine cellar were more important than drugs.”

To furnish a complete and satisfactory description of Das Allgemeine Krankenhaus would require more space than can properly be devoted here to the consideration of this single topic. Those who take a special interest in the subject will find full details in Puschmann’s monograph (See Bibliography); for the majority of readers the following brief account will probably suffice.

The Allgemeine Krankenhaus consists of a very large group of three-story buildings in which there are numerous individual spaces large enough to serve as wards, as small lecture rooms, or as reception rooms for ambulant patients (eye, ear, throat, skin and minor surgical cases). The ceilings are usually high and the openings for windows are of such dimensions as to furnish excellent ventilation and liberal daylight illumination. Ample facilities are provided for bathing, for cooking the needed food, and for preparing and dispensing remedies; and the individual buildings are grouped in such a manner as to afford numerous small park-like spaces in which the patients may obtain outdoor exercise or may enjoy the fresh air and some social intercourse with their fellows. Although in 1784 the buildings were almost ready for occupancy and the park-like surroundings completed, it was only at a much later date that the institution was really prepared for the reception of patients. Somewhere about the year 1830 it had been so thoroughly organized that physicians and students came from different parts of the world, and especially from Great Britain and from America, to enjoy fully those extraordinary facilities for the study of every possible form of disease which were to be obtained only in the city of Vienna. Whereas in London, New York, Philadelphia and Boston, it was necessary at that time for all but a few of the students to waste many precious hours and much physical strength in traveling from one hospital to another in order to acquire by direct observation some familiarity with disease, here in Vienna was provided, in a single group of buildings, ample provision for all the clinical teaching that the most eager and serious student of medicine could possibly desire.

New Methods of Diagnosis, and First Appearance of Instructors in Special Departments of Medicine at Vienna.—It was during van Swieten’s lifetime that Auenbrugger’s new invention “for detecting, by means of percussion, the obscure diseases of the chest,” was published for the first time (1761) in Vienna. The value of this discovery, which was termed by him “Novum Inventum,” was not appreciated by physicians at that time. Even van Swieten and de Haen rather looked down on the method; and its importance was not fully recognized until Corvisart, the celebrated Paris physician, published a French translation of Auenbrugger’s book in 1808. This work, in which Corvisart gave his own experience and added many notes and comments, served to popularize Auenbrugger’s method as a valuable aid to diagnosis in affections of the chest. In his preface Corvisart announced that he was well aware of the small glory that came to translators and to those who simply comment on the work of others, but notwithstanding this fact he preferred that the major part of the glory should go to Auenbrugger who had rendered such a great service to the Profession by his invention.

Auenbrugger, who died in 1809 at the age of 87, lived long enough to enjoy the pleasure of this triumph. His private practice grew to be very large, and he performed, more often than any other physician of his time, the operation of thoracentesis. He was universally loved and respected in Vienna.

One of the first specialties to take root in Vienna toward the end of the eighteenth century was that of ophthalmology, and the physician who first succeeded in bringing it to a high stage of development was George Joseph Beer, who was born at Vienna in 1763. During his student days and for a short time subsequently he acted as a draughtsman for Joseph Barth, the professor of anatomy and physiology in the Vienna University, and in this way he obtained unusual opportunities for acquiring a knowledge of both the normal and the pathological anatomy of the eye. Already in 1793 he applied for, and was granted, permission to treat, in the Allgemeine Krankenhaus, such poor people as were suffering from cataract, and to perform the requisite operations. Each year, during the months of May and June, a suitable room was gotten ready for Beer in the hospital, and here, during this most favorable season of the year, he performed many cataract operations.

In 1812 he received the double appointment of Director of the Eye Clinic and Professor Extraordinary of Ophthalmology; and from this time forward he rapidly gathered about him a great crowd of pupils, among whom were men who—like C. F. von Graefe, Philip von Walther, T. W. G. Benedict, F. Jaeger, Rosas, Quadri, J. N. Fischer, Mackenzie, Reisinger, Chelius and others—were soon to be known in every part of Austria, Germany, Italy and England as the leading eye surgeons of their respective countries. Beer therefore exerted a most decided influence on the development of ophthalmology.

Beer’s early writings, the first of which date from the year 1791, also exerted a great influence. Such, for example, were his “Practical Observations on the Gray Form of Cataract” and on the “Different Eye Diseases which Owe their Origin to Some General Disease”; and also his “Treatise on Diseases of the Eyes.” The last-named passed through several enlarged and improved editions between 1813 and 1817. In 1799 he issued a Summary of all the treatises on ophthalmological topics which had been published up to the end of 1797; and soon afterward he published an account of his method of extracting a gray cataract together with its capsule. Still other memoirs of decided value were published by him in the following years; and among them one especially deserves to be mentioned, viz., that on the affliction known as “Pannus,” of which condition he was the first to give a correct explanation.

In 1819 Beer was stricken with an illness of a serious nature, and two years later he died. He was succeeded by Anton Rosas, whose death occurred in 1855.