PROCHASKA, HYRTL AND ROKITANSKY, THREE OF THE MOST DISTINGUISHED TEACHERS AT THE MEDICAL SCHOOL OF VIENNA DURING THE EARLY PART OF THE NINETEENTH CENTURY

George Prochaska, born at Lipsitz, Moravia, in 1749, was appointed Professor of Anatomy and Ophthalmology at the Prague Medical School in 1778. Eight years later he was transferred to the Chair of Physiology. In 1791 he received the appointment of Professor of Higher Anatomy and Physiology in the University of Vienna. In 1819 he resigned this chair, probably owing to poor health; and his death occurred during the following year.

Between 1780 and 1797 he published, in Latin, important monographs on the physiology of man. Later, these were thoroughly revised and then published in German under the title of “Physiology, or the Doctrine of the Nature of Man.”

Prochaska was esteemed very highly as an eye surgeon of exceptional skill and wide experience, no fewer than 3000 cataract operations having been performed by him. His greatest achievements, however, belong in the domain of physiology. Already as early as in 1797 he hinted at the possibility that, in the case of the spinal nerves, one of the portions might transmit centripetal and the other centrifugal impulses. It was reserved, however, for the great English physiologist, Sir Charles Bell, to establish firmly, several years later, the law governing these two currents.

Prochaska’s ideas with regard to the nature of “vital force”—that question which in those days gave biologists so much trouble—may be inferred from the following quotations:—

In the performances of the nervous system there occur manifestations which bear a striking resemblance to the phenomena produced by electricity.... In my opinion it is not permissible to conceive of vital force as an independent power, one that depends upon a single and special principle, but rather as an aggregation of all the forces of Nature, representing in one set of instances the cause and in another set the effect of these forces, and combining in this body of ours, by their foreordained harmony, to create what we call life. Therefore, among the powers that are commonly meant when we use the expression “vital power,” there are no specific forces, but only the general forces which exist in Nature; but at the same time they are combined under a special relationship,—in fact, they are entangled the one with the other in such an inextricable snarl that it is simply impossible for us to gain a clear conception of their causes and effects.

Finally, it is quite remarkable, says Puschmann, how closely Prochaska’s ideas regarding the formation of bone agree with the teachings of our modern authorities. Here is the paragraph in which he formulates these ideas in full detail:—

The business of nutrition is carried on in such a manner that, when new conditions arise, whole organs which for some time previously were performing useful work, are swept out of existence, and new ones, better adapted to the work required of them, are put in their places. As an instance in point we may mention certain cartilages which, for a limited period of time during childhood, take the place of bone structures, and which at the same time play the part of really necessary aids to the growth of the bone. These cartilages gradually become converted into the latter tissue, the process reaching the stage of completion at different times, but yet at a fixed and definite time for each particular bone. Thus, in the case of the long bones, the cartilage becomes completely ossified somewhere between the twenty-second and the twenty-fourth year. This process of ossification does not consist in a simple hardening or change of the cartilage into bone; the essential features of the process may more correctly be described as follows: the cartilage, in the depths of whose substance bone-tissue centres are being nourished and are progressively undergoing development, is steadily being crowded to one side and ultimately destroyed. At the same time there appear here and there in the cartilage a few blood-vessels which, so far as one is able to judge, spring, in the majority of instances, from the neighboring fully-formed bone substance. And, as a further stage in the process of growth, there appear alongside the new blood-vessels centres of ossification, which in due time become foci of genuine bone tissue. Then, as these foci increase in size, the surrounding cartilage steadily dwindles in quantity until nothing remains but a few scattered cavities or hollows, which persist for only a short time before they disappear altogether.

Prochaska’s discoveries in regard to the growth of bone excited the admiration of his contemporaries, and well they might, for they involved prolonged investigations with the aid of the microscope and much close and careful thinking. It is safe to say that at this early date (end of the eighteenth century) original investigations like the one just described must have been very few indeed in Austria.

Carl Rokitansky, who was born at Koeniggratz, Bohemia, in 1804, received his medical training at the universities of Prague and Vienna. For several years after he had been given the degree of Doctor of Medicine he served as an Assistant in the Pathologico-Anatomical Institute, and in 1832, after the death of Johann Wagner, the Custodian of the Museum that formed a part of the Institute, he was appointed his successor, not only in this particular office but also in those which were closely related to it—viz., the office of Prosector of the Allgemeine Krankenhaus and that of Judicial Anatomist for the City of Vienna. The duties which he had to perform in connection with these offices and as an Instructor in the Medical Faculty of the University left him very little time for anything else. His pet ambition was, not merely to do well the work which these different official positions entailed upon him, but also to build up, so far as in his power lay, a systematized knowledge of the relationship that subsists between the different pathological conditions revealed at the post-mortem examination and the clinical phenomena manifested during the patient’s lifetime. Therefore he was accustomed to insist that a reasonably full history of the case should be submitted with every corpse on which he was asked to make a post-mortem examination. This afterward became a firmly fixed practice at the hospital. After he had read these case-histories and had compared them with the facts revealed by the corresponding autopsies he prepared, at proper intervals, a report on the diseases which were then prevalent at the hospital. This method of procedure, it will easily be seen, constituted an important advance beyond the practice of simply studying and then recording the various pathological lesions which develop in the different organs of the body. It established a connecting link between these lesions and the lifetime manifestations of disease; in other words, it revealed a way in which the medical practitioner at the bedside might, by a proper use of his reasoning powers, infer from the symptoms and physical signs what changes were taking place in the unseen organs of the body. From this time forward, therefore, physicians began to place before their mental vision—in every case which they were called upon to treat—a picture of the anatomical changes that were taking place in the patient’s body, instead of symptom groups. In the words of that distinguished TÜbingen physician, Wunderlich, “Rokitansky was endeavoring with untiring zeal to convert pathological anatomy into an anatomical pathology.” The reader will, I am confident, agree with me when I say that there are very few instances in the history of medicine where an advance toward a better knowledge of the art of diagnosis is more clearly revealed than in the work which Rokitansky carried on so patiently, so conscientiously and so successfully during the early years of the nineteenth century. Compare the record of the work accomplished by Morgagni with the remarkable results reached by the Vienna pathologist, and it will be quickly appreciated how little fitted the former searcher after truth was to carry out successfully the advance which Rokitansky effected and which I have tried to describe in these pages.

Rokitansky’s earliest contributions to medical literature consisted in quite a large number of memoirs which were published at different times in the “Medicinische JahrbÜcher des Oestreichischen Staates.” They deal with topics like the following: “Incarcerations and Intussusceptions of the Intestines”; “New Formations of Bone on the Internal Surface of the Skull in Pregnant Women”; “Spontaneous Rupture of the Aorta”; “So-called Duplication of the Uterus”; “Strictures of the Intestinal Canal and Other Abnormal Conditions that give rise to Constipation and to Ileus”; “Perforating Gastric Ulcer”; “Contributions to our Knowledge of the Different Forms of the Curvature of the Spine”; etc. Subsequently he published in three volumes his great work on Pathological Anatomy; Vol. 3 appearing in 1842 and Vol. 2 in 1844. These last two volumes were devoted to special pathological anatomy. The first volume of the series, which deals with general pathological anatomy, was not published until the year 1846. In these volumes, which are rich in newly discovered facts, the author keeps constantly in mind the needs of the general practitioner; and how great was the importance which he attached to this feature of his work may be inferred from the frequent reference which he makes to it in other parts of his writings. Thus, for example, in the Preface to Vol. 1 he says: “In regard to the manner in which I have planned and constructed the present treatise I will briefly remark: ‘I have tried from the very beginning, and all through the work, to look at the subject from the viewpoint of the practicing physician, and I believe that, in adopting this course, I have accomplished a thing which was most urgently needed in our time; and I also believe that I have utilized the gigantic mass of material that was at my disposal in a worthy manner.’” Then, again, farther on in the Introduction, he says: “The first attempt to treat the subject of pathological anatomy in the manner which I have just described,”—an attempt, by the way, that was crowned with brilliant success,—“was made by LaËnnec in his discussion of the subject of diseases of the chest.”

In strong corroboration of Rokitansky’s belief in the importance of pathological anatomy stands the statement attributed to the celebrated anatomist Vesalius, to wit: “I am very sorry not to have devoted to pathological anatomy the large amount of time and strength which I spent on physiological anatomy.”

Rudolf Virchow calls Rokitansky the “Linnaeus of pathological anatomy.”

It was my original intention to furnish at this point a few brief extracts from the original text of Rokitansky’s great treatise, in order that the reader might learn, from this pathologist’s own words, just how he managed to teach pathological anatomy in the manner best adapted to subserve the interests of the practitioner. After looking in vain, however, for a section of the desired degree of shortness, I came to the conclusion that it would be better to abandon the attempt altogether and rest satisfied with a simple enumeration of the captions of some of the more important subsections that treat of alterations in bone. Here are those which I selected: “Bone Deficiency and Bone Excess”; “Anomalies in Size and Shape”; “Bone Atrophy”; “Anomalies of Bone in its Connection with other Bones”; “Anomalies in Consistence”; “Break in Continuity and the Manner in which Healing Takes Place”; “Callus Formation and New Joints”; “Healing of Bone by First Intention”; “Healing of Bone through the Medium of Suppuration”; “Healing of Wounds in Bone with Loss of Substance”; “Inflammation of Bone”; and “Bone Caries.”

Not being specially interested in pathological anatomy I have read only small portions of the text of this celebrated treatise; but, judging from this superficial examination and from the unanimous testimony given by men who are expert judges in this department of medical science, I feel confident that satisfactory answers will be found in this great work to nearly every question that may arise in a physician’s mind concerning the pathology of some part of the human body. It is a book, however, that is intended for reference purposes, and not for reading as one would read Trousseau’s work; and this undoubtedly explains why, so far as I am able to discover, no English version of this treatise exists.

I may here call attention to the fact that the first edition (1842–1846) of Rokitansky’s treatise contains no cuts, but that of 1855 is well furnished with illustrations.

After Rokitansky had held for ten years the position of Professor Extraordinary of Pathological Anatomy in the University of Vienna he was promoted in 1844 to that of Ordinary Professor.

As an evidence of Rokitansky’s popularity as a teacher I will mention the following fact. In my student days at the College of Physicians and Surgeons, New York, my father, the late Dr. Gurdon Buck, frequently referred to the benefit which he had derived from the lectures and dead-house instruction which he received from Rokitansky during his stay in Vienna (about 1833 or 1834). From the statement made by Prof. Alfred C. Post of New York, I learn that he and my father were Rokitansky’s first American pupils.

Rokitansky’s death occurred in 1878.

Joseph Hyrtl was born at Eisenstadt, Hungary, in 1811. His father was a professional musician (Capellmeister) in the service of Prince Esterhazy. He received his medical training in Vienna, and in 1833, while he was still only a student in the university, he was given the appointment of Prosector in the Anatomical Institute. Two years later he received his doctor’s degree, and in 1837 he was chosen Professor of Anatomy at the University of Prague. According to Puschmann “Hyrtl handled his pen with the same skill as he did the scalpel, and also in his spoken lectures he manifested to a wonderful degree the gift of making dry facts interesting to his auditors, thus keeping them fascinated by his remarks and stimulated to advance in that branch of medical science. The remarkable manner in which the teaching in the Vienna Medical School increased in popularity at this period of its history was in no small degree due to the fact that Hyrtl had, a short time before (in 1845), been called to occupy the chair of anatomy in that institution.” In confirmation of Puschmann’s estimate of Hyrtl’s power to write entertainingly upon anatomical and physiological topics which are commonly classed as “dry” I will furnish here a few extracts from Hyrtl’s General Treatise on Anatomy. And, if the reader will pardon me for referring once more to my father’s interest in those who played a part, either as teacher or as simple friend and companion, in his student life at Vienna, I will preface these extracts with the statement that, more than once in the early sixties, I surprised my father reading with evident pleasure, after the day’s work was over, this very treatise on anatomy.

In his preface Hyrtl says: “A general treatise on anatomy should not confine itself to the mere teaching of this branch of the science of medicine, but should also inspire the students who read the book with a love for this science and the ambition to make original investigations.”

Speaking about the behavior of an artery after it has been divided with the knife Hyrtl explains why, in the living body, the complete division of such a blood-vessel produces a narrowing of the lumen at the point where it has been divided, whereas a similar division of the vessel, if carried out upon the dead body, results only in a retraction of the tube in the direction of its length; in other words, in the corpse the diameter of the lumen remains unchanged as a result of such division. From these and other facts (which he mentions, but which the lack of space compels me to omit) Hyrtl draws the inference that the contractility of the wall of an artery is a phenomenon that occurs only in the living vessel. Then he goes on to remark:—

Beginning at the point where the ligature has been applied the artery loses its symmetrical shape, both above and below the site of the ligature, as far as to the spot where the next collateral branch is given off. At first this distortion of the vessel’s shape is due simply to the fact that its calibre is filled with clotted blood (provisional obliteration). Later, a solid plug takes the place of the soft clot. It is composed of plastic material that, becoming fused with the clot (thrombus), gradually undergoes organization and permanently attaches itself to the wall of the artery through actual growth of tissue (definitive obliteration). Thus there is formed, as the final result of all these changes, a firm and solid cord the circumference of which is smaller than that of the artery from which it springs in direct continuity.

The ligating of one of the larger arteries—as, for example, the brachial or the crural artery—does not interfere seriously with the circulation in the parts located below the point where the ligature has been applied; for the blood continues to flow into these parts although with diminished energy, owing to the fact that it is obliged to travel through roundabout channels (anastomoses).... I once owned a dog upon whom, in the days of my youthful sinning in the domain of physiological experimentation, I performed, within the short period of a single year, the operations of tying the innominate artery and both crural arteries; and, notwithstanding the fact that the blood needed by the adjoining regions was thereby forced to travel to them by unaccustomed routes, the dog’s health did not seem to be in any way affected.

Among the anatomical remarks which Hyrtl makes at various points in the course of his formal treatment of the subject under consideration I find several that seem to me to be worthy of reproduction here. In one place, for instance, he makes the statement that voluntary movements of the auricle of the ear are by no means a rare phenomenon, and in support of this statement he quotes Haller as mentioning (“Elementa Physiologiae,” Tomus V., p. 190) many instances of this kind; he also narrates how B. S. Albinus (1697–1770), the greatest anatomist of the eighteenth century and a colleague of Boerhaave at the University of Leyden, was in the habit of removing his wig whenever he wished to exhibit to the students how great was his control over the movements of the auricle of the ear.

In another place Hyrtl calls attention to the not uncommon error of giving, to the structureless membrane which Descemet described in 1758, the name of Membrana Descemetii. According to him it was first described by the Englishman E. Duddel, twenty-nine years earlier, in his “Disease of the Horny Coat of the Eye,” London, 1729.

In addition to his famous general treatise on anatomy, of which, in the course of 38 years, no fewer than 17 editions were printed, Hyrtl published in 1845 a memoir on the organ of hearing, and in 1860 a “Manual for the Use of Dissectors.”

His death occurred in 1884.