Karl von Rokitansky

Karl Freiherr von Rokitansky was een van de grondleggers van de Neue Wiener Schule in de medsiche wetenschap. en van de pathologische anatomie als serieuze wetenschapsdiscipline. Basis daarvan vormen de duizenden, waarschijnlijk tienduizenden autopsieën, die hij in zijn leven uitvoerde. Als een van de weinige supporters van Semmelweis in de controverse over methoden valt zijn positieve politieke en praktische invloed evenmin te onderschatten.

Rokitansky (geboren in Königgrätz, nu Hradec Krilové, in Noord-Bohemen) studeerde geneeskunde in Praag en Wenen. In 1827 werd hij aldaar assistent bij de leerstoel pathologische anatomie, voerde zijn eerste autopsie uit, en studeerde in 1828 af. Hij praktiseerde nooit als arts, maar bleef de pathologie trouw, en werd de beste beschrijvende patholoog van zijn tijd. Toen hij in 19875 met pensioen ging stond zijn persoonlijke autopsie-teller op 59.786. Daar kunnen nog zo'n 25.000 "juridische" autopsieën aan worden toegevoegd: de geleerden zijn het over de aantallen oneens.

He was the first person to show bacteria in lesions of bacterial endoca rditis and to distinguish between lobar and bronchopneumonia. He gave an outstanding account of yellow atrophy of the liver, naming that disorder in 1843. He gave the first descriptions of spondylolithesis and the pelvic deformations which result there from in 1839, first described acute dilatation of the stomach in 1842, and differentiated Bright's disease from amyloid degeneration of the kidney. He wrote an outstanding monograph on the diseases of arteries and on congenital defects of the heart.

It was not until his 39th year that Rokitansky familiarised himself with the use of a microscope, and his histological techniques remained relatively simple. His most important histological investigations were published in 1854 in an article titled On the growth of connective tissues – “Über das Auswachsen der Binde-Gewebssubstansen" - and in 1857 titled On connective tissue tumours in the nervous systems – "Über Bindegewebswucherung im Nervensysteme".

It was Rokitansky who in 1846 inspired the bohemian student, Ignaz Semmelweis, to study medicine. It was the death of one of Rokitansky's colleagues, Jakob Kolletschka (1803-1847), in 1847, that convinced Semmelweis of the transmission of sepsis. Kolletschka had cut his finger during dissection, and this developed into a chronic pyaemia which caused his premature death on March 13, 1847, at the age of only 44 years. Semmelweis, who was present at the autopsy of Kolletschka, noticed that the pathological impressions of the corpse of his former teacher were similar to those of the puerperal fever he had observed only too often in his own department.

Rokitansky supported him in his efforts to eradicate puerperal fever by cleaning up the delivery wards of European hospitals, and he stood by Semmelweis when he was viciously attacked by his clinical colleagues in the medical establishment.

Rokitansky's textbook of pathology, Handbuch der pathologischen Anatomie, represents a pioneering effort in elevating pathology to the status of recognised science. He worked on this book for many years, and most probably the publishing would have been delayed even longer, if somebody had not whispered to his ear that the professor of forensic medicine, Jakob Kolletschka (who died a few passages ago), would maybe precede him with a similar work.

The number of original descriptions in his Handbuch is staggering. Included here are the first differentiation between lobar and lobular pneumonia, the first pathological account of spondyloisthesis, the first accurate description of acute yellow atrophy of the liver, and the correct classification of patent ductus arteriosis as a congenital lesion.

Not without its shortcomings, the work includes Rokitansky's anachronistic humoral disease theory concerning "crases and stases", the doctrine of bodily fluids and how they are mixed in the body. This attracted a great deal of criticism from Rudolf Virchow, then professor of anatomy in Berlin. It is said that following Virchow's criticism he could never look at the first edition of his textbook again; he admitted the error and rewrote the entire work, and in the 2nd edition all reference to "crases and stases" was eliminated. After abandoning chemiatrics, Rokitansky laid more emphasise on the basic rules of morphology. In spite of such theoretical miscalculations, Rokitansky revealed more clearly than any of his predecessors the natural history of disease and its structural manifestations.

As an academic speaker Rokitansky possessed a great talent for philosophical speculations. But although he could be an outstanding party orator, and was no less brilliant when demonstrating new preparations, his lectures suffered from his weak and monotonous voice. He is said to have been lecturing as if telling an anecdote - fearing that half the audience had heard it before.

As medical reporter Rokitansky contributed importantly to the establishment of a practical organisation of the medical faculties in Innsbruck and Graz, and just like he had previously recalled Josef Skoda (1805-1881) - with great success - to the chair of internal medicine, he now got Theodor Billroth (1829-1894) to Vienna, Edwin Klebs (1834-1913) and August Breisky (1832-1889) to Prague, and was instrumental in having the first psychiatric clinic in Austria established for Theodor Meynert, (1833-1892) who also owed for the corpse material he had available for his investigations. Rokitansky also contributed to Salomon Stricker (1834-1898) being given an institute for experimental pathology.

Rokitansky rightly may be regarded as the finest anatomical pathologist of his age, and it was largely through his influence that the Vienna School reblossomed into world prominence. Yet, until 1862 his housing facilities mostly resembled a shed at the mercy of wind and rain, serving as both corpse- and dissection room. It was not until this year that a new building was put at his disposal, housing both his office, a new dissection room, and, not least, his collections.

One of many honours bestowed on him on his 70th birthday, was his elevation to knighthood, making him Freiherr von Rokitansky. The title of Freiherr corresponds to baron.

Rokitansky was an untiring and shrewd observer. Seemingly withdrawn, taciturn, but unpretentious and devoid of all the conceited bullshit so often haunting the learned environments.

Rokitansky had a reputation as an extraordinary pleasant, happy-go-lucky and unassuming individual, charming, and with an infallibly striking humour, always pointing directly to the heart of the matter, and sometimes even burlesque. He had four sons, two of whom where physicians and the other two singers, about whom he commented: "die Einen heilen, die Anderen heulen" - the first are healers, the others are howlers.

Besides his scientific work Rokitansky concerned himself with medical philosophy. He declared materialism an absolute prerogative for science, but rejected it as a view of life. He took a great interest in the philosophy of Arthur Schopenhauer (1788-1860), adding his own interpretations. These are two Schopenhauer-stories, both taking place in his Stammkneipe:

As usual, Schopenhauer was mixing his wine with water, for which he was ridiculed by the men at the neighbouring table. He then said: "Wasser allein macht stumm, das beweisen im Meere die Fische. Wein allein macht dumm, das beweisen die Herren am Tische. Da ich keines von beiden will sein, trinke ich mit Wasser mein Wein."

Another day the waiter asked Schopenhauer why he always had a thick gold coin lying on the table in front of him. "That is for you," Schopenhauer asked, "on the day when the officers at the table behind me talk of anything but women, weapons and horses."

It was not without reason that Rudolf Virchow called him the Linné of pathological anatomy. It was Johann Friedrich Meckel (1781-1833), Johann Friedrich Lobstein (1777-1835), and Gabriel Andral (1797-1876) who, through their writings, inspired Rokitansky to specialise in pathological anatomy. He thanked Johann Wagner, his teacher, for his outstanding dissection technique, for his desire to build a museum, and his drive to conduct extra accurate descriptions.

As dean of the medical faculty, later as rector of the university, Rokitansky was a distinguished Vienna personality, and in 1874 celebrated his Emeritierung with great pomp and circumstances.

"I am willing to state that we are on the threshold of decadence, that the so-called modern individualism is about to turn the realistic, and just developing, concept of the individual into a cult which accepts success without considering the ways and means by which it has been attained, which absolves the guilty of responsibility for the crime, and manipulates punishment and the conditions for which it may be applied. Would it be surprising if society, drunk from its triumphant delusions of freedom, would find itself face to face with a reaction which, spurred on by moral indignation, would demand intervention by government, restriction and rigid authority?"
Valedictory address, 1857. Translated by Max Samter.

 

Rokitansky became reporter for the medical studies with the title of Hofrath in 1863, and in 1869 was elected president of the Wiener Akademie der Wissenschaften of which he had been a member since 1843. In 1870 he became a member of the academy of sciences in Paris, as well as president of the Anthropological Society of Vienna, like he had long before been elected president of the Wiener Gesellschaft der Ärzte.

Rokitansky also was politically active; in 1867 he became a member for life of the Herrenhaus (House of Lords), and for a period of time was the speaker of this institution. As a member of the Herrenhaus he preserved his liberal mind, something he demonstrated with perfect irony in his speech advocating the separation of school from church.

He retired in 1875, after his 70th birthday and thus having overstayed the regular retirement age for Austrian professors. He died in 1878 of a bout of asthma, which had afflicted the otherwise both mentally and physically unimpaired man more and more frequently during his last years.