Heidelberg, Germany (Spring 2015)
Dedicated to another great German Cancer Surgeon, J.R. Siewert, who has introduced me to the legacy of Vinzenz Czerny
On the 25th of September 1906, a large crowd of Heidelberg citizens expectantly lined the town boulevard to the university’s Great Hall, waiting to cheer on the Grand Duke Friedrich of Baden and his wife Luise in their open carriage. In the Hall they were to meet the elite of European cancer research, who had gathered for the very first International Conference on Cancer.
But before they had to fulfil the official engagement to open the new cancer research institute and its hospital “Samariterhaus”. “IN SCIENTIA SALUS” – “Salvation through Science” had been chiselled into the sandstone on the imposing front of the building, which was to be the clinical cornerstone of the new “Institut fuer Experimentelle Krebsforschung” (Institute for Experimental Cancer Research). Two supporting departments – for histo-parasitology and biological-chemistry – were located nearby, forming a closely-knit complex on the campus of the University Hospital, adjoining the management facility1.
That morning, the center of attention was most emphatically the four-storied, red brick hospital building which contained every conceivable facility a modern hospital should have. As the duke and duchess stepped inside, a band was playing, and little girls spread flowers on the floor. For this September day was also the day of the noble couple’s golden wedding, which they had decided to crown with the opening of the Heidelberg hospital.
Shown around by the founder of the hospital, the Heidelberg surgeon Vinzenz Czerny, the duke and duchess were deeply impressed by the architectural grandeur of the “Samariterhaus”, its art nouveau design and modern medical and laboratory equipment, including innovative features such as a daylight operating theatre. With his white hair and long beard having a similar appearance to the grand duke Friedrich himself, Czerny had welcomed their guests in the entrance hall of the Samariterhaus, where long lists of sponsors graced the walls.
What a truly noble day for the old university and the town! In retrospect, though, it was first and foremost a landmark day in the history of cancer research and oncology. For the institute was to become a model institution for charitable health care as well as scientific excellence in Germany and abroad, blossoming for three decades – until wantonly cut down by the brutal destruction of the lives and careers of extraordinary scientists and doctors by the Nazi regime. Remarkably, both the Samariterhaus and its spirit survived the dark years to recover after the war, until the building was converted in 2004 into upmarket residential apartments. Today, the Samariterhaus is remembered as the mother institution of Heidelberg cancer research, oncology and immunology, radiotherapy, and nuclear medicine.2
But back to the happy days of September 1906! For the duke and the duchess this was not an ordinary representative duty, but a matter of the heart. They had been closely involved in the far-sighted enterprise of Czerny to build a new hospital for cancer patients and a cancer research institute, uniting science and therapy under one roof. Captivated by the high-spirited yet sound request of the founder, the grand duke and his Baden government had agreed to contribute the considerable sum of 150,000 Deutschmark towards the erection of the building. And the duchess Luise, whose devotion to the care of the sick and poor was of a serious and practical nature, enthusiastically agreed to take over the patronship. At the turn of the 20th century, Vinzenz Czerny (1842-1916), a pupil of the godfather of European surgery, Theodor Billroth, was one of the most renowned surgeons, with an impressive list of pioneering surgical achievements.3 However, nearing the end of his successful surgical career, he struggled with deep frustration: cancer was a death sentence, unless detected and removed at an early stage. Self-critically, he remarked:
The surgeons who have the main responsibility for the treatment of cancer patients are often carried away by the huge progress from aseptic treatment. They forget that two thirds of their cancer patients nevertheless suffer a relapse and have an even greater right of redress after an operation which failed to bring the desired cure.4
To Czerny, it was a surgeon’s duty to take the initiative in the fight against cancer, in contrast to his conservative physician colleagues who shied away from the untreatable disease whose pathogenic mechanisms were not understood, seeing little merit to be gained for themselves.
Czerny had already taken on the challenge of cancer by using his extraordinary surgical skills for daring operations such as mastectomy and vaginal hysterectomy. However, as he accurately recorded in his annual reports, only a quarter of the 400 patients treated in his Heidelberg surgical hospital every year left cured. But what other options were there? X-Rays, discovered by Wilhelm Conrad Roentgen in 1895 in nearby Wuerzburg, were just appearing on the horizon, primarily as an option to treat wounds after cancer removal, in addition to their recognized use as a diagnostic tool. The “Magic Bullets” of Salvarsan were to be presented two years later by Paul Ehrlich, one of the speakers at the 1906 Heidelberg Cancer Conference, as the first effective drug against Syphilis, but also the forerunner of chemotherapy.5 Czerny’s conclusion was clear: intensive bench-to-bedside research was needed. That meant: wards, outpatient departments, laboratories for animal and chemical experiments on one site, with scientists and practitioners working hand in hand. On his travels abroad Czerny had visited innovative cancer centers in Buffalo (Roswell Park) and Moscow. In Germany, only the Charité hospital in Berlin had a cancer institute, but lacking a hospital. Yet when an inspired Czerny presented his project to the Heidelberg Medical Faculty, the reaction was one of suspicion and fear. Would it draw patients from other hospitals? Under no circumstances should outpatient departments apart from Czerny’s private surgery be allowed. And, with funding already scarce, where was the money to come from? The grounds, the buildings and their interior equipment would cost almost a Million Deutschmark!
Czerny did not allow himself to be disheartened. Encouraged by the Grand Duke´s initial donation, he sent out letters to potential sponsors. “I would never have managed to collect such a large sum of more than 900,000 Mark … without the general determination of the public to find the causes and treatments for cancer, which has been so much on the rise in the past decades.”6 The biggest fundraising success was a donation of 150,000 Mark by a newspaper publisher. Czerny himself contributed 100,000 Mark, in memory of his son Paul, a young doctor, and his grievous suicide.
The first years of the hospital were a struggle, though what a successful one! In 1912 Czerny and his co-workers published a report about the clinical and scientific achievements. In particular, Czerny’s surgical registrar Richard Werner listed six clinical guidelines7:
- Operable tumors have to be radically removed, if there is no counter-indication like heart disease.
- Managable sarcoma and carcinoma should have first line experimental treatment of radio- and chemotherapy, e.g. local radiotherapy and intravenous injection of Salvarsan, possibly with Coley’s toxin from inactivated bacteria, which might necrotize the tumor tissue. If the tumor does not react and continues to grow, it has to be removed.
- The indications for conservative treatment also apply to cases who could not be operated because of other diseases.
- For tumors which might exceed the size for an operation the listed conservative methods might be used in order to reduce their size before the operation
- After a radical operation radiotherapy and possibly an injection of choline salt solution should be administered. If at doubt the wound should be treated with thermos-penetration.
- For inoperable tumors options are surgical exposure as well as consecutive radiation treatment and electrical fulguration for wound healing. Furthermore, chemotherapy should be applied vigorously.
The Samariterhaus had become a magnet for cancer patients far beyond Heidelberg, also due to specialized oncological nursing, so that Czerny had to refer patients to other hospitals.
Equally successful were the scientific institutes. Their directors Emil von Dungern and Theodor von Wasielewski presented an impressive list of 83 publications in the 1912 report8, e.g. about tumor cells being inhibited by serological reactions and the production of animal tumors providing evidence for their “parasitic” nature, from tiny unknown infectious organism to mites. Young scientists like the Nobel prize winner Otto Warburg and the eminent immunologist Ludwig Hirschfeld started their careers here, thriving in the open scientific climate9.
However, Czerny’s legacy was never recognized by the university. When the Baden government asked the medical faculty to name the institute after its founder “Czerny-Institut” the request was turned down on the grounds that “the name would disguise the true nature of the institution as a cancer institute”. Today, Czerny’s name survives in Heidelberg only as a bridge.
Czerny himself felt increasingly “tired and old” from financial worries and struggles with the faculty. In 1916 he retired, just one month before his death from leukemia, probably due to X-ray exposure. In the coming years, hospital and institutes drifted apart, with the Samariterhaus serving as military hospital in the First World War. Following the rise of the Nazis in the 1930s, Richard Werner, Otto Hirschfeld and other scientists were persecuted, with many emigrating, and Werner eventually dying in the concentration camp Theresienstadt.10
After the war, the scientific institute eventually recovered, becoming the centerpiece of the German Cancer Research Center, founded in Heidelberg in 1964. Radiotherapy became a renowned clinical department. But it took a century to pick up Czerny’s idea and open a Comprehensive Cancer Center on the new university hospital site across the river Neckar. Today, Vincent Czerny’s bust can be seen in the Heidelberg Ion Therapy Center, opened in 2009. Surely, he would have liked that.11
1. Rahel Friedrich. Das Institut fuer experimentelle Krebsforschung Heidelberg von den Anfaengen 1906 bis zur Neugruendung 1948, Inauguraldissertation, Universitaet Heidelberg; 2009: 20-23.
2. Press release Heidelberg Univerait 2006: Von Vinzenz Czerny bis zur Schwerionentherapie. http://www.uni-heidelberg.de/presse/news06/2609vinc.html. Accessed 31st of January, 2015.
3. Cornelia Lindner. Vinzenz Czerny, Freiburg, Centaurus Verlag, 2009: 169-179.
4. Vinzenz Czerny. Das Heidelberger Institut fuer Experimentelle Krebsforschung, I. Teil, Tuebingen, Verlag der H. Lauppschen Buchhandlung; 1912: 50.
5. The Nobel Prize in Physiology or Medicine 1908: Paul Ehrlich – Biographical. http://www.nobelprize.org/nobel_prizes/medicine/laureates/1908/ehrlich-bio.html. Accessed 31st of January, 2015.
6. Vinzenz Czerny. Das Heidelberger Instut fuer Experimentelle Krebsforschung, I. Teil, Tuebingen, Verlag der H. Lauppschen Buchhandlung; 1912: 50.
7. Cornelia Lindner. Vinzenz Czerny, Freiburg, Centaurus Verlag, 2009: 221-222.
8. Vinzenz Czerny. Das Heidelberger Instut fuer Experimentelle Krebsforschung, I. Teil, Tuebingen, Verlag der H. Lauppschen Buchhandlung; 1912: 68-90.
9. The Nobel Prize in Physiology or Medicine 1931: Otto Warburg – Biographical. http://www.nobelprize.org/nobel_prizes/medicine/laureates/1931/warburg-bio.html. Accessed 31st of January, 2015.
10. Wikipedia: Richard Werner. http://de.wikipedia.org/wiki/Richard_Werner. Accessed 31st of January, 2015.
11. Heidelberger Ionenstrahl Therapiezenrtum HIT, Bust of Vinzenz Czerny. http://www.klinikum.uni-heidelberg.de/Strahlentherapie-in-Heidelberg.112981.0.html. Accessed 31st of January, 2015.
ANNETTE TUFFS studied medicine at the universities of Giessen, Wuerzburg, Cambridge (UK) and Bonn. She completed her doctoral thesis at the University of Bonn on the effects of UV light on rat lenses. In 1986, she trained as a journalist with the newspaper Die Welt and worked as science journalist in daily newspapers until 1993. Since 1993, she has been the Head of Public Relations of the German Organ Transplant Foundation, and from 2002 to 2015, she was the Head of Public Relations of University Hospital Heidelberg. She was also a freelance correspondent from Germany for the Lancet from 1990-1999 and for the British Medical Journal from 1999-2012.