Carl von Rokitansky (1804-1881)

For a brief period between 1860 and 1910, Vienna became the cultural capital of Europe, just as Constantinople had been in the Middle Ages and Florence during the Renaissance. It had become an attractive metropolis of two million people, capital of an empire that in the wake of two serious military defeats had abandoned its geopolitical ambitions and turned inwards, attending to the political and cultural aspirations of its people. As described by 2000 Nobel Prize winner Eric Kandel in his beautifully illustrated book, newly promulgated liberal laws attracted to Vienna an influx of talent from all over the empire, resulting in an extraordinary cultural and intellectual flowering – in architecture, philosophy, psychology (Sigmund Freud), literature (Arthur Schnitzler), music (Gustav Mahler), and painting (Gustav Klimt, Oscar Kokoschka, Egon Schiele). Vienna became one of the birthplaces of Modernism, a reaction against the Rationalism perception that human behavior and its mental processes were governed by reason. In their writings Freud and Schnitzler explored the irrational depths of the unconscious. In art Klimt and his disciples began painting people in stark realistic or greatly distorted forms, their knowledge of the human body based in part on having briefly studied medicine and witnessed dissection at the famous Allgemeines Krankenhaus. In that hospital an atmosphere of science, exploration, innovation, and creativity has been fostered by, among others, the chief of the department of pathology, Carl von Rokitansky.

Born in 1804 in Bohemia, then part of the sprawling Habsburg Empire, Rokitansky first studied philosophy at the Charles University in Prague, started medicine in 1822, then transferred to Vienna where he found the teaching more inspiring. He graduated in 1824, then began his career by accepting an unpaid position as prosector in anatomy. For the rest of his life he remained in Vienna, except for a brief stint as cholera physician doctor in Galicia, then ruled by Austria but now in Poland and the Ukraine.

In Vienna Rokitansky found a health service already under imperial sponsorship. Medical teaching had been reformed in the middle of the seventeenth century, the city hospital founded and expanded. Famous physicians had established the so-called first or old Vienna school, famous for its excellence but in somewhat of a decline and stagnation. After 1834 Rokitansky advanced in ranks with succeeding appointments in pathologic anatomy, becoming full professor in 1844. Then with his clinical colleagues Joseph Skoda and Ferdinand von Hebra he developed the new or second Vienna school, which became foremost in Europe for clinical medicine and science. Rokitansky’s fame is based on his insistence of strictly correlating the symptoms and signs observed during life with what was found on autopsy, a great advance in the modern understanding of disease.

In his efforts Rokitansky was able to take advantage of the shift away from the repressive days of Metternich and of Emperor Franz I – who had once declared that he needed brave men, not scholars.  Already earlier on the empress Maria Theresa had decreed that every patient dying in hospital was to have an autopsy. During his tenure as chief of pathology Rokitansky is said to have supervised 7,000 autopsies and personally done over 3,000, working seven days a week for over forty-five years. The experience gained from such vast exposure to necropsy material is reflected in the many clinical and pathological syndromes which to this day eponymously bear his name – tumors, diverticula, ulcers, sinuses, vascular lesions, and other findings affecting every part of the body, the heart, brain, lungs, and abdomen. He made contributions to the understanding of congenital heart disease, bacterial endocarditis, pneumonia, emphysema, typhoid fever, multiple sclerosis, amyloidosis, goiter, perforating gastric ulcer and cancer, acute dilatation of the stomach, intestinal obstruction and intussusception, superior mesenteric artery syndrome, acute yellow atrophy of the liver, hepatic vein obstruction, and polycystic disease of the ovaries. As a prolific writer he reported his findings in numerous scientific articles and monographs, and published in 1846 a major handbook in three volumes of pathological anatomy. He translated the works of Sydenham, and is regarded as the forerunner of the modern clinicopathological conference.

In 1847 Rokitansky also became the medicolegal anatomist of the city of Vienna, and in 1863 was appointed by the government to advise on all matters of medical teaching. He was elected to the Academy of Sciences in 1848, became president of the Medical Society of Vienna, and was an elected honorary member of many foreign societies and academies. A pioneer in ethics and advocate for improved medical care, he was actively engaged in medical education, serving several times as dean of the university, and greatly contributing to the flowering of Austrian culture and liberalism in his time. In 1867 emperor Francis Joseph appointed him to the upper house or senate, and in 1872 he became president of the Anthropological Society.

Retiring at the age of 70, he received a baronetcy and was invested with the Cross of Commander of the Order of Leopold in a splendid ceremony in which he also received from King Victor Emmanuel the Cross of a Grand Officer of the Order of the House of Italy. In the banquet in the dining hall of the Academy of Vienna attended by 240 guests, he was greatly honored by representatives from many countries; and in reply he acknowledged the many marks of esteem by saying that in Vienna he had found a second home and had labored with his best powers for the development of science and the welfare of his fellow citizens. In a more recent editorial Dr. Gilder pointed out that as a modest hard-working pathologist in an unglamorous profession he is unlikely to have ever had a movie made about him. But as a pioneer in pathologic anatomy and a leader in education and ethics, he undoubtedly remains a shining figure in the history of scientific medicine.

References

Bures, J: Carl von Rokitansky. On the 20 on the 200th anniversary of the birth of the founder of clinical pathology: History of Czech Gastroenterology (Google) .

Editorial: Carl von Rokitansky. JAMA 1963, 183: 1105.

Gilder SBB: Carl von Rokitansky. Canadian Medical Association Journal 1954, 71:70.

Kandel, ER: The Age of Insight. Random House, 2012.

Rokitansky Festival: British Medical Journal, Feb 28, 1874, p. 282.

Weyers,W: Carl von Rokitansky his life work and contributions to dermatology. Am J  Dermatology 2004, 26:431

 


George Dunea (Winter 2015), MD, Editor-in-Chief

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