Pediatric Department, Queen’s University Hospital, UK
Pediatric Department, Queen’s University Hospital, UK (Summer 2015)
|Wax models at the Josephinum
Frantisek Chvostek was an eminent physician widely known for his description of the Chvostek sign, still widely used in clinical practice.Being born as the son of a leather tanner in nineteenth century Moravia was not the ideal start for a boy dreaming to become a surgeon, but that was the problem facing Frantisek Chvostek. He was born in Mistek, now part of the Czech Republic, on May 21, 1835. Working conditions in the tanning industry were appalling. Animal skins were prepared and treated in large baths with a variety of toxic chemicals such as chrome to form leather. Little if any consideration was given to safety or protective clothing. The heat and the smell of animals and chemicals were overpowering. Not surprisingly, Chvostek chose to follow a different career from that of his father.
Opportunities for young men from his background being limited, Chvostek joined the army as military surgeon. Surprisingly, this was a position that did not require a medical degree. It was nevertheless recognized that army surgeons needed to develop their skills, and a scheme was set up to promote trades people wishing to become doctors at the Josephs Academy, or Josephinum, in Vienna, Austria. In 1861, at the age of 26, Chvostek entered the Academy. At this time France and Austria were in the midst of a war, but it is unlikely that he would have seen many military casualties, as Vienna was a long distance from the war zone.
An unusual feature of the Josephinum was that anatomy was taught there using a collection of over 1,000 wax models. These were made using moulds taken from cadavers or drawings from anatomy books, and were displayed in seven rooms, arranged like the chapters of a textbook. Chvostek perfected his knowledge of anatomy by studying these models, along with the colored diagrams and explanations that accompanied them, rather than on real patients or bodies. Around 1000 of these models exist to this day, and are a popular tourist attraction in Vienna (see figure). This method of teaching emphasized the need for observation, compared with more traditional teaching methods such as dissecting cadavers or observing real operations.
The 1860’s were an exciting time in Vienna. The Second Viennese Medical School, part of the University of Vienna, was carrying out pioneering work in many areas of medicine, including the establishment of the first dermatology and eye clinics in the world. The city was massively expanded and organized into districts. The previously inadequate drinking water system was also rejuvenated and the first Vienna Spring Water Mains was commissioned in a bid to improve public health. Public health was in dire need of improvement because of the industrialization of the city and the poor working conditions.
In 1863, Chvostek received his doctorate from the Josephinium and became a regimental surgeon and physician at the Garrison Hospital, a military hospital in Vienna. He continued to spend time at the Josephs Academy as an assistant to Adalbert Duchek in the department of medicine until 1867. In October, 1864, Chvostek’s son Franz Chvostek, junior was born. Franz, junior would later go on to train as a doctor in Vienna and became director of the 3rd Medical Clinic in Vienna. Unlike his father, he did not have to join the army to become a doctor.
Chvostek was an excellent observer, which was of great importance in a time when most medical discoveries were by observation rather than by science. Most of his publications were observational writings that described patients with neurological conditions such as multiple sclerosis, encephalitis, vasomotor neurosis, and Parkinson’s disease. He also wrote descriptive reports of patients with paralysis, aphasia, and sarcoma of the spine and skull.
From 1868-1871, Chvostek lectured on electrotherapy at Josephs Academy. In 1871, when Duchek was appointed to the University of Vienna, Chvostek took over his medical clinic, running it until the dissolution of Josephs Academy in 1874. He returned to the Garrison Hospital, working as director in the department of internal medicine and remaining there until his untimely death in 1884 at the age of only 49. He wrote extensively about many different medical conditions, but his main area of interest was tetany. He confirmed Wilhelm Heinrich Erb’s discovery that the electrical excitability of motor neurones was increased in tetany.
In 1876, Chvostek published the article describing the discovery of what later become the clinical sign to bear his name – Chvostek’s sign – a sign of motor neurone hyperexcitibility seen in latent tetany. When the facial nerve is tapped in front of the ear and behind the zygomatic arch, muscular spasm is provoked manifesting in twitching of the face, mouth or nose. Chvostek’s sign became a widely used diagnostic tool for latent tetany and later became associated with hypocalcaemia. This discovery added to the already existing Trousseau sign of latent tetany, which was discovered in 1861 by French physician Armand Trousseau. Chvostek’s sign is now known not to be a very sensitive indicator of hypocalcaemia, but his contributions helped in the understanding of the underlying pathology of many diseases.
Chvostek published over 100 papers, many in the Vienna Medical Press and the Army Journal. His early writings focused on neuronal excitability, tetany, and the use of electrostatic therapy. He also contributed to endocrinology, particularly focusing his attention on Graves’ disease, and also wrote extensively on the neurological complications of syphilis, specifically tabes dorsalis and syphilitic meningitis. He also wrote early case reports on patients with spinal tuberculosis, or Pott’s disease, as tuberculosis was very prevalent in Europe in the late 19th century.
Frantisek Chvostek enjoyed an excellent reputation in Vienna and across Europe and was active in teaching medical students at the Josephs Academy until his death. He contributed to increasing the medical knowledge of a wide range of conditions and was one of the most eminent doctors of his time. The key was his humble beginnings that led him to perfect the observational skills that helped him develop into the great physician he later became.
- Deutschsprachige Neurologen und Psychiater: Ein biographisch-bibliographisches Lexikon von den Vorläufern bis zur Mitte des 20. Jahrhunderts, Volume 1, 225-226.
- Syphilis figures: http://www.sciencemuseum.org.uk/broughttolife/themes/publichealth/sti.aspx
- TB figures: http://ocp.hul.harvard.edu/contagion/tuberculosis.html
MAS AHMED, FRCPCH, has been a consultant pediatrician with interest in childhood neurology at the Queen’s University Hospital since 1998. He received training in pediatrics and in particular pediatric neurology at different teaching hospitals, including York Hill Hospital Glasgow and Great Ormond Street Hospital in England. His particular interest is childhood epilepsy and childhood headaches. He has taken different clinical and managerial pediatric responsibilities, including Pediatric Medical Student Lead, Pediatric Research & Development Lead, Pediatric Audit Lead, Royal College of Pediatric and Child Health Tutor, and Pediatric Clinical Director at the Queen’s University Hospital.
Highlighted in Frontispiece Summer 2015 – Volume 7, Issue 3