|Joseph Skoda. Charcoal drawing by Berger, 1883, after A. F. Baschta.. Credit: Wellcome Collection. Public Domain Mark|
Medicine in Vienna developed in two distinct phases.1-3 The first began in 1745 when Empress Maria Theresa on the advice of Herman Boerhaave4 invited Gerard van Swieten5 to become her personal physician. She also appointed him in charge of medical education, thus creating what became the illustrious First Vienna School of Medicine.1-3 This phase lasted until the turn of the century when it was interrupted for about fifty years by the autocratic policies of Prince Metternich.6 In the revolution of 1848 Metternich was overthrown and had to seek refuge in England.6 The change in regime led to what has been called a miracle, a Second Vienna School of Medicine “rising like a phoenix from the ashes.”1 Its main architect was Karl Rokitansky.7 Also responsible for this flowering of medical excellence were the physician Joseph Škoda and the dermatologist Ferdinand von Hebra.1-3, 8
Joseph Škoda was born in 1802 in Pilsen, Bohemia, then part of the sprawling Habsburg Austro-Hungarian Empire. His father was a locksmith. He grew up under poor circumstances, had tuberculosis as a child, and studied by the light of the kitchen stove flame because there was no money for candles. In opposition to his parents’ wishes he chose to become a doctor rather than a priest and had to pay for his education by giving private lessons. He also studied mathematics and physiology, graduated near the top of his gymnasium class in 1825, then walked six days on foot from Pilsen to Vienna to study medicine. He received the degree of Doctor of Medicine in 1831.2, 3, 8
Returning to Pilsen to a medical practice in 1831, he became the “cholera doctor” during an epidemic of this disease, and successfully instituted preventive public health measures (later in Vienna he eliminated typhoid with similar measures). Between 1833 and 1838 he became a non-salaried resident at the Algemeines Krankenhaus (also working in pathology with Karl von Rokitansky7). In 1839 he worked as physician treating the Vienna poor, and the next year became non-salaried chief physician at the new university department of tuberculosis. In 1845, thanks to the support of Rokitansky but against the wishes of the general faculty, he was appointed professor of medicine at the University. In 1848 he was elected to the Imperial Academy of Science.1-3, 8
Škoda was reserved, pedantic, and generally not liked by his colleagues. He was a short stocky man, always wearing an ill-fitting suit, apparently out of loyalty to his tailor.3 In 1848 he began to lecture to his students in German instead of Latin—with a strong Slavonic accent. With patients he adopted a somewhat distant attitude, often neglecting the personal aspect of medicine in favor of the scientific. He believed that in internal medicine one made more progress by doing as little as possible and was accused of being a therapeutic nihilist, but used digitalis, chloral hydrate, and salicylates, as well as aspiration of plural and pericardial effusions. He supported the hygienic measures espoused by Ignaz Semmelweis, established separate clinical departments at the university, and by appointing Ferdinand von Hebra laid the foundations of modern dermatology.1
|Altes AKH in Wien, Kolorierter Stich von 1784. by Josef & Peter Schafer. Via Wikimedia.|
Škoda was a skillful diagnostician, remembered for his bedside clinical diagnosis of conditions such as pericarditis and a leaking abdominal aortic aneurysm. He adopted Rokitansky’s scientific approach and applied it to his methods of examining patients. His findings were collected in his magnum opus, Abhandlung über Perkussion und Auskultation (1839). He modernized bedside clinical medicine by re-introducing the diagnostic technique of percussion as first described by Auenbrugger and describing the various sounds obtained by it.1 He refined and simplified auscultation of the heart and lungs, describing the sounds heard by listening with a stethoscope, and adapting the physical signs described in France by Corvisart,9 Laennec,10 and Piorry. He described the heart sounds and murmurs, pericardial friction rubs, and classified breath sounds as vesicular, bronchial, or crepitant.
Škoda had a brilliant academic career and a successful medical practice. Having a large income, he became wealthy, but maintained a simple lifestyle. He bequeathed legacies to several benevolent institutions and financially supported his cousin who founded the Škoda automobile company. As he aged, he suffered from gout. He retired in 1871 and the occasion was celebrated by the students and population of Vienna with a great torchlight procession in his honor. He died in 1881 and was found at autopsy to have had aortic stenosis, atheroma of the aorta and coronary arteries, and old scarring of the lungs. He is remembered as a medical pioneer, an innovator and a reformer. His efforts helped make Vienna, for a time, one of the foremost centers of medical teaching and practice.1
- Vogle: Six hundred years of medicine in Vienna. A history of the Vienna School of Medicine. Bull N Y Acad Med. 1967: 43(4): 282–299.
- Fejfar Z and Hlavackova L: Joseph Skoda. Clin. Cardiol 1997;20:741.
- Sakula A: Joseph Skoda 1805-81: a centenary tribute to a pioneer of thoracic medicine. Thorax 1981;36:404-411.
- Dunea G: Herman Boerhaave. Hektoen International, Physicians of Note, Fall 2014.
- Dunea G: Gerard van Swieten and his reforms. Hektoen International, Moments in History, Spring 2018.
- Alan Palmer: Metternich. Harper & Row, Publishers, 1972.
- Dunea G: Carl von Rokitansky. Hektoen International, Physicians of Note, Winter 2015.
- Zhang G: Joseph Skoda. Medical Eponym Library, Nov 3 2020.
- Dunea G: Jean Corvisart. Napoleon’s physician. Hektoen International. Spring 2013, Cardiology.
- Liebson P.R: René Théophile Hyacinthe Laënnec and the stethoscope. Hektoen International. Spring 2013, Cardiology.
GEORGE DUNEA, MD, Editor-in-Chief