Robert Hage
Grenada

In the long tradition of physician-humanists, few figures are as quietly compelling as Otto Lanz (1865–1935), a Swiss surgeon whose life unfolded not only in the operating theater but also among Renaissance paintings, antiquities, literature, and poetry. Although remembered primarily for the transverse incision that bears his name in appendectomy, Lanz embodied an older ideal of medicine in which scientific excellence and artistic cultivation were inseparable. For him, anatomy was not merely the basis of surgery but part of a broader appreciation of beauty, proportion, and craftsmanship.

Born in Steffisburg, Switzerland, Lanz was educated within the German-speaking tradition of Bildung, the philosophy that regarded the humanities as essential to the development of an educated individual.¹ During his medical studies in Geneva, he developed an enduring fascination with works of art. What began as youthful curiosity evolved into remarkable expertise. He learned to recognize quality, acquired pieces through exchanges and purchases, and gradually established relationships with leading art dealers and private collectors across Europe.^2,3 After serving as a prosector in anatomy, Lanz received his medical degree in 1889 and completed his doctorate two years later. He then became assistant to the renowned Swiss surgeon Theodor Kocher, who was later awarded the Nobel Prize in Physiology or Medicine in 1909 for his pioneering work on thyroid surgery. Working with Kocher exposed Lanz not only to surgical innovation but also to influential social circles. Among his acquaintances was Crown Prince Rupprecht of Bavaria, reflecting the cosmopolitan world he moved through with ease.

In 1897, Lanz founded the Lindenhof Clinic in Bern, which he later entrusted to the Red Cross when he accepted the chair of surgery at the University of Amsterdam in 1902, declining prestigious offers from Bologna and Heidelberg,¹ as well as Giessen, Utrecht and Konigsberg.⁴ His private clinic stood adjacent to the Boerhaave Hospital and only a short walk from the Rijksmuseum, a fitting location for a surgeon whose professional and artistic lives were so closely intertwined.

Lanz’s home in Amsterdam—often referred to as Casa Lanz—resembled a private museum rather than a physician’s residence. Renaissance paintings, sculptures, furniture, ceramics, and antiquities were carefully arranged throughout the rooms, each object chosen to complement the others rather than merely to impress visitors. His collection of early Italian paintings included works attributed to Botticelli and masters of the Florentine school. The collection became sufficiently renowned that the Rijksmuseum mounted two exhibitions featuring more than four hundred objects from his holdings.¹

The Renaissance fascination with the human body resonated deeply with Lanz. The anatomical precision sought by artists such as Leonardo da Vinci paralleled the surgeon’s own understanding of structure and function. To Lanz, medicine and art were not separate pursuits but complementary ways of observing humanity.

His surgical career coincided with one of the most transformative periods in modern medicine. During the late nineteenth century, surgery evolved rapidly with the adoption of antiseptic and aseptic techniques, safer anesthesia, radiography, and a new understanding of abdominal disease. One landmark event occurred in 1886, when the American pathologist Reginald Heber Fitz presented his influential paper on perforating inflammation of the vermiform appendix.⁵ Fitz demonstrated that appendicitis represented a distinct disease entity requiring early surgical treatment, replacing the older concepts of typhlitis, perityphlitis, and paratyphlitis.

Lanz quickly embraced this new understanding. Building upon Charles McBurney’s work,⁶ he refined the surgical approach to appendectomy and described several anatomical landmarks that eventually became eponyms. The Lanz point became an important surface landmark in diagnosing appendicitis, while the Lanz incision—a more transverse approach than McBurney’s oblique incision—provided improved cosmetic and functional results.⁷ He also described the loss of the right cremasteric reflex in appendicitis, later known as the Lanz sign.

Innovation characterized his career. Inspired by watching his daughter create decorative paper cutouts, Lanz designed the Hautschlitzapparat, an instrument capable of producing meshed skin grafts through multiple parallel incisions.⁸ The device increased the surface area of skin grafts while facilitating drainage, illustrating his ability to draw practical inspiration from everyday observation.

Lanz also introduced chloroform anesthesia to Amsterdam,⁴ replacing the ether then in common use, and became a vigorous advocate for aseptic surgical practice. He believed that technical excellence extended to the appearance of the wound itself. His small, carefully fashioned incisions—his celebrated “buttonholes”—were described as the surgeon’s visiting card, reflecting both craftsmanship and respect for the patient. Colleagues remarked that during abdominal operations his index finger functioned as “the eye of the surgeon,” emphasizing the tactile sensitivity that distinguished accomplished surgeons before the advent of modern imaging.

His scientific writings, published in both German and Dutch journals, ranged widely across experimental surgery, endoscopy, animal research, and the use of air insufflation. Yet unlike many technical papers of the period, Lanz’s articles often wandered beyond scientific observation into humor, self-reflection, and personal anecdote.

He did not hesitate to recount his own mistakes. In one memorable account, he described an emergency operation for what appeared to be a massive abdominal tumor. Only after opening the abdomen did he discover that the “tumor” was simply an enormously distended urinary bladder, prompting him to close the incision immediately. With characteristic candor, he admitted his embarrassment and reflected that had the patient been male, the diagnosis likely would never have escaped him. In another report, he recounted excising what he believed to be a tumor from the dorsum of the tongue before realizing that it represented an ectopic lingual thyroid. Such admissions were unusual in an era when surgeons rarely publicized their errors.⁹

His concern for patients extended beyond the operating room. Before discharge, he handed each patient a self-addressed, stamped postcard with instructions to report on recovery, creating an early and remarkably personal system of postoperative follow-up.

Medicine was only one expression of Lanz’s intellectual life. He contributed regularly to the literary supplement of the Bernese newspaper Der Bund and published poetry and dramatic works throughout his career. These included Erstlinge (1894),¹⁰ a collection of poems; Auf der Olympus (1908), a satirical play in which Hippocrates and the Muses induct a colleague into an imaginary academy of immortal physicians; Amor’s Rache (1927),¹¹ a humorous mythological wedding play; and Xenien MCMXXXII (1934),¹² another volume of verse. The physician and the writer comfortably inhabited the same person.

His interests extended into public life as well. He advocated for the construction of Amsterdam’s indoor public swimming pool, one of Europe’s largest when completed in 1912, while simultaneously criticizing what he regarded as society’s growing obsession with competitive sport.¹ Long before organ transplantation became reality, he argued in 1894 that physicians should not dismiss treatments aimed at replacing organs that had lost their function—a remarkably prescient observation.¹³ It was Alexis Carrel who described in 1902 a method of anastomosing arteries and veins in dogs, laying the foundation for transplantation.¹⁴

Lanz possessed strong opinions and rarely concealed them. After the First World War, he voiced his protest about the exclusion of German surgeons and the German language from the International Surgical Society, and “retaliated” by refusing to address any colleague in their language other than German or Dutch. He also wrote to the Italian government urging it not to join the Axis powers, a position that reportedly rendered him persona non grata in Italy for years.¹

His passion for collecting occasionally led him into ethically ambiguous territory. He advised collectors on acquisitions, described himself as the only surgeon among art dealers, and became known for ingenious methods of transporting artworks across borders, including concealing valuable objects beneath inexpensive copies or hiding them in crates of oranges. Some shipments reportedly bore the warning “Beware, poisonous snakes” to discourage customs inspections.¹

Not all Lanz’s views have aged well. Like many intellectuals of his era, he expressed opinions that today appear culturally insensitive or scientifically unsupported, commenting disparagingly on modern art, women’s cosmetics, and speculative causes of prostatic enlargement. These views remind us that even gifted physicians remain products of their historical moment.

Contemporaries found him unforgettable. The Dutch novelist Simon Vestdijk, who studied medicine in Amsterdam during Lanz’s tenure, immortalized him as “Dr. Lenz,” a brilliant, sharp-tongued surgeon with a rugged face and unmistakable German accent.¹⁵ Petronella van Heerden, the first South African woman physician and one of Lanz’s assistants, described him as flamboyant, unconventional, and intellectually fearless. Others remembered him as charismatic, vain, generous, outspoken, and impossible to ignore. The famous artist Jan Toorop presented Otto Lanz with a portrait, a color charcoal and pencil drawing on paper, to honor his silver jubilee as a surgeon in 1927.

Otto Lanz occupies a curious place in medical history. His name survives in surgical anatomy, yet the breadth of his life has largely faded from memory. He was not simply a skilled operator but a physician whose intellectual world encompassed anatomy and aesthetics, science and literature, collecting and craftsmanship. At a time when medicine increasingly rewards specialization, Lanz reminds us of an older tradition in which the physician was expected to cultivate not only technical mastery but also the humanities. His life suggests that the surgeon’s hand may be guided as much by an appreciation of beauty, history, and culture as by anatomy alone.

One Friday morning, March 22, 1935, Lanz stood in front of his students, felt unwell, went home, and died.¹⁶

References

1. Veen, FT. Het Nederlandse Palazzo. Verzamelingen van vroeg-Italiaanse kunst. The Dutch Palazzo. Collections of early Italian art, Rijksmuseum/Nieuw Amsterdam (2008).
2. Van Gulik, TM, Brummelkamp, WH. Otto Lanz, surgeon and art collector, Neth J Surg. 1988;31-36.
3. De Maasbode. De avonturen van een verzamelaar. Delpher, August 30, 1940.
4. Van Capellen, D. In memoriam Prof. Dr. Otto Lanz. Ned Tijdschrift Geneeskunde, 1935;13:1366-8.
5. Fitz, R.H. Perforating Inflammation of the Vermiform Appendix. The American Journal of the Medical Sciences, 1886;92:321-346.
6. McBurney, C. The indications for early laparotomy in appendicitis. Ann Surg. 1891;13:233-254.
7. Lanz, O. Der McBurney’sche Punkt. Zentralbl Chir. 1908;35:185-190.
8. Lanz, O. Over Transplantatie. Ned Tijdschrift Geneeskunde. 1907;51:1335-7.
9. Clinische lessen, Inleiding tot de Chirurgie der urinewegen. Ned Tijdschrift Geneeskunde. 1928;72:154-164.
10. Lanz, Otto. Erstlinge, Schmid, Francke & Co, 1894.
11. Lanz, Otto. Amor’s Rache. Ein Polterabendscherz und Rasher Ausflug in’s Ferne Traumland Der Mythologie. L.J. Veen, 1927.
12. Lanz, Otto. Xenien. MCMXXXII. Nypels, 1934.
13. Schlich T. An Ancient Dream of Mankind? The Historicity of Organ Transplantation. In: The Origins of Organ Transplantation: Surgery and Laboratory Science, 1880-1930. Rochester Studies in Medical History. Boydell & Brewer, 2010:3-13.
14. Carrel, A. “Father of transplant surgery” and supporter of eugenics. Br J Gen Pract. 2019;69(684):352. doi: 10.3399/bjgp19X704441.
15. Vestdijk, S. De rimpels van Esther Ornstein. Nygh & Van Ditmar, 1959.
16. Der Bund, Volume 86, Number 141, March 25, 1935.