Baron Carl von Rokitansky (, ; 19 February 1804 – 23 July 1878) was an Austrian medical doctor, pathologist, humanist philosopher and liberal politician, founder of the Viennese School of Medicine of the 19th century.Helmut Rumpler, Helmut Denk (Hrsg.), Christine Ottner (Redaktion): Carl Freiherr von Rokitansky 1804–1878. Pathologe, Politiker, Philosoph, Gründer der Wiener Medizinischen Schule des 19. Jahrhunderts. Wien, Böhlau 2005, ISBN 3-205-77205-9. He was the founder of science-based diagnostics,Österreichisches Biographisches Lexikon und biographische Dokumentation: Rokitansky, Carl Frh. von. 2003, accessed 3 April 2021. connecting clinical with pathological results in a feedback loop that is standard practice today but was daring in Rokitansky's day.
Early life Carl Joseph Wenzel Prokop Rokitansky, usually known as Carl Rokitansky, was born in Hradec Králové (), in the Kingdom of Bohemia, then part of the Habsburg monarchy and an imperial state of the Holy Roman Empire. His father Prokop Rokitansky (1771–1813) was a civil servant in Leitmeritz. His mother Theresia (1772–1827) was the daughter of Václav Lodgman Ritter von Auen, the first regional commissioner of Hradec Králové. Carl was the eldest of four children (Prokop, Marie, Theresie). Due to the early death of his father († 1812), Carl and his siblings grew up in straitened circumstances. Despite this, his mother made sure that he attended grammar school in Hradec Králové and made it possible for him to study at the Charles University in Prague. Rokitansky described his upbringing as very liberal.Carl Rokitansky: Carl von Rokitansky. Selbstbiographie und Antrittsrede-. Erna Lesky, 1960, p 47. Rokitansky remembered his father, as having been very widely read and erudite. For this reason, Rokitansky originally intended to study classical philology at the University of Prague.
University studies
Rokitansky began university in 1818 with the obligatory philosophical propaedeutics. Some of his classes were taught by the philosopher Bernardo Bolzano (1771–1848), who was to have a lasting influence on his political and social ideas.Felicitas Seebacher: "Freiheit der Naturforschung!" Carl Freiherr von Rokitansky und die Wiener medizinische Schule. Wissenschaft und Politik im Konflikt. Verlag der Österreichischen Akademie der Wissenschaften [ÖAW], Wien 2006, p 47. However, in 1821 he decided to study medicine in Prague. In 1824 he moved to Vienna to live with his uncle Lodgman von Auen and to continue his medical studies at the University of Vienna. In 1827 he began his research at the Pathological-Anatomical Prosecture at the Vienna General Hospital. His first complete autopsy report is dated 23 October 1827.Helmut Rumpler, Helmut Denk, Christine Ottner: Carl Freiherr von Rokitansky 1804–1878. Pathologe, Politiker, Philosoph, Gründer der Wiener Medizinischen Schule des 19. Jahrhunderts. Wien, Böhlau 2005, p 9. ISBN 3-205-77205-9. He obtained his doctorate in medicine from the University of Vienna on 6 March 1828. His doctoral thesis was entitled "De Varioloide Vaccinica",Carl Rokitansky: Dissertation; De Varioloide Vaccinica. Wien 1828. and was a study of the smallpox vaccination, as he had very early on developed an interest in serology.
Medical career From 3 January 1827 onwards Rokitansky began working at the Pathological-Anatomical Prosecture as an unpaid assistant, as can be seen from some of his early autopsy protocols.Kletter G. Hic locus est ubi mors gaudet succurrere vitae, Die Geschichte der Entwicklung der pathologischen Anatomie im 19. Jahrhundert. p 21. unpublished manuscript Narrenturm, Naturhistorisches Museum Wien. 1832 he was appointed interim director of the Pathological-Anatomical Prosecture and in 1834 became Extraordinary Professor for Pathological Anatomy at the University of Vienna and Curator of the Pathological-Anatomical Museum.
First chair for pathological anatomy in the German-speaking world:
In 1844 he was appointed to the first chair for pathological anatomy in the German-speaking world and in the years 1849/50, 1856/57, 1859/60, and 1862/63 served as Dean of the Faculty of Medicine. In 1852/53 academic year he was the first freely-elected rector of the University of Vienna.Österreichisches Biographisches Lexikon und biographische Dokumentation: Rokitansky, Carl Frh. von. 2003, retrieved 3 April 2021.
Pathologist New Viennese School
The 1830s saw the emergence of the New Viennese School that was based on the new scientific methods established by Carl Rokitansky. In the 20th century, this became known as the Second Viennese School of Medicine. Other well-known proponents besides Rokitansky were the clinician Josef Škoda and the dermatologist Ferdinand Ritter von Hebra. However, contemporary students such as Sigmund Freud described themselves until well into the 20th century as students of the New Viennese School and regarded Rokitansky as a father figure,Werner Hanak-Lettner: Die Universität. Eine Kampfzone. Hrsg.: Werner Hanak-Lettner im Auftrag des Jüdischesn Museums Wien. Picus, Wien 2015, ISBN 978-3-7117-2031-3, S. 54. calling him "Vater Roki". The New Viennese School sought to introduce a new system of science-based medicine. Until then, pathology had been a purely descriptive science that was disconnected from clinical practice. While contemporary pathologists, such as Gabriel Andral and Jean Frédéric Lobstein, compiled autopsy reports containing descriptions of illnesses they did not make any diagnoses or connect their findings with the clinician who had treated the patient when alive. They believed that the origins of an illness were to be found in the "dynamic moment", an imbalance of the four humours as postulated by Hippocrates.
For Rokitansky, however, such an approach no longer sufficed; he wanted to find explanations, to reach science-based diagnoses. One of his first autopsies that he performed as a young man together with his superior Johann Wagner (1799–1832) was that of Ludwig van Beethovenhttps://geschichte.univie.ac.at/de/personen/carl-freiherr-von-rokitanskyhttps://doctorlib.info/gynecology/history-endometriosis/2.htmlThe Dawn of Modern Pathology - PMC (nih.gov)Genius-between-music-and-disease-Medical-considerations-on-Ludwig-van-Beethoven.pdf (researchgate.net) In this autopsy the question of the composer's deafness was of particular interest and the pathologists did far more than produce the customary description as they sought to find an explanation for Beethoven's deafness in anatomical changes. This was to have a lasting impression on Rokitansky's approach to research, which was driven by a desire to explain the origins of illness with the help of anatomy,Ursula Rokitansky-Tilscher: Beethoven's influence on Rokitansky's methodology. Retrieved 3 April 2021. an intellectual approach that had first been initiated by the Italian pathologist Giovanni Battista Morgagni in the 18th century. Rokitansky's approach differed from that of his contemporaries as he no longer looked for the "dynamic moment", but for the "anatomical seat" of the illness.Carl von Rokitansky: Handbuch der pathologischen Anatomie. Band 1. Braumüller & Seidel, Wien 1846, S. 1–2 (google.at [accessed 3 April 2021]). The inscription on the Pathological-Anatomical Institute subsequently erected in Spitalgasse in the ninth district of Vienna therefore reads: "Indagandis sedibus et causis morborum" (Der Erforschung des Sitzes und der Ursachen der Erkrankungen).Strukturen und Netzwerke. 3 December 2018, doi:10.14220/9783737009164 (vr-elibrary.de [retrieved 3 April 2021]).
Diagnostics
Rokitansky developed pathology from a descriptive discipline into an explanatory science. Over the course of his life he performed almost 60,000 autopsies in which he compared the patients' medical history and clinical symptoms with their autopsy protocols. He recognised that physicians named illnesses after the most conspicuous external symptom without considering the underlying internal disease of the organs (e.g. diagnosing jaundice in patients who presented with yellowish skin with no thought given to the underlying liver disease). It became clear to him that these symptomata, (which in Greek means coincidences) are not coincidences but in fact external indications of a pathological change to an internal organ.
In close collaboration with the internist Joseph Škoda he made clear the relationships between clinical symptoms that can be seen, felt or heard and pathological changes to organs, i.e. clinico-pathological correlation. Thus it was now possible for the first time to make scientifically sound diagnoses. Rokitansky thus initiated a paradigm shift from speculative, natural-philosophical medicine to systematic, science-based medicine. By classifying illnesses according to their stage of progression, it became possible to diagnose how far a pathological condition had advanced and to deliver a prognosis. From the 1830s onwards medical students and physicians from all over the world came to Vienna to learn about Rokitansky's diagnostic methods and nosology, which soon became known internationally as the Young or New Viennese School. The systematic investigation of each individual organ led to the development in Vienna of new clinical disciplines. Rokitansky also supported this development in his role as a medical advisor to the Minister of the Interior as well as the establishment of the world's first clinic for otology. As a pathologist and philosopher, Rokitansky thought about patients holistically and was vehement in his demands that patients with psychological disorders, back then called "lunatics" also had the right to a diagnosis, treatment and healing. He therefore demanded the establishment of the first University Clinic of Psychiatry in Austria. In his application, he wrote that the clinic should be headed by Theodor Meynert. The importance subsequently given to the psyche paved the way not only for Sigmund Freud, psychology and psychoanalysis, according to Eric Kandel it also influenced modernist art which turned its gaze below the surface appearance of things and placed the depiction of its models' emotions in the foreground.Eric Kandel: The age of insight. Random House. New York 2013, p 27.
Manual of Pathological Anatomy:
Rokitansky documented the results of his research in his three-volume Handbuch der pathologischen Anatomie published in 1842–46 by Braumüller & Seidel. He systematically described pathological changes to each and every organ and explained how to arrive at a diagnosis on the basis of the respective symptoms. The third edition (1855–1861) contains woodcut prints of his hand-drawn sketches of his histopathological specimens at 550-times magnification.Pathologisch-anatomische Sammlung im Narrenturm, MN 11.931, Naturhistorisches Museum Wien. Eigenhändige anatomische Zeichnungen von Carl Rokitansky. An order of the Emperor in 1846 made it compulsory for all medical students in the Habsburg Monarchy to study Rokitansky's manual. In response to the stream of physicians and students from abroad who came to Austria to study Rokitansky's methods, the manual was translated into a number of languages to worldwide acclaim. It was published in countries including Russia: Rukovodstvo k patologicheskoy anatomii, 3 volumes, published by Moscow Imperial University, Moscow 1844–1849, the United States (New York): A Treatise on Pathological Anatomy, New York: WM. Radde 1845, and at the same time in the United Kingdom: A Treatise on Pathological Anatomy, London: H. Balliere 1845, the Netherlands: Handboek bijzondere ziektekundige ontleedkunde, Two Volumes, Erven F. Bohn, Gent 1846–1849,