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Intellectual Development of Carl Von Rokitansky

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Abstract

Fortunately, Goethe’s scientific philosophy of precise observation spread to Austria as an antidote to Schelling’s natural-philosophical system that had retarded medical science in Austria as it had in Germany.2 Natural scientific pathology emerged out of natural philosophical pathology. In the latter case Sigerist explained, one “tries to work out a system of manifestations abstractly, which is as nearly as possible without gap.” On the other hand, in natural scientific pathology “one explains only as much as may be sustained by observation and in experiments.” Instead of speculation, one constructs and tests hypotheses to bridge gaps in knowledge, hypotheses which are discarded when new observations make them indefensible.3

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Notes

  1. 1.

    Johann Wolfgang Goethe, Wilhelm Meisters Journeyings I, 4 (1829), 19, 39. Ronold King, “Goethe and the challenge of science in western civilization,” in Goethe on Human Creativeness and other Goethe Essays, ed. Rolf King [Athens, GA: University of George Press, 1950], 227.

  2. 2.

    Erna Lesky, The Vienna Medical School of the 19th Century [Baltimore, MD: Johns Hopkins University Press, 1976], 78. “True, Brunonianism had collapsed in Vienna as elsewhere in 1804; but as elsewhere, it was succeeded also in Vienna by Schelling’s natural-philosophical system which claimed with great confidence that all phenomena in nature could be deduced from reason alone.”

  3. 3.

    Henry E. Sigerist, Man and Medicine: An Introduction to Medical Knowledge, trans. Margaret Galt Boise [New York: W. W. Norton & Company, 1932], 116.

  4. 4.

    Erna Lesky, The Vienna Medical School of the 19th Century [Baltimore, MD: Johns Hopkins University Press, 1976], 79.

  5. 5.

    Erna Lesky, 79.

  6. 6.

    Erna Lesky, 81. See also Lesky p. 152–4. Ernst von Feuchtersleben (1806–1849), well read in the philosophy of Goethe and who made Goethe’s insistence on careful observation based on personal experience his credo, “felt most attracted to Philipp Carl Hartmann,” of all his medical teachers. Subsequently, Feuchtersleben was a colleague of Rokitansky, both members of the exclusive circle of the Society of Physicians founded in 1837 by Türkheim.

  7. 7.

    R. J. Rather, Eva R. Rohl. An English Translation of the Hitherto Untranslated Part of Rokitansky’s Einleitung to volume 1 of the Handbuch der allgemeinen Pathologie (1846), with a Bibliography of Rokitansky’s published works. Clio medica 1972;7:215–227:224–227.

  8. 8.

    Henry E. Sigerist, Man and Medicine: An Introduction to Medical Knowledge [New York: WW Norton & Company, 1932], 170. Sigerist, himself a physician, appreciated that chronic diseases are often difficult to define. “Now there are a number of diseases which begin gradually and insidiously, which bring with them no stormy periods of doubtful outcome but which may last a long time, sometimes years, and sometimes decades. These are the chronic diseases.”

  9. 9.

    Sonia Horn, “Vom Leichenoffnen…Beobachtungen zum Umgang mit anatomischen und pathologischen Sektionen in Wien vor 1800,” Wiener Klinische Wochenschrift 2004;116/23:792–803:801.

  10. 10.

    Roy Porter, Blood and Guts: A Short History of Medicine [New York: W. W. Norton & Company, 2002], 137–8.

  11. 11.

    Webster’s New Biographical Dictionary [Springfield, MA: Merriam-Webster Inc., 1988], 159. Cabanis was a French physician and philosopher, who became Professor of Hygiene in 1794 at the Medical School in Paris.

  12. 12.

    Webster’s New Biographical Dictionary, 368. Frank was one of the chief founders of the science of public health.

  13. 13.

    Erna Lesky, The Vienna Medical School of the 19th Century [Baltimore, MD: Johns Hopkins University Press, 1976], 68.

  14. 14.

    Erna Lesky, 68.

  15. 15.

    Erna Lesky, The Vienna Medical School of the 19th Century [Baltimore, MD: Johns Hopkins University Press, 1976], 4. As professor of medicine, Frank was a clinician. 278.

  16. 16.

    Erna Lesky, 76. This was the beginning of the comprehensive teaching tradition whereby medical students from the Vienna General Hospital performed autopsies in the morgue followed by physical examinations of patients in the hospital that resulted in a high maternal mortality from puerperal sepsis on the wards attended by medical students. See also pages 181–186. Students would work in the autopsy house and carry infection from corpses back to the Maternity Clinic where they unknowingly infected postpartum patients resulting in many deaths from puerperal sepsis. It was students working in Rokitansky’s autopsy rooms that were responsible for epidemics of death from puerperal sepsis when Semmelweis made his discovery of the relationship between contaminated bare hands from autopsy and maternal deaths from puerperal sepsis, a discovery anticipated by Rokitansky.

  17. 17.

    Max Neuburger. “Johann Peter Frank as Founder of the Pathology of the Spinal Cord,” in Essays in the History of Medicine, trans. by various hands and edited with foreword by Fielding H. Garrison [New York: Medical Life Press, 1930], 131–143:142–43. Max Neuburger, Professor of the History of Medicine at the University of Vienna wrote: “May we never forget Frank as one of the founders of the pathology of the spinal cord, even today [1930] when, unexpectedly after the lapse of a hundred years, the seed he sowed has shot up into a flourishing stalk.”

  18. 18.

    Erna Lesky, The Vienna Medical School of the 19th Century [Baltimore, MD: Johns Hopkins University Press, 1976], 75. Roland Sedivy, Carl Freiherr von Rokitansky: Wegbereiter der Pathologischen Anatomie [Vienna: Verlag Wilhelm Maudrich, 2002], 26.

  19. 19.

    Erna Lesky, 76. “A scientist of Vetter’s caliber was a guarantee that the development of pathological anatomy that was taking place around the medical clinic would not be smothered by pure didactic or by casuistics and museum collections. Vetter, however, also possessed the knowledge required for these fields; as a self-taught man he had acquired the technical skill necessary for making preparations; from Stoll he had learned to apprehend morphological as well as clinical-symptomatic details by keen observation. Thus he, a pathological anatomist, was also firmly rooted in the Hippocratic foundations of Vienna empirical medicine…He attempted to develop a general pathology in which two great classes of diseases would be distinguished on a genetic-morphological basis, “the active or rapidly developing changes” and the “passive, mechanical or chronic ones.” This attempt was too early, of course, at a time when pathological anatomy hardly used a microscope.” “Vetter proved himself a congenial ancestor of Rokitansky…[he was] the first and only thinker in the series of Vienna prosectors in the years 1796–1832.”

  20. 20.

    Erna Lesky, 77.

  21. 21.

    Erna Lesky, 76.

  22. 22.

    Erna Lesky, 20, 58, 87. Webster’s New Biographical Dictionary [Springfield, MA: Merriam-Webster Inc., 1988], 368. Dismissed by the Austro-Hungarian Emperor, Frank served as physician to Czar Alexander I of Russia from 1805 to 1808.

  23. 23.

    Erna Lesky, 77.

  24. 24.

    Erna Lesky, The Vienna Medical School of the 19th Century [Baltimore, MD: Johns Hopkins University Press, 1976], 98.

  25. 25.

    Erna Lesky, 75, 77.

  26. 26.

    Erna Lesky, 77.

  27. 27.

    Erna Lesky, 77. It was from one of these museum specimens that Rokitansky was to publish a case of partial müllerian agenesis in 1838.

  28. 28.

    Erna Lesky, 90–91.

  29. 29.

    Erna Lesky, The Vienna Medical School of the 19th Century [Baltimore, MD: Johns Hopkins University Press, 1976], 75, 77.

  30. 30.

    Erna Lesky, 77.

  31. 31.

    Erna Lesky, 77.

  32. 32.

    Ivo Steiner, “Rokitansky in his Bohemian years and his relations with Jan E. Purkyne,” Wiener Klinische Wochenschrift 2004;116/23: 788–791. This is an excellent source of biographical information on Rokitansky from birth until 1824 when he departed Prague for Vienna.

  33. 33.

    Erna Lesky, 107. “Mechanical memorizing of prescribed textbooks was all this system could offer him during his years of study in Prague (1822–1824) and in Vienna (1824–1828).” Paul Klemperer. Notes on Carl von Rokitansky’s autobiography and inaugural address. Bulletin of the History of Medicine 1961;35:374–80:374. “The description which Rokitansky gives of medical education in Prague and Vienna shows the low level of instruction at the time. It was determined by the rule of a bureaucracy which mistrusted talent and aimed at developing a safe mediocrity. The professors were uninspired drill masters of their disciplines.” Gilder SSB. Carl von Rokitansky (1804–1878). Canadian Med J 1954;71:70–72.

  34. 34.

    Erna Lesky, 107–108.

  35. 35.

    Erna Lesky, 77–78. See also pages 18–19: Rokitansky’s 5-year medical school curriculum had first been introduced in 1810. The fifth year studies were particularly strong in pathology and included “Special Pathology and Therapy of the Internal Diseases; Practical Medical Instruction at the Bedside; Forensic Medicine, and in the summer session: Medical Police.” The curriculum of 1810 was changed in 1833 after Rokitansky graduated.

  36. 36.

    Erna Lesky, 107.

  37. 37.

    Hui ACF, Wong SM. Deafness and liver disease in a 57-year-old man: a medical history of Beethoven. Hong Kong Medical Journal 2000 Dec;6(4):433–438. The original autopsy report, written in Latin, was found in the Vienna Museum of Anatomical Pathology in 1970.

  38. 38.

    Gilder SSB. Carl von Rokitansky (1804–1878). Canadian Med J 1954;71:70–72.

  39. 39.

    Carl Rokitansky, A Manual of Pathological Anatomy, Volume I. General Pathological Anatomy. trans. William Edward Swaine [Philadelphia, PA: Blanchard & Lea, 1855], viii. Editor’s Preface to Vol. I.

  40. 40.

    Carl Rokitansky, A Manual of Pathological Anatomy, Volume II. The Abdominal Viscera. trans. Edward Sieveking [Philadelphia, PA: Blanchard & Lea, 1855], ix. Editor’s Preface. “Rokitansky,” as Mr. Wilde correctly remarks, “differs from all other pathologists, in not engaging in the study or treatment of disease during life; he is not a practical physician, and seldom sees one of the many hundreds of cases, whose bodies he dissects.” Erna Lesky, The Vienna Medical School of the 19th Century [Baltimore, MD: Johns Hopkins University Press, 1976], 107. While in Prague preparatory to the study of medicine, Rokitansky’s “basic melancholic disposition became evident, the deep pessimism of his nature, which later made him accept the philosophy of Schopenhauer as the interpretation of the world most appropriate to his nature.” See also: Alexander M. Rokitansky, “Ein Leben an der Schwelle,” Wiener Medizinische Wochenschrift 2004;154/19-20:454–457. Prim. Univ.-Prof. Dr. Alexander M. Rokitansky, Vienna, Austria.

  41. 41.

    Erna Lesky, The Vienna Medical School of the 19th Century [Baltimore, MD: Johns Hopkins University Press, 1976], 77–78.

  42. 42.

    Erna Lesky, 78.

  43. 43.

    Max Neuburger. “Johann Peter Frank as Founder of the Pathology of the Spinal Cord,” in Essays in the History of Medicine, trans. by various hands and edited with foreword by Fielding H. Garrison [New York: Medical Life Press, 1930], 131–143: 143. Frank was one of the founders of the pathology of the spinal cord.

  44. 44.

    Gilder SSB. Carl von Rokitansky (1804–1878). Canadian Med J 1954;71:70–72. Erna Lesky, The Vienna Medical School of the 19th Century [Baltimore, MD: Johns Hopkins University Press, 1976], 78. “As Rokitansky stated in his autobiography (p. 51), ‘notwithstanding the daily contradictions between the results of dissection and the records on disease and diagnosis,’ Wagner ‘was not able to grasp the lesion beyond casuistics or to form a clear idea of the reforming impact his subject was destined to make…”

  45. 45.

    Erna Lesky, The Vienna Medical School of the 19th Century [Baltimore, MD: Johns Hopkins University Press, 1976], 78.

  46. 46.

    Gilder SSB. 1954;71:70–72. “[Rokitansky] had a gift for exact observation, and clear exposition.”

  47. 47.

    Paul Strathern, A Brief History of Medicine from Hippocrates to Gene Therapy [New York: Carroll & Graf, 2005], 207–211. “Two centuries previously Morgagni had emphasized the organs in which disease is located, and subsequently pathology had very much concentrated on the appearances of diseases” at autopsy. See also: Venita Jay, “The legacy of Karl Rokitansky,” Arch Pathol Lab Med 2000;124:345–346:345. “At the completion of a postmortem examination, he worked backward to determine what could have led to the observed pathology.”

  48. 48.

    Erna Lesky, The Vienna Medical School of the 19 th Century [Baltimore, MD: Johns Hopkins University Press, 1976], 77–78.

  49. 49.

    The marvel of magnification via telescope [Galileo: 1564–1642] and microscope [Leeuwenhoek: 1632–1723] opened for scientific study the vast natural world beyond the visual acuity of humans. Eventually Rokitansky would use the microscope, one of the marvels of technology, but he never mastered the instrument.

  50. 50.

    Erna Lesky, The Vienna Medical School of the 19th Century [Baltimore, MD: Johns Hopkins University Press, 1976], 107.

  51. 51.

    Venita Jay, “The legacy of Karl Rokitansky,” Arch Pathol Lab Med 2000;124:345–346:345. Gilder SSB. Carl von Rokitansky (1804–1878). Canadian Med J 1954;71:70–72.

  52. 52.

    Joseph Needham, A History of Embryology 2nd ed. [New York: Abelard-Schuman, 1959], 223. Needham wrote: “It was not until 1812 that J. F. Meckel the younger translated Wolff’s papers into German.” Temkin parses this statement of Needham. Owsei Temkin, “Basic Science, Medicine, and the Romantic Era,” in The Double Face of Janus and Other Essays in the History of Medicine [Baltimore, MD: Johns Hopkins University Press, 1977], 375. “It is a mistake, though often repeated, that Wolff’s Theoria generationis was forgotten or failed to make a serious impression and that it took the German translation of Wolff’s other work, On the Formation of the Intestines, to remind the world of him. It is true that the latter essay remained practically unknown until Meckel’s translation in 1812. It is equally true that the emphasis in these two works is placed differently. But I am afraid that Goethe is partly responsible for the misapprehension that in 1790, when he published his Metamorphosis of Plants, preformation still prevailed and Wolff was unknown. Goethe learned of the Theoria generationis only about 1792, but this was due to his own oversight, not to that of his contemporaries. Moreover, by that time epigenesis, in Germany, had found an even more aggressive and popular protagonist in Blumenbach…At any rate, before the century had passed, epigenesis, though not without qualifications, was accepted by leading German biologists and philosophers, to mention only Herder, Kant, and Schelling among the latter.”

  53. 53.

    Thomas H. Broman, The transformation of German academic medicine 1750–1820 [Cambridge: Cambridge University Press, 1996], 178. Three generations of Meckel professors: Johann Friedrich Meckel the Elder (1714–1774), his son Philipp F. T. Meckel (1755–1803) and his grandson Johann Friedrich Meckel the Younger (1781–1833).

  54. 54.

    Arleen Marcia Tuchman, Science, Medicine, and the State of Germany: The Case of Baden, 1815–1871 [New York: Oxford University Press, 1993], 15. “Not until the Napoleonic Wars and the collapse of the Holy Roman Empire were these institutions significantly restructured and redefined.” When the University of Halle reopened in 1808, it was in the newly formed Kingdom of Westphalia.

  55. 55.

    Thomas H. Broman, The transformation of German academic medicine 1750–1820 [Cambridge: Cambridge University Press, 1996], 178.

  56. 56.

    Johann Hermann Baas, Outlines of the History of Medicine and The Medical Profession. Trans. H. E. Henderson [Huntington, NY: Robert E. Krieger Publishing Co., 1971], 951 n. [Original edition 1889, one volume; Reprint 1971, two volumes]. Erna Lesky, The Vienna Medical School of the 19th Century [Baltimore, MD: Johns Hopkins University Press, 1976], 211. Joseph Hyrtl (1810–1894) “like Rokitansky, he was a self-taught man and received his anatomic knowledge from Meckel.”

  57. 57.

    Thomas H. Broman, 186–7. “Pathological anatomy, Meckel observed as early as 1805, had usually been studied in one of two ways. It had consisted either of a catalogue of an organ’s possible deviations from its normal form and mixture, without regard for the impaired or defective processes by which the deviation occurred, or it had laid primary weight on the processes, appending a merely supplemental description of the anatomical changes undergone by the organ. In either case, pathological autonomy had studied the degenerative changes of organs that were at one time healthy and normal, an inquiry driven by medical practitioner’s desire to know what changes were produced by diseases in the body. Although such goals may be laudable, Meckel argued that the subject need not be restricted to serving clinical needs; it could also serve a “higher interest. This interest, he continued, consisted of ‘the developmental history of the organ under normal circumstances,’ along with ‘the harmonization of various organs and systems with each other.”

  58. 58.

    Erna Lesky, The Vienna Medical School of the 19th Century [Baltimore, MD: Johns Hopkins University Press, 1976], 108.

  59. 59.

    Thomas H. Broman, 178.

  60. 60.

    Erna Lesky, 112–3.

  61. 61.

    Venita Jay, “The legacy of Karl Rokitansky,” Arch Pathol Lab Med 2000;124:345–346:345.

  62. 62.

    Roswell Park, An Epitome of the History of Medicine 2nd ed. [Philadelphia: F. A. Davis Company, 1908], 244–245. Venita Jay, “The legacy of Karl Rokitansky,” Arch Pathol Lab Med 2000;124:345–346:345. Erwin H. Ackerknecht, Medicine at the Paris Hospital 1794–1848 [Baltimore, MD: Johns Hopkins Press, 1967], 83–4, 166–7.

  63. 63.

    Erwin H. Ackerknecht, Medicine at the Paris Hospital 1794–1884 [Baltimore, MD: Johns Hopkins Press, 1967], 25. See also: 89. Laennec “and his teacher Bichat both emphasized the fact that pathological anatomy was imported into medicine by surgeons.”

  64. 64.

    Erwin H. Ackerknecht, 164, 167. Cruveilhier (1891–1873) was the most celebrated member of the Paris School. Roswell Park, An Epitome of the History of Medicine 2nd ed. [Philadelphia: F. A. Davis Company, 1908], 244. The American surgeon and medical historian Roswell Park (1852–1914) wrote of the Paris School of Pathological Anatomy and Diagnosis: “It made it the duty of the physician to search for changes in the human body, to investigate the local products of disease, and assigned to medicine the duty of removing these products. The tendency of its teaching was to treat the patient rather as a living cadaver than as a sentient being endowed with vital forces.” Park went on to quote an author named Kratzmann. “Kratzmann wrote some years ago: ‘In France every one experiments on the sick, less to attain the best method of cure than to enrich science with an interesting discovery and to advance the accuracy of diagnosis by some new physical sign.”

  65. 65.

    Gilder SSB. Carl von Rokitansky (1804–1878). Canadian Med J 1954;71:70–72

  66. 66.

    Erwin H. Ackerknecht, Medicine at the Paris Hospital 1794–1884 [Baltimore, MD: Johns Hopkins Press, 1967], 167.

  67. 67.

    Erwin H. Ackerknecht, 168.

  68. 68.

    Erwin H. Ackerknecht, 167–8.

  69. 69.

    Erna Lesky, The Vienna Medical School of the 19 th Century [Baltimore, MD: Johns Hopkins University Press, 1976], 107.

  70. 70.

    Erna Lesky, 108.

  71. 71.

    Erna Lesky, 108.

  72. 72.

    Erna Lesky, 108. Henry E. Sigerist, The Great Doctors: A Biographical History of Medicine. Trans. Eden and Cedar Paul [New York: W. W. Norton & Company, 1933], 292, 294.

  73. 73.

    Erna Lesky, 108. See also: R. J. Rather, Eva R. Rohl. An English Translation of the Hitherto Untranslated Part of Rokitansky’s Einleitung to volume 1 of the Handbuch der allgemeinen Pathologie (1846), with a Bibliography of Rokitansky’s Published Works. Clio medica 1972;7:215–227:215. “Rokitansky, too, believed that the task facing the general pathologist centered on the explanation of the disease process.”

  74. 74.

    Erna Lesky, 107.

  75. 75.

    Owen H. Wangensteen and Sarah D. Wangensteen, The Rise of Surgery: From Empiric Craft to Scientific Discipline [Minneapolis, MN: University of Minnesota Press, 1978], 440. Kussmaul worked at Rokitansky’s side for 4 months while they performed autopsies. Kussmaul returned to Germany. He taught Robert Meyer at the German University of Strassburg. At Strassburg, Friedrich von Recklinghausen performed autopsies for Kussmaul.

  76. 76.

    Erna Lesky, The Vienna Medical School of the 19th Century [Baltimore, MD: Johns Hopkins University Press, 1976], 109. Skoda remained at the University of Vienna where he and Rokitansky became dominant figures in the specialties of medicine and pathological anatomy in the Second Vienna Medical School.

  77. 77.

    Gilder SSB. Carl von Rokitansky (1804–1878). Canadian Med J 1954;71:70–72.

  78. 78.

    Erna Lesky, 106. This would not be the only time that a yearbook or journal was to be intimately associated with the rise of a University Medical School; the same occurred 10 years later, in 1845–1846 in Buffalo, New York, USA with the publication of the Buffalo Medical Journal and the incorporation of the University of Buffalo Medical School and in 1889 with the opening of Johns Hopkins Hospital and the inauguration of The Bulletin of Johns Hopkins Hospital.

  79. 79.

    Erna Lesky, 99. The Vienna Society of Physicians which met in Türkheim’s apartment published its own “house organs,” Verhandlungen (Transactions) commencing in 1842 and the Zeitschrift der k.k.Gesellschaft der Arzte zu Wien (Journal of the Imperial Royal Society of Physicians in Vienna) commencing in 1844.

  80. 80.

    Roland Sedivy, Carl Freiherr von Rokitansky: Wegbereiter der Pathologischen Anatomie [Wien: Verlag Wilhelm Maudrich, 2002,] 26. The pathological anatomy museum, where Rokitansky found his specimens, was constructed in 1796 on the personal order of Kaiser Joseph II. An illustration of this pathological anatomy museum is rendered on page 27 of Sedivy’s monograph.

  81. 81.

    Ghirardini G, Popp LW. The Mayer-von Rokitansky-Küster-Hauser syndrome (uterus bipartitus solidus rudimentarius cum vagina solida): the development of gynecology through the history of a name. Clin Exp Obstet Gynecol 1995;22:86–91. These authors state that partial müllerian agenesis with solid vagina was known to Avicenna and Albucassis in the middle ages.

  82. 82.

    The various lenses through which scientists, clinicians, and patients have viewed endometriosis will be described and evaluated from a chronologic perspective beginning in the early nineteenth century with Mayer’s description of vaginal agenesis, the first contribution in a nearly two-century long evolution of the Mayer-Rokitansky-Küster-Hauser [M-R-K-H] syndrome further clarified by Fedele et al. in 2007. The M-R-K-H syndrome may serve as a Rosetta stone for understanding the classic theories of pathogenesis of endometriosis.

  83. 83.

    Mayer, Ueber Verdoppelungen des Uterus und ihre Arten, nebst Bemerkungen uber Hasenscharte und Wolfsrachen. Journal der Chirurgie und Augen Heilkunde 1829;13:525–564. Mayer’s cases were not true duplications of the uterus as described by Joe Leigh Simpson. See: Simpson JL. Genetics of the female reproductive ducts. Am J Med Genet (Semin Med Genet) 1999;89:224–39:235. True duplication of the uterus “is very rare and almost always misclassified. Affected women must have two separate uteri, each of which can have two fallopian tubes….Embryogenesis presumably involves division of one or both müllerian ducts early in embryogenesis…True duplication should be distinguished from incomplete müllerian fusion, the much more common condition in which each of two hemiuteri is associated with only a single fallopian tube.”

  84. 84.

    Mayer, Ueber Verdoppelungen des Uterus und ihre Arten, nebst Bemerkungen uber Hasenscharte und Wolfsrachen. Journal der Chirurgie und Augen Heilkunde 1829;13:525–564. See also: Ghirardini G, Popp LW. The Mayer-von Rokitansky-Küster-Hauser syndrome (uterus bipartitus solidus rudimentarius cum vagina solida): the development of gynecology through the history of a name. Clin Exp Obstet Gynecol 1995;22:86–91.

  85. 85.

    Johannes Müller, Bildungsgeschichte der Genitalien aus anatomischen Untersuchungen an Embryonen des Menschen und der Thiere [Düsseldorf: Arnz, 1830].

  86. 86.

    Harold Speert, “Johannes Müller and the Müllerian Ducts,” in Obstetric & Gynecologic Milestones Illustrated, 2nd ed. rev. [Parthenon Publishing Group, 1996], 102.

  87. 87.

    Von Prof. Dr. Rokitansky, Uber die sogenannten Verdoppelungen des Uterus. Medicinische Jahrbucher des kaiserl. konigl osterreichischen Staates 1838;26:S39–77:40. Later their names became associated with the syndrome of partial müllerian agenesis, the Mayer-Rokitansky-Küster-Hauser syndrome.

  88. 88.

    Von Prof. Dr. Rokitansky, 1838;26:S39–77.

  89. 89.

    Parenthetically, it is interesting to see that patient anonymity was not preserved, nor were the identities of other patients Rokitansky presented. He identified some by their full name, others by their first name and the first letter of their family name. Presumably this was standard practice in Vienna in 1828 because Rokitansky would not have had the authority to initiate such a practice during his first year in the autopsy house in 1827–1828. In 1829 in Bonn, (Germany) Mayer identified his cases by the noun “subject” or “person” instead of the patient’s proper name.

  90. 90.

    Partial müllerian agenesis is relatively uncommon, 1 in 5,000 births or autopsies. See: Aittomaki K, Eroila H, Kajanoja P. A population-based study of the incidence of müllerian aplasia in Finland. Fertil Steril 2001;76:624–5. There are two forms of müllerian aplasia: partial müllerian agenesis, Mayer-Rokitansky-Küster-Hauser syndrome and complete müllerian aplasia characterized by absence of the vagina, uterus, and fallopian tubes. Complete or total müllerian aplasia may occur in XX females and in XY phenotypic females when it is called androgen insufficient syndrome. “Most women with müllerian aplasia are otherwise healthy and have normal female chromosome constitution, hormonally active functioning ovaries, and normal female secondary sexual characteristics. However müllerian aplasia also occurs in specific syndromes such as androgen insensitivity.” In Finland, the incidence of vaginal aplasia over a period of 10 years [including Mayer-Rokitansky-Küster-Hauser syndrome and complete müllerian agenesis] was 1:5,000 newborn girls. In Finland, most patients had Mayer-Rokitansky-Küster-Hauser syndrome.

  91. 91.

    Ramirez JC, Puerta AJ, Rebollo A, Benitez R, Pena A, de la Macorra JC. Rokitansky’s syndrome in association with reno-ureteral abnormalities. Teratogenic period. Eur Urol 1987;13:346–50.

  92. 92.

    Acien P. Lloret M, Chehab H. Endometriosis in a patient with Rokitansky-Küster-Hauser syndrome. Gynecol Obstet Invest 1988;25:70–72.

  93. 93.

    Griggs JA, Rudoff J, Coddington CC. Mayer-Rokitansky-Küster-Hauser syndrome with splenosis. A case report. J Reprod Med 1990;35:821–3.

  94. 94.

    Carl Rokitansky, A Manual of Pathological Anatomy, Volume II. The Abdominal Viscera. trans. Edward Sieveking [Philadelphia, PA: Blanchard & Lea, 1855] Chapter III. Abnormalities of the Female Sexual Organs, 201–202. Note how Rokitansky intuits the importance of retained blood that ordinarily would have been expelled. Only in 1921 would John Sampson recognize the significance of retrograde menstruation as one mode of pathogenesis of endometriosis.

  95. 95.

    Carl Rokitansky, A Manual of Pathological Anatomy, Volume II. The Abdominal Viscera. trans. Edward Sieveking [Philadelphia, PA: Blanchard & Lea, 1855]. Chapter III. Abnormalities of the Female Sexual Organs, 206–207.

  96. 96.

    Carl Rokitansky, A Manual of Pathological Anatomy, Volume I. General Pathological Anatomy. trans. William Edward Swaine [Philadelphia, PA: Blanchard & Lea, 1855], 23. [Author’s] Introduction. “XVI. With reference to the period during which anomalies originate, we have to distinguish congenital, or such as have become established during intra-uterine life, and acquired, or such as have arisen during extra-uterine life. The former comprehend primitive anomalies.” “XVII. Primitive anomalies comprise malformations. These are deviations of the organism, or of an organ, so intimately blended with its primary development, as to occur only at the earliest periods of embryonic life, or at any rate before that of mature fœtal existence.”

  97. 97.

    Carl Rokitansky, A Manual of Pathological Anatomy, Volume I. General Pathological Anatomy. trans. William Edward Swaine [Philadelphia, PA: Blanchard & Lea, 1855], 25. [Author’s] Introduction. See also page 30 where Rokitansky discussed the classification of malformations according to Bischoff. “First Class. – Malformations deficient in some essential attribute of their kind.” “At this day, however, so much in this assumption is still hypothetical that we are compelled to deal with it cautiously, addressing ourselves, where it is possible, to other causes, more especially to interrupted evolution of an organ out of its germ, or to its development being impeded through external influences, such as impression wrought upon the mother; destruction of the organ, in the progress of its development, through disease, particularly through dropsical accumulation; finally, destruction of an organ through mechanical influence-for example, the amputation of a limb by means of the umbilical cord or a pseudomembranous formation with the ovum, etc.”

  98. 98.

    Sherwin B. Nuland, “The New Medicine: The Anatomical Concept of Giovanni Morgagni.” In Doctors [New York: Alfred A. Knopf, 1988], 145–170: 147.

  99. 99.

    Sherwin B. Nuland, 147–149.

  100. 100.

    Roy Porter, Blood and Guts: A Short History of Medicine [New York: W. W. Norton & Company, 2002], 73.

  101. 101.

    Roy Porter, ed. The Cambridge Illustrated History of Medicine [Cambridge: Cambridge University Press, 1996], 652, 707, 1112.

  102. 102.

    Roy Porter, Blood and Guts: A Short History of Medicine [New York: W. W. Norton & Company, 2002], 73.

  103. 103.

    Steven I. Hajdu, Pathologists who attained fame without using microscopy. Annals of Clinical & Laboratory Science 2003;33:119–122. Both Morgagni and Baillie had clinical practices; Rokitansky did not. Henry E. Sigerist, The Great Doctors: A Biographical History of Medicine. Trans. Eden and Cedar Paul [New York: W. W. Norton & Company, 1933], 236. Morgagni’s “ideas of general pathology were entirely conventional. His chosen field was that of special pathological anatomy, and, as a matter of course, naked-eye pathological anatomy.” Sherwin B. Nuland, “The New Medicine: The Anatomical Concept of Giovanni Morgagni.” in Doctors [New York: Alfred A. Knopf, 1988], 145–170: 152. Morgagni, the clinician practiced anatomy without the benefit of microscopy. Nuland, page 161: Historians consider Morgagni as the founder of modern medical diagnosis.

  104. 104.

    Sherwin B. Nuland, “The New Medicine: The Anatomical Concept of Giovanni Morgagni.” In Doctors [New York: Alfred A. Knopf, 1988], 145–170:241–2.

  105. 105.

    Roswell Park, An Epitome of the History of Medicine, 2nd ed. [Philadelphia: FA Davis Company, 1908], 250-1. See also: Rickman John Godlee, Lord Lister [Oxford: Clarendon Press, 1924], 346. The Allgemeines Krankenhaus in Vienna as well as Rokitansky’s autopsy house were “hopelessly out of date” in the 1860s. “About 1865 the most celebrated hospitals on the continent, the Allgemeines Krankenhaus at Vienna, the Hotel-Dieu at Paris, the Charite at Berlin, The Julius Hospital at Würzburg, and others…were hopelessly out of date.”

  106. 106.

    Laura Otis, Müller’s Lab [Oxford: Oxford University Press, 2007], 19.

  107. 107.

    Laura Otis, 19.

  108. 108.

    Erna Lesky, The Vienna Medical School of the 19th Century [Baltimore, MD: Johns Hopkins University Press, 1976], illustration number 20.

  109. 109.

    Bankl H. Die Prosektur Rokitanskys: Historische Erinnerungen zu den Jubilaumsjahren der Wiener Pathologie 1996 und 1997. (The Rokitansky morgue. Historical retrospect on the occasion of the anniversary years of Vienna pathology 1996 and 1997) Wien Kin Wochenschr 1997;109:858–60.

  110. 110.

    Laura Otis, Müller’s Lab [New York: Oxford University Press, 2007], 15. Berlin had gas lighting in 1829. Considering that Berlin was still a provincial city compared to Vienna, it is reasonable to assume that the Leichenhaus, the Vienna autopsy house, had gas lighting in 1829 or within a reasonable time thereafter.

  111. 111.

    Erna Lesky, The Vienna Medical School of the 19th Century [Baltimore, MD: Johns Hopkins University Press, 1976], illustration number 41. “Dissection room in the “Alte Gewehrfabrik” (“Old Rifle Factory”)

  112. 112.

    Doug Macdougall, Frozen Earth: The Once and Future Story of Ice Age [Berkeley, CA: University of California Press, 2004], 217. “The Little Ice Age lasted from approximately 1300 to 1850, and its coldest period was near its end.” Macdougall is Emeritus Professor of Earth Sciences at the Scripps Institution of Oceanography, University of California, San Diego. See also: Brian Fagan, The Little Ice Age: How Climate Made History 1300–1850 [New York: Basic Books, 2002].

  113. 113.

    Carl Rokitansky, A Manual of Pathological Anatomy, Volume II. The Abdominal Viscera. trans. Edward Sieveking [Philadelphia, PA: Blanchard & Lea, 1855], vii–ix. Editor’s Preface. “The immense fund of material thus placed at his disposal [the number of corpses dissected by him is summed up at 30,000] was almost entirely reserved for the elaboration of that grand work on pathological anatomy, which, in the consciousness of having thoroughly mastered the subject, he gave to the world between the years 1842 and 1846; which has passed, unaltered, through three reimpressions; and which, under the auspices of the Sydenham Society, has been translated into the English language.” See also: Roswell Park, An Epitome of the History of Medicine, 2nd ed. [Philadelphia: FA Davis Company, 1908], 250-1. The Sydenham Society translation of Rokitansky’s 1846 Handbook of Pathological Anatomy that I reviewed at the Health Sciences Library, State University of New York at Buffalo was owned and signed by Roswell Park with his surname Park. It is a reasonable assumption that Park derived his estimate of over 30,000 autopsies from that source.

  114. 114.

    Lester S. King, The Medical World of the Eighteenth Century [Huntington, NY: Robert E. Krieger Publishing Co., 1958, Reprint 1971], 276-277. Henry E. Sigerist, Man and Medicine: An Introduction to Medical Knowledge. Trans. Margaret Galt Boise [New York: W. W. Norton & Company, 1932], 127. Anatomical pathology may be divided into “two great lines of research; the study of deformities called teratology, and the study of disease, [called] nosology.” Henry E. Sigerist, Man and Medicine: An Introduction to Medical Knowledge. Trans. Margaret Galt Boise [New York: W. W. Norton & Company, 1932], 120. “In order to relate causally an anatomical change to a disease symptom one must first know the normal function of the organ. Only then is it possible to judge in how far a symptom is an expression of disturbed function. An anatomical pathology not only presupposes anatomy but also physiology. Before the eighteenth century’s new physiology [when Morgagni practiced] had gained a certain point in progress pathological anatomy could be of no great importance.” Henry E. Sigerist, Man and Medicine: An Introduction to Medical Knowledge. Trans. Margaret Galt Boise [New York: W. W. Norton & Company, 1932], 123. Marie-Francois-Xavier Bichat [1771–1802], working in late eighteenth century and within the ontological conception of disease, took anatomical pathology to a new and finer level; he explained that “each separate tissue may be attached by disease.” Carl Rokitansky [1804–1878] working in the nineteenth century, performed pathological anatomy within the ontological conception of disease, except when he tried to explain disease with minimal or no localized pathology, then he reverted to the ancient physiological conception of disease and formulated his hematohumoral theory. Henry E. Sigerist, Man and Medicine: An Introduction to Medical Knowledge. Trans. Margaret Galt Boise [New York: W. W. Norton & Company, 1932], 124. Rudolf Virchow [1821–1902], working also in the nineteenth century and within the ontological conception of disease, championed the cell as the seat of disease in his famous Cellular Pathology published in 1858.

  115. 115.

    Henry E. Sigerist, Man and Medicine: An Introduction to Medical Knowledge. Trans. Margaret Galt Boise [New York: W. W. Norton & Company, 1932], 119.

  116. 116.

    Georges Canguilhem, The Normal and the Pathological. Trans. Carolyn R. Fawcett in collaboration with Robert S. Cohen [New York: Zone Books, 1991], 51. Canguilhem continues, “The observation of pathological cases offers numerous, genuine advantages for actual experimental investigation. The transition from the normal to the abnormal is slower and more natural in the case of illness, and the return to normal, when it takes place, spontaneously furnishes a verifying counterproof.” Canguilhem wrote while in prison during World War II and this last sentence was not operative when Rokitansky wrote his Handbook of Pathological Anatomy; in 1846, the year when the final volume was published, anesthesia had just been discovered. Without anesthesia there was not surgical pathology, that is, examination of tissues removed from a patient who survived surgery and hence the ability to visualize and examine microscopically to ascertain whether or not the diseased organ or tissues had indeed “returned to normal.”

  117. 117.

    John A. Talbott, A Biographical History of Medicine: Excerpts and Essays on the Men and Their Work [New York: Grune & Stratton, 1970], 586. John Talbott was the author’s professor of medicine at the State University of New York at Buffalo and later editor of the Journal of the American Medical Association.

  118. 118.

    Roy Porter, The Greatest Benefit to Mankind: A Medical History of Humanity [New York: W. W. Norton & Company, 1998], 315. “Rokitansky was the age’s champion dissector-his institute did over 1,500 necropsies a year and he supposedly performed 60,000 autopsies in the course of his career.”

  119. 119.

    Prim. Univ.-Prof. Dr. Roland Sedivy, e-mail message to author, September 2, 2007. “Rokitansky had no refrigeration and there was no ice-box. I checked most of all autopsy books where he signed all reports of autopsy. This fact does not certify that he performed the autopsies…I am convinced that he discussed each case and signed the report.”

  120. 120.

    Carl Rokitansky, A Manual of Pathological Anatomy, Volume II. The Abdominal Viscera. trans. Edward Sieveking [Philadelphia, PA: Blanchard & Lea, 1855], vii – ix. Editor’s Preface.

  121. 121.

    Erna Lesky, The Vienna Medical School of the 19th Century [Baltimore, MD: Johns Hopkins University Press, 1976],113. “He held the highest academic office and executed the most responsible corporative and administrative functions in the spirit of progress: as the first freely elected dean of the medical collegium of professors (1849–1850, 1856–1857, 1859–1860), as the first freely elected chancellor of the Vienna University (1852–1853), as president of the Society of Physicians (1850–1878) and as president of the Academy of Sciences (1869–1878).”

  122. 122.

    Venita Jay, “The legacy of Karl Rokitansky,” Arch Pathol Lab Med 2000;124:345–346:345.

  123. 123.

    Arleen Marcia Tuchman, Science, Medicine, and the State of Germany: The Case of Baden, 1815–1871 [New York: Oxford University Press, 1993], 160. Medical students were supervised in their autopsies under Rokitansky who was interested in morbid macroscopic pathological anatomy. However, that was apparently not the case with medical students in Berlin under the direction of Johannes Müller who was interested in microscopic anatomy and physiology rather than autopsies. “In Müller’s dissection courses … the students [were] left to their own devices, hacking away at corpses without any guidance.”

  124. 124.

    Dr. John A. Talbott was the author’s professor of medicine at the State University of New York at Buffalo in the 1950s. He later became Editor-in-Chief of the Journal of the American Medical Association. For many years Dr. Talbott had had an interest in the history of medicine. The estimate of 60,000 autopsies attributed to Rokitansky is contained in his Biographical History of Medicine published in 1970.

  125. 125.

    Erna Lesky, The Vienna Medical School of the 19th Century [Baltimore, MD: Johns Hopkins University Press, 1976], 115.

  126. 126.

    Owen H. Wangensteen and Sarah D. Wangensteen, The Rise of Surgery: From Empiric Craft to Scientific Discipline [Minneapolis, MN: University of Minnesota Press, 1978], 440. Kussmaul worked at Rokitansky’s side for 4 months while they performed autopsies. The Wangensteen’s recorded that “Kussmaul wrote that he spent four months working daily beside Rokitansky, assisting with autopsies. During all that time the only words Rokitansky spoke to him occurred during an interruption of work while the two stood together for a few minutes in the doorway on a fine autumn morning. Said Rokitansky, “Today we have beautiful weather.” The astounded Kussmaul pulled himself together and replied, “Yes, it is truly a beautiful day.”

  127. 127.

    Gilder SSB. Carl von Rokitansky (1804–1878). Canadian Med J 1954;71:70–72.

  128. 128.

    Harvey Cushing, The Life of Sir William Osler [Oxford, UK: Clarendon Press, 1926], 113.

  129. 129.

    Ronold King, “Goethe and the Challenge of Science in Western Civilization,” in Goethe on Human Creativeness and other Goethe Essays, ed. Rolf King [Athens, GA: University of Georgia Press, 1950], 223–252:229.

  130. 130.

    Erna Lesky, The Vienna Medical School of the 19th Century [Baltimore, MD: Johns Hopkins University Press, 1976], 99.

  131. 131.

    Ann La Berge and Caroline Hannaway, “Paris Medicine: Perspectives Past and Present,” in Constructing Paris Medicine, ed. Caroline Hannaway and Ann La Berge [Amsterdam, NL: Editions Rodopi B. V., 1998], 1–69:19.

  132. 132.

    Ann La Berge and Caroline Hannaway, 1–69:18.

  133. 133.

    Erna Lesky, 16–20. As the result of the aggressive and repressive “restoration program” that Joseph Andreas von Stifft began in 1803, Johann Peter Frank – the physician who had reorganized pathological anatomy at the University of Vienna – was dismissed in 1804 as part of Stifft’s unrelenting spirit of persecution. See Erna Lesky, p 77. Frank left Vienna in 1804. “Thus the first attempt at establishing pathological-anatomical dissection in Vienna, which had seemed so promising, temporarily came to an end.” Klemperer reference is more explicit. See: Paul Klemperer, Notes on Carl von Rokitansky’s Autobiography and Inaugural Address. Bulletin History of Medicine 1961;35:364–80:377. “It was deplorable for the glory of Vienna that this exceptional man [Johann Peter Frank] was forced to abandon his office in 1803, but pathological anatomy found another home in Paris where it could grow beyond the scope of descriptive correlation of Morgagni into the rational science of medicine.”

  134. 134.

    Erwin H. Ackerknecht, A Short History of Medicine [New York: Ronald Press, 1968], xiii.

  135. 135.

    Ann La Berge and Caroline Hannaway, “Paris Medicine: Perspectives Past and Present,” in Constructing Paris Medicine, ed. Caroline Hannaway and Ann La Berge [Amsterdam, NL: Editions Rodopi B. V., 1998], 1–69:7.

  136. 136.

    Erwin H. Ackerknecht, 51.

  137. 137.

    Othmar Keel, “Was Anatomical and Tissue Pathology a Product of the Paris Clinical School or Not?” in Constructing Paris Medicine, ed. Caroline Hannaway and Ann La Berge [Amsterdam, NL: Editions Rodopi B. V., 1998], 117–183:133–4.

  138. 138.

    Ann La Berge and Caroline Hannaway, 1–69:25.

  139. 139.

    Carl Rokitansky, A Manual of Pathological Anatomy, Volume I. General Pathological Anatomy. trans. William Edward Swaine [Philadelphia, PA: Blanchard & Lea, 1855], 17–19. [Author’s] Introduction.

    Rokitansky presented a brief historical review of an “occasional, fragmentary, indeterminate study of pathological anatomy” that commenced in the sixteenth century. However, he believed pathological anatomy to be “modern science.” “It is indeed only of late years that it has assumed the dignity of an independent science at all.”

  140. 140.

    Erna Lesky, The Vienna Medical School of the 19th Century [Baltimore, MD: Johns Hopkins University Press, 1976], 99. “With Türkheim’s assistance, the laboratory of pathological-chemical examinations was established in [1842] at the General Hospital, under the direction of Johann Florian Heller, and thus became the nucleus of the subsequent medical-chemical institute.

  141. 141.

    Erna Lesky, 77, 99. Vienna was the second university to establish a Chair of Pathological Anatomy. The first Chair of Pathological Anatomy was established at the University of Strasbourg, France in 1791, 2 years after the onset of the French Revolution.

  142. 142.

    Erna Lesky, The Vienna Medical School of the 19th Century [Baltimore, MD: Johns Hopkins University Press, 1976], 109. Lesky noted also that Virchow, at the end of the nineteenth century, wrote that Rokitansky’s Handbuch der Pathologischen Anatomie “of all existing textbooks in this discipline … immediately proved to be the best and the actual basis of practical medicine.”

  143. 143.

    Erna Lesky, 109.

  144. 144.

    Rokitansky acknowledged the pathological anatomical contributions of Johannes Müller. Carl Rokitansky, A Manual of Pathological Anatomy, Volume I. General Pathological Anatomy. trans. William Edward Swaine [Philadelphia, PA: Blanchard & Lea, 1855], 168, 193, 206, 219.

  145. 145.

    Henry E. Sigerist, The Great Doctors: A Biographical History of Medicine. Trans. Eden and Cedar Paul [New York: W. W. Norton & Company, 1933], 295–296.

  146. 146.

    Carl Rokitansky, A Manual of Pathological Anatomy, Volume I. General Pathological Anatomy. trans. William Edward Swaine [Philadelphia, PA: Blanchard & Lea, 1855], 17–19. [Author’s] Introduction.

  147. 147.

    Carl Rokitansky, A Manual of Pathological Anatomy, Volume I. General Pathological Anatomy. trans. William Edward Swaine [Philadelphia, PA: Blanchard & Lea, 1855], ix, x. Author’s Preface.

  148. 148.

    Carl Rokitansky, ix. Author’s Preface. Vienna, July, 1846.

  149. 149.

    Henry E. Sigerist, The Great Doctors: A Biographical History of Medicine. Trans. Eden and Cedar Paul [New York: W. W. Norton & Company, 1933], 296–297.

  150. 150.

    Lester S. King, The Medical World of the Eighteenth Century [Huntington, NY: Robert E. Krieger Publishing Co., 1958, Reprint 1971], 264.

  151. 151.

    Castagnoli L, Jonjic N, Rizzardi C, Melato M. Carl von Rokitansky and the Italian translation of the Handbuch der Pathologischen Anatomie: a linguistic and doctrinal enigma. Pathologica 2001;93:654–61. Carl Rokitansky, A Manual of Pathological Anatomy, Volume I. General Pathological Anatomy. trans. William Edward Swaine [Philadelphia, PA: Blanchard & Lea, 1855], 20. [Author’s] Introduction.

    Rokitansky explained some general points before embarking on his discussion of the anomalies of organization. “IV. This demonstration of general disease is indeed a step in advance for pathological anatomy. It threatens, however, to mislead us into the error of exclusive, transcendental, all-pervading humoralism-into the error of denying all local disease, by deducing the latter in every instance from a corresponding general affection,-not but that many diseases really are but the localization of a pre-existent general disease.” Next, note how in the editor’s preface, the English editors respectfully chose to use Rokitansky’s own word “transcendental” to skillfully avoid the subject of “all-pervading humoralism” which was not acceptable in England in 1846. Carl Rokitansky, A Manual of Pathological Anatomy, Volume I. General Pathological Anatomy. trans. William Edward Swaine [Philadelphia, PA: Blanchard & Lea, 1855], viii. Editor’s Preface to Vol. I. “The editor has felt the necessity of abridging somewhat the author’s general introduction, partly because, totally unlike the general tendency of the work, it is too “transcendental” a character either to suit the English language or to harmonize with English ideas; but more particularly because it is interwoven with a train of speculative reasoning upon the relation between power and matter, which might, in this country, very possibly give rise to misinterpretation and rebuke.”

  152. 152.

    Erna Lesky, The Vienna Medical School of the 19th Century [Baltimore, MD: Johns Hopkins University Press, 1976], 110.

  153. 153.

    R.J. Rather, Eva R. Rohl. An English Translation of the Hitherto Untranslated Part of Rokitansky’s Einleitung to volume 1 of the Handbuch der allgemeinen Pathologie (1846), with a Bibliography of Rokitansky’s Published Works. Clio medica 1972;7:215–227:215, 218.

  154. 154.

    Gilder SSB. Carl von Rokitansky (1804–1878). Canadian Med J 1954;71:70–72.

  155. 155.

    Erna Lesky, 18. “Stifft [the reformer] decreed to his students a ready made, precisely regulated textbook knowledge based on Boerhaave’s old aphorisms and Stoll’s humoral pathology. The student who memorized these best was classified as eminent. This procedure was likely to reduce a generation of physicians to the level of mechanical medical artisans, and to “encourage general regimentation instead of developing individuality, which is so very desirable in medicine.”

  156. 156.

    Erna Lesky, 81.

  157. 157.

    Erna Lesky, The Vienna Medical School of the 19th Century [Baltimore, MD: Johns Hopkins University Press, 1976], 81.

  158. 158.

    Robert J Miciotto, Carl Rokitansky: a reassessment of the hematohumoral theory of disease. Bulletin History Medicine 1978;52(2):183–99:185. Gilder SSB. Carl von Rokitansky (1804–1878). Canadian Med J 1954;71:70–72. Henry E. Sigerist, The Great Doctors: A Biographical History of Medicine. Trans. Eden and Cedar Paul [New York: W. W. Norton & Company, 1933], 295. Lobstein the Younger was the first professor of Pathological Anatomy in France. The Chair of Pathological Anatomy at Strasbourg, France founded in 1819 was the first chair of pathological anatomy in Europe; Lobstein the Younger was the first professor of pathological anatomy in Europe.

  159. 159.

    Arleen Marcia Tuchman, Science, Medicine, and the State of Germany: The Case of Baden, 1815–1871 [New York: Oxford University Press, 1993], 64.

  160. 160.

    Harris L. Coulter, Divided Legacy: A History of the Schism in Medical Thought. Volume II: The Origins of Modern Western Medicine: J. B. Van Helmont to Claude Bernard [Berkeley, CA: North Atlantic Books, 1977, 2000], 706. Magendie and Andral “came to feel that medicine was in its infancy and destined to make a precipitate advance.” Ann La Berge and Caroline Hannaway, “Paris Medicine: Perspectives Past and Present,” in Constructing Paris Medicine, ed. Caroline Hannaway and Ann La Berge [Amsterdam, NL: Editions Rodopi B. V., 1998], 1–69:22. When Rokitansky visited Paris in 1842, Andral was a powerful force, one of the young “triumvirate of the Paris School: Andral, Chomel, and Louis.”

  161. 161.

    Harris L. Coulter, 628.

  162. 162.

    Harris L. Coulter, 618. Coulter, page 620. Magendie’s experimented on the nervous system of animals and discovered the “distinction between motor and sensory nerves.”

  163. 163.

    Harris L. Coulter, Divided Legacy: A History of the Schism in Medical Thought. Volume II: The Origins of Modern Western Medicine: J. B. Van Helmont to Claude Bernard [Berkeley, CA: North Atlantic Books, 2000], 620. Erwin H. Ackerknecht, A Short History of Medicine [New York: Ronald Press, 1968], 165. Claude Bernard (1813–1878) was a pupil of Magendie.

  164. 164.

    Erwin H. Ackerknecht, Medicine at the Paris Hospital 1794–1848 [Baltimore, MD: Johns Hopkins Press, 1967], 107.

  165. 165.

    Erwin H. Ackerknecht, 106. “After an eclipse of almost forty years, humoralism had a comeback in the 1830s in, of course, a new and scientific vein and mostly in the form of hemopathology.” Ackerknecht gave some of the names prominent in this movement: Lobstein, Prevost (1820s), Dumas (1820s), Magendie (1820s), Gaspard (1820s), Denis (1830s), Lecanu (1830s), Rochoux (1823), Velpeau (1824), Piorry (1840), and Bouillaud (1853), all in support of hemopathology.

  166. 166.

    Harris L. Coulter, Divided Legacy: A History of the Schism in Medical Thought. Volume II: The Origins of Modern Western Medicine: J. B. Van Helmont to Claude Bernard [Berkeley, CA: North Atlantic Books, 2000], 538.

  167. 167.

    Harris L. Coulter, 534.

  168. 168.

    Harris L. Coulter, 537.

  169. 169.

    Robert J Miciotto, Carl Rokitansky: a reassessment of the hematohumoral theory of disease. Bulletin History Medicine 1978;52(2):183–99:185. Erwin H. Ackerknecht, Medicine at the Paris Hospital 1794–1848 [Baltimore, MD: Johns Hopkins Press, 1967], 106. “It was only logical that Andral, after his demonstrations of symptoms without lesions in the solid organs, should develop in [the] direction of … humoralism … mostly in the form of hematopathology.”

  170. 170.

    Erwin H. Ackerknecht, Medicine at the Paris Hospital 1794–1848 [Baltimore, MD: Johns Hopkins Press, 1967], 167.

  171. 171.

    Erwin H. Ackerknecht, 106.

  172. 172.

    Erwin H. Ackerknecht, Medicine at the Paris Hospital 1794–1848 [Baltimore, MD: Johns Hopkins Press, 1967], 106.

  173. 173.

    Erna Lesky, The Vienna Medical School of the 19th Century [Baltimore, MD: Johns Hopkins University Press, 1976], 110, 220.

  174. 174.

    Roy Porter, The Greatest Benefit to Mankind: A Medical History of Humanity [New York: W. W. Norton & Company, 1998], 330.

  175. 175.

    Arleen Marcia Tuchman, Science, Medicine, and the State of Germany: The Case of Baden, 1815–1871 [New York: Oxford University Press, 1993], 59.

  176. 176.

    Roy Porter, The Greatest Benefit to Mankind, 330.

  177. 177.

    Roy Porter, The Greatest Benefit to Mankind: A Medical History of Humanity [New York: W. W. Norton & Company, 1998], 330–1.

  178. 178.

    Roy Porter, 331. Porter’s explanation of the blastema theory and Rokitansky’s employment of same is the clearest exposition the author has found.

  179. 179.

    Erwin H. Ackerknecht, A Short History of Medicine [New York: Ronald Press, 1968], 160.

  180. 180.

    Robert E. Fechner, “The Birth and Evolution of American Surgical Pathology,” in Guiding the Surgeon’s Hand: The History of American Surgical Pathology, ed. Juan Rosai [Washington, DC: Armed Forces Institute of Pathology, 1997], 9. “However Schwann erroneously viewed cells as continuously being generated out of a primitive body fluid (a lingering holdover of the humoral theory of disease).”

  181. 181.

    Carl Rokitansky, A Manual of Pathological Anatomy, Volume I. General Pathological Anatomy. trans. William Edward Swaine [Philadelphia, PA: Blanchard & Lea, 1855], x. Author’s Preface. Vienna, July 1846. Rokitansky drew singular attention to his “doctrine of a primitive diversity in blastemata, as the only tenable basis for a humoral pathology.” See also Robert J Miciotto, Carl Rokitansky: a reassessment of the hematohumoral theory of disease. Bulletin History Medicine 1978;52(2):183–99:185. Erna Lesky, The Vienna Medical School of the 19th Century [Baltimore, MD: Johns Hopkins University Press, 1976], 222. In effect Rokitansky’s theory was a direct “application of Schwann’s theory of blastema to pathology.”

  182. 182.

    Carl Rokitansky, Handbuch der allgemeinen Pathologischen Anatomie [Wien: Braumüller & Seidel, 1846]. Quotation from Robert J Miciotto, Carl Rokitansky: a reassessment of the hematohumoral theory of disease. Bulletin History Medicine 1978;52(2):183–99: 184. Miciotto quoted Rudolph Virchow: “Rudolph Virchow, who later became the doyen of nineteenth-century medicine, characterized Rokitansky’s hematohumoralism as an ungeheurer Anachronismus – monstrous anachronism – in his famous review of December 1846 in the Preussische Medizinal-Zeitung.” Rudolph Virchow, “Rokitansky, Handbuch der pathologischen Anatomie,” Medizinische Zeitung des Vereins fur Heilkunde in Preussen, Literarische Beilage zur medicinischen Zeitung, December 1846, no. 49, pp. 237f.; no. 50. pp. 243f. See also R.J. Rather, Eva R. Rohl. An English Translation of the Hitherto Untranslated Part of Rokitansky’s Einleitung to volume 1 of the Handbuch der allgemeinen Pathologie (1846), with a Bibliography of Rokitansky’s Published Works. Clio medica 1972;7:215–227:219–221. Rather quoted Rokitansky regarding why he developed a theory known as the crasis or hematohumoral theory of disease: “The goal of the anatomical treatment of nosology: to furnish definite material foundations for the investigation of the nature of a disease process and thereby reliable premises throughout, to widen the scope of the investigation of disease and to offer therein objects worthy of and accessible to the human understanding – in short, to furnish pathology a broader and more secure basis, to elevate it to physiological pathology. Just as pathology can no longer dispense with an anatomical basis (an anatomical component) so also can pathological anatomy be treated with a steady regard for clinical observation, as follows from much of what has already been said; indeed she [pathology] must take this practical course if she is to achieve an anatomical description of the disease-process as broad as possible, in addition to the expansion of her field already noted. The following points contain the most essential foundations of such a workup: 3. She must be determined by general phenomena in such a way as to base disease not on changes in the solids but instead, and primarily, on anomalies of the blood mass, the more so the harder it becomes for her to discover strict localization in general, or alternatively disturbances therein that are sufficient in degree and kind. Here she joins up with an allied pathological chemistry, which cannot be pursued without her in a manner at all fruitful…Since pathological anatomy studies are the disease-process in the most varied stages of its advance and retreat from the very beginning, where the organic changes characterizing it just become noticeable, the supposed objection therefore really involves the following one in addition, namely it is thought: That the earliest beginnings of disease, the dynamic factor, has not successfully been demonstrated in the material substrate by pathological anatomy, that there are still very many diseases which run their course and become lethal without a palpable disturbance of organization.”

  183. 183.

    Erna Lesky, The Vienna Medical School of the 19th Century [Baltimore, MD: Johns Hopkins University Press, 1976], 111.

  184. 184.

    Lester S. King, Medical Thinking: A Historical Preface [Princeton, NJ: Princeton University Press, 1982], 48.

  185. 185.

    Laura Otis, Müller’s Lab [New York: Oxford University Press, 2007], 162. “Ultimately, the best indication of Virchow’s regard for Müller, is not what the student said but what he did…Through his rigorous microscopic and chemical studies of the blood, Virchow disproved Karl Rokitansky’s dominant pathological theory that blood disorders underlay all diseases, which had been based on the assumption that blood produced the raw material that gave rise to sick cells.”

  186. 186.

    Laura Otis, 132.

  187. 187.

    Alexander Hellemans and Bryan Bunch, The Timetables of Science: A Chronology of the Most Important People and Events in the History of Science, Touchtone Edition [New York: Simon & Schuster, 1988], 304. Harold Speert, “Johannes Müller and the Müllerian Ducts,” in Obstetric & Gynecologic Milestones Illustrated, 2nd ed. rev. [Parthenon Publishing Group, 1996], 104. “In Müller’s youth there had been no knowledge of cells, no microtome, no histologic staining methods, no binocular microscope. Schwann became known as the founder of the cell theory, and Rudolph Virchow, another of [Müller’s] disciples, as the father of cellular pathology.” See also Henry E Sigerist, The Great Doctors [New York: WW Norton, 1931], 307-11. Quoting Virchow: Müller “did not make original discoveries of primary importance in any of these fields, but whatever subject he touched was given by him an added depth.”

  188. 188.

    Laura Otis, 138.

  189. 189.

    Harold Speert, “Johannes Müller and the Müllerian Ducts,” in Obstetric & Gynecologic Milestones Illustrated, 2nd ed. rev. [Parthenon Publishing Group, 1996], 104. Karl Sudhoff, “In Memory of Johannes Müller.” Essays in the History of Medicine. Translated by various hands and edited, with foreword and biographical sketch, by Fielding H. Garrison. New York: Medical Life Press, 1926:363–367:365. Sudhoff notes in his discussion of the extensive research of Müller that “of greatest importance were his investigations of the blood.”

  190. 190.

    Paul Strathern, A Brief History of Medicine from Hippocrates to Gene Therapy [New York: Carroll & Graf, 2005], 207–211. In 1840, Virchow’s master, Johannes Müller, published the last volume of his magnum opus, The Handbook of Human Physiology based on microscopic studies. Virchow took meticulous notes in Müller’s physiology course in the summer of 1840, as he did in Müller’s embryology lectures. In 1841 he attended Müller’s comparative anatomy course and in the summer of 1842, he attended Müller’s pathological anatomy course where Müller discussed his research on tumors. Laura Otis, Müller’s Lab [Oxford: Oxford University Press, 2007], 135–137.

  191. 191.

    Laura Otis, Müller’s Lab [Oxford: Oxford University Press, 2007], 42. “For thirty years, Müller attracted some of Europe’s brightest young scientists.” Virchow’s biological theory of disease was based on microscopic observations, research that easily flowed from the emphasis on microscopy and exact observation that Johannes Müller fostered among his assistants.

  192. 192.

    Laura Otis, 62.

  193. 193.

    Robert P. Hudson, Disease and Its Control: The Shaping of Modern Thought [Westport, CT: Greenwood Press, 1983], 130–2. Claude Bernard (1813–1878) demonstrated the material cause of fluctuations in the level of blood sugar. In 1861 he demonstrated by experiments that the liver metabolized sugar into glycogen which was released as the body required it. He also demonstrated that the blood normally contained sugar, that it was not present only as a sign of pathology. Of even broader physiological (material) significance, Bernard established the concept of the internal fluid environment which he termed milieu interieur. In his classic book An Introduction to the Study of Experimental Medicine (1865) he explained his experimental method. Bernard demonstrated repeatedly that bodily functions, physiological and pathological could be investigated by chemical and physical experimentation. Erwin H. Ackerknecht, A Short History of Medicine [New York: Ronald Press, 1968], 165. With Claude Bernard’s “discovery of the glycogen-forming function of the liver [he demonstrated] for the first time that the body plays a synthesizing role in the metabolic process as well as a decomposing one.” Timothy Lenoir, The Strategy of Life: Teleology ad Mechanics in Nineteenth-Century German Biology [Chicago, IL: University of Chicago Press, 1989], 124, 126. Lenoir gives a more nuanced interpretation: “Schwann argued that there are two frameworks within which to conceive organic phenomena: ‘The first view is that a special ‘force’ lays at the basis of each class of organ which forms them in accordance with an immaterial idea, and arranges the molecules in the manner necessary for achieving the purpose intended by this idea. … The other view is that the elementary forces of the organism are in fundamental agreement with the forces of inorganic nature to the extent that they operate blindly according to the laws of necessity independently of any particular purpose; in short that they are forces which are presupposed with the existence of matter, just like physical forces.”

  194. 194.

    Laura Otis, Müller’s Lab, 62.

  195. 195.

    Laura Otis, 21.

  196. 196.

    Laura Otis, 20.

  197. 197.

    Laura Otis, 13–14, 26.

  198. 198.

    Laura Otis, 20, 27. Otis, p. 23. Classification of marine life bordered on an obsession and consumed much of his vacation time.

  199. 199.

    Karl Sudhoff, “In Memory of Johannes Müller.” Essays in the History of Medicine. Translated by various hands and edited, with foreword and biographical sketch, by Fielding H. Garrison. New York: Medical Life Press, 1926:363–367:363.

  200. 200.

    Laura Otis, 21. For an erudite discussion of vital forces, see Jacques Roger, The Life Sciences in Eighteenth-Century French Thought, ed. Keith R. Benson and trans. Robert Ellrich [Stanford, CA: Stanford University Press, 1997], 336–53.

  201. 201.

    Laura Otis, 27.

  202. 202.

    Laura Otis, Müller’s Lab [Oxford: Oxford University Press, 2007], 73.

  203. 203.

    Laura Otis, 22. In 1838, [Müller] applied Schwann’s cell theory to the pathology of tumors in his book On the Fine Structure of Pathological Tumors, “demonstrating…that tumors consist of cells.”

  204. 204.

    Laura Otis, 73.

  205. 205.

    Erwin H. Ackerknecht, Medicine at the Paris Hospital 1794–1848 [Baltimore, MD: Johns Hopkins Press, 1967], 54.

  206. 206.

    Laura Otis, 34. Loved in the sense they shared the ability to work closely together, scientific intimacy, combined with Müller’s paternalistic affection for Henle and Schwann.

  207. 207.

    Laura Otis, 50.

  208. 208.

    Laura Otis, 60.

  209. 209.

    Laura Otis, 53.

  210. 210.

    Laura Otis, 59. “Quiet, serious Theodor Schwann used the microscopes of the mid-1830s better than just about anyone.”

  211. 211.

    Laura Otis, Müller’s Lab [Oxford: Oxford University Press, 2007], 60.

  212. 212.

    Laura Otis, 60.

  213. 213.

    Laura Otis, 61, 64.

  214. 214.

    Laura Otis, 63. Illustrated Stedman’s Medical Dictionary 24th ed. [Baltimore, MD: Williams & Wilkins, 1982], 962. “Notochord 1. In primitive vertebrates, the primary axial supporting structure of the body, derived from the notchordal or head process of the early embryo; an important organizer for determining the final form of the nervous system and related structures. 2. Chorda dorsalis or vertebralis; in embryos, the axial fibrocellular chord about which the vertebral primordial develop; vestiges of it persist in the adult as the nuclei pulposi of the intervertebral disks.”

  215. 215.

    Laura Otis, Müller’s Lab [Oxford: Oxford University Press, 2007], 63.

  216. 216.

    Laura Otis, 65.

  217. 217.

    Laura Otis, 63.

  218. 218.

    Laura Otis, 64.

  219. 219.

    Laura Otis, 62–64.

  220. 220.

    Laura Otis, Müller’s Lab [Oxford: Oxford University Press, 2007], 67. Erwin H. Ackerknecht, A Short History of Medicine [New York: Ronald Press, 1968], 160. Medical historians often refer to the Schleiden–Schwann cell theory.

  221. 221.

    Paul Strathern, A Brief History of Medicine from Hippocrates to Gene Therapy [New York: Carroll & Graf, 2005], 207-211. Robert Meyer, Autobiography of Dr. Robert Meyer (1864–1947): A Short Abstract of a Long Life [New York: Henry Schuman, 1949], 38-9. In his autobiography, Meyer stated that Virchow is known, or should be known, “the world over as the founder of cellular pathology. … It was a logical continuation from Schleiden, who recognized the cell as the element of the development and morphology of plants (1838), to Schwann, who recognized the cell as the element of the normal tissue in animals (1839), and to Virchow (about 1852) who was the first to describe the pathological proceedings as change of the cells. In 1858, he published his Cellular Pathology, in which he called the cell the ultimate formative element of all life and, at the same time, designated illness as due to physical and chemical changes of the cells. This ingenious doctrine was revolutionary. It brought medicine out of the humoral way of thinking to the realization that we must look for physico-chemical changes in the cells themselves. This was a concrete theory on which everyone could build. It was the localization of disease in special cells which first gave medicine a firm basis.”

  222. 222.

    Erwin H. Ackerknecht, A Short History of Medicine [New York: Ronald Press, 1968], 171. Virchow became better known in 1847 when he and Reinhardt established a new journal, the Archives for Pathological Anatomy, Physiology, and Clinical Medicine, which later became known as Virchow’s Archives. Virchow and the German School of Pathologic Physiology believed that the disease process could not be ascertained at the autopsy table, but only “by a study of disturbed function.”

  223. 223.

    Owsei Temkin, “Basic Science, Medicine, and the Romantic Era,” in The Double Face of Janus and Other Essays in the History of Medicine [Baltimore, MD: Johns Hopkins University Press, 1977:396. See also Laura Otis, Müller’s Lab [Oxford: Oxford University Press, 2007], 170 and note #32 on page 281. Otis: 171. Robert Remak, an assistant of Johannes Müller, was internationally known for his embryologic studies. Remak identified the three embryonic germ cell layers and the organs that developed from each layer. According to Otis, some authors believe that Remak deserves credit for the principle of omnis cellula a cellula, not Virchow. Otis: 165. Despite support from Johannes Müller and Alexander von Humboldt, Remak never received an appointment as professor in any Prussian university, but continued his research and practiced from his home. Erwin H. Ackerknecht, A Short History of Medicine [New York: Ronald Press, 1968], 159-60. “Since the beginning of the [nineteenth] century medical scientists such as Oken and Meckel, and later Raspail, Dutrochet, and other, had claimed that living bodies consisted basically of ‘vesicles,’ ‘cells,’ or ‘globules.’… The formulation of the cell theory was crystallized through the efforts of Theodor Schwann (1809-1885)…That cells developed from cells, and only from cells, was demonstrated by Hugo von Mohl, John Goodsir, Robert Remak, and preeminently by Rudolf Virchow in 1854.”

  224. 224.

    Rudolf Virchow, Die Cellularpathologie in ihrer Begründung auf physiologische und pathologische Gewebelehre [Berlin: Hirschwald, 1858].

  225. 225.

    Harris L. Coulter, Divided Legacy: A History of the Schism in Medical Thought. Volume II: The Origins of Modern Western Medicine: J. B. Van Helmont to Claude Bernard [Berkeley, CA: North Atlantic Books, 1977, 2000], 607.

  226. 226.

    Robert E. Fechner, “The Birth and Evolution of American Surgical Pathology,” in Guiding the Surgeon’s Hand: The History of American Surgical Pathology, ed. Juan Rosai [Washington, DC: Armed Forces Institute of Pathology, 1997], 10. Laura Otis, Müller’s Lab [Oxford: Oxford University Press, 2007], 140. Johannes Müller acted as official advisor for his thesis.

  227. 227.

    Laura Otis, Müller’s Lab [Oxford: Oxford University Press, 2007], 141.

  228. 228.

    Andreas W. Daum, “Wissenschaft and knowledge,” in The Short Oxford History of Germany: Germany 1800–1870 [Oxford: Oxford University Press, 2004], 137–161: 143.

  229. 229.

    Laura Otis, 143.

  230. 230.

    Laura Otis, Müller’s Lab [Oxford: Oxford University Press, 2007], 141–3.

  231. 231.

    Laura Otis, 141.

  232. 232.

    Erna Lesky, The Vienna Medical School of the 19th Century [Baltimore, MD: Johns Hopkins University Press, 1976], 111.

  233. 233.

    Andreas W. Daum, “Wissenschaft and knowledge,” in The Short Oxford History of Germany: Germany 1800–1870 [Oxford: Oxford University Press, 2004], 137–161: 159. “In fact, the revolution of 1848 marked the beginning of a fundamental transformation of the Austrian universities, which were now restructured according to the model of the Prussian reforms a generation earlier and experienced massive increases in the number of students up to 1871.”

  234. 234.

    Erna Lesky, 96. See also Laura Otis, Müller’s Lab [Oxford: Oxford University Press, 2007], 148. The impetuous genius Virchow actually manned the barricades in Berlin during the 1848 revolution. Rokitansky and Virchow were cut from the same liberal cloth, only they enacted reform differently.

  235. 235.

    Carl Rokitansky, Lehrbuch der pathologischen Anatomie, Vol. I [Wien: Braumüller, 1855]

  236. 236.

    V. Becker, [Rokitansky and Virchow: throes about the scientific term of disease] Wien Med Wochenschr 2005;155:463–7. See also Byers JM 3rd. Rudolph Virchow – father of cellular pathology. Am J Clin Pathol 1989 Oct;92 (4 Suppl 1):S2–8.

  237. 237.

    Roy Porter, Blood and Guts: A Short History of Medicine [New York: W. W. Norton & Company, 2002], 93.

  238. 238.

    Robert J Miciotto, Carl Rokitansky: A reassessment of the hematohumoral theory of disease. Bulletin History Medicine 1978;52(2):183–99:185.

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    Ronald E. Batt M.D., Ph.D. (Professor of Gynecology)

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Batt, R.E. (2011). Intellectual Development of Carl Von Rokitansky. In: A History of Endometriosis. Springer, London. https://doi.org/10.1007/978-0-85729-585-9_2

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