The Dawn of Modern Pathology

摘要

The declining rate of autopsies worldwide, which has been observed in recent decades, has been extensively debated. Although many reasons have been suggested for the genesis of this unfortunate process, none is convincing. The history of medicine is far from being a linear progression of discoveries. Twists and turns occurred, which, over time, completely changed the current concepts. One of these turns was based on the wealth of knowledge acquired through the observation of thousands of autopsies. Paradoxically, in our day a and age, the medical procedure of autopsy is often considered to be unimportant and sometimes even worthless. Surprisingly, in the 19th century–more than 200 years ago–the practice of autopsy was met with hostility, not only from the general public but also from some of the medical community. It would take the untiring work of a remarkable man, in Vienna, to change the future of medicine thanks to the knowledge he gained through his determination, dedication, and belief of the truth that autopsy would reveal. Maria Theresa (1717-1780), sovereign of the Austro–Hungarian Empire, started her 40-year reign in the middle of the 18th century after the death of her father, Emperor Charles VI (1685-1740). She ruled by the counsel of her advisors and contributed to financial and educational reforms as well as promoted greater unification of the Habsburg monarchy. According to recommendations by Dr. Gerard van Swieten [long‐time student of Hermann Boerhaave (1668‐1738), brought from Leyden University – Holland, imperial personal physician], the Vienna General Hospital (The Algemeines Krankenhaus) was rebuilt. Viennese medicine had first attained international significance through its incentives. Similarly, following van Swieten’s advice, Maria Theresa signed a decree making it mandatory to autopsy every hospital death (the motivation for this decree was the high infant mortality in Austria, mostly in the city of Graz). This practice continued—especially for forensic cases—into the following century. This decree (still theoretically in effect in Austria, but no longer strictly followed) led to many morphologic observations that contributed immeasurably to the development and progress of modern medicine. In the early part of the 19th century, the Austro‐Hungarian Empire showed many societal defects precipitated by the Napoleonic wars. Emperor Francis II (who succeeded his father, Leopold II, the King of Belgium, who was the son of Maria Theresa) dissolved the Holy Roman Empire, and suffered various defeats until Napoleon’s abdication in 1815. When Francis II died, his son, Ferdinand, who tried unsuccessfully to enhance the power of the throne by leaving an heir, was depicted as feeble-minded and incapable of ruling, which left the actual carrying out of government affairs to the austere Klemens Wenzel von Metternich. Ferdinand eventually abdicated in favor of his nephew, Franz Josef, who, somehow — and despite many military disputes — proved to be a progressive and powerful ruler of the Austro–Hungarian Empire during the second half of the 19th century. Metternich and Franz Josef concentrated on military initiatives to reinforce the Empire, while allowing society to pursue a variety of intellectual activities. In the midst of this political scenario, in 1804 Karl von Rokitansky was born in K?niggr?tz, a city in Bohemia (formerly part of the Austro–Hungarian Empire), which is currently called Hradec Králové, and is part of the Czech Republic. He lost his father early in childhood and sustained significant financial difficulties during that time along with his mother and three siblings In spite of those difficulties, he completed primary school at his hometown before moving to Prague where he continued his education and graduated from secondary school at the age of 14 (in 1818). He started his advanced studies in philosophy, which was the usual preliminary to a course in medicine, and was greatly influenced by the contemporary philosophers Kant, Schopenhauer, and Schiller. In 1822, still in Prague, he began his medical studies, but two years later he moved to Vienna to live with his uncle and finish his medical studies there. Highly dedicated, self-taught, and skeptical of ancient medical concepts, early on Rokitansky focused his interest in anatomy, and was substantially influenced by the publications of Jean-Frédéric Lobstein (1777-1835), Johann Friedrich Meckel (1781-1833), and Gabriel Andral (1797-1876). He started working as a trainee in the poorly equipped and underdeveloped pathological institute of the Vienna General Hospital. At the age of 24 he attained a doctorate in medicine after defending a thesis dedicated to the vaccination against smallpox (De variolide vaccinica), which had been a plague in Europe until the end of the 18th century, when Edward Jenner’s experiment was successfully developed (the cowpox inoculation — the cradle of immunology). The professional debut of Rokitansky to