The rise & fall of a leading medical university

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Till early 1900s, Vienna was a leading centre for medical education. Ranked after Paris, and Berlin Medical University of Vienna had brought many innovations. University was so prestigious, that American Medical Association had a branch in Vienna. University provided training even for US doctors, who then moved back to their own country to set up medical schools. Changed political scenario after the First World War (1914-1918), and later terrible events of 1938 led to demise of its glory. In March-April 1938, government dismissed 153 of a total of 197 Medical faculty members, on racial or political grounds. This blog is a story of Vienna Medical University, told through postage stamps.

Two dutch physicians, and beginning of Vienna medical school

University of Vienna was founded in 1365. While, it had some medical teachers, medical school received its first push during the reign of Habsburg empress Maria Theresa (1717-1780). She invited Gerard van Swieten, a dutch physician (from Leiden in Netherlands) to Vienna (seat of Austrian empire). He in 1745, along with another dutch physician Anton de Hean laid foundation of Vienna medical school. Thus began structured curriculla, post-mortems and scientific thought. Gerard van Swieten was a personal physician to the empress, and could sway her decisions. In this Roman Catholic empire, persecution of members of other faiths such as Jews, Protestants, Jesuits was prevalent.

We know Leopold Auenbrugger (1722-1809) as father of modern Medicine. He graduated from Vienna in 1744, invented percussion – a method of tapping over chest and abdomen to know what lies inside. Jean Corvisart in Paris, and later Joseph Skoda in Vienna, further popularised Auenbrugger’s findings. Skoda graduated from university of Vienna in 1831, a good 87 years after Auenbrugger. This was a glorious time for study of medicine in Vienna.

Modern (or Second) Medical school of Vienna

Joseph Skoda (1805-1881), Karl Rokitansky (1804-1878), and Joseph Hyrtl (1810-1894) were compatriots as students and later as faculty members in Vienna Medical school. Together they brought out more progressive changes to teaching of medicine. Skoda (graduate of 1831) was a physician, who combined Percussion with Auscultation (use of stethoscope). Rokitansky (graduate of 1828) mastered pathologic anatomy, and later became rector of university. Hyrtl (graduate 1837) was an anatomist, an excellent teacher, and author of atlas of anatomy in his time. After Rokitansky, he became rector of the university. They were instrumental in establishing many new specialities in the university.

Karl Rokitansky helped establish clinical chemistry, and later ophthalmology. Johann Heller (1813-1871) was a chemist, and not a physician. He came to Vienna in 1842, after completing his initial education from Prague. Since, he was not a physician, his acceptance in medical fraternity was poor. Rokitansky, recognised his abilities and helped him establish an independent lab of Pathologic Chemistry. Today, we consider Johann as father of clinical chemistry.

Ferdinand Ritter von Arlt (1812-1887) from Vienna and Albrecht von Graefe (1828-1870) from Berlin were pioneers in diseases of the eye. Both of them trained and collaborated with each other. They devised clinical signs (such as Von Graefe’s) and surgery for glaucoma (iridectomy). Opthalmology became a new growing speciality, at that time.

Hebra and Semmelweis

Ferdinand Ritter Von Hebra (1816-1880) and Ignaz Semmelweis (1818-1865) were both medical graduates from Vienna (Semmelweis in 1837, and Hebra in 1841). Both were friends, Hebra a German-austrian and Semmelweis a Hungarian. Hebra became a faculty in Vienna, and under patronage of Rokitansky and Skoda, founded a separate speciality of Dermatology. On the other hand, Semmelweis, trained as an obstetrician, struggled with getting an appointment in Vienna Medical School. His contemporary and learned physicians ridiculed simple and rational concept of hand-wash before conducting a labour. Shunned by the medical community, Hebra tricked Semmelweis to a mental asylum in 1865. Over next two weeks, asylum guards tortured Semmelweis, and he died of gangrene.

An era of heroic surgeries and beginnings of intolerance

Theodore Billroth (1829-1894) was a towering German Surgeon. Trained in Germany, he chaired department of Surgery at Zurich in 1860. Seven years later, in 1867 he came as Professor of Surgery to Vienna Medical School. He pioneered various heroic surgeries such as gastrectomy (removal of stomach), esophagectomy (removal of diseased oesophagus), and laryngectomy (removal of larynx). He was a bold surgeon, bred in German traditions of heroism and valour.

Billroth passed on surgical skills to Anton Eiselsberg (1860-1939) who pioneered surgeries of spinal cord, pituitary and thyroid. Leopold Schonbauer (1888-1963) studied at Prague, and started his career as an assistant to Eiselsberg.

This was a period of political upheaval in Europe. Austrian empire had declined, and in 1866 it had lost to Prussia. In 1867, a compromise dual-constitutional-monarchy of Austria-Hungary was in place. Nationalist movements gained strength throughout Europe, and there was an exodus of Jews, Hungarians, and Slavs to Vienna. and expressed dismay at influx of recently immigrated minorities in medical students. Proportion of Jews, Slavs and Hungarians as medical students was on the rise. In 1875, Billroth wrote a book on medical education, and observed:

“Such empty-headed strivers, with their purblind eyes, hands like lead, and brains like clay, with a dictionary knowledge and pathetic incompetence are to be found in large numbers…. They tremble when they are spoken to during examination and lose their mite of intelligence completely when one looks at them…….”

This book caused an uproar. Faculty as well as students in University of Vienna stood divided. These divisions extended to teaching, and appointments to department chairs, rectors and deans. Simmering intolerance had come out in the open.

Neurology, Psychiatry and Sigmund Freud

Theodor Meynert (1833-1892) graduated from Vienna in 1861. He established psychiatry clinic in Vienna. Both Wagner Jauregg (1857-1940) and Sigmund Freud (1856-1939) were his students, who graduated in 1880 and 1881 respectively. Jauregg got a university appointment, inherited Meynert’s mantle, and went on to receive 1927 Nobel Prize in Medicine. His treatment (of injecting malarial parasites to produce fever) in General paresis of insane (GPI) was initially considered revolutionary. However, it was abandoned due to a high mortality. Constantin von Economo (1876-1931) who went on to become Professor of Psychiatry, was his student. Politically Jauregg was a Nazi-supporter, advocated Racial Hygiene, and endorsed forced sterilisation of mentally ill.

Freud was a Jew. He started his private practice in Vienna. Freud’s theories on psychoanalysis were controversial, but these were also quite popular. Professionally both Meynert, and Jauregg were quite critical of Freud’s ideas. Eventually Freud obtained a faculty position in Vienna Medical School in 1902.

Exodus of the Jews and events of 1938

Karl Landsteiner (1868-1943) and Robert Barany (1876-1936) graduated from Vienna medical school in 1891 and 1900 respectively. Both of these graduates went on to receive a Nobel Prize in Medicine or Physiology, Barany in 1914 and Landsteiner in 1930. Barany was an Otologist, he described vestibular system and gave concept of endolymph. Landsteiner discovered blood-groups, and identified poliovirus. Both of them were Jews (Landsteiner had converted to christianity), who Chose to emigrate in search of better opportunities. Barany chose Sweden in 1919, and Landsteiner chose US in 1923.

While, none of them was directly persecuted, but life in Europe had become unstable after the First World War. Austria-Hungary empire had collapsed. Prussia had lost the war, living conditions were poor, and nationalism was on the rise. In a way, exodus of the intellectuals had started early in 20th century. It is no wonder, that in 1923, nine of the top ten universities (in terms of student enrolment) in the world, were from the United States. Vienna had slipped from 3rd to below 20th rank.

Riding on the popular wave, and after disintegration of the Austrian Empire, many nationalists wanted to unite all German speaking nations as one. Thus began Anschluss of Austria and Germany. After a series of political turmoils, on 12th March 1938, German Reich forces reached Vienna, and Austria became a province of Germany. Anschluss was achieved. All faculty, who had any Jews in the previous three generations, were dismissed. About 65% of Viennese Physicians, most of whom were Jews were forced to leave. Some others were captured, killed or died in concentration camps. By the summer of 1938, cleansing was complete. Sigmund Freud was a prominent Jew, who had to flee to London. His four sisters were however killed in Vienna.

The aftermath

As Vienna medical school emptied, many faculty positions were occupied by the Nazi sympathisers. Some previous sympathisers continued to progress in their careers. There was no opposition to this professional exodus, both due to fear and an atmosphere of extreme intolerance. Leopold Schonbauer (1888-1963) an assistant to Eiselsberg, became a professor in 1939. He had a role in forced sterlization of the physically disabled inmates in the hospital. Many other physicians had a role in design and conduct of fatal medical experiments, that were conducted in concentration camps.

Ferdinand Sauerbruch (1875-1951) was another prominent German doctor who served on Reich Research council, and served as a physician to the Nazi Propaganda Minister. It is indeed surprising that Austria and Germany issued postage stamps to honour Jauregg, Schonbauer, and Sauerbruch who all had a dubious past. These issues were much after Second World War was over. In post-holocaust world, they are hardly fit to be the role-models. Indirectly, they contributed to the genocide that killed millions of civilians in Nazi holocaust.

Medical doctors Who lived through the Nazi occupation in stamps

Even after 1945, Vienna Medical school, could not gain its lost glory. Ravaged Europe became busy in reconstruction. Medical innovation had moved across the Atlantic. Only a handful of the displaced medical faculty, were willing to return back to Vienna. Further, most Nazi sympathiser faculty members, continued to be on the rolls. Today Vienna medical school is ranked 50th, and lives on with a disturbing legacy. This story is an important reminder, about the consequences of extreme nationalism, and politics, especially when it engulfs medical education.