Prochaska’s discoveries in regard to the growth of bone excited the admiration of his contemporaries, and well they might, for they involved prolonged investigations with the aid of the microscope and much close and careful thinking. It is safe to say that at this early date (end of the eighteenth century) original investigations like the one just described must have been very few indeed in Austria.
Carl Rokitansky, who was born at Koeniggratz, Bohemia, in 1804, received his medical training at the universities of Prague and Vienna. For several years after he had been given the degree of Doctor of Medicine he served as an Assistant in the Pathologico-Anatomical Institute, and in 1832, after the death of Johann Wagner, the Custodian of the Museum that formed a part of the Institute, he was appointed his successor, not only in this particular office but also in those which were closely related to it—viz., the office of Prosector of the Allgemeine Krankenhaus and that of Judicial Anatomist for the City of Vienna. The duties which he had to perform in connection with these offices and as an Instructor in the Medical Faculty of the University left him very little time for anything else. His pet ambition was, not merely to do well the work which these different official positions entailed upon him, but also to build up, so far as in his power lay, a systematized knowledge of the relationship that subsists between the different pathological conditions revealed at the post-mortem examination and the clinical phenomena manifested during the patient’s lifetime. Therefore he was accustomed to insist that a reasonably full history of the case should be submitted with every corpse on which he was asked to make a post-mortem examination. This afterward became a firmly fixed practice at the hospital. After he had read these case-histories and had compared them with the facts revealed by the corresponding autopsies he prepared, at proper intervals, a report on the diseases which were then prevalent at the hospital. This method of procedure, it will easily be seen, constituted an important advance beyond the practice of simply studying and then recording the various pathological lesions which develop in the different organs of the body. It established a connecting link between these lesions and the lifetime manifestations of disease; in other words, it revealed a way in which the medical practitioner at the bedside might, by a proper use of his reasoning powers, infer from the symptoms and physical signs what changes were taking place in the unseen organs of the body. From this time forward, therefore, physicians began to place before their mental vision—in every case which they were called upon to treat—a picture of the anatomical changes that were taking place in the patient’s body, instead of symptom groups. In the words of that distinguished Tübingen physician, Wunderlich, “Rokitansky was endeavoring with untiring zeal to convert pathological anatomy into an anatomical pathology.” The reader will, I am confident, agree with me when I say that there are very few instances in the history of medicine where an advance toward a better knowledge of the art of diagnosis is more clearly revealed than in the work which Rokitansky carried on so patiently, so conscientiously and so successfully during the early years of the nineteenth century. Compare the record of the work accomplished by Morgagni with the remarkable results reached by the Vienna pathologist, and it will be quickly appreciated how little fitted the former searcher after truth was to carry out successfully the advance which Rokitansky effected and which I have tried to describe in these pages.
Rokitansky’s earliest contributions to medical literature consisted in quite a large number of memoirs which were published at different times in the “Medicinische Jahrbücher des Oestreichischen Staates.” They deal with topics like the following: “Incarcerations and Intussusceptions of the Intestines”; “New Formations of Bone on the Internal Surface of the Skull in Pregnant Women”; “Spontaneous Rupture of the Aorta”; “So-called Duplication of the Uterus”; “Strictures of the Intestinal Canal and Other Abnormal Conditions that give rise to Constipation and to Ileus”; “Perforating Gastric Ulcer”; “Contributions to our Knowledge of the Different Forms of the Curvature of the Spine”; etc. Subsequently he published in three volumes his great work on Pathological Anatomy; Vol. 3 appearing in 1842 and Vol. 2 in 1844. These last two volumes were devoted to special pathological anatomy. The first volume of the series, which deals with general pathological anatomy, was not published until the year 1846. In these volumes, which are rich in newly discovered facts, the author keeps constantly in mind the needs of the general practitioner; and how great was the importance which he attached to this feature of his work may be inferred from the frequent reference which he makes to it in other parts of his writings. Thus, for example, in the Preface to Vol. 1 he says: “In regard to the manner in which I have planned and constructed the present treatise I will briefly remark: ‘I have tried from the very beginning, and all through the work, to look at the subject from the viewpoint of the practicing physician, and I believe that, in adopting this course, I have accomplished a thing which was most urgently needed in our time; and I also believe that I have utilized the gigantic mass of material that was at my disposal in a worthy manner.’” Then, again, farther on in the Introduction, he says: “The first attempt to treat the subject of pathological anatomy in the manner which I have just described,”—an attempt, by the way, that was crowned with brilliant success,—“was made by Laënnec in his discussion of the subject of diseases of the chest.”
In strong corroboration of Rokitansky’s belief in the importance of pathological anatomy stands the statement attributed to the celebrated anatomist Vesalius, to wit: “I am very sorry not to have devoted to pathological anatomy the large amount of time and strength which I spent on physiological anatomy.”
Rudolf Virchow calls Rokitansky the “Linnaeus of pathological anatomy.”
It was my original intention to furnish at this point a few brief extracts from the original text of Rokitansky’s great treatise, in order that the reader might learn, from this pathologist’s own words, just how he managed to teach pathological anatomy in the manner best adapted to subserve the interests of the practitioner. After looking in vain, however, for a section of the desired degree of shortness, I came to the conclusion that it would be better to abandon the attempt altogether and rest satisfied with a simple enumeration of the captions of some of the more important subsections that treat of alterations in bone. Here are those which I selected: “Bone Deficiency and Bone Excess”; “Anomalies in Size and Shape”; “Bone Atrophy”; “Anomalies of Bone in its Connection with other Bones”; “Anomalies in Consistence”; “Break in Continuity and the Manner in which Healing Takes Place”; “Callus Formation and New Joints”; “Healing of Bone by First Intention”; “Healing of Bone through the Medium of Suppuration”; “Healing of Wounds in Bone with Loss of Substance”; “Inflammation of Bone”; and “Bone Caries.”
Not being specially interested in pathological anatomy I have read only small portions of the text of this celebrated treatise; but, judging from this superficial examination and from the unanimous testimony given by men who are expert judges in this department of medical science, I feel confident that satisfactory answers will be found in this great work to nearly every question that may arise in a physician’s mind concerning the pathology of some part of the human body. It is a book, however, that is intended for reference purposes, and not for reading as one would read Trousseau’s work; and this undoubtedly explains why, so far as I am able to discover, no English version of this treatise exists.
I may here call attention to the fact that the first edition (1842–1846) of Rokitansky’s treatise contains no cuts, but that of 1855 is well furnished with illustrations.
After Rokitansky had held for ten years the position of Professor Extraordinary of Pathological Anatomy in the University of Vienna he was promoted in 1844 to that of Ordinary Professor.