New Viennese School The 1830s saw the emergence of the
New Viennese School that was based on the new scientific methods established by Carl Rokitansky. In the 20th century, this became known as the
Second Viennese School of Medicine. calling him "Vater Roki". The New Viennese School sought to introduce a new system of science-based medicine. Until then, pathology had been a purely descriptive science that was disconnected from clinical practice. While contemporary pathologists, such as
Gabriel Andral and
Jean Frédéric Lobstein, compiled autopsy reports containing descriptions of illnesses they did not make any diagnoses or connect their findings with the clinician who had treated the patient when alive. an intellectual approach that had first been initiated by the Italian pathologist
Giovanni Battista Morgagni in the 18th century. Rokitansky's approach differed from that of his contemporaries as he no longer looked for the "dynamic moment", but for the "anatomical seat" of the illness. The inscription on the Pathological-Anatomical Institute subsequently erected in Spitalgasse in the ninth district of Vienna therefore reads: "Indagandis sedibus et causis morborum" (Der Erforschung des Sitzes und der Ursachen der Erkrankungen).
Diagnostics Rokitansky developed pathology from a descriptive discipline into an explanatory science. Over the course of his life he performed almost 60,000 autopsies in which he compared the patients' medical history and clinical symptoms with their autopsy protocols. He recognised that physicians named illnesses after the most conspicuous external symptom without considering the underlying internal disease of the organs (e.g. diagnosing jaundice in patients who presented with yellowish skin with no thought given to the underlying liver disease). It became clear to him that these symptomata, (which in Greek means coincidences) are not coincidences but in fact external indications of a pathological change to an internal organ. In close collaboration with the internist Joseph Škoda he made clear the relationships between clinical symptoms that can be seen, felt or heard and pathological changes to organs, i.e. clinico-pathological correlation. Thus it was now possible for the first time to make scientifically sound diagnoses. Rokitansky thus initiated a
paradigm shift from speculative, natural-philosophical medicine to systematic, science-based medicine. By classifying illnesses according to their stage of progression, it became possible to diagnose how far a pathological condition had advanced and to deliver a prognosis. From the 1830s onwards medical students and physicians from all over the world came to Vienna to learn about Rokitansky's diagnostic methods and nosology, which soon became known internationally as the Young or New Viennese School.
Manual of Pathological Anatomy: Rokitansky documented the results of his research in his three-volume
Handbuch der pathologischen Anatomie published in 1842–46 by Braumüller & Seidel. He systematically described pathological changes to each and every organ and explained how to arrive at a diagnosis on the basis of the respective symptoms. The third edition (1855–1861) contains woodcut prints of his hand-drawn sketches of his histopathological specimens at 550-times magnification. An order of the Emperor in 1846 made it compulsory for all medical students in the Habsburg Monarchy to study Rokitansky's manual. In response to the stream of physicians and students from abroad who came to Austria to study Rokitansky's methods, the manual was translated into a number of languages to worldwide acclaim. It was published in countries including • Russia:
Rukovodstvo k patologicheskoy anatomii, 3 volumes, published by Moscow Imperial University, Moscow 1844–1849, • the United States (New York):
A Treatise on Pathological Anatomy, New York: WM. Radde 1845, and at the same time in • the United Kingdom:
A Treatise on Pathological Anatomy, London: H. Balliere 1845, • the United Kingdom:
Manual of Pathological Anatomy, London: Sydenham Society 1849–54., • Italy:
Trattato completo di anatomia patologica, Venezia: Lombardo Venetto 1852, • the United States (Philadelphia):
A Manual of Pathological Anatomy. Philadelphia: Blanchard & Lea 1855 '''Rokitansky's Doctrine of Crases and Dyscrases as the Groundwork for Modern Humoral Pathology''' Ancient humoral pathology based on the theory of the four humours espoused by Hippocrates was concerned with the balance of the four bodily fluids, blood, yellow bile, black bile and phlegm and considered that illness was the result of an imbalance of these fluids. Nowadays, humoral pathology is an integral aspect of the humoral immune response,i.e. antibody-mediated immunity. Humoral factors in the blood stream participate in the body's immunological response to ward off infection. Rokitansky's doctrine of crases and dyscrases laid the groundwork for modern humoral pathology. As mentioned above, Rokitansky developed an interest in serology even as a student. In his subsequent pathological investigations, he analysed blood,
blood plasma, blood serum, secretion, excretions, lymphs and exudates. In his doctrine of crases and dyscrases he described illnesses of the protein, nowadays also known as paraproteinemia, amyloid and immune deficiencies, as well as illnesses of the fibrin, i.e. coagulopathies. He also analysed the influence of proteins on inflammation and the effect of diseased blood components (dyscrases) on human tissue. In this regard, his ideas were far ahead of those of his contemporaries, which resulted in fierce academic debates. The physician Gustav Zimmermann (1817–1866) concurred with Rokitansky and wrote in his text book that Rokitansky's studies on blood "were like an electric shock for all those who were driven by a zeal to uncover the secrets of the pathological processes themselves". However, the physiologist and chemist Carl Gotthelf Lehmann (1812–1863) described the doctrine of crases and dyscrases as a "monstrosity" of pathological anatomy. The 25-year-old physician
Rudolf Virchow (1821– 1902), who later became a renowned cellular pathologist, accused Rokitansky of having fallen back into an outdated doctrine of humoral pathology, calling the illnesses of proteins and fibrin "grave ontological errors" and Rokitansky's Manual a danger to medicine. In response to the controversy, Rokitansky withdrew those aspects of his visionary humoral pathological views which could not yet be scientifically proven. However, this did not mean that he disavowed his theory and thus he petitioned for the establishment of two new faculties in Vienna, the Institute of Medical Chemistry and the Department for General and Experimental Pathology, to press ahead with research in these fields. Virchow's criticism was not just scientifically motivated: At the time, Virchow was a young protégé of the influential privy councillor Joseph Hermann Schmidt (1804–1852) at the Ministry of Culture in Berlin. He had sent Virchow to Vienna to develop strategies to ensure the success of the Berlin Medical School on the Austrian model. Schmidt was discontented with the situation in Prussia, complaining that "it is unbearable that we are outstripped by the Viennese.". In December 1846, after staying just 10 days in Vienna, Virchow presented the Minister of Education Friedrich Eichhorn (1779–1856) with a programme on pathological anatomy. In his report Virchow criticised several respected Austrian scientists, but focused chiefly on Rokitansky as the founder of the New Viennese School. He hoped that this would lead to his rapid advancement to a position of associate professor – a hope that was not disappointed. As early as February 1847, Virchow's application for early habilitation was approved by the Prussian Minister of Education. This was highly unusual, as physicians were ordinarily required to demonstrate three years of medical practice before they could submit this application. The Prussian government, however, credited Virchow with having shaken one of the "pillars" of the Viennese School. Virchow had thus served both the interests of the Prussian educational bureaucracy and his own career. ==Political career==