The Legacy of Karl Rokitansky

By the middle of the 19th century, Vienna flourished as a European center of excellence in medical teaching. This fame is attributable to the New Vienna School, one of the founders of which was the eminent pathologist, Karl Rokitansky. At the Institute of Pathological Anatomy, the coming of Rokitansky marked the beginning of a new era in the history of pathology.Karl Rokitansky (1804–1878) was born in Königsgrätz, Bohemia. He studied medicine in Prague and Vienna, graduating in 1828. Shortly thereafter, he became an assistant in Pathological Anatomy to Wagner at the Vienna School. As a student, Rokitansky was profoundly influenced by the French school of medicine and by the concepts of comparative anatomy and embryology put forth by Johann Friedrich Meckel.Rokitansky became professor of pathological anatomy at the Vienna School and remained there until 4 years prior to his death. Rokitansky was an astute observer who recorded all he saw with admirable clarity and thoroughness. Stressing what the naked eye could see helped him lay the foundations of pathological anatomy, following the initiatives of the preeminent anatomist, Giovanni Morgagni. It was not enough to simply get a good anatomical exposition; Rokitansky stressed the importance of correlating symptomatology and disease with anatomical appearances. At the completion of a postmortem examination, he worked backward to determine what could have led to the observed pathology. His writings were masterful and won him praise for their clarity and vitality.At the Pathology Institute of the Allgemeines Krankenhaus, a new hospital regulation had increased the availability of bodies for postmortem examination. It is believed that Rokitansky probably had access to between 1500 and 1800 cadavers annually. Great diagnosticians like Skoda performed their studies on living patients and later checked their observations with gross findings in Rokitansky's postmortem room. By the time Rokitansky retired, after having spent an active career in Vienna, he had performed more than 30 000 postmortem examinations and had several thousands more available for his review.Rokitansky's record of scientific publications was astounding. His Handbuch der pathologischen Anatomie, published between 1842 and 1846, was an authoritative work that far surpassed previous texts of the time. Several notable contributions included his observations on goiter; lobar and lobular pneumonia; endocarditis; diseases of the arteries; cardiac malformations; spondylolisthetic deformity of the pelvis; perforating gastric ulcer; lardaceous disease of the spleen, liver, and kidney (Virchow's “amyloid”); emphysema; pulmonary complications of typhoid; cysts in various viscera; and various neoplasms. His classic description of acute yellow atrophy of the liver is well known and still bears the name he gave.Rokitansky's emphasis was on gross observation. He unfortunately formulated a modified form of the humoral theory with his doctrine of “crases” and “dyscrases,” wherein he advocated a chemical hypothesis to disease susceptibility. He was great-minded in accepting the merciless criticism voiced in this regard by the younger Virchow and rewrote the first edition of his Handbuch, discarding this theory.One of Rokitansky's greatest works was The Defects in the Septum of the Heart, representing the fruit of 14 years of painstaking observation. Published in 1875, this book featured, among other themes, his transposition theory of the deviation of the aortic septum. It served as a logical completion and sequel to his earlier treatise, On Some of the Most Important Diseases of the Arteries, published in 1852. In this major undertaking on the study of congenital heart disease, Rokitansky was obviously influenced by the great teratologist Johann Friedrich Meckel. His good foundation in embryology helped him to understand aberrant development and to predict what might evolve when development went astray. With this ability to logically predict these sequelae, Rokitansky filled in the gaps in the understanding of congenital heart disease.In the English translation of his work, A Manual of Pathological Anatomy (translated from German by George E. Day and printed for The Sydenham Society), volume IV is devoted to the organs of respiration and circulation. “In this form, the foetal passages,—the foramen ovale, and the ductus arteriosus,—remain open,” he wrote. “The degree of the patency of the foramen ovale varies considerably, its valve being very nearly or entirely absent in some cases, but more commonly the upper third or fourth portion of it is wanting. … The aorta may originate from both ventricles, owing to a deficiency in the partition-wall between them, in which case it is deflected somewhat to the right.” This treatise describes with utmost clarity a number of developmental lesions, including anomalies of the aorta; pulmonary artery and ductus arteriosus; deficiencies of the valves and septae; malformations per excessum, such as duplication of the heart; anomalies of cardiac form and position; anomalous origin of the vascular trunks; transposition; anomalies of size; and obstructive pathology.Rokitansky firmly established the New Vienna school, which stressed pathological study and correlation of clinical symptoms and signs with structural abnormalities observed at autopsy. Even Virchow conceded that Rokitansky was the greatest descriptive pathologist of the time. His fame extended beyond the sphere of pathology. In 1849, he became dean of the medical faculty, and in 1850, rector of the university. A well-known medical figure in the city, Rokitansky retired from active work in 1875 and later died on July 23, 1878.Words from his final lecture echo his passion for his vocation and emphasize his sentiment that “Pathological Anatomy is the essential basis for pathological physiology, to be supplemented further by pathological histology, chemical pathology, and experimental pathology.”

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