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TWO EMINENT GERMAN SURGEONS OF THE PRE-ANTISEPTIC PERIOD

Johann Friedrich Dieffenbach, born in 1794 at Koenigsberg, an important city of Northern Prussia, received his early medical education in France; first under Boyer, Dupuytren, Larrey and Magendie, at Paris, and then later at Montpellier, under Delpech. After his return to Germany in 1823 he devoted his efforts largely to surgery, and soon distinguished himself so greatly in this department of medicine that in 1840, after the death of Karl von Graefe, he was chosen his successor in the office of Director of the University Surgical Clinic at Berlin. His death occurred in 1847.

Dieffenbach was universally considered a very clever operator, particularly in the field of plastic surgery. He was distinguished by a high degree of manual skill, remarkable presence of mind under the most trying circumstances, and boldness combined with prudence. His triumphs in the reconstruction of damaged parts of the body, effected largely by the transplantation of flaps of normal skin, were quite remarkable; he seemed to know just what steps were required for restoring a mutilated soft palate, ear, nose, eyelid, etc. But his interest was not confined to plastic surgery; he also performed successful operations in tenotomy, myotomy, transfusion of blood, and the injection of drug infusions into the veins.

The Schleswig-Holstein campaign, says George Korn in his “Progress of Medicine during the Nineteenth Century,” furnished a great stimulus to the advance of German surgery, by providing an extensive field for the activity of such men as von Langenbeck, Stromeyer and his son-in-law, Esmarch. The scantiness of available space, as well as of satisfactory sources of information, compels me to give here only the briefest details concerning these three distinguished surgeons.

The founder of modern German surgery, says George Korn, was Bernhard von Langenbeck (1810–1887). When he began active work as a surgeon he was already thoroughly familiar with human anatomy, physiology and pathology, and with the experimental methods of research. His first appearance as a teacher was at the University of Goettingen, where he remained for a few years, and then moved to Berlin, to occupy the chair of surgery vacated in 1847 by the death of Johann Friedrich Dieffenbach. In 1882 he gave up his professorship in Berlin and retired to Wiesbaden, where he spent the remainder of his life in quietude.

Before von Langenbeck’s day much stress was laid in Germany upon the importance of anatomy in its relationship to the science of surgery. It was a common practice in the medical schools, for example, to combine in one the two chairs of anatomy and surgery, and, imbued with the idea that this viewpoint was the correct one for them to adopt, the leaders in surgery, with few exceptions, strove to make advances in their branch of knowledge by cultivating energetically the study of anatomy. The efforts of von Langenbeck and his followers, on the other hand, were directed to giving new life to surgery by calling to its aid physiology, pathological anatomy and pathological histology, as well as experiments upon animals, sources of information which before von Langenbeck’s time had been very little utilized by the surgeons. Korn, in his comments upon the preceding statement, begs the reader not to interpret it as signifying that von Langenbeck permitted himself to neglect anatomy in the slightest degree. Quite the contrary, he continued to insist upon it that a knowledge of anatomy was the most useful foundation upon which a surgeon could build. As corroborative evidence of the correctness of Korn’s statement I will quote here the remarks made by an English physician who visited Goettingen in 1818 (London Quarterly Journal of Foreign Medicine and Surgery, Vol. 1, 1818–1819):—

We were pleased in observing the great attention which Professor von Langenbeck paid in these clinical exercises to relative anatomy. He omitted no opportunity of impressing on the students that the mere dissection of bodies could never make them good anatomists, and that, as surgery without the knowledge of anatomy would be a dangerous art, so anatomy without a constant reference and application to the living body would be vain and futile....

The foundation of the surgical hospital at Goettingen is entirely due to Professor von Langenbeck. In 1807, at his representations, a certain sum was appropriated to its support from the Cloister-fund. In 1808 the professor built the present hospital, which is still his own property, the Hanoverian Government paying him a yearly rent for it. The beautiful collection of surgical instruments also belongs to the professor.... The whole as it now (1818) stands is undoubtedly the first in Germany. It comprises all instruments that have ever been used in surgery from the earliest days to the present time.

Professor von Langenbeck, as a practical surgeon, is unrivalled in Germany. We have seldom seen a man so enthusiastically devoted to any pursuit, or who brought to the profession of surgery more capability of excelling in it.... As an operator, he is unrivalled in his own country, and we are not aware that he is excelled in any. He is clear and decisive in his judgments.

This account certainly places von Langenbeck on a very high pedestal, and reveals the true reasons of his great popularity as a teacher. Upon a close analysis these reasons may be stated thus: they were whole-heartedness in his chosen work; readiness to sacrifice himself, if necessary, in order to secure every possible advantage for his pupils; and the possession of the rare gift of knowing how best to impart knowledge to those who show a strong desire to acquire it. It is not to be wondered at, therefore, that von Langenbeck was such a favorite with such pupils as Hueter, Trendelenburg, Gurlt, Luecke, von Esmarch and Billroth, all of whom in time acquired celebrity as surgeons.

One more point deserves to be mentioned here: von Langenbeck was an accomplished master in the technique of operative work, and he took pains to transmit his skill to his pupils. One of his great feats, as narrated by those who often witnessed incidents of this nature, is briefly described as follows:—von Langenbeck would appear from time to time at the operating table dressed in a light summer suit of clothes, and would immediately proceed to his work without putting on a gown or taking other measures to protect himself from the soiling which so frequently is associated with operative work; and yet, when the operation was completed, the closest observation failed to discover a single spot of blood or other pathological product upon his clothes. The narrator of this tale evidently believed, and perhaps rightly, that the incident showed how thoroughly familiar von Langenbeck was with the distribution of the blood-vessels that supplied the region upon which he was operating and also how skilful he was in the handling of his scalpel. The incident, it should be remembered, occurred many years before it was thought necessary to take certain precautions against the spread of infection.