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Christian Albert Theodor Billroth (26 April 18296 February 1894) was one of the most eminent surgeons of the 19th century, with his main contributions in gastrectomy, laryngectomy and anatomical pathology and is generally regarded as the founding father of modern abdominal surgery.
As early as 1874 he discovered the bacteriostatic effects of penicillium,Ernst Kern: Echter und vermeintlicher Fortschritt in der Chirurgie. In: Würzburger medizinhistorische Mitteilungen. Band 9, 1991, S. 417–429, hier: S. 418. which makes him the primary discoverer of penicillin.Ernst Kern: Sehen – Denken – Handeln eines Chirurgen im 20. Jahrhundert. ecomed, Landsberg am Lech 2000, ISBN 3-609-20149-5, S. 93.
He was a close friend and confidant of Johannes Brahms, a leading patron of the Viennese musical scene, and one of the first to attempt a scientific analysis of musicality.
Billroth wrote his thesis, in Latin, in which he described the effects of vagotomy on the lungs and the value of tracheostomy. He graduated in 1852). After the official state examination was over he fulfilled his obligatory military service, which he considered a waste of time, except for the training in discipline. Thereafter he tried to start a practice as a family doctor in Berlin, which failed because no patients consulted him.
While in Zurich, Billroth published his classic textbook Die allgemeine chirurgische Pathologie und Therapie ( General Surgical Pathology and Therapy) (1863). At the same time he introduced the concept of audits, publishing all results, good and bad, which automatically resulted in honest discussion on morbidity, mortality, and techniques – with resultant improvements in patient selection.
He was appointed professor of surgery at the University of Vienna in 1867, in succession to Franz Schuh; there, he practiced surgery as chief of the Second Surgical Clinic at the Allgemeine Krankenhaus (Vienna General Hospital). Though he laid the foundation of his fame at Zurich, it was in Vienna, a larger and more conspicuous theater, that he established himself as the power that he was in the surgical world. A speech he gave in 1875, protesting influxes of Jewish medical students, has been counted as one of the first events in the development of Viennese political anti-Semitism.
During the Franco-Prussian War, Billroth did excellent work in the military hospital at Mannheim and Weissenburg, treating a variety of horrific battlefield injuries with aggressive and ambitious surgeries; he embodied his experience of war surgery in his Surgical Letters from Mannheim and Weissenburg. He was so impressed by the horrors of war that he was ever afterwards an ardent advocate of peace. On December 3, 1891, he delivered an address on the care of the wounded in war which made a profound sensation and led to large sums of money being voted by the Austrian legislative chambers for the provision of adequate means of succour for the wounded.
He did not limit himself to surgery only, and conducted extensive research on an ailment that affected many surgery patients at the time: wound fever. His treatise on wound fever, Untersuchungen über die Vegetationsformen von Coccobacteria septica (1874; “Investigations of the Vegetal Forms of Coccobacteria septica”) concluded that the cause was bacterial; Billroth was quick to use antiseptic techniques in his surgical practice, and the number of surgical patients afflicted with wound fever greatly decreased. With the threat of fatal surgical infections lessened through his work and others’, Billroth proceeded to turn his attention to surgery and the pioneering field of altering or removing organs that had previously been considered inaccessible.
An early adopter of the "white coat" (as shown in Seligmann's c.1890 painting), Billroth was directly responsible for a number of landmarks in surgery; in 1872, he was the first to conduct an esophagectomy, removing a section of the oesophagus and joining the remaining parts together. In 1873, he performed the first laryngectomy, completely excising a cancerous larynx. He was the first surgeon to excise a rectal cancer and by 1876, he had performed 33 such operations. By 1881, Billroth had made intestinal surgery seem almost commonplace. But his most famous accomplishment is unquestionably the first successful gastrectomy for gastric cancer. On January 29, 1881, after many ill-fated attempts, Billroth performed the first successful resection for antral carcinoma on Therese Heller, who lived for almost 4 months and died of liver metastases. He accomplished this operation by closing the greater curvature side of the stomach and anastomosing the lesser curvature to the duodenum, in an operation that is still known as the Billroth I to this day.
Billroth's literary activity was widespread, with the total number of published books and papers of which he was the author numbering about one hundred and forty. He collaborated with Franz von Pitha on a Textbook of General and Special Surgery (1882). To this, Billroth contributed the section on Scrofulosis and Tuberculosis, Injuries and Diseases of the Breast, Instruments and Operations, Burns, Frostbites, etc.
Billroth passed his restless intellectual spirit to numerous distinguished students, creating the "Billroth School" of followers. No aspect of his profession seemed to escape his intense scrutiny, be it research, teaching, administration, or nursing. He not only had something valuable to say about each but often saw to it that his ideas became concrete reality. In all the spheres he sought to influence, he was guided by a belief in the unity of science and art, and by confidence in his own ability to effect change.
Billroth was instrumental in establishing the first modern school of thought in surgery. He had radical ideas on surgical training, advocating a prolonged surgical apprenticeship on completion of medical studies consisting of preliminary work in hospitals followed by performing operations on cadavers and experimental animals. This would be followed by a 2-3 year assistantship in a surgical department with studies of the surgical literature and the acquisition of advanced practical skills. Among his disciples were the notable surgeons Alexander von Winiwarter, Jan Mikulicz-Radecki and John B. Murphy. William Halsted's pioneer surgical residency program was greatly influenced by Billroth's own methods of surgical education.
Billroth and Brahms, together with the acerbic and influential Viennese music critic Eduard Hanslick, formed the core of the musical conservatives who opposed the innovations of Richard Wagner and Franz Liszt. In the conflict, known as the War of the Romantics, Billroth supported Brahms, but was always fair and measured in his comments. "Wagner was indeed a very considerable talent in many directions," he wrote in 1888.Letter written Sept. 3, 1888, translated in Dorothy Schullian and Max Schoen, Music and Medicine (1948) New York, Henry Schuman, Inc.
Billroth started an essay called "Wer ist musikalisch?" ("Who is musical?"), which was published posthumously by Hanslick. It was one of the earliest attempts to apply scientific methods to musicality. In the essay, Billroth identifies different types of amusicality (Tone-deaf, rhythm-deafness and harmony-deafness) that suggest some of the different cognitive skills involved in the perception of music. Billroth died in Opatija, Austria-Hungary, before he could complete the research.
Excelling at both his vocation and his avocation, Billroth never saw science and music as being in conflict. On the contrary, he considered the two to complement each other. "It is one of the superficialities of our time to see in science and in art two opposites," he wrote in a letter. "Imagination is the mother of both."Letter to Lubke, quoted in
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