History of Medicine

THE MUSICAL SURGEON: THEODORE BILLROTH

     One of the great figures of 19^th century medicine was Theodor Billroth, a skilled, inventive surgeon and a consummate musician. His accomplishments are too numerous to fit into a short essay but even a few comments will reveal his great breadth.

     Billroth was born on the island of Rügen, Prussia. His father, a Lutheran minister, died when he was five. Theodor took to music at an early age, but after a gymnasium education he was induced, for monetary reasons, to study medicine rather than music. He

Theodor Billroth (Nat Library of Medicine)

obtained his medical degree in Berlin followed by a period of study in Vienna. On return to Berlin he received an appointment as surgical assistant to the famous Bernhard von Langenbeck at Berlin University. Here, in addition to practicing surgery, he immersed himself in pathology, publishing on polyps, testicular tumors, the spleen, and other topics. In 1860 he was tapped for a professorship of surgery at the University of Zürich, where he published a textbook on surgical pathology and was the first to publish “total” results of operations, including complications and mortality rates. In 1867 he was called to Vienna as professor of surgery at the famous Vienna General Hospital (Allgemeine Krankenhaus). Here he remained until his death in 1894. Lacking experience in battle surgery he volunteered at field hospitals in the Franco-Prussian war, developing triage techniques and principles of ambulance service. He took an

                                        "Theodor Billroth Operating" by Adalbert Seligman, painted between 1880-90 (Wikipedia)
                                          Notice the resemblance to "The Gross Clinic" by Thomas Eakins painted years earlier.
                                    Notice also the gowns but no gloves or masks, lighting by sunlight, and open drop anesthesia.
         According to the artist the operation is a neurotomy for trigeminal neuralgia. The artist and the Duke of Bavaria (who enjoyed attending)                                                                                       are depicted in the audience. The painting was found forgotten in a closet at the Surgical Clinic in 1963 (LITMED:    http://medhum.med.nyu.edu/view/10332 ) 

interest in wound infections, developed important new operations,  published a surgical text, and authored numerous articles. His students went on to professorships in university centers around the world.

     One of his famous operations became known as “Billroth I”. Two of Billroth’s assistants had worked on dogs to see if partial gastric resection was feasible, and especially to learn whether gastric juice would dissolve an anastomosis. So he was ready when in January, 1881, a 43 year-old woman, Therese Heller, presented with over 3 months of regurgitation and vomiting. A tumor was easily felt through her wasted abdominal wall. Under chloroform, using Lister’s antiseptic principles (except the spray), and after washing the stomach with 14 liters of warm water, a horizontal incision exposed the moveable, apple-

Frau Heller's Excised Pyloric Tumor
(Billroth, T. Clinical Surgery: Extracts from
the Reports of Surgical Practice, 1860-76. Eng Trans, 1881.
New Sydenham Soc., Hathi Trust)

sized, pyloric tumor, which was resected. The greater curvature of the stomach was narrowed and a residual opening sutured to the duodenum. The operation lasted 1½ hours. Postoperatively Frau Heller had little pain and almost no fever. She took sour milk, then a soft diet, and finally beefsteak. She had no intravenous fluid or antibiotics. She died 4 months later from metastatic disease and with an intact anastomosis. It was the first successful partial gastric resection, after which the field developed rapidly.

     While in Zürich Billroth took time to indulge his musical interests. Already accomplished on the piano and violin, he taught himself the viola and became part of a quartet. He was taken on as a music critic by the local paper, Neuen Zürcher Zeitung. After an uncomplimentary review of the Zürich Symphony he was fired, but rehired when the orchestra musicians protested that they needed expert criticism to maintain good quality. In Zürich he met Johannes Brahms twice, once hosting him as a guest in his home. He surprised Brahms by recognizing his compositional ability before the public had appreciated him.

     Musical theory fascinated Billroth so much that later in life he attempted a complicated manuscript, combining science and esthetics, to explain what made a person “musical”.

     The Vienna that greeted Billroth was a major cultural center, where compositions of Johann Strauss, Liszt, Bruckner, Dvorak, and Robert Schumann were bringing audiences to their feet. Brahms was already resident there and he and Billroth formed a close friendship, often joined by the music critic Eduard Hanslick in extended conversations on music. Brahms came to appreciate Billroth’s musical judgment so much that he often tried out compositions in Billroth’s home, which had a sumptuous music room, before public performances. The two men carried on an extensive correspondence, largely about music.

Johannes Brahms, c 1872 (Wikipedia)

     Both men were disciplined workers, but in many ways they were not alike. Billroth was well educated, outgoing, gracious, and fond of social gatherings. Brahms had been born in poverty in a Hamburg slum. His father was a fiddler in local bars who taught him the violin and piano. Young Johannes had been forced to play piano in similar bars and in brothels to earn money. His education was self-acquired, he was more introverted, and could be rude or gruff with others. His friendship with Billroth was warm, however, and he sought Billroth’s opinions on many occasions.

     Shortly before Billroth’s death Brahms happened to see a letter from Billroth to Hanslick, mentioning that he, Brahms, was often abrupt and discourteous to others, “like Beethoven”, and

House of Brahms' Birth, destroyed in WW II
(Wikipedia)

hampered by the poverty of his youth and his lack of education. Brahms and Billroth continued to correspond, but their relationship thereafter was cooler. Billroth died 2 years later of heart failure, and Brahms died 3 years after that of liver disease. Both were honored by large funeral processions and both were buried in the Central Cemetery in Vienna, not far from the graves of Beethoven, Schubert, and a monument to Mozart.

     Billroth was a great surgical innovator and an inspiring teacher. He emphasized the importance of research for surgery and introduced the fashion of surgical statistics, along with 5-year survival rates, into surgical literature. He was also an accomplished and insightful musician with a refined esthetic sensibility. Brahms was his primary sounding board and major link to the world of music.

SOURCES:

Rutledge, R H. “A Musical Friendship: Billtorh and Brahms”. 2007; J Surg Education 64: 57-60.

Rutledge, R H. “In Commemoration of Theodor Billroth on the 150^th Anniversary of his Birth”. 1979; Surgery 86: 672-93.

Ellis, Harold. Famous Operations. 1984; Harwal Publishing. pp29-35.

Wangensteen, Owen. The Rise of Surgery.  1978; Univ of Minnesota Press. pp 142-57.

McLaren, N and Thorbeck, R. “Little-Known Aspect of Theodor Billroth’s Work: His Contribution to Musical Theory”. 1997; World J Surg 21: 569-71.

Buklijas, T “Surgery and National Identity in Late Nineteenth-Century Vienna”. 2007; Stud Hist Philos Biomed Sci 38: 756-74.

    

Billroth, T. Clinical Surgery: Extracts from the Reports of Surgical Practice, 1860-76. Eng Trans, 1881. New Sydenham Soc. pp 502-5.

Hemmeter, J C. “Theodor Billroth, Musical and Surgical Philosopher. A Biography and a Review of his Work on Psycho-physiological Aphorisms on Music”. 1900; Bull J Hopkins Hosp. 11: 297-317.

Nagel, M, Schober, K-L, Weiss, G. Theodor Billroth: Chirurg und Musiker. 1994; Regensburg.