Biography

Christian Albert Theodor Billroth is considered the founder of modern abdominal surgery. Billroth introduced epoch-making treatments which for subsequent decades constituted a pattern for surgical operations of the stomach, bile and female genitalia. For many years he was the Vienna school of surgery; because of his own work and that of his many eminent pupils, he must probably be considered the most single influence on the development of modern surgical knowledge. His operational methods or modifications of these are still in use. " Billroth" is a household word.

Christian Albert Theodor Billroth was the first of five sons born to Carl Theodor Billroth, a priest – Diaconus – in the Lutheran church and his wife Johanna Christina, born Nagel, the daughter of a Berlin Kammerrat (counsellor of the exchequer). The family lived in Klosterstrasse, later renamed Billrothstraß e. A plaque on the house reads:

Three years after Billroth's birth the family moved from the fishing village Bergen on the Baltic coast, to Reinberg. His father died when Theodor was five, and his mother then moved to his grandfather in Greifswald, where Billroth attended the Gymnasium. He was musically inclined – a family characteristic – and probably for that reason was not an exceptional pupil, even needing tutoring at home. He seemed unable to master languages and mathematics, was not quick-witted, and spoke slowly. However, in 1848 he passed the Abitur.

· Into medicine

His mother and two professors of medicine in Greifswald, Wilhelm Baum (1799-1883) and Philipp Magnus Seifert (1800-1845), induced Billroth to become a doctor for financial reasons. Billroth was a nephew of the medical officer in Stettin, Wilhelm Friedrich Billroth, who distinguished himself during the cholera period.

During his first semester as a medical student in Greifswald, Billroth studied natural sciences and began the multifaceted activity and careful use of his time that characterised his later years. He followed Baum to the University of Gö ttingen, where he established a lasting friendship with Georg Meissner (1829-1905). Like Billroth, Meissner was interested in music and a pupil of the physiologist Rudolph Wagner (1805-1864), who taught Billroth microscopy.

With Wagner and Meissner, Billroth went to Trieste to study the origin and insertion of the nerves of the torpedo fish. In 1851 he continued his studies at Berlin with Bernhard Rudolf Konrad von Langenbeck (1810-1887), Johann Lukas Schö nlein (1793-1864), Moritz Heinrich Romberg (1795-1873), and Ludwig Traube (1818-1876). Traube taught him experimental pathology and encouraged him to write the thesis De natura et causa pulmonum affectionis quae nerve utroque vago dissectro exoritur. On September 30, 1852, Billroth received his doctorate in Berlin, and that winter he passed the state medical examination, after which he worked in the ophthalmological clinic of Albrecht von Graefe (1828-1870).

· The young surgeon

In order to take courses in dermatology with Ferdinand von Hebra (1816-1880), in pathology with August Wilhelm Eduard Theodor Henschel (1790-1856) and in internal medicine with Johann von Oppolzer (1808-1871), Billroth went to Vienna in the spring of 1853. That fall he tried in vain to establish himself as a general practitioner in Berlin, but after a few months he was appointed assistant to Bernhard von Langenbeck - the man who developed 21 surgical methods – in the surgical clinic at the Berlin University (1853-1860).

He published on pathological histology and in 1856 became Privatdozent in surgery and pathological anatomy. Later he lectures on surgery and gave practical demonstrations. In 1855 he produced his first monograph on polyps and concluded that benign and malign polypoid tumours of the colon were related and suggested early treatment. He published numerous works on pathology of cystoid tumours in the testis, blood vessel development and comparative anatomy of the spleen.

· Competing with Virchow

On the death of Heinrich Meckel von Helmsbach (1822-1856) from intestinal tuberculosis, Billroth was short-listed for the Chair of Pathologic anatomy in Berlin with Robert Remak (1815-1865) and Virchow (1821-1902). The former had lost support because he had made application before Meckel's death and was Jewish, and Virchow had publicly expressed strong political views favouring democracy and freedom. Following Virchow's monograph in 1848/49, Die medizinische Reform which set out his strong opposition to unproven hypotheses laid down by authoritarian professors, he was dismissed from Berlin where he was a prosector. In the end Virchow was appointed with Billroth being the second candidate.

It was in Berlin that Billroth met his wife Christine, daughter of the court physician Heinrich Sabatier Michaelis (1791-1857) and of Karoline Eunike. They were married in 1858, and of their four daughters and one son, three daughters survived.

· Professor in Zurich

Billroth next turned to teaching and writing on historical developments in surgery and was nominated professor of surgery and director of the well-known surgical hospital and clinic in Zurich in 1860, staying in this position until 1867, when he became professor at the University of Vienna and head of the 2nd Surgical Clinic at the General Hospital in Vienna.. During his seven year stay as director in Zurich he added greatly to the fame and growth of the surgical clinic.

Modern surgery was in its infancy, and Billroth was especially interested in the causes of wound fever. He insisted on regular temperature-taking and believed that wound fever was caused by a chemical poison produced by some living organism.

While at the University of Zurich (1860-1867) as professor and director of the surgical clinic, Billroth published his classic textbook Die allgemeine chirurgische Pathologie und Therapie (1863). In Zurich 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 improvement in patient selection

· The master of surgery

The peak of Billroth's career, however, began when he joined the faculty of the University of Vienna, where he worked from 1867 until his death in 1894. Here Billroth excelled as a surgeon, as a teacher, and as a scientist.

In 1870 he volunteered for the Franco-Prussian War, working in the field hospitals at Weissenburg and Mannheim.

He was a pioneer in the study of the bacterial causes of wound fever, as evidenced by Untersuchungen ü ber die Vegetationsformen von Cocobacteria septica (1874). Billroth was quick to use antiseptic techniques in his surgical practice and performed many hazardous operations successfully because of his great ability and caution. With the threat of fatal surgical infections eradicated, Billroth proceeded to alter or remove organs that had hitherto been considered inaccessible. In 1872 he was the first to remove a section of the oesophagus, joining the remaining parts together, and in 1873 he performed the first complete excision of a 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 and was ready to attempt what appeared in his time as the most formidable abdominal operation conceivable: excision of a cancerous pylorus (the lower end of the stomach). His successful execution of the operation caused a great sensation and initiated the modern era of surgery. His methods of resection, although modified, remained in use for many years. Plastic surgery, especially of the face, was another of his specialities.

He is regarded by many as the leading German surgeon of late 19th century. As well an outstanding surgical technician he was able to bring experimental medicine to clinical practice. He had radical ideas for the time 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. His ideas were taken up by many who visited him

Billroth founded the House of the Society of Physicians in Vienna - K. K. Haus der Gesellschaft der Ä rzte - and it was due to his energetic efforts that the " Rudolfinerhaus", a teaching institution for " worldly" nurses, was established in Vienna. For this purpose he wrote the handbook Ueber die Krankenpflege im Hause und im Spitale (1881). On the other hand, he never succeeded in having a new surgical clinic built.

· The man

Billroth was also a man of strong artistic bent, above all a great lover of music. He was an artist by nature: intuitive, humane, inventive. His home in Vienna became a musical centre where he played second violin and viola and became friends with Johannes Brahms and with the musical theorist and writer Eduard Hanslick (1825-1904). Two of Brahm's string quartets are dedicated to Billroth, and during his last illness Billroth was working on the physio-psychological book " Wer ist musikalisch? ", published by Hanslick in 1896. In Zü rich he was invited at times to be guest conductor of the Zurich ymphony Orchestra.

Billroth was a member of the Academy of Sciences in Vienna and honorary member of thirty-two scientific societies, and a member of the Austrian Herrenhaus from 1886. He was also honoured with sixteen high decorations. His bibliography contains some 150 items.

Until the spring of 1887 he was exceptionally robust and healthy, when he or the first time fell ill with a severe inflammation of the lungs, already then threatening to kill him, and suffered from cardiac weakness that increased during his last years. However, he lived to enjoy is sixtieth birthday as well as his 25th anniversary as professor in Vienna. Billroth died on February 6, 1894, and was buried with " princely" honours in Vienna.

Fig no 1 Theodor Billroth

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