Josef Skoda

Josef Skoda was the third son of a poor locksmith. Since Skoda was frequently ill during childhood, he entered high school in Pilsen (Plzeň) only at the age of twelve. There was no money for candles or lamp oil, and the adolescent Skoda spent evenings studying by the light from the kitchen stove flames. In order to attend the gymnasium he had to give private lessons as a teenager. Also while studying medicine he earned money by giving private lessons.

He graduated near the top of his class at the gymnasium in 1825 and went to Vienna to study medicine. In addition to medicine he studied higher mathematics and physics and he passed the examination so successfully that his teacher, Professor Baumgartner, urged him to devote his life to mathematics. During his student days he is said to have walked the distance between Pilsen and Vienna back and forth.

The degree of doctor of medicine was conferred upon him on July 18, 1831. Skoda then returned to Pilsen and established a medical practice. At this time the first pandemic of Asiatic cholera was approaching Bohemia, and he became Bohemian Cholerabezirksarzt - the district cholera specialist, first in the Chrudim region, then in Kourim, and finally in Pilsen (1831-1832). He realized how little his formal training in medicine had prepared him for medical practice, and further that in the fight against cholera, more could be achieved through preventive hygienic measures than by means of many officially recommended medicines.

Following two years of practice in Bohemia he returned to the Allgemeines Krankenhaus in Vienna where he got a job as a housman without pay, working in the internal department from the autumn of 1833. He also worked in the Karl Rokitansky¡¯s Pathology-Anatomy Institute and developed a close relationship with him.

The sounds of sickness
Around 1836 Skoda began investigating the fundamentals of percussion and auscultation, then two of the modern examination methods in clinical medicine. The discovery of the method of percussion diagnosis, published in 1761 by the Viennese physician, Josef Leopold Auenbrugger (1722-1809), had been forgotten, and the knowledge of it was first revived in 1808 by Baron Jean-Nicolas Corvisart des Marest (1755-1821), court-physician to Napoleon I. Ren¡§¦-Th¡§¦ophile-Hyacinthe Laennec (1787-1826) and his pupils Piorry and Bouillaud added auscultation to this method.

Skoda critically evaluated the doctrines of the French school of medicine, which distinguished percussion sounds according to the organ ¡§C the thigh, the liver, the intestine, the lung, or whatever ¡§C and substituted a physical classification of percussion sound in four categories: from full to empty, from clear to muffled, from tympanous to nontympanous, from high to deep.

In contrast, Skoda's approach was based solely on the objective description of physical signs. To him, the acoustic phenomena produced by percussion were not specific for a given organ, but for the amount of air or fluid; hollow, empty, tympanic, high, deep, clear, dull. Based on acoustic phenomena, Skoda tried to explain the physical changes in an organ and then, from the anatomical and pathologic possibilities, he reached a clinical diagnostic conclusion.

In the theory of auscultation Skoda first distinguished reverberations (heart sounds) from cardiac murmurs. On the basis of comparative observations of healthy people and those known to have heart disease he learned to diagnose various heart illnesses from the presence of murmurs in individual valves. He also evaluated pulsations of the neck veins and accentuation of further reverberations in the pulmonary artery. Through his lucid account of functional changes and symptoms attendant upon various changes in valves of the heart or the pericardium, he established thr principles of the clinical physiology of heart diseases.

About 1836, he began courses in percussion and asucultation for doctors, which were his sole source of income; he continued them until his appointment as professor in 1846. These courses soon attracted young colleagues from the Austrian monarchy as well as from other European countries and carried his doctrines to foreign universities.

Breaking rules
Although he was famous abroad and well-known in European intellectual circles, he was not accepted ¡ª was even rejected ¡ª by older Austrian doctors who could not understand his new diagnostic procedures. Before instituting a new procedure at the Vienna General Hospital, it was necessary to obtain the approval of the director and the chief physician of the hospital. In their absence and thus without their consent, Skoda performed a tracheotomy with his colleague, the famous surgeon Franz Schuh (1804-1865). The procedure was performed correctly; nevertheless, Skoda was in danger of losing his medical license. Fortunately, thanks to his fame, which was recognized in Austria by, among others, the Court Councellor Ludwig Freiherr von T¡§¹rkheim (1777-1846), officer in charge of the Court Committee for Studies. As a punishment, he was transferred to the ward for the insane, where he worked for three months.

Skoda's chief in the medical department allowed him, however, to continue his diagnostic investigations. Nevertheless, Skoda declined to prolong his contract with the Vienna General Hospital that year and, in October 1839, started work as city physician of Vienna for the poor in St. Ulrich, a suburb of Vienna.

On 13 February, 1840, on the recommendation of von T¡§¹rkheim, Skoda was appointed to the unpaid position of chief physician of the department for consumptives just opened in the general hospital.

A correct diagnosis
Skoda was asked by baron von T¡§¹rkheim of the imperial Chancellory to give another opinion on the French minister, le Duc de Blacas, a resident of Vienna, in whom other doctors had made the diagnosis of liver disease, Examining the patient, Skoda diagnosed an aneurysm of the abdominal aorta. At autopsy Skoda¡¯s diagnosis was proven to be correct and T¡§¹rkheim created a department of chest diseases for him at the Allgemeines Krankenhaus. A department for diseases of the skin and another for internal medicine were later attached to this department. It was during Skoda¡¯s tenure here that Ferdinand von Hebra laid the foundation for his later fame as a dermatologist.

In 1846, thanks to the energetic measures of Karl Rokitansky, Skoda he was at last given the chair of Professor of Special Pathology and Therapy at the Vienna University and became Ordinarius at the Department of Internal Medicine. This was against the wishes of the rest of the medical faculty. Two years later, on July 17, 1848, he was elected a full member of the mathematico-physical section of the Royal Academy of Sciences in Vienna. Also in 1848, he began to lecture in German instead of Latin, being the first professor in Vienna to adopt this course.

For reasons of health, he had suffered from severe gout for years, Skoda resigned from all his functions in 1871. The students and the population of Vienna honoured him with a famous torch parade. He died in Vienna 10 years later and was buried in the same cemetery as Hebra and Rokitansky. The three stars of the Vienna second medical school remain together for eternity

A poorly dressed nihilist
Josef Skoda was an excellent teacher, but said to be much more reserved and pedantic than Rokitansky, although he had an eccentric charm. He completely neglected the humane and psychosomatic side of disease and treated the patient virtually as an experimental animal. He was the first person in Vienna to teach in German. Thus in this respect and in the way he treated his patients, he resembled Johann Lukas Schönlein (1793-1864). He championed the approach of therapeutic nihilism and said, ¡¡ãwhilst a disease can be described and diagnosed, we can dare not to suspect to cure it by any manner of means¡¡À.

His therapeutics were exceedingly simple in contrast to the great variety of remedial agents used at that time, which he regarded as useless, as in his experience many ailments were cured without medicines, merely by suitable medical supervision and proper diet.

Skoda almost entirely eliminated typhoid fever in Vienna by securing the construction of a water main from mountain springs at a time when the true cause of the disease was unknown. he had already demonstrated preventive measureswhen a young physician during the cholera epidemic in Bohemia.

Rokitansky calls him "a light for those who study, a model for those who strive, and a rock for those who despair". Skoda's benevolent disposition is best shown by the fact that, notwithstanding his large income and known simplicity of life, he left a comparatively small fortune, and in his will bequeathed legacies to a number of benevolent institutions. One of the beneficiaries in his will was his cousin in Pilzen, Emil Skoda (1839-1900), the founder of the Skoda automobile factory.

We thank Patrick Jucker-Kupper, Switzerland, and Martin Krssaand, Austria, for information submitted.

Works referred to etc.
• Josef Leopold Auenbrugger:
  Inventum novum ex percussione thoracis humani ut signo abstrusos interni pectoris morbos detegendi.
  Wien, J. T. Trattner, 1761, 1763, 1775. First German translation in Vienna, 1843.
  (A New Discovery that Enables the Physician from the Percussion of the Human Thorax to Detect the Diseases Hidden Within the Chest).
• J. N. Corvisart des Marest:
  Essai sur les maladies et les lésions organiques du coeur et des gros vaisseaux.
  Paris, Migneret, 1806. English translation, 1812..
• R. T. H. Laënnec:
  De l'auscultation médiate, ou traité du diagnostic des maladies des poumons et du coeur, fondé principalement sur ce nouveau moyen d'exploration.
  2 volumes. Paris 1819; 1826. German translation, 1822; 1823.
• Pierre Adolphe Piorry (1794-1879):
  De la percussion médiate et des signes obtenus à l'aide de ce nouveau moyen d'exploration, dans les maladies des organes thoraciques et abdominaux.
  Paris, J. S. Chaudé, 1828.
  Piorry, pioneer of mediate percussion. introduced the percussor and the pleximeter in 1826. He also developed refinements to Laënnec's stethoscope.
• William Stokes (1804-1878):
  An Introduction to the Use of the Stethoscope, with its application to the Diagnosis in Diseases of Thoracic Viscera.
  The Lancet, London, 1825: 471-475.
  Edinburgh, Maclachlan & Stewart., 1825. London, Baldwin & Co., 1825.
• Franz Schuh and Josef Skoda:
  Ueber den Einfluss der Percussion und Ausculatation auf die chirurgishe Praxis; nebst Versuchen über das Eindringen der Luft in die Brusthöhle.
  Medicinische Jahrbücher des kaiserlich-königlichen österreichischen Staates, volume 41, 1838.
• Franz Schuh and Josef Skoda:
  Erfahrungen über die Paracentese der Brust und des Herzbeutels.
  Medicinische Jahrbücher des kaiserlich-königlichen österreichischen Staates, volume 41, 1838. Works by Josef Skoda:
• Uber Pericarditis in pathologisch-anatomischer und diagnostischer Hinsicht.
  Written with Jakob Kolletschka (1803-1847).
  Medicinische Jahrbücher des kaiserlich-königlichen österreichischen Staates, 1834.
  
  
• Ueber die Perkussion. Medicinische Jahrbücher des kaiserlich-königlichen österreichischen Staates, Wien, 1836, 20: 453-473. (new series, volume 9).
• Über den Herzstoss und die durch die Herzbewegungen verursachten Töne und über die Anwendung der Perkussion bei Untersuchung der Organe des Unterleibes.
  Medicinische Jahrbücher des kaiserlich-königlichen österreichischen Staates, Wien, 1837, 22: 227-266. (new series, volumes 13 and 14)
• Anwendung der Perkussion bei Untersuchung der Organe des Unterleibes.
  Written with A. Dobler. Medicinische Jahrbücher des kaiserlich-königlichen österreichischen Staates, Wien, 1838, 24: 5-46.
• Untersuchungsmethode zur Bestimmung des Zustandes des Herzens.
  Medicinische Jahrbücher des kaiserlich-königlichen österreichischen Staates, 1839, 27: 528-559.
• Über Abdominaltyphus und dessen Behandlung mit Alumen crudum.
  Medicinische Jahrbücher des kaiserlich-königlichen österreichischen Staates, volume 15, 1838.
• Untersuchungsmethode zur Bestimmung des Zustandes des Herzens.
  Medicinische Jahrbücher des kaiserlich-königlichen österreichischen Staates, volume 18, 1939.
• Ueber Pericarditis in pathologischer und diagnostischer Beziehung.
  Written with Jakob Kolletschka.
  Medicinische Jahrbücher des kaiserlich-königlichen österreichischen Staates, 1839, 28: 55-74, 227-272, 397-433.
• Über Piorrys Semiotik und Diagnostik.
  Medicinische Jahrbücher des kaiserlich-königlichen österreichischen Staates, volume 18, 1839.
• Über die Diagnose der Herzklappenfehler. Medicinische Jahrbücher des kaiserlich-königlichen österreichischen Staates. New series, volume 21, 1840.
• Abhandlung über Perkussion und Auskultation. 271 pages.
  Wien, J. G. Ritter von Mösle Witwe & Braumüller, 1839. 6th edition, 1864.
  This work established Skoda's universal renown as a diagnostician and is by many considered unsurpassed in its field. It rant hrough many editions and was translated into foreign languages.
• Ueber die Pleura- und Herzbeutelergüsse. With Franz Schuh.
  Medicinische Jahrbücher des kaiserlich-königlichen österreichischen Staates, 1842.
• Auszug aus der Eintrittsrede.
  Zeitschrift der Gesellschaft der Aerzte in Wien, 1847, 3: 258-265.
• Erscheinungen, aus denen sich die Verwachsung des Herzens mit dem Herzbeutel am lebenden Menschen erkennen lässt.
  Reprint of the Royal Academy of Sciences (mathematics-natural history class) session, November 1851.
• Fälle von Lungenbrand behandelt und geheilt durch einathmen von Terpentinöldampfen.
  Zeitschrift der Gesellschaft der Aerzte in Wien, 1853, 9: 445-447.
• Ueber die Funktion der Vorkammern des Herzens und über den Einfluss der Kontraktionskraft der Lunge und der Respirationsbewegungen auf die Blutzirkulation.
  Zeitschrift der Gesellschaft der Aerzte in Wien, 1853, 9: 193-213. Biographical
• Constantin Wurzbach:
  Biographisches Lexikon des Kaiserthums Oesterrerich. Wien, 1877, 35: 66-72.
• Maximillian Sternberg:
  Josef Skoda. Wien, 1924.
• Erna Lesky:
  Die wiener medizinische Schule im 19. Jahrhundert. Graz-Köln, 1965: 142-149.
• Zdenék Hornof:
  Josef Skoda als Choleraarzt in Böhmen. Clio Medica, Amsterdam, 1967, 2: 55-62.
• Zdenék Hornof:
  The study of Josef Skoda at the Medical Faculty in Vienna in the period 1825-1831.
  Plzenský lékarský sbornik, 1968; 31: 131-148. In Czech with English summary.
• Zdenék Hornhof:
  Škoda, Josef. In Charles Coulston Gillispie, editor in chief: Dictionary of Scientific Biographies. Charles Scribner¡¯s Sons. New York, 1970. Volume 12: 450-451.
• A Sakula:
  Joseph Skoda 1805-81: a centenary tribute to a pioneer of thoracic medicine.
  Thorax, London June 1981, 36 (6): 404-411.
• Zdenek Fejfar and Ludmila Hlavácková:
  Profiles in Cardiology: Joseph Skoda.
  Clinical Cardiology, Mahwah, New Jersey, August 1997, 20 (8): 740-741.
• A. N. Rubakin:
  [Life and activities of Josef Skoda, 1805-1881.] [Article in Russian]
  Klinicheskaja meditsina, Moscow, June 1956, 34 (6): 81-88.
• J. Gottlieb:
  [Josef Skoda (1805-1881) and the birth of the modern diagnostic] [Article in Spanish]
  Folia clinica internacional, Barcelona, January 1975, 25 (1).50-53.