Josef Skoda

Born 1805
Died 1881

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Bohemian clinician, born December 10, 1805, Pilsen, Bohemia; died June 13, 1881, Vienna, Austria. Czech spelling: Josef Škoda Pilsen is the German spelling of Plzeň, now in the Czech Republic.

Biography of 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.

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