Johann Lukas Schönlein
Biography of Johann Lukas Schönlein
Johann Lukas Schönlein is reckoned among the most important medical secientists of the Biedermeier Zeit, the period following the Napoleonic wars, 1815 to 1858, in Germany. In medicine this period inaugurated the era of modern science. The work of Schönlein contributed greatly to the establishment of medicine as a natural science and, above all, to the development of modern methods in the teaching and practice of clinical medicine.
Schönlein was born Johannes Schönlein, and only later added the middle name of Lukas. He was the son of Thomas Schönlein, a well-to-do ropemaker. His mother Margarethe, née Hummer (1764-1847), was probably more influential in his choice of a career in medicine. Instead of learning his father’s craft, and acquiring the well-known “ropemaker’s cough,” he attended the Bamberg gymnasium.
This was during the turbulent times of the Napoleonic wars. In 1803 the princely bishopric - Fürstbistum - Bamberg fell to Bavaria. Some of the Bamberg professors went to the University of Landshut, others stayed in Bamberg to continue teaching medicine and surgery at the teaching institution there. The leading person in Bamberg medicine was Adalbert Friedrich Marcus (1753-1816), a main representative of natural-philosophical medicine, and in his works a physician of the age of enlightenment. He is credited the building in 1789 of a 120 bed hospital. This was not only established, as was usual at the time, in order to care for the incurably sick, the aged and the poor, but also for medical treatment of the ill and the education of physicians and surgeons. While the famous Christoph Wilhelm Hufeland (1762-1836) in 1797 still denied the importance of hospitals in medical education, Marcus in 1803 developed a program for a clinical instruction, in which the students were mainly taught at bedside.
Schönlein thus grew up in a city which was one of the cradles of German hospital medicine. His interests however, were not in medicine, but in natural knowledge, which experienced a period of scientific advances in the beginning of the nineteenth century.
In 1811 he began his studies of the natural sciences, particularly under Georg Augustin Bertele (1767-1818) at the University of Landshut, which was well known for its fundament of natural philosophy. The leading teachers here were the former Bamberg professors Andreas Röschlaub (1768-1835) and Philipp Franz von Walther (1782-1849), who taught that the only way for medicine to progress, was by the use of physics, chemistry and the natural sciences. Schönlein changed his course to that of medicine, and already whilst a student he sought beyond the ordinary medical curriculum and concerned himself with comparatory anatomy, particularly under Friedrich Tiedemann (1781-1861). One of his other important teachers in the main curriculum was Martin Muenz (1785-1848).
In 1813 Schönlein went to Würzburg to continue his education, attending the lectures of Philipp Joseph Horsch (1772-1820), Ignaz Döllinger (1770-1841), Kajetan von Textor (1782-1860), and Josef Servaz von d’Outrepont (1776-1845), graduating there in 1816. His special field of interest was the anatomy of the brain, which was the topic for his doctoral thesis in 1816, Von der Hirnmetamorphose - an unusually long dissertation of 140 pages that clearly demonstrates his inclination towards natural philosophy.
A young man’s career
After reciving his doctorate, Schönlein in 1816 left Würzburg, still not considering a clinical career. Hoping for a position with the Dutch East India Company, to have the opportunity to undertake studies in natural history. Instead of the voyage to the east, he practiced medicine for a few months in the Allgemeines Krankenhaus in Bamberg, headed by Christian Pfeufer (1780-1852) after the death of Marcus in April 1816. He then went on an educational journey to Göttingen and Jena, before completing his education in the Münchener Allgemeines Krankenhaus. Working here was Johann Nepomuk Ringseis (1785-1880), later to become one of Schönlein’s most bitter adversaries.
In the autumn of 1817, by the support of Döllinger, Schönlein was habilitated as Privatdozent at the University of Würzburg. In the spring of 1818 he commenced lecturing on pathological anatomy, later also on diseases of the eye, children’s diseases (1818/1819) and public health.
Unlike most medical faculties, the Wüzburg faculty was associated with a large hospital, the Juliusspital. Head of the medical clinic at the hospital was also the professor of special pathology and therapy, Nicolaus Anton Friedreich (1761-1836). Shortly after Schönlein had commenced teaching as a Privatdozent, Friedreich fell ill with an eye disturbance, and chose the not yet 26 year old Schönlein as his successor. Schönlein gave his inaugural address as professor extraordinary on November 4, 1819. When Friedreich eventually had to resign his position in early 1824, Schönlein was promoted from deputy director to chief of the Juliusspital, as well as full professor of special pathology and therapy.
Schönlein’s activity was of great importance both to the hospital that he directed and to the university. His clinic soon became one of the the most famous in Germany. During this time he turned down an invitation to Freiburg.
Because of his liberal political views Schönlein was fired from his academic position in 1832. Instead of accepting a transfer to Passau as Kreis-Medicinalrath, he quit his job. Due to the Frankfurt Attentat he feared arrest and fled to Switzerland, where in 1833 he became the first professor of medicine at the newly founded Hochschule in Zurich. In 1839 he returned to Prussia to take over the chair of clinical medicine in Berlin, entering this position in 1840. He was also appointed personal physician to king Frederick William IV (reigned 1840-61).
Teacher and scientist
Schönlein was the founder of the natural historic school of studies and classification of medicine, introducing methods equivalent to those used in botany and zoology. He enjoyed the reputation of an exceptionally competent teacher among his students; he laid the foundation for this reputation while in Würzburg, and it would follow him through the rest of his teaching career. At the Berlin Charité he was the first to lecture on medicine in German rather than in Latin and introduced into Germany modern methods of clinical investigations like percussion and auscultation, and he was the first to use the microscope in conjunction with chemical analyses of urine and blood for diagnosing diseases. His introduction of bedside teaching was a novelty that quickly enhanced his reputation as a teacher. A number of positions that had previouslyy been reserved for military physicians, under Schönlein were given to civilian physicians.
Schönlein conducted his clinical teaching in much the same way that patients are presented to the students today, with a presentation of case history, chemical, physical and microscopic findings. He would control these findings and instigate a discussion towards a diagnosis, then discuss etiology and therapy with the students. If the patient died, there would be a discussion of the pathological findings and errors in the diagnosis.
Schönlein wrote relatively little - his doctoral thesis and two papers of 1 and 3 pages respectively. Still, despite his lack of enthusiuasm for writing, it was Schönlein who introduced the terms haemophilia and tuberculosis (1839). The word "tuberculosis" was derived from "tubercle", a word introduced by the English physician Richard Morton (1637-1698) in 1689 to describe the characteristic lesions of consumption.
Schönlein's description of purpura rheumatica was written down by his students and published in Allgemeine und specielle Pathologie und Therapie, a work containing true empirical medicine. In it he descriebes the peteccies and the associated joint troubles - Schönlein's purpura.
During his later years he acquired the habits of a recluse and often avoided his patients or treated them with a degree of aloofeness which was then fashionable. However, he was held in very high esteem by people such as Rudolf Virchow and he had an immense influence on German medicine. At one time he threatened to resign because of some slight, but was persuaded to stay by the award Order of the Red Eagle with Diamonds.
Schönlein was not among the most sensitive of men, and when an elderly clinician tried to excuse his ignorance by pointing to his grey hair, Schönlein said: "Donkeys are also grey". Virchow's succinct summation of his teaching was "little system, many facts".
His wife died in 1846, and in 1856 his son Philipp died while on a botanical expedition to West Africa. This accident, the fact that for a number of years he had suffered from goitre, as well as a generally ailing health, caused him to retire from professional life in 1859 and moved with both his daughters to his native city of Bamberg, where he died on January 22, 1864.
After his retirement he was offered the title of Excellenz, but turned it down, as he had done with an offer of nobility.
Keiner seiner zahlreichen Gegner hat Schönlein das Verdienst bestritten, dass er zuerst die Methode der deutschen Klinik festgestellt habe.
Rudolf Virchow, in Gedächtnisrede auf Schönlein. Berlin, 1865.
- R. Morton:
Phthisiologia, seu exercitationes de phthisi. Londini, imp. S. Smith, 1689.
The first application of the principles of pathology to the study of pulmonary tuberculosis. Morton showed that the formation of tubercles is a necessary part of the development of this lung disease, and pointed out that the tubercles often heal spontaneously. He noted the enlargement of the tracheal and bronchial glands in cases of pulmonary tuberculosis. The book was translated into English in 1694. Works by Schönlein:
- Von der Hirnmetamorphose. Doctoral thesis, Würzburg, 1816.
- Ansprache, gehalten am 4. November 1819. Address.
In: Deutsche Ärztereden aus dem 19. Jahrhundert. Hrsg. von E. Ebstein. Berlin, 1826, pp. 6-12.
- Ueber Krystalle im Darmcanal bei Typhus abdominalis. Aus brieflicher Mitteilung an den herausgeber.
[Müller’s] Archiv für Anatomie, Physiologie und wissenschaftliche Medicin, 1836. (Letter to the editor.)
- Zur Pathogenie der Impetigines. Auszug aus einer brieflichen Mitteilung an den Herausgeber.
[Müller’s] Archiv für Anatomie, Physiologie und wissenschaftliche Medicin, 1839, page 82. With his discovery of the Achorion-Schönleinii (Schönlein’s trichophyton), a term introduced by Robert Remak (1815-1865).
- Krankheitsfamilie der Typhen. Zürich, 1840.
Published by his students:
- Dr. J. L. Schönleins allgemeine und specielle Pathologie und Therapie. Nach seinen Vorlesungen niedergeschrieben von einigen seiner Zuhörer und nicht autorisiert herausgegeben.
2 volumes; Würzburg; 1832. 3. Aufl. Herisou, Lit-Comp, 1837; 4th edition, 4 volumes; St. Gallen and Leipzig, 1839. 6th edition, St. Gallen, 1846.
- Dr. J. L. Schönleins Krankheitsfamilie der Typhen, nach dessen neuesten Vorlesungen. Zurich, 1840.
- Schönlein’s klinische Vorträge in dem Charité-Krankenhaus zu Berlin.
Berlin, 1842; 3rd edition, 1843-1844. Published by Ludwig Güterbock (1814-1895) with Schönlein’s permission. Biographical and historical works:
- Ludwig Güterbock (1814-1895), Lehrs, Gustav Wilhelm Scharlau (1809-1861):
Dr. Schönlein als Arzt und klinischer Lehrer aus der Schilderung des Dr. Güterbock einer unabweisbaren Kritik unterworfen. Berlin, 1842.
- G. W. Scharlau:
Dr. Schönlein und sein Anhang. Letzte Abfertigung. 1843.
- Günter Klemmt:
Johann Lukas Schönlein’s Manuskript über den “Keuchhusten”
(Schönlein’s unpublished manuscript on the whooping cough). In: Abhandlungen zur Geschichte der Medizin und der Naturwissenschaften. Hrsg. von R. Winau, H. Müller-Dietz. Heft 53. Husum, 1986, pp. 13-80.
- W. Griesinger:
Gedenkrede auf Schönlein. 1864.
In: Deutsche Ärztereden des 19. Jahrhunderts. Hrsg. von E. Ebstein. Berlin, 1926, pp. 35-50.
- E. Seckendorf:
Schönleins Anschauungen über die Lustseuche in seiner Würzburger Zeit.
Dermatologische Wochenschrift, Hamburg, 1930; pp. 1594-1598.
- W. Löffler:
Johann Lukas Schönlein und die Medizin seiner Zeit.
In: Zürcher Spitalgeschichte. Hrsg. vom Kanton Zürich. Volume 2, Zürich, 1951, pp- 2-89.
- D. Caspary:
Johann Lukas Schönlein und seine Würzburger Zeit.
Dissertation, Würzburg, 1972.
- J. Bleker:
Die naturhistorische Schule 1825-1845.
In: Medizin in Geschichte und Kultur. Hrsg. von K. E. Rothschuh, R. Toellner. Volume 13. Stutgart, 1981.
Darstellung der Beziehung J. L. Schönlein-R. Remak anhand überlieferten Schrifttums. Diss, Würzburg, 1985.
- Rudolf Virchow:
Gedächtnisrede auf Johann Lukas Schönlein. Berlin, 1865.