Ernst Wertheim

Ernst Wertheim was the son of Theodor Wertheim, professor of chemistry at the Universities of Pest and Graz. In 1844 Theodor Wertheim distilled a pungent substance from garlic and called it allyl, the Latin name for garlic. Four years later, Louis Pasteur in Paris showed that allyl could inhibit the growth of bacteria. This was a great discovery because 150 years ago, doctors had nothing to kill bacteria; it could have been the first penicillin.

Ernst Wertheim studied medicine in Graz and received his medical degree on February 29, 1888, then became an assistant in the department of general and experimental pathology. Under the supervision of Rudolf Klemensiewicz (1848-1922) he learned the bacterial and histological techniques that later enabled him to conduct his fundamental research of gonorrhoea in the female genital tract. The first result of his work at Graz, however, was a paper on fowl cholera.

Wertheim left Graz on April 30, 1889 and studied until mid-November under Otto Kahler (1849-1893) at Vienna’s Second University Clinic. Here he also worked with Christian Albert Theodor Billroth (1829-1894). He then worked for some time under Friedrich Schauta in Prague, and accompanied him back to Vienna.

At this time, Wertheim had become interested in gynaecology, the field to which he was to devote a lifetime of research. At the time both of Vienna’s women’s clinics possessed excellent facilities for postgraduate training in obstetrics and gynaecology, where pupils studied for two years at state expense. Upon leaving Kahler, Wertheim entered the institute attached to the second Vienna Women’s Clinic, which was headed by Rudolf Chrobak (1843-1910) and remained there as a student until September 30, 1890. He then moved to Prague as assistant to Friedrich Schauta (1849-1919) at the university women’s clinic, returning to Vienna in 1891 when Schauta was appointed head of the First Vienna Women’s Clinic.

In his years as assistant, Wertheim focused his research on gonorrhoea in the female genital tract. His training in experimental and bacteriological methods allowed him to give a unique, definitive explanation of the then much-disputed path of the gonorrhoeal infection. In 1890 he demonstrated the existence of gonococcus in tissue of the Fallopian tubes; previously they had been detected only in smear samples. More important, in a series of papers containing the results of bacteriological and histological studies and of experiments on animals, Wertheim showed that the gonococcus affects not only the cylindrical epithelium – as Ernst von Bumm (1858–1925) first maintained in his widely accepted theory – but also the squamous epithelium (the peritoneum). Through these papers, especially “Die aszendierende Gonorrhoe beim Weibe. Bakteriologische und klinische Studien zur Biologie des Gonococcus neisser (Archiv für Gynäkologie, 1892; 42: 1-86), Wertheim placed his theory of ascending gonorrhoea in the female on a firm foundation.

Wertheim was habilitated for obstetrics and gynaecology at Vienna in 1892, becoming titular professor in 1899.

Wertheim gained world fame for systematically developing – to the point where it became standard practice – a radical abdominal operation for cervical cancer. In 1897 he was named chief surgeon of the gynaecological service in the Bettina Pavilion of the Elisabeth Hospital and thereby obtained his own operating facilities. By then he had long realised that the customary method of vaginal extirpation was highly unsatisfactory because of its bad after-effects. The abdominal method, however, had been abandoned because of its mortality rate of 72 percent. Consequently, elaborating the work of predecessors Emil Ries in Chicago, John G. Clark in Baltimore and Heinrich Theodor Maria Rumpf (1851-1934) in Hamburg, Wertheim decided to place the operation for cervical cancer on a modern surgical basis.

No longer satisfied with the extirpation of the deceased organ, he sought to remove as much as possible of the organ’s surroundings, the perimetrium, along with the neighbouring lymph glands. He recognized, as had Julius Ritter von Massari (1846-1884) in 1878, that the greatest possible attention must be directed to protecting ureters during their exposure and preparation.

On November 16, 1898, Wertheim performed his first radical abdominal operation based on these principles. For his first twenty-nine operations he reported a mortality rate of 38 percent (Archiv für Gynäkologie, 1900; 61: 627-668). Tirelessly working to improve his surgical technique, he succeeded in reducing the mortality rate to 10 percent, This assured universal acclaim for his radical abdominal surgery. He gave a full account of his success in Die erweiterte abdominale Operation bei Carcinoma colli uteri (auf Grund von 500 Fällen). Berlin-Vienna, 1911. By that time he had treated 500 patients.

In 1910 Wertheim was appointed director of the First University Women’s Clinic in Vienna. Firmly determined to replace unsatisfactory surgical procedures with improved ones, he returned his attention to the treatment of uterine prolapse. He had already made a contribution in this area in 1899 with his interposition method, which involved covering the uterus with vaginal lobes. He then developed a version of the operation that is known as suspension and superposition; his richly illustrated book on it appeared a year before his death as Die operative Behandlung des Prolapses mittelst Interposition und Suspension des Uterus (Berlin, 1919).

Wertheim was as difficult in his personal relations as he was brilliant in his research. Held in great esteem by his colleagues, he was a corresponding or honorary member of many foreign learned societies. At Vienna he created a distinguished school of gynaecological surgeons; and his work was carried out there, as well as in Prague and Berlin, by his most outstanding students, Wilhelm Weibel and Georg August Wagner.

Besides his extensive work in the field of obstetrics, he devised the first substrate for the pure culture of gonococcuses, thus making easier the use of this bacterium as a vaccine.

We thank Ralf Wieking, Hamburg, for information submitted.

• Die aszendierende Gonorrhoe beim Weibe. Bakteriologische und klinische Studien zur Biologie des Gonococcus neisser. Archiv für Gynäkologie, Berlin, 1892, 42: 1-86.
• Ueber Uterus-Gonorrhöe.
  Verhandlungen der Deutschen Gesellschaft für Gynäkologie, 1896, 6 199-223.
  Wertheim emphasised the importance of latent uterine gonorrhoea.
• Über Blasen-Gonorrhöe.
  Zeitschrift für Geburtshilfe und Gynäkologie, Stuttgart, 1895, 35: 1-10.
  Wertheim demonstrated the gonococcus in acute cystitis.
• Die Technik der vaginalen Bauchhöhlen-Operationen.
  With H. Micholitsch. Leipzig, 1906; translated into English.
• Die erweiterte abdominale Operation bei Carcinoma colli uteri (auf Grund von 500 Fällen). Berlin and Vienna, 1911.
• Die operative Behandlung des Prolapses mittelst Interposition und Suspension des Uterus. Berlin, 1919. Biographical, works referred to, etc.
• E. von Bumm:
  Der Mikro-Organismus der gonorrhöischen Schleimhait-Erkrankungen, Gonococcus Neisser. Deutsche medicinische Wochenschrift, 1885, 11: 508-509.
  Bumm cultured the gonococcus. By human inoculations he demonstrated its pathogenicity in pure culture.
  Der Mikro-Organismus der gonorrhöischen Schleimhait-Erkrankungen, "Gonococcus Neisser". Nach Untersuchungen beim Weibe und an der Conjunctiva der Neugeborenen dargestellt.
  Wiesbaden 1885.
• Wilhelm Weibel (1876–), in
  Monatsschrift für Geburtshilfe und Gynäkologie, 1920; 61: 271-279. With bibliography, in Archiv für Gynäkologie, Berlin, 1920; 113: v-xvi; in Zentralblatt für Gynäkologie, Leipzig, 1920; 44: 281-285; and “25 Jahre ‘Wertheimscher’ Carcinomoperation,” in Archiv für Gynäkologie, Berlin, 1929; 135: 1-57.
• Fritz Kermauner (1872–1931), in Wiener klinische Wochenschrift, 1920, 33: 183-185.
• Wilhelm Latzko (1863-), in Wiener klinische Wochenschrift, 1920, 70: 545-549.
• Wilhelm Weibel, publisher:
  Die gynäkologische Operationstechnik der Schule Ernst Wertheims.
  Berlin, J. Springer, 1923. XIV + 251 pages.
• E. Navratil:
  Die Entwicklung der Operationsmethoden zur Entfernung der karzinomatösen Gebärmutter. Wiener klinische Wochenschrift, 1948, 60: 233-238.
• R. Elert:
  Zum Gedenkjahr des dobbelten Jubiläums der abdominellen Radikaloperation des Gabärmutterkrebs). W. A. Freund (1878) – Wertheim (1898).
  Klinische Medizin, 1949, 4: 249-262. Very detailed.
• P. Werner, J. Sederl:
  Die Wertheimsche Radikaloperation bei Carcinoma colli uteri.
  Wien-Innsbruck, 1952.
• E. Lesky:
  Die Wiener geburtshilflich-gynäkologische Schule.
  Deutsche Medizinische Wochenschrift, Stuttgart, 1962, 87: 2096-2101.
• Die Wiener medizinische Schule im 19. Jahrhundert. Graz-Cologne, 1965.
• J. Artner, A. Schaller:
  Die Wertheimsche Radikaloperation. Anfänge, Fortschritte, Ergebnisse. 1898-1968. Wien, 1968.
• G. Reifenstuhl, in Wiener klinische Wochenschrift, 1970; 82: 554-559.
• T. Antoine:
  Letter From Austria. Obstetrical and Gynecological Survey, Baltimore, 1969, 24: 1129-1137.
• G. Köhler:
  100 Jahre Wertheimoperation - Ernst Wertheim zwischen Mythos und Wirklichkeit.
  Zentralblatt für Gynäkologie, Leipzig, 1999, 121.