Theodor Billroth

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Christian Albert Theodor Billroth (26 April 1829 – 6 February 1894) was a Prussian-born Austrian surgeon and amateur musician. He is often thought of as the founding father of modern abdominal surgery.

He was a close friend and confidant of Johannes Brahms, a leading patron of the Viennese musical scene, and one of the first to attempt a scientific analysis of musicality.

Early life and education

Billroth, the son of a pastor, was born in Bergen, Prussia. Billroth died of tuberculosis when he was five years old. He attended Greifswald, where he obtained his Abitur degree in 1848. Billroth was an indifferent student and spent more time playing piano than studying. Torn between a career as a singer and a physician, he acceded to his mother's wishes and enrolled himself at the University of Greifswald to study medicine, but Professor Wilhelm Baum followed him to Göttingen, where his medical career was decided. Professor Baum was then transferred to Göttingen University, where he completed his medical doctorate at Berlin's Frederick William University in 1852. Billroth, along with Rudolph Wagner (1805-1804) and Georg Meissner (1829-1955), traveled to Trieste to research the torpedo fish.

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Career in surgery

Billroth served as an assistant in Bernhard von Langenbeck's surgical clinic in Berlin from 1853 to 1860. He was also apprenticed to Carl Langenbuch. Billroth accepted a University of Zurich's invitation to become the Chair of Clinical Surgery in 1860 and became the director of the surgical hospital and clinic in Zurich. The start of his teaching career in Switzerland was unpromising: he had only ten students in his first semester, and he said that the funds he earned from his private sector was insufficient to pay for his morning cup of coffee. Billroth's fame grew quickly; however, his name quickly grew; he had an infectious demeanor, attracting both students and surgical trainees to his ranks. He was adored by his students and served as both an excellent undergraduate and a graduate tutor. Students flocked to his lectures, and with the support of energetic colleagues, he was able to push the Medical Faculty of Zurich to a high academic level in only a few years.

Billroth's classic book Die allgemeine chirurgische Pathologie und Therapie (General Surgical Pathology and Therapy) (1863) was published in Zurich. He introduced the concept of audits, publishing both findings, positive and negative, which eventually led to open discussion of morbidity, mortality, and techniques, which culminated in open debate on morbidity, epidemics, among other things, which culminated in informed patient selection.

In succession to Franz Schuh, he was appointed professor of surgery at the University of Vienna in 1867; there, he practiced surgery as chief of the Second Surgical Clinic at the Allgemeine Krankenhaus. Though he laid the foundations of his fame in Zurich, it was in Vienna, a larger and more prominent theater, that he established himself as the king of the surgical world. A speech he gave in 1875, protesting influxes of Jewish medical students, has been listed as one of the first events in the rise of Viennese political anti-Semitism.

Billroth did excellent work in Mannheim and Weissenburg, treating a variety of battlefield injuries with innovative and inventive surgeries; he portrayed his experience of war surgery in his Surgical Letters from Mannheim and Weissenburg. He was so taken by war that he was hardly a ardent promoter of peace long after. On December 3, 1891, he gave a speech on the care of the wounded in war that caused a major shock and resulted in large sums of money being voted by Austrian legislative chambers for the provision of adequate means of succour for the wounded.

He didn't limit himself to surgery only, and he did extensive research into a condition that affected many surgery patients at the time: wound fever. The treatment, which focused on wound fever, came to a conclusion; "Investigations into the Vegetative Forms of Coccobacteria septica") concluded that the problem was bacterial; Billroth was keen to use antiseptic methods in his surgical practice; and the number of surgical patients with wound fever has greatly decreased. Billroth began to shift his attention away from surgical infections to organ transplantation or removing organs that had previously been deemed inaccessible.

Billroth, an early adopter of Seligmann's c.1890 painting, was responsible for a number of landmarks in surgery; in 1872, he was the first to perform an esophagectomy, removing a portion of the oesophagus and joining the remaining portions together. He did the first laryngectomy in 1873, effectively ending a cancerous larynx. He was the first surgeon to excite a rectal cancer, and by 1876, he had undergone 33 such operations. Billroth had made intestinal surgery seem nearly commonplace by 1881. However, his most notable achievement is, without question, the first good gastrectomy for gastric cancer. Billroth performed the first successful resection for antral carcinoma on Therese Heller, who lived for almost four months and died of liver metastases, on January 29, 1881, after many failed attempts. In an operation that is still known as the Billroth I to this day, he completed this mission by closing the greater curvature side of the stomach and anatomizing the lesser curvature to the duodenum.

Billroth's literary work was widespread, with a total number of published books and journals of which he was the author numbering about one hundred and forty. He collaborated with Franz von Pitha on a Textbook of General and Special Surgery (1882). Billroth contributed to this article on Scrofulosis and Tuberculosis, Injuries and Diseases of the Breast, Instruments and Operation, Burns, Frostbites, and others.

Billroth devoted his restless intellectual spirit to many respected students, establishing the "Billroth School" of followers. No part of his career seemed to have been under intense scrutiny, whether it be research, teaching, administration, or nursing. He not only had something valuable to share about each, but he often saw to it that his ideas became concrete reality. He was guided by a belief in the unity of science and art as well as his own ability to effect change in all the areas he sought to influence.

Billroth was instrumental in the establishment of the first modern school of thought in surgery. He had pioneering surgical experience, recommending a long surgical apprenticeship on completion of medical studies based on preliminary research in hospitals and experiments on cadavers and experimental animals. This will be followed by a three-year assistantship in a surgical department with research into the surgical literature and the acquisition of advanced practical skills. Alexander von Winiwarter, Jan Mikulicz-Radecki, and John B. Murphy were among his followers. Billroth's pioneer surgical residency program was heavily influenced by William Halsted's own surgical education methods.

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