*Albert Mudry and â Zoltan Dekany
*Lausanne, Switzerland, and â ENT Department, Bacjcsy-Zsilinszky Hospital-Budapest, Budapest, Hungary
Objective: Adam Politzer was one of the most well-known otologists of the 19th century. Unfortunately, very little is known about his life during his years as a medical student and about his publications in Hungarian. The aim of this study is to summarize Politzerâs student years between 1854 and 1859 and his 13 publications in Hungarian.
Data Sources: Eleven of Politzerâs 13 Hungarian publications were published while he was a student, and the remaining two were published in 1862 and 1908. These are rarely mentioned in Politzerâs curriculum vitae.
Conclusion: The student publications concern only general medicine and deal with pleural effusion, pernicious anemia and iron deficiency, lung emphysema, bronchitis, ischialgia, Bright disease of the kidney, hepatic cancer, acute yellow atrophy of the liver, cystovarium, ectopic kidney, and ejaculatio praecox. This broad array of diseases demonstrates once again that to be a good otologist, it is necessary to have an open mind concerning others parts of the body. Along with the different influences of his teachers, this certainly explains why Politzer reached such a high a level in otology. The last two publications in Hungarian concern otology and deal with the effect of mud ear on parts of hearing (1862) and acute suppurative otitis media (1908).
Key Words: HistoryâHungarian publicationsâOtologyâPolitzer.
(j) Published inÂ Otol Neurotol 25:72â78, 2004 and inserted here with the permission of the Publisher Lippincott Williams and Wilkins.
Only highly talented boys who have either extraordinary powers of quiet concentration or vigourous and ambitious natures, can be educated to become ambitious youths or men of serious purpose (1).
Adam Politzer was one of the most well-known otologists of the 19th century. Many publications have been written about his life and contributions to otology (2). Unfortunately, very little is known about his life during medical school and his publications in Hungarian. The aim of this study is to summarize Politzerâs student years between 1854 and 1859 and his 13 publications in Hungarian, 11 of which were published while he was a student. None of these publications are ever mentioned in his curriculum vitae. He also published two other articles in Hungarian, one in 1862 and the second in 1908. They concern otology and will be partially translated into English and commented on, which has not been done previously.
In 1848, Vienna University underwent a revolution of students and professors under the slogan âFreedom of Teaching and Freedom of Learning,â which was to lead to the overthrow of the old medical system of studies. This old system was organized around teachers of the medical faculty, town practitioners, and the collegium of physicians. This situation was very difficult for the university professors because they were in the minority and were supervised by the others practitioners in all their own activities. The professors of medicine wanted to be âmasters of their own house,â to constitute the university and the individual faculties, to examine their students, and to nominate their future colleagues solely on the basis of scientific achievement (3). The introduction of basic science subjects at the beginning of studies was necessary in association with the new teaching method that allowed greater emphasis on practical and demonstrative ways of learning. A dissertation was no longer necessary to obtain a medical doctorate. The art of medicine was one single and indivisible entity; accordingly, there was to be only one single medical degree, the doctor universae medicinae. The first rector of the newly organized Viennese medical faculty was Carl von Rokitansky (1804â1878), freely elected in 1852. This revolution led to the second Vienna medical school and allowed Vienna to become one of the most important cities for medical training in the second part of the 19th century (4).
The medical studies lasted 5 years. The program of study was quite free, and the students were able to choose the different subjects in which they were interested; the main point was the choice of teacher. It was only necessary to produce documentation to prove oneâs participation in the chosen lessons. The first 2 years were organized around three basic main science subjects: zoology, botany, and mineralogy. The last 3 years were purely clinical and totally free in their organization. The quality of the studies was in relation to the chosen teacher. At the end of the 5 years, the student had to present three examinations (Rigorosen).
The first examination concerned physics, chemistry, anatomy, and physiology. The candidate must have completed two semesters of dissection before the examination. The examination consisted of two parts: one theoretic and one practical with a dissection, a histology preparation, and a chemistry analysis. The second and third examinations were concerned only with clinical subjects. To take these two examinations, the candidate must have completed six clinical semesters: two in medicine, two in surgery, one in obstetrics, and one in ophthalmology. The second examination concerned general and internal pathology and therapy. The candidate had to examine a patient and to describe a pathologic preparation. The third and final examination concerned external disease, ophthalmology, legal medicine, and obstetrics. A large part of this examination was practical, with an operation on a cadaver and a delivery on a mannequin. The promotion to medical doctor followed immediately after the final examination and the
candidate was directly able to practice medicine in private practice (5).
POLITZERâS MEDICAL STUDIES
|Born in 1835 in Alberti, Hungary, of a Jewish family, Adam Politzer began his medical studies in Pest in 1854 (Figs. 1 and 2). After his first two semesters, he went to Vienna to continue his studies. It was typical for Jewish students to go to Vienna because no religious limitation existed at the university. A second reason was that some poorer Jewish students needed to find jobs to pay for their studies, which was easier in a big city than in a small town. Politzer began his third semester of medical studies in Vienna in 1855 (Fig. 3). The quality of the studies depended on the different teachers the student chose. The freedom to choose subjects was in fact limited because the study of medicine has a natural sequence from natural and basic sciences to clinical topics. Anatomy and physiology were very important for the final examination and deserved greater credit for improving the scientific training of the Viennese physicians. The general regulations of the medical faculty were clear: âAlthough they must be prepared to meet the requirements for the state examination and for the examination for the degree, the students are in general free to choose which courses they wish to attend, and under which teacherâ (1). Politzer followed the lessons of the most renowned teachers of the Viennese school, notably Rokitansky, Joseph Skoda (1805â1881), Johann von Oppolzer (1808â1871), and Joseph Hyrtl (1810â1894).||
FIG. 3. Vienna University around 1860. (From the InstituÂ¨ t fuÂ¨ r Geschichte der Medizin in Vienna. Reprinted with permission from Brigitte Maurer.)
FIG. 4. Joseph Skoda. (From the Institut fur Geschichte der Medizin in Vienna. Reprinted with permission from Brigitte Maurer.)
|A self-taught anatomopathologist and macromorphologist, Rokitansky based his conception of work on two principles. First, it was necessary to sort the facts scientifically on a purely anatomic basis; thereby, he created the separate subject of general pathologic anatomy. The second principle was to demonstrate the applicability of the facts and their usefulness for diagnosis in live patients. He established definite types of diseases and sharply outlined their individual characteristics. The correlation of the anatomic substrate and the clinical symptom became the basis for the explanation of the disease process. Rokitansky was in favor of freedom of scientific research and encouraged his students in this direction (6).
An internist who was passionate about disease, Skoda (Fig. 4) was a self-taught man who aimed only at finding facts. To establish a single fact with certainty, he compared in every case numerous observations in healthy and in sick people from the results of autopsies. He experimented on models, animal organs, and sections of corpses. He tried first to obtain a clear insight into the given physical patterns underlying the modern method of observation and examination (notably auscultation and percussion). Skoda considered every clinical sign to be of value only to the extent that it was directly connected with the material change (in the organs) in an understandable, demonstrable, physical or physiologic manner. This method required a completely new way of thinking and complicated the diagnostic approach. Skoda was responsible for introducing the concept of diagnosis by exclusion (7).
In 1850, Oppolzer (Fig. 5) began collaborating with Skoda. In the beginning, Oppolzer sounded exactly like a pupil of Skoda in stating that diagnosis must be anatomic in the first instance or that the physiologic orientation of disease assigned a certain meaning to a symptom but only to the extent that the latter indicates the physical necessity of an anatomic relation. Progressively, Oppolzer placed the physiologic point of view above pathologic-anatomic considerations, and he particularly did so in defining his therapeutic principles. He was a beloved teacher with an almost insatiable desire for teaching. He warmly encouraged his students in their special interests (8).
An anatomist and histologist, Hyrtl was passionate about anatomic preparations. He developed different techniques, such as corrosion anatomy and the preparation of ear models. He was aware of every detail in his work. Hyrtl was also a medical historian. He was admired by some students as a fascinating teacher because of his facility in teaching anatomy (9).
Other teachers who also influenced Politzer were the ophthalmologist Ferdinand Arlt (1812â1887), the dermatologist Ferdinand von Hebra (1816â1880), the physiologist Ernst Wilhelm von BruÂ¨cke (1819â1892), the pharmacologist Carl Damian Schroff (1802â1887), the hygienist and state physician Johann Dlauhy (1808â 1888), and the chemist Joseph Redtenbacher (1810â 1870). All of these teachers were also the examiners for the final examination (10).
FIG. 5. Johann von Oppolzer. (From the Institut fur Geschichte der Medizin in Vienna. Reprinted with permission from Brigitte Maurer.)
On July 26, 1859, Politzer passed the first part of the final examination (Rigorosen II) (Fig. 6), and on November 29, 1859, he passed the second part (Rigorosen III) (Fig. 7) with the mention âValde beneâ which was the highest level possible at the university. Politzer received the title of Doctor in Medicine, Doctor in Surgery, and Master of Obstetrics. Influenced by all of his teachers, Politzer was ready to begin his career. Oppolzer allowed and advised him to train as an ear specialist under different European leaders in this field. However, during his study, Politzer also began his career as a scientific writer with his first publications.
FIG. 6. Politzerâs final examination, first part, July 1859. (From the Institut fur Geschichte der Medizin in Vienna. Reprinted with permission from Brigitte Maurer.)
FIG. 7. Politzersâ final examination, second part, November 1859. (From the Institut fur Geschichte der Medizin in Vienna. Reprinted with permission from Brigitte Maurer.)
PUBLICATIONS AS A STUDENT
Politzer published 11 articles in Orvosi Hetilap (literal translation, Medical Weekly Journal), the medical journal of Hungary. This journal was first published in 1857 by Dr. Janos Markusovszli in Pest and edited by Emil MuÂ¨ller. Politzer probably chose this journal because it was a Hungarian journal. In 1857, Politzer began his publications with three articles under the supervision of Skoda. In the October 15, 1857, issue he described the treatment of pleural effusion with vaporized iodine to stimulate a decrease of inflammation (11).
On November 12, Politzer presented Skodaâs theory about the efficacy of iron treatment in pernicious anemia and iron deficiency in one patient (12). On December 3, he described the efficacy of treatment of lung emphysema with vaporization of turpentine oil in two patients (13).
On November 26, 1857, Politzer published his first article under the supervision of Oppolzer. In this article, he described a patient with bronchitis. After a clear clinical presentation, Politzer explained the anatomicpathologic report of the autopsy (14). In 1858, Politzer wrote six more articles. On January 10, he presented a patient with a ischialgia and proposed a successful treatment with acid of Halleri (15). On February 7, March 7, and March 21, Politzer presented a case of Bright disease of the kidney that explained the death of the patient. The necropsy report confirmed the clinical diagnosis (16). On April 18 and 25, Politzer presented a patient with hepatic cancer with an anatomic-pathologic diagnosis of cystocarcinoma (17). On May 16, June 13, and June 20, Politzer described a case of acute yellow atrophy of the liver followed by the death of the patient (18). Â On November 14 and 21, Politzer presented a patient with a cystovarium that was confused with a pregnancy. The treatment was a successful punction via the vagina to relieve the symptoms of the illness (19). On December 12 and 26, Politzer presented a case of ectopic kidney manifested by a tumor in the right lumbar region, which is in reality not an illness but a variation of the normal position of the kidney (20). Politzer published a final article on March 20, 1859, concerning the causes and medical treatment of ejaculatio praecox (premature ejaculation) (21).
These different works illustrate Politzerâs qualities andhis ability to study and understand all parts of medicine. These 11 publications in Hungarian were completed with two final articles in Hungarian dealing with ear problems.
âTHE SHATTER EFFECT OF MUD EAR ON PARTS OF HEARINGâ
Published in 1862 also in Orvosi Hetilap, this article presented the risks associated with an accumulation of cerumen in the auditory canal (22). In his introduction, Politzer explained the origin and cleaning mechanism of ear wax: âIn the chondrous part of the auditory meatus are special glands (glandulae ceruminosae). When examinated with the microscope, they are similar to the sweat glands and they produce the cerumen in association with the sweat glands. The cerumen is on the wall of the auditory canal and it moves off with the movement of the mandibule and the man handwork.â Politzer added that this mandibular movement is insufficient in the elderly. Then, Politzer explained that the cerumen is able to invade different parts of the ear by presenting a case of invasion of the middle ear in a 70-year-old woman with no previous history of ear disease. She suffered from progressive pain and hearing loss in the left ear. The patient died, and Politzer carried out the anatomicpathologic examination of the ear: âI dissected the upper wall of the cavum tympaniâI could see the eardrum and the malleus which were shattered by cerumen. The long arm of the incus and the superstructure of the stapes were missing. The stapes plate was fixed in the ovale window.â Politzer concluded the article with the proposition that all ear mud must be carefully cleaned using oil infused 2 or 3 days in the ear and then washed with water, without using an instrument in the ear canal. This article was discussed by Gyula BoÂ¨ke (23), requiring a response by Politzer (24). The content of this article is not far from current knowledge about this subject.
ACUTE SUPPURATIVE OTITIS MEDIA
Published as an independent article in 1908, this work provided a good abstract concerning acute suppurative otitis media (25). Politzer recognized the four stages of an inflammation: hyperemia, swelling, exudation, and necrosis. He wrote: âTypical inflammation was characterised by hyperemic and tumefied mucosa of the tympanic cavity . . . exudation . . . and it resulted in perforation of the membrana tympani.â He explained the evolution of the inflammation beginning with hyperemia and finishing with the perforation of the eardrum, modifying the symptoms, which normally began with ear pain. He also mentioned different complications such as mastoiditis, labyrinthitis, and meningitis. Politzer ended the first part of the article with the prognosis of an acute suppurative otitis media: âIt is good, when the perforation is at the beginning of the inflammation. Prognosis is related to unfavorable symptoms evolved under the process: pain and otorrhea stay permanently or they return day after day, week after week. This is related to abcess in the cavity of the mastoid.â In the second part, Politzer presented the atticitis in detail, that is, an inflammation âstarting in Prussakâs area, which can be called atticitis.â Otoscopy allowed its differentiation from acute otitis media because the process is localized only in the upper region of the tympanic membrane. The treatment is the same as for acute otitis media. Politzer also discussed the place of paracentesis: âWhen doctors make an early paracentesis, it can prevent the development of mastoid cavity abcess.â The normal treatment was local application of boric acid and cocaine in an aqueous solution. Politzer concluded his article with: âWhen secretions stay in the tympanic cavity, they need to be cleared away and if we use antiseptic medications, we will reduce the length of the inflammatory process and we will avoid the development of complications.â This article is clear and very up to date except for the fact that antibiotics did not exist during Politzerâs time.
FIG. 8. Adam Politzer, a few years after his final examination. (From the Institut fur Geschichte der Medizin in Vienna. Reprinted with permission from Brigitte Maurer.)
The quality of medical education determines the quality of medical practice and, in the long run, of medical science in a given period and country. Conversely, medical education reflects the general cultural level and the structure of medicine in a given society (26). It was quite unusual at this time that a student published so many articles. Politzer was probably already in advance of his epoch. This large panel of published diseases demonstrates once again that to be a good otologist, it is necessary to have an open mind about other parts of the body. Associated with the different influences of his teachers, this certainly explains why Politzer (Fig. 8) reached such a high level in otology. This was also because the objective of a good system of instructionshould be to train the mind and at the same time to pay due attention to the requirements of life. Politzer was very aware of this, and his qualities as an art specialist were well-known in Vienna (27). His two otologic articles written in Hungarian were at the same level of scientific rigor and precision of his more than 150 other publications.
Acknowledgment: The authors thank Brigitte Maurer for valuable collaboration in collecting the documents related to Politzer.
The Address correspondence and reprint requests to Dr. Albert Mudry, ENT & HNS Specialist, Av. de la Gare 6, CH-1003 Lausanne, Switzerland. Email: email@example.com Otology & Neurotology
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5. Lermoyez M. Rhinologie, Otologie, Laryngologie a` Vienne. Paris: CarreÂ´, 1894.
6. Lesky E. Carl von Rokitansky Selbstbiographie und Antrittsrede. Wien: BoÂ¨hlaus, 1960.
7. SchoÂ¨nbauer L. Joseph Skoda. In: Das Medizinische Wien. 2nd ed. Wien: Urban & Schwarzenberg, 1947:228â44.
8. SchuÂ¨tte W. Johann Ritter von Oppolzer Leben und Werk. Inaug. Diss. Bochum: PoÂ¨ppinghaus, 1937.
9. Gasser RJ. Der Anatom Joseph Hyrtl 1810â1894. Wien: Maudrich, 1991.
10. Catalog der medicinischen FacultaÂ¨t Studirenden. Wien: Archiv der UniversitaÂ¨t Wien, 1859.
11. Politzer A. Az iblany mellhartya izzadvanyokrol. Orv Hetil 1857;1(20):312â5.
12. Politzer A. Vas-sap korrol. Orv Hetil 1857;1(24):357â8.
13. Politzer A. Horghurut-Szivszorongas heveny tudovizdaggalâHalalos veg (catarrhus bronchialisâstenocardia cum oedemate pulm acutoâexitus lethalis). Orv Hetil 1857;1(26):408â12.
14. Politzer A. A terpetinolaj gozkeÂ´peni alkalmazana. Orv Hetil 1857;1(27):426â8.
15. Politzer A. Ul-zsaba (Ichias). Orv Hetil 1858;2(1):5â8.
16. Politzer A. Bright kor. Orv Hetil 1858;2(5,9,11):69â73, 135â8, 166â9.
17. Politzer A. A maj toÂ¨mlos-rakja-Cseplesz es hashartya velogombas rakja (Cystocarcinoma hepatisâcarcinoma medullare omenti et peritonei). Orv Hetil 1858;(15,16):230â3, 245â8.
18. Politzer A. Heveny majsorvadas (Atrophia hepatis acuta). Orv Hetil 1858;2(19,23,24):293â6, 359â67, 373â6.
19. Politzer A. Petefeszektomlo-csapolas a huvelyen atâtomlolob kovetkezteben osszezsugorodas (Cystovariumâpunctio per vaginamâ inflammatio cystidis cum exitu in obsolescentiam). Orv Hetil 1858; 2(45,46):705â9, 722â6.
20. Politzer A. Vese helyvaltoztatasa (ectopia renis locularis). Orv Hetil 1858;2(49â51):775â8, 799â802.
21. Politzer A. MagomlesekâPollutionenâokai es gyogyitasarol. Orv Hetil 1859;3:186â8.
22. Politzer A. A fuÂ¨lzsirdugaszok roncsolo befolyasa a hallas muÂ¨szerveire. Orv Hetil 1862;6:561â64.
23. BoÂ¨ke G. EszreveÂ´telek Politzer A., beÂ´csi egyet. FuÂ¨lgyeÂ´gya`szati m.tanar ur e lapokban koÂ¨zloÂ¨tt âA fuÂ¨ldugaszok stb.â: czimuÂ¨ czikkeÂ´re. Orv Hetil 1862;6:30.
24. Politzer A. Vedelem a fuÂ¨lzsirdugaszokra vonatkozolag. Orv Hetil 1862;6:650â651
25. Politzer A. A Heveny Genyes Dobureggyuladas. Budapest: Lloyd, 1908.
26. Puschmann T. A History of Medical Education from the Most Remote to the Most Recent Times. London: Lewis, 1891 (facsimile: New York: Hafner, 1966).
27. Pappas DG Sr, Pappas DG Jr, McGuinn M. Adam Politzer as an art collector. Otolaryngol Head Neck Surg 1999;121:772â5.