The musical surgeon: Theodor Billroth

On the streets of Vienna in the mid-1880s, you could bump into Johannes Brahms, Anton Bruckner, or Gustav Mahler.

In that same city, Sigmund Freud was beginning his medical career and Friedrich Goldscheider was opening his first ceramics factory. And among other Viennese luminaries less well known today was Brahms’ great friend Dr Theodor Billroth, a distinguished professor of surgery on the staff of Vienna’s leading teaching hospital (where Freud was studying cerebral anatomy).

BillrothBillroth’s love of music was second only to his devotion to medicine. He had studied violin and he played viola with professional musicians in private performances of Beethoven’s quartets and Brahms’ sextets. He could play the piano, was a good sight-reader, and as a music critic occasionally wrote for the newspapers.

Billroth’s pioneered discovering safe ways of mending the human body. In 1872, he was the first to remove a section of the oesophagus, joining the remaining parts together and in 1873, he performed the first complete excision of a larynx. He was the first surgeon to excise a rectal cancer and by 1876 he had performed 33 such operations.

By 1881, Billroth had made intestinal surgery seem commonplace and was ready to attempt what in his time was the most formidable abdominal operation conceivable: excision of a cancerous pylorus (the lower end of the stomach). The successful operation caused a sensation and initiated the modern era of surgery. According to Siddhartha Mukherjee, in his audacious and astonishing biography of cancer, The Emperor of All Maladies (2010):

“Until Billroth’s time, the mortality following abdominal surgery had been forbidding. Billroth’s approach to the problem was meticulous and formal: for nearly a decade he spent surgery after surgery simply opening and closing abdomens of animals and human cadavers, defining clear and safe routes to the inside. … [He wrote] ‘I hope we have taken another good step forward towards securing unfortunate people hitherto regarded as incurable.’”

By the mid-1880s, Billroth had operated on 41 patients with gastric carcinoma using what Mukherjee labels “novel anatomical reconfigurations” and 19 of those patients had survived the ordeal.

In 1882 Brahms and Billroth went for a three week tour of Italy. By all accounts, Billroth was an extrovert, who loved life and was a great teacher. He had a tremendous wealth of knowledge not only of his own profession, but of music and literature as well. One wonders what the two men talked about. “Good news, Brahms! We’ve found a way to remove that tune stuck in your head…”

When Billroth died in 1894, his funeral procession was attended by huge crowds of people, with Brahms among the onlookers smoking his customary cigar. Billroth’s last words, written a few hours before his death, reveal his humanity as well as a deeply poetic nature:

“It is night and everything has been quiet for a long time and now I am very calm. My mind begins to wander. An ethereal blue sky envelops me. My soul soars upwards. The most beautiful harmonies of invisible choirs are audible – in soft undulations like the breath of eternity! I also recognize voices and the gentle whisperings: ‘Come, tired man, we will make you happy. In the charm of these spheres we will free you of the thoughts which may have been of the greatest joy or deepest sorrow. You have felt yourself as a part of the universe, now be distributed throughout the universe and comprehend the whole.’”

In the courtyard of the University of Vienna there is a statue of Billroth to which few passers-by pay attention. He is buried in Vienna’s Central Cemetery, not far from the graves of Beethoven, Schubert, and his great friend Brahms. A fitting monument to a man whose life was devoted to making music and relieving pain.

Billroth-monument

Advertisements

Leave a Reply

Fill in your details below or click an icon to log in:

WordPress.com Logo

You are commenting using your WordPress.com account. Log Out / Change )

Twitter picture

You are commenting using your Twitter account. Log Out / Change )

Facebook photo

You are commenting using your Facebook account. Log Out / Change )

Google+ photo

You are commenting using your Google+ account. Log Out / Change )

Connecting to %s