ŠKODA, JOSEF

(b. Pilsen, Bohemia [now Czechoslovakia], 10 December 1805; d. Vienna, Austria, 13 June 1881)

internal medicine.

Since Škoda was frequently ill during childhood, he entered high school in Pilsen only at the age of twelve. He graduated near the top of his class in 1825 and entered the Faculty of Medicine at Vienna. His dissertation, on the “De morborum divisione,” may be considered the first evidence of his critical turn of mind.

After graduation on 18 July 1831, Škoda returned to Pilsen and established a medical practice. At this time the first pandemic of Asiatic cholera was approaching Czechoslovakia: and he became the district cholera specialist, first in the Chrudim region, then in Kouřim, and finally in Pilsen (1831–1832). He realized how little his formal training in medicine had prepared him for medical practice, and further that in the fight against cholera, more could be achieved through preventive hygienic measures than by means of many officially recommended medicines. Škoda therefore returned to Vienna for further study. Before obtaining an unsalaried post as a doctor in the internal department of the General Hospital (autumn of 1833), he worked in Karl Rokitansky’s Pathology-Anatomy Institute and developed a close relationship with him. The collaboration did not cease when Škoda moved to clinical work; indeed, it was only when Škoda confirmed his clinical diagnoses on the dissection table and was able to perform experiments in the dissection room that his collaboration with Rokitansky achieved its real purpose.

Around 1836 Škoda began investigating the fundamentals of percussion and auscultation, two of the modern examination methods in clinical medicine. Both had been propagated in France (Corvisart, Laënnec, Gaspard Bayle) and in Great Britain (Charles Williams, Robert Graves, William Stokes) within clinics but had not penetrated into general medical practice because they were difficult to master. Škoda used his knowledge of physics, which he had learned at the high school in Pilsen and had studied further at the University of Vienna under Julius Baumgärtner.

Škoda based his research into percussion and auscultation on physical acoustics. He simplified and unified the terminology, defined concepts, and supplemented them with his own observations and experience. After his first publications in 1836 and 1837, he elaborated his doctrine and in 1839 published it formally as Abhandlung über Perkussion und Auskultation. Škoda improved each of the five new editions, responding to criticism and to new ideas. The book was also translated into English and French.

Škoda critically evaluated the doctrines of the French school of medicine, which distinguished percussion sounds according to the organ—the thigh, the liver, the intestine, the lung, or whatever—and substituted a physical classification of percussion sound in four categories: from full to empty, from clear to muffled, from tympanous to nontympanous, from high to deep. A part of modern diagnostics is Škoda’s discovery of tympanou percussion in the presence of serous pleurisy.

In the theory of auscultation Škoda first distinguished reverberations (heart sounds) from cardiac murmurs. On the basis of comparative observations of healthy people and those known to have heart disease he learned to diagnose various heart illnesses from the presence of murmurs in individual valves. He also evaluated pulsations of the neck veins and accentuation of further reverberations in the pulmonary artery. Through his lucid account of functional changes and synonyms attendant upon various changes in valves of the heart or the pericardium, he established the principles of the clinical physiology of heart diseases.

By comparing manifestations of sickness in the body, and its physical and chemical signs, with pathological findings at autopsies, Škoda was able to make accurate diagnoses. His critical approach to therapy led him to replace obsolete, inefficient methods (venesection) with rational new methods (puncture of empyema of the pericardium and pleura); he also introduced effective medicines, such as chloral hydrate and salicylic acid. His principles formed the basis of diagnoses and a simpler and more humane therapy. He also evaluated the results of medical treatment by means of statistical methods. Because of this, he was unjustly regarded as a therapeutic nihilist.

Škoda was a born teacher. In high school he taught his classmates, and while studying medicine he earned money by giving private lessons. About 1836, while on a hospital staff, he began courses in percussion and auscultation for doctors, which were his sole source of income: he continued them until his appointment as professor of internal diseases at the Vienna Faculty of Medicine on 26 September 1846. These courses carried his doctrines to foreign universities.

Škoda almost entirely eliminated typhoid Fever in Vienna by securing the construction of a water main from mountain springs at a time when the true cause of the disease was unknown. (He had already demonstrated preventive measures during the cholera epidemic in Czechoslovakia.) Thus he enlarged the sphere of his activities into public health and epidemiology.

BIBLIOGRAPHY

I. Original Works. Škoda’s most important works are “Ueber die Perkussion,” in Medizinischer Jahrbücher des K. K. osterreichischen Staates, 20 (1836), 453–473, 514–566: “Ueber den Herzstoss und die durch Herzbewegungen verursachten Töne,” ibid., 22 (1837), 227–266: “Anwendung der Perkussion bei Untersuchung der Organe des Unterleibes,” ibid., 23 (1837), 236–262, 410–439; “Ueber Abdominaltyphus und desse Behandlung mit Alumen crudum,” ibid., 24 (1838), 5–46, written with A. Dobler: “Untersuchungsmethode zur Bestimmung des Zustandes des Herzens,” ibid., 27 (1839), 528–559: “Ueber Pericarditis in pathologischer und diagnostischer Beziehung,” ibid., 28 (1839), 55–74. 227–272, 397–433, written with J. Kolletschka: Abhandlung über Perkussion and Auskultation (Vienna, 1839; 6th ed., 1864); “Äuszug aus der Eintrittsrede,” in Zeitschrift der Gesellschaft der Aerzte in Wien, 3 (1847), 258–265: “Fälle von Lungenbrand behandelt und geheilt durch Einathmen von Terpentinöldampfen,” ibid., 9 (1853), 445–447; and “Ueber die Funktion der Vorkammern des Herzens und über den Einfluss der Kontraktionskraft der Lunge und der Respirationsbewegungen auf die Blutzirkulation,” ibid., 193–213.

II. Secondary Literature. See the following, listed chronologically: Constantin Wurzbach. Biographisches Lexikon des Kaiserthums Oesterreich, XXXV (Vienna, 1877), 66–72: Maximillian Sternberg. Josef Skoda (Vienna, 1924); Erna Lesky, Die Wiener medizinische Schule im 19 Jahrhundert (Graz-Cologne, 1965), 142–149; and Zdeněk Hornof, “Josef Škoda als Choleraarzt in Böhmen,” in Clio Medica, 2 (1967), 55–62: and “The Study of Josef Škoda at the Medical Faculty in Vienna in the Period 1825–1831,” in Plzeňskŷ lékařskŷ sbornik, 31 (1968), 131–148, in Czech with English summary.

ZdenĚk Hornof