WERTHEIM, ERNST

(b. Graz, Austria, 21 February 1864; d. Vienna, Austria, 15 February 1920), gynecology.

Son of the professor of chemistry at the University of Graz, Wertheim studied medicine there and received his medical degree on 29 February 1888, before becoming an assistant in the department of general and experimental pathology. Under the supervision of Rudolf Klemensiewicz he learned the bacteriological and histological techniques that later enabled him to conduct his fundamental research on gonorrhea in the female genital tract. The first result of his work at Graz, however, was a paper on fowl cholera.

Wertheim left Graz on 30 April 1889 and studied until mid-November under Otto Kahler at Vienna’s Second University Clinic. In the same year he became interested in gynecology, 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 specialized postgraduate training in obstetrics and gynecology, where puplis 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, and remained there as a student until 30 September 1890. He then moved to Prague as assistant to Friedrich Schauta at the university’s women’s clinic, returning to Vienna in 1891 when Schauta was appointed head of the First Vienna Women’s Clinic.

In this years as an assistant, Wertheim focused his research on gonorrhea 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 gonorrheal infection. In 1890 he demonstrated the existence of gonococci 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 Bumm maintained in his widely accepted theory (1895) but also the squamous epithelium (the peritoneum). Through these papers, especially in “Die aszendierende Gonorrhoe beim Weibe. Bakteriologische und Klinische Studien zur Biologie des Gonococcus neisser” (Archiv für Gunäkologie, 42 [1892], 1–86), Wertheim placed his theory of ascending gonorrhea in the female on a firm foundation.

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 gynecological service (Bettina Pavilion) of the Elisabeth Hospital and thereby obtained his own operating facilities. By then he had long realized that the customary method of vaginal extirpation was highly unsatisfactory because of its bad aftereffects. (The abdominal method had been abandoned because of its mortality rate of 72 percent.) Consequently, elaborating the work of his predecessors Emil Ries, Theodor Rumpf, and J. G. Clark, Wertheim decided to place the operation for cervical cancer on a modern surgical basis. No longer satisfied with the extirpation of the diseased organ, he sought to remove as much as possible of the organ’s surrounding, the perimetrium, along with the neighboring lymph glands . He recognized, as had Julius Massari in 1878, that the greatest possible attention must be directed to protecting the ureters during their exposure and preparation.

On 16 November 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, 61 [1900], 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).

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 gynecological surgeons; and his work was carried on there, as well as in Prague and Berlin, by his most outstanding students, Wilhelm Weibel and Georg August Wagner.

BIBLIOGRAPHY

Many of Wertheim’s works are mentioned in the text. See also the bibliography in the obituary by Weibel (below).

Secondary literature includes. J. Arther and A. Schaller, Die Wertheimsche Radikaloperation. Anfänge, Fortschritte, Ergebnisse. 1898-1968 (Vienna, 1968); R. Elert, “Zum Gedenkjahr des doppelten Jubiläums der abdominellen Radikaloperation des Gebärmutterkrebes. W. A. Freund (1878)–Wertheim (1898),” in Klinische Medizin, 4 (1949), 249–262, very detailed; F. Kermauner, in Wiener Klinische Wochenschrift, 33 (1920), 183–185; W. Latzko, in Wiener medizinische Wochenschrift, 70 (1920), 545–549; E. Lesky, “Die Wiener geburtshilflich-gynäkologische Schule,” in Deutsche medizinizche Wochenshrift, 87 (1962), 2096-2102; and Die Wiener medizinische Schule im 19. Jahrhundert (Graz-Cologne, 1965); E. Navratil, “Die Entwicklung der Operationsmethoden zur Entfernung der Karzinomatösen Gebärmutter,” in Wiener klinische Wochenschrift,60 (1948), 233–238; G. Reiffenstuhl, ibid., 82 (1970), 554–559; W. Weibel, in Monatsschrift für Geburtshülfe und Gynäkologie, 61 (1920), 271–279, with bibliography, in Archiv für Gynäkologie (Berlin), 113 (1920), v–xvi; in Zentralblatt für Gynäkologie, 44 (1920), 281–285; and “25 Jahre Wertheimscher’ Carci nomoperation,” in Archiv für Gynäkologie (Berlin), 135 (1929), 1–57; P. Werner and J. Sederl, Die Wertheimsche Radikaloperation bei Carcinoma colli uteri (Vienna-Innsbruck, 1952); and T. Antoine, “Letter From Austria,” in Obstetrical and Gynecological Survey,24 (1969), 1129-1137.

Erna Lesky