O
World J. Surg. 9, 361-366, 1985
Discovery
Vficlav Treitz (1819-1872): Czechoslovakian Pathoanatomist and Patriot
Richard S. Fox, M.D., Claire G. Fox, Ph.D., and William P. Graham, III, M.D.
Department of Plastic and Reconstructive Surgery, Hershey Medical Center, and the Department of Clinical Sciences, University of
Pennsylvania, Philadelphia, Pennsylvania, U.S.A.
Charles-Ferdinand University, now known as
Charles University, was and is the home of one of
Europe's oldest medical schools, one whose roots
are now shrouded in antiquity. In the nineteenth
century, the medical school became involved in the
political, social, and scientific controveries of the
day. As a center of intellectual life, its faculty
members could not escape the grip of Austrian
imperial bureaucracy. Indeed, most of them were
an integral part of it, and accepted Viennese he-
gemony.
One member of the medical faculty who objected
to Austrian domination and continued Germaniza-
tion of the medical school was V~clav Treitz
(1819-1872), the Bohemian-born pathoanatomist
whose name is associated with various terms in
general medical usage today. These include Treitz's
arch, fossa, and hernia and the suspensory muscle
of the duodenum usually referred to as the ligament
of Treitz [1].
For the most part, biographical details of Treitz's
life remain obscure. However, there is enough
available information to reveal that Treitz became
unavoidably involved in the political and scientific
controveries of mid-nineteenth-century Europe be-
cause of his Bohemian heritage and the turbulent
times in which he lived.
Treitz was born in the town of Hostomice,
Bohemia, in 1819, where his father was a judiciary
in the court of Count Vratislav. The young man
took his pre-college training at the Piarist College in
Bene~ov (Beneschau), where he received a good
education at the hands of the Catholic priests who
Reprint requests: Claire G. Fox, Ph.D., 380 Shady
Retreat Road, Doylestown, Pennsylvania 18901, U.S.A.
Sdr, D/
9 1985by the Soci6t6
Internationalede Chirurgie
were his teachers. Treitz then attended the Charles-
Ferdinand University in Prague where he studied
the required humanities before devoting himself to
the study of medicine. As a Bohemian, Treitz was
one of the growing number of Czech youths who
were qualified for higher education in German-
speaking universities [2].
In 1846, Treitz received his medical degree from
Charles-Ferdinand University. Following the cus-
tom of many European students of the day, he
furthered his education and training in Vienna,
where a group of illustrious specialists held forth as
the so-called New or Second Vienna School, a term
used to distinguish it from the Old Vienna School,
which, under the medical leadership of the Dutch
physician, Gerard van Swieten (1700-1772), had
flourished during the eighteenth-century reign of
Maria Theresa (1717-1780) and Josef II (1741-1790)
[3].
By the middle of the nineteenth century, Vienna
was the acknowledged capital of the medical world
as well as of the Austrian Empire. As the center for
the New Vienna School, the city was truly cosmo-
politan, with students from all over Europe and
various parts of the Empire. There were Bohem-
ians, Moravians, Slovaks, Croats, Hungarians, Ital-
ians and, of course, the Austrians and Germans.
The German language, both spoken and written,
provided a common linguistic medium.
As the acknowledged capital of the medical
world, opportunities for medical studies in Vienna
were among the finest in all of Europe. There was
the prestigious University of Vienna with its famous
faculty and splendid library. The Vienna Society of
Physicians provided the medical community with a
forum for the exchange of scientific thought [4]. The
sprawling Allgemeines Krankenhaus (The Vienna
General Hospital), the largest hospital in the city,
362
offered excellent opportunities for study, observa-
tion, and training with its emphasis on medical
specialties. In addition, another large medical train-
ing center, the medical-surgical Joseph's Academy,
specialized in military medicine.
The Allgemeines Krankenhaus, in particular, was
a most unusual institution. Built in various sections,
its high forbidding walls enclosed beautiful gardens,
winding paths, and tree-lined walkways, where
medical students strolled with their professors and
patients relaxed on benches, weather permitting.
The wards of the huge hospital were another mat-
ter. They were depressingly overcrowded and the
patients received minimal care. However, they did
provide the tremendous amount of clinical material
so eagerly sought by the professors, assistants, and
students.
The Pathological Institute was considered one of
the most important features of the Allgemeines
Krankenhaus and the most distinguished member of
the New Vienna School was the great pathologist
Karl Rokitansky (1804-1878), who had originally
come from Hradec Krfilov6 (K6niggrfitz), Bohemia.
Next, there were Rokitansky's close associate, the
clinician, Josef Skoda (1805-1881), born in Plzefi
(Pilsen), Bohemia; and the dermatologist,
Ferdinand von Hebra (1816-1880), from Brno
(Brunn), Moravia. Rokitansky and his assistants
performed an enormous number of autopsies,
which they considered the foundation of research
and the practice of medicine. Rokitansky had per-
sonally performed 30,000 autopsies by the time he
retired to write his most important book. Many of
his specimens, no doubt, were victims of "thera-
peutic nihilism," popular in Vienna, especially with
Skoda who focused on diagnosis and abhorred the
use of drugs [5, 6].
A great many who entered the Allgemeines
Krankenhaus for treatment never came out alive,
particularly those hapless child-bearing women who
dreaded the hospital. Large numbers died from
child-bed or puerperal fever, then poorly under-
stood. The doctors, eager to observe and learn,
attended the autopsies, and then, without washing
their hands, proceeded to the obstetric wards.
Treitz pursued his training in anatomy and pa-
thology under the direction of the eminent
Hungarian-born physician, Dr. Joseph Hyrtl
(1810-1894), professor of anatomy and at the time
the most popular teacher of that subject on the
continent [2]. In the German-speaking countries,
Hyrtl was the first "to combine anatomy with
clinical medicine" [4].
In 1847, while Treitz was doing his postgraduate
study in the Krankenhaus, the entire medical com-
munity was badly shaken when the fiery Hungarian,
Ignaz Philipp Semmelweis (1818-1865), an assistant
World J. Surg. Vol. 9, No. 2, April 1985
in the first obstetric ward, noted the correlation
between puerperal fever and erisepelas. Sem-
melweis was present at the postmortem examina-
tion of Jacob Kolletschka (1803-1847), one of
Rokitansky's assistants who had died of a dissec-
tion wound. As Semmelweis stood by the body of
his former instructor, he noticed that the pathologi-
cal appearances were the same as those of women
who died in childbed fever in the great city hospital
[31.
An uproar ensued in the medical community of
Vienna as Semmelweis affirmed that the cause of
puerperal fever was to be found in blood poisoning.
Most physicians were unconvinced. Those practic-
ing obstetrics refused to see any correlation be-
tween Semmelweis' observations and their own
practice [7]. When Semmelweis sent his famous
communication to the Vienna Medical Society, the
obstetricians of the city scoffed at him [8].
The period of Treitz's study in Vienna and his
return to Prague were some of the most tumultuous
years in Europe's history. In 1848, all of Europe
was in revolt. With Emperor Ferdinand I
(1793-1875) incapacitated by feeble-mindedness
and periodic bursts of insanity, the Austrian Empire
had been virtually ruled for 30 years by Prince
Klemens Lothar Metternich (1773-1858), Chancel-
lor of Austria. Metternich's archenemy was nation-
alism, a growing problem and one to which the
Austrian Empire was particularly vulnerable. Un-
der Metternich's system, all attempts at freedom,
and most especially nationalism, were suppressed,
for the Chancellor believed that the only alternative
to autocracy, which he practiced, was revolution.
Therefore, in order to prevent any outbreaks of
revolution, Metternich ruled the empire tightly
through the Crown, Church, Army, secret police,
and censorship [9]. Finally, it was the intelligentsia,
including faculties and students in Vienna and
Prague, who challenged imperial authority. In spite
of Metternich's efforts, patriotism seemed to ex-
plode everywhere, and students and faculty staged
riots and demanded better facilities and more aca-
demic rights.
In Prague, revolutionary sentiments had been
brewing for years and it had become the center for
Bohemian nationalism. The original goal of the
Czech nationalists was to heighten their country-
men's awareness of Bohemia's rich heritage. In its
early stages, the movement for nationalism had
been largely literary. Fostered by the Society of the
Bohemian Museum, the focus was on Czech litera-
ture and language. During the second quarter of the
nineteenth century, however, demand for official
recognition of the Czech language accelerated. The
use of the Czech language became a tool for resist-
ing continued Germanization and Austrian control.
R.S. Fox et al.: V~iclav Treitz 363

In the midst of this political and social chaos,

Treitz practiced as an independent physician in
Prague. However, pathology, anatomy, and clinical
medicine absorbed his interest. His practice as a
private physician was brief and he soon became an
assistant to Dr. Johann Dlauhy (1808-1880), a na-
tive of Plzen (Pilsen), Bohemia, who had also
studied in Vienna and had been an assistant to
Rokitansky [2]. It was Dlauhy who introduced the
ideas of Rokitansky to Prague. Treitz also became
an assistant to Josef E. Engel (1816-1899), who in
1849 became professor of pathological anatomy at
Prague [4].
In 1850, a new member joined the medical com-
munity of the University, Johannes Evangelista
Purkinj6 (1787-1869), a noted researcher and physi-
ologist. Purkinj6, a remarkably articulate and intel-
ligent man, was also an ardent Bohemian national-
ist. Having already achieved great fame in other
European teaching posts, Purkinj6, now at the age
of 63, began to devote considerable energy to
motivating students to work for Bohemian national-
ist goals. Undoubtedly, Treitz and Purkinj~ shared
these sympathies [10]. Fig. 1. Attachment of the suspensory muscle of the
In 1851, Treitz left Prague for Poland where he duodenum (ligament of Treitz, T) to the diaphragm. R and
was appointed Prosector at the Jagellonian Univer- R1 are the two parts of the right crus, L, the left crus.
sity in Cracow, formerly an independent city state (From Low, A: J. Anat & Physiol. 42:93, 1907. Re-
that had come under Austrian rule in 1846 when produced from Fig. 8-30, Anatomy for Surgeons, 1971
vol. 2, The Thorax, Abdomen, and Pelvis, W.H. Hol-
local authorities were unable to put down an insur- linshead, p. 411, used by permission)
rection. Treitz was appointed professor of
pathoanatomy the following year, a position he held
for approximately 3 years. Two years after his return to Prague, Treitz
While Treitz was at Cracow, his first major paper published his "Hernia retroperitonealis, ein Beitrag
was published in the German language Prague zur Geschichte innerer Hernien" (Hernia
Quarterly 37 (1853) entitled "lJber einen neuen retroperitonealis, a contribution to the history of
Muskel am Duodenum des Menschen, fiber internal hernias), in the Prague Quarterly, 1857. In
elastische Sehnen und einige andere anatomische this work, Treitz discussed the anatomical relations
Verh~ltnisse" (On a new muscle in the human of the site where these hernias occur, that is, the
duodenum, over elastic sinews and some other depression located at the site of the passage of the
anatomical relations). In this work, Treitz described duodenum into the jejunum. Treitz defined the
the suspensory muscle that was later to be called anatomical conditions for a retroperitoneal hernia
the ligament of Treitz (Fig. 1). He depicted the and then discussed the pathology of the hernia. He
suspensory band as consisting of smooth connec- then offered 13 points relevant to possible strangu-
tive fibrils, each little bundle passing into a sepa- lation of even a small hernia [11].
rate, neat ligament. Treitz also noted and described When Hyrtl referred to Treitz's 1857 publication
similar terminations of the smooth muscles of other in his own Handbook of Topographical Anatomy,
organs, which included the pharynx, third layer of he wrote "Treitz, in treating retroperitoneal hernia,
the stomach, sphincter ani, urinary bladder, and the had displayed the greatest insight into the matter
tunica dartos of the scrotum [11]. and high dissecting skills in a singular work, the
In 1855, Charles-Ferdinand University offered high value of which was universally recognized and
Treitz a professorship which he accepted. He also appreciated" [11].
became Prosector at the Prague General Hospital In 1859, Treitz's last major work was published
and was appointed Director of the Pathological under the title "Uber uramische Darmaffektionen"
Institute established in 1858. After Engel's depar- (On uremic intestinal diseases), in the Prague Quar-
ture to Vienna, Treitz was appointed to the Chair of terly. In this paper, Treitz described the changes in
Pathoanatomy, in which he served until shortly the intestine that occurred in uremia. He contended
before his death in 1872. that ammonical discharges in the intestines occur-
364
Fig. 2. Dr. V~clav Treitz, age 41. Reproduced by permis-
sion of the Institut fifr Geschichte der Medizin der
Universit~t Wien, Vienna, Austria.
ring with the onset of Bright's disease exert a
corrosive effect on the intestines. Treitz further
pointed out that the urate secreted when there was
interruption of the excretion of urine accumulates in
the blood, and then passes from the blood into all of
the body's secretions. In the intestine the urate is
transformed by the fluids into ammoniated carbon-
ate which causes irritation, blennorrhea, tender-
ness, catarrh, mortification, and dysentery. Am-
monemia then occurs by the absorption of ammonia
in the intestinal tract [11].
Despite the excellence of this work, based on
detailed pathoanatomical research, including ani-
mal experiments, one of his eulogists said that
Treitz had to defend his findings in a "Reply to the
Clinical Communication of Prof. Jaksch," pub-
lished in the Prague Quarterly, 1860 (Fig. 2). This
attack on Treitz's credibility was only one of many,
which came from the predominantly German scien-
tific community centered in Vienna [11].
Forced to function in the divisive academic at-
mosphere of Prague, Treitz developed his teaching
and "research to a remarkable degree." His
method of delivery, clarity of presentation, and the
practicality of his course popularized Treitz's lec-
tures. Expanded to 2 semesters, an unusual feat for
World J. Surg. Vol. 9, No. 2, April 1985
the day, his courses continued to attract students
[121.
Consequently, because he had so many students,
Treitz was able to select from among them the most
promising to be his assistants. August Breisky
(1832-1889), from Klattau, Bohemia was one who
achieved eminence [4]. Breisky, who was also an
assistant to the obstetrician Bernhard Seyfert
(1871-1870), was thus enabled to combine training
in obstetrics and pathology. Breisky became profes-
sor of obstetrics in Salzburg in 1866 and in 1867 was
called to Bern. A serious student of both Sem-
melweis and Lister, Breisky had an unusually low
mortality rate for women in childbed [4].
In spite of success with his students and assist-
ants, Treitz's problems with his colleagues
mounted. Convinced of the soundness of his prin-
ciples as a pathoanatomist, Treitz challenged his
colleagues in two areas of controversy. He contin-
ued to maintain, as Semmelweis had affirmed in
1847, that puerperal fever was contagious and that
physicians and attendants should take special pre-
cautions. He also believed that tuberculosis re-
quired a treatment of rest, instead of the usually
prescribed regimen of increased activity [13].
Treitz's supreme confidence in himself as a patholo-
gist and clinician is said to have antagonized some
members of the medical faculty. The rift was wid-
ened by his ardent nationalism and, perhaps, also
by his lecturing in Czech. It is not clear when Treitz
began to do this. However, one former student
recalled after Treitz's death that the professor de-
livered very animated, interesting lectures in Czech
[13].
Throughout the 1860s tension mounted between
the German-speaking minority who controlled the
political and economic life of Prague, and the grow-
ing Czech majority of citizenry. This strife became
very evident at the Charles-Ferdinand University
where most of the faculty was German and an
increasing number of students were Czech. German
students counteracted what they saw as a weaken-
ing of their position by establishing associations for
promoting Pan-Germanic ideas. The Czech medical
students formed their own nationalist group, the
Czech Medical Society, which another ardent pa-
triot and faculty member, Johannes Purkinj6,
helped establish in the mid-1860s [10].
The official position taken in Vienna was that the
language of instruction should be at the professor's
discretion. This apparently had negligible effect in
the University, for in 1863 Czech students and
Czech faculty members demanded more lectures in
their native tongue. During the following year,
1864, the issue was discussed officially in the Con-
gress with the Czechs calling for official recognition
of their language in the existing University. How-
R.S. Fox et al.: V~iclav Treitz
Fig. 3. Institute of Pathology, Charles University. Picture
courtesy of Professor MUDr. J. Dobias, Dr.Sc. of that
University.
ever, instead, the Austrians recommended the es-
tablishment of a separate, new Czech University
[141.
At Charles-Ferdinand University, Treitz,
Purkinj6, and others were determined to fight for
the right to lecture in Czech and put that language
on an equal footing with German (Fig. 3). Thus, the
faculty became increasingly divided and the dis-
approval of members of the New Vienna School of
medicine manifested ifself in a hard line [14].
On July 28, 1869, when Purkinj6 died after a
protracted illness, Treitz lost his closest friend and
colleague on the medical faculty. In the obituary
notice published in the Proceedings o f the Royal
Society of London, it was stated that his death
"was mourned by every class of society in
Bohemia" [15]. In fact, there were exceptions.
Although Purkinj6 was loved by the Czech people
and Czech students, Treitz was the only member of
the Faculty of Medicine who attended Purkinj6's
burial. Determined Bohemian nationalists, both
Purkinj6 and Treitz were isolated by their German
or German-speaking colleagues from the glory of
the New Vienna School and the mainstream of
German medicine. This hardly affected Purkinj6 in
his declining years, and he continued to take a very
active part in the life of the emerging Czech nation.
In contrast, Treitz, when attacked publicly for his
medical theories and political beliefs, avoided con-
tact with colleagues. On at least one occasion,
Treitz was visited by a group of German faculty
members [11], who importuned him to attend fac-
ulty meetings [13]. He refused and the situation
worsened. Dissension with colleagues found its way
into the lecture halls, polarized students, and ulti-
mately spilled into newsprint.
In time, because of his voluntary isolation from
society and the constant attacks made on him,
365
Treitz developed a persecution complex and even-
tually melancholy. His mental condition was exac-
erbated by attacks from pyemia which originated
from a wound received during a dissection. These
attacks were accompanied by a painful furunculo-
sis. Attributing the furuncles to his contacts with
cadavers, Treitz refused to perform any further
dissections or to prepare specimens [13].
On August 27, 1872, Treitz committed suicide by
taking potassium cyanide. His last words, "But I
will still be pursued," were overheard by relatives
who had been summoned to Prague. Treitz was
buried 2 days later on August 29. A former student,
Dr. Vitezslav Janovsky, in a tribute published in
Casopis L~kafftv Cesk~jch (Journal of Czech Physi-
cians), 1872, described the gloomy occasion as
follows:
When the setting sun of August 29th g i l d e d . . , the coffin
which held the physical remains of Treitz, when we
consigned him to the silent tomb, and when, somberly,
the clods of earth dully sounded, as it were, a last honor
rendered to the great master, then we all certainly felt
fervently, as we stood around, the severe loss we had
suffered; then, certainly, there came over each of us a
feeling of deep grief, along with heart-felt gratitude for the
instruction that the deceased had imparted to us, instruc-
tion not having the value of passed-on classroom proposi-
tions, but of experience acquired on the basis of actions
from profound investigatory understanding [11].
Thus, a group of Czech medical students and physi-
cians laid a Czech medical patriot to rest.
R6sum6
V~tclav Treitz (181%1872) qui fut un grand
anatomiste et pathologiste d'origine tch~que s'est
oppos6 h la domination autrichienne de son pays et
la germanisation de l'enseignement de
l'Universit6 Charles Ferdinand si~ge de l'une des
plus anciennes des Ecoles de M6decine eu-
ropdennes. I1 a lutt6 toute sa vie en faveur de la
Boh6me sa pattie et pour que l'enseignement
mddical ~ Prague soit dispens6 en langue tch6que
bien qu'il ait fait ses 6tudes m6dicales en pays
germanique, ~t Vienne, capitale du monde m6dical
au milieu du dix-neuvi6me si~cle.
Au cours de ses pdrigrinations entre Vienne o0 il
6tudia, Prague et Cracovie o0 il enseigna il suivit
toujours la m6me conduite, s'interessant
l'anatomie, ~tl'anatomie-pathologique et h la chirur-
gie. En 1853, alors qu'il exerqait ~t Cracovie il publia
en allemand pour diffuser ses id6es la description du
ligament suspenseur de l'angle duoddno-jdjunal qui
porte son nom depuis lors. I1 d6crivait aussi d'autre
formations constitu6es de fibres lisses au niveau du
pharynx, de la troisi~me couche de l'estomac, du
366
sphincter anal, de la vessie et de la "tunica dartos"
du sacrum. En 1857, il publia un autre article
important intitul6: hernie rdtro-p6riton6ale, contri-
bution/t l'histoire des hernies. En 1859, son dernier
travail important consacr6 aux "16sions intestinales
de l'ur6mie" d6crivait non seulement les lesions
mais le m6canisme de leur constitution. Esprit
ouvert il fut l'un des premiers h soutenir la th~se de
Semmelweis affirmant que la fi~vre puerp6rale 6tait
d'origine infectieuse, l'infection 6tant transmise par
le corps saignant, et aussi h prouver le traitement de
la tuberculose par le repos.
Esprit contestataire et frondeur mais avis6 et
rigoureux, V~tclav Treitz fut un grand anatomiste
innovateur, un pathologiste rigoureux et aussi un
grand patriote dont la Tch6coslavaquie peut 6tre
fi6re.
Resumen
Brillante miembro del profesorado de la
Universidad de Carlos-Ferdinando de Praga,
actualmente conocida como la Universidad de
Carlos, sede de una de las mgts antiguas facultades
de medicina de Europa, fu6 V~iclav Treitz
(1819-1872), anatomopat61ogo y patriota checoes-
lovaco. Treitz estuvo involucrado en las
controversias polfticas y cientfficas de la turbulenta
mitad del siglo XIX en Europa y, en virtud de su
ascendencia (nacido en Hostomice, Bohemia), se
opuso junto con Johannes E. Purkinj6 (1787-1869),
a la dominaci6n austrfaca y a la germanizaci6n de la
facultad de medicina. Despu6s de su grado en
Praga, continu6 estudios en la Segunda, o Nueva,
Escuela M6dica de Viena, ciudad por entonces
reconocida como capital del mundo m6dico, a la
vez la cosmopolita capital del Imperio Austrfaco.
Allf convergfan estudiantes de diversa procedencia;
Karl Rokitansky (1804-1878) era el m~is distinguido
profesor, en el famoso Instituto de Patologfa. Treitz
hizo estudios en anatom~a y patologfa con Joseph
Hyrtl (1810-1894) el m~is renombrado profesor de
anatomfa del continente europeo. En su 6poca
Ignaz Philipp Semmelweis (1818-1865) hizo su
revolucionaria comunicaci6n a la benem6rita
Sociedad M6dica de Viena sefialando el contagio
como causa de la temida fiebre puerperal
hospitalaria. A su regreso a Praga, Treitz ejerci6
brevemente como m6dico independiente para ser
luego asistente de Johann Dlauhy y de Josef E.
Engel, este t~ltimo profesor de anatomfa patol6gica
en Praga desde 1849. En 1851 fu6 nombrado prosec-
t o r y luego profesor de patoanatomia en Cracovia,
Polonia, en esa 6poca bajo la dominaci6n austrfaca.
En 1853 public6 un trabajo describiendo la
estructura suspensoria del duodeno que hoy se
conoce como ligamento de Treitz. En 1855 regres6
World J. Surg. Voi. 9, No. 2, April 1985
a la Universidad Carlos-Ferdinando de Praga,
donde luego fu6 nombrado Director del Instituto de
Patologfa establecido en 1858. Otras contribuciones
hist6ricas sobre hernias internas retroperitoneales y
sobre enfermedades intestinales ur6micas
aparecieron en 1857 y 1859. A la salida de Engel
hacia Viena, Treitz fu6 nombrado en la cgttedra de
patoanatomia, cargo que sirvi6 hasta poco antes de
su muerte, por suicidio con cianuro de potasio, en
1872. Sus tiltimas palabras, "pero seguir6 siendo
perseguido", fueron registradas por los familiares
que habfan sido llamados a Praga. Su discipulo,
Vitezlav Janovsky, hizo el conmovedor recuento
del sepelio del gran maestro, ocurrido dos dfas
despu6s, el 29 de agosto de 1872.
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