No washing our hands of the Austro-Hungarian legacy

In our decade of commemorations, we might easily miss two interesting sesquicentennials of 2017, commemorating 150 years of the Canadian Confederation and the Austro-Hungarian Compromise establishing the dual monarchy.

While Canada lives on in a vibrant form, Austria-Hungary was dissolved in 1918. For many, the dominant perception of the twin capitals of Vienna and Budapest is that of arts and culture, from the operettas of Strauss and Léhar to the ground-breaking art of Klimt and Kokoschka.

This was indeed one of the brightest periods of advancement in the art and science of medicine, a truly golden age

We are less well acquainted with the degree to which the Hapsburg empire was a powerhouse of industry, science and technology, third in the world at the time only to the US and Germany. For students of medical history this was indeed one of the brightest periods of advancement in the art and science of medicine, a truly golden age.

The foundations had been set by Emperor Joseph II, one of the great Hapsburg reformers, who founded the first state-run general hospital in Europe, the Algemeines Krankenhaus (the General Hospital) in 1784 on the site of a poorhouse, dedicated to improving standards of diagnosis and treatment.

Are schools ready to look after children’s ‘wellbeing’?

---

‘We had been through so much and fought so hard and I thought my son might die’

---

Are you ready for puberty?

---

Lucifer effect: hellish heat is the most lethal weather disaster

---

For our era marked by concerns over patients on trollies, one striking aspect of the Algemeines Krankenhaus was the limit of two patients to a bed!

Joseph II also founded an academy for army surgeons and medical officers, the Josephinum, also the first of its kind and an important focus for teaching, research and the future flowering of innovations of the Viennese medical school.

These developments provide a striking backdrop to an absorbing tour of Austro-Hungarian medical history in Vienna. A good starting point is the imposing main University of Vienna building. The large courtyard is a tour of the achievements of the era through busts and plaques, with names of polyglot origin reflecting the many nationalities in the Empire.

A particularly touching bas-relief plaque is that of Ignaz Semmelweis, the abrasive Hungarian obstetrician who discovered the importance of hand-washing in preventing puerperal sepsis

Here we meet the pioneers in psychiatry Kraft-Ebbing and Sigmund Freud, famous surgeons such as Billroth whose name is still attached to gastrectomy in our time, the discoverer of blood groups, Landsteiner, and Kaposi of Kaposi's sarcoma (associated with Aids in the modern era) among others.

A particularly touching bas-relief plaque is that of Ignaz Semmelweis, the abrasive Hungarian obstetrician who discovered the importance of hand-washing in preventing puerperal sepsis, a major cause of maternal mortality. Due to a combination of factors, Semmelweis was unable to advance professionally in Vienna, and eventually became the professor of obstetrics in Budapest with huge effect.

A plaque on the imposing marble steps in the university building in memory of Moritz Schlick, the celebrated philosopher and opponent of fascism who was assassinated on that spot in 1936, is a potent reminder of how the forward impetus of Viennese medical science was damaged by the exile, oppression and extermination of the Nazi era.

Further waypoints on the medical history tour are the Josephinum, the original Algemeines Krankenhaus (now part of the University of Vienna following the opening of a new Algemeines Krankenhaus in 1994) and the Sigmund Freud museum, based in his former rooms and home.

Each is deserving of a visit. Particularly striking in the beautiful Josephinum building, now a medical museum, is a marvellous collection of wax models of dissection which were used to each anatomy. The craftsmanship is exquisite, the detail painstaking, and the range extraordinary: in addition, it avoided the need for preserved human specimens.

Dublin will celebrate the founding of Austria-Hungary and the coronation of Emperor Franz-Josef in Budapest in 1867

The old Algemeines Krankenhaus buildings include the Narrenturm (Fools’ Tower), the oldest hospital for psychiatric illness in continental Europe, founded 37 years after our own St Patrick’s Hospital in Dublin. A circular tower of rather forbidding form and aspect, it is now an anatomy and pathology museum.

The Freud museum is a bittersweet experience, combining a sense of the extraordinary confluence of science, art and literature in fin-de-siècle Vienna with the toxic terrors, racism and anti-Semitism that burst forth several decades later, a stark contrast to the remarkable tolerance of the Austro-Hungarian Empire.

Dublin will celebrate the founding of Austria-Hungary and the coronation of Emperor Franz-Josef in Budapest in 1867 next Sunday afternoon, when the Irish premiere of Franz Liszt's Coronation Mass will take place at the National Concert Hall, paired with Rossini's exuberant Stabat Mater.

The Coronation Mass is a stunning work reflecting the synergy between two great cultures and should give cause to reflect on what we gained in medicine, music and many other fields from the golden era of the Austro-Hungarian Empire.

• Prof Desmond O'Neill is a consultant physician in geriatric and stroke medicine and Professor in Medical Gerontology, Tallaght Hospital and Trinity College Dublin. Trinity Centre for Health Sciences, Tallaght Hospital, Dublin 24, Ireland: Tel +353 1 414 3215, Fax +353 1 414 3244
• http://blogs.bmj.com/bmj/category/desmond-oneill/ @Age_Matters