Mudry, Albert*; Kraft, Marcel†
In 1861, Politzer became privat-docent in otology at the Vienna University and was promoted to the position of "first official teacher of otology" (Fig. 1). To be nominated privat-docent, two conditions were necessary: to be able to speak German and to have published some scientific articles without absolutely reaching the level of sophistication of a dissertation. The nomination of privat-docent was associated with the permission to give a public lecture on a specific field chosen by the candidate (1). The candidate had to present his request in a hand-written letter sent to the Collegium of Professors of the Viennese medical school. Politzer made his request on September 26, 1861 (2) (Fig. 2). He wrote: "Dear professor of the assembly. Since at the Viennese medical faculty otology is not yet recognized as a separate discipline as commonly found at the large universities of Germany, I humbly request from this assembly the designation of the venia docenti for otologic diseases.... Having completed my special training in otology, I feel entitled to request of this assembly the designation of the venia docenti based mainly on my scientific research and publications in the field of physiology and pathology of the ear." In this request, Politzer detailed his training in otology in the different European cities that he had visited. He also presented a program of lectures on otologic diseases. These different points will be studied in the present work.
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FIG. 1. Politzer circa 1861 |
FIG. 2. Politzer\'s request for privat-docent |
Johann von Oppoltzer (1808-1871), one of Politzer\'s teachers, was a great promoter of specialization and of its young representatives. He encouraged the Viennese medical school to promote otology and proposed to train an otologist through contact with the most prominent European specialists of the subject (3). He chose Politzer in this role to render the Viennese school of medicine able to compete in this field with other European faculties. After being brilliantly promoted to doctor in medicine, doctor in surgery, and master in obstetrics (4), Politzer began his training in otology at the beginning of 1860. This training period lasted approximately 2 years. It was divided into three main learning components: physiological research, anatomopathologic research, and bedside clinical training. For the development of this specialty, he visited Würzburg, Heidelberg, Paris, and London after spending 5 months in Vienna.
Politzer began his training in otology by practicing physiological research. Physiology was based on a physicochemical basis that was well accepted by the medical world. The German physiologists, represented by Carl Ludwig (1816-1895), Ernst von Brücke (1819-1892), Emil du Bois-Reymond (1818-1896), and Hermann von Helmholtz (1821-1894), were the leaders in this field, with the French school engendered by François Magendie (1783-1855) and Claude Bernard (1813-1878). This is the reason why Politzer began his research in the laboratory of Ludwig in Vienna. He concentrated his works on two mains points: the innervation of the middle ear muscles and the air movements through the eustachian tube. He stimulated the trigeminal and facial nerves near their centers in the cranial cavity in animals to demonstrate that the stapedius muscle was innervated by the facial nerve and the tensor tympani muscle by the trigeminal nerve. He studied, in humans, the air movements in the eustachian tube by connecting a manometer at the entrance of the external auditory canal: "I made use of a small glass tube, 2-3 mm. wide, fitted into an indiarubber stopper (ear-manometer), and furnished with a drop of colored fluide (Fig. 3). This tube was hermetically sealed into the external meatus. During the Valsalvian experiment, the fluid in the manometer was seen to rise. If an act of swallowing was performed with the closed mouth and nose, during the first stage of this act a slight rise (positive fluctuation) of the fluid in the manometer took place, followed-up, however, during the second stage of the act of deglutition, by a considerable fall (negative fluctuation), as the air in the tympanic cavity is rarefied and the membrana tympany is pressed inward" (5). With this method, he demonstrated that the eustachian tube was open during deglutition. He finally demonstrated the influence of the tensor tympani on the pressure of the inner ear fluids in the dog and the influence of the modification of middle ear pressure on the inner ear on human hearing organs dissected just after death. He inserted a hermetic manometer in the semicircular canal to register the modification of the pressure: "The condensation and rarefaction of air in the tympanic cavity were produced by an air-pump connected with the Eustachian tube. A manometrical tube, partly filled with a solution of carmine, was introduced into the opened superior semicircular canal [Fig. 4], and fastened hermetically. Now, when the air in the tympanic cavity was condensed by compression of the balloon, an outward curvature of the membrana tympani and also a rising of the fluid in the manometrical tube in the labyrinth...were observed, while during rarefaction a distinct fall of the fluid in the manometer was noticed" (5). The results of these experiments were presented at the Kaisserliche Akademie der Wissenschaften in Vienna and then published in 1861 under the title Beiträge zur Physiologie des Gehörorgans (Contribution to the Physiology of the Hearing Organ) (6) and Zur Physiologie und Pathologie des Gehörorgans (On the Physiology and Pathology of the Hearing Organ) (7). Some of these experiments were published again in 1862 in two other articles (8,9). Politzer demonstrated great recognition of the influence of his contacts with Ludwig. He dedicated the third edition of his Textbook of the Diseases of the Ear to him in 1893 (10). He also participated in the Ludwig Jubileaum on October 14, 1874, presenting and subsequently publishing a work entitled Zur Anatomie des Gehörorgans (On the Anatomy of the Auditory Organ) (11). Politzer kept a photograph of Ludwig in his collection (Fig. 5) with Politzer\'s handwritten notation: "Prof. Carl Ludwig, one noble and good man, who supported me in my physiological and experimental works in the Josephinum with disinterested devotion" (12).
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FIG. 3. External hearing canal manometer |
FIG. 4. Semicircular canal manometer |
| Politzer continued his physiological studies in Würzburg with Heinrich Müller (1820-1864) and Albert von Kölliker (1817-1905). There, he focused on studies of the innervation of the eustachian tube in dogs and chickens. He demonstrated that the trigeminal nerve was responsible for the aperture of the tube by stimulation of the tensor vela palatini. He presented the results of this study at the Physikalisch-Medizinischen Gesellschaft Würzburg and published it in 1861 under the title Ueber eine Beziehung des Trigeminus zur Eustachischen Ohrtrompete (On a Relation Between the Trigeminus Nerve and the Eustachian Tube) (13). In Würzburg, he also completed his manometric experiments during deglutition, which preceded the invention of the Politzer\'s method of inflating the middle ear in 1863 (14). Politzer wrote: "I quote here the second experiment, which I demonstrated to Professor v. Tröltsch in 1861. If I introduce the extremity of the escape-pipe of a force-pump into the nose, half an inch deep, and compress the alae round it, and then perform an act of swallowing while the compressed air rushes into the nasal cavity, I feel the air at the same moment entering with force into both tympanic cavities, while the drop of fluid in a manometer, inserted into the external meatus, moves outwards" (5). |
FIG. 5. Carl Ludwig |
He continued on to Heidelberg and visited with von Helmholtz. No report exists concerning this involvement in his official account of his privat-docent. This collaboration is mentioned in his biography, which was written by his pupil, Gustav Alexander (1873-1932), and published in the second volume of his Geschichte der Ohrenheilkunde (History of Otology) in 1913 (15). The results of his visit were not published, but they certainly generated some of the experiments conducted in the laboratory of the acoustician Rudolf König (1832-1901) in Paris.
In Paris, Politzer visited Claude Bernard and Rudolf König. There, he was particularly interested in the motion of the ossicles after sound stimulation, as was von Helmholtz. For these experiments, he used the chymograph invented by Ludwig to register the movements of the ossicular chain observed by the motion of small pointers inserted in the ossicles on a freshly extracted human hearing organ from a cadaver. To stimulate the chain, he used the phonautograph (Fig. 6) invented by König: "Fine threads of glass, 10-12 cm. in length, with the fiber of a feather attached to their point, were fastened by means of resin one after the other to the malleus, incus and the footplate of the stapes, and the tones of organ-pipes of different height were conducted through the external meatus to the membrana tympani. The vibrations of the ossicula were rendered considerably more perceptible by the sensitive glass levers which were fastened to them, and were plainly visible to the naked eye. The vibrations may, however, be most distinctly traced if the ossicula are made to register them themselves. For this purpose a brass drum is used, which revolves round its longitudinal axis and moves forward, is covered with paper and blackened by the smoke of a turpentine lamp" (Fig. 7) (5). With these experiments, Politzer definitively demonstrated the mechanical function of the ossicles in the physiology of hearing before von Helmholtz. The proportion of the vibrations of the ossicles depended principally on the mechanism of the joints. Politzer wrote: "I was the first to furnish the experimental proof that the ossicula vibrate as a whole body with extensive oscillations under the influence of the waves of sound which strike the membrana tympani" (5); even more, "This is plainly a foreshadowing of Helmholtzs very recent description of the mechanism of the articulation of the malleus and incus" (5). The results of these experiments were not published by Politzer but only presented by Claude Bernard at the Académie des Sciences de Paris in 1861 (16). During this presentation, Claude Bernard said that Politzer was "a young Hungarian anatomist with great expectation." Furthermore, Claude Bernard wrote a letter to Ludwig in 1863 mentioning that all of Ludwig\'s students who visited him "were without exception very distinguished persons" (17). In his candidate letter sent to the Collegium of Professors of the Viennese faculty, Politzer mentioned a manuscript relating the results of these studies. Unfortunately, this manuscript was lost. Politzer thanked König for his help and support in research in an article concerning the mechanical transmission of sound by the ossicles published in 1864 (18). Politzer kept a photograph of Claude Bernard in his collection with Politzer\'s handwritten notation: "Dr. Claude Bernard. Prof. of physiology at the Sorbonne, one noble and valuable man" (Fig. 8) (19).
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FIG. 6. König\'s phonautograph |
FIG. 7. Ossicular movements registered by the chymograph |
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FIG. 8. Claude Bernard |
Politzer had the chance to visit the most eminent physiologists of the 19th century. Alongside them, he learned the basis of physiological research, bases that are recognizable in all his subsequent publications. This new way of physicochemical experimentation gave birth to new scientific explanations for the disease. For Politzer, research in physiology was very important to understanding a disease clearly. He wrote: "functional troubles of an organ cannot be studied with success, if we don\'t use, as a basis for research, the knowledge of normal function of the organ" (18). |
Besides physiology, Politzer engaged himself in the study of anatomopathology of the ear, which was the basis of the new development of otology engendered by the works of William Wilde (1815-1876) and Joseph Toynbee (1815-1866) in Great Britain. Two places were very important for this training: Würzburg and London. In Würzburg, he learned the microscopic anatomy of the ear with Kölliker. This completed his development in macroscopical anatomopathology as taught by Carl von Rokintansky (1804-1878) during his medical studies. He completed his training with Anton von Tröltsch (1829-1890), a pupil of Toynbee, by studying his collection of preparations of ear abnormalities. Tröltsch was very aware of the importance of pathologic studies in understanding the disease of the ear. He went further with the objective that otology should become a scientific specialty as he wrote: "In order that diseases of the ear may receive the attention that their importance demands, aural medicine and surgery must endeavor to elevate itself, in a scientific and ethical point of view" (20). This scientific elevation needed to go through anatomopathologic studies. Politzer and Tröltsch became very close friends, and they founded with Hermann Schwartze (1837-1910) the Archiv für Ohrenhheilkunde (Archives of Otology), the first journal dealing only with otology in 1863; the first issue was published in 1864.
Politzer finished his anatomopathology training in London alongside Toynbee. During this stay, Politzer used two books written by Toynbee: A Descriptive Catalogue of Preparations Illustrative of the Diseases of the Ear published in 1857 (21) and The Diseases of the Ear: Their Nature, Diagnosis and Treatment published in 1860 (22). The catalogue was very important because it provided support for the study of Toynbee\'s collection of approximately 2,000 specimens of ear preparations. Politzer received one dedicated copy: "To Dr. Adam Politzer with Mr. Toynbee\'s very kind regards. July 16.61" (Fig. 9) (21). The main point of Toynbee\'s teaching was the importance given to pathologic studies to understand the diseases of the ear, as he wrote in his catalogue: "The dissections detailed in the following pages justify me in expressing the hope that they will be regarded as a solid basis, on which ultimately a complete system of Aural Pathology may be reared" (21). Politzer greatly appreciated his stay with Toynbee in London: "I received a hospitable reception from him. For hours he was at my side to explain to me the precious specimens of his collection. I keep him in faithful memory for the support of my scientific career" (23). During his entire career, Politzer referred to Toynbee and his importance in the development of otology: "Ever since the labors of Toynbee, it has been fully realized that a knowledge of the pathologic anatomy of the organ under discussion (ear) is absolutely necessary to a right comprehension and successful treatment of its diseases" (24). Even more: "The most important fact that he (Toynbee) noticed, in relation to numerous anatomic observations, was that, in contrast to the aformentioned opinions, which were relatively vague regarding the interpretation of most ear diseases as being nervous, the main cause of hearing loss results from inflammatory peripheric processes affecting the tympanic cavity" (25). Politzer honored Toynbee in writing two biographies, one in French in 1905 (25) and the second in German in 1914, unpublished but recently translated into English (23).
| Anatomopathology was the second domain in which Politzer performed research. During his entire career, Politzer continued with his research in anatomopathology. This was possible because Politzer was elected as a physician of the poor, in Vienna, in 1863. This allowed him to practice on thousands of autopsies to study the macroscopic and microscopic alterations found in ear diseases. Even more so, it was a very good way to learn surgery: "To the aural surgeon in particular, practice in dissection work is indispensable. It is only by unremitting study and manipulation of specimens that he can hope to attain that degree of confidence so necessary to produce satisfactory results, when performing an operation in such close proximity to organs of vital importance" (24). |
FIG. 9. Toynbee\'s dedication to Politzer |
Bedside teaching was the third training area of Politzer\'s development in otology. Tröltsch in Würzburg, Prosper Menière (1799-1862) in Paris, and Toynbee in London gave him such experience. With Tröltsch, he specifically learned otoscopy, which was indispensable for a complete and exhaustive diagnosis in otology. For Tröltsch, clinical examination of the ear was essential for determining a diagnosis: "The more exactly we observe the thing, the more fails every fitting answer to the question" (26). Everything revolved around this examination and explains why Tröltsch was engaged in the development of the new otoscopic method using the perforated mirror and the ear speculum (27). He associated the otoscopic examination with the goal of joining the pathologist with the clinician. Politzer wrote: "The most important results in this field, however, were furnished by the profound researches of von Tröltsch. He compared his observations, made upon patients by means of an essentially improved method of examination, with the corresponding post-mortem appearances; and, from the harmony between conjectured and authenticated causes of disease, he showed with what brilliant success inspection of the membrana tympani may be used for the diagnosis of pathologic processes in the ear" (28).
With Menière, the director of the Institut Royal des Sourds-Muets, Politzer learned how to examine a deafmute. No details exist concerning this teaching, notably in Menière\'s journal (29). In a recent biography of Menière, it is mentioned that Politzer visited Menière many times, concluding that Politzer was interested in Menière\'s ideas (30). This fact cannot be proven because Politzer did not provide details about his contact with Prosper Menière. What is certain is that Politzer visited Menière during the period that he was publishing his famous description of what we know today as Menière\'s disease (31). Politzer developed a description of this disease in an article published in 1867, unfortunately without personal details concerning his collaboration with Menière (32).
Finally, alongside Toynbee, Politzer completed his development of clinical training. Toynbee gave great importance to the clinical examination in forming a diagnosis: "My object in citing the foregoing case has been to show that after carefully collecting the history of a case, and making a thorough inspection of the organ, there is generally not much difficulty in forming a tolerably correct diagnosis" (22). Toynbee\'s bedside teaching was an excellent complement to the learning of Toynbee\'s collection of ear preparations.
Who can imagine a physician today without skills in clinical examination? This is the most important part in forming the relationship between physician and patient. The quality of the examination will enlighten and expand the quality of the diagnosis, the final aim of every medical consultation: "we are satisfied that ocular inspection essentially facilitates the establishment of a diagnosis" (28). The new possibilities given by otoscopy permitted new approaches and descriptions of diseases of the ear. Quickly, otoscopy became indispensable in otology. Politzer had already published his first work on the subject the year after his visit in London (33).
Physiology brought Politzer the support needed to comprehend the disease. Anatomopathology brought Politzer the understanding of the development of a disease and the ability to practice surgery. Clinical training brought Politzer the method of examining a patient. All ingredients were assembled and acquired to become an otologist. Every young physician who intended to be trained in otology could dream, and can dream even today, when the opportunities and facilities that Politzer lived in the middle of the 19th century are seen. Basic training was the foundation for Politzer\'s career and explains in part his success in otology. In fact, it was not so easy for Politzer. It was necessary to travel for 2 years without the ease of travel that we experience today. However, Politzer had the chance to study in Vienna in a university that had decided to have a teacher in otology. Oppolzer chose Politzer because of his great potential. We are lucky today to have had such great ancestors in our specialty. This study is also a type of recognition and tribute to Politzer. If you possess a photograph of Politzer, you could write: "Prof. Dr Adam Politzer, an excellent physiologist, a very competent anatomopathologist, and a marvelous clinician; one of the fathers of otology."
Politzer\'s achievement was recognized by the Collegium of Professors of the Viennese university. He received his privat-docent on December 6, 1861 (34). That opened the door for Politzer\'s first lessons in otology. Politzer finished his request for the privat-docent with these words: "If I should be given the permission to hold public lectures on otology by this assembly based on the aformentioned reasons, then I will ever be eager to be worthy of such a designation by actively and diligently continuing research and by behaving in a manner becoming to one with such a lofty position.... Finally, I would like to submit a program of lectures on otology to the members of this assembly." To give lessons was an important fact for a physician because this was a good way to earn money to compensate for the low official salary given by the medical faculty. Every student had to pay to participate in these lessons. Politzer divided his lectures into six mains chapters in his own words:
1. The anatomy of the ear, with special emphasis on the topography of the middle ear and its relationship to the important neighboring structures.
2. The microscopic anatomy of the covering of the external auditory canal, the tympanic membrane, and the labyrinth.
3. The physiology of the ear, with special emphasis on experimental physiology and its application to the pathology of the ear.
4. The pathologic anatomy and histology with preparations.
5. The special pathology, diagnostic procedures, and therapy of otologic diseases and their application to the patient.
6. The operative part of otology, with special emphasis on the removal of foreign bodies, surgery for ear polyps, myringotomy, application of artificial tympanic membranes, and catheterization of the eustachian tube.
| For his first lesson, Politzer had four students; one of them was August Lucae (1835-1911) from Berlin (1). Quickly, his lessons were well attended and largely appreciated by the students (Fig. 10). Politzer gave his lectures on otologic diseases for over 46 years without interruption and received more than 7,000 students from all over the world. Vienna became an indispensable stop in Europe for the training in medicine, particularly in the special field of otology (35). |
FIG. 10. Politzer with students
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