surgical universe, where he pioneered surgical techniques, tutored
numerus graduates from Europe and America, refined his version of
surgical residency, published numerous articles and refined his classic
textbook, promulgated the process of surgical audits (predecessor of
surgical outcomes), and inspired generations of surgical leaders. All the
while, he fostered intimate relationships with musicians and composers,
including his close friend Johannes Brahms.
Professor Theodor Billroth was uniquely poised to drive the final stake
through the vampire heart of ancient, nonsensical humoral theory and
quackery. The amalgamation of chemistry, microscopy, bacteriology,
embryology, physiology, and diagnostics heralded a stunning transitional
moment in medicine, with Billroth the unquestioned dean of surgeons. “It
was a yeasty time for researchers, and the atmosphere of the German
hospitals was a ferment of possibilities.”^8 Bloodletting, cupping, purging,
leeching, and poisoning were being replaced with careful German
laboratory studies and scientific interventions based on organ and cell
function. It was the German understanding of disease that enlightened
investigators about normal structure and function.
Billroth spent long hours dissecting cadavers and planning on surgical
interventions. He was able to pioneer abdominal surgery with careful
preparation and strict adherence to meticulous antiseptic technique.
Animal experimentation and cadaveric-rehearsed surgery emboldened the
Viennese professor; perhaps the abdomen could be entered. Nothing short
of a “godlike creative spirit,” as Mukherjee calls it, would suffice when it
came to intestinal surgery. Vienna has a centuries’ old reputation for
virtuoso performances; with Imperial spirit, maestro Billroth would take
his place for master class performances in the greatest theater in the City
of Music: the Allgemeines Krankenhaus operative theater.
In 1872, Billroth resected a portion of the esophagus and joined the
ends together. In 1873, he performed the first complete excision of a
larynx. Even more amazing, he became the first surgeon to excise a rectal
cancer, and by 1876, he had performed thirty-three such operations.^9
What seems commonplace today (abdominal surgery) is nothing short
of a stupendous magic act, in reality.
First, surgery on any part of the bowel is fraught with danger,
particularly the lowermost portion of the bowels: the colon and rectum.
Conceptually, the gastrointestinal tract connects the mouth to the anus in a