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Theodor Billroth (1829-1894)

Theodor Billroth was born in Bergen and studied medicine in Berlin, Gottingen and Greifswald. He obtained his medical degree from Berlin in 1852 and became assistant to Bernhard von Langenbech in 1854. He was appointed Professor of Clinical Surgery in Zurich in 1860 and Professor of Surgery at the University of Vienna in 1867. He is regarded by many as the leading German surgeTheodor Billrothon of late 19th century. As well an outstanding surgical technician he was able to bring experimental medicine to clinical practice. He had radical ideas for the time on surgical training advocating a prolonged surgical apprenticeship on completion of medical studies consisting of preliminary work in hospitals followed by performing operations on cadavers and experimental animals. This would be followed by a 2-3 year assistantship in a surgical department with studies of the surgical literature and the acquisition of advanced practical skills. His ideas were taken up by many who visited him

In 1855 he wrote a monograph on colonic polyps recognising the relationship between adenomatous polyps and colorectal cancers. He was the first surgeon to excise a rectal cancer and by 1876 he had performed 33 such operations. He carried out the first oesophageal resection in 1872 and the first larnygectomy in 1874. He is best known for the two types of partial gastrectomy that are named after him.

The first Billroth I partial gastrectomy was performed on a 43 year old woman in 1881 for a pyloric gastric cancer. A 14 cm portion of stomach was excised and an anastomosis fashioned with about 50(!) carbolised silk sutures. Billroth wrote 'the operation lasted, including the slow induction of anaesthesia about one and a half hours'. The following day there was 'No weakness, no vomiting and no pain'....'Within the first 24 hours only ice by mouth, then peptone enema with wine. The following day, first every hour and then every half hour, one tablespoon of sour milk. Patient a very understanding women, feels well, lies extremely quiet, sleeps most of the night with the help of a small injection of morphia. No pain in the operative area or a subfebrile reaction'. Billroth was a close friend of Johannes Brahms and he was an occasional guest conductor of the Zurich Symphony Orchestra.

"The pleasure of a physician is little, the gratitude of patients is rare and even rarer is material reward, but, these things never deter the student who feels the call within him"

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