Joseph Skoda
Joseph Škoda (1805–1881) was a Czech physician.
He was a pioneer of percussion and auscultation signs in physical examination, publishing a key work in 1839 ‘Abhandlung über Perkussion und Auskultation‘ [A treatise on precussion and auscultation], in which he refined the descriptions of physical signs and the classical art of auscultation founded by French physicians Laennec and Piorry.
Škoda was a member of the triad of medical scientists ‘Dreigestirn‘, with Carl von Rokitansky (1804-1878) and Ferdinand von Hebra (1816–1880). They were responsible for the revival of Vienna as the great medical center of the world in the mid-19th century. He was a skilled diagnostician, and published renowned works in thoracic disease, particularly of the heart, aiding in the first pericardiocentesis in 1840.
He is eponymous with Škodaic ressonance (1837) on percussion, and Škoda sign (1852) of adherent pericardium.
He was described as a therapeutic skeptic and nihilist, stating: “...whilst a disease can be described and diagnosed, we can dare not to suspect to cure it by any manner of means“.
Biography
- Born 5 December 1805 Pilsen, Bohemia (now Czech Republic)
- Suffered from tuberculosis infection as a child, and desired to enter the priesthood by his parents
- 1825 – Walked by foot to Vienna from Pilsen (6 days!) to study medicine, mathematics, and physics at the University of Vienna
- 1831 – Graduated with MD from the University of Vienna
- 1833 – Assistant physician at the Allgemeine Krankenhaus (Vienna General Hospital), and worked with Karl von Rokitansky (1804-1878), a pioneer of anatomical pathology
- 1835 – Commenced private lectures and tutorials, focussing on diseases of the thoracic region
- 1839 – Worked as armenartz (doctor for the poor) in St Ulrich. During this time, Škoda correctly diagnosed The Duke of Blacas with a ruptured abdominal aortic aneurysm after the Duke’s symptoms baffled the top Austrian physicians.
- 1840 – Appointed head of the chest diseases ward at Allgemeine Krankenhaus following his diagnostic proficiency of The Duke of Blacas
- 1841 – Full physician of both the ward for chest and skin diseases at Allgemeine Krankenhaus, but handing over the latter to Ferdinand von Hebra (1816-1880) who later became a pioneer in dermatology
- 1846 – Chair of internal medicine at the Vienna school of medicine
- 1849 – At the Academy of Science meeting, Skoda supported Ignaz Philipp Semmelweis’ (1818-1865) controversial idea that puerperal fever in the midwifery wards of the hospital was due to infectious agents from other patients carried by medical staff.
- 1870 – Retired from the chair of medicine
- Died 13 June 1881 in Vienna
Medical Eponyms
Škodaic ressonance (1837)
Škoda classified the various sounds obtained on percussion according to their musical pitch and tone as a diagnostic sign in pneumonia and pericardial effusion. Škodaic ressonance refers to the tympanic resonance heard on percussion above a pleural effusion.
“that the lungs, partially deprived of air, should yield a tympanic, and, when the quantity of air in them is increased, a non-tympanic sound, appears opposed to the laws of physics. The fact however is certain, and is corroborated both by experiments on the dead body, and also, by this constant phenomenon, viz: that when the lower portion of the lung is entirely compressed by any pleuritic effusion, and its upper portion reduced in volume, the percussion sound at the upper part of the thorax is distinctively tympanitic”
Škoda, 1839
Škoda sign (1852)
Škoda described three patients with patients with an adherent pericardium and systolic depression at the intercostal spaces to the left or over the apical heart beat and diastolic elevation at the same area [1852; 314-315]
Key Medical Attributes
- Škoda was doubtful about the therapeutic interventions performed in his time, such as application of leeches, venesection, sweating, and multiple plant extracts.
- “Ach das ist jar alles eins” [They are all equally useless]
- Despite his therapeutic scepticism, Škoda still experimented with various therapies, including digitalis, salicylates, chloral, turpentine inhalation, and pleural fluid aspiration. He aided Franz Schuh (1804-1860) during the first pericardiocentesis in 1840.
Through repeated examination of patients and cadavers, Škoda classified percussion and auscultation findings with more objective descriptions compared to the organ-specific descriptions by Laennec and Piorry
Percussion:
- From full to empty
- From clear to dull
- From tympanic to nontympanic
- From high to deep
Auscultation:
- Lungs
- Breath sounds
- Pulmonary or vesicular
- Bronchial
- Amphoric echo and metallic tinkling
- Indeterminate
- Rales
- Vesicular
- Consonating
- Dry crepitant
- Amphoric and metallic tinkling
- Indeterminate
- Pleural friction
- Breath sounds
- Heart
- Pericardial friction rub in pericarditis
- Heart sounds and murmurs (which he attributed to valvular disease)
…in any disease of the heart, as long as the valves are intact, there is no appreciable alteration in the heart sounds; but in examples of valvular defects there are constant and significant variations; the heart sounds are replaced by completely different (sounds) murmurs. The heart sounds are clear if the tendinous attachments of the valves are normal; if the chords lose their elasticity, become thickened and contain calcium, the clarity of the sound is affected and if the volume is weak it becomes a murmur; if the volume is strong the sound resembles harsh snoring, grating or a bellows
Škoda (1839)
Major Publications
- Skoda J. Über die Perkussion. Medicinische Jahrbücher des kaiserlich-königlichen österreichischen Staates. 1836;9
- Skoda J. Über den Herzstoss und die durch die Herzbewegungen verursachten Töne. Medicinische Jahrbücher des kaiserlich-königlichen österreichischen Staates. 1837;13:227-266. [Skodaic ressonance]
- Skoda J. Über Abdominaltyphus und dessen Behandlung mit Alumen crudum. Medicinische Jahrbücher des kaiserlich-königlichen österreichischen Staates. 1837;15:5-46.
- Skoda J. Abhandlung über Perkussion und Auskultation. Wien: Braumüller. 1839. [Skodaic ressonance: 10-11]
- Skoda J. Ueber die Erscheinungen, aus denen sich die Verwachsung des Herzens mit dem Herzbeutel an lebenden Menschen erkennen lässt. Zeitschrift der Kais Kön Gesellschaft der Ärzte zu Wien. 1852; 1: 306–15
- Skoda J. A treatise on auscultation and percussion. London: Highley and son 1853 (4e translation: Markham WO.) [Skodaic ressonance: 46-47]
- Skoda J. Auscultation and percussion. 1854. [English translation Markham WO]
References
- Drasche A. Skoda. 1881
- Editorial: Joseph Skoda (1805-1881) – Physical diagnostician. JAMA. 1964; 190(3):240-240.JAMA. 1964; 190(3):240-240.
- Sakula A. Joseph Skoda 1805-81: a centenary tribute to a pioneer of thoracic medicine. Thorax. 1981 Jun; 36(6): 404–411.
- Fejfar Z, Hlavácková L. Profiles in Cardiology: Joseph Skoda. Clinical Cardiology 1997;20(8):740-741.
- Davies MK, Hollman A. Joseph Skoda (1805-1881). Heart. 1997; 77(6):492.
- Ye F et al. Physical Examination Signs of Inspection and Medical Eponyms in Pericarditis Part I: 1761 to 1852. Erclyes Med J 2019; 41(2): 223–229
Doctor in Australia. Keen interest in internal medicine, medical education, and medical history.