Karel Rokitansky

Biography

• Born on February 19, 1804 in Hradec, Králové (Königgrätz)
• 1828 – Graduated medicine, University of Vienna
• Pathologist “Allgemeines Krankenhaus”
• 1875 – Rokitansky’s final publication was the monograph Die Defecte der Scheidewände des Herzens [The Defects of the Heart Septum]. His observations of 24 patients with VSD; 20 with ASD; description of the evolution of chicken embryos; and of the origin of heart malformations.
• Died on July 23, 1878

Medical Eponyms

Mayer-Rokitansky-Küster syndrome (1838)

Syndrome characterised by congenital absence of vagina, primary amenorrhoea, rudimentary cornua uteri and morphologically normal ovaries and Fallopian tubes situated on the pelvic sidewall. Normal ovulation; normal breast development; normal body and hair.

• Rokitansky K. Über die sogenannten Verdoppelungen des Uterus. Medicinische Jahrbücher der kaiserlichen königlichen Österreichischen Staates, 1838; 26: 39–77.

Rokitansky disease (1842)

More commonly known as Budd-Chiari syndrome. Obstruction of hepatic veins by a blood clot in liver cirrhosis. Hans Chiari (1851 – 1916) was assistant to Rokitansky in Vienna 1874-1875. Together they studied and referred to the appearance of the syndrome that leads from the liver cirrhosis and ascites and results in the destruction of hepatic veins as a result of clot or mass

• Rokitansky C. Entzündung der Leber; Entzündung der Pfortader. In: Handbuch der pathologischen Anatomie. 1842; III: 324-332

Rokitansky–Aschoff sinuses (1842, 1905)

Rokitansky-Aschoff sinuses diverticula of the gallbladder wall which may be microscopic or macroscopic. They are the result of hyperplasia and herniation of epithelial cells through the fibromuscular layer of the gallbladder wall and are usually referred to as adenomyomatosis of the gallbladder. [aka *Luschka’s sinuses, crypts, glands, or ducts]

Rokitansky-Cushing ulcer

Gastric ulcer believed to be caused by hypersecretion of gastric acid, secondary to direct stimulation of the vagal nuclei from raised intracranial pressure. Treatment includes decreasing intracranial pressure, anti-acid medications such as proton-pump inhibitors, and vagotomy.

1842 – Rokitansky described in detail multiple cases of acute perforating ulcers. He also described a “softening” of the stomach lining and attributed this to stimulation of the vagus nerve.

1932 – Harvey Williams Cushing (1869 – 1939) detailed case reports of patients presenting with epigastric pain and vomiting coupled with an intracranial brain tumor who unexpectedly died of perforated peptic ulcers. Puzzled by the pathogenesis of these peptic ulcerations and perforations, Cushing proposed several theories, one of which involved advancing Rokitansky’s theory by speculating disturbance of vagal centers in the brainstem.

What has incited my interest in the subject has been the disturbing experience of having lost three patients from acute perforations of the upper alimentary canal soon after what appeared to be successful operations for the removal of intracranial tumors, and that each of these tumors happen to be situated in a cerebellum could not it seems to me be other than some significance…extrapyramidal lesions anywhere from the intracranial course of these fiber tracts from the anterior hypothalamus to vagal center, presumably from parasympathetic stimulation within, or possibly from vagal release due to sympathetic paralysis are prone to cause gastric erosions, perforations, or ulcers. Intracranial injuries and diseases affecting these same basilar regions of the brain are known to be accompanied by ulcerative lesions of the upper alimentary canal. It is reasonable to believe, therefore, that the perforations following the cerebellar operations forming the base of this study were produced in like fashion by an irritative disturbance either of fiber tracts or vagal centers in the brainstem

Cushing. Peptic Ulcers and the Interbrain; 1932: 2,32

Rokitansky-Maude Abbott syndrome (1875, 1924)

Rare congenital heart disease characterized by persistence of the interatrial ostium primum associated with a cleft of the internal valve of the mitral orifice, thus separated into two half-valves, anterior and posterior, each inserted on a special pillar.

In 1924, Maude Abbott (1869 – 1940) published on “Persistent ostium primum with cleavage of anterior mitral segment and deformity of tricuspid septal cusp. No cyanosis.”

The auricular septum presents a valvular patency of the foramen ovale and ends below in a crescentic free border which forms the upper boundary of a defect 3 by 2 cm. large, the lower border of which is formed by the overlapping upper halves of the completely divided anterior mitral segment. From an infant which presented a peculiar murmur over the precordium and was the subject of mongolian idiocy. Death at 10 months from bronchopneumonia.

[Abbott 1924; 10: 111] [Abbott 1936; Plate XIV: Fig 8]

Abbott further commented that:

Cleavage of the anterior of the mitral valve was described by Rokitansky as a practically constant feature in all cases of persistent ostium primum, and it has been present in all the cases that have come under our observation

Abbott 1924; 10: 116

Rokitansky syndrome (aka superior mesenteric artery syndrome)

In 1842 Rokitansky described a type of acute dilatation of the stomach due to compression of the duodenum by the root of the mesentery and its vessels and nerves. In the 3rd edition (1861-1863) in speaking of intestinal incarceration due to pressure of one part of the intestine or it’s mesentery on another, so as to compress it against the posterior abdominal wall, he says:

Herewith belongs the compression of the lower transverse section of the duodenum by the mesentery of the small intestine and especially, by the superior mesenteric artery and nerves contained in the root of the mesentery.

Rokitansky 1863

Key Medical Contributions

Rokitansky Humoral Pathology (Krasenlehre) (1848)

In 1848 Rokitansky proposed a hypothesis he called “Krasenlehre” with the site of the disease state being somewhere within the blood fluid embracing all organs. He postulated that atherosclerosis follows initial fibrin deposition on the vessel wall. The idea was ahead of its time, before organic chemistry or biochemistry came into existence. The wrath of Virchow ensued and Rokitansky removed the theory from the second edition of ‘Lehrbuch der pathologischen Anatomie’ in 1855.

The theory was renewed in the 1940’s and 50’s and sometimes referred to as the Rokitansky-Duguid-Astrup hypothesis

Rokitansky suggested that fibrinous deposits were produced on the vessel wall by an effect of the exudate released from injured tissue on some components in the blood. This concept was one of the main reasons for Virchow’s rejection of Rokitansky’s idea, since he thought blood clotting was caused by oxygen. Intuitively, Rokitansky reached views concerning physiological processes which forecast observations made many years later. His concepts were developed before fibrinogen was known as an entity, before thrombin was known, before the clot promoting effect of the tissue extract was known, and more than sixty years before its role as an activator and its difference from thrombin was revealed by Morawitz and Fuld and Spiro.

Tage Astrup 1958

• Rokitansky C. A manual of pathological anatomy. 1852; IV
• Duguid JB. Thrombosis as a factor in the pathogenesis of coronary atherosclerosis. J Pathol Bacteriol. 1946; 58: 207-212.
• Astrup T. Neuere Aspekte in der Blutgerinnung und der Fibrinolyse und ihren Beziehungen zur Koronarthrombose und Koronarsklerose [New aspects in blood coagulation and fibrinolysis and their relations to coronary thrombosis and coronary sclerosis]. Wien Z Inn Med. 1958;39(9):373-386.
• Astrup T: Role of blood coagulation and fibrinolysis in the pathogenesis of arteriosclerosis. In: Connective Tissue, Thrombosis and Atherosclerosis (ed. Page IH). 1959: 223-240
• Rokitansky-Tilscher U. Carl Freiherr von Rokitansky’s Manual and Rudolf Virchow’s criticism: The controversial subject of Rokitansky’s doctrine of crases and dyscrases and the groundwork for modern humoral pathology. Wien Med Wochenschr (2020).

Major Publications

• Rokitansky K. Über die sogenannten Verdoppelungen des Uterus. Medicinische Jahrbücher der kaiserlichen königlichen Österreichischen Staates, 1838; 26: 39–77.
• Rokitansky C. Handbuch der pathologischen Anatomie. 1842-1846 [Band II, Band III] with English translation: A manual of pathological anatomy. 1849-1852 [Vol II, Vol III, Vol IV]
• Rokitansky C. Entzündung der Leber; Entzündung der Pfortader. In: Handbuch der pathologischen Anatomie. 1842; III: 324-332 [Rokitansky disease]
• Rokitansky C. Handboek der bijzondere ziektekundige ontleedkunde. 1846 [2e 1849]
• Rokitansky C. A manual of pathological anatomy 1852; IV [English translation of the 1848 Lehrbuch der pathologischen Anatomie]
• Rokitansky K. Über das Auswachsen der Bindegewebs-Substanzen und die Beziehung desselben zur Entzündung. 1854
• Rokitansky C. Lehrbuch der pathologischen Anatomie 2e. 1855 [Vol II]
• Rokitansky K. Über Bindegewebs-Wucherung im Nervensysteme. 1857
• Rokitansky C. Ueber Uterusdrüsen-Neubildung in Uterus- und Ovarial-Sarcomen. 1860
• Rokitansky C. Ein Beitrag zur Lehre vom Abortus und vom fibrinosen Uteruspolypen. 1860
• Rokitansky C. Die Defecte der Scheidewände des Herzens: pathologisch-anatomische Abhandlung. Braumüller, 1875  [Rokitansky-Maude Abbott syndrome]

Controversies

Alternate names in literature: First name as ‘Karel’, ‘Karl’, ‘Carl’ or ‘Carol’; Surname as ‘Rokitanski’ or ‘Rokitansky’;

Title most often as ‘Karl Freiherr von Rokitansky’. Rokitansky became a member for life of the House Lords of the Imperial Council in 1967 and elevated to knighthood in 1874 with the title Freiherr (Baron) von Rokitansky

References

• Laffer WB. VI. Acute Dilatation of the Stomach and Arterio-Mesenteric Ileus. Ann Surg. 1908;47(3):390-416.
• Gilder SSB. Carl Von Rokitansky (1804-1878). Can Med Assoc J. 1954;71(1):70–72.
• Editorial: Carl Von Rokitansky (1804-1878). JAMA. 1963;183(13):1105-1106
• Fejfar Z, Hlaváckova L. Karl Rokitanski. Clin Cardiol. 1997;20(9):816-818.
• Weyers W. Carl von Rokitansky his life work and contributions to dermatology. Am J Dermatology 2004;26(5):431-438
• Bibliography. Rokitansky, Carl von 1804-1878. WorldCat Identities