Surgery stories

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Polish Patriot.

Polish Patriot.

There are not many people in our history who made so much contribution for the country and development of Polish medicine, as Ludwik Rydygier. Born in 1850 in Dusocin, in a small village in kujawsko-pomorskie province, he spent his childhood surrounded by the reality of partitions. However, his father’s German-sounding surname, Riediger, did not prevent Ludwik from manifesting his patriotic attitude. He passed his baccalaureate examination, then went out into the world in order to acquire a longer-for medical profession. He first studied at the Faculty of Medicine in Cracow, then in German Greifswald. It was then, when staying abroad, that he changed his surname as translated into Polish – Rydygier – with no regard to repressions of the environment.

He gained his professional experience, among others, in Chełmno, where he had his private practice, as well as in the already mentioned Greifswald, Cracow, Jen, Gdańsk and Lvov. It was at the Lvov University where he obtained his title of a professor and became the head of the clinic of surgery there.

Ludwik Rydygier became also famous as an activist during IWW. He worked then in a hospital in Brno, and participated – in November 1918 – the fights for the liberation of Lvov, which was his beloved city. He became famous as an outstanding military doctor, an organiser of first-aid service, the so-called Eaglets. He also obtained the rank of Brigadier-General.

Honest nonconformist.

Ludwik was famous for his accuracy, fascination with new technologies, a will to modernize hospitals where he worked and great courage. It is enough to read the anecdote which shows Rydygier’s bravado. During his audience with the Archduke of the Austro-Hungarian Empire, the doctor did not hesitate to present a bold idea, saying that the world was moving forward and it’s time to install lifts in hospitals. As a comment to the suggestion given by the monarch that people had coped themselves well for many years without such equipment, he was to said: “Your Imperial Highness! When we were young, we went to shit behind the barn, but today it is impolite!”

Another curiosity says about his unconventional approach towards cleanliness in operating rooms. This keen supporter of antiseptics and aseptics, did not use surgical gloves or cauls when he operated. Despite the fact, the mortality rates of the operations performed by him were very low.

Unfortunately, though he was a mentor for many outstanding doctors, some of his bold views are mentioned as disgraceful. Among others, it refers to loudly expressed objection against accepting women to the faculty of medicine, when Rydygier took the position of the chancellor at the University of Lvov. Women – adepts of surgery often became victims of his repressions.

Rydygier’s method.

We know him, first of all, as an author of the Rydygier’s method, namely Billroth I, used during operations in which the pylorus is removed and the distal stomach is anastomosed directly to the duodenum (gastroduodenostomy). Description of the operation, divided into acts, has been preserved until today, and reads follows: „Act I – cutting the skin and peritoneum, from the xiphoid process to the umbilicus and sewing the peritoneum with the skin with the use of catgut stitches. Act II – exposure of the pylorus with a tumour, skeletonization of a 5-centimetre long part of the stomach, ligation of vessels, placing flexible braces on the duodenum and stomach. Act III – resection of the pylorus with a tumour. Act IV – gastroduodenostomy with the use of 60 stitches. Rydygier levelled the differences in stomach cross-section (bigger) and duodenum cross-section (smaller) by cutting a wedge out of the big stomach curvature. Act V – sewing of abdominal linings .”[1] Though Rydygier performed the difficult, pioneer operation as the second person in the world (after the French doctor, Péan), and published description of its course in „Przegląd Lekarski” on 11 December 1880, his patient dies, so his surname was not mentioned at first in the history of medicine. The way of operation is known under a different eponym, as Billroth I, originating from the surname of the first surgeon who successfully performed the operation. It was a big blow for Ludwik, maybe the greatest one in his career. Actually, it was not the first time when Theodor Billroth thwarted Rydygier’s plans. Many years ago, he prevented Rydygier from taking up the position of the head of the chair at the Jagiellonian University. Many years of fights finally led to the situation, in which the method began to be described also with the use of the Polish surgeon’s surname. And the doctor himself, taught by his experience, quickly described and published all the improved operations in medical magazines.

Ludwik kept introducing innovations which revolutionized surgery, one by one. He was the first person to introduce the method of gastric ulcers treatment with the use of partial gastrectomy and gastrointestinal anastomosis. It is the method used until present in case of bleeding and perforations. Ludwik’s was an exceptionally versatile person – he performed gastrological, gynaecological and urological operations, and even dealt with pseudarthroses. Actually, he practised orthopaedics comprehensively, cooperating with Robert Koch in the use of tuberculin for treatment of tuberculosis of bones. He based his habilitation thesis on the description of innovative methods used in bone anastomoses and blocks. Moreover, he considerably developed gynaecology and urology. He performed operations of ovarian, cervical or breast tumours. He is also an author of a pioneer method, also called the Rydygier’s method, involving resection of the prostate gland in case of adenoma, with no damage to the urethra. He also operated aneurisms and proposed an innovative access to the heart muscle without interfering with pleural continuity. He performed operations in the scope of plastic surgery as well. He was the first to use musculocutaneous flaps to reconstruct various tissues. He spent many years with a vice, learning how to perform tight anastomoses with the use of scarce equipment available during that period. It is really remarkable how much you may achieve if you have only a scalpel, stitches, a vice and a head filled with daring ideas. Rydygier himself is called a father of the ‘surgical school of Lvov’, which established innovations and maximum shortening of the operation time as its goals.

Perfect teacher.

In the Rydygier’s clinic, not only new methods were used, but also a new generation of enthusiastic doctors was trained and great care was given to perfect organisation of work. The discipline bore fruit – the first operations involving intussusceptions in intestinal obstructions, temporary removal of the sacrum when removing a rectal tumour, setting the spleen through its stabilisation in the peritoneal pouch or esophageal plasty following burns – these are examples of the operational techniques initiated by Ludwik, immediately popularised throughout Europe.

Rydygier trained a whole generation of outstanding doctors, paying particular attention to handing them down with his passion for the profession. He also acted actively in the Society of Scientific Assistance, trying to get support for the students in need. He also revolutionized the curriculum for the adepts of surgery at the Jagiellonian University, introducing innovative teaching methods, among others, holiday practices for students or individual scientific and research works.

His merits are, for sure, visible even today. Apart from introducing innovative surgical methods, he also contributed to the establishment of the White Surgery in Cracow, he initiated conventions of the Society of Polish Surgeons, as well as participated in the plans of establishing the Military Medical Academy.

Rydygier is one of the most unusual figures in the history of medicine. His enormous scientific output, published in international magazines, serves as the foundation of surgery until present. It may even be stated that professor pursues his life goal even after his death, with the use of an exceptional medical legacy – he still teaches next generations of Polish doctors.

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