Erdheim’s Autopsy: Dissection, Motion Pictures, and the Politics of Health in “Red Vienna”

By Tatjana Buklijas (Liggins Institute, University of Auckland, New Zealand), Birgit Nemec (Research Fellow, Department for History and Ethics of Medicine, Heidelberg, Germany), and Katrin Pilz (PhD Fellow, Université Libre de Bruxelles; Researcher & Teaching Assistant, Department & Collections of History of Medicine, Medical University of Vienna, Austria)

Sometime in the last century a fragment of silent film landed at the National Library of Medicine. Like many of the older films in the collection, how it got there is a mystery: no paperwork survives to tell the tale; no other prints of the film appear to have survived; no other sources on its making or showing have turned up.^[1] The film itself gives no direct information on its origins or purpose. It has no real title or credits, only a single intertitle that tersely announces the featured player, setting, and time: “Herr Professor Doktor Jakob Erdheim Prosektor. Krankenhaus Der Stadt Wien. September 1933.” What comes after that is extraordinary, a minor landmark of medical cinema: an autopsy, perhaps the first ever performed before a motion picture camera. On screen, a bespectacled man in a white coat happily cuts open an unidentified dead man, chatting all the while with students and colleagues.

We don’t know who planned the making of the film (which we will here call, for the sake of convenience, Professor Doktor), who paid for it or provided the equipment. Most likely it was the genial autopsyist himself, Jakob Erdheim (1874–1937), a pioneering neuro-endocrinologist and cranial pathologist, an important figure in medical research and the Vienna public hospital system. The grainy black-and-white footage has the casual amateur feel of a home movie. Even so, it gives us a tantalizing glimpse of Erdheim’s skills, character and work. And documents an important location in the exemplary municipal health and welfare network that was forged in the contentious politics of Austria in the era between the end of the First World War and the start of the Second. The peculiar interest and unique qualities of the film fragment will become all the more apparent as we consider the political and professional context of Erdheim’s career in Viennese medicine, along with the contemporary enthusiasm for medical film.

The Lainz Hospital and Socialist Healthcare in the Interwar Vienna

Professor Doktor opens with a glimpse of the exterior of Vienna’s Lainz Hospital (today Hietzing Hospital). Brief shots capture the main entrance and people in the hospital gardens and buildings. We see patients meandering through the grounds, then the camera pans along the south-facing sunlit tuberculosis pavilion, with its right wing for male, and left for female patients, and open space in the middle. Lainz was originally built in 1913, as the “Imperial Jubilee Hospital,” to meet a shortage of hospital beds. (Vienna, then the capital of the Habsburg Empire, was at the peak of its population size.) Climate considerations were central to the decision to plant the hospital on the edge of the city, in the vicinity of the Vienna Woods and the Lainz Zoo, considered a more healthful location than the more polluted city center. When the Empire disintegrated in 1918, after the defeat of the Central Powers, Vienna found itself a disproportionately large and diverse city in the shrunken and ethnically homogeneous, and politically troubled, “First Republic” of Austria.^[2] In 1919, the city diverged from the rest of Austria. Vienna elected an administration of Social Democrats (“Reds”) and the provinces elected the conservative “Christian Socials” (“Blacks”). Between 1919 and the Fascist putsch of 1934 that outlawed the Social Democratic Party, the city became known as “Red Vienna,” and was the site of comprehensive, and much lauded, urban renewal and reform projects. It was also a battlefield of competing ideologies: the progressive, secular Jewish Social Democrats against conservatives supported by the Roman Catholic Church and German nationalist factions, both united by their shared and growing attachment to ideological anti-Semitism.^[3]

In the late 1920s, the renovated and renamed Lainz became the flagship of the municipal socialist healthcare system. Julius Tandler, the city councillor in charge of health and welfare from 1919 to 1934, was a Jewish anatomist who converted to Christianity, a Social Democrat, and a friend of Erdheim. Tandler called Lainz “his” hospital.^[4] In 1931, Lainz had 2,000 beds (out of 22,000 municipal hospital beds). It also had the aforementioned tuberculosis-pavilion, and a department for each of the exciting new disciplines of endocrine and nutritional diseases, dietetics and radiotherapy.

Lainz was the city’s premier public hospital not only for its size but also for its research performance.^[5] The Red Vienna reform program set out to remake the city into a population of healthy, strong, optimistic “New Men” (neue Menschen), a vision of the socialist future that brought together clinical medicine, medical research and municipal reform.^[6] At the non-academically affiliated Lainz, research played a vital role in developing an idiosyncratic social welfare program.^[7] In contrast, the university hospitals—funded from the “Black” province of Lower Austria—dealt with individual treatment and research apart from social policy. Lines were drawn. The right-wing Catholic newspaper Reichspost denounced Lainz as a “Trutzuniversität,” a “counter-university” established in opposition to the conservative University of Vienna administration.^[8]

Without any strong direction or intention, the casual footage of Professor Doktor hints at Lainz’s ideological affiliations. Public hospitals were sometimes shabby and out-of-date, but here we see modern materials, facilities and methods: a spacious tiled room, porcelain dissection table, the use of gloves and professional equipment (the autopsy instruments placed on the table, and on the cadaver). Erdheim was an advocate for modern methods in public hospitals. He and his colleagues were proud that Red Vienna’s hospitals met the highest scientific and sanitary standards and contributed to the development of medical science, in order to better serve the clinical needs of patients and the public in a newly constructed system where every citizen was entitled to free healthcare.

Introducing Jakob Erdheim, Pathologist

Mostly Professor Doktor shows the pathologist at work. In 1933, Erdheim was at the peak of his career, the head of the hospital’s Department of Pathological Anatomy (today the Jakob Erdheim Institut). Surrounded by white-gowned students and colleagues, he dissects a cadaver; at a side-table, others work on a body-part.

The evident pleasure with which the pathologist conducts his brief anatomical performance is an odd sight in the medical cinema of the 1930s: contemporary anatomists and surgeons only rarely appear on screen, and if they do appear, they assume a more sober demeanor. But Erdheim gesticulates, chats with colleagues, smiles throughout. He begins the autopsy with a flourish, uses his scalpel to make a swift and certain Y-cut: the procedure still used today to open up the body in autopsies.^[9] He then dissects the chest, cuts the ribs open, examines the lungs. Extracting the major thoracic organs, he places them carefully alongside the middle-aged male corpse. He then works towards the pituitary gland—one of his main research interests. The camera doesn’t show Erdheim peeling down the skin of the face—is he deliberately sparing the viewer this difficult scene?—but it does show him removing the scalp and examining it for a moment. He then takes a small chisel to detach the part of the skull that covers the area of the pituitary gland. Later we see him remove and clean the brain, before he turns to his audience, apparently explaining the structures at the base of the gland.

Erdheim’s road to prominence as a clinician and scientist was typical of his generation. He was one of six children of a mine-owning Jewish family in the eastern province of Galicia (then a part of Austria-Hungary, today part of Poland). His family moved to Vienna during his childhood, in the big wave of Jewish immigration from the east that followed the Austro-Hungarian constitutional reform of 1867. Erdheim graduated from the Vienna Medical School in 1900, then joined the Institute of Pathological Anatomy of the University of Vienna. He trained under Anton Weichselbaum and was later promoted to assistant. He received his teaching license (venia docendi) in 1913 and appointment to extraordinary professorship (Extraordinarus) in 1916.^[10]

The Imperial Jubilee Hospital’s department of pathology was the first such unit to be established outside a university, in 1913. Within the hospital’s park-like grounds, a modern morgue was constructed and given a prominent location next to the tuberculosis pavilion. In 1923, Erdheim succeeded Rudolf Maresch as head of the department. Once appointed to the chair, Erdheim became the city’s premier pathologist.^[11] Red Vienna health politics aimed at improving both the individual health and the “human capital” of the city. To that end, Julius Tandler sought to foster close collaborations between clinicians, anatomists and pathologists. With clinical colleagues Tandler developed “pathological topography” of organ systems and bodily regions (i.e., the anatomical relationships between organs in pathological conditions), using X-rays to visualize living anatomy, and building models to simulate the living body.

The experience of the First World War—mass starvation, epidemic and chronic disease, as well as mass slaughter and injury—inspired Tandler to focus on populations and not just individual patients. While today eugenics is commonly associated with maltreatment, segregation, sterilization and the murder of groups deemed inferior (“negative eugenics”), in the early twentieth century the term also encompassed a broad range of programs and methods that sought to harness science to improve the lives and bodies of the people. Tandler’s “productive” eugenics was not based on a Darwinian or Mendelian fixed notion of heredity but instead on Neo-Lamarckism, a more fluidly environmentalist theory of evolutionary development.^[12] The doctrine, which owed its name to Lamarck’s theory of the inheritance of acquired characteristics, suggested that the environmental changes, mediated through the activity of glands, could produce new heritable traits. If so, progressive reform—premarital counselling, support for children and parents (new-born layettes, kindergartens, free maternity and pediatric care), good nutrition, better housing, and access to healthcare for all adults—could improve the race.^[13]

Like Tandler, Erdheim also brought wartime experience with bacteriology, military medicine, and hygiene education into his post-war work. Though affiliated with the University of Vienna, in his early career Erdheim had acquired much clinical and teaching experience before taking the Lainz position.^[14] He had been an Aspirant at the department of dermatology and syphilis of the General Hospital, an anatomical demonstrator in St.-Anna-Children’s Hospital in Vienna, and successfully fought a typhus epidemic in Serbia during the Great War.^[15] The diversity of his professional work is reflected in publications on rickets, tuberculosis, and scoliosis.^[16] (His name appears, alongside the American pathologist and visitor to Lainz, William Chester, in Erdheim-Chester disease, a rare form of macrophage multiplication and expansion.)^[17]

At Lainz, Erdheim worked hard, slept little, hardly ever left the hospital. A loner who never married and who had few close friends, he was regarded as an eccentric, yet was well liked by those who knew him. He was not politically active (though he likely fellow-travelled with the Social Democrats). However, with growing anti-Semitism and the sharpening political polarization of interwar Vienna, he experienced difficulties. Even in earlier times, Jewish academics often had a hard time getting university appointments, but the increasingly contentious racial politics of interwar Austria made university career paths even more problematic, and probably pushed Erdheim to move to the municipal hospital system.^[18] Independently wealthy (he inherited oil-rich land in Galicia), he used part of his inheritance to build a pathological institute in Tel Aviv, an indication of Zionist sympathies.^[19]

Medical Filmmaking in Early 20th-Century Vienna

In the early decades of the twentieth century, the moving picture appeared as a herald of the modern era, a technology of transformation. Medical professionals were especially enthusiastic: the motion picture promised to open up new ways to scientifically study biological organisms and the human body, new ways to document conditions and treatments, new ways to teach. Targeted at different audiences and produced for different purposes, medical filmmaking emerged at the intersection of experimentation, training, pedagogy, advertisement, and entertainment.^[20]

Experiments with film as a medium of medical visualization date back to the late nineteenth century. The physiologist Salomon Stricker (1834–1898) and his assistant Ludwig Braun (1867–1936) promoted visual aids in medical education and research practice, and were the first in Vienna to experiment with the “cinematograph” for medical purposes.^[21] In 1897, they produced a film on “cardiac activity in a dog”.^[22] It demonstrated the movement of a beating heart during vivisection of a dog at the Department of Physiology of the University of Vienna.^[23] Stricker and Braun made early pathological-physiological films, micro-pathological serial photographs and motion pictures, and presented their electrical Episkop (an overhead projector used for showing microscopic serial photographs) at Urania, the headquarters of the public education movement in Vienna.^[24]

Red Vienna filmmaking was especially influenced by German developments. In the United States, and many European countries,^[25] medical films were mostly funded by charities such as the Red Cross and the Rockefeller Foundation or privately.^[26] But in Germany and Austria, medical films were initially produced with state funding, under state supervision. In Austria, the Staatliche Film-Hauptstelle (FHS) was founded in 1918, upon the model of Germany’s Universal Film AG (UFA). Both FHS and UFA had strong ties to the public education movement, especially Urania, which engaged the wider public with scientific films in theater-like demonstration halls.^[27]

Death, Dissection and Movies in Vienna

Vienna was then a great center of scientific medical research and learning. Students came from all over the world to study there and the international fame of its great medical school rested, in part, on its abundant supply of patients and dissectible cadavers. In the Catholic Hapsburg empire, where absolutist monarchs ruled over a diverse and numerous population, the medical profession was granted access to the bodies of deceased patients who had no survivors, or whose kin lacked the means to provide for a funeral. In the hospitals where middle- and upper-class doctors gave treatment, a utilitarian quid pro quo took hold. The price of free healthcare was that clinicians and students could do as they wished with their poor patients, both before death and after.^[28] Hence the ease with which Erdheim performed an autopsy before the camera: he was only responsible to the hospital authorities and his colleagues.

The autopsy, of course, only appears in a film fragment that was never shown to the public, and probably never intended for public showing. But it was made in a culture where the representation of human remains, and even the showing of actual remains, was a common occurrence. For centuries, the body parts and skeletons of saints and monarchs had been exhibited to the Austrian public for centuries in sumptuously decorated churches. And, contemporary to Erdheim, Vienna’s art scene was notorious for its extravagant representations of disease and death (Gustav Klimt’s Medizin, 1901), dissection (Herbert Boeckl’s Die Anatomie, 1931), and surgical operations (John Quincy Adams’s Die Operation, 1909, with four surgeons hovering over a half-covered female body, surgical instruments stuck into the blood-red mass of the uterus at the centre of the painting).^[29] There was also Vienna’s Pathologisch-Anatomische Museum, located within the confines of the former General Hospital. It showed (and continues to show) specimens of human body parts, foetuses, and children, dried and in jars, as well as wax moulages of disfiguring skin and venereal diseases.^[30]

Even so, this relaxed attitude towards the showing of patients, corpses, pathological conditions, and human remains did not entirely overrule resistance to the public showing of those difficult subjects on the silver screen. Scenes from clinical films, with surgical operations and pathological specimens, and occasionally cadavers, originally intended only for medical audiences, were sometimes repurposed as stock footage for use in public health films. Throughout the 1920s, Viennese scientific and lay audiences could see pathological specimens in Hygiene der Ehe (Marital Hygiene), Die Tuberkulose (Tuberculosis), Geschlechtskrankheiten (Sexually-transmitted Diseases), and other films.^[31] But this gave rise to controversy. The showing of these difficult subjects was fiercely debated by critics and the national health administrators responsible for the evaluation—and censorship—of film scenes for public demonstration.

Here, as elsewhere, there was a split. In conservative Catholic (Christian Social) Lower Austria these films, or just the parts showing invasive and pathologic images, were mostly prohibited from further public distribution. But in Red Vienna, lay audiences, were permitted to see. Julius Tandler, and other Social Democratic health officials and clinicians, argued that these pictures were entirely appropriate for the wider public.

There was another impetus for the showing of cadavers on screen. Within the medical profession, medical films were increasingly promoted as a substitute for the use of patients and cadavers. In Vienna, students and clinicians enjoyed easy access to corpses until about 1920, when a surge in student population, combined with an economic and political crisis, and a great reduction in the national population, suddenly diminished the supply of cadavers. In the late 1920s, the anatomist Ferdinand Hochstetter obtained funding to promote the development of an anatomical film archive as a solution to the problem of cadaver shortage.^[32] The grant enabled his assistants Eduard Pernkopf and Gustav Schmeidel to produce a series of anatomical instructional films. From the late 1920s onward Hochstetter’s department used films in anatomical teaching.^[33]

Pernkopf would later enjoy a meteoric career as the leading Nazi academic at the Vienna Medical School, going from Second Anatomical Chair (1933) to vice-chancellor of the university (1943). In 1945 he was dismissed and imprisoned by the Allies.^[34] His anatomical atlas, considered by some a scientific and artistic masterpiece, is notoriously tainted by its use of the bodies of executed prisoners and the appearance of swastikas.

Pernkopf’s work in medical film is less well known. In 1927, discussing a series of amateur anatomical films he and Schmeidel had produced, Pernkopf argued that pathologists could benefit from the new medium more than surgeons, because pathological research material, the cadaver, was stationary and not covered in blood, unlike subjects in surgical films, hence more legible in black-and-white motion pictures. Rudolf Maresch, Jakob Erdheim’s predecessor at Lainz, supported Pernkopf’s argument by showing two films of the dissection of the heart at a lecture, taken from his own medical film collection.^[35]

Medical Film in the Late Red Vienna

The increased interest in anatomical and pathological motion pictures was part of a larger movement.^[36] The early and late interwar period was the heyday of medical filmmaking in Vienna, especially in the fields of surgery, orthopaedics and microbiology. The more advanced film productions, mainly under the aegis of university medical departments, were nationally funded and professionally assisted by the successor to FHS, the Österreichischer Lichtbild und Filmdienst des Bundesministeriums für Unterricht (OeLF).^[37] Lechner, a Viennese manufacturer of photographic equipment, often participated in individual film projects and commissioned pieces.^[38] Lechner-Medizinfilm cooperated with department heads at the Wilhelmina Hospital to produce series of surgical, micro-physiological and gynaecological-obstetrical films, for screening in medical education and professional meetings.^[39] The films that Lechner coproduced enjoyed more freedom with regard to content, style and composition.

Medical filmmaking grew in popularity in the 1930s, especially in the fields of surgery, psychiatry and neurology.^[40] Surgeon-filmmakers promoted film as a way to study, analyze and rationalize surgical procedures, document rare and common operations, and visualize otherwise invisible details. The filming of neurological pathologies allowed researchers to capture sequences of involuntary movement disorders, and to analyze them with the help of cinematographic techniques such as slow motion and zoom.^[41] Yet clinicians and scientists also criticized the film medium. They worried that the scientific value of motion pictures was overstated, that film could degenerate into a vehicle for self-promotion, and feared it would distract from research.^[42] Notwithstanding the enthusiasm for the use of film in medicine, this ambivalence, combined with reluctance to expose the public to the difficulty of medical subjects (the dead body, disfigurement, wounds, surgeries, great suffering, etc.), meant that the medical motion picture came to be hard pressed to justify itself.^[43]

In 1932 a series of screenings of FHS clinical films made between 1918 and 1924 was organized to review filmmaking practices, assess the films’ educational value, and to respond to critics.^[44] Prominent members of the local medical community, such as faculty members and heads of clinical departments, including Lainz Hospital, and representatives of health organizations (Volksgesundheitsamt) and education centers (Urania), attended these exclusive screenings, at the behest of OeLF.

Jakob Erdheim was undoubtedly well acquainted with the enthusiasm for medical motion pictures, and well aware of this swirl of activity.^[45] Oddly, while Lainz was in many ways the leader among municipal hospitals, and some films were made there, it had no institutional commitment to medical film.^[46] Beyond that, although motion pictures dealing with specialized topics did sometimes include anatomical or pathological elements, films devoted purely to anatomy and pathology were rare, and the topic of post-mortem dissection was entirely neglected. One may wonder then whether Erdheim hoped to remedy that. If so, Professor Doktor may be more than a scrap of amateur moviemaking, and instead a casual screen test, an informal trial run that, for some reason, never went any further than an impromptu one-day shoot.

Underscoring that possibility, we should emphasize that, in the clinical films of the 1920s and ‘30s, the division between amateur and professional production was not entirely distinct.^[47] The camera that Erdheim used was probably professional equipment, and the scenes are well lit, something that was hard to do in surgical and anatomical filmmaking, which required special lighting equipment.^[48] But the camera work is jittery and the composition and editing deficient compared to contemporary professionally produced clinical films.^[49] And, as previously discussed, the film has no credit and no narration, is just a visual record of some portions of an autopsy as it proceeds in the customary order.^[50] We don’t know who was involved, but considering Erdheim’s personal wealth, and the fact that researchers often invested own money in the making of medical films, it is likely that Erdheim himself paid for the production, and recruited a medical assistant or colleague to work the camera, rather than a professional operator. (In this period, hand-held 16mm film cameras were newly arrived on the scene; they were much lighter and easier to handle, but still had to be cranked.^[51]) That would explain why the camera sometimes appears to be unsure whether to focus on Erdheim or the dissected cadaver and body parts.

In any case, Erdheim’s autopsy, and full appearance onscreen, is unlike other contemporary anatomical films, which were made to be teaching aids for medical students. Eduard Pernkopf’s OeLF-sponsored series of anatomical films (1929 to 1934) showed only the operative field, and the dissecting hands of the anatomist to demonstrate procedures, techniques, instruments, and skills to students.^[52] The contemporary visual standard, established by Von Rothe for the surgical film, purposely did not show the surgeon, to avoid any criticisms of filmic self-promotion, like those that had arisen in response to the earlier and still controversial surgical films of Eugène-Louis Doyen.^[53]

Professor Doktor, then, has very little in common with contemporary medical films, and nothing in common with contemporary public health and hygiene films, which often mixed in voice narration, composed soundtracks, fictional elements, and anatomical diagrams with clinical settings. Instead, we see something very real, a bit of cinema verité—Erdheim relaxed, interacting with students while performing a dissection, a private documentary that captures him joyfully doing his work, a little bit of screen magic that very modestly, intimately, capitalizes on the uneasiness or thrill that only viewings of dissections, cadavers and death can provoke.

Coda

Professor Doktor was made in 1933, the last year of Red Vienna. In 1934, the Catholic Austro-Fascist party came to power. Life for Social Democrats and other political opponents became more difficult but a bit safer for Jews.^[54] (The new ruling party actually managed to protect Jews at the University better from violent anti-Semitic attack than Red Vienna—and Nazi terror was banned.) Erdheim, who had no political party membership, was able to keep his position as head of the Lainz pathology department. He died in 1937, at age 63—the post-mortem examination revealed the cause, a heart attack. In 1938, a year after his death, the armed forces of the Third Reich crossed the border and annexed Austria (the Anschluss). The Nazis won control of the Austrian state. Erdheim never had to witness and suffer from the wave of dismissals and persecutions that followed. In those dark days, his friend and pupil, Ernst Freund, rescued a large portion of manuscripts, drawings and other materials that Erdheim had saved to document his work. Freund moved from Vienna to Florence and then to the U.S. We do not know for sure if Professor Doktor came to the National Library of Medicine directly as a gift from Freund, but it seems likely that the extraordinary film fragment presented here was once part of those precious holdings.^[55]

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