Johann Nepomuk von Nussbaum: The Surgeon Who Believed an Englishman
In the mid-1870s a professor of surgery in Munich did something his profession found almost insulting: he accepted that a Scottish surgeon in Glasgow had been right, and that everything his own wards had been doing was killing people. Johann Nepomuk von Nussbaum went to learn Joseph Lister's antiseptic method, brought it back to Bavaria, and then wrote the manual that carried it through German-speaking surgery. His guide to antiseptic wound treatment ran to five editions and was translated across Europe. It is the least original thing he ever did, and it saved more lives than all his innovations combined.
A Munich Life
He was born in Munich on 2 September 1829 and died there on 31 October 1890, and he is buried in the city's Alter Südfriedhof. The whole arc of a career that reshaped German surgery took place inside one city, at one university.
He studied at the Ludwig-Maximilians-Universität under Karl Thiersch and Franz Christoph von Rothmund, two of the leading figures in Bavarian surgery, and took his doctorate in 1853. His dissertation was on the artificial cornea — *Ueber Cornea Artificialis* — which is a striking subject for a young man in 1853, an attempt to replace a diseased window of the eye with a manufactured one. The instinct it reveals, that the body's failed parts might be substituted rather than merely excised, runs through everything he did later.
The Grand Tour
Between 1853 and 1857 he did what ambitious young German surgeons did: he travelled, and he attached himself to the best operators in Europe. In Paris he worked with Auguste Nélaton, Charles Chassaignac and Jules Maisonneuve; in Berlin with Bernhard von Langenbeck, the most influential German surgical teacher of the century; in Würzburg with Textor.
This was an education in technique acquired by watching hands. There were no journals with photographs, no film, no way to learn an operation except to stand beside someone performing it. Four years of that, across three national traditions, gave Nussbaum an unusually cosmopolitan repertoire — and, more importantly, the habit of going to look at what other people were doing rather than assuming his own school had it right.
The Chair
He returned to Munich, became a *Privatdozent* in 1857 with work on diseases of the cornea, and in 1860 — at thirty-one — was made professor of surgery at the university. He held the chair for almost thirty years, until his death.
His teaching was resolutely practical. He produced something close to a hundred publications across his career, on ovariotomy, bone transplantation, hernia repair and the surgical treatment of cancer — the working problems of a general surgeon, addressed one at a time. He also designed an orthopaedic device, remembered as Nussbaum's bracelet, for the treatment of writer's cramp, which is a fair illustration of his range: from removing ovarian tumours to fixing the hand of a clerk.
Spencer Wells and the Ovary
In the early 1870s he went to England to study with Thomas Spencer Wells, the surgeon who had made ovariotomy — removal of a diseased ovary — into a survivable operation at a time when opening the abdomen was very close to a death sentence.
The lesson of that visit was arithmetic. Wells's results were better than the Continent's, and they were better for reasons of technique and cleanliness rather than genius. Nussbaum was the sort of man who could look at another surgeon's mortality figures and change his own practice accordingly, which sounds unremarkable and was in fact rare.
Lister
The great decision followed. Joseph Lister had proposed in the 1860s that wound infection was caused by living organisms and could be prevented by carbolic acid, and much of the surgical establishment — particularly in Germany — had received the idea with scepticism or contempt. Surgical wards of the era were places where clean amputations went septic and patients died of hospital gangrene and blood poisoning as a matter of routine, and the profession had largely made peace with it.
Nussbaum learned antisepsis from Lister and imposed it on his own clinic, where it markedly cut deaths from infection. Then he did the thing that mattered more: he wrote *Leitfaden zur antiseptischen Wundbehandlung*, a practical guide to antiseptic wound treatment, and made himself the method's advocate in Germany. The book went through five editions and was translated into several languages, and Nussbaum is credited as instrumental in getting Lister's system into German surgical clinics generally.
He was also the consultant surgeon-general to the Bavarian troops in the war of 1871 — which meant he had seen, at industrial scale, exactly what wound infection did to healthy young men.
Why Johann Is Called a Genius
The honest answer is that Nussbaum was not an original thinker, and the sources do not present him as one. The idea that made his reputation was Lister's. The operation he improved was Spencer Wells's. His teachers were Thiersch, Rothmund, Langenbeck and Nélaton, and his surgical style was assembled from theirs. He discovered no principle and named no disease.
What he had was a quality that the history of medicine undervalues badly, because it is unglamorous and involves admitting error: evidential humility on a scale that changed a national practice. German surgery in the 1870s had every professional and nationalistic incentive to reject an English innovation, and most of it did. Nussbaum, an established professor with a chair and a reputation, went to look at the evidence, concluded that his own tradition was wrong, adopted a method that made him personally ridiculous in the eyes of colleagues, and then campaigned for it in print until the profession moved. That requires an unusual combination of intellectual honesty and social nerve, and it is not the same virtue as inventiveness — it is arguably rarer.
The counter-case is straightforward and should be conceded. If genius means origination, Nussbaum has no claim to it: he was a superb technician, a prolific and useful writer, and an early adopter. The hundred papers are competent contributions rather than landmarks; the bracelet for writer's cramp is a curiosity. He is remembered because he was right about someone else's idea sooner and louder than his peers. But the distance between a discovery and a standard practice is where most medical progress is lost, and Nussbaum's whole career was spent closing it.
Legacy
Nussbaum's monument is a negative one — the infections that stopped happening in German operating theatres in the last quarter of the nineteenth century, and the surgery that became possible once they did. Every abdominal, joint and reconstructive operation that German surgeons attempted after 1880 rested on the assumption he had helped install, that a wound could be protected from putrefaction.
He was a devout Catholic to the end and died, according to the encyclopedia entry that records his life, pronouncing the words "Praised be Jesus Christ." Thirty years in one chair at one university, a hundred papers, a manual in five editions, and a city that still holds his grave: it is not the biography of a revolutionary. It is the biography of the person a revolution needs in order to actually arrive.
Achievements
- Held posts at Ludwig-Maximilians-Universität München
- Fields: medicine and surgery
