Józef Dietl (1804 - 1878)

An outstanding physician and specialist in internal medicine, Dietl promoted modern diagnostic methods in Polish lands, such as auscultation and percussion. In the clinic he ran, he established a pathological and chemical laboratory. He protested against the practice of bloodletting in patients with pneumonia, demonstrating through well-conducted clinical studies and post-mortem observations the harmfulness of such actions. He actively fought against superstitions, such as the still prevalent belief in "kulturn" (a form of superstition or folk remedy) in Polish lands. Finally, with remarkable energy, he promoted spa treatment, researching the mineral water springs in the Galician territories, becoming one of the pioneers of Polish balneology.

Despite his father being an Austrian civil servant, Dietl considered himself a Pole. He defended the Polish character of the Jagiellonian University, which brought him into disfavor with the Viennese authorities and ended his university career. Unfazed, he continued his efforts to introduce the Polish language into schools. Unable to work scientifically, Dietl became active as a member of the Viennese State Council and, in 1866, became the first president of autonomous Krakow. Even in this position, Józef Dietl demonstrated boundless energy.

Dietl’s scientific activity was rich and multifaceted. Without a doubt, his most important achievement was conducting research on the justification of bloodletting in the case of pneumonia. Phlebotomy, or bloodletting, was a popular therapeutic method since ancient times (from today’s perspective, a pseudomedical practice). Derived from the works of the famous Roman physician Galen, phlebotomy had been used for hundreds of years, despite growing voices challenging its therapeutic value. The lack of awareness about the proper blood volume in the circulatory system meant that doctors often bled patients excessively, leading to their deaths, as was the case with the first U.S. president, George Washington, who died weakened by bloodletting during a throat infection. As early as 1842, in Vienna, Dietl published the article “Erster statistischer Beitrag zum Aderlasse in der Lungenentzündung” (First Statistical Contribution on Bloodletting in Pneumonia). This was his first statement against the practice of bloodletting used in the treatment of pneumonia at that time. Prior to Dietl, the French physician Pierre Charles-Alexandre Louis had written about this topic. In 1835, he published the results of his research using the so-called “numerical method,” which involved clinical trials on patients divided according to age and disease progression. By tabulating the data statistically, Louis found bloodletting to be of minimal effectiveness. However, his work only referred to the cases he had studied and did not formulate conclusions for the future.

The most important and highly debated work in the scientific world was Dietl’s next publication, “Der Aderlass in der Lungenentzündung. Klinisch und physiologisch erörtert” (Bloodletting in Pneumonia. Clinically and Physiologically Discussed), which was published twice in Vienna in 1848 and 1849. In this book, the Polish physician summarized his more than five years of clinical observations of a group of patients, divided by therapeutic methods into:

• Those who underwent bloodletting,
• Those who were given emetic treatments (purgatives),
• Those who were treated only with diet.

Analyzing the mortality statistics, Dietl conclusively demonstrated that the first two methods increased the risk of death (the mortality rate in these groups hovered around 20%), and therefore, they should be discontinued. It is worth noting that Dietl’s inclusion of a group of patients who did not receive any pharmaceuticals or radical therapeutic methods corresponds to what we now consider a control group or the use of a placebo. This represents one of the earliest conscious applications of such research design concepts in Polish medicine.

In his 1851 publication “O leczeniu zapalenia płuc bez upustu krwi” ("On Treating Pneumonia Without Bloodletting") in the Rocznik Towarzystwa Naukowego Krakowskiego (Yearbook of the Krakow Scientific Society), Dietl presented further data from a study of 750 male and female patients treated at the District Hospital in Vienna. He meticulously analyzed variables such as gender, age, body type, medical history, and the course of the pneumonia itself, statistically compiling all the data. He compared these clinical findings with anatomical pathology reports from autopsies of deceased patients. This research provided conclusive evidence against phlebotomy, which led, among other things, to liver-like changes in lung tissue in patients on whom the procedure was performed.

Another significant contribution of Dietl’s scientific career was his work in balneology. The idea of spa treatments was gaining increasing support at the time. The concept of using the healing power of nature was close to Hippocratic principles, which Dietl adhered to. Between 1854 and 1856, he visited prominent foreign spas, publishing his observations in 1856 in Vienna under the title “Balneologische Reisenskizzen” ("Balneological Travel Sketches"). After familiarizing himself with spas outside of Polish lands, Dietl undertook a thorough analysis of the spas in the Austrian region of Galicia in 1857. His findings were published the following year in the book “Uwagi nad zdrojowiskami krajowymi ze względy na ich skuteczność, zastosowanie i urządzenie” ("Remarks on Domestic Spas in Terms of Their Effectiveness, Application, and Organization"). In this work, Dietl meticulously described the therapeutic factors of each spa he visited, their medical indications, treatment methods, and the infrastructure of the spas, to which he dedicated much attention. As part of his rationalist worldview, he evaluated the technical and sanitary conditions necessary for effective spa treatments, pointing out many deficiencies. Consequently, he placed great emphasis on the role of spa doctors, who oversaw the best practices in therapy. It is no surprise, then, that Dietl was the initiator of the establishment of the Komisja Balneologiczna (Balneological Commission) in 1858, which, after his death, ceased its work, only to be revived in the next century as the Polskie Towarzystwo Balneologiczne (Polish Balneological Society).

From today’s perspective, Dietl’s battle against the “kołtun” (tangled hair) may seem somewhat humorous, but in his time, it had enormous significance from the standpoint of hygiene and public health. This superstition, prevalent in rural Poland since the 16th century (known abroad as plica polonica and in German-speaking countries as Weichselzopf, meaning "Vistula braid"), mandated wearing a long tuft of matted, dirty hair that had become glued together with skin secretions. It was commonly believed that cutting the kołtun was forbidden except in certain circumstances, and violating these rules was thought to lead to blindness, paralysis, or even death. Many educated Polish doctors in the 18th and 19th centuries regarded the kołtun as a disease in itself, sometimes going so far as to offer entire discourses on “kołtun diseases.”

Dietl opposed this superstition in his work titled “Kołtun. Sprawozdanie Komisji w Towarzystwie Naukowym Krakowskim zarządzone w celu zbadania choroby kołtunem zwane” ("The Kołtun. Report of the Commission in the Krakow Scientific Society Appointed to Investigate the Disease Known as Kołtun"), published in the Rocznik Towarzystwa Naukowego Krakowskiego in 1862 and also released as a standalone book. A special commission appointed by the Krakow Scientific Society, with Dietl's participation, studied cases of kołtuns and conclusively proved that there was no such thing as a “kołtun disease.” The condition of this questionable head adornment was found to result from poor hygiene and the constant wearing of head coverings, while the overall health of the individuals was unrelated to it. Dietl advocated for educating the population on the harm caused by kołtuns and, if necessary, the use of administrative measures to combat it.

In each of these accomplishments, there is evidence of Dietl’s deep love for science, understood as the necessity for meticulous observation of facts, organizing them statistically, and drawing general conclusions from these observations. His rational, objective, and scientifically grounded methods made a significant contribution to Polish science.

Biography

Józef Konrad Dietl was born on January 24, 1804, in Podbuże near Sambor, as the son of Austrian official Franciszek Dietl and a poor Polish noblewoman, Anna Kulczycka. He began his education in Sambor, continuing it in Tarnów and Nowy Sącz. In 1819, while still in school, young Dietl lost his father, which significantly worsened his financial situation.

In 1821, he enrolled at the Lviv University, where he completed a three-year philosophical course. During this time, he earned a living by giving private math lessons. Despite these difficult circumstances, he found time to study Italian and French. In 1823, after obtaining his diploma, he enrolled in medical studies at the University of Vienna, graduating in 1829. He also took a position as an assistant in the Department of Mineralogy and Zoology, where he defended his doctoral dissertation.

Dietl gained recognition from the Austrian authorities in 1830 when he was assigned to combat a cholera epidemic in Vienna. When another wave of the cholera plague hit two years later, the authorities confidently appointed the young but experienced doctor, Dietl, to lead the largest hospital for the infected.

The lack of prospects for an academic career, including the inability to assume the chair of natural history, and the need to provide financial support to his family, particularly his mother, led Dietl to pursue a medical practice. In 1833, he became the municipal physician (city doctor) for the Vienna suburb of Wieden (now the 4th district of Vienna). In 1841, he was appointed head of the internal medicine department at the local hospital, and seven years later, he became the director of that hospital. At that time, he maintained close contacts with the environment of the younger Vienna school of medicine, including Karl von Rokitansky and Joseph Skoda. Under their influence, he published a work in 1845 titled "Praktische Wahrnehmungen nach den Ergebnissen in Wiedner – Bezirkskrankenhause" ("Practical Observations Based on Results from the District Hospital in Vienna"). It was Rokitansky who set the new direction for his followers: the scientific understanding of the pathogenesis of diseases, based not only on clinical observations but, more importantly, on precise anatomopathological and chemical studies. Rokitansky himself performed over 30,000 autopsies, accumulating a rich comparative material that enabled him to analyze various diseases in different stages and thus not only accurately identify diseases but also describe their detailed progression. He also relied on the work of clinicians like Skoda and Dietl, but gave particular importance to chemical analysis, especially when anatomopathological examination did not indicate changes that could explain the severe course of a disease.

In his work, we can observe Dietl’s approach, which was brilliant and passionate. Based on his own practice, he argued that the best doctor is one who understands the essence of diseases. For the Polish physician, diseases were "pathological individuals"—independent entities of nature with a material dimension, and therefore, with physical and chemical characteristics. Understanding these diseases could not rely on mere empirical observation, but had to be grounded in anatomopathological and chemical knowledge about the nature of the ailments. For Dietl, medicine was a strictly scientific discipline, founded on mathematical principles, which, as new phenomena and laws of nature were discovered, would continually redefine itself.

From today’s perspective, the so-called "therapeutic nihilism" promoted by the Vienna school may seem like a dark side of its approach. Faced with increasing knowledge about diseases and their nature, the founders of the school confronted a lack of effective treatments for many ailments. Therefore, they believed that the role of the physician was to discover and describe the nature of diseases, leaving treatment to nature for the time being. Dietl also expressed similar thoughts in his doctoral dissertation. Here, too, he argued that physicians should focus on treating acute or obvious conditions, limiting therapeutic interventions to a minimum. Was this an indication of insensitivity to the patients’ plight? No, because for Dietl, rational and effective treatment was only possible once certain, confirmed, and verified knowledge about diseases was acquired. According to him, the flaw in earlier medical schools was that they attempted treatment without first researching the nature of diseases. The younger Vienna school, in his view, aimed to delve into these issues to enable effective treatment.

In 1850, when Maciej Józef Brodowicz stepped down from the Chair of Internal Medicine at the Jagiellonian University, the Medical Faculty began searching for his successor. Despite resistance from the Austrian authorities, who found Dietl insufficiently "loyal," the unwavering stance of the Kraków university led to Dietl’s appointment in 1851. With his characteristic energy and talent, the newly appointed professor of internal medicine began implementing modern scientific diagnostic methods in his clinic. He increased the number of beds and introduced new diagnostic techniques such as auscultation (with a stethoscope) and percussion. While waiting for him, the faculty began searching for a separate professor of pathological anatomy, but due to the lack of candidates, Dietl took over this role during his first year as a professor. Following the Viennese model, Dietl also engaged with medical chemistry, organizing and equipping a chemistry laboratory and facilitating the habilitation of the first docent in forensic medical chemistry at the University. He also ensured the clinics were properly equipped with apparatus, preparations, models, and necessary medical literature. Finally, in order to focus solely on internal diseases, he established separate departments for dermatology and venereal diseases, as well as pediatrics, which had previously been combined with internal medicine.

The preserved notes from Dietl’s students at his clinic show that he was extremely meticulous in examining patients. He conducted thorough interviews combined with physical examinations, analyzing their physiological fluids and parameters such as temperature. Contrary to the therapeutic nihilism of the Vienna school, Dietl never neglected therapy, always striving to deeply understand the patient’s condition in order to make accurate prognoses. According to him, the foundation of good treatment lay in a detailed examination of the patient, which would then guarantee straightforward treatment. He outlined this view as a motto in his "Clinical Aphorisms" (published in 1862-63), which also reinforced the stance he took in his earlier work, "Praktische Wahrnehmungen."

Dietl also worked towards promoting Polishness in education. As early as 1860, as part of a delegation from the Jagiellonian University to Vienna, he lobbied for the restoration of the Polish language in education, which resulted in only partial success. When he was elected rector for the 1861/62 term, he strongly advocated for the autonomy of the university in terms of teaching and for the full reinstatement of the Polish language in education. At the same time, he presented these demands in the Galician Sejm and, from 1861, in the Vienna State Council, to which he was also elected. For these actions, he faced a kind of punishment from the occupying authorities. Despite being elected rector again in 1862/63, his position was not approved by the Viennese authorities. A subsequent re-election in 1865/66 led not only to the rejection of his approval but also to his removal from office without explanation. Despite these setbacks, he succeeded in establishing the National School Council (a local body overseeing education) and played a crucial role in the reinstatement of the Polish language in public schools.

Dietl's final great task was assuming leadership over Kraków as its first democratically elected president. From 1866 to 1872, Dietl tirelessly worked to improve the quality of life for the residents of Kraków. He oversaw the draining of the old Vistula riverbed, creating the beautiful Dietl's Planty promenades. As president, he took responsibility for paving streets, cleaning the city, building wells, and maintaining sewers. Although his plans for a municipal water supply were never realized, he succeeded in preserving Kraków’s historical monuments, overseeing the renovation of the Cloth Hall and significantly contributing to the establishment of the National Museum there. Dietl managed to increase the city's revenue without imposing additional burdens on its residents. Under his leadership, the city established a fire brigade and the Academy of Fine Arts became independent. When a cholera epidemic broke out in 1873, Dietl chose to remain in office despite his desire to retire, actively leading the fight against the epidemic until it subsided.

Dietl died on January 18, 1878. He was mourned by large crowds of Kraków residents. Today, his majestic figure looks down upon passersby from a monument in front of the Kraków City Hall, and he is depicted in a portrait by Jan Matejko in the collection of the Jagiellonian University Museum. However, the best monument to this great physician, social activist, local government leader, and patriot is his legacy, visible in nearly every corner of old Kraków.

Bibliography

Leon Blumenstok, Józef Dietl, wspomnienie pośmiertne, Kraków 1878.

Anita Magowska, Manifest nowej szkoły wiedeńskiej, czyli choroba i jej leczenie według Józefa Dietla, „Acta Medicorum Polonorum” 2013/3.

Ryszard W. Gryglewski, Notatki z kliniki lekarskiej prof. Józefa Dietla, „Przegląd Lekarski” 2014/71/5.

Ryszard W. Gryglewski, Miejsce Evidence-Based Medicine (EBM) w historii medycyny, in: Wybrane problemy w historii medycyny. W kręgu epistemologii i praktyki, edited by Anita Magowska, Katarzyna Pękacka-Falkowska, Michał Owecki, Poznań 2020.

Tadeusz Tempka, Józef Dietl (1804-1878), in: Sześćsetlecie medycyny krakowskiej. Tom I: Życiorysy, Kraków 1963.

Author: Michał Chlipała