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J Med Biogr OnlineFirst, published on March 6, 2015 as doi:10.1177/0967772014555301

Original Article

Victor Eisenmenger (1864–1932): The man behind the syndrome

Journal of Medical Biography 0(0) 1–4 ! The Author(s) 2015 Reprints and permissions: sagepub.co.uk/journalsPermissions.nav DOI: 10.1177/0967772014555301 jmb.sagepub.com

Martin Duke

Abstract Although much has been written about the cardiovascular abnormalities present in Eisenmenger’s syndrome, little has been recorded previously in the medical literature about Victor Eisenmenger, the Austrian doctor whose name is attached eponymously to this disorder. Archival material together with information provided by his descendants and relatives has been gathered to make available further details of his life, family, schooling, medical training and accomplishments. An examination of Eisenmenger’s book about his observations and experiences while serving from 1895 to 1914 as personal physician to Archduke Francis Ferdinand, the heir presumptive to the Austro-Hungarian throne, also sheds light on Eisenmenger’s personality, abilities and interests.

Keywords Victor Eisenmenger, Archduke Francis Ferdinand, Austro-Hungarian throne, Eisenmenger’s syndrome

In 1897, an article by Dr Victor Eisenmenger entitled ‘Die angeborenen Defecte der Kammerscheidewand des Herzens’ [‘The congenital ventricular septal defects of the heart’] appeared in a German medical journal.1 During the years that followed, the anatomy, physiology and diagnostic features of the abnormalities described in his report became better understood and increasingly relevant to the practice of cardiology.2–4 It was during these years that Eisenmenger’s name became attached eponymously to this disorder.2,3 Previously, biographical and personal details about Victor Eisenmenger have been sparse and difficult to locate.4,5 For this reason, archival material was obtained and his descendants and relatives were contacted in order to make additional information about him available.

Family background Victor Eisenmenger (Figure 1) was born in Vienna on 29 January 1864, the son of August Eisenmenger (1830–1907), an accomplished Austrian painter of portraits and historical subjects and a Professor at the Academy of Fine Arts of Vienna, and his wife Emma, born Singer von Wyszogurska (1841–1907).6 Victor died almost 69 years later on 11 December 1932,7,8 apparently from stomach cancer,9 and was buried in

the Ottakringer Friedhof, a cemetery in the 16th district of Vienna. In 1977, his remains were reinterred in the tomb of his father in the Zentralfriedhof, the central cemetery of Vienna.10,11 Victor and his wife Anna, born Hoberg (1874–1944), had two daughters (Figure 2), Anna (Annie) who became a talented sculptress and Hilde who was an accomplished tennis player.8,11 He also had two brothers—Ewald, a ‘Hofrechnungsrat’ (a civil servant of the financial administration) in the AustroHungarian monarchy12 and Hugo who moved to the United States and was a well-known electrical engineer in New York.7

Medical training Victor attended the Akademisches Gymnasium, founded in the 16th century and the oldest secondary school in Vienna.13 He pursued his medical studies at the Faculty of Medicine of the University of Vienna

Honorary Medical Staff, Manchester Memorial Hospital, Manchester, CT, USA Corresponding author: Martin Duke, Manchester Memorial Hospital, 186 Jerry Browne Road, #5416, Mystic, CT 06355, USA, Email: [email protected]

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Figure 1. Dr Victor Eisenmenger (1864–1932) (reproduced with courtesy of Dr Othmar Karzel, Salzburg, Austria).

from the Winter of 1882/1883 until the Summer of 1887,13 stating many years later that an artistic career and a study of natural science were both denied to me, the former because my talent was not sufficiently pronounced, the latter due to the fact that I was forced to earn my living as soon as possible. Thus, I decided to study medicine.14

Completing his final exams in the years 1887– 1889, he received his medical degree on 23 February 1889.15 From March 1899 until October 1890, Eisenmenger served as aspirant and Assistant Physician in the 2nd Medical Department of the Wiener Allgemeines Krankenhaus (the Vienna General Hospital).16 Following this, he worked for a period of more than two and a half years, until June 1893, as a Surgical Assistant at the 1st Surgical Clinic of Professor Eduard Albert, an innovator in orthopaedic surgery.16 The remaining months of 1893 were spent at the Kaiser

Figure 2. Anna Eisenmenger (1874–1944) and her two daughters (reproduced with courtesy of Dr Othmar Karzel, Salzburg, Austria).

Franz Josef Kinderhospiz (Kaiser Franz Josef Children’s Hospice) in Sulzbach, Austria.16 Eisenmenger’s future career was determined, although not in the way he had foreseen, when from 1894 to 1895 he was appointed Assistant to Professor Leopold Schro¨tter, Director of the 3rd Medical Clinic in Vienna and well known for his work in laryngology and chest diseases.16 Prone to recurrent periods of illness and poor health, Eisenmenger experienced another such episode in July 1895: ‘My ambitious plans were thus destroyed’ he wrote years later.17 Since continuing to work at the clinic would be physically too demanding, Schro¨tter had proposed him for the less rigorous position of Personal Physician to the Archduke Francis Ferdinand (Erzherzog Franz Ferdinand), heir presumptive to the AustroHungarian throne, who had fallen ill with pulmonary tuberculosis.17 As a result, in 1895 Eisenmenger was appointed ‘Titular Hofarzt’ (titular Court Physician) and two years later ‘Wirklicher Hofarzt’ (real Court Physician) to the Archduke.16

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Medical writings and the years that followed Eight papers by Eisenmenger appeared in medical publications between 1893 and 1902 covering tumours of the mouth and pharynx,18,19 pseudo-leukemia20 and cardiovascular disorders,1,21–24 the latter including the report that eventually gave birth to Eisenmenger’s Syndrome.1 Records from the Society of Physicians in Vienna show that he was elected a member of this association in 1893, that he was a Hofrat (Court Councillor) and KK Regierungsrat (Senior Government Official), and that in December 1901, he gave a lecture on cardiac cirrhosis at a society meeting.25 Subsequently, this talk was also published.24 In the late 1920s, Eisenmenger wrote a book describing his observations, travels and experiences as personal physician to Archduke Francis Ferdinand from 1895 until the fatal year of 1914 when the Archduke and his wife were assassinated in Sarajevo, a prelude to World War I.14 In a review of the book, the historian, lecturer and author Emil Lengyel wrote: ‘Dr Eisenmenger, for years physician of the late Crown Prince, contributes many anecdotes to his [the Archduke’s] psychical portrait’.26 Indeed, despite his patient’s known temper and at times lack of restraint, Eisenmenger seemed to have remarkable skill in managing not only the physical but also the psychological and emotional problems of the Archduke. This could not have been an easy task as witness the following carefully worded remark he once made to his temperamental royal patient: ‘It is not for me to give the Archduke Francis orders or to forbid anything. It is the disease which either commands or forbids. I am but the interpreter’.14 In an ironic twist of fate, it may have been Eisenmenger’s success as physician to the Archduke that in part prevented him from leaving this position with the result that his applications to be head physician at a public hospital and a medical teacher at the university, which he so much desired, were turned down.14 Disappointed about this, he would write I grew tired and gave up the struggle. A rather good private practice which I had acquired in the course of time, indemnified me somewhat for my renunciation and, in the course of years, I earned a tidy little fortune. Sad to relate, I was cheated of it by the inflation and a rascally banker and so my old bones must still bear the burden of work.14

At the time of the book’s publication, Eisenmenger was criticized for disclosing confidential and intimate information about his patient.27 To this, he replied in a lengthy epilogue to the book, defending his action in

doing so and responding to his critics.14 One is reminded of a similar series of events that took place years later following the publication of Lord Moran’s memoir in which medical problems experienced by his patient Winston Churchill, the former well-known British Prime Minister, were also revealed.28 As Clyde Partin rightfully noted, Eisenmenger’s book is ‘bereft of biographical details’ about the author himself.5 Indeed, there are only brief passages within its pages referring to his relationship with Professor Schro¨tter, to the circumstances of his appointment as the Archduke’s physician, to his exceptional height of six feet four inches, and to his own personal health problems. Nevertheless, several other details about Eisenmenger and his interests and personality emerge from reading this book. He seems to have had a good sense of humour, a liking for the arts and an adventuresome spirit when travelling. His thoughtful observations and descriptions of the palaces of Europe, the River Nile, the pyramids of Egypt, the people with whom he came in contact, the intrigue within the Habsburg Court surrounding the Archduke, a bullfight in Spain, the casinos of Monte Carlo and their patrons, the pageantry celebrating sixty years of Queen Victoria’s reign, the spells of seasickness experienced while aboard a steamer in the Mediterranean, and even a visit to a harem — these observations and much else he wrote about in the book suggest he also possessed a keen intellectual curiosity and considerable literary skill. Acknowledgements The author thanks the following for their contributions to this article: Dr Ulrike Denk, Archive of the University of Vienna, for providing the details about Victor Eisenmengers’s education, training and medical activities; Dr Hermann Zeitlhofer, Librarian of the Society of Physicians in Vienna, Billrothhaus, for obtaining the information about Victor Eisenmenger and the Society; Dr Clyde Partin, Emory University School of Medicine, USA, for allowing me to review his files on Dr Eisenmenger; and those individuals with family ties to Victor Eisenmenger, especially his great-granddaughter Alexandra Aichelburg, Dr Harold Eisenmenger and Dr Othmar Karzel, for patiently and graciously responding to my queries about his life.

References and notes 1. Eisenmenger V. Die angeborenen Defecte der Kammerscheidewand des Herzens [The congenital ventricular septal defects of the heart]. Zeitschrift fu¨r Klinische Medicin 1897; 32(Suppl.): 1–28. 2. Abbott ME and Dawson WT. The clinical classification of congenital cardiac disease, with remarks upon its pathological anatomy, diagnosis and treatment. International Clinics 1924; 4: 156–188.

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3. Wood P. The Eisenmenger syndrome or pulmonary hypertension with reversed central shunt. British Medical Journal 1958; 2: 701–709, 755–762. 4. Kaemmerer H, Niwa K, Oechslin E, et al (eds) Pulmonary arterial hypertension in congenital heart disease: Eisenmenger’s syndrome — a global perspective. Bremen: UNI-Med Verlag AG, 2013. 5. Partin C. The evolution of Eisenmenger’s eponymic enshrinement. American Journal of Cardiology 2003; 92: 1187–1191. 6. Eisenmenger V. Austrian biographical encyclopedia 1815– 1950 (O¨BL) Volume 1. Vienna: Academy of Sciences, 1957, p.237. 7. Eisenmenger V. Obituary. The New York Times, 12 December 1932, p.15. 8. Eisenmenger V. Obituary. Neue Freie Presse (Vienna), 12 December 1932, Nr. 24515, p. 4. 9. Aichelburg A. Personal communication, 28 March 2014. 10. Denk U. Personal communication, 5 February 2014. 11. Eisenmenger H. Personal communication, 26 February 2014. 12. Denk U. Personal communication, 24 March 2014. 13. Archive of the University of Vienna. Nationalien der Medizinischen Fakulta¨t (student files) 1882/83–1887. 14. Eisenmenger V. Archduke Francis Ferdinand (Erzherzog Franz Ferdinand). Translated by James A Galston. London: Selwyn & Blount, 1928, p.17, p.56, pp.184– 185, p.185, pp.263–266, pp.271–285. 15. Archive of the University of Vienna. Rigorosenprotokoll der Medizinischen Fakulta¨t (register of medical final exams), MED 12.2, fol. 74v. 16. Archive of the University of Vienna. Personalakten der Medizinischen Fakulta¨t (personnel files of the Faculty of

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Medicine), MED PA 911, Personalakt Viktor Eisenmenger, fol. 21r. Eisenmenger V. (op. cit. Ref. 14): 18. Eisenmenger V. Ueber Lymphosarcomatosis des Pharynx und des weichen Gaumens. Wiener Klinische Wochenschrift 1893; 52: 936–941. Eisenmenger V. Ueber die plexiformen Sarkome des harten und weichen Gaumens und deren Stellung zu den anderen dort vorkommenden Geschwu¨lsten. Deutsche Zeitschrift fu¨r Chirurgie 1894; 39: 1–34. Eisenmenger V. Zur Kenntnis der Pseudoleuka¨mie. Wiener Klinische Wochenschrift 1895; 28: 505. Eisenmenger V. Ursprung der Aorta aus beiden Ventrikeln beim Defekt des septum ventriculorum. Wiener Klinische Wochenschrift 1898; 11: 25. Eisenmenger V. Ueber die sogenannte pericarditische Pseudolebercirrhose. Wiener Klinische Wochenschrift 1900; 11: 249–254. Eisenmenger V. Zur Kenntnis der Tuberkulose des Herzmuskels. Zeitschrift fu¨r Heilkunde 1900; 21: 74–92. Eisenmenger V. Ueber die Stauungscirrhose der leber. Zeitschrift fu¨r Heilkunde 1902; 23: 171–194. Zeitlhofer M. Personal communication, 12, 18 February 2014. Lengyel E. The New York Times, Book Review Section, 1 June 1930, pp. 11, 22. Memoirs Stir Doctors. The New York Times, Second News Section, 21 July 1929, p. 28. Wilson CM (Lord Moran). Churchill: The struggle for survival 1940–1965. London: Constable, 1966.

Author biography Martin Duke, MD, is former Chief of Cardiology and Director of Medical Education, Manchester Memorial Hospital, Manchester, CT, USA and Assistant Clinical Professor of Medicine at the University of Connecticut School of Medicine, Farmington, CT, USA.

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Victor Eisenmenger (1864-1932): The man behind the syndrome.

Although much has been written about the cardiovascular abnormalities present in Eisenmenger's syndrome, little has been recorded previously in the me...
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