If you were to ask a surgeon, or indeed anyone who has studied medicine beyond the second year what Billroth I & II mean, they would at once tell you that the terms refer to complex surgical procedures performed on the gastrointestinal tract in the treatment of refractory peptic ulcer and stomach cancer.
The contribution to surgery by Christian Albert Theodor Billroth (1829-1894) is huge. He introduced the concept of audits, publishing all results irrespective of outcome, paving the way for mortality and morbidity statistics that are commonplace in the medical field today.
His experience at a military hospital during the Franco-Prussian war led him to push for improvements in transportation of the wounded in battle. He gave a speech on War Budget in 1891, underlining the need for an efficient ambulance service.
His ingenious ability to invent new surgical techniques and procedures earned him the title “Surgeon of great initiatives”. He pioneered plastic surgery, especially of the face. He is credited with the first oesophagectomy (1871), the first laryngectomy (1873), and the first successful gastrectomy (1881), after several failed attempts. Some sources claim that Billroth was nearly stoned to death in Vienna after the first patient upon whom he attempted a gastrectomy died of the procedure. However the surgical techniques (Billroth I & II) elaborated by him have stood the test of time and are still in use.
But Billroth I & II have another meaning. In the music world, certainly among chamber musicians, they indicate Brahms’ string quartets no. 1 & 2 from his Opus 51. This is because Billroth, besides being the “father of modern abdominal surgery” was also a skilled amateur pianist and violinist, music critic and close personal friend of Johannes Brahms.
Billroth’s love of music began early, often at the peril of his studies, causing him to spend more hours at piano practice than at his books. Although torn between music and medicine, he acceded to his mother’s wishes, enrolling as a medical student in Greifwald and completing his medical doctorate at the University of Berlin.
Billroth and Brahms met in Zurich in 1865, when Brahms was beginning to be noticed and recognised. Billroth accepted the chair of surgery at the University of Vienna in 1867, and Brahms moved to that city two years later. Their friendship quickly blossomed, and lasted more than thirty years. Brahms valued Billroth’s opinion so much that he often sent his original manuscripts for his assessment before they could be published. Billroth also encouraged Brahms to publish many of his later compositions, and might have saved these for posterity. So much of Brahms’ output was consigned by the extremely self-critical composer himself to the flames as the works were not deemed worthy enough by him.
Billroth also participated (often at soirées at his own home) as musician in trial rehearsals of Brahms’ compositions of chamber music before their debut performances. And so it was that Brahms dedicated his first two string quartets, Opus 51, to Billroth.
Billroth and Brahms, together with Viennese music critic Eduard Hanslick were conservatives pitted against the innovations of Richard Wagner and Franz Liszt in the ideological conflict called the War of the Romantics. Billroth, while supporting his friend Brahms, was also candid enough to acknowledge Wagner’s “very considerable talent in many directions.”
Brahms supported Billroth in the writing of his essay “Wer ist Musikalisch?” (“Who is Musical?”), published posthumously. It was one of the earliest attempts to scientifically examine the concept of “musicality”. Although Billroth’s research into the subject was cut short by his death, he identifies various types of “amusicality” (tone-deafness, rhythm-deafness, harmony-deafness) and the cognitive skills involved in music perception.
The extent of the friendship between Billroth and Brahms is evident to us today from the over 300 letters and exchanges that survive between them.
The friendship cut across social lines. Both were born in port cities in north Germany, Brahms in Hamburg and Billroth in Bergen auf Rügen on the Baltic Sea. But there the similarity ended. Brahms came from a poor family. His father played bass in the taverns and brothels of the Reeperbahn, Hamburg’s notorious red-light district, and some historical sources even claim that Brahms himself as a teenager played piano in the brothels for a living. Billroth on the other hand was born into an upper middle-class family; his father was a Protestant pastor of Swedish descent and his mother had French ancestry.
The friendship, however, did have its rough patches, almost unravelling towards the end of their lives. Billroth increasingly began to get irritated by the lack of social etiquette and “gruffness” of Brahms. His views are better understood in a reading of Billroth’s book “The Medical Sciences in the German Universities” in the section titled “A Study in the History of Civilization” in which he betrays a contempt for students of humbler socio-economic backgrounds (pretty much like Brahms) aspiring to a medical career, coupled with anti-Semitism. One could argue that his views were a reflection of the thinking of the time, but one cannot help noticing the ironic contrast between the two friends: Brahms did not let his origins hamper his vision or his legacy; whereas Billroth, for all the privilege at his command from birth and his very obvious surgical genius was unable to shake off petty prejudices despite having in his friend a living example to prove them wrong. One of his quotes reads; “Science and art scoop from the same well.” It is sad that he was unable to see that people like him and Brahms were also “from the same well”, regardless of birth or circumstance.
Nevertheless, he apparently remarked on learning of Brahms dedicating the string quartets to him, that Billroth would now be remembered for posterity on account of the dedication. We know better, of course.
Another of his quotes: “It is a most gratifying sign of the rapid progress of our time that our best text-books become antiquated so quickly”. Billroth continues to find mention in text-books, while his abiding love of music has faded into the background. But what if he had chosen the path of music over medicine? Would we still remember him today?
(An edited version of this article was published on 13 September 2015 in my weekend column ‘On the Upbeat’ in the Panorama section of the Navhind Times Goa India)