From the Vienna School to modern health care
The scientific approach to medicine in Austria can be traced back to the foundation of Vienna University (1365) and to Galeazzo de Sancta Sophia from Padua and his Austrian pupil J. Aygel who performed pioneering dissections.
As a founding element of Alma Mater Rudolfina (1365) the medical faculty was a widely acknowledged authority as early as in the Middle Ages.
During the reign of Maria Theresa the Vienna School of Medicine acquired international fame for the first time. In 1745 the empress summoned Gerard van Swieten from the Netherlands to Vienna. He laid the foundations for the first Vienna School of Medicine. It was under van Swieten’s aegis that a start was made to introducing health legislation, and a new epoch unfolded for medical education in the Austrian hereditary territories. Anton von Störck, van Swieten’s successor as protomedicus, was regarded as a pioneer of experimental pharmacology. Highly qualified physicians such as Anton de Haen, Maximilian Stoll, Lorenz Gasser and Leopold Auenbrugger taught and did their research in the imperial city. In 1784, during the reign of Emperor Joseph II the Vienna General Hospital was opened, which henceforth became the home of Viennese medical practice.
The Vienna General Hospital came to be increasingly regarded as the most important research centre. During the course of the 19th century the Second Vienna School of Medicine took shape thanks to doctors such as Karl von Rokitansky, Josef Skoda, Ferdinand von Hebra (who discovered scientific dermatology) or Ignaz Philipp Semmelweis (who discovered the fact that infection from outside could cause childbed fever). The fundamental aspects of medicine were assembled and specialisation encouraged. The world’s first eye clinics and ear, nose and throat clinics were founded in Vienna. The leading surgeon Theodor von Billroth became a university professor in Vienna. In 1874 he performed the first complete laryngectomy and in 1881 the first gastrectomy. He encouraged the re-building of the first Haus der Gesellschaft der Ärzte (House of the Society of Doctors), and of the Rudolfinerhaus for training hospital nurses. He also promoted the establishment of Vienna’s voluntary ambulance service. The influence of the Billroth School spread throughout Europe.
A centre of top-class medicine
At the beginning of the 20th century medicine in Vienna was rated very highly in international circles. Clemens von Pirquet defined the parameters of allergy and of serum sickness. Ernst Peter Pick carried out important investigations into the chemical specificity of immunological reactions. The Vienna School of Dentistry (founded by Bernhard Gottlieb) reached its zenith in the 1920s.
All the four Nobel Prizes for Medicine which were awarded to (former) Viennese doctors during these decades – Robert Bárány (1914), Julius Wagner-Jauregg (1927), Karl Landsteiner (1930) and Otto Loewi (1936) – derived from fundamental research performed during this time. The outstanding medical and research tradition continued until well on into the days of the First Republic. The American Medical Association of Vienna, founded in Vienna, organised well-attended post-graduate courses for doctors from all over the world up until the 1930s.
On account of the effects of the First World War Vienna lost its reputation as a world centre of medical research. However, the successful retention of a high medical standard throughout the economic crises of the First Republic and the Second World War as well as during the reconstruction phase may well be attributed to the lasting influence of the Vienna School of Medicine.
The “Anschluss” (annexation) of Austria by Germany on 13 March 1938 heralded the darkest chapter in the history of Viennese medicine. More than 50% of all university teachers and professors, mainly of Jewish origin, were fired, and 65% of all Vienna’s doctors were prohibited from practising. Many gifted researchers, doctors and students were forced to emigrate or lost their lives either in concentration camps or under other tragic circumstances. The victims of National Socialism will always be remembered. 13 March 1938 should be seen as a warning to the Vienna School of Medicine and a date never to be forgotten.
The public health situation in 1945 was catastrophic. All Vienna’s hospitals had been severely damaged during the war. Particularly seriously affected were the Kaiser-Franz-Josef-Spital, the Allgemeine Poliklinik, the Gottfried von Preyer’sches Kinderspital and the Nervenheilanstalt Maria-Theresien-Schlössl. The infrastructure was completely paralysed in places. There were no windows, no heating materials, far too little food and medicine as well as, from time to time, no gas or electricity. Many hospitals had been turned into military hospitals for the German Army. When the German troops were put to flight they took with them most of the medical instruments and medicines.
The Allied occupation powers requisitioned more than 2,000 beds in Vienna’s hospitals. This meant that in 1945 there were barely 10,000 beds available. Before the war there had been 17,000. Vital help in countering the spread of epidemics was given by the occupying powers. Large-scale vaccination campaigns were carried out in Vienna.
After 1945 the difficult task of rebuilding Austria and its hospitals began. The former fame had been appreciably diminished. In addition, in 1949, about 75% of all the medical training staff at the university of Vienna had to be dismissed because of having had more or less close involvement with the Nazis, and they were replaced only gradually by a newly educated generation. This double loss of talents and expertise – within only a few years – was to have a lasting effect on Viennese medicine for decades.
But the Vienna public health system developed with significant success. Major investments were made into preventive medicine and early diagnosis as well as into intensive care in cases of illness.
The most obvious success has been in the increase of life expectancy. For persons born in 1900 a man could expect to live for 44 and a woman for 47 years. Someone born a hundred years later, in 2000, could look forward, according to statistical forecasts, to a life span of 74 (men) and 80 years (women). In 2011 the life expectancy for men is 78 years, for women 83.5 years.
In 1900, 173 per thousand newborns died before their first birthday, in 1930 90 children per thousand died at birth; in 1960 it was 40. Since the early 1970s the infant mortality rate has been reduced continuously. In 2011 the infant mortality rate was 5‰. In no other field of public health can progress be demonstrated with such impressive figures.
Thanks to adaptation and modernisation hospitals have been extensively altered since the war. One large hospital, the Donauspital in Vienna’s 22nd district, has been built from scratch. It was set up between 1985 and 1996 as part of the SMZ-Ost (Socio-Medical Centre–East). A further major project was the Rudolfstiftung. The original hospital was built on the orders of Emperor Franz Josef to commemorate the birth of his son, Crown Prince Rudolf. It was replaced by a totally new building between 1965 and 1977 because it had become completely obsolete.
Austria’s biggest hospital
The decision to erect a new General Hospital (AKH) was taken as early as 1957, and construction started in 1964. The new AKH was officially opened in 1994.
Despite extensive discussion the new construction of the Vienna General Hospital (AKH) confirmed the tradition of the world-famous Vienna Medical School. The new building cost around 45 billion Austrian schillings (almost 3,3 billion euros). The Vienna General Hospital has a total floor area of 345,000 m2 and houses 27 university departments, 10 institutes, 42 departments, 62 general outpatient clinics, 330 specialist outpatient clinics, 82 normal care units, 21 intensive care units, 51 operating theatres, 21 treatment rooms and around 2,200 beds for patients. Currently in 2011, 9,300 people are employed at the AKH, of which 1,600 are doctors and around 4,500 are medical and health care staff. Yearly around 99,000 people are treated as inpatients and half a million are treated ambulatory in 397 walk-in centres.
All AKH departments and institutes enjoy an excellent reputation far beyond Austria’s borders thanks to their medical and scientific achievements.
The world’s smallest inner ear implant was successfully inserted at the AKH: a world premiere. In 2003, a team of doctors transplated a human tongue for the first time worlwide. In the treatment of cancer major advances have been made, also in spinal surgery and cartilage cell transplantation.
The Vienna Hospitals Association (KAV)
Vienna’s public health system, judged by all the relevant parameters, is one of the best in Austria. Vienna’s health-care facilities dispose of by far the best personnel. The major part of all top-class medicine is practised in Vienna; and the largest number of top medical beds are located in the federal capital.
It is the KAV's task to provide medical, nursing and psychological care for the sick and people in need for care. Therefore, the KAV runs all City of Vienna hospitals and nursing homes and any other insitutions, which provide assistance to these hopitals and nursing homes.
With its 12 hospitals, twelve homes for the elderly (including the social-therapeutic centre in Ybbs) and three nursing homes and 32.000 employees the KAV iranks among the largest health-care facilities in Europe. Every year the hospitals, nursing homes and geriatric centres provide excellent medical and care services for an average 400,000 inpatients. In addition, 3.5 million people are treated in walk-in centres.
The Vienna North Hospital
The scheduled opening for the new Vienna North Hospital in Floridsdorf with its 600 to 850 hospital beds is 2015. The project plan, overseen by the KAV, suggests that the hospital can take 40,000 inpatients a year, provide a walk-in centre for 250,000 patients and perform 16,000 surgical procedures. In the near future, the Vienna North Hospital will become one of the cornerstones of the Viennese health care landscape.
This new hospital takes into account the demographic changes in Vienna and at the same time evens out regional differences. In Vienna there is an average of 7.39 beds per thousand inhabitants whereas the average number is only 3.99 in the north-east of the city. However the districts concerned – 2nd, 21st and 22nd – have the highest rates of population increase.
Good training guarantees quality
The City of Vienna, by tradition, lays great store in the training of its health-care personnel. The KAV runs schools for general medicine and nursing, for paediatric and adolescent nursing, for psychiatric health and nursing as well as courses for nursing attendants, an academy for midwifery and academiesfor advanced medico-technical services.
Centre for top-class medicine
Today, Vienna is a centre of top-class medicine. Both the WHO and OECD have confirmed that the City of Vienna’s public health system is excellent. Thanks to their scientific output and international reputation, Vienna hospitals– especially the internationally recognised General Hospital – attract many congresses and international specialists of all fields to Vienna.
Hospital Reform Act 2030
Vienna needs modern hospitals, which can provide top class care. The planning horizon for the realisation of the health strategy guarantees that future challenges such as the demographic trend and the medical progress will also be met in 20 years time. In 2030, Vienna is estimated to be Austria's youngest city, but at the same time housing most people over 85 years.
Thus, the new hospital reform scheme optimises the relevant structures. Hospitals which have only one speciality will be integrated with hospitals having a special treatment emphasis and the appropriate infrastructure. Thus, highest quality can be combined with maximum efficiency and economy as well as a completely new structure of patient admission with interdisciplinary departments.
This method will ensure the highest level of medical care in the whole of Vienna and strengthen the city’s leading role in Europe with respect to public health facilities. The new Vienna hospital plan will further improve Vienna’s entire hospital landscape. In cooperation with the Vienna Chamber of Medicine doctors’ practices will be integrated into existing outpatient care.
The guiding principle for Vienna’s public health policy is to ensure top-class medical care for everybody, irrespective of income or social status.
Impartial access to the public health system is a human right and has to be the same for everyone – independent of age, income and living conditions.