Góndola

but also in the dissecting theatre and with the microscope in the laboratory.

Aged thirty-two the young scientist and physician took over the direction of Heidelberg's medical

hospital and was appointed Professor for special

pathology and therapy at the University. Friedreich's move to the Badenese university has often been

interpreted as his eventually realizing his due potential and vocation as a clinician:

There he reached his goal towards which his genuine ambition and desire had always been directed; he had considered the anatomical position only as the

transitional stage to the clinical one, and indeed, according to his entire nature Friedreich was the born clinician, chosen unlike many.^^

Among the medical students at Heidelberg

University eagerly awaiting Friedreich's first lectures and demonstrations was Wilhelm Erb. He once gave a

vivid account of his training under Friedreich:

He (Friedreich) took over a clinical department in the third floor of the old "Seminar" which consisted initially of seven, later of eight beds - the rooms were just about big enough - and two clinical

assistants, relatively few nursing staff; there was also a prospering "Ambulatorium" with an assistant living in town who was also responsible for the direction of the facilities for dermatology and

venereal diseases, which were housed in a room in the fourth floor but under the auspices of the medical "Klinik". This "Ambulatorium" was often used for clinical teaching. There were only few

students, during the first semester only seven attended the "Klinik"; for a number of years there were hardly more than ten to eighteen students attending the "Klinik" (in winter 1862/63

twenty; during the seventies forty to forty three as

Ibid., p.198 Ibid., p.198

maximum); that was probably less stimulating for the teacher, yet for us apprentices (I had joined them Easter 1860) that proved to be useful, since we were called upon frequently and enjoyed the teacher's immediate input upon our studies and exercises. Friedreich's clinical teaching method was

particularly advantageous for beginners. He ascertained with greatest care the patient's history, followed by a very accurate and total physical examination, which had to be performed by the student (Praktikant) under the teacher's guidance and control; then the diagnosis in all its aspects was being considered; we were often most impressed by Friedreich's trained and practical eye; his therapy was simple, but well considered, free from nihilism based on therapeutic optimism and was - once decided upon - carried out consistently and without frequent changes. A particular feature [of his

procedure] was the constant attention to the single case presently under consideration; rarely

generalizations or summaries were made. The students were given an excellent education, since they were often called upon and had to examine the patients themselves; thus Friedreich's Klinik became very popular and was scarcely missed out. The post

mortems were also carried out by him with Virchowian diligence and were submitted to thorough

criticism.^

Friedreich's teaching activities were not

restricted to the Klinik, which was held for nine hours each week. He also lectured on special pathology and therapy (medicine), general pathology and diagnostics. Only in 1866 was pathological anatomy delegated to Arnold, following Friedreich's suggestion. Till then dissections had also been performed by him fairly

regularly. In other words during his first eight years at Heidelberg University Friedreich had developed an active teaching life and held more or less two

professorial posts in one.

Friedreich and Arnold (jr) cooperated closely and

Friedreich continued to be involved in teaching pathological-histological courses and setting up a collection of pathological anatomical material. When Erb started in 1862 as Friedreich's assistant one of his first tasks was the labelling of the various specimens which were housed in a dark cellar.^*

Besides being an university teacher (Klinik

Ambulatorium, lectures, dissection) Friedreich was also the clinical director and chief physician at the local medical hospital:

Whenever possible, he did a daily ward round (Visite) covering the entire department, mostly also on

Sundays and extended it often over the usual time span, totally unaware of himself and unconcerned about his own needs. He cultivated especially physical diagnostics and relied a lot on

his junior staff with wardwork. But also patient care in its narrower sense, the whole conduct and direction of the wards, the supervision and training of assistants and nursing staff were of immediate concern to him, the direction of the "Heidelberger medizinische Klinik" was and remained always

exemplary. Yet Friedreich generated a particularly beautiful and far reaching impact upon his

disciples...He was strict with them and demanded ability, dedication and a strong sense of

duty. He was little inclined to grant time off, but it was also a pleasure to work under him. He

supported his assistants in their scientific work,but granted them independence so that they did not have to work merely for him. That was something which he did not like at all. He was pleased with their

successes and results and would encourage them to persevere. Often he would discuss not only his own but also their work.(research)

Likewise Friedreich patiently supervised his students at the bedside discussing the patient examination and findings. He put a particularly strong emphasis on

Ibid., p.166 Ibid., p.167

diagnostic questions, percussion and auscultation, the venous pulse curve, the microscopy of sputa and so forth. He did it to such an extent that even his

assistants thought Friedreich was at times overdoing it a hit.IS

Nikolaus Friedreich also participated actively in the administrative and political life of the university as a member of the medical faculty. Having experienced himself the inertia of academic institutions in earlier years at Würzburg and the inability of the older

generation to give way to younger colleagues, he was particularly concerned with the welfare of younger scientists and the respective disciplines which they represented or attempted to advance. Thanks to

Friedreich's influence a professorate for pathological anatomy was created at Heidelberg in 1866; but he was also actively engaged in the creation of a professorate for ophthalmology. The establishment of special

teaching posts (Lehrauftrag) in physical diagnostics, electrotherapy, forensic medicine and hygiene,

dermatology and "syphilodology" can be traced back to his spirited and relentless initiative, not to speak of his and Otto Weber's robust campaign for the erection of a new Akademisches Krankenhaus. The latter project was eventually completed in 1876. Friedreich pushed for the creation of a psychiatric hospital and chair in psychiatry withstanding numerous hindrances. He was one

of the leading faculty members and "despite the odd outbursts of odious opposition he managed to represent medicine (Innere Medlzln) and the Klinik with dignity

for almost a quarter of a century at Heidelberg University"

One should assume that the busy life of

university professor, physician, clinical director and faculty member should have left no time at all for any substantial production of medical research. That was not sol Friedreich was a truly learned man, even a

bookish person. He had a lifelong passion for books, so that a certain sum of money was put aside every year to keep his valuable collection updated. A large portion of his library consisted of neurological literature. Friedreich's former library is now

housed as a separate collection in Heidelberg's University Library, the "Bibliotheka

Friedreichiana".

Friedreich was a relentless researcher and a prolific writer. During his Würzburg period under

Virchow he published mainly anatomical and pathological anatomical work. This branch of medicine remained a

life long interest. His contributions to pathology and pathological anatomy were mostly of the Kasuistik type, then gaining in popularity among clinicians. The

Ibid., p.169

Ibid., pp. 169-170; A.Kussmaul, op.cit., note 1, p p .194-195

greater part of his publications dealt with

physikalische Dlagnostik which overlapped with his clinical interest in cardiovascular and respiratory diseases. Many of these publications are excellent pieces of semiotlc character.

He made his most "brilliant contributions",

however, in his favourite field of nervous and muscular d i s e a s e s . A l r e a d y his "Habilitation" covered a

neurological theme. It was an attempt to relate clinical symptoms to the anatomical seat and distribution of cerebral tumours prior to the introduction of diagnostic aids like the

ophthalmoscope. Soon after his arrival in Heidelberg Professor Friedreich began to publish those papers which procured him "neurological fame".

For Friedreich Heidelberg's genius loci was the ideal breeding ground naturally suited to nurture the growth of neurology:

My clinical activity at a location where nature had created such a peculiar contrast between the beauty spots along the banks of two converging rivers and the most hideous forms of numerous and widespread goitre, cretinism, progressive muscular atrophies and various forms of central paralyses, offered me such opportunities to observe chronic forms of spinal diseases, which I would have hardly enjoyed at any other place in such favourable circumstances and in such abundance.2°

In 1863 Friedreich's famous study 'Ueber