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Christian Gerhard Leopold: Fascinating History of a Productive Obstetrician

Gynecologist

Article  in  Obstetrical and Gynecological Survey · January 2012

DOI: 10.1097/OGX.0b013e31823662d7 · Source: PubMed

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Volume 67, Number 1
OBSTETRICAL AND GYNECOLOGICAL SURVEY
Copyright © 2012 by Lippincott Williams & Wilkins
OB/GYN Mentors
Christian Gerhard Leopold: Fascinating
History of a Productive Obstetrician
Gynecologist
David Kachlik, MD, PhD,*† Ingrid Kästner, MD, PhD,‡
and Vaclav Baca, MD, PhD*†
*Professor, Department of Anatomy, Third Faculty of Medicine, Charles University in Prague, Prague, Czech
Republic; †Professor, Department of Health Care Studies, College of Polytechnics Jihlava, Jihlava, Czech
Republic; and ‡Professor, Karl-Sudhoff-Institute for the History of Medicine and Natural Sciences,
Medical School, University Leipzig, Leipzig, Germany

Christian Gerhard Leopold (Fig. 1), of German na- He was born on February 24, 1846, in Meerane
tionality, was one of the most influential gynecologists (Saxony, Germany), as the third child of a local
and obstetricians of the second half of the 19th century physician, Just Heinrich Leopold (1815–1878). He
and well into the 20th century. Until presently, he has studied medicine at the university in Leipzig, worked
been known because of the eponymous Czerny- as an assistant in a hospital in Dresden, and later in
Leopold’s method, which is applied to the fixation of the lunatic asylum in Leipzig-Thonberg. In 1840, he
the uterus to the anterior abdominal wall, and the obtained his doctor’s degree and started his private
Leopold’s maneuvers, the 4 classical maneuvers for the practice in his native town Meerane. On February 7,
diagnosis of the position of the fetus in utero. 1841, he married Caroline Luise Schneider (1818–
As late as 1992, Ulrich briefly summarized 1886), and they had 7 children. He was a reputable
Leopold’s curriculum as homage on the occasion of citizen, and in 1863, he was appointed the district
the 68th birthday of Christian Lauritzen, professor of physician in Glauchau. Moreover, he published sev-
gynecology.1 eral scientific articles.4
In 2004, Ludwig not only pointed out that Leopold His son, Christian Leopold, attended the Freema-
was an eminent obstetrician but also a gynecologist son School in Dresden.1 After passing his A levels in
who was keenly interested in different fields of his 1865 in St. Afra in Meißen (one of the 3 most
discipline.2 His work dealt with the etiology of can- prestigious schools in central Germany), he studied
cer, the anatomy of the pelvis, the histology of the medicine at the Alma Mater Lipsiensis from 1865 till
uterus, ovulation, menstruation, nidation, and rela- 1870, during a period of excellence in teaching and
tionship between Blastomycetes and carcinogene- scientific research.5 Among the famous professors
sis.1,2 It was not until 2005 that a detailed thesis by and scholars of Leopold were Carl Ludwig, 1816–
Otto dealing with Leopold and his work, especially 1895, one of the founders of experimental physiol-
his time in Dresden, was published.3 ogy, and Carl Thiersch, 1822–1895, one of the most
In 2011, we commemorated the 100th anniversary of influential surgeons of the 19th century. On June 23,
his death, and this article pays tribute to him. 1870, Leopold obtained his doctorate6 by defending
his thesis Untersuchungen über das Epithel des
Ovarium und dessen Beziehung zum Ovolum (Exam-
Life of Leopold
ination of the ovary epithelium and its relation to the
Who was Leopold and what was his position in the ovary).7
scientific community of his time? He was particularly interested in gynecology and
Correspondence requests to: David Kachlik, MD, PhD, Department of
obstetrics, the special discipline of Carl Siegmund
Health Care Studies, College of Polytechnics Jihlava, Tolstého 16, Franz Credé (1819–1892), inventor of the AgCl-
Jihlava 58601, Czech Republic. E-mail: [email protected]. prophylaxis of the ophthalmia neonatorum. Credé also
www.obgynsurvey.com | 1
2 Obstetrical and Gynecological Survey

Later, in Edinburgh, he studied gynecology at the

gynecological and obstetrical clinic, which became
renowned, thanks to Sir James Young Simpson
(1811–1870), who invented chloroform as an anesthetic
gas. Leopold worked there under the supervision of
Simpson’s successor, James Matthews Duncan (1826–
1890). After this experience, he moved to London and
was taught by the famous and skilful surgeon, Spencer
Wells (1818–1897).9
Having returned to Leipzig, on Easter 1872,
Leopold became an assistant at the Institute of path-
ological anatomy and afterward at the Medical Poli-
clinic. In 1873, Leopold worked as a physician in
Leipzig, where, a year later, he obtained his habili-
tation in the field of gynecology and obstetrics from
the Leipzig University and finally became a “Privat-
dozent,” a private lecturer.10 For the first time, he
conducted tutorials in the gynecological operative
practice on cadavers for students and young physi-
cians at Leipzig University. He was an excellent
teacher and his lectures were always well attended.11
Fig. 1. Christian Gerhard Leopold (1846–1911)–bust, Dresden,
Despite the workload, Leopold mastered at the
Hospital Friedrichstadt (courtesy of Professor C.-P. Heidel, Dresden).
private clinic he had founded in 1879. He taught
midwifery at the gynecological clinic at Leipzig Uni-
established the so-called Credé’s grip (Credé’scher versity (Universitäts-Frauenklinik), and was ap-
Handgriff), which was used to express the placenta pointed associate professor at the Leipzig University
manually. in 1883. Afterward, he succeeded Franz von Winckel
Leopold was on friendly terms with his teacher, (1837–1911) as director of the Royal Gynecological
and he was a frequent guest in Credé’s house. In Infirmary in Dresden (Königliche Frauenklinik und
1873, he married Credé’s daughter, Anne-Marie Car- Hebammenlehranstalt). Leopold turned the clinic
oline Wilhelmine, and had 3 daughters. into a leading hospital in Germany and organized the
In 1870, Leopold joined the army and volunteered construction of the New Royal Women‘s Infirmary
to take part in the Franco-German war as a field (Neue Königliche Frauenklinik), one of the most mod-
doctor. He served in the 1st Field Hospital and was ern and eminent women’s infirmaries at that time.12
involved in the battle of Metz and the siege of Paris Between 1883 and 1910, Leopold trained more
and served as head of a medical division for typhus than 1750 physicians; his students came from Ger-
patients.1 many and abroad.11 He was a strong supporter of
After the war, in 1871 and 1872, he visited univer- further education for both physicians and midwives,
sities in Breslau (now Wrócław in Poland), Vienna, and was very active in the field of social politics. The
London, and Edinburgh, as well as the gynecologic part he played in the development of maternal care in
infirmaries in Leiden, Amsterdam, and Utrecht as Germany is well known: he was one of the initiators
part of his “Scientific Grand Tour.” of advice centers for mothers and he has earned
From September to December 1871, he visited the special merits in the field of midwifery. During his
University of Vienna with its famous Medical stay in Dresden, he educated approximately 1900
School,8 where he examined several pregnant women midwives.12
in the gynecological department of Joseph Späth As a surgeon, he was more radical in his youth. He
(1823–1896), who, as a follower of Ignaz Philipp belonged to the supporters of a then very frequent
Semmelweis (1818–1865), strictly adhered to pro- and now almost forgotten procedure called “hebos-
phylactic antisepsis. In the gynecological department teotomia.” But his main operative field was plastic
of Rudolf Christian Chrobak (1843–1910), Leopold operations, thanks to his excellent technique of clos-
was taught several operational techniques, the most ing wounds.11
famous being the Chrobak’ operation—a supravagi- In his personal life, he was keen (apart from his
nal amputation of the vagina. professional work which occupied almost all his day
 OB/GYN Mentors 3

and night time) on classical music, was an excellent

pianist, and possessed a valuable collection of paint-
ings and other artistic treasures. His neighborhood
considered him a kind man and some even called him
“Darling of People” (Liebling des Volkes). His life
motto was “carpe diem.”
Leopold died on September 12, 1911, following a
heart attack in Bärenburg, a small town in southern
Saxony in the Krušné Mountains (Erzgebirge).1 The
cause of his death was the atherosclerosis of the
coronary arteries with heavy dilation of both ventri-
cles.13 His death was strongly felt and deeply regret-
ted by both the scientific community and his patients.
Christian Gerhard Leopold was one of the most out-
standing personalities of world of obstetrics of all
times.

Publications
Leopold’s scientific work comprises 192 mono-
graphs and articles covering a wide range of topics
which can be divided into 4 main fields: 1) anatomy
and physiology of the female organs; 2) complica-
tions by anatomically contracted pelvis (e.g., ky-
Fig. 2. Four Leopold’s maneuvers.
phoscoliosis); 3) new operational methods; and 4)
prevention of puerperal fevers. The last problem was
of special interest for him. Credé and Leopold com- with correct assessment of the shape of the maternal
piled together the 4th edition of Handbook for Mid- pelvis can indicate whether the delivery was going to
wives (Lehrbuch für Hebammen).14 After Credé’s be complicated or whether cesarean delivery was
death, Leopold re-edited the Handbook as the 7th and necessary.
8th edition in 1902 and 1909, respectively, with Paul The first Leopold’s maneuver (sometimes called
Zweifel (1848–1927), professor of gynecology and fundal grip) helps to define the height of the body of
obstetrics.12,15 the uterus, its shape, and position (dextrotorsio/sin-
Leopold was a long-standing co-editor of the jour- istrotorsio can be classified according to the position
nal “Archiv für Gynäkologie,” together with Adolf of uterine tubes and ovaries) to determine the month
Ludwig Sigismund Gusserow (1836–1906), German of pregnancy, the tonus of the uterus, and the position
gynecologist and obstetrician who worked at the of the fetus (Fig. 3). The second Leopold’s maneuver
Berlin hospital, Charité. Leopold took this post after (sometimes called umbilical grip) helps to define the
Credé’s death, and held it until his own death. position of the back and small parts of the fetus to
determine the lie and position of the fetus (Fig. 4). Its
mild adjustment for the precise determination of the
Homage to Current Medicine
position of the fetus back is called Budin’s maneuver
In countless lectures, articles, and scientific com- (Pierre-Constant Budin (1846–1907), a French obste-
munications, as well as in his books on midwifery, he trician who worked in Paris). This maneuver is the
propagated the so-called Leopold maneuvers: a best choice to examine the content of uterine mar-
method for the examination of pregnant women.8 gins.16 The third Leopold’s maneuver helps to define
With the help of those, as well as the strictest mea- the lie and position of the fetus according to the
sures of disinfection, he could minimize the cases of presenting part of the body, that is, either the head or
puerperal fever in his clinic. Leopold’s maneuvers the breech of the fetus, and, in the case of head
(Leopold-Handgriffe) (Fig. 2) helped to determine presentation, to measure the height of the cervical
the lie (situs, Lage), position (positio, Stellung), at- groove (Fig. 5). The grip, although single-handed
titude (habitus, Haltung), and presentation (presen- (double-handed is now favored and recommended
tatio, Einstellung) of the fetus, which in conjunction worldwide), is still used in Central Europe. It was
4 Obstetrical and Gynecological Survey

Fig. 3. First Leopold’s grip. Fig. 5. Third Leopold’s grip.

necologist and obstetrician who worked in

Prague.
• Second Pawlík’s grip: carry on by sliding the
hand upward to determine the cervical groove.
A special maneuver, called Pit’ha’s double grip:
combines the first Pawlík’s grip and Budin’s grip
and can serve as the simplest and most appropriate
way of the external examination of the fetus.17 The
fourth Leopold’s maneuver (sometimes called sec-
ond pelvic grip): helps to define the approximate
distance between the presenting part (head or
breech of the fetus) and the maternal pelvis (Fig.
6). The third and fourth maneuvers serve to check
the entry of the presenting part into the pelvic inlet
(aditus pelvis). The fifth Leopold’s maneuver, also
known as Zangemeister’s grip (Zangemeisterscher
Fig. 4. Second Leopold’s grip. Handgriff): helps to determine the possibility of
a disproportion between the child’s head and
the pelvis. Wilhelm Karl Zangemeister (1871–
1930) was a German gynecologist and obstetrician
modified by Karel Pawlík (1849–1914), a Czech who worked in Königsberg (now Kaliningrad in
gynecologist and obstetrician, renowned for his tech- Russia).
nique of ureter catheterization by “free hand.” This The usefulness of Leopold’s maneuvers was, for
Pawlík’s grip is composed of 2 phases: example, well described in screening of malpresen-
• First Pawlík’s grip (sometimes called first pelvic tation by Thorp et al and Lydon-Rochelle et al.18,19
grip): helps to define which presenting part of Leopold focused strictly on the external investigation
the fetus is situated in hypogastrium using the of the pregnant women to reduce the danger of in-
following method: grab the hypogastrium by the fection.7,20 Although this was in the tradition of
thumb and fingers of the right hand close above Credé, the idea and the method of the palpation of the
the pubic symphysis and draw the thumb and abdomen were used well before the time of Credé
finger near to clasp the lower uterine segment and Leopold. It had already been taught by the
including its contents. This maneuver, when per- French obstetrician, André Levret, and the German
formed by 2 hands, is called Rubeška’s grip, obstetricians, Georg Roederer and Justus Wigand,
after Václav Rubeška (1854 –1933), Czech gy- over the course of the 18th century but it had been
 OB/GYN Mentors 5

REFERENCES
1. Ulrich U. Christian Gerhard Leopold (1846–1911) [in German].
Geburtshilfe Frauenheilkd. 1992;52:310–312.
2. Ludwig H. Christian Gerhard Leopold (1846–1911)—Nicht nur
der Lehrmeister der Geburtshilfe. Gynäkologe. 2004;37:961–966.
3. Otto A. Der Direktor der Dresdener Frauenklinik Gerhard Chris-
tian Leopold (1846–1911) und sein Beitrag zur Entwicklung der
Gynäkologie und Geburtshilfe in Deutschland. Diss med. Dres-
den: TU Dresden, Med Fak Carl Gustav Carus, 2005.
4. Zweifel P. Leopold. Zbl Gynäkol. 1911;35:1449.
5. Kästner I, Thom A. 575 Jahre Medizinische Fakultät der Univer-
sität Leipzig. Leipzig, Germany: Johann Ambrosius Barth, 1990.
6. Universitätsarchiv Leipzig. Med Fak, Prom. 8370; Promotions-
buch 1865–1877, fol. 160.
7. Leopold CG. Dritter Beitrag zur Verhütung des Kind-
bettfiebers. Arch Gynäkol. 1889;35:159–165.
7a.Lesky E. Die Wiener Medizinische Schule im 19. Jahrhundert.
Graz-Köln: Hermann Böhlaus Nachfolger, 1965.
8. Universitätsarchiv Leipzig. Med Fak, PA 1487, Bl. 2.
9. Universitätsarchiv Leipzig. Med Fak, PA 1487, fol. 1–6.
10. Richter A. Gerhard Leopold. Monat Geburts Gynäkol. 1911;34:7–8.
11. Leopold GC, Zur Eröffnung der neuen Königlichen Frauen-
klinik in Dresden. Arch Gynäkol. 1903;69:718.
12. Bumm E, Leopold G. Arch Gynäkol. 1912; 95:1.
13. Leopold CG, Credé CS. Lehrbuch der Hebammenkunst. 4th
ed. Leipzig, Germany: Hirzel, 1886.
14. Leopold CG, Zweifel P. Lehrbuch für Hebammen. 7th ed.
Fig. 6. Fourth Leopold’s grip. Leipzig, Germany: Hirzel, 1902.
15. Leopold CG, Zweifel P. Lehrbuch für Hebammen. 8th ed.
Leipzig, Germany: Hirzel, 1909.
16. Leopold G, Spörlin F, Die Leitung der regelmässigen Geburten
nur durch äussere Untersuchung. Arch Gynäkol. 1894;45:
forgotten during the following century. Only 50 337–351.
years later, Credé and his student, Leopold, rekindled 17. Pit’ha V. O zpùsobu zevního vyšetøování těhotných a rodiček
the idea, refined the method, which resulted in their na základě methody Pawlíkovy. Praha: Nákl. vlast., v komisi
knihkup. Bursík a Kohout, 1900.
most significant contribution—the introduction to ob- 18. Thorp JM, Jenkins T, Watson W. Utility of Leopold maneuvers
stetrical practice. The French physician, Adolphe Pi- in screening of malpresentation. Obstet Gynecol. 1991;78(3 Pt
nard (1844–1934), supported the external examination 1):394–396.
19. Lydon-Rochelle M, Albers L, Gorwoda J, et al. Accuracy of
as well, and proved that it was possible to determine the Leopold maneuvers in screening for malpresentation: a prospec-
child’s position in utero only by palpation. tive study. Birth. 1993;20:132–135.
Acknowledgments—The authors thank Mirka Ple- 20. Leopold CG. Zur Verhütung des Kindbettfiebers. Deutsch
Med Wochenschr. 1887;13:541f.
citá and Vladimír Musil for the technical and bibli- 21. Leopold CG. Dritter Beitrag zur Verhütung des Kind-
ographic support. bettfiebers. Arch Gynäkol. 1889;35:159–165.

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