It has been a long tradition to quote from Joseph Dietl's 'manifesto' of therapeutic nihilism from 1845 to illustrate the perils of medical extremism. But Dietl's claim for medicine as a natural science cannot fully be understood without considering the social and political circumstances the developing New Vienna School had to face. The professionalization of Viennese academic medicine was opposed by the forces of restaurative absolutism and, in particular, the traditional preponderance of medical practitioners who played a major role in the medical faculty.