The Jewish Chronicle - - COMMENT - John Sil­ver

THE COM­MON­WEALTH Games be­gan this week in Glas­gow and will run un­til Au­gust 3. They are fully in­te­grated and the able-bod­ied and dis­abled ath­letes will com­pete in the same sta­dium, on the same day, al­ter­nat­ing able-bod­ied and dis­abled sport. The dis­abled will be ac­cepted on equal terms, and their medals will count in the over­all medal tally for their coun­try, a tri­umph for the founder of the Par­a­lympics Games, Sir Lud­wig Guttmann, a Ger­man Jewish refugee from Nazi Ger­many.

The suc­cess­ful treat­ment of spinal in­juries is widely at­trib­uted to Don­ald Munro (1936, USA) and Guttmann (1944, UK). How­ever, this view has re­cently been con­tested by Dr Pa­trick Kluger, a Ger­man doc­tor, who has sug­gested that the treat­ment of spinal in­juries orig­i­nated not in the USA or Bri­tain, but in Ger­many be­fore the First World War. He ar­gued that this knowl­edge had been sup­pressed and for­got­ten for po­lit­i­cal and so­cial rea­sons in the in­ter-war pe­riod.

The first ef­fec­tive spinal unit was es­tab­lished by Wil­helm Wag­ner (1848-1900) in Ger­many at the end of the 19th cen­tury, at a small ac­ci­dent hos­pi­tal at Königshütte.

Wag­ner founded the spinal unit to treat the many in­jured min­ers who had sus­tained spinal in­juries as a re­sult of the col­lapse of tun­nels. Pa­tients were turned reg­u­larly and their blad­ders were drained so that early deaths from pres­sure sores and uri­nary tract in­fec­tion could be avoided. The unit was so suc­cess­ful that some pa­tients were dis­charged home. But when Wag­ner died, the unit closed down.

Just as the con­gre­ga­tion of in­jured coal min­ers led Wag­ner to found a spinal unit, so the First World War, with an un­prece­dented num­ber of ca­su­al­ties, showed that the ex­ist­ing meth­ods of treat­ment were un­sat­is­fac­tory, as there was no triage and the sol­diers were ad­mit­ted in­dis­crim­i­nately to gen­eral mil­i­tary hos­pi­tals. Con­se­quently, spe­cialised units were es­tab­lished by all the bel­liger­ents for the treat­ment of ab­dom­i­nal wounds for orthopaedic and plas­tic surgery and for spinal in­juries.

Pa­tients with spinal in­juries were be­ing treated in Vi­enna, Tübin­gen and Leipzig, in Ber­lin and in Bres­lau by a num­ber of Ger­man doc­tors, many of them Jews.

France and Bri­tain set up spinal units but the metic­u­lous treat­ment pi­o­neered in Ger­many, whereby nurs­ing staff and phys­io­ther­a­pists worked as a team with the doc­tors, was not fol­lowed and the mor­tal­ity was much higher. Mar­burg recorded 50 deaths out of 150 (33 per cent mor­tal­ity) com­pared to a mor­tal­ity of 82 per cent in France and 65 per cent in the UK.

When the war ended, the flow of in­jured sol­diers ceased and the mil­i­tary hos­pi­tals closed down. The treat­ment of chronic spinal in­jury pa­tients in France and the UK was un­sat­is­fac­tory, de­spite French at­tempts at re­ha­bil­i­ta­tion. In Bri­tain, paral­ysed pa­tients were treated by orthopaedic sur­geons in gen­eral and vol­un­tary hos­pi­tals, and there were very few doc­tors trained in re­ha­bil­i­ta­tion. At the out­set of the Sec­ond World War, spinal units were set up all over the coun­try to treat ca­su­al­ties, but con­sul­tants rarely vis­ited, staffing was in­ad­e­quate and pa­tients were no bet­ter after three years than when first ad­mit­ted. A de­featist at­ti­tude pre­vailed.

Ger­many, in con­trast, main­tained its tra­di­tion of re­ha­bil­i­ta­tion and neu­rol­ogy, with Ot­frid Fo­er­ster a dom­i­nant fig­ure. His par­tic­u­lar in­ter­est in the treat­ment and the re­ha­bil­i­ta­tion of pe­riph­eral nerve in­juries started dur­ing the First World War, when he treated 4,748 such pa­tients and op­er­ated on 775 of them. When he re­turned to his neu­ro­log­i­cal depart­ment in Bres­lau after the war, he treated all forms of neu­ro­log­i­cal dis­eases, in­clud­ing spinal in­juries. Cru­cially, Fo­er­ster trained Lud­wig Guttmann in neu­ro­surgery, phys­i­o­log­i­cal re­search and the re­ha­bil­i­ta­tion of pa­tients with pe­riph­eral nerve in­juries. It was this rig­or­ous Prus­sian train­ing that would later in­flu­ence Guttmann in the found­ing of the only suc­cess­ful spinal unit in the UK at Stoke Man­dev­ille Hos­pi­tal.

AFTER 1933, with the ad­vent of Hitler, there was a dra­matic de­cline in Ger­man medicine. The Nazis as­sumed con­trol of the med­i­cal pro­fes­sion in­clud­ing train­ing and ap­point­ment of doc­tors. Spe­cial­i­sa­tion and spe­cial­ist hos­pi­tals were op­posed in favour of gen­eral prac­tice. The role of an­ti­semitism has a par­tic­u­lar significance on spinal in­jury man­age­ment, since so many of the doc­tors, es­pe­cially the neu­rol­o­gists car­ing for spinal in­jury pa­tients dur­ing the First World War, were Jewish. There was in­sti­tu­tional an­ti­semitism in Ger­many prior to the Nazi regime. Racism was openly prac­tised against any­one who was not Aryan. Dis­tin­guished Jewish sci­en­tists such as Fritz Haber and Paul Ehrlich, who sub­se­quently won No­bel Prizes for their work, had ex­pe­ri­enced an­ti­semitism ear­lier in their ca­reers.

Guttmann con­firmed that Jews were forced into ca­reers in un­pop­u­lar spe­cial­i­ties such as neu­rol­ogy, ra­di­ol­ogy, re­ha­bil­i­ta­tion or psy­chi­a­try (as was Freud) be­cause through an­ti­semitism, main­stream med­i­cal and sur­gi­cal posts were not open to them. Con­se­quently, a dis­pro­por­tion­ate num­ber of Jewish doc­tors treated spinal in­juries pa­tients dur­ing the First World War in Ger­many and the Aus­trio-Hun­gar­ian Em­pire. Among them were Mar­burg, Ranzi, Bor­chard, Cas­sirer, Weil and Sch­warz.

In 1933, all Jewish pro­fes­sors were dis­missed from uni­ver­si­ties and Jewish books were burned and banned. Jewish doc­tors were dis­missed from hos­pi­tals, could not con­tinue their in­surance work or their pri­vate prac­tice, were only al­lowed to treat Jews and by 1939, had their qual­i­fi­ca­tions stripped from them al­to­gether so that they could not prac­tise medicine at all. Jewish au­thors had their names re­moved from books and publi­ca­tions and were no longer al­lowed to pub­lish sci­en­tific pa­pers.

An­ti­semitism greatly af­fected the ca­reers of Jewish doc­tors; many fled Ger­many and their knowl­edge was lost. Fo­er­ster wasn’t Jewish, but he had a Jewish wife and his chil­dren were ex­pelled from school. He was chal­lenged as to why he em­ployed so many Jewish as­sis­tants. He replied that he chose his staff for their in­tel­li­gence, not for their re­li­gion.

Mar­burg, an Aus­trian, held a full univer­sity chair at the neu­ro­log­i­cal in­sti­tute in Vi­enna. He was a pro­lific and fun­da­men­tal writer on neu­rol­ogy but when the Nazis came to power, he fled to Amer­ica where he was again ap­pointed pro­fes­sor and wrote a text­book on the man­age­ment of spinal in­juries.


Early wheelchair sports at Stoke Man­dev­ille Hos­pi­tal

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