Related to Otfrid Foerster
Description:

'In 1929... Foerster was the leading neurosurgeon of Europe. Though he had trained in France as well as in Germany, he 'shared the scientific methodology of the Anglo-Saxons'. He had a mastery of the anatomy and physiology of the nervous system and he never lost an opportunity of investigating the function of spinal roots and pain pathways, stimulating roots at operation and studying the effects of their section at leisure. During the 1914-18 war he had taken up neurosurgery, and had published his results on a series of twelve patients with spinal cord tumours, with a return of function in nine of them. Unfortunately his neurosurgery was self-taught, and though he later visited Harvey Cushing, he never adopted Cushing's technique and used neither silver clips, electrocautery nor suction apparatus. Cairns (1941) described him as a rather ungainly craftsman, and his haemostasis and even his asepsis were not above reproach.' (228)#

 

'Foerster's only relaxation was to invite his junior colleagues to his house once or twice a week, when they drank Rhine wine and pink champagne and talked till midnight. After the Nazis came to power in 1933 Foerster was for a time under surveillance as the government disapproved of the close contacts he had had with Lenin when he was his chief neurological physician for a year before his death.' (228-229)

 

'The writings of Otfrid Foerster, which are extensive, provide a useful picture both of the state of knowledge in 1920-30 of neurology in general and of studies on paraplegia in particular... The Handbuch der Neurologie of Bumke & Foerster (1935-40) contains long articles by Foerster on pain pathways and the cerebral cortex and most usefully an article by him of 403 pages on the symptomatology of spinal cord injuries (1936a). This includes a detailed description of the sensory and motor losses found with spinal transection at each vertebral level from upper cervical to sacral segments, and also discusses the effects of transection on pilomotor activity, sweating and vasomotor control in the same detail. Andre Thomas in Le reflexe pilomoteur (1921) makes very clear the distinction between pilo- motor activity triggered from the upper intact spinal cord and that triggered from the isolated cord. Foerster does the same for the control of sweating, which he mapped by using starch-iodine powder and is quite clear on the distinction between thermoregulatory sweating triggered from the midbrain, and reflex sweating from the isolated cord. Though his available experimental methods for displaying vasomotor activity were limited, he made the same distinction there... 

The works of both Andre Thomas and Foerster make disagreeable reading, from the contrast between the most elegant and precise neurological observations and the patients' unhindered physical decay.' (231-232)

Related to Professor Sir Ludwig Guttmann
Description:

'After visiting Portugal in December 1938, Guttmann 'decided to emigrate [frm Germany] with his wife and children. The Board of his hospital gave him permission to go; many at the time were on the way out themselves. At Guttmann's memorial service the officiating Rabbi revealed that they gave more than permission, for in memory of his efforts on behalf of the community they gave him a Menorah, the seven- branched candlestick. Each of his houses in turn was called 'Menorah'.' (231)

 

'Guttmann's... early publications are mostly concerned with points of radiological technique in neurosurgical diagnosis...  Scientifically the most interesting is a series of papers arising from the use of an improved method of displaying active sweat glands using quinizarin, a dye that is light grey when dry and deep purple when wet (Guttmann 1937, 1942a). This he used to outline non-sweating areas in lesions of peripheral nerves, and found con- siderable variations between subjects, in the distribution of the central area of complete anhidrosis and border zones of partial sweating loss (Guttmann 1940).' (232)

 

At Oxford ''Guttmann... worked with J. Z. Young and Peter Medawar (1942) on the rate of regeneration of nerve fibres, and there was some collaboration with F. K. Sanders and myself who were measuring conduction rates in nerves above and below the site of crush. He also worked with Medawar (1942) on the chemical inhibition of regeneration and neuroma formation.' (233)

 

'St Hugh's College [Oxford] had become the Military Hospital for Head Injuries, one of its principal aims being the training of mobile surgical teams for neurosurgery in the field. For this, standardization of technique and equipment was essential and it was Cushing's technique that was adopted. Mr J. Pennybacker, then Sir Hugh Cairns's first assistant, has told me that although the Cushing technique produces very long slow operating sessions, it can be taught to aspiring neurosurgeons, when more idiosyncratic methods cannot, though they may be successful in the hands of their developers. Guttmann had been his own master for eight years and was always an individualist, and it is not clear that he would have fitted into such teams.' (233)

 

At Stoke Mandeville, 'Guttmann gave orders that patients were to be turned prone to supine and back or from one side to the other every two hours, night and day, waking or sleeping. His first orderlies had been released from the R.A.M.C. and had learned little there. One man, asked what he had done in the R.A.M.C., said 'Shovelling coal, Sir'. Guttmann had to be in the wards for every hour of the night until his orders were carried out, and the benefits began to appear.' (235)

 

'Only continual vigilance and a drill of moving the body at regular intervals could prevent the recurrence of bedsores, and the patient had to be taught to be conscious of the danger for the rest of his life. One of his many clashes with orthopaedic surgeons occurred at a meeting in 1946 at which I was present, when Guttmann denounced the practice of transporting paraplegics on plaster beds. The principle of spreading the weight of the body so that there were no points of localized pressure was admirable. However, paraplegics, in pain and not eating, wasted so rapidly that they ceased to fit the plaster bed, and arrived at Stoke Mandeville not only with the usual sores over the sacrum, the greater trochanter and the ischial tuberosities, but also with a sore over each vertebral spine, a sight never seen except with plaster beds. Criticism from a civilian was not welcome to the service orthopaedists, but the evidence was incontrovertible.' (235)

 

'While trying intrathecal injections of prostigmine for the relief of spasticity, Guttmann found that it produced erection and ejaculation in paraplegics. Subsequently he used prostigmine to increase fertility either directly or with the help of assisted insemination. One hundred and eight paraplegic men have now had 205 children, a few by this method, and 16 paraplegic women have borne 22 children. The fact that efforts were made to improve their fertility had a considerable effect on the morale of patients.' (236)

 

'When a patient took his first steps [at Stoke Mandeville], often with light walking callipers to fix the knees, he did so not in the physiotherapy department but in the middle of the ward, so that other patients could see that there was hope for them too... Guttmann acquired the respect, confidence and ultimately the adoration of his patients, who privately called him 'Poppa'. He could encourage, cajole and bully patients into making the most of their remaining abilities without causing resentment.' (237)

 

'A number of problems... were.. investigated [at Stoke Mandeville]. In the classic description of patients with lesions at C8 or above, the intercostal spaces are sucked in during inspiration by the negative intrathoracic pressure created by the diaphragm. During recovery this appearance becomes less marked, which led to the suspicion that stretch during inspiration might cause reflex contraction of the intercostal muscles. Guttmann & Silver (1965) demonstrated electromyographically that this is so, but did not make the important distinction between external intercostals, which produce inspiration, and internal intercostals, which are active in expiration (Draper, Ladefoged & Whitteridge 1960). Draper, Ladefoged and I went to Stoke Mandeville in 1959 to test in paraplegics the effect of the reduction of expiratory muscle power on speech. Although Guttmann claimed indignantly that patients with cervical lesions were fully able to speak their parts in the ward Christmas pantomime, we found that their peak expiratory pressure was greatly reduced, as one would expect: they could only count up to about 15 on a single breath, and, like patients with severe emphysema, they were unable to stress the last word of an utterance on a single breath, they could not say 'Please pass the salt!' To find out something about his patients that Guttmann did not already know was very rarely achieved.' (240)

 

'After lunch one day in 1945 Guttmann came across a group of patients in their heavy leather padded wheelchairs sunning themselves on the concrete apron outside the wards, and hitting a puck with reversed walking sticks. His eye brightened as he said something to the effect 'Games, sport, that is what we must have'. He had been trying exercise machines in bed and had the impression that a spell of muscular exercise decreased spasticity in paralysed parts. He and the chief physiotherapist took wheelchairs and tried out wheelchair polo in the gymnasium and made it a recognized game, using a ball and the walking sticks. As long as one could avoid bumping and boring with the chairs, this was a great success, but according to Miss Scruton, his secretary and later Adminis- trator of the Sports Centre, on one occasion the carnage was such that the game had to be given up, and Guttmann started wheelchair basketball instead.' (240-241)

 

'Some of the reasons for Ludwig Guttmann's tremendous impact on the treatment of paraplegia are easy to see. The arrival of the antibiotics meant that effective treatment of bedsores and urinary infections became possible at the end of the war - Lady [Ethel] Florey used to bring over minute quantities of penicillin [to Stoke Mandeville] herself.' (242)

 

'In the early days, a variety of treatments were tried and the failures rapidly discarded. By the mid-1950s he felt he had final solutions for most problems. Dissent he could not tolerate, and he did not find it easy to collaborate with equals. He believed in concentration of power in his hands as Director of the National Spinal Injuries Centre, partly because this was German practice and partly because a single Director had been absolutely essential in the early days in the patients' interests.' (242)