Lawrence A Zeidman & Lauren Mohan. Journal of the History of the Neurosciences. Volume 23, Issue 1, 2014.
All neurologists are familiar with Wallenberg Syndrome, the brainstem syndrome caused by lateral medullary infarction, and first described by neurologist and neuroanatomist Adolf Wallenberg (1862-1949) in 1895 (Wallenberg, 1895). But few know of the story of the man behind the syndrome, especially the struggles he endured later in life when he was tragically forced to flee his homeland after a lifetime of service to his specialty and his country. Other recent articles in the neurology literature have summarized Wallenberg’s professional and personal story (Pearce, 2000; Hydén & Norrving, 2005 Shoja et al. 2008). But given his ties to the University of Illinois at Chicago (UIC) Department of Neurology (initiated by Wallenberg himself in the 1940s and later maintained by his daughter), we have a number of letters, documents, articles, and photos as well as a special memorial to Wallenberg. Of note, Wallenberg-Chermak donated to UIC her father’s handwritten 92-page diary. Despite difficulty in reading the handwriting, the German was in the modern form, and we were able to obtain a translation. Of note, Wallenberg’s style is very neutral, he only lists the facts and doesn’t comment on his emotions or thoughts during his escape from Nazi Danzig or later emigrations. Wallenberg-Chermak had also condensed her father’s diary into her 6-page German-language biography published in 1963 (of which we also have a copy translated to English by her) (Wallenberg-Chermak, 1963). Given this access to much primary and secondary material, we decided to write a detailed account regarding Wallenberg. By understanding his exceptional story and tribulations, we further honor his memory.
Early Life and a Burgeoning Medical Career
Wallenberg was born in Danzig, Germany (now Gdansk, Poland) to a physician father and was the grandson of a Rabbi. Adolf’s father died when he was six, and he and his three brothers were raised solely by their mother. In addition to their academic education, they received a musical education, and Adolf would play the violin even into late age. Many years later when he immigrated to the United States from Nazi Germany, his violin was his most precious possession, providing him much relaxation and recreation. After he passed the graduation exam, he traveled to Heidelberg to begin his medical studies and also spent a semester in Leipzig learning anatomical pathology and working in the neurological clinic with Adolf Strümpell (1853-1925). Wallenberg was friends in medical school with Heinrich Lissauer (1861-1891), another neuroanatomy enthusiast who tried to recruit Adolf to join him at Carl Wernicke’s (1848-1905) famed clinic. Wallenberg later regretted having missed this opportunity (Wallenberg-Chermak, 1963). He wrote his doctoral dissertation on “Infantile Cerebral Paralysis” (cerebral palsy) and opened a general medicine practice in Danzig in 1885. One year later, he became an assistant physician and prosector at Danzig City Hospital and, from 1907-1927, was Chief of Internal Medicine and Psychiatry there (von Witzleben, 1950; Wallenberg-Chermak, 1963). Wallenberg maintained the private practice partly for financial reasons but also because of his love of medicine. He cared for many poor patients without fees, and according to Max Nonne (1861-1959), famed neurologist and colleague, “As a human being Wallenberg was distinguished [by] a rare modesty and unusual warmth and helpfulness” (Wallenberg-Chermak, 1963, p. 192).
Wallenberg sustained a basilar skull fracture in 1891 in a horse carriage accident when the horse ran wild. He experienced chronic anosmia and diplopia following this accident and may have become less compulsive and rigid in personality. His daughter recounted how it was easy to cook for him thereafter because he only noticed basic tastes and scents. During World War I, Wallenberg was recruited as a consulting and senior physician to the 17th German Army Corps, which caused him to temporarily stop his research, but he returned to his experiments immediately following the war’s end (Wallenberg-Chermak, 1963).
Interest in Neurology and Eponymous Status
Wallenberg had early interests in neurology and neuroanatomy but had no academic affiliation and was a “self-made man” in the field, building a primitive anatomical laboratory in his home initially, and later transferring it to the hospital (von Witzleben, 1950). Throughout his career, he authored 63 papers himself and coauthored four others with Ludwig Edinger (1855-1918) (Wallenberg-Chermak, 1963). Despite a prior description of lateral medullary syndrome by Vieusseaux in the literature from 1811 (Romano & Merritt, 1941), Wallenberg’s comprehensive 1895 paper on an “acute bulbar lesion” (Wallenberg, 1895), along with his 1901 publication (Wallenberg, 1901) of the neuropathological findings on the same patient, led to the syndrome being named “Wallenberg Syndrome” (von Witzleben, 1950). The patient he examined was from his private clinic and amongst the many poor patients Wallenberg treated; clinical-pathologic correlation was not standard practice at the time, but he was able to see its utility in confirming the diagnosis (Wallenberg-Chermak, 1963). The patient presented in 1893-1894 with the following symptoms and signs of short duration:
1) Relative slowing of the pulse; 2) Hypesthesia for pain and temperature sensation [on] the left; 3) Expansion of the anesthesia … to the left half of [the] face, including the inside of the mouth … [as well as] the ear [and] lower jaw margin, 4) slight hyperaesthesia of the left half of the body; 5) total swallowing paralysis; 6) … anesthetic zones in the left face—and right half of the body; 7) Missing … patellar reflexes, of which the right one returned on the third, and the left one on the eighth day after the insult; 8) A missing left cremaster reflex. (Wallenberg, 1901, pp. 944-945)
Other “symptoms lasting several months or years” included the following:
1) Dizziness, tendency to fall toward the left; 2) Slight difficulties in swallowing; 3) Ataxia of the left side, at first very pronounced in both the arm and leg, and later more demonstrable in the leg, which was still affected three months after the insult; 4) Diminished “sense of strength” i.e. the ability to estimate weights when lifting them, likely from ataxia of the left arm (1-4 disappear later entirely); 5) Slight paresis of the left half of the uvula; 6) Left vocal cord paresis, which I discovered a short time before his death [but “The left vocal cord paresis did not hinder the patient from actively participating, as before the illness, in a song club”]; 7) Left slight paresis of the hypoglossal muscle; 8) Sensation disturbance in the dermatome of the first [and] less of the second branch of the left trigeminus … weakening of the left corneal reflex; 9) Disturbances of pain and temperature sensation (especially cold sensation) in the … right torso-half and the right extremities; 10) [Impaired sensory discrimination] on [the] right breast and half of the back, [as well as] on [the] left shoulder and neck … ; 11) Missing abdominal reflexes (doubtful as a focal symptom); 12) … sound on the right mastoid process audible … behind the crista occipitalis, down to the lower jaw angle, to the front (but very weak!) unto the temple, and pulsation of the neck vessels stronger on the right than left. (Wallenberg, 1901, pp. 944-945)
Unlike the original report by Vieusseaux, Wallenberg’s description did not mention Horner’s syndrome also being present, likely because the patient had a cataract in one eye and a corneal scar in the other (Pearce, 2000).
Through his localization skills, he hypothesized that the lesion was in the lateral medulla:
On the basis of a great number of striking phenomena, I believed [I am] justified in assuming [that] an extremely limited [infarction] of a certain position, shape, and extension within the medulla oblongata [was responsible for the patient’s presentation]. As a probable cause of this [infarction] I hypothesized … in conjunction with my studies of the normal vessel distribution within the bulbus, [that] an embolus of the arteria cerebelli inferior posterior sinistra [was responsible]. (Wallenberg, 1901, pp. 957-959)
When the patient died following a second stroke five years later, on the autopsy, Wallenberg was unclear if the thrombus developed in situ in the posterior inferior cerebellar artery or was an embolus from the adjacent vertebral artery:
The anatomical examination … results [indicate] a blockage of this artery through a thrombosis, of which one cannot state [with] any more certain[ty] if it originated in [situ] or came from … atherosclerosis with thrombus formation [in the adjacent] extremely [stenosed] vertebralis sinistra [artery]. (Wallenberg, 1901, pp. 957-959)
Between 1895 and 1915 alone, Wallenberg published 45 papers (Wallenberg-Chermak, 1963), including the third paper describing a patient with Wallenberg Syndrome (Wallenberg, 1915). The fourth and final paper on Wallenberg Syndrome described his fifteenth case overall (Wallenberg, 1922). German neuropsychiatrist Viktor von Weizsäcker (1886-1957), a friend of Wallenberg’s, later stated the following regarding the description of Wallenberg Syndrome:
[It is] not only an especially beautiful historical example [of] the kind of thinking and research of that patholog[ical] epoch in which the anatomy still was the undisputed leader of this science. But it also shows the high level of scientific mind and the spirit of this representative of [neuroanatomy]. … Such mastery is only given to the one who works with endless patience and [devotion], the one who is modest [but has a] proud conscience. (Von Weizsäcker, 1947, p. 529)
Edinger invited Wallenberg to the 1896 German Society of Neurology meeting in Frankfurt, after he had read Wallenberg’s description of lateral medullary syndrome. Indeed, Wallenberg’s 1895 publication was a turning point in his life. Edinger and Wallenberg became friends and worked together until Edinger’s death. Wallenberg’s unabashed critical nature regarding neuroanatomy caused Edinger to state to Nonne that “Wallenberg is my anatomical conscience!” In 1910, he had received the title of professor and, in the same year, gave a lecture with Otto Marburg (1874-1948) on the “Anatomy and Clinical Features of Acute Bulbar Lesions” at the German Neurological Association meeting in Berlin. Wallenberg was reportedly offered a Chair at various foreign universities but refused the offers and remained attached and faithful to his native Danzig (Wallenberg-Chermak, 1963).
Between the World Wars and Continued Career Successes Until the Nazification of Danzig
In 1923, Wallenberg invited the German Neurological Society to hold their meeting in Danzig. Nonne, Strümpell, von Weizsäcker, and Otfrid Förster (1873-1941) were all present and Strümpell received the golden Wilhelm Erb medal, one of the highest awards a neurologist could receive. Strümpell later played an after-dinner violin concert in the Wallenberg home. Wallenberg-Chermak recounted how her lifelong mentorship and guidance from von Weizsäcker began at that time. Wallenberg presented at the 50th annual “Southwest neurologists meeting” in Baden-Baden, Germany in 1925 on the “several tasks of neuroanatomy and its treatment in the last 50 years” (Wallenberg-Chermak, 1963, p. 194). In 1927, at the Viennese neurological meeting, Wallenberg gave the “anatomical report” on the sensory system, discussing the “centrifugal” topographic layout of the sensory tracts (Wallenberg-Chermak, 1963). Wallenberg himself received the Erb medal at the German Neurological Society meeting in 1929 (von Witzleben, 1950) “for his merits in the field of neuroanatomy, neurophysiology, and neuropathology” (Wallenberg-Chermak, 1963, p. 194). He assured the meeting assembly that he would continue to devote himself to his neuroanatomical research “as long as fate would [allow] him” (Wallenberg-Chermak, 1963, p. 194). Beginning in 1928 at age 65, after he had retired from being chief physician at Danzig City Hospital (a position that “was so dear to me”), he was allowed to continue his scientific work in the basement of the pathological institute (Wallenberg diary, p. 87a).
Meanwhile in the Free City of Danzig, the Nazis began to assume positions of power as early as May 1933 when they won an absolute majority in the city’s Popular Assembly (Senate); after this point, though the Senate President Hermann Rauschning was a Nazi, the true power lay in the hands of the Nazi Party leader in Danzig, Albert Forster. Danzig became a “district of the Nazi Party,” subject to directives straight from Berlin. Rauschning advocated a moderate approach toward Danzig’s Jewry and even proclaimed that Nazi anti-Semitism was not racial in nature. He believed anti-Jewish policies would harm Danzig. But Rauschning stepped down in 1934, removing his moderating force toward Danzig’s Jewry. Thereafter, terror and physical violence against Jews, arrests of political opponents, and extensive propaganda became commonplace, just as in the Reich (Bacon, 1980; Cieslak & Biernat, 1988a). The 1938 November pogrom (Kristallnacht, night of broken glass), with violence against Jews and the destruction of Jewish businesses and synagogues, was the culmination of anti-Semitic terror directed against Danzig Jews. The subsequent implementation of the Nuremberg race laws (implemented in 1935 in Germany) stripped Jews of any remaining ability to be professionally or culturally integrated into society. Of the 10,000 Jews in Danzig at the beginning of the 1930s, 5,000 had left by 1938 (Bacon, 1980). By 1939, 2,000 Jews remained in Danzig (Cieslak & Biernat, 1988a). The Jews were given until the fall of 1939 to evacuate all but the sick and elderly, though the elderly left too. The Jewish American Joint Distribution Committee gave some assistance, the Jewish community raised money by selling the Great Synagogue, and some Jews were able to obtain international visas, but most of them immigrated to Poland and some were put on illegal transports to Palestine. By 1941, emigration from Danzig was blocked by the Nazis, and remaining Jews were sent to ghettos in Poland or Czechoslovakia, from which they were later sent to death or concentration camps (Bacon, 1980).
In 1934, Wallenberg and his wife had to move from their apartment because the building was occupied by “Nazi authorities.” They were given another “very pleasant apartment with a picturesque location” where he still was able to see private patients, among them the former “President of the Gdansk [Senate],” Rauschning (Wallenberg diary, n.d., p. 86). Because he was Jewish, in 1938, Wallenberg was prohibited from further work and publications, including the use of his hospital laboratory (Wallenberg-Chermak, 1963). He had to relocate his laboratory equipment and found shelter in rooms belonging to an “an insurance company” and later in rooms belonging to a “pleasant fur trader,” where he “still was able to produce some small scientific results” (Wallenberg diary, n.d., p. 87a). Wallenberg was also forced to renounce his honorary membership in the Danzig Society of Nature Researchers, to which he was a member since 1887 and later a director.
Wallenberg procrastinated in deciding to emigrate, despite many offers of assistance from abroad (Wallenberg-Chermak, 1963). When it became clear that
Hitler wanted to use the Free City of Gdansk as springboard to Poland, it was not possible to stay any longer in Gdansk, and on 29 August, three days before Hitler’s attack on Poland, my wife and I left Gdansk with only the most necessary luggage. We travelled from Berlin, via Hannover and … Holland to the UK. (Wallenberg diary, n.d., p. 87)
Apparently, it was the steady insistence and urging of his wife that finally resulted in them fleeing Danzig in late August 1939, only days before World War II began. He was able to store his specimens, slides, and other work in the warehouse of the furrier with whom he was friends (Wallenberg-Chermak, 1963). Wallenberg’s reluctance to emigrate was not uncommon among German physicians. Beside financial issues, including Nazi flight taxes and travel costs, emigrant physicians needed a sponsor abroad to obtain visas, there were language barriers, and they often encountered entanglements obtaining practice licenses as foreigners. Typically only established physicians with a strong reputation or younger physicians with “nothing to lose” were the ones who emigrated (Zeidman & Kondziella, 2012). Even prominent neuropathologists like Otto Marburg, the pre-eminent Viennese neuropathologist who described the Marburg variant of multiple sclerosis, had severe difficulty obtaining a practice license in New York after immigrating there in 1938 (Triarhou, 2008). Additionally, there was a fierce loyalty among German physicians to their fatherland, and Wallenberg apparently felt this loyalty also, like some other Danzig Jews. Ludwig Pick (1868-1944), another famous German neuroscientist who co-described Niemann-Pick disease, also felt a false sense of security from a prior war record and had strong loyalty to Germany, refusing to emigrate despite offers in Chicago and Shanghai. Pick died in the Theresienstadt ghetto in 1944 (Simmer, 1994).
Immigration and Life in England and Chicago
Neuroanatomist and paleoanthropologist Sir Wilfrid Le Gros Clark (1895-1971) at Oxford University sponsored Wallenberg, and he looked at his years in Clark’s Institute examining histological slides as “extremely happy ones,” despite the constant air raids from the war going on at the time, and sharing cold and hunger with the local population (von Witzleben, 1950; Wallenberg-Chermak, 1963). Wallenberg wrote:
I used Le Gros Clark’s hospitality to examine histological material from the CNS [central nervous system] of various animals (rabbits, cats, apes). These examinations largely corroborated Clark’s results but clarified some points. (Wallenberg diary, n.d., p. 88)
Wallenberg held regular neurology lectures for German-speaking physicians living in exile in England and also enjoyed lectures by exiled Spanish neuroscientist and microglia discoverer Pío del Río Hortega (1882-1945) on pathologic-anatomical preparations from the lab of the Oxford Neurosurgery Clinic run by renowned British neurosurgeon Hugh Cairns (1896-1952), prior to Río Hortega immigrating to Buenos Aires and dying there (Wallenberg diary, n.d.; Wallenberg-Chermak, 1963). Wallenberg and at least eight other German neuroscientists immigrated to the United Kingdom (Emergency Committee in Aid of Displaced German Scholars, 1993; Peiffer, 1998), although British anti-Semitism and a desire to appease Nazi Germany may have played a role in the refusal of visas to non-“distinguished” or world-renowned neuroscientists (Kater, 1989). Wallenberg’s reasons for wanting to leave the United Kingdom seem to be related only to wanting to join his daughter in the United States and not due to the wartime strife in England or to the persecution of some Jewish German émigré neuroscientists in the United Kingdom, such as Erich Guttmann (1896-1948), who had worked at London’s Maudsley Psychiatric Hospital and the Mill Hill Emergency Hospital following immigration in 1934 on a Rockefeller fellowship but was interned and had difficulty subsequently finding a position (Lewis, 1943; Peiffer, 1998). In his diary, Wallenberg made no remarks whatsoever on possible discrimination and wrote, “In August 1943 we followed the invitation of our daughter, and we left hospitable Oxford following a touching farewell from our Oxford friends” (Wallenberg diary, n.d., p. 90).
In 1943, Wallenberg and his wife obtained American visas and immigrated to the United States, arriving in Chicago after three weeks travel by way of Liverpool, Halifax, Montreal, and New York (Wallenberg diary, n.d.). Wallenberg was one of eight Jewish German neuroscientists to immigrate to Illinois before or during the war (Peiffer, 1998; Schwoch, 2009) and may have been aided by the fact that Illinois was one of the six most liberal US states toward such immigration (Kater, 1989).
The Wallenbergs joined their daughter, who was Clinical Director at Manteno State Hospital in Manteno, Illinois, and lived in a residence inside the hospital. Wallenberg gave lectures in neuroanatomy and neurophysiology to the hospital’s physicians and was often consulted for interesting cases. Wallenberg read fluently in English and understood spoken English but had trouble with conversational English (Wallenberg-Chermak, 1963). At the encouragement of German neurologist Henry von Witzleben, in 1944, Wallenberg read a paper on “Anatomical Contributions to the Problems of Sensation, Perception, and Attention” before the Chicago German Medical Society. Subsequently the paper was read in English by von Witzleben to the Chicago Neurological Society (the latter presentation being facilitated by Dr. Percival Bailey [1892-1973], who was so impressed by the initial lecture). After that presentation, Wallenberg was made an honorary member of the Chicago Neurological Society (von Witzleben, 1950; Wallenberg-Chermak, 1963).
In 1948, Wallenberg was asked to contribute to the book honoring Karl Bonhoeffer’s (1868-1948) 80th birthday and wrote of “Anatomical Contributions to Problems of Sensation, Perception, and Attention,” which was related to the lectures he delivered in Chicago in 1944. Wallenberg stressed the function of the neurologic pathways in their topographic layout and how the centrifugal nature allowed them to fit in to the “total machinery” of the central nervous system (Wallenberg-Chermak, 1963). On his own 85th birthday, Wallenberg received many complimentary letters from international colleagues he had worked with throughout the years. Wallenberg-Chermak found these among her father’s possessions and also donated them to our department (Boshes, 1996). Kurt Goldstein (1878-1965) wrote:
It is a pity that we do not see each other occasionally, but to be so far away from each other in America is almost as if one is in Europe. … I hope that you are in good health and that you are celebrating a beautiful birthday within your family. Within the next days, Tilly Edinger (Ludwig Edinger’s daughter) will come here for a short visit. I know that we shall speak a great deal about you. Otherwise one is making it on and on. We both must work diligently. Life is not quite easy but one has to be satisfied. (Collection of the History of Neurosciences, Department of Neurology, University of Illinois at Chicago)
Nonne wrote to Wallenberg also, stating
[Y]ou must permit a still older (by 2 years) colleague to greet you heartily and to tell you that he has not forgotten you … you, coming from the Northeast, lectured us about your newest research and functioned as the “conscience of Edinger.” At the congresses of the Society of the neurologists you always functioned as the authoritative—not authoritarian—expert of neurohistology. … May the years beyond the biblical age be relatively easy for you and may in the distant country the sun which is shining there still [provide] some warm rays for you! (Collection of the History of Neurosciences, Department of Neurology, University of Illinois at Chicago)
Von Weizsäcker wrote:
But I also dare send you a respectful congratulation in the name of the now [reappearing] German Journal of Neurology. However this occurs out of a feeling of duty and because of the gratitude of neurology; not to revive memories upon which a shadow fell. I know that the strength of the personal feeling for your life work, for your person, could never suffer any damage; however, I also know that we have no right to pay honors … I hope that you continue to microscope; that means that you enjoy the happiness to be the pathfinder to the finest organ, critic in the most difficult labyrinth, proclaimer of the truth among the ones weaker in spirit—and this good luck may stay with you. (Collection of the History of Neurosciences, Department of Neurology, University of Illinois at Chicago)
Wallenberg’s diary ends with statements on his satisfaction at receiving these congratulations from his colleagues in Europe and the United States on his 85th birthday and his delight about the marriage of his daughter Marianne (Wallenberg diary, n.d.). Through contact with Bailey, one of the founders of the Neurology Department at UIC, Wallenberg had signed a contract to donate his entire library and slide collection here (Boshes, 1996), but it was found out later via the Polish Embassy in Washington, DC, that the warehouse in Danzig containing the collection was destroyed by bombing. Until his last day Wallenberg took an interest in American neurology, reading and studying as much as possible. This modest man, referred to as a “noble gentleman” at his funeral, died of a myocardial infarction and third degree heart block, quietly and inconspicuously, in his home at age 86 (von Witzleben, 1950).
In recognition of his accomplishments, the German Neurological Society, in conjunction with the German Stroke Society, since 1999 has awarded the “Adolf Wallenberg Prize” to young German and foreign doctors (under age 40) for excellent research on cerebrovascular diseases, cerebral blood flow, or brain metabolism. The award includes a certificate and a cash prize of 5000 euros (Deutsche Gesellschaft für Neurologie Web site, 2010; Deutsche Schlaganfall-Gesellschaft Web site, 2012). From 1975 to 1999, the award had been named the “Hugo Spatz Prize” after German neuropathologist Hugo Spatz (1888-1969) but was renamed given Spatz’s collaboration with the Nazi euthanasia program during World War II (Zeidman & Pandey, 2012).
From Wallenberg’s diary, we ascertained that he did not seem to harbor any regrets or apparent bitterness. By the time the Nazis assumed power in Danzig, he was already retired and in his 70s, well respected locally and internationally, physician to at least one Nazi, and loyal to the Germany for whom he had fought in World War I. The persecution he and his family faced was not dissimilar from other Jewish neuroscientists in Nazi Europe nor was their potential difficulty in emigration unique. Wallenberg did have international fame and easily found visa sponsors Le Gros Clark in the United Kingdom and later his psychiatrist daughter near Chicago in the United States. Because he was already retired, he was not subject to frustrations obtaining a medical license like his colleague Marburg in New York. Near Chicago, Wallenberg peacefully lived out his last days, continued to contribute to American neurology and was recognized in Chicago. The letters written to him for his 85th birthday from some of the top neurologists at the time reflect the impact that this small bent-over German emigrant had on the history of neuroscience.