Bernd Holdorff. Journal of the History of the Neurosciences Basic and Clinical Perspectives. Volume 25, Issue 3. 2016.
This article focuses on the settlement of emigrating German-speaking neuropsychiatrists and neuroscientists from the wider Berlin area to the United States. The main emphasis will be put on the movement of “brain gain” in America vis-à-vis the “brain drain” in Germany; that is, the question if a second career and a measurable impact on North American neuroscience could be identified. It is beyond the scope of this survey to detail the full working biographies of these colleagues in clinical neurological clinics prior to their immigration, as well as their importance for German neurology and neuropathology, which has been described elsewhere (Peiffer, 1998). Their working context in Berlin has been described in particular by Holdorff (2004) for the clinical neurology field.
Professional Conditions of Medical Émigrés in the United States
The forced migration of Jewish physicians in Germany was initiated through the inauguration of the Nazi “Law on the Re-Establishment of the Professional Civil Service” (Gesetz zur Wiederherstellung des Berufsbeamtentums) from April 7, 1933. During the same year, when the first refugees reached their new host countries, primarily in the United States, various medical and social assistance groups had also come into existence. However, in 1933, the American Medical Association (AMA) was one of the largest and most powerful pressure groups for the protection of medical interests in the United States became engaged in a campaign to restrict the relicensing for foreign-educated physicians in the United States (Pearle, 1981, p. 14). More than half of the American states made official citizenship in the United States an obligatory requirement for the medical relicensing process, while most of them also required a professional exam before allowing foreign physicians to resume their medical practice. The states of New York and Massachusetts however had some of the most liberal licensing laws, initially requiring only a language test. They conferred a foreign medical license by professional endorsement until October 15, 1936 when medical exams were made mandatory for all immigrants. Four of the émigré candidates went to court after they had failed the examination and eventually succeeded in having their case vindicated (Pearle, 1981, pp. 47-184). Another famous petitioner, however, Prof. Dr. Otto Marburg (1874-1948), the former chair of the Institute of Neurology at the University of Vienna, who wanted to be reconsidered for medical practice, lost his lawsuit in July 1941 (Pearle, 1981, p. 225).
On the one hand, the hostile attitude towards refugee doctors by the professional medical community could be explained by several factors: the economic fear of an overcrowding of the profession, the nation was still suffering from the Great Depression during the first years of the 1930s (Kater, 1989, p. 210), xenophobia (Rypin, 1937, as cited by Pearle, 1981), and anti-Semitism among the membership groups of the AMA (Kroener, 1988) as well as in the US medical education system (Halperin, 1955, as cited by Zeidman & Kondziella, 2012). On the other hand, solidarity of the American society largely prevailed. Some private aid foundations had, for example, been founded only months after the “Law on the Re-Establishment of the Professional Civil Service” had come into effect in Nazi Germany (Pearle 1981, p. 29, 39). In June 1933, the “Emergency Committee in Aid of Displaced German Scholars” was founded, later called “Emergency Committee in Aid of Displaced Foreign Scholars.” It had three guiding principles (Duggan 1941): (1) To support only institutions, not individual scholars, and preference to Americans in cases of equal merit, (2) to spend grants only to mature scholars between 30 and 58 years of age; and (3) to expect that the scholar be absorbed by the institution in its faculty (resulting in a success rate of about half of the cases). Mostly, these grants were duplicated by the Rockefeller Foundation to the sum of $2,000 per year (Duggan, 1941).
In October 1933, Bernard Sachs (1858-1944), who was the acting president of the New York Academy of Medicine (NYAM) and who was familiar with European medicine through his own postgraduate neurological training, cofounded a specialized Committee in Aid of Displaced Physicians. Between 1933 and 1942, it evolved into the most reliable relief organization for the resettlement of the newly arriving émigrés in America (Pearle, 1981, pp. 210-217).
The majority of the foreign physicians were not scientists and scholars and yet can be seen as belonging to the group of practicing physicians; their impact on U.S. medicine, however, can only hardly be assessed or even quantified. Their medical education level prior to their forced migration differed markedly to the North American one, both in terms of content variances as well as language problems. The acute shortage of doctors during WWII seemed to greatly improve the refugee physicians’ chances of integration into American society (Pearle, 1981, p. 30). Nevertheless, xenophobic attitudes and antirefugee resentments had to be noted as well, at a time when medical boards did not accept Jewish members and when numerus clausa (NCs) existed at many American medical schools for students of Jewish faith (Kater, 1989, p. 211).
The list of displaced German scholars until 1936/1937 (Strauss et al., 1987, pp. 69-73, suppl. p. 10) contains 62 mostly Jewish scholars in clinical neurology, psychiatry, psychopathology, and psychotherapy. The majority were neuropsychiatrists, not neurologists, due to the German tradition of combining both specialties in education and practice (see also Stahnisch, 2008, pp. 443-446). The high percentage of immigrating neuropsychiatrists, the largest group of medical specialists following to that of the internists, is striking in this regard: They represented the classical nerve doctors (Nervenaerzte) in the tradition of Emil Kraepelin (1856-1926) in Munich and Julius Wagner-Jauregg (1857-1940) in Vienna (Kroener, 1988, pp. 2573-2578), while others stood for psychoanalytically oriented or dynamic psychiatry (Peters, 1992, 2008), including the different psychoanalytical schools. Most of the émigré neuropsychiatrists could not fully re-establish their former professional quality, not at least due to their initial or enduring language problems. Several neuropsychiatrists continued practicing but failed the licensing exam. Some young students from Berlin, among those forced to emigrate to North America, seemed to have had the best chances for a successful acculturation in their new homeland.
Medical Students from the University of Berlin
The following students and trainees only later qualified as clinical or basic neuroscientists during their career in the United States:
Hans-Lukas Teuber (1916-1977) had received a classical education at the French Gymnasium College in Berlin and studied biology and philosophy at the University of Basel in Switzerland. In 1941, Teuber came to the Department of Psychology at Harvard University as a graduate student and, in the same year, married Marianne Liepe an art historian. She came to play a central role in the groups (sometimes referred to as extended families) that later formed his experimental psychology laboratory at New York University, as well as the groups in his department at the Massachusetts Institute of Technology (MIT) in Cambridge, Massachusetts. Teuber’s most important educational experiences during his graduate school period were probably the two years that he had spent away from his studies in the US Navy. During this time, he began to work with the neurologist Morris B. Bender (1905-1983) at the San Diego Naval Hospital on the effects of human brain lesions in injured soldiers. This collaboration lasted more than 15 years and produced a series of important neuropsychological articles, particularly on the effects of penetrating head wounds vis-à-vis visual and haptic functioning (Teuber, 1960). After returning to Cambridge, Teuber completed his doctoral dissertation at Harvard in 1947, which was based on a study of the effects of psychotherapy on teenagers with risk for delinquency. In 1947, Teuber established his Psychophysiological Laboratory at the New York University’s Bellevue Medical Center.
A systematic experimental neuropsychology program had been pioneered and established at Bellevue, which led to a transformation of the study of human brain function from collected data of single neurological case reports. Teuber joined the Massachusetts Institute of Technology in the fall of 1961, where he was hired to organize a new department of psychology. Over the next decade, this became a world center for the behaviorally oriented neurosciences. He also ventured to study the case of H. M. in Canada. This epilepsy surgery patient had memory deficits after bilateral removal of the temporal hemispheric poles of his brain. Teuber applied new standards in neuropsychology and delivered revisions of the classical, anatomically based distinction between perception and cognition (Teuber, 1960). It transcended classical views of perceptual neurological disorders such as visual object agnosia (Teuber, 1965; Milner & Teuber, 1968), simultaneous agnosia, and other conditions. Teuber was a prolific scientific author (Teuber, 1978), who was also highly esteemed by European neuropsychologists such as Henri Hécaen (1912-1983; Hécaen, 1979) in France or Klaus Poeck (1926-2006; Poeck, 1982) in Germany, and Teuber was also a charismatic teacher at every level of undergraduate and postgraduate education in psychology and neurology (Hurvich, Jameson, & Rosenblith, 1987).
Fritz A. Freyhan
Dr. Fritz A. Freyhan (1912-1982) was born in Berlin and came to the United States in 1937 after graduating from the University of Berlin. His research in the 1950s examined the use of drugs for the treatment of psychosis and depression. He had interned at Sydenham Hospital in New York and then joined the staff of Delaware State Hospital, in Wilmington, in 1940. In 1961, he went to the National Institute of Mental Health in Bethesda, Maryland, where he worked for five years before he was appointed director of research at St. Vincent’s. Five years later, he became the research director at St. Vincent’s Hospital and Medical Center in Manhattan, New York City. Several papers and books dealing with social psychiatry or psychiatric care attest to his engagement in modern psychiatry. In 1972, Freyhan retired and went into private practice in Washington, DC.
Heinz Lehmann (1911-1999) received his MD at the University of Berlin in 1935 at a young age and was then forced to migrate to Montreal, Canada, where—as an untrained psychiatrist—he initially conducted ethically dubious therapies in psychiatric patients and later introduced chlorpromazine to North America in 1953 (Shorter, 1997, pp. 248-251). He eventually became one of the most prominent champions of modern psychopharmacology as the chair of the McGill University Department of Psychiatry at the Allan Memorial Institute (Stahnisch, 2008).
Karl Bonhoeffer (1868-1948), Director of the Neuropsychiatric Clinic (Psychiatrische und Nervenklinik) at the Charité Hospital in Berlin from 1912 to 1938, played an important role in delaying the dismissal of his Jewish coworkers and supporting their emigration to secure foreign countries—most of them leaving for the United States. Two physicians, Edith Jacobson (1897-1978) and Alfred Quadfasel (1902-1970), were even imprisoned by the Nazi regime for political accusations, for two years and two months, before being allowed to leave the country. Bonhoeffer delayed the dismissal of his most experienced coworker, Prof. Dr. med. Franz Kramer (1878-1967), until 1935. Kramer settled down in a private practice by 1938 and immigrated thereafter to the Netherlands where his medical prospects were poor during the Nazi occupation and at times he had to work as a physician in secret locations.
Kramer’s colleague, Dr. med., Dr. phil. Hans Pollnow (1902-1943) had been his coauthor on scientific papers on hyperkinesia in children (Kramer & Pollnow, 1930, 1932; for the Kramer-Pollnow-Syndrome, see Neumaerker, 2005). Pollnow fled to France, where he was caught by the Nazi persecutors (Gestapo) and eventually murdered in the concentration camp Mauthausen in Austria on October 21, 1943.
At the turn of 1938/1939, Dr. Hanns Schwarz (1898-1977) attempted to settle down in the United States but, disappointed about the materialistic competition among the physicians and the language problems of a foreign psychiatrist, he soon returned to. And thereafter, he was again assisted by Bonhoeffer from 1939-1941, who succeeded in having the Nazi report on his questionable Jewish origin revoked, which saved his and his family’s life. In 1946, Schwarz was appointed Director of the Neuropsychiatric Clinic of the University Greifswald in the Soviet Occupied Zone, which later became the German Democratic Republic (GDR; Schwarz, 1975; Gerrens, 2001).
Dr. Martin Grotjahn (1904-1990) emigrated because of his endangered Jewish wife Etelka Grosz and son Michael to the United States in 1937, first to Topeka, Kansas (Menninger Clinic), and later to Chicago, Illinois. When the war had ended, he and his family moved to Los Angeles, California, in 1945, where he became an influential clinical psychoanalyst.
Herta Seidemann (1900-1984), coworker of Bonhoeffer, conducted extensive studies on “Dyslexia” (Scheller & Seidemann, 1932). However, her habilitation file was not moved forward for her thesis defense by the new National Socialist (NS) authorities at the Berlin Charité. Dr. Seidemann took up an interim position in Switzerland and then returned to Berlin in 1936. On her return, she was presumably hidden by her friends, before she finally immigrated to New York in 1938. This again was aided by Bonhoeffer, who facilitated her emigration by contacting émigré neurologist Kurt Goldstein (1878-1965) at the Montefiore Hospital in Brooklyn, New York. She worked there beginning in 1942 and also joined a psychoanalytical institution, where she collaborated with the German-American émigré psychoanalyst Karen Horney (1885-1952).
Assistant physician and honorary professor Erwin Strauss (1891-1975) continued his tenured job until 1935 because of the “Hindenburg exemption” (Frontkaempfer-Paragraph), by which Jewish men, who had served in the military during WWI, were allowed to stay in their position, but then lost this privilege and the other civil rights through the Nuernberg Race Laws of 1935.
At the beginning of his exile in the United States, he lectured in philosophy and psychology at Black Mountain College in North Carolina. Between 1944 and 1946, he received his license to practice as a physician and became a Research Fellow at Johns Hopkins University, Baltimore, Maryland. He was also Director of the Veterans Administration Hospital in Lexington, Kentucky, from 1946 to 1961 and eventually a lecturer in neurology at the University of Kentucky beginning in 1956. Dr. Strauss resumed his relations with German and Swiss psychiatric colleagues very soon after WWII, in that he lectured in meetings and as guest professor in Frankurt/Main (1952) and Wuerzburg (1961/1962).
Lothar B. Kalinowsky
Lothar B. Kalinowsky (1899-1992) had for some years been a student of the neurologists Richard Cassirer (1868-1925), Paul Schuster (1867-1940), and Karl Bonhoeffer in Berlin. He prepared his scientific habilitation thesis on “Hallervorden Disease,” later substituted by the term “pantothenate kinase-associated neurodegeneration” (Kalinowski, 1936) but then had to leave Berlin and immigrate to Rome in Italy. There, he learned the procedures of electroconvulsive therapy (ECT) from the Italian psychiatrist Ugo Cerletti (1877-1963), with whom he had worked since 1935. After exiles in Paris, France, and Amsterdam, Holland, he immigrated to London, England, in 1938. Kalinowsky left Europe for New York City in 1940. At Columbia University, he became a pioneer of ECT and, in 1958, was promoted to an Associate Professor for Neuropsychiatry at the New York Medical College, while clinically working on the wards of Mount Sinai Hospital.
Paul Jossmann (1891-1978) had been an Adjunct Professor (Privatdozent) at Bonhoeffer’s clinic since 1929 and one of Bonhoeffer’s most experienced and indispensable coworkers. His working contract was prolonged until December 1935 (Gerrens, 2001), when the Nuernberg Race Laws had been enacted. Thereafter, he had to seek refuge in the United States with a letter of recommendation from Bonhoeffer (July 11, 1938), but it took him quite a while to receive a position as an advisory neurologist at the Boston University Medical School and in the Veterans Administration neurology service.
Fred (“Fredy“) Quadfasel (1902-1981) was a resident in Frankfurt/Main during 1925/1926 in the clinic of Kurt Goldstein, who in turn had been a former coworker of Carl Wernicke (1848-1905) but Goldstein’s direct contact with Wernicke must have been mostly as a student and for a very short time as his assistant (Quadfasel, 1968). Quadfasel, at the Charitè Hospital Berlin under Bonhoeffer since 1928, had been imprisoned for opposition to the NS regime in November 1934 and was sentenced to two months in jail in February 1935 (Quadfasel, n.d.), before deciding to leave Germany and seeking refuge in the United States. There, he joined the Boston Veterans Administration and was appointed head of the neurological department in 1947 (his impact will be discussed later).
Karl Birnbaum and Franz Josef Kallmann
Two more of Bonhoeffer’s former psychiatric collaborators had been expelled from their positions before 1933. Bonhoeffer, through his letters of recommendation to American colleagues facilitated their emigration. However, Prof. Karl Birnbaum (1878-1950) was not allowed to practice due to his lack of a medical license, while Prof. Franz Josef Kallmann (1897-1965) came to lead the Genetics Laboratory of the New York State Psychiatric Institute at Columbia University between 1938 and 1961.
In conclusion, Bonhoeffer’s intercessions for his endangered or dismissed coworkers was apparent in at least three directions: (1) to prolong their contracts at the Charité hospital and by declaring them “indispensable” to the clinical work, (2) to help with recommendation letters to foreign colleagues in the host countries, and (3) to use his relations to the higher NS administration and diplomacy for getting passports for Quadfasel or a new “race expert’s report” for Schwarz issued. Bonhoeffer’s role during the NS period remained nevertheless ambivalent. He took an ambivalent stance towards the eugenics programs of the NS regime and accepted the contemporary sterilization programs, which could be interpreted in line with the Zeitgeist among most of the psychiatrists of this time. However, once he was out of office in 1938, Bonhoeffer had to face the even more cruel measures of the Nazi politics. His intercession and aid for his coworkers and émigrés for their settlement in the United States became an instance of noticeable admiration and thankfulness. The former émigrés from his own staff as well as other exiled colleagues in America dedicated an appreciative Festschrift for his 80th birthday (March 31, 1948) in an edited collection of 21 papers (Strassmann, 1949: For the great psychiatrist and man who stood firm to his convictions through years of terror and oppression), which appeared shortly after Bonhoeffer’s death on December 10, 1948.
Quadfasel’s Influence on Neuropsychology in Boston
The appreciation of Quadfasel’s achievements in the Boston’s clinical neurology community was expressed by E. Philipp Richardson, Jr. (1924-2013): “Clinical and EEG [Electroencephalography] units at the Veterans Administration Hospitals, esp. that directed by Quadfasel from 1947 to 1964, also played a considerable role” (1975, p. 421). Quadfasel exerted a clear influence on clinical neuropsychology and notable neuropsychologists: Harold Goodglass (1920-2002), later a prominent pioneer of neuropsychological tests and assessment, began his neuropsychological research in the laboratory of Quadfasel. With Quadfasel, he published his first landmark paper (Goodglass & Quadfasel, 1954), in which he showed that the left hemisphere is dominant for language not only in righthanders but also in the majority of lefthanders, thus shaking the classical doctrine that language and handedness are controlled by the same hemisphere (qtd. after Stemmer in Gainotti, 2008, p. XXI; see also, Goodglass, Quadfasel, & Timberlake, 1964).
Quadfasel also influenced Norman Geschwind’s (1926-1984) work on aphaseology and neuropsychology and encouraged him to study classical texts of neurology from the nineteenth and early-twentieth century that exposed him to traditional localizationist theory. As Geschwind, who had met Quadfasel in 1958, recalled in his memoirs:
I would like to express my thanks to two neurologists who grew up under the great German classical tradition, Dr. F. A. Quadfasel, formerly chief of the Neurology Service of the Boston Veterans Administration Hospital, who (together with Dr. Samuel Tartakoff, b. 1903) first provided the author with the opportunity to study a large aphasic population and who constantly provided able criticism and the benefit of profound knowledge of classical writings on aphasia… [And as Geschwind continued: Josephe Jules] Déjerine’s [1849-1917] paper, first post-mortem case of pure alexia without agraphia, of which my chief at the Boston VA Hospital Dr. Fred Quadfasel, had an original reprint. The impact of the paper was multiple. (Geschwind, 1974, p. 2)
Geschwind became a founder of modern (behavioral) neuropsychology and the local Aphasia Unit at the Boston Veterans Administration Hospital. He was in line with the classical localizationists (“diagram makers”) Carl Wernicke (Kushner, 2015) and referred to earlier papers of German neurologists Hugo Liepmann (1863-1925) and Kurt Goldstein from 1900 to 1909. In particular, Geschwind gathered a sample of observations of so-called disconnection syndromes like pure alexia, color-naming deficits, and motor apraxia, summarized in his work “Disconnection Syndromes in Animals and Man” (Geschwind, 1965a, 1965b), which seemed to have their origin in Quadfasel’s library as Geschwind’s remembrance implies (Kean, 1994, pp. 351, 356). Quadfasel’s own publishing on neurology was not extensive; he figured mostly as a second or third author, such as one with Geschwind on so-called “conduction aphasia” and “isolation of the speech area,” supposedly by interruption of the fasciculus arcuatus (Geschwind, Quadfasel, & Segarra, 1968; Kean, 1994).
Exodus from Berlin’s Independent Neurological Departments
The disciplinary emancipation of neurology, the beginning of clinical neurology, and the foundation of independent neurological hospital units in Germany happened mainly after WWI, when there was a need to look after the many wounded war veterans. In the prewar years, there existed in Berlin already several outpatient institutions of neurology of a high standard, run mainly by Jewish colleagues like Hermann Oppenheim (1858-1919) who were mostly excluded from academic clinical neurology positions (Holdorff, 2001, pp. 127-139, 2004). Yet during the postwar period, the municipal administration favored the founding of independent hospital units outside of the university. One exception was a special adjunct professorship for neurology and psychiatry at the University of Berlin for Kurt Goldstein, who worked at the academic Hospital of Moabit in Berlin. The neurological avant-garde consisted of a group of Jewish colleagues, who were at the scientific forefront of their time (Holdorff, 2004). Among this particular group figured the following neurological clinical directors:
- Kurt Goldstein, MD, was born in Kattowitz, Silesia, in 1878 and died in New York City in the United States in 1965 (Neurological Department Berlin-Moabit, 1930-1933).
- Fritz Heinrich Lewy, MD, was born in Berlin in 1885 and died in Pennsylvania in the United States in 1950 (Neurological Institute, Hansa-Clinic Berlin, 1932-1933).
- Paul Schuster, MD, was born in Cologne in 1867 and died in London, England, in 1940 (Neurological Department, Friedrich-Wilhelm, or: Hufeland-Hospital Prenzlauer Berg, Berlin, 1920-1933).
- Clemens Ernst Benda, MD, was born in Berlin in 1898 and died in Munich, Germany, in 1975 (Neurological Department of the Augusta-Hospital Berlin, 1929-1933).
- Otto Maas, MD, was born in Berlin in 1874 and died in London, England, in 1965 (Neurological Department of the Clinic in Berlin-Buch, 1910-1933).
- Kurt Loewenstein, MD, was born in Iserlohn, Germany, in 1894 and died in Tel Aviv, Israel, in 1953 (Neurological Department of the Hospital in Berlin-Lankwitz, 1921-1933).
These Jewish physicians all had to leave their Berlin positions in 1933 and were forced under the Nazi regime to immigrate to other countries outside of Germany, primarily to North America, Britain, and Palestine (Israel). Most of the clinical and research departments, in which they had worked before, disappeared after 1933 or were destroyed during the war (Holdorff, 2004). The assistant medical director (Oberarzt) Lipman Halpern (1902-1968), working with Kurt Goldstein at the Moabit Hospital, immigrated first to Switzerland (Zurich). He later migrated onwards to Palestine, where he was appointed as Head of the Department and Professor of Clinical Neurology at the Hebrew University in Jerusalem (Feinsod, 2012).
Hermann Pineas and Ernst Haase
Hermann Pineas (1892-1969?) served as an assistant medical director in Paul Schuster’s clinic and succeeded him from 1939 until 1943 in the director’s position of the Jewish Hospital in Berlin. Thereafter, he only survived the Holocaust in Germany through hiding from his Nazi persecutors (Pineas, 1970, 1982). Pineas eventually immigrated to New York when the war had ended, where he took a post as a clinical neurologist from 1952 to 1969 in the Veterans Administration’s outpatient clinic. Ernst Haase (1894-1961) had been trained in neurology and psychiatry at several clinics, such as at the Parisian Salpêtrière in France with Georges Charles Guillain (1876-1961) and at the Hufeland-Hospital in Berlin with Paul Schuster, before joining Kurt Goldstein at the Moabit Hospital as a medical consultant in 1930. In 1932, however, he returned to youth welfare as well as the care of drug and alcohol addicts (Pross & Winau, 1984). After losing his medical license to practice due to the new Nazi legislation in 1933, he seized on the opportunity to run a private practice as a doctor until October 1939, when he left Germany for England. Eventually, he reached the United States in 1940 where he soon settled in Chicago as a guest physician. In 1941, he passed the State Board Examination and started a private neurological practice. He soon developed contacts to clinical departments in the city, which enabled him to receive an adjunct appointment at the department of neuropsychiatry of the Mount Sinai Hospital from 1941 to 1945. During the same period he also worked in the capacity of a consultant at the Eye and Ear University Clinic in Chicago, Illinois, from 1942. His work then was remunerated with a 20% appointment, which led to an annual salary of $1,500 and allowed for his subsistence. From 1942 to 1947, Haase lectured on neurology at the neuropsychiatric department of the university. After the war, he was appointed as an assistant clinical professor of neurology at the University Clinic of Neurology and Neurosurgery, starting in 1949 in a part-time position with an annual salary of $1,440 (Baule, 1995, p. 129). Haase belonged to the so-called “courtesy staff” at the big municipal Michael Reese Hospital since 1954. With his reaching of retirement age, he was made an adjunct clinician from 1956 to 1958, and, in 1961, shortly before his death, he received the title of an associate attending physician. His scientific papers on neurological and psychotherapeutic topics during the period from 1946 to 1959 display his strong academic engagement (Baule, 1995, p. 129). With the end of the war in 1945, he had held a one-year presidency term of the “executive staff” of the university and, in this position, he became further invited to give talks and addresses to several medical conferences in North America.
Carl Felix List
Carl Felix List (1902-1968) was a German neurologist and neurosurgeon. Following his medical studies in Berlin, he pursued graduate work in neurology in both Berlin and Breslau (of particular importance was his period as a coworker of Paul Schuster in the neurological department of the Hufeland-Hospital in Berlin). In 1932, he furthermore became a guest surgeon at the Peter Bent Brigham Hospital in New Haven (in neuropathology and neurosurgery with Harvey Cushing) and in Chicago, Illinois, for some months. On his return to Berlin, he trained at Moabit Hospital with the neurosurgeon Moritz Borchardt (1868-1948) until the latter’s dismissal in March 1933. Via Brussels, he reached the United States in 1934, where he joined the Department of Neurosurgery in Ann Arbor, Michigan. He also became appointed as a teaching lecturer and received his medical license for neurology and psychiatry before the outbreak of the war. In 1941, he passed the American Board of Psychiatry and Neurology examinations and eventually became a member of the American Neurological Association. When the war had ended, List moved to Grand Rapids, Michigan, in 1946, where he stayed in several clinical positions until his sudden death in 1968, leaving his wife, Eva, a daughter and a son behind. List’s clinical focus was on arteriography of the neck vessels and abnormalities of the osseous cervico-occipital region (DeJong, 1970; Davenport, 1993).
The former chiefs of neurological departments from Berlin—Clemens Ernst Benda, Fritz Heinrich Lewy, and Kurt Goldstein—all settled in the United States in very different scientific and clinical fashions.
Clemens Ernst Benda
Clemens Ernst Benda (1898-1975) was a neuropsychiatrist and neuropathologist, who had trained at diverse teaching hospitals in Southern and Northern Germany, as well as in Switzerland. He was a coeditor of the widely read German medical journal Die Medizinische Welt, and, from 1929 to 1933, he was the head of neurology at the Augusta-Hospital in Berlin. In 1936, he immigrated to Boston, where he was appointed as the director of the Wallace Research Laboratory for the Study of Mental Deficiency. He also assumed the clinical directorship at Wrentham State School and received educational duties at Harvard Medical School, primarily in the area of psychiatry. Both of his two great studies of 1949 and 1952 (appearing in German in 1960) on mongolism (trisomia 21) and cretinism as well as their influences on developmental psychological disorders, such as oligophrenia and associations with cerebral palsies resulted in Benda’s wide acknowledgement in the scientific community, in which he was recognized as one of the founders of child neurology (cf. Ashwal, 1990, pp. 421-426). But his clinical inclination was more towards the field of psychiatry and psychotherapy. Increasingly, Benda became interested in philosophical and Christian-religious topics about which he started to write at length, resulting in several books—primarily monographs written in German between 1932 and 1970. He stayed in close contact with his former countrymen, while dying in 1975 on his last visit in Munich (Yakovlev, 1975).
Fritz Heinrich Lewy (1885-1950)
The life and work of Fritz Heinrich Lewy in the first decades of the twentieth century has been described in several recent historical articles (Schiller, 2000; Holdorff, 2002, 2006; Rodrigues e Silva et al., 2010; Holdorff, Rodrigues e Silva, & Dodel, 2013) and may be studied there in detail. Lewy’s outstanding milestones of his early career were his description of “intracellular eosinophilic inclusion bodies” in Parkinson’s disease in Lewandowsky’s Handbook of Neurology in 1912, the interruption of his neuroscientific work by the obligation of a military officer in WWI, and the founding of the Neurological Research Institute and Clinic at the Hansa Hospital in Berlin in 1932 (Holdorff & Neumaerker, 2002).
Lewy immigrated with his wife to London during the summer of 1933. However, deprived of the opportunity to find a long-term position in Britain, he decided to emigrate again and directed his plans this time to the United States. In Philadelphia, Charles Harrison Frazier (1870-1936), head of the department of neurosurgery at the University of Pennsylvania School of Medicine in Philadelphia eventually offered Lewy a clinical position. Here, in 1934, he started to work as a university consultant neurologist in neurosurgery and a guest professor of neurophysiology. On September 14, 1934, the Lewys made a request for naturalization to the American government. During the process, Lewy changed his name in steps from “Fritz Heinrich Lewy” to “Frederic Henry Lew(e)y.” Yet, it took altogether six years, after their initial request, that the Lewys were finally naturalized on June 12, 1940. Before the war, on August 27, 1936, Lewy had received the American medical license to practice. Influenced through their own experiences as refugees from Germany, Lewy and his wife Flora M. Lewy (1892-1961) kept on helping other displaced persons to find positions in the United States (Rodrigues e Silva et al. 2010).
In the search for a successor in 1936 to the neurology professor and head of the Neurological Institute at the University of Pennsylvania, William Gibson Spiller (1863-1940), the committee under its chair, and the American biophysicist Detlev Bronk (1897-1975) had held the prevailing opinion that Germans could not become accustomed to the American way of treating patients, which also excluded Lewy from being considered for this position. Lewy managed to subsist on an annual research award, which was granted to him on June 13, 1935. He received a yearly allocation of $1,000 starting September 17, 1935 for his interesting work in trigeminal research, which eventually led to some papers (Lewy & Grant, 1938; Lewy, Grant, & Groff, 1937, 1940). Assisted by the Emergency Committee in Aid of Displaced Physicians and also by Frazier, Lewy managed to keep an annual salary of $3,000. This was contributed in equal means by the University of Pennsylvania, the Emergency Committee in Aid of Displaced Physicians, as well as the Rockefeller Foundation. It was a relatively comfortable financial arrangement that served to prolong Lewy’s unsecured situation in fixed-term contracts for a longer time.
However, Frazier passed away on July 26, 1936, and Lewy submitted an additional research application to the Rockefeller Foundation (RF) on October 3, 1936, intending to establish a research program to investigate the trigeminal neuralgias and tuberculous meningites. The members of the university committee, Detlev Bronk and the physiologist Henry Cuthbert Bazett (1885-1950), acknowledged Lewy’s role in strengthening the neurology service at the university by combining laboratory work and clinical research in the same unit. Nevertheless, the review commission for the RF research application preferred a younger candidate with modern professional training (Bronk 1936). In his assessment of Lewy, Bronk described him as a good clinician yet not a great scientist, suggesting that Lewy should only be offered a part-time position with the university. Bronk would have even rejected Lewy’s application if he had been the chair of the committee, but he acknowledged Frazier’s previous aid for Lewy “Frazier’s death leaves Lewy uncared for” (Bronk, 1936). Lambert from the Rockefeller Foundation’s program in psychiatry and psychosomatics concluded in the same sense: “The answer is, I think, that if Frazier had not looked after Lewy no one else would have” (Bronk, 1936, folder 198). The Rockefeller Foundation was eventually informed by Bronk on February 23, 1937, that the Emergency Committee in Aid of Displaced Physicians would support Lewy with an annual sum of $1,500 for the next two years. Additional matching support from the United Jewish Appeal Committee was also assured after a community donation action. This allowed the Rockefeller Foundation to withdraw its support as was also the case for the Emergency Committee in Aid of Displaced Physicians that ended its support for Lewy in 1939 (Rodrigues e Silva, 2014, p. 98).
In the meantime, local Jewish organizations provided Lewy’s full annual salary of $3,000, a situation that remained constant until America entered the war. On September 10, 1940, Lewy had complained to the Rockefeller Foundation that, despite his six-year long tenure with the university, he was still in the position of a visiting professor. Yet, this appeal remained unheard by university officials, and Lewy never received a full-time position in the United States. During his university career at the University of Pennsylvania, Lewy also assumed the position of a visiting professor for neuropathology and neuroanatomy until 1949. Between 1943 and 1946, Lewy had been in the US army in the rank of a lieutenant colonel, in the capacity of which he worked as both a physician and medical researcher. The Lawson Hospital in Atlanta, Georgia, was his first station and Lewy afterwards served as the head of the neurology service at the Cushing General Hospital in Framingham, Massachusetts. While at Framingham, he conducted studies on peripheral nerve damage, laying the foundation for the concept of specialty centers largely devoted to the study of injuries of the peripheral nervous system (“Peripheral Nerve Units”). In cooperation with the Pennsylvania neurosurgeon William P. van Wagenen (1897-1961), Lewy built the first “Peripheral Nerve Unit” at the Cushing General Hospital, which was later expanded by the neurologist Barnes Woodhall (1905-1985) from Duke University and the neurosurgeon Roy Glenwood Spurling (1894-1968) at the US Army’s Walter Reed Hospital (Denny Brown, Rose, & Sahs, 1975, p. 535). After WWII in 1946, Lewy returned to his position in the department of neurosurgery and neuropathology at the University of Pennsylvania. Hereafter, he travelled to Argentina in 1949 to learn the Hortega method, a specialized histological silver staining technique, which he later successfully applied to the pathological diagnosis of brain tumors. Lewy and his wife converted to the Quaker community as Lewy’s mother had already done in 1943, and the family visited regular meetings of the Haverford Quaker community from that point on. In 1949, Lewy retired from university service for health reasons that were caused by diabetes and arteriosclerosis. On October 5, 1950, at the age of 65, Lewey died suddenly due to coronary thrombosis at his summer home in Pennsburg, Pennsylvania; both he and his wife, who died in 1961, are buried in the cemetery of Haverford, Pennsylvania (Holdorff, 2002; Rodrigues e Silva et al., 2010).
During the years of 1908 to 1923, F. H. Lewy was the first researcher to detail the pathological anatomy of Parkinson’s disease (PD) leading to his seminal contribution, entitled “Paralysis agitans. Pathol. Anatomie” (1912). In this work, he described the neuronal eosinophilic inclusion bodies in the brainstem, later accomplished by more systematic investigations in 1923. He generally mentioned the widespread pathology but not expressively the inclusion bodies as a hallmark of PD pathology. In spite of the findings of the Russian neuropathologist Konstantin Nikolaevitch Tretiakoff (1892-1958) in 1919, which experimentally determined the significance of the substantia nigra in PD and coining of the term “Corps de Lewy,” this research impact had been surprisingly underestimated by Lewy himself (Lewy, 1924). Since his expulsion from Nazi Germany, Lewy had been cut off from his previously successful research on PD. His article from 1942, entitled “Historical Introduction: The Basal Ganglia and their Diseases” seemed to have been intended as a tribute to the bulk of his earlier basic work on PD. Yet, similarly to his first publication, this article largely avoided discussion of the inclusion bodies. However, who ought to have acknowledged his pioneering discovery than Lewy himself? The same holds for his contemporaries, so that the era of the Lewy bodies and Lewy-body-disease came to follow only after Lewy’s death in 1950 (Holdorff, 2002; Holdorff, Rodrigues e Silva, & Dodel, 2013).
The various memberships and fellowships that Lewy received in the United States (Rodriguez e Silva, 2014, pp. 10-11) can be seen as representative of Lewy’s commitment to clinical neurological research. Among these count his membership in the American Neurological Association, his membership and vice presidency (1938) of the American Association of Neuropathologists, Lewy’s membership in the American Physiological Society and the Association for Research in Mental and Nervous Diseases, as well as his chair’s position of the neuropathologic section of the American Hospital Association, and the Board of Trustees of the American Academy of Neurology. Likewise, Lewy was a fellow of the American Medical Association, a member of the Philadelphia Physiological Society and the Philadelphia Neurological Society, correspondence member of the Argentinean Society for Normal and Pathological Anatomy, as well as an honorary member of the Argentinean Society for Neurology, Psychiatry, and Neurosurgery, while also holding fellowships in the American College of Physicians and the College of Physicians of Philadelphia.
A letter, dating October 10, 1943 to the secretaries Miss Simpson, and another one to Miss Ursell on September 13, 1947 at the Society for the Protection of Science and Learning in London, England, offer some further insights into the scholars’ acculturation overseas and in the US Army. He also mentions in these letter exchanges that he had returned to his former position in the Department of Neuropathology and Neuroanatomy at the University of Pennsylvania in 1946:
To complete your list: I am now Professor of Neuroanatomy in the Graduate School of Medicine and Associate Professor of Neuropathology in the Medical School of the University of Pennsylvania, and Consultant to the Surgeon General of the Army. A group of our friends over here talked over the scholars we know and who have come to this country since 1933. The general impression is that everybody has found his nook. During the wartime, even older people were gainfully employed…. Still, I believe that practically everyone makes a living, as small as it may be. The country has been very good to us. (Letter to the Academic Assistance Council (Ms. Ursell), dating September 13, 1947)
In conclusion, in spite of his contentment, Lewy’s position at the University of Philadelphia School of Medicine was insecure, and he had to struggle permanently during his American exile. In his first training years in Germany, he had moved between diverse disciplines such as physiology, neuroanatomy, neuropathology, neurology, and internal medicine. Before and after his emigration, his subjects of research ranged widely, a good condition for the directorship of his neurological clinic and research institute in Berlin but perhaps not for finding a firm ground in the host country. He could not profit from his earlier discovery of the inclusion bodies in Parkinson’s disease, because he himself and the scientific community were not yet aware of their importance.
Kurt Goldstein (1878-1965) between the Natural Sciences and Humanities
Goldstein was forced to leave Germany in 1933. Having arrived in Berlin from the University of Frankfurt am Main, he had spent only three years at the teaching hospital of Moabit until his arrest and emigration. During his temporary refuge in Amsterdam, he wrote his famous book Der Aufbau des Organismus. Einfuehrung in die Biologie unter besonderer Beruecksichtigung der Erfahrungen am kranken Menschen (Goldstein, 1934, 1939) and, hereafter, supported by the Rockefeller Foundation, emigrated to the United States in 1935, where he started to work in private practice. Shortly after his arrival, in 1936, he was appointed as a clinical professor of psychiatry at Columbia University and for some time joined the New York State Psychiatric Institute. He then accepted a position as the chief of the newly founded Laboratory of Neurophysiology at Montefiore Hospital in Brooklyn, where he shifted more to experimental psychology, and, from 1940-1945, he became a clinical professor of neurology at Tufts College Medical School in Boston, Massachusetts. At the age of 67, he then returned to his private practice in New York City and assumed various teaching and educational activities. In the last years of his life, he taught once a week at Brandeis University in Waltham, Massachusetts; however, after suffering from a stroke, he died three weeks later in September 1965.
With his holistic approach to neurology and neuropsychology, Goldstein represented a counterweight to the mainstream of neurological practice. Already during his time in Frankfurt/Main under neuroanatomist Ludwig Edinger (1855-1918) and then being Edinger’s successor from 1918 to 1930, Goldstein led an institute to study the sequels of traumatic brain injuries—a very innovative program for the rehabilitation of brain-injured patients at this time. Together with Adhémar Gelb (1887-1936), Goldstein also introduced Gestalt psychology into neurology and cofounded the Internationale Gesellschaft fuer Psychotherapie [International Society for Psychotherapy] in 1927. Both historical scholars and contemporary neurologists alike have regarded him as an initiator of a multidisciplinary, holistic brain pathology (including aphasiology and neuropsychology), in which psychological, organic, and environmental factors had been inseparable. According to his scientific credo, brain functions could not be individually localized; at best, symptoms and defects could be so diagnosed in neurological diseases and injuries (Goldstein, 1930). A brain-damaged person would lose the ability to proceed from the concrete to the abstract or to distance oneself from the concrete phenomenology of his or her condition and proceed into a world of possibilities to compensate for neurological and behavioral losses received. The concrete attitudes in what Goldstein called the “catastrophic reaction” had thereby to be understood in their dependency as the very individual inner and outer conditions of the individual patients.
Goldstein thereby developed his views about neurological patients from analyses of brain-damaged individuals. He avoided giving additional labeling, primarily of specific brain dysfunctions, since he believed that otherwise the holistic understanding—always considering the whole organism in the practice of neurology—would be lost. He criticized the somatic medicine and psychotherapy. For Goldstein, it was an expression of the atomistic-materialistic way of thinking at the beginning of the twentieth century, which denied the individuality of the personal and social categories (Goldstein, 1931). His debate with Otfrid Foerster (1873-1941) at the Society of German Nerve Doctors (Gesellschaft Deutscher Nervenaerzte) on plasticity and regenerative powers in brain-injured patients, which occurred in 1930, offered several insights into the high theoretical and clinical level of the discussion (Holdorff, 1996). It can likewise be seen as an expression of a contemporary crisis in medicine (Rimpau, 2009) due to the schism that appeared between the brain localizationist and holistic approaches. American historian of science Anne Harrington and neurologist Oliver Sacks (1933-2015) have repeatedly stressed Goldstein’s view of an “anthropological neurology” in the re-editions of Goldstein’s Der Aufbau des Organismus (2014) and The Organism: A Holistic Approach to Biology, Derived from Pathological Data in Man (1995). The publications from his time in Berlin (1930-1933) reflect a continuation of his earlier work at the University of Frankfurt since WWI. His earlier studies on aphasia were later compiled and republished as a summary volume during his exile in 1948. In view of the skepticism and pragmatism in mainstream American neurology, Goldstein felt the strong need to defend the philosophical implications of his earlier studies on the aphasias (Noppeney, 2000; Noppeney & Wallesch, 2000).
In contrast to his numerous antilocalizationist declarations, his paradoxical linkage to the classical Hirnpathologie [brain pathology] and to his teachers Carl Wernicke in Breslau and Edinger in Frankfurt has been noticed by the Boston aphasiologist Norman Geschwind (1926-1984) in an appraisal of Goldstein’s role in the history of aphasia research (Geschwind 1965a, 1965b, 1974). To Geschwind, however:
the most interesting of the four reformers [von Monakow (1853-1930), Pierre Marie (1853-1940), Henry Head (1861-1940), and Goldstein] is Kurt Goldstein, who has actually had much more profound effects on thought about the higher functions, certainly in the United States and probably even in England, than any of the others, even including Head. (Geschwind, 1974, pp. 65-67)
He could never adapt to American culture, and New York remained for him a “home in exile” (Shakow, 1966; and Simmel, 1968, as cited by Noppeney, 2001). In these years, his original writings were almost completely devoted to abstract aspects of psychology and neurology, and he had less impact on current neurology than he deserved (Denny-Brown, 1966). He never managed to take root again or to play as large a role as he had at the height of his earlier career in Germany (Teuber, 1966). The Berlin-born émigré Hans Lukas Teuber (1916-1977), who had met Goldstein in Berlin in familiar conditions as a schoolboy and later became a brilliant neuropsychologist in his own right (Gross, 1994), held tight relations to Goldstein so we owe to him an authentic report of Goldstein (Teuber, 1966). The William James Lectures on Philosophy and Psychology at Harvard during the winter 1938 to 1939, at the invitation from his friend and admirer Karl Spencer Lashley (1890-1958) at Harvard University, were not a success in their oral and written form (Teuber, 1966). With his coinvestigator, the psychologist Martin Scheerer (1900-1961), like him a German émigré, Goldstein developed a test on abstract and concrete behavior to document the individual reactions in brain-injured patients (Goldstein & Scherer, 1941; see also, Henderson, 2010), yet it could not withstand the objections of several neurological and psychological critics. The famous patient Johann Schneider (1891-1962)—traumatized in WWI and studied by Goldstein and his coworker and Gestalt psychologist Adhémar Gelb (Goldstein & Gelb, 1920)—seemed to represent a case of “mind-blindness” (“Seelenblindheit”).
In later years, however, this patient was reexamined in 1942 in Germany by the neurologists Richard Jung (1911-1986) in 1942 and again by Eberhard Bay (1908-1989) in 1949 with the conclusion that the original disturbances were due to psychological suggestion or swindling on behalf of the patient. Goldstein himself did not accept that he had been “fooled” by his former patient and took the opportunity to visit Schneider again in postwar-Germany and could confirm his original findings (Goldstein 1956). As McDonald Critchley (1900-1992) pointed out, his personal skepticism about Goldstein’s famous case darkened their friendly relationship for many years. For him, this showed Goldstein’s sensitivity and also inability to distance himself from the conclusions of his paper and the arguments of his critics (Critchley, 1990). Yet up to this day, however, the paradigmatic patient case remains unresolved (Marotta & Behrmann, 2004). In his earlier years in Germany, Goldstein had made many important contributions to mainstream clinical neurology (Benton, 2003). His spectrum of scientific interests included a large number of related disciplines, such as psychotherapy, psychiatry, philosophy, along with neuropsychology and of course neurology, and neuropsychology as well as neurorehabilitation.
In conclusion, Goldstein’s expulsion from his home country in 1933 nearly extinguished his influence on German neurological thinking. After his death, several researchers pointed out that he had a lasting impact on American neuropsychology (Teuber, 1966; Eling, 2012) as well as overseas (Luria, 1966), and less on clinical neurology than he deserved (Denny-Brown, 1966). In the view of Iowa psychologist Arthur Lester Benton (1909-2006) four decades later, not all but just a few of his observations and reflections had been accepted by the neurological community. This particularly regards his concept of “abstract attitude” and the “abstract behavior” or symptoms of episodic apathy, stubbornness, and facetiousness as an expression of defensive reactions to protect the patient’s self-esteem or to ward off anxiety, following neurological injuries such as stroke (Benton, 2003).
The best chances to learn English and to master the professional challenges, following their arrival in North America, had the young undergraduate medical students from Berlin. This is demonstrated by the later Heinz Lehmann (1911-1999) and Fritz A. Freyhan (1912-1982) and the neuropsychologist Hans-Lukas Teuber (1916-1977). The émigré neurologists and psychiatrists, who had formerly worked on Karl Bonhoeffer’s staff, were all specialized in the German tradition of neuropsychiatry; their professional settlement often depended on specific local and personal circumstances. Fred Quadfasel and Paul Jossmann were able to continue their work in clinical neurology, while Quadfasel even rose through the ranks to becoming a chief of the neurological department in the Veterans Administration hospital in Boston, Massachusetts. Some could continue their professional work quite smoothly: Psychiatrist Lothar B. Kalinowsky could apply electroconvulsive therapy (ECT) broadly after he had learned this technique with Ugo Cerletti during his previous exile in Rome. Hertha Seidemann found her first refuge in Goldstein’s laboratory at the Montefiore Hospital in Brooklyn; Kallmann, following his receipt of a family affidavit, could continue his research program in genetic psychiatry. On the contrary, Erwin Strauss was only able to recommence his clinical psychiatry work after struggling for some years to receive his medical license of practice.
It is beyond the scope of this survey to describe and qualify the émigré physicians in the field of psychiatry in North America as well; yet clearly a noticeable influence could be appreciated. The émigrés from Germany typically combined both neurology and psychiatry in their clinical and research work, as they had been trained in their home country. Not seldom, however, they needed to change their disciplinary orientation, as a reflection of the job offers they were to receive in the United States in both disciplines. German-American psychoanalysts Edith Jacobson (1897-1978) and Martin Grotjahn (1904-1990) from Bonhoeffer’s staff, for example, settled again in psychoanalysis. Broader description of the fate of psychoanalysis and psychoanalysts in Germany and their settlement and influence in the United States is presented by Lockot (1985) and respectively by Shorter (1997, pp. 166-189, concerning the Berlin group: p. 167). In accordance with the observations of the Cologne psychiatrist Uwe-Hendrik Peters (1992, 2008), the impact of academically working clinical émigré psychiatrists on British psychiatry was high; in the United States, the émigré psychoanalysts dominated psychiatry, increasingly after WWII (Shorter 1997, pp. 166-169).
The former avant-garde of clinical neurology in Berlin consisted of highly qualified neurologists, who frequently could not resume their former clinical and research directions field or only to a minor degree: for example, Kurt Goldstein or Frederic Henry Lewy (Denny-Brown, 1966; Teuber, 1966; Rodrigues e Silva et al. 2010; Holdorff, Rodrigues e Silva, and Dodel 2013). The struggle for their resettlement in North America was enormous and sometimes even deploring. Lewy could himself rely on the aid and tutelage of the acquainted neurosurgeon Charles Harrison Frazier (1870-1936) in Philadelphia, help from the Rockefeller Foundation, the Emergency Committee in Aid of Displaced Scholars, and eventually also on local Jewish community funds. However, at the university, he never reached his former level of clinical neurology work and research again. This appears to have had several reasons: Before his forced migration from Berlin, he had struggled to found and head a neurological clinic and research institute until its final opening in 1932. His neuroscientific activities were multiple and spanned neuropathology, neuroanatomy, and clinical neurology, yet they were too broad for a new start overseas. His plan to begin an altered research program on the trigeminal neuralgias was not a promising one. His claim to fame, as the discoverer of the “inclusion bodies” in Parkinson’s disease (Lewy, 1912), was itself a development that rather ensued after his death—even Lewy himself had not fully recognized its importance. The fact that German-Jewish neurologists and neuroscientists used to pursue their rotations and postgraduate training in Germany in several clinics and laboratories before the war appears to have hampered their professional resettlement in America. Goldstein pursued widely diversified topics with little interrelation. He seemingly scattered his efforts, often as a reflection of the sheer necessities of daily practical problems in the medical field of his new host country (Goldstein, 1967). His impact on mainstream neurology was much less than that on neuropsychology and anthropology. Neuropsychology generally plays a larger role in the diagnostic process of special cases and employs laboratory studies and theoretical considerations than did contemporary neurology. Neuropsychiatrist Clemens Ernst Benda had a much better start in Boston as a clinical fellow. Very soon he became appointed as the head of an institution for “feeble-minded” and handicapped children, where he gathered extensive clinical and neuropathological data that led to two important books on trisomia 21 and cretinism as well as developmental disorders. This later credited him a place as one of the founders of child neurology in North America. Other émigré neurologists from Berlin resettled successfully in medium-sized American hospitals and clinics: Carl Felix List, Ernst Haase, and Hermann Pineas can be seen as respective examples of this group.
A very different integration process into the professional and cultural life of American society can be seen in the cases of two non-Berlin scholars: the neurologists Alfred Hauptmann from the University in Halle/Saale and Robert Wartenberg from Freiburg University. The overseas conditions for their emigration to the U.S. were much better for Wartenberg due to his knowledge of the language and the acquaintance with American clinics from his previous Rockefeller fellowship in 1925/1926. Also a new house in San Francisco was immediately available for the Wartenberg family at their arrival (Rosenow, Dietz, and Frowein, 2007). Robert Wartenberg was a Russian-born, German-educated professor of neurology from the German University Freiburg, where he had served at the Department of Neurology for almost 15 years. At the end of 1935, he immigrated to New York, and, in April 1935, he and his family moved to San Francisco where his wife’s relatives owned private property. Under the tutelage of the neurologist Bernard Sachs (1858-1946) and with the aid of the biochemist Daniel E. Koshland (1920-2007) along with the local neurosurgeon Howard Naffziger (1884-1961), he received an academic position at the University of California School of Medicine at San Francisco. Here, however, he faced several conflicts with the Neuropsychiatric Division of the Department of Medicine, since Wartenberg’s interests collided with those of the other division in which psychiatry and neurology were likewise integrated under one roof as well, which was fairly unusual in the US medical schools of the time (Aird, 1988). As American child neurologist Roger Baker Aird recalled:
Except for the generous and continuing local support of refugee funds, plus the intervention of us, Wartenberg could not have survived for long in this precarious situation. (Aird, 1994, p. 24)
Aird’s personal reminiscences on Wartenberg, as well as on other German émigrés’ teaching of neurology reflect insightful observations as well as problematic generalizations at the same time in that he concluded from Wartenberg’s “bombastic” “showman’s” teaching to the German medical teaching with its “primadonnas,” who ignore “the more realistic experience of patient workups and follow through with their complex problems” (Aird, 1994, pp. 223-224). However, Wartenberg’s personality and teaching skills have been lauded by other observers (Denny Brown, Rose, & Sahs, 1975, p. 491; Schiller, 2003, p. 80). Aird’s successor Robert Fishman (1924-2012) stated in a personal communication: “Wartenberg was the first well-trained neurologist in Northern California,” but, concerning Wartenberg’s influence in US-American neurology, “There were so many other neurologists of his generation who had a greater impact” (Fishman to Rosenow 2005, cit. in Rosenow, Dietz, & Frowein, 2007, p. 449). His textbooks on “Reflexes” and “Diagnostic Tests in Neurology” became very popular in American and German Neurology (Wartenberg, 1945, 1953, 1958a; see also, Boes, 2015; Maranhão-Filho, Borges Vincent, & Martins da Silva, 2015; Wartenberg, 1958b). In honoring his work, several eponyms still bear his name, such as “Wartenberg’s Disease” and “Wartenberg’s Sign,” and the regular Robert Wartenberg Lectures are given at the annual meetings of the American Academy of Neurology, while the bestowment of the Robert Wartenberg Prize in Germany is a tribute to his enduring memory in his former homeland.
In contrast to these instances of a successful integration of the above-mentioned neurologists in North America stands the tragic fate of Alfred Hauptmann (1881-1948). He was more a clinical neurologist than a psychiatrist and was well accepted for his studies on phenobarbital therapy in epilepsy. Hauptmann was expulsed from his chair of psychiatry at the University of Halle and was imprisoned in the concentration camp Dachau for several weeks in 1935 before he could eventually flee to Switzerland. Lacking a medical license to practice, he emigrated on to London, England, and finally to Boston, Massachusetts, in the United States in October 1939. There he joined the Joseph Pratt Diagnostic Hospital as an advisory neurologist, and together with a fellow émigré physician, the internist Siegfried Joseph Thannhauser (1885-1962) he described a dominant hereditary myopathy, later credited with the eponym Hauptmann-Thannhauser myopathy (Hauptmann & Thannhauser, 1941). However, Hauptmann was already 58 years of age and could never accept his exile. On April 5, 1948, he seemed to have died of a “broken heart” (Obituary of his widow Selma Hauptmann, as qtd. in Kumbier & Haack, 2002).
The neurological scholars, expelled from their clinical work in Berlin, were mostly integrated into the new scientific communities of their host countries, as the examples of Clemens Ernst Benda, Kurt Goldstein, Frederic Henry Lewy, and Robert Wartenberg show. They, including psychiatrist Lothar Bruno Kalinowsky, contributed to the great sample of Webb Haymaker’s and Francis Joseph Schiller’s “Founders of Neurology” (1953 (2nd ed.), 1970). The editors Haymaker, a previous visiting scientist in Europe, and Schiller, also an émigré physician from Europe himself, both held the European founders of neurology in high esteem. In the official historical survey of the centennial anniversary of American neurology in the 1970s (Merritt and other contributors in Denny Brown, Rose, & Sahs, 1975), however, Lewy was only mentioned for his foundation of a peripheral nerve unit during WWII, Wartenberg for his clinical and educational contributions, and Quadfasel for his considerable role at the Boston Veterans Administration Hospital (Richardson, 1975). None of them were included in the “History of 20th Century Neurology” (Tyler et al., 2003a, 2003b), which shows that their biographies and important contributions to American neurology had largely fallen into obscurity in the American neurological community. Nevertheless, as this article has shown, their contributions and achievements can still be identified and appraised in the neurological eponym of the Lewy bodies, the Wartenberg signs, Benda’s impact as one of the founders of child neurology, as well as in the continuous discussions regarding Goldstein’s contributions to neuropsychology, rehabilitation neurology, anthropology, and philosophy.