27 May 2017

Revolutionising the care of spinal injuries - Ludwig Guttmann

Ludwig Guttmann (1899-1980) was born in Upper Silesia Germany/now Poland, into a religious Jewish family. His parents were Bernhard and Dorothea, and his sisters were Margarethe Guttmann, Alice Bamberger and Liesel Karger. He started studying medicine at the University of Breslau in 1918 and continued his studies in Würzberg and Freiburg, graduating in 1924.

Guttmann returned to Breslau and worked with Europe’s leading neur­ologist Prof Otfrid Foerster from 1924-8. In 1928, he was in­vited to start a neuro-surgical unit in Hamburg but this post only last­ed a year as Foerster asked him to return to Breslau as his assistant. Guttmann remained in this job until 1933 when the Nazis forced all Jewish staff and patients to leave Aryan hos­p­it­als. Fortunately Guttmann became a neurologist in Breslau's Jewish Hos­p­ital for 6 years.

On Kristallnacht (9th November 1938), Guttmann gave orders that any male person entering the hospital was to be treated, despite the racial laws specifying that Jewish doctors could only treat Jewish patients.  The next morning, he had to justify to the Gestapo the large number of admissions. In fact he saved 60 Jews from certain death by telling German officers they were too sick to be transported.

Like all Jews, Gutt­mann's passport had been confiscated and he was not allowed to travel, yet in Dec 1938 he was ordered by von Ribbentrop to travel to Lisbon! Perhaps it was to treat Portugal’s prime minister, Antonio Salazar.

There must be a God in heaven; Guttmann was already in contact with the British Society for the Protection of Science and Learning, and was suddenly offered a position in Britain, plus visas. Ludwig left Germany in March 1939 with his wife Else and children, and went to live in Oxford. [His parents and relatives all died in Germany in 1943, except for Curt and Alice Bamberger who survived by escaping to the USA].

Stoke Mandeville Games,1948
Photo credit: Dialogo

In 1939 Gut­tmann worked at the Radcliffe Infirmary and at St Hugh’s Coll­ege Military Hospital for Head Injuries. But as WW2 con­tinued, the British Government became acutely aware of the influx of paralysed servicemen. So in Sept 1943, they asked Guttmann to become Direc­t­or of the new National Spinal Injury Centre at the Emergency Medical Ser­­vices Hospital, Stoke Mandeville in Aylesbury.

When the centre opened in Feb 1944, Guttman did not like what had been the typical care for spinal patients in Britain – flat on their backs, full body plaster casts and pain relief. As director of the UK's first specialist unit for treating spinal in­jur­ies, Guttmann believed that physical activity was the major meth­od of therapy for injured servicemen and car accidents, helping them build up both strength and self-confidence. Thus he was the neurologist who revolut­ion­ised the treat­ment­ for, and lives of those with spinal injuries.

Of course Guttman was seen as a bit of a radical neurologist, and his many conflicts with colleagues and the hospital adminis­t­ration were loud. But he was an attractive doctor, and compassionate. And his relation­ships with his patients were heartfelt. He challenged the old-fashioned staff and insisted his patients participate in their own recovery. Central to His Big Plan, Guttmann introduced the idea of physio­therapy as a medical treat­ment. Physiotherapy was the way to build strength and to fight depression. He hired an army physical trainer to lift weights with patients and practise movements.

Within months, his Spinal Unit became a place of optimistic noise and activity. In a few years he had transformed the treatment of spinal patients, first in Stoke Mand­eville then across Britain. The knowledge, gained in treating and preventing complications to young soldiers and traffic accident victims, forced Stoke Mandeville’s Spinal Unit to expand rapidly. Only one productive thing had come out of WW2 - Guttmann and his staff gave paralysed patients the skills and treatments to face a useful future and to be reintegrated back into normal society.

Sport
To coincide with the opening of the 1948 London Olympics, Dr Ludwig Guttmann held the first Stoke Mandeville Games on the lawns of the hospital. He presided over a wheel chair archery com­petition where the comp­et­itors, 16 ex-servicemen, were young people with severe spinal injuries. 

The games were held again at the same location in 1952 where dis­abled Dutch WW2 ex-servicemen took part along side the British in archery, table tennis, darts and snooker. The games were the first step in Ludwig Guttman’s dream. At first he used the term Paraplegic Games, in order to encourage his patients to take part. Later they were called Paralympic Games.

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The queen and Dr Guttmann presenting a medal to an Israeli champion
Stoke Mandeville Sports Stadium, 1969

By 1960, 400 athletes from many countries* participated in the first Olympic Games For the Disabled which were held in Rome, alongside the Rome Olympics. In Toronto in 1976, two other disability groups (blind and amputee athletes) were added and a truly international sports competition took place. In the same year, the first Paralympic Winter Games took place in Sweden.

After retirement, Guttmann wrote Textbook of Sport for the Disabled (published in 1976, Aylesbury).

The Stoke Mandeville Stadium is the National Centre for Disability Sport in Britain. Located alongside Stoke Mandeville Hospital, the stadium was formally opened in August 1969. When Ludwig Guttmann died in 1980, it was renamed Ludwig Guttmann Sports Centre, Stoke Mandeville.

*Argentine, Australia, Austria, Belgium, Finland, France, Germany, Great Britain, Greece, Ireland, Israel, Italy, Lebanon, Malta, Netherlands, Norway, South Rhodesia, Sweden, Switzerland, USA and Yugoslavia




23 May 2017

Corfu - was it Venetian, British, Greek or something else?

The Ionian island of Corfu, off the west coast of Greece, is 56 ks long but only 18 ks wide.

Now some quick and messy history. Before the French Revolutionary Wars, the Ionian Islands had been part of the Republic of Venice. Then the 1797 treaty dissolved the Republic of Ven­ice, and Corfu was ann­ex­ed to the French Republic as the French depart­ments of Greece. In 1798-9, the French were driven out by a joint Russo-Ottoman force. The occupying forces founded an island republic which enjoyed relative independence under Ottoman and Russian control from 1800-7; Greek was to be the primary local language.

The Ionian Islands were briefly re-occupied by the French, but very soon after, in 1809-10, the UK defeated the French fleet and capt­ured some Greek Islands. After Napoleon, many countries were inter­ested in the control of the prize island, Corfu island. Thanks to the aid of a Greek General, a treaty was signed in Paris in 1815 that recog­nis­­ed autonomous Ionian islands under exclusive British control.


Venetian buildings in Corfu Town

A formal federation, the United States of the 7 Ionian Islands, was created in Aug 1817 via a Parliament with a 2-house legislature. The gov­ernment was organised under the direction of a Lord High Com­m­is­sion­er, appointed by the British monarch on the advice of the Brit­ish government. Then the Supreme Council of Justice was established.

The first (1815-23) British high commissioner (and Governor of Malta) was Sir Thomas Mait­land, a rather repressive dictator who quickly stir­ring strong complaints from the locals. Yet the British era (815-64) was probably the most flourishing period in the history of Corfu. Corfu established the first Greek University, the Ionian Academy, which was established by Frederick North, 5th Earl Guil­ford in 1824. Its 3 faculties included Med­icine. The estab­lish­ment of schools, which had been neglected by the Venetians, was imp­roved and by 1850 there were 200 schools. Corfu gain­ed its first Philharmonic Orchestra and the first School of Fine Arts.

There were extensive public works providing prisons, hospit­als, marsh clear­ance, a widened road network and a public aqueduct water-supply system that still operates. Commerce with the neighbouring countries grew impressively.

Despite these benefits, the islanders came to resent British rule. And it all came to an end when a 1863 treaty demanded Britain renounce the Ionian islands. In March 1864, representatives of the UK, Greece, France and Russia pledged the transfer of sovereignty to Greece, under the newly install­ed King George I of the Hellenes. And in May 1864, by proclamation of the Lord High Commissioner, the Ionian Islands were united with Greece. The city of Corfu lost power in favour of Athens, but the rest of the island began to pros­per both polit­ically and economically.

   

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The Durrells' White House (top)                               Beautiful Corfu beaches (bottom)

Even then, British influence continued. Way back in 1823, a cricket match was held in Corfu between Royal Navy officers and men in the British Garrison. Thus began a lasting union of this most British of games and the Greek island of Corfu. Of the many cricket clubs drawing excited crowds on the island these days, the loveliest field is Spianada square in town, a UNESCO World Heritage Site with a view of the Old Fortress. Also organised by local British-ex pats, Corfu was where the first tennis clubs opened in Greece.

But the biggest attraction for British tourists now seems to be the tv series The Durrells (2016). Based on The Corfu Trilogy by Gerald Durrell and set in 1935, the Durrell family left home in Britain and settled near Corfu Town. So modern tourists want to rent a villa in the pretty NE corner, where The Durrells was filmed, or stay in the flats at the White House in nearby Kalami, where Law­ren­ce wrote. The lovely bay of San Stefano has the tortoises that fascinated young Gerald, especially in late June. Plus pods of dolphins and sea-turtles.

The quotation inscribed at the foot of a statue of author and naturalist Gerald Durrell in these beautiful gardens was dedicated to him and his brother Lawrence. The brothers’ writing, especially ‘My Family and Other Animals’, popularised this green isle in the world’s imagination.

Corfu Town is a unique blend of histories, with a nod to all the nations that controlled it during its mixed history. On arrival in Mandracchio harbour, the Old Fort can be seen from the water. Fit visitors climb to the top of the fort and can enjoy the magnificent view over the town. Then the fit and the unfit can visit the black­ened remains of St Spyridon, Corfu’s patron saint, in his church. The public buildings of the Venetian rule blend well with narrow winding streets, lovely little bars and shops, and small secluded squares.

Cultural sites are everywhere. Once home to Greece’s King George I, the elegant Saint Michael and George Palace sits on top of a hill outside Corfu Town. The Pal­ace, also the birthplace of Britain’s Prince Philip, opens its elegant interiors to the public and hosts a museum dis­pl­aying artworks, statues, historical and arch­aeological treasures.

The British Cemetery is near San Rocco square. Founded in 1814 by the British Protectorate it was used as a garden cemetery where the British officials, soldiers and residents were interred. After the departure of the British, the cemetery served as the graveyard for the foreign families who stayed on (and it is still being used as a cemetery for the Anglican residents of Corfu today). Note the monument to the seamen of the two Royal Navy destroyers mined by the Albanians in The Corfu Channel Incident of 1946.

100 cricket matches are played each year, 
against local Corfu teams and against touring sides

Visit Greece proudly notes that Corfu became part of the European world rather than part of the Levant.





20 May 2017

Mentoring Noel Pearson - a guest post

I was born in Eastern Europe and eventually moved into a UN refugee camp for people seeking visas to safe countries. Life for me was fine once we got to Aust­ralia, but I was always aware how my parents worked long, miserable hours every week to give us children a decent life. It must have succeeded because my sister became a 4-language translator in the Health Department, my brother became a mathematician and maths teacher, and I became a doctor.

Throughout those years of struggle, my parents never forgot the people who mentored them, enrolling them for citizenship ceremonies (successfully), teaching them English (with mixed success) and help­ing them with driving lessons. Now it was possible to mentor a new generation of young people in medical practices, preferably migrants or the children of migrants. Each year my coll­eagues and I decided to take one undergraduate student into our practices; there they spend one term of hard work, professional supervision and personal support. A very minor contribution to be sure, but one that brings an emotional thank-you from parents in the same heavily accented English my parents spoke.

 Noel Pearson, Prof Marcia Langton, Professor Patrick Dodson, Mark Leibler. 
Expert Panel on Constitutional Recognition of Aboriginal and Torres Strait Islander peoples, 2010

Here is an example of a mentoring program I really admire. Noel Pearson (born 1965) was born in Cooktown and grew up at Hope Vale, a Lutheran Mission in the Cape York Peninsula. His father was from one Aboriginal people, and his mother was from another. After finishing primary school in Hope Vale, Pearson left and travelled all the way to Brisbane where he was a boarder at St Peters Lutheran College. He did two degrees at the University of Sydney – the first in history, and the second in law.

The young legal graduate had to do his articled clerkship in a reputable, large legal firm so he chose Arnold Bloch Leibler, in a totally unfamiliar city 2000 ks away - Melbourne.

Pearson wrote “During an articled clerkship at ABL’s Collins St headquarters, I came to know the story of Australia’s Jewish community and how a people endured oppression and discrimination through history; how they rose up from the ashes of the Holocaust”.

“It was Ron Castan QC who recommended me to Leibler. Ron was one of the greatest legal advocates this country has known and I got to know him following his long crusade with Eddie Mabo to establish native title in the Murray Islands. He later worked with us on the Wik peop­le’s claim to Cape York and was a paternal mentor to me.”

“My time at ABL was a crucial period: I learned so much interacting through the firm with the Jewish community of Melbourne, in the worlds of business, education, arts and culture. I learned how you can be victimised by discrimination but never succumb to victimhood. How you can never forget history but you must engage the future.”

“I came to understand Castan and Leibler’s mentorship in their community is a virtuous cycle through the generations. So I was inspired to start sponsoring young girls from Cape York Peninsula, enabling them to attend private boarding schools in Brisbane. The first one went on to become the first university graduate from her community. Others started their own programs”. [All the quotes come from The Australian Newspaper, 21/12/2013].

As everyone in Australia now knows, Pearson went on to become famous as an advocate for Indigenous peoples' rights to land. In 1990 Pearson co-founded and directed the Cape York Land Council. Pearson's first official appointment was to a Queensland government taskforce which was formed to develop land rights legis­lation. He was also a legal advisor for the Aboriginal and Torres Strait Islander Commission. In 1993 Pearson acted as representative to the traditional owners in the first land claim (successful) to the Flinders Island and Cape Mel­ville National Parks. Following the Mabo decision of the High Court of Australia, Pearson played a key part in negotiations over the Native Title Act 1993 as a member of the Indigenous negotiating team.

In Dec 2010, the Australian Government announced the membership of the Expert Panel on Constitutional Recognition of Aboriginal and Torres Strait Islander Peoples. The Panel included Indigenous and community leaders, constitutional experts and parliamentary members. It was co-chaired by Professor Patrick Dodson and Mr Mark Leibler AC. Noel Pearson and Professor Marcia Langton were vital members of the Expert Panel.

Noel Pearson, 2014
Melbourne lecture

And mentoring is passed on to the next generation. Jawun is a not-for-profit organisation pioneered by Noel Pearson to help indigenous people regenerate their local communities through corporate partnerships. Bank staff, for example, are taken to visit parts of Australia to engage in a culture most Australians would rarely engage in. Using mining royalties, the bankers sit down with elders and local land councils, to help with legal obligations, rights, income distribution, school reforms and information technology.

Mentoring is valuable.
Joe

**

I (Helen) would like to add two thoughts. Readers might like to find Noel Pearson's Quarterly Essay 55 A Rightful Place: Race, recognition and a more complete commonwealth, published in Sept 2014. Pearson shows how the idea of race was embedded in the constitution, and the distorting effect this has had. Now there is a chance to change it. Pearson shows what constitutional recognition means, and how true equality and a renewed appreciation of an ancient culture would be possible. This is a wide-ranging, eloquent call for justice.

At the 1967 referendum on removing discrimination against Aboriginal people from the constitution, 91% of us voted yes, making it the most successful in Australia's history. Now each of Australia's major parties committed to hold a referendum to change the constitution to recognise Aboriginal and Torres Strait Islander peoples. Leaders have yet to agree on the model for change, so the words of the change to the constitution remain uncertain. But the Federal Government will announce a timetable for the referendum soon. May 2017 is the 50th anniversary of Australia's landmark 1967 referendum.