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The Life of Oscar Fehr
REITER'S
SYNDROME
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R E F E R E N C E S
1. Lucas, R. L . , and W e i s s , H . : Reiter's disease: Gonorrheal syndrome w i t h o u t gonorrhea. A r c h . Ophth., 3 4 : 9 7 - 9 8 ( A u g . ) 1945. 2. Bailey, H . J . : Reiter's disease. Internat. Coll. S u r g . J., 3 3 : 1 7 - 1 8 ( M a y ) 1960. 3. Reiter, H . : U e b e r ein B i s h e r unerkannte Spirochaetenfecktion. D e u t s c h e M e d . Wchnschr., 4 2 : 1 5 2 9 , 1916. 4. Cates, J. K., and Csonka, G. W . : Reiter's disease in the female. A n n . R h e u m a t i c D i s . , 1 8 : 3 7 - 4 4 ( M a r . ) 1959. 5. Csonka, G. W . : Reiter's syndrome: T h e o r i e s and facts. E x e r p t a M e d i c a X I I I , 1 3 : 3 8 1 - 3 8 6 ( A u g . ) 1959. 6. Paronen, I . : Reiter's disease: S t u d y of 344 cases observed in Finland. A c t a Med. Scand. ( S u p p . 2 1 2 ) , 1 3 1 : 1 - 1 1 4 , 1948. 7. Csonka, G. W . : Recurrent attacks in Reiter's disease. A r t h r i t i s & Rheumatism, 3 : 1 6 4 - 1 6 9 ( A p r . ) 1960. 8. W e i n b e r g e r , H . J., and Bauer, W . : D i a g n o s i s and treatment o f Reiter's syndrome. Med. Clinics N . A m . , 3 9 : 5 8 7 - 5 9 9 ( M a r . ) 1955.
T H E LIFE OF OSCAR FEHR A.
JOKL,
M.D.
Johannesburg, South
Africa
The life of Oscar Fehr is worthy of commemoration. A leading German eye specialist, he was for many years one of the directors of the Rudolf Virchow Hospital in Berlin. Later, this outstanding doctor and scientist was one of Hitler's victims. Forced to leave Germany, he succeeded at an advanced age in re-establishing himself in England but, eventually, a cruel fate forced him into inactivity. It is hoped that the following pages will be read with compassion by those who knew him, and with interest by others. H e was born in Brunswick on October 9, 1871, the third child of his father Salomon and his mother Helene, née Behrens. Both parents came from Northern Germany. They were married in 1866 in Ebstorf, in the Lüneburg Heath, his mother's birthplace. Oscar's grandfather had already moved from Peine, where the family had lived for a long time, to Brunswick and had acquired a stately old house in the heart of the city. It stood close to the market square with its famous Gothic fountain, the city hall and the Martini church. From the windows of the upper floor one could see, far
Fig. 1 ( J o k l ) . Oscar
Fehr.
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in the south, the Harz Mountains, while northward the endless North-German plain stretched out toward the Baltic. At the time of his birth the whole of Germany was jubilant. The Franco-Prussian War had been won, a United Germany had been created and prosperity was expected from the influx of French' reparation payments. An atmosphere of good will and of liberalism prevailed. There was little antisemitism in these days, particularly in a comparatively small place like Brunswick where Jews were not numerous. The family was respected and well to do. At that time, the Duchy of Brunswick was an important center of horse breeding and Oscar Fehr's father, together with his cousin, had the largest horse-dealing business in town. They were a happy family and Oscar grew up in an atmosphere of harmony and security. H e was the third child. T w o sisters had been born before him and a brother followed. The mother, a beautiful woman, left the running of the house as much as possible to the servants, while she devoted herself to the care and the education of the children. A n uncle, a man of stunted growth but extremely intelligent and with an encyclopedic knowledge, had much influence on young Oscar. After passing the grammar school he entered the Gymnasium Martini-Catarineum at the age of 10 years. It was an oldfashioned school with the main emphasis on classical languages, mathematics and German history and literature. In the upper classes the pupils proudly wore a black velvet cap, which made them resemble university students who belonged to a "Corps." Apart from his school work he enjoyed literature, poetry and play reading. H e also did a lot of drawing and painting, copying the pictures in the local museum. In 1892, at the age of 21 years, he passed his matriculation. He followed the custom, still prevalent in Germany today, particularly among the students who come from
wealthy homes, of studying at different universities—Heidelberg, Kiel and Berlin. Among his teachers were world famous men—the zoologist Buetschli, the anatomist Gegenbaur, the physiologist Hoppe-Seyler, the physician Quincke, the neurologists Erb and Kraepelin, the gynecologist Olshausen and the ophthalmologists von Hippel and Hirschberg. There cannot be any doubt that Fehr received an excellent medical training. H e took his examinations in Heidelberg— in 1894 the primary, in March, 1897, the state examination and in July of the same year his doctor's degree, "summa cum laude." His first practical work was in the hospital in Brunswick. However, his heart was already in ophthalmology. After a few weeks (April, 1897) he entered Hirschberg's clinic in Berlin as an unpaid, voluntary assistant. Hirschberg, then already world famous and one of the busiest eye specialists in Berlin, had accepted Fehr because he needed a draughtsman and Fehr was good with brush and pencil. In the beginning Hirschberg took little notice of him and Fehr felt like the fifth wheel on a carriage. However, his intelligence, diligence and devotion to duty enabled him to acquire the confidence of his chief, particularly after the publication of his first paper (Hemangioma of the conjunctiva) which was accepted by the famous Graefe Archiv for publication. Within a few years he became second and soon afterward first assistant. H e was given two rooms in the attic of the clinic as his living quarters. H e advocated the creation of a clinical laboratory and eventually Hirschberg yielded. After that, Fehr often spent part of the night there occupied with microscopic examinations. His work was not easy. Hirschberg, himself an extremely conscientious doctor, made very great demands on his assistants. Fehr was called at night if a patient was restless. H e accompanied Hirschberg during his rounds at the clinic and assisted at operations. Private patients of Hirschberg had
T H E LIFE OF OSCAR
to be seen first by Fehr, who made the preliminary examinations and then reported to his chief. H e alone was allowed to perform operations in Hirschberg's absence. H e had to read the current medical and particularly the ophthalmic publications. Interesting cases were demonstrated by him before the ophthalmologic society. And last, though not least, he did a lot of original research work. It all meant long hours of work and readiness for duty during the remainder of the day, seven days a week, with very little rest and few holidays. After the death of his mother, Oscar took the desolate father to the Harz Mountains. After a few days, he received a telegram from Hirschberg recalling him, as he was needed to assist in a difficult operation. There were compensations, however. U n der the watchful eye and the expert leadership of such an excellent man as Hirschberg, Fehr was acquiring the knowledge, the experience and the operative skill which made him later one of the foremost ophthalmologists, not only of Berlin but of Germany and of the world. Already in 1899, Fehr had been elected a member of the Medical Society in Berlin, whose "grand old man" was Rudolf Virchow. In 1906, a new hospital which bears Virchow's name was completed in Berlin and Fehr applied for the position of head of the Eye Department. Hirschberg, who had hoped that one day Fehr would take over his clinic and become his successor, was loath to let him go. However, he loyally supported Fehr and gave him an excellent testimonial, Probably the recommendation of Hirschberg played a decisive role. Fehr was appointed. From 1906 to 1934—nearly 30 years—he was director of this important clinic. When he started, he had only 25 beds at his disposal. At the end there were 120. During the last years of his directorship the number of in-patients rose to 1,500, while 6,000 to 7,000 out-patients were attended and 1,300 operations were performed every year,
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among them about 400 senile cataract extractions. Thus, under his leadership, the Ophthalmological Department of the Rudolf Virchow Hospital became one of the most important eye clinics in Germany. His duties included lectures to students and courses for foreign physicians, as well as the training of assistants. One of the latter, Dr. Max Herzog, now living in the United States, who had been Fehr's assistant from 1926 to 1930, has kindly furnished me with a detailed description of his work on which the following presentation is based. Fehr arrived at the clinic usually at about 10:00 A . M . After having formally shaken hands with all assistants and house surgeons down to the youngest, the patients were presented to him by the staff and the diagnosis and the course of treatment were discussed. T w o or three days a week were operating days, and up to 10 operations were performed in one day. At 2:00 P . M . he left the clinic to devote himself for the rest of the day to his private practice. In his operative work Fehr was no pioneer. Apparently his main consideration was to play safe. H e operated well and fast with scrupulous attention to asepsis but followed a conservative technique. Cataracts were done without preparatory injections and without sutures. The capsule was opened with a cystotome and a peripheral iridectomy was made. Each operation took only about five minutes. Needlings were often necessary. Complications were not frequent. His other operations all followed classical lines. One has the impression that in his operative technique he advanced only slowly. Intracapsular extractions were tried only after 1928. Of interest are his operations for detachment of the retina in the pre-Gonin era. H e performed a posterior sclerotomy with draining of the subretinal fluid followed by a pressure bandage and rest in bed for three weeks. H i s rate of success with this method was five percent which, at that time, was regarded as good.
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H e did excellent magnet extractions of metallic foreign bodies. This technique he had learned from Hirschberg. H e had an uncanny ability to diagnose brain tumors even if they had been overlooked by others. Just like Hirschberg he suffered great anguish when things went badly which, of course, happens occasionally even to an excellent operator. H e had a great sense of responsibility toward his patients. During World War I, the Rudolf Virchow Hospital became partly a military hospital and, in addition to his ordinary work, Fehr had to treat the eyes of many hundreds of wounded soldiers. For this he was rewarded with several military distinctions. Fehr devoted much time to the instruction of his assistants and particularly to the teaching of surgery. Once a week—on Saturday after work was finished—he proceeded with the whole staff to the morgue where operations were performed on cadavers whose eyes were filled with water to restore the normal pressure. Nobody was permitted to operate on a living person before he had done a great number of cadaver operations. In the clinic the second eyes were usually operated on by an assistant with Fehr's help. When not at the clinic his time was devoted to his private practice which soon became very large, thanks not only to his skill but also to his captivating personality. H e conducted it in his private apartment in Keithstrasse 10, situated in a dignified residential district in the western part of Berlin, close to the Tiergarten, which was a large and beautiful public park. Part of his apartment, which was on the ground floor of the house, was fitted out as suitable waiting, consulting and examination rooms. The rest contained the living rooms. Like Hirschberg, Fehr had a private assistant, who conducted preliminary examinations before Fehr saw the patients himself. H e remained old fashioned in many ways. His filing system consisted of many large volumes in which the records of the patients
were entered. This was cumbersome and unpractical but Fehr kept it up right to the end of his practice in Berlin. The rooms were beautifully carpeted, curtained and panelled and contained valuable pictures and other works of art. Part of his library was housed in his consulting room. One of the cabinets was closed. It contained his guns! Here Fehr worked the greater part of the afternoons and evenings, often until 9:00 or 10:00 P . M . The proximity of his private apartment enabled him to make occasional small pauses for rest and tea. His private operative work was done in the early mornings, in a private clinic not far from his home. It belonged to another ophthalmologist, Prof. Carstens. Here he operated with only a trained surgical nurse for assistance and here he attended to his private in-patients. His practice soon became very large. He was the fashionable ophthalmic surgeon in Berlin. Actors and actresses are the first to favor a famous doctor. Albert Bassermann, Elizabeth Bergner, Max Pallenberg were among his patients. From England came Lord and Lady Samuel, Frank Harris, the friend of Oscar Wilde, and many others; from India the Maharaja and the Maharani of Baroda. The children and grandchildren of Emperor William II and other members of high German nobility were among his patients. One day, a Mr. Braun had made an appointment and took his place in the waiting room. When asked his occupation he answered, "prime minister." H e was the last prime minister of Prussia before the Nazis took over. Fehr's fees were low. This was a sign of his modesty, not a desire to undercut his colleagues. Nevertheless, it was resented. "Fehr is unfair," they said. In spite of this, he was generally liked and admired. Everybody who had any dealings with Fehr—his staff at the hospital, his patients, both high and low, his colleagues and his friends—were impressed by his personality. H e was always calm, friendly and very
T H E LIFE OF OSCAR
kind, a born gentleman who moved with equal grace in all strata of society. It must be emphasized here that he was also a scientist of no mean quality. During the 40 years of his active life in Berlin he published 46 papers and frequently lectured before the ophthalmologic societies in Berlin and in Heidelberg. He was interested mainly in the clinical manifestations of different eye diseases, in the influence of general illnesses on the human eye and in pathologic-anatomic questions. A paper on endemic swimming bath conjunctivitis, described by Fehr for the first time, made his name known all over the world. The disease is not serious but widely spread. This eye inflammation is transmitted by bath water, by wet towels and by the fingers. The discovery of this disease led to the introduction of chlorination of swimming pool water, which acts as an effective prophylactic. All Fehr's publications show that he was a good observer, that he was familiar with the past and current literature, that he knew when he had found something new and interesting which deserved to be communicated to a greater audience. Most of his papers are short, to the point, and make easy reading. During the first 10 years, his research work was done as the assistant of Julius Hirschberg who must have read Fehr's manuscripts before their publication and undoubtedly influenced him greatly. Several papers were published by them jointly. Fehr never wrote a textbook of ophthalmology but he made important contributions in medical handbooks. In 1911 he wrote the chapter on the use of electricity in ophthalmology in the Handbuch der gesamten medizinischen Anwendungen der Elektrizitaet. (In 1928, a supplement to this work appeared, bringing the subject up to date.) In the Handbuch der Balneologie, der medizinischen Klimatologie und der Balneographie ( 1 9 2 6 ) , Fehr treated the ophthalmologic side of the subject. Finally, in
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Jadasson's large Handbuch der Haut- und Geschlechtskrankheiten (vol. X X , I I ) he gave a comprehensive description of gonorrheal eye diseases, dealing with all aspects of the subject. H o w deeply Fehr delved into it is clear from the list of references to the literature—it fills eleven pages. Though conservative in his methods, he kept his eyes open for progress in operative technique. In 1932 he published a paper about his results in 119 cases of intracapsular cataract extraction after the method of Stanculesco-Török (up to 1928 he had operated by the extracapsular method). In a very lucid way he discusses the indications, the advantages and the dangers of the new method. Similarly, in 1913, he wrote about the combination of puncture and pressure bandage for the treatment of the detachment of the retina. Later on, he used a posterior sclerotomy instead of the puncture and, during the period 1926-1930, he had about 10percent successes. However, when Gonin published his new method of treatment, it was eagerly adopted by Fehr, and he also tried the modifications advised by Weve and Guist. His results were published in 1935. His successses with the method of Gonin were now 40 percent. It is astonishing how many interests Fehr had besides his hospital work, his private practice and his scientific investigations. H e was outstanding with pen and brush and at one time he seriously considered becoming a painter. H e was good at chess and he had a billiard room in his Berlin apartment. H e could play bridge and he was an expert photographer. H e had a great understanding for physics and chemistry and their applications to engineering; small repairs in his motor car he liked to make himself. Though he did not play any musical instrument, he was very fbnd of music and attended concerts frequently. On his excursions, and when driving a car, he enjoyed singing old German folk and student songs. His excellent memory enabled him to re-
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tain much poetry and he often entertained his family by reciting long passages from Goethe and Homer. H e frequently visited theatre performances and had a great admiration for the actors Kainz, Schildkraut and Moissi. H e was also well versed in all kinds of sport. In his youth he went hiking, skated on ice and did gymnastics. Later he played tennis, he sailed in Kiel and played golf in Maloja. At one time, he kept a stable and rode his own horses. H e climbed mountains in the Dolomites and went hunting on the estate of Count Forgacs in Hungary. Trophies of his hunts were mounted in his consulting room. He owned a bicycle at a time when this was still an unusual sport in Germany; later a motor bike, until he was able to buy a car. He loved driving and many of his holidays he spent partly at the wheel. Even after his 83rd birthday he still drove his car and was proud of the fact that he was never ticketed for a traffic offence. Fehr was tall and slender but broad shouldered and muscular. His face was expressive, his nose straight and somewhat broad. H e had abundant brown hair which he retained until his old age. On account of his short-sightedness he had to wear glasses. Behind them his gray-blue eyes appeared clear, lively, intelligent, understanding and full of kindness. His hands were admired by many. They were well formed, strong and slender—an artist's hands. H e was always elegant and well groomed, even in his outward appearance a perfect gentleman and a man of the world. Only a few words will be said here about his family life. In 1910 he married an extremely beautiful woman, Toni Brieger, and, during the next year, his only son, Robert, was born. Unfortunately, shortly afterward his beloved wife became very ill. This caused him great unhappiness. H e remained alone for 10 years, always hoping for her recovery. However, in 1921 the marriage was dissolved and soon afterward he married
Jeanne Traub. His second wife adored and idolized him and he gave her all the love and affection his rich soul was capable of. T w o daughters (Ingeborg and Kitty) were born to them. Though his numerous tasks and duties left him little time, he was a very good father and the family lived an extremely happy life. In April, 1932, on the occasion of the 25th anniversary as director of the Eye Department of the Rudolf Virchow Hospital, the Lord Mayor of Berlin offered his congratulations and expressed his thanks with the following words: "Our wishes are that you may remain in this capacity and be able to give for a very long time valuable work and apply your eminent knowledge for the benefit and welfare of our patients." It would seem that the position of Fehr was strong and unassailable. H e was at the head of one of the largest eye clinics in Germany; he had an enormous practice; his character was stainless; he was loved by everybody, disliked by none. What could happen to such a man ? However: D o c h mit des Geschickes M a e c h t e n Ist kein e w i g e r B u n d zu flechten U n d das U n g l u e c k schnell. ( W h a t chain s o strong, w h a t girth so great T o bind the giant f o r m of f a t e ? S w i f t are the steps of W o e ! )
Hitler took Germany, the Nazi party with their antisemitic doctrine came into power and Fehr had to share the fate of all German Jews, high or low. One blow after the other fell upon him. In 1934, only two years after the one just cited, he received another letter from the Lord Mayor of Berlin. N o w he was informed that he was forbidden to enter the clinic where he had worked since 1906. The year afterward he was expelled from the German Medical Association and the Automobile Club. Still he tried to hold on. H e did not believe that the Hitler regime would last. H e continued his private practice and operated in different nursing homes. However, the last one was closed in 1937. In 1938, Jewish doctors
T H E LIFE OF OSCAR
were forbidden to treat Gentiles ; 175 Jewish doctors were allowed to remain in practice as "Jew Treaters" (Judenbehandler). Fehr became one of them. A t his door he had to display a blue name plate with a yellow star of David. A s one humiliating restriction followed the other—Jews were not allowed to visit theatres, cinemas and concerts, they were banned from the main streets of Berlin, Jewish shops were looted, Jews beaten and killed and thousands thrown into the concentration camps—Fehr finally decided to emigrate with his wife and his two daughters. His son had already left Germany for the United States some years previously. There were many difficulties, among others his passport had been confiscated, but through his good connections he eventually succeeded in obtaining a visa for England. The family arrived there shortly before the outbreak of World War II. They had lost all their possessions, as the four consignments which contained them were confiscated in Hamburg and were sold at auction. Fehr had been promised permission to practice in England, provided that he first took a British medical degree. However, only seven doctors were allowed to start their studies each year and these seven already had been chosen. In the hope that he would be accepted in Scotland, the family left for Edinburgh. In the meantime war had broken out. This made registration at any university impossible for him for the time being. The family was confined to the city of Edinburgh, where Fehr did some work at the Eye Department of the Royal Infirmary under Prof. Traquair. At the beginning of 1940, the Fehrs were ordered by the police to leave Edinburgh as it had been declared a forbidden area for "aliens." They went to the little town of Peebles, 20 miles further south. On the 25th of June, Fehr was arrested and interned. The following months he was in different camps and, though he suffered from the
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separation from his family and from the numerous inconveniences connected with life in an internment camp, he tried to keep his spirits up. On the Isle of Man, where he spent most of the time as an internee, he found congenial company and participated in different cultural activities. H e became the eye specialist of the island and treated not only the inmates of the camps but also the British commanders and their families. Eventually, he was released because of his advanced age and in March, 1941, he was at last allowed to register at the University of Edinburgh. In the meantime the family had to leave Peebles as the guests in the hotel had objected to the presence of Germans. They moved to Eddleston, four miles outside Peebles. B y special permission Fehr was allowed to travel 20 miles every day into and out of Edinburgh to attend his lectures. H e was then in his 70th year. While he was studying, his daughter Inge kept house; Kitty still went to school. In October, 1941, the family rented a cottage which was without electricity. Every morning, before leaving for the university, and in the evening before he started with his home work, Fehr helped with the numerous menial household tasks. H e took his first examination in October, 1941, and his second in Glasgow in April, 1942. In the meantime Mrs. Fehr became seriously ill. She died of cancer in December, 1942. N o wonder that under these circumstances Fehr failed in his first attempt at his final examination in Glasgow. However, he did not give up. H e moved with the children to Glasgow so that he would be spared the long tiring daily journeys. Eventually, he passed his final on April 9, 1943. Fehr wanted to start private practice in London but this was at first refused. Nevertheless, the family moved to London and, eventually, thanks to the support of eminent British doctors, his application was granted. In July, 1943, he was able to put his plate up at 81, Harley Street. H e also did volun-
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tary work twice weekly at Moorfields Eye Hospital. After his sufferings in Germany, the enforced inactivity in the detention camps and the strain of repeating his medical studies and sitting for his examinations, it was a great relief for him to be back at his professional work. Now he was rewarded for his efforts in repeating a large section of his medical course and for his determination to carry on in spite of all adversity. His fame had followed him to London. It did not take long before he again had a considerable practice. His outstanding qualities as a doctor and as a man again came into play. Among his patients during this period might be mentioned Dr. Chaim Weitzmann on whom he operated twice, Baron de Rothschild, the writer Pasternak and the philosopher Dr. Leo Baeck. He was held in the highest esteem by his colleagues. Many old patients and friends called on him. H e was able again to buy some of his favorite books which he had lost, as well as the books of the day which interested him. Many authors presented him with the products of their pen. He always followed with great interest the progress of medicine in general and ophthalmology in particular. At the International Congress of Ophthalmology in London in 1950, he was one of the central figures. In 1952 he read, before an audience of distinguished scientists in London, a paper about the progress of ophthalmology during the first half of the century. It is written with the deep understanding of a wise and experienced doctor, the ripe fruit of a mature mind. It holds all the pride of the progressive spirit in what has been achieved, and all the humility experienced by the numerous disappointments and failures with which every doctor has to contend. Unfortunately, this paper has never been published. In 1948, accompanied by his daughter Inge, he went for the first time to the United States. He visited his son who at that time
held an important position with the General Electric Company in Schenectady, N e w York, and other relatives living in Washington. H e also met many of his former assistants and friends. He was much feted and his visit proved a great success. It was repeated in 1951 and he spent his 80th birthday with his son and his family. Three years earlier his daughter Inge had married Dr. Samson, the head of the Gynecologic-Obstetric Department at the hospital in Bishop's Stortford in Hertfordshire. Fehr visited them frequently and they were apparently very happy in each other's company. Kitty had specialized in biochemistry. She lived near London, looking after her father as much as her time permitted. Only after her father's death was she married to Ernest Glanville. Perhaps in every human life the amount of happiness experienced must be paid for with an appropriate amount of suffering. It seems that when Fehr was well in the ninth decade of his life, this account had not yet been settled. In August, 1954, he suffered a heart attack, which half a year later was followed by a second and more severe one. Under the skilful attention of Dr. Worms, who probably saved his life, he gradually recovered. However, very regretfully, he had to give up work. The heaviest blow was still to fall. Apparently as a result of repeated retinal hemorrhages he gradually lost his eyesight, until only a small part of the peripheral visual fields remained. H e was an invalid now, forced into inactivity, dependent on others. When I visited him in a little boarding house on the outskirts of London in August, 1956, I found him in a small, simply furnished room. However, there was not a trace of bitterness in the friendly smile with which he greeted me. Here was a man who bore his fate with courage and even with cheerfulness. Conversation with him was as interesting and stimulating as it had been when he was young. N o w he was an
T H E LIFE OF OSCAR
old, wise man, who had experienced the heights and the depths which fate can bring to a human being. In the enforced seclusion of almost complete darkness he did everything possible to keep his mind alert; modern books were read to him ; music was played on the gramophone. Many of his old friends were gone but visits of those left were always welcome. One of these was Mrs. Margaret Jacoby. She did much for him in the evening of his life. Most of all he enjoyed the regular visits of his daughters. Kitty came every weekend and the Samson family came as often as possible. H e took the keenest interest in everything which concerned them and he loved to play with his grandchildren. T o derive happiness from life is a gift not granted to everybody. Fehr had retained it even in the time of misfortune. In 1956, on the occasion of the 50th anniversary of the foundation of the Rudolf Virchow Hospital, he was belatedly honored in Berlin. His picture was set up in his old clinic and a street was named after him. Fehr himself was not present.
TRANSPLANTATION A N WENDELL
A.
JOHNSON,
PARKHILL,
A comparison with another noted German refugee, Stefan Zweig, might not be out of place. Both were victims of the Nazi terror ; both left Germany under great difficulties, losing all their possessions; both found asylum in friendly foreign countries. Zweig was 10 years younger that Fehr and one would have expected a greater resilience and adaptability from this outstanding student of human history. However, Zweig faltered and gave in. His "world of yesterday" was dead and he could not fight his way into a new one. In 1942, while Fehr was busy working for his degree in England, Zweig, in far off Brazil, took his own life. His suicide added to the despair of the Jewish people, who just at that time were in need of encouragement. Fehr, by courageously making the best out of a difficult situation, proved to be the stronger character. H e was rewarded for his efforts. Not only was he able to resume his professional activities but he remained serene and happy to the end of his days. H e died on August 1, 1959. 316 Lister Building.
HOMOGRAFTS
EXPERIMENTAL
M.D.,
M.D.,
OF
JOHN AND
W.
JOHN
Rochester,
The purpose of this study is to determine what happens in dogs when the sclera is excised, either completely or partially, and the area covered with a homotransplant of * F r o m the Section of Ophthalmology, the S e c tion o f Surgical P a t h o l o g y and the Section o f Surgical Research, M a y o Clinic and M a y o F o u n d ation. T h i s paper is a n abridgment of the thesis submitted b y D r . J o h n s o n ( F e l l o w in Ophthalmology, M a y o F o u n d a t i o n ) to the F a c u l t y o f the Graduate School o f the U n i v e r s i t y of M i n n e s o t a in partial fulfillment of the requirements f o r the d e g r e e of Master o f Science in Ophthalmology.
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OF
SCLERA*
STUDY HENDERSON,
H.
GRINDLAY,
M.D.,
EDITH
M.
M.D.
Minnesota
sclera. Although the idea of a scleral resection, full-thickness or lamellar, as a possible aid in severe myopia is well established, " the idea of using sclera for reinforcement either for support or for rendering a surgical shortening procedure more permanent is relatively new. The use of sclera to reinforce a scleral resection done for pathologic myopia was reported by Borley and Snyder. Curtin* reported some work with fascia lata, tendon and sclera in rabbits. 1
5
4
SYNDROME
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R E F E R E N C E S
1. Lucas, R. L . , and W e i s s , H . : Reiter's disease: Gonorrheal syndrome w i t h o u t gonorrhea. A r c h . Ophth., 3 4 : 9 7 - 9 8 ( A u g . ) 1945. 2. Bailey, H . J . : Reiter's disease. Internat. Coll. S u r g . J., 3 3 : 1 7 - 1 8 ( M a y ) 1960. 3. Reiter, H . : U e b e r ein B i s h e r unerkannte Spirochaetenfecktion. D e u t s c h e M e d . Wchnschr., 4 2 : 1 5 2 9 , 1916. 4. Cates, J. K., and Csonka, G. W . : Reiter's disease in the female. A n n . R h e u m a t i c D i s . , 1 8 : 3 7 - 4 4 ( M a r . ) 1959. 5. Csonka, G. W . : Reiter's syndrome: T h e o r i e s and facts. E x e r p t a M e d i c a X I I I , 1 3 : 3 8 1 - 3 8 6 ( A u g . ) 1959. 6. Paronen, I . : Reiter's disease: S t u d y of 344 cases observed in Finland. A c t a Med. Scand. ( S u p p . 2 1 2 ) , 1 3 1 : 1 - 1 1 4 , 1948. 7. Csonka, G. W . : Recurrent attacks in Reiter's disease. A r t h r i t i s & Rheumatism, 3 : 1 6 4 - 1 6 9 ( A p r . ) 1960. 8. W e i n b e r g e r , H . J., and Bauer, W . : D i a g n o s i s and treatment o f Reiter's syndrome. Med. Clinics N . A m . , 3 9 : 5 8 7 - 5 9 9 ( M a r . ) 1955.
T H E LIFE OF OSCAR FEHR A.
JOKL,
M.D.
Johannesburg, South
Africa
The life of Oscar Fehr is worthy of commemoration. A leading German eye specialist, he was for many years one of the directors of the Rudolf Virchow Hospital in Berlin. Later, this outstanding doctor and scientist was one of Hitler's victims. Forced to leave Germany, he succeeded at an advanced age in re-establishing himself in England but, eventually, a cruel fate forced him into inactivity. It is hoped that the following pages will be read with compassion by those who knew him, and with interest by others. H e was born in Brunswick on October 9, 1871, the third child of his father Salomon and his mother Helene, née Behrens. Both parents came from Northern Germany. They were married in 1866 in Ebstorf, in the Lüneburg Heath, his mother's birthplace. Oscar's grandfather had already moved from Peine, where the family had lived for a long time, to Brunswick and had acquired a stately old house in the heart of the city. It stood close to the market square with its famous Gothic fountain, the city hall and the Martini church. From the windows of the upper floor one could see, far
Fig. 1 ( J o k l ) . Oscar
Fehr.
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in the south, the Harz Mountains, while northward the endless North-German plain stretched out toward the Baltic. At the time of his birth the whole of Germany was jubilant. The Franco-Prussian War had been won, a United Germany had been created and prosperity was expected from the influx of French' reparation payments. An atmosphere of good will and of liberalism prevailed. There was little antisemitism in these days, particularly in a comparatively small place like Brunswick where Jews were not numerous. The family was respected and well to do. At that time, the Duchy of Brunswick was an important center of horse breeding and Oscar Fehr's father, together with his cousin, had the largest horse-dealing business in town. They were a happy family and Oscar grew up in an atmosphere of harmony and security. H e was the third child. T w o sisters had been born before him and a brother followed. The mother, a beautiful woman, left the running of the house as much as possible to the servants, while she devoted herself to the care and the education of the children. A n uncle, a man of stunted growth but extremely intelligent and with an encyclopedic knowledge, had much influence on young Oscar. After passing the grammar school he entered the Gymnasium Martini-Catarineum at the age of 10 years. It was an oldfashioned school with the main emphasis on classical languages, mathematics and German history and literature. In the upper classes the pupils proudly wore a black velvet cap, which made them resemble university students who belonged to a "Corps." Apart from his school work he enjoyed literature, poetry and play reading. H e also did a lot of drawing and painting, copying the pictures in the local museum. In 1892, at the age of 21 years, he passed his matriculation. He followed the custom, still prevalent in Germany today, particularly among the students who come from
wealthy homes, of studying at different universities—Heidelberg, Kiel and Berlin. Among his teachers were world famous men—the zoologist Buetschli, the anatomist Gegenbaur, the physiologist Hoppe-Seyler, the physician Quincke, the neurologists Erb and Kraepelin, the gynecologist Olshausen and the ophthalmologists von Hippel and Hirschberg. There cannot be any doubt that Fehr received an excellent medical training. H e took his examinations in Heidelberg— in 1894 the primary, in March, 1897, the state examination and in July of the same year his doctor's degree, "summa cum laude." His first practical work was in the hospital in Brunswick. However, his heart was already in ophthalmology. After a few weeks (April, 1897) he entered Hirschberg's clinic in Berlin as an unpaid, voluntary assistant. Hirschberg, then already world famous and one of the busiest eye specialists in Berlin, had accepted Fehr because he needed a draughtsman and Fehr was good with brush and pencil. In the beginning Hirschberg took little notice of him and Fehr felt like the fifth wheel on a carriage. However, his intelligence, diligence and devotion to duty enabled him to acquire the confidence of his chief, particularly after the publication of his first paper (Hemangioma of the conjunctiva) which was accepted by the famous Graefe Archiv for publication. Within a few years he became second and soon afterward first assistant. H e was given two rooms in the attic of the clinic as his living quarters. H e advocated the creation of a clinical laboratory and eventually Hirschberg yielded. After that, Fehr often spent part of the night there occupied with microscopic examinations. His work was not easy. Hirschberg, himself an extremely conscientious doctor, made very great demands on his assistants. Fehr was called at night if a patient was restless. H e accompanied Hirschberg during his rounds at the clinic and assisted at operations. Private patients of Hirschberg had
T H E LIFE OF OSCAR
to be seen first by Fehr, who made the preliminary examinations and then reported to his chief. H e alone was allowed to perform operations in Hirschberg's absence. H e had to read the current medical and particularly the ophthalmic publications. Interesting cases were demonstrated by him before the ophthalmologic society. And last, though not least, he did a lot of original research work. It all meant long hours of work and readiness for duty during the remainder of the day, seven days a week, with very little rest and few holidays. After the death of his mother, Oscar took the desolate father to the Harz Mountains. After a few days, he received a telegram from Hirschberg recalling him, as he was needed to assist in a difficult operation. There were compensations, however. U n der the watchful eye and the expert leadership of such an excellent man as Hirschberg, Fehr was acquiring the knowledge, the experience and the operative skill which made him later one of the foremost ophthalmologists, not only of Berlin but of Germany and of the world. Already in 1899, Fehr had been elected a member of the Medical Society in Berlin, whose "grand old man" was Rudolf Virchow. In 1906, a new hospital which bears Virchow's name was completed in Berlin and Fehr applied for the position of head of the Eye Department. Hirschberg, who had hoped that one day Fehr would take over his clinic and become his successor, was loath to let him go. However, he loyally supported Fehr and gave him an excellent testimonial, Probably the recommendation of Hirschberg played a decisive role. Fehr was appointed. From 1906 to 1934—nearly 30 years—he was director of this important clinic. When he started, he had only 25 beds at his disposal. At the end there were 120. During the last years of his directorship the number of in-patients rose to 1,500, while 6,000 to 7,000 out-patients were attended and 1,300 operations were performed every year,
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among them about 400 senile cataract extractions. Thus, under his leadership, the Ophthalmological Department of the Rudolf Virchow Hospital became one of the most important eye clinics in Germany. His duties included lectures to students and courses for foreign physicians, as well as the training of assistants. One of the latter, Dr. Max Herzog, now living in the United States, who had been Fehr's assistant from 1926 to 1930, has kindly furnished me with a detailed description of his work on which the following presentation is based. Fehr arrived at the clinic usually at about 10:00 A . M . After having formally shaken hands with all assistants and house surgeons down to the youngest, the patients were presented to him by the staff and the diagnosis and the course of treatment were discussed. T w o or three days a week were operating days, and up to 10 operations were performed in one day. At 2:00 P . M . he left the clinic to devote himself for the rest of the day to his private practice. In his operative work Fehr was no pioneer. Apparently his main consideration was to play safe. H e operated well and fast with scrupulous attention to asepsis but followed a conservative technique. Cataracts were done without preparatory injections and without sutures. The capsule was opened with a cystotome and a peripheral iridectomy was made. Each operation took only about five minutes. Needlings were often necessary. Complications were not frequent. His other operations all followed classical lines. One has the impression that in his operative technique he advanced only slowly. Intracapsular extractions were tried only after 1928. Of interest are his operations for detachment of the retina in the pre-Gonin era. H e performed a posterior sclerotomy with draining of the subretinal fluid followed by a pressure bandage and rest in bed for three weeks. H i s rate of success with this method was five percent which, at that time, was regarded as good.
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H e did excellent magnet extractions of metallic foreign bodies. This technique he had learned from Hirschberg. H e had an uncanny ability to diagnose brain tumors even if they had been overlooked by others. Just like Hirschberg he suffered great anguish when things went badly which, of course, happens occasionally even to an excellent operator. H e had a great sense of responsibility toward his patients. During World War I, the Rudolf Virchow Hospital became partly a military hospital and, in addition to his ordinary work, Fehr had to treat the eyes of many hundreds of wounded soldiers. For this he was rewarded with several military distinctions. Fehr devoted much time to the instruction of his assistants and particularly to the teaching of surgery. Once a week—on Saturday after work was finished—he proceeded with the whole staff to the morgue where operations were performed on cadavers whose eyes were filled with water to restore the normal pressure. Nobody was permitted to operate on a living person before he had done a great number of cadaver operations. In the clinic the second eyes were usually operated on by an assistant with Fehr's help. When not at the clinic his time was devoted to his private practice which soon became very large, thanks not only to his skill but also to his captivating personality. H e conducted it in his private apartment in Keithstrasse 10, situated in a dignified residential district in the western part of Berlin, close to the Tiergarten, which was a large and beautiful public park. Part of his apartment, which was on the ground floor of the house, was fitted out as suitable waiting, consulting and examination rooms. The rest contained the living rooms. Like Hirschberg, Fehr had a private assistant, who conducted preliminary examinations before Fehr saw the patients himself. H e remained old fashioned in many ways. His filing system consisted of many large volumes in which the records of the patients
were entered. This was cumbersome and unpractical but Fehr kept it up right to the end of his practice in Berlin. The rooms were beautifully carpeted, curtained and panelled and contained valuable pictures and other works of art. Part of his library was housed in his consulting room. One of the cabinets was closed. It contained his guns! Here Fehr worked the greater part of the afternoons and evenings, often until 9:00 or 10:00 P . M . The proximity of his private apartment enabled him to make occasional small pauses for rest and tea. His private operative work was done in the early mornings, in a private clinic not far from his home. It belonged to another ophthalmologist, Prof. Carstens. Here he operated with only a trained surgical nurse for assistance and here he attended to his private in-patients. His practice soon became very large. He was the fashionable ophthalmic surgeon in Berlin. Actors and actresses are the first to favor a famous doctor. Albert Bassermann, Elizabeth Bergner, Max Pallenberg were among his patients. From England came Lord and Lady Samuel, Frank Harris, the friend of Oscar Wilde, and many others; from India the Maharaja and the Maharani of Baroda. The children and grandchildren of Emperor William II and other members of high German nobility were among his patients. One day, a Mr. Braun had made an appointment and took his place in the waiting room. When asked his occupation he answered, "prime minister." H e was the last prime minister of Prussia before the Nazis took over. Fehr's fees were low. This was a sign of his modesty, not a desire to undercut his colleagues. Nevertheless, it was resented. "Fehr is unfair," they said. In spite of this, he was generally liked and admired. Everybody who had any dealings with Fehr—his staff at the hospital, his patients, both high and low, his colleagues and his friends—were impressed by his personality. H e was always calm, friendly and very
T H E LIFE OF OSCAR
kind, a born gentleman who moved with equal grace in all strata of society. It must be emphasized here that he was also a scientist of no mean quality. During the 40 years of his active life in Berlin he published 46 papers and frequently lectured before the ophthalmologic societies in Berlin and in Heidelberg. He was interested mainly in the clinical manifestations of different eye diseases, in the influence of general illnesses on the human eye and in pathologic-anatomic questions. A paper on endemic swimming bath conjunctivitis, described by Fehr for the first time, made his name known all over the world. The disease is not serious but widely spread. This eye inflammation is transmitted by bath water, by wet towels and by the fingers. The discovery of this disease led to the introduction of chlorination of swimming pool water, which acts as an effective prophylactic. All Fehr's publications show that he was a good observer, that he was familiar with the past and current literature, that he knew when he had found something new and interesting which deserved to be communicated to a greater audience. Most of his papers are short, to the point, and make easy reading. During the first 10 years, his research work was done as the assistant of Julius Hirschberg who must have read Fehr's manuscripts before their publication and undoubtedly influenced him greatly. Several papers were published by them jointly. Fehr never wrote a textbook of ophthalmology but he made important contributions in medical handbooks. In 1911 he wrote the chapter on the use of electricity in ophthalmology in the Handbuch der gesamten medizinischen Anwendungen der Elektrizitaet. (In 1928, a supplement to this work appeared, bringing the subject up to date.) In the Handbuch der Balneologie, der medizinischen Klimatologie und der Balneographie ( 1 9 2 6 ) , Fehr treated the ophthalmologic side of the subject. Finally, in
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Jadasson's large Handbuch der Haut- und Geschlechtskrankheiten (vol. X X , I I ) he gave a comprehensive description of gonorrheal eye diseases, dealing with all aspects of the subject. H o w deeply Fehr delved into it is clear from the list of references to the literature—it fills eleven pages. Though conservative in his methods, he kept his eyes open for progress in operative technique. In 1932 he published a paper about his results in 119 cases of intracapsular cataract extraction after the method of Stanculesco-Török (up to 1928 he had operated by the extracapsular method). In a very lucid way he discusses the indications, the advantages and the dangers of the new method. Similarly, in 1913, he wrote about the combination of puncture and pressure bandage for the treatment of the detachment of the retina. Later on, he used a posterior sclerotomy instead of the puncture and, during the period 1926-1930, he had about 10percent successes. However, when Gonin published his new method of treatment, it was eagerly adopted by Fehr, and he also tried the modifications advised by Weve and Guist. His results were published in 1935. His successses with the method of Gonin were now 40 percent. It is astonishing how many interests Fehr had besides his hospital work, his private practice and his scientific investigations. H e was outstanding with pen and brush and at one time he seriously considered becoming a painter. H e was good at chess and he had a billiard room in his Berlin apartment. H e could play bridge and he was an expert photographer. H e had a great understanding for physics and chemistry and their applications to engineering; small repairs in his motor car he liked to make himself. Though he did not play any musical instrument, he was very fbnd of music and attended concerts frequently. On his excursions, and when driving a car, he enjoyed singing old German folk and student songs. His excellent memory enabled him to re-
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tain much poetry and he often entertained his family by reciting long passages from Goethe and Homer. H e frequently visited theatre performances and had a great admiration for the actors Kainz, Schildkraut and Moissi. H e was also well versed in all kinds of sport. In his youth he went hiking, skated on ice and did gymnastics. Later he played tennis, he sailed in Kiel and played golf in Maloja. At one time, he kept a stable and rode his own horses. H e climbed mountains in the Dolomites and went hunting on the estate of Count Forgacs in Hungary. Trophies of his hunts were mounted in his consulting room. He owned a bicycle at a time when this was still an unusual sport in Germany; later a motor bike, until he was able to buy a car. He loved driving and many of his holidays he spent partly at the wheel. Even after his 83rd birthday he still drove his car and was proud of the fact that he was never ticketed for a traffic offence. Fehr was tall and slender but broad shouldered and muscular. His face was expressive, his nose straight and somewhat broad. H e had abundant brown hair which he retained until his old age. On account of his short-sightedness he had to wear glasses. Behind them his gray-blue eyes appeared clear, lively, intelligent, understanding and full of kindness. His hands were admired by many. They were well formed, strong and slender—an artist's hands. H e was always elegant and well groomed, even in his outward appearance a perfect gentleman and a man of the world. Only a few words will be said here about his family life. In 1910 he married an extremely beautiful woman, Toni Brieger, and, during the next year, his only son, Robert, was born. Unfortunately, shortly afterward his beloved wife became very ill. This caused him great unhappiness. H e remained alone for 10 years, always hoping for her recovery. However, in 1921 the marriage was dissolved and soon afterward he married
Jeanne Traub. His second wife adored and idolized him and he gave her all the love and affection his rich soul was capable of. T w o daughters (Ingeborg and Kitty) were born to them. Though his numerous tasks and duties left him little time, he was a very good father and the family lived an extremely happy life. In April, 1932, on the occasion of the 25th anniversary as director of the Eye Department of the Rudolf Virchow Hospital, the Lord Mayor of Berlin offered his congratulations and expressed his thanks with the following words: "Our wishes are that you may remain in this capacity and be able to give for a very long time valuable work and apply your eminent knowledge for the benefit and welfare of our patients." It would seem that the position of Fehr was strong and unassailable. H e was at the head of one of the largest eye clinics in Germany; he had an enormous practice; his character was stainless; he was loved by everybody, disliked by none. What could happen to such a man ? However: D o c h mit des Geschickes M a e c h t e n Ist kein e w i g e r B u n d zu flechten U n d das U n g l u e c k schnell. ( W h a t chain s o strong, w h a t girth so great T o bind the giant f o r m of f a t e ? S w i f t are the steps of W o e ! )
Hitler took Germany, the Nazi party with their antisemitic doctrine came into power and Fehr had to share the fate of all German Jews, high or low. One blow after the other fell upon him. In 1934, only two years after the one just cited, he received another letter from the Lord Mayor of Berlin. N o w he was informed that he was forbidden to enter the clinic where he had worked since 1906. The year afterward he was expelled from the German Medical Association and the Automobile Club. Still he tried to hold on. H e did not believe that the Hitler regime would last. H e continued his private practice and operated in different nursing homes. However, the last one was closed in 1937. In 1938, Jewish doctors
T H E LIFE OF OSCAR
were forbidden to treat Gentiles ; 175 Jewish doctors were allowed to remain in practice as "Jew Treaters" (Judenbehandler). Fehr became one of them. A t his door he had to display a blue name plate with a yellow star of David. A s one humiliating restriction followed the other—Jews were not allowed to visit theatres, cinemas and concerts, they were banned from the main streets of Berlin, Jewish shops were looted, Jews beaten and killed and thousands thrown into the concentration camps—Fehr finally decided to emigrate with his wife and his two daughters. His son had already left Germany for the United States some years previously. There were many difficulties, among others his passport had been confiscated, but through his good connections he eventually succeeded in obtaining a visa for England. The family arrived there shortly before the outbreak of World War II. They had lost all their possessions, as the four consignments which contained them were confiscated in Hamburg and were sold at auction. Fehr had been promised permission to practice in England, provided that he first took a British medical degree. However, only seven doctors were allowed to start their studies each year and these seven already had been chosen. In the hope that he would be accepted in Scotland, the family left for Edinburgh. In the meantime war had broken out. This made registration at any university impossible for him for the time being. The family was confined to the city of Edinburgh, where Fehr did some work at the Eye Department of the Royal Infirmary under Prof. Traquair. At the beginning of 1940, the Fehrs were ordered by the police to leave Edinburgh as it had been declared a forbidden area for "aliens." They went to the little town of Peebles, 20 miles further south. On the 25th of June, Fehr was arrested and interned. The following months he was in different camps and, though he suffered from the
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separation from his family and from the numerous inconveniences connected with life in an internment camp, he tried to keep his spirits up. On the Isle of Man, where he spent most of the time as an internee, he found congenial company and participated in different cultural activities. H e became the eye specialist of the island and treated not only the inmates of the camps but also the British commanders and their families. Eventually, he was released because of his advanced age and in March, 1941, he was at last allowed to register at the University of Edinburgh. In the meantime the family had to leave Peebles as the guests in the hotel had objected to the presence of Germans. They moved to Eddleston, four miles outside Peebles. B y special permission Fehr was allowed to travel 20 miles every day into and out of Edinburgh to attend his lectures. H e was then in his 70th year. While he was studying, his daughter Inge kept house; Kitty still went to school. In October, 1941, the family rented a cottage which was without electricity. Every morning, before leaving for the university, and in the evening before he started with his home work, Fehr helped with the numerous menial household tasks. H e took his first examination in October, 1941, and his second in Glasgow in April, 1942. In the meantime Mrs. Fehr became seriously ill. She died of cancer in December, 1942. N o wonder that under these circumstances Fehr failed in his first attempt at his final examination in Glasgow. However, he did not give up. H e moved with the children to Glasgow so that he would be spared the long tiring daily journeys. Eventually, he passed his final on April 9, 1943. Fehr wanted to start private practice in London but this was at first refused. Nevertheless, the family moved to London and, eventually, thanks to the support of eminent British doctors, his application was granted. In July, 1943, he was able to put his plate up at 81, Harley Street. H e also did volun-
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tary work twice weekly at Moorfields Eye Hospital. After his sufferings in Germany, the enforced inactivity in the detention camps and the strain of repeating his medical studies and sitting for his examinations, it was a great relief for him to be back at his professional work. Now he was rewarded for his efforts in repeating a large section of his medical course and for his determination to carry on in spite of all adversity. His fame had followed him to London. It did not take long before he again had a considerable practice. His outstanding qualities as a doctor and as a man again came into play. Among his patients during this period might be mentioned Dr. Chaim Weitzmann on whom he operated twice, Baron de Rothschild, the writer Pasternak and the philosopher Dr. Leo Baeck. He was held in the highest esteem by his colleagues. Many old patients and friends called on him. H e was able again to buy some of his favorite books which he had lost, as well as the books of the day which interested him. Many authors presented him with the products of their pen. He always followed with great interest the progress of medicine in general and ophthalmology in particular. At the International Congress of Ophthalmology in London in 1950, he was one of the central figures. In 1952 he read, before an audience of distinguished scientists in London, a paper about the progress of ophthalmology during the first half of the century. It is written with the deep understanding of a wise and experienced doctor, the ripe fruit of a mature mind. It holds all the pride of the progressive spirit in what has been achieved, and all the humility experienced by the numerous disappointments and failures with which every doctor has to contend. Unfortunately, this paper has never been published. In 1948, accompanied by his daughter Inge, he went for the first time to the United States. He visited his son who at that time
held an important position with the General Electric Company in Schenectady, N e w York, and other relatives living in Washington. H e also met many of his former assistants and friends. He was much feted and his visit proved a great success. It was repeated in 1951 and he spent his 80th birthday with his son and his family. Three years earlier his daughter Inge had married Dr. Samson, the head of the Gynecologic-Obstetric Department at the hospital in Bishop's Stortford in Hertfordshire. Fehr visited them frequently and they were apparently very happy in each other's company. Kitty had specialized in biochemistry. She lived near London, looking after her father as much as her time permitted. Only after her father's death was she married to Ernest Glanville. Perhaps in every human life the amount of happiness experienced must be paid for with an appropriate amount of suffering. It seems that when Fehr was well in the ninth decade of his life, this account had not yet been settled. In August, 1954, he suffered a heart attack, which half a year later was followed by a second and more severe one. Under the skilful attention of Dr. Worms, who probably saved his life, he gradually recovered. However, very regretfully, he had to give up work. The heaviest blow was still to fall. Apparently as a result of repeated retinal hemorrhages he gradually lost his eyesight, until only a small part of the peripheral visual fields remained. H e was an invalid now, forced into inactivity, dependent on others. When I visited him in a little boarding house on the outskirts of London in August, 1956, I found him in a small, simply furnished room. However, there was not a trace of bitterness in the friendly smile with which he greeted me. Here was a man who bore his fate with courage and even with cheerfulness. Conversation with him was as interesting and stimulating as it had been when he was young. N o w he was an
T H E LIFE OF OSCAR
old, wise man, who had experienced the heights and the depths which fate can bring to a human being. In the enforced seclusion of almost complete darkness he did everything possible to keep his mind alert; modern books were read to him ; music was played on the gramophone. Many of his old friends were gone but visits of those left were always welcome. One of these was Mrs. Margaret Jacoby. She did much for him in the evening of his life. Most of all he enjoyed the regular visits of his daughters. Kitty came every weekend and the Samson family came as often as possible. H e took the keenest interest in everything which concerned them and he loved to play with his grandchildren. T o derive happiness from life is a gift not granted to everybody. Fehr had retained it even in the time of misfortune. In 1956, on the occasion of the 50th anniversary of the foundation of the Rudolf Virchow Hospital, he was belatedly honored in Berlin. His picture was set up in his old clinic and a street was named after him. Fehr himself was not present.
TRANSPLANTATION A N WENDELL
A.
JOHNSON,
PARKHILL,
A comparison with another noted German refugee, Stefan Zweig, might not be out of place. Both were victims of the Nazi terror ; both left Germany under great difficulties, losing all their possessions; both found asylum in friendly foreign countries. Zweig was 10 years younger that Fehr and one would have expected a greater resilience and adaptability from this outstanding student of human history. However, Zweig faltered and gave in. His "world of yesterday" was dead and he could not fight his way into a new one. In 1942, while Fehr was busy working for his degree in England, Zweig, in far off Brazil, took his own life. His suicide added to the despair of the Jewish people, who just at that time were in need of encouragement. Fehr, by courageously making the best out of a difficult situation, proved to be the stronger character. H e was rewarded for his efforts. Not only was he able to resume his professional activities but he remained serene and happy to the end of his days. H e died on August 1, 1959. 316 Lister Building.
HOMOGRAFTS
EXPERIMENTAL
M.D.,
M.D.,
OF
JOHN AND
W.
JOHN
Rochester,
The purpose of this study is to determine what happens in dogs when the sclera is excised, either completely or partially, and the area covered with a homotransplant of * F r o m the Section of Ophthalmology, the S e c tion o f Surgical P a t h o l o g y and the Section o f Surgical Research, M a y o Clinic and M a y o F o u n d ation. T h i s paper is a n abridgment of the thesis submitted b y D r . J o h n s o n ( F e l l o w in Ophthalmology, M a y o F o u n d a t i o n ) to the F a c u l t y o f the Graduate School o f the U n i v e r s i t y of M i n n e s o t a in partial fulfillment of the requirements f o r the d e g r e e of Master o f Science in Ophthalmology.
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OF
SCLERA*
STUDY HENDERSON,
H.
GRINDLAY,
M.D.,
EDITH
M.
M.D.
Minnesota
sclera. Although the idea of a scleral resection, full-thickness or lamellar, as a possible aid in severe myopia is well established, " the idea of using sclera for reinforcement either for support or for rendering a surgical shortening procedure more permanent is relatively new. The use of sclera to reinforce a scleral resection done for pathologic myopia was reported by Borley and Snyder. Curtin* reported some work with fascia lata, tendon and sclera in rabbits. 1
5
4