ITEM No* 24 
PILE No. XXXX-13 
COPY No.l ? 
RESTRICTED 
MISCELLANEOUS INTERVIEWS ON MEDICAL 
PRACTICE AND RESEARCH IN GERMANY 
RESTRICTED 
COMBINED INTELLIGENCE OBJECTIVES 
SUB-COMMITTEE RESTRICTED 
MISCELLANEOUS INTERVIEWS ON MEDICAL 
PRACTICE AND RESEARCH IN GERMANY 
Reported by 
Capt. chas. l. McCarthy, m.c., u.s.n.r. 
Capt. HANS G. SCHLUMBERGER, M.C., AUS 
1st Lt. THOMAS LEEBUCKY, M.C., ADS 
all of HQ. TSFET 
CIOS Item 24 
Medical 
COMBINED INTELLIGENCE OBJECTIVES SUB-COMMITTEE 
G-2 Division, SHAEF (Rear) APO 413 
RESTRICTED RESTRICTED 
TABLE OF CONTENTS 
Subject Page No* 
I* Experiments on Malaria Immunity 3 
II* Typhus Vaccine and Typhus Diagnosis 6 
III. Tuberculosis 7 
IV. Hauptkontrollamt fdr Tuberkulose for the 
Province of Thuringia at Weimar 8 
V. An Interlvew with Prof. Dr. Walther SchSnfeld, 9 
Director of the Skin and Venereal Diseases 
Department of the Heidelberg University 
Medical School 
VI. Neurologic Diagnosis 12 
VII. Neurology and Psychiatry 13 
VIII. Gastroenterology 14 
IX. Psychiatric Therapy 16 
X. Orthopedics * • 19 
XI* Pathology 20 
XII* Insect Attractants 11 
XIII. Report of an Interview with Prof. Dr. Gerhard 
Mntscher. 23 I. EXPERIMENTS ON MALARIA IMMUNITY 
Dr. Klaus Schilling was formerly the director of the S3 
Malaria Experimental Station at the concentration camp at 
Dachau and has conducted his research at the concentration 
camp since February 1942. In previous years he had been the 
pathologist at the University of Munich. He has traveled 
extensively in Africa, where he conducted tropical disease 
research. 
He was connected with the Robert Koch Institute in Berlin 
during the years of 1905 to 1935. His final position at 
that Institute was that of chief of the Department of Tropi- 
cal Diseases. He has conducted various expeditions into the 
tropics with the support of the Robert Koch Institute. In 
the years 1935 and 1936, he conducted extensive research in 
the field of malaria at the Wlttenau Insane Asylum near Berlin. 
From 1937 to 1942 his studies were continued at Italian insane 
asylums at Siena, Florence and Voltena. His most important 
published works Include a manual entitled “Tropical‘Hygiene? 
To the book of Kolle and Wassermann he contributed a chapter 
on Immunity and protozoan diseases. 
In 1920 Dr. Schilling was granted the sum of five thou- 
sand ($5,000) dollars by the Rockefeller Foundation for the 
study of African sleeping sickness and the tsetse fly. 
Dr. project at Dachau was the attempt to 
find a method of procedure for immunization of personnel 
against malaria. His only interest was that of immunization; 
he did not attempt to produce an anti-serum. Subjects were 
prisoners from the concentration camp. These were selected 
by Dr. Schilling from a group of prisoners made available to 
him by the camp commandant; they were definitely not volun- 
teers. Dr. Schilling claims to have no conception of his 
crime. His argument is based on the fact that he is “only a 
man of science" and that his work carried with it great im- 
portance for the benefit of mankind. He also defended him- 
self by saying that the prisoners in his charge received 
better care, quarters and privileges than the average prisoner. 
He also kept a close physical check on his subjects. Dr. 
Schilling denies that there was a large mortality, dismissing 
this with the statement that “only a few1' died due to uncoh- 
trolable circumstances. Dr. Schilling pleaded at great length 
with this interviewer that he be released immediately for the 
purpose of publishing and continuing his work and he claims 
a complete lack of appreciation as to why he Should be held 
prisoner. His work at the camp consisted of the following: The 
patient was Infected with the parasite, in all cases a ter- 
tian strain. He then awaited the incubation period. If no 
fever occurred in seven to nine days, drug therapy was in- 
stituted. If the first fever attack occurred prior to this 
period, drug therapy was immediately Instituted at the first 
elevation. Drug therapy was also commenced on the first dem- 
onstration of parasites in the blood. In other words, it 
was his aim to cause a malarial infection, but to suppress 
the pyrexial symptoms and prevent their appearance. This 
type of infection with its subsequent chemo-therapy was re- 
peated for as many as six times consecutively. The patient 
was then closely observed for a year or for a longer period 
of time. He had previously been released for work in the 
camp after an observation period of six to eight weeks fol- 
fowing the last appearance of parasites. 
In tnls way. Dr. Schilling claims to have produced a 
large percentage of entirely immune subjects and an even 
larger percentage of subjects with partial immunity. He 
believes that the basis of his attained phenomena can be 
explained in the following way: Immunity depends on the 
stage of "labile infection" which immediately follows the 
acute or first stage of infection. In the second labile 
stage the patient is a carrier of the parasite; he transmits 
and may have a relapse of the disease at any time. In this 
second stage there is an equilibrium between the parasite 
and the host, which may be disturbed through adverse envi- 
ronmental conditions. The third stage of the disease is the 
stage of immunity without parasitaemia. The patient has an 
entirely negative blood and is incapable of transmitting the 
disease. On experimental or other reinfection of such immune 
persons there are subjective symptoms of a mild nature, such 
as headaches which quickly disappear, and the patient does 
not show any malaria symptoms. He believes that the various 
native populations have acquired this type of immunity, 
although he stresses the great racial differences in immuni- 
ty to this disease. There are, therefore, two factors in- 
volved in the resistance to malaria. The first, that of 
previous infection with the same organism, the second, that 
of inborn racial immunity. 
As mentioned, before. Dr. Schilling had worked only 
with tertian malaria. He had used three culture strains, 
the first was an old culture from Madagascar; the second 
culture was obtained from the island of Crete in 1939; the 
third strain originated near Lake Ilmen in Russia and was 
obtained in 1941. All three of these cultures were very 
virile and possessed the sexual phases. Parasites were 
given either intravenously, subcutaneously, intracutaneously 
or by mosquito bite. Sporozoites were also used as infecting material in certain cases. These were obtained from mos- 
quito-gland preparations. No attempt was made to control 
or establish accurately malaria parasite dosage. An arbi- 
trary volume of blood was chosen for injection and during 
the disease no parasite counts were made of the patients 
blood. Those cases receiving in travenous Infection re- 
ceived immediate chemo-therapy. w 
These parasite cultures were maintained from patient 
to patient. He had several subjects whom he used solely as 
reservoirs, who did not figure in his research work. 
Chemo-therapy consisted of quinine, one to two grams 
dally given usually by mouth, but also intramuscularly or 
intravenously. Another group of patients were given 0.3 
grams of atabrine by mouth or intramuscularly. Two other 
groups of subjects received as additional chemo-therapy to 
the quinine or atabrine neosalvarsan in the dosage of 0.3 
to 0.6 grams daily. 
Dr. Schilling has also used experimentally a dye labeled 
#2516 and produced by the Boehringer Pharmaceutical House. 
This anti-malarial dye in his opinion was not considered as 
useful as atabrine, but he was quite confident that German 
chemical Industry is close at hand in discovering a new and 
better anti-malarial dye or drug. 
Summary. 
Three tertian strains of malaria were given to the sub- 
jects intravenously, subcutaneously, incutaneously or by 
mosquito bites. Spororoite-gland preparations were also 
injected. 
Chemo-therapy of atabrine or quinine, with or without 
neosalvarsan was given at the latest nine days after infec- 
tion; earlier if the patient spiked before that time or if 
he showed parasitaemia. 
When the patient was free of the parasites and symptoms 
for six weeks a second, third, fourth and sometimes a fifth 
and sixth series of infection were restarted. 
Patient received a physical check up every *wo weeks 
following these courses, over a period extending for more 
than a year. 
His conclusions are that he has successfully produced a 
complete or partial immunity in the large majority of eases 
treated in this way. Ha fXPHUS VACCINE AND TYPHUS DIAGNOSIS 
Dr. Kyer, who la now a prisoner at the U.S. Seventh 
Army Interrogation Center waa chief of the Institute for 
Typhua and Virus Research (Instltut fir Pleckfleber-und 
Vlrusforsohung), whose last location was at Roth near 
Nflrnberg. Dr. Heinrich Mueckter was his assistant. This 
Institution concerned Itself mostly with the production of 
typhus vaccine and only a small part of this project was 
devoted to research. 
This Institute was established In Cracow, Poland In 
1959. Its first Job was the production of louse vaccine 
using the methods described by Welgl of Lemberg. Or. 
Przybulklewcz was the head of this Instltue at this time. 
By April 1940, the first vaccine had been produced. Out- 
put was gradually Increased In quantity as their technique 
and organization were Improved. In 1941, the institute 
moved to Tschenstoohau In Poland and began to function there. 
Another and small part of the laboratory moved to Rabka near 
Cracow where It began to manufacture mouse lung preparations. 
In July 1944, the Cracow and Rabka laboratories were greatly 
reduced In capacity, finally to be removed to Roth In January 
1945. At Roth, limited production was restarted and contin- 
ued until taken over by the United States Army. 
The production of vaccine was to a great extent that of 
the louse type. Dr. Eyer says he prefers louse vaccine as 
he believes It to be of a greater potency than the egg vac- 
cine with negligible reactions. Louse vaccine Is also bet- 
ter known at the present time. He stated that he believes 
louse vaccine always to be effective ehile he could not say 
the same for the egg type. However, although the Institute 
utilized lice In the main, It also had produced limited quan- 
tities of egg and mouse lung vaccine. Other vaccines pro- 
duced by this Institute were rabies vaccine which was pro- 
duced at Lemberg and yellow fever vaccine which was prepared 
at Cracow by the mouse brain and egg method. Another line 
of research was carried out on trench fever and its virus 
etiology. They attempted to prepare a trench fever vaccina- 
tion material, but were not successful. 
For their preparations of the vaccine, the institute 
received Its typhus organisms from Polish and German hospi- 
tals and from cultures of Dr. Welgl. Guinea pigs were then 
Infected and the guinea pig brain cultures used for the pre- 
paration of either the egg, louse or mouse vaccine. Rabbit 
vaccine was never prepared. Another research project which was successfully comple- 
ted by the Institute was that of ths simplification of ths 
Well-Fellx raaotion to woks a wort rapid test, which at ths 
um tlas would bs handler under field conditions and could 
be used by the Wehrmackt. They hare thus worked out this 
modification of Wsll-Fsllx r east Ion which can bs run at bed- 
side: Dr* Iyer has produced a Fro teas X-19 conserve. Some 
of ths dried reagent and Proteus X-19 Is Impregnated on cel- 
lophane strips, the else of a micros oops slide. A drop of the 
blood to be examined Is placed on the cellophane strip and 
agglutination may be directly read. They have tried to sup- 
ply this method for agglutination tests of the other diseases. 
The Institute received Its funds from the HeeressanitAt- 
slnspektlon, that Is, the Surgeon General's Office. These 
funds were submitted then through local Wehrkrelssanltdts- 
parks or through the looal general hospitals. The Surgeon 
General1 a Department was thus In complete control of all pol- 
icies regarding this Institute. 
Some of their published literature has appeared In the 
following Journals: a. Follen Test, Deutsoher Mllltaerarst 
1945; b. Serodlagnose des Fleokflebcrs, Zeitsohrlft fuer 
Hygiene, 1942; c. Konservierungsmethode von Proteus &>19, 
Zeitsohrlft fuer Hygiene, 1940; d. Teohnlk elner Objekt- 
triger Agglutination, Zeitsohrlft fuer Hygiene, 1940. 
HI- TTOEBCPLOStt 
Dr. Peter Beckmann Is Stabsarst at the Luftwaffen 
Lazarett In Oautlng, near Munich. This Is the only hospi- 
tal built by the Luftwaffe for the express purpose of car- 
ing for tuberculosis patients; It had a bed capacity of 650 
which has now been raised to 1,000. For several years prior 
to the war there were about 550,000 new eases of pulmonary 
tuberculosis treated In Germany each year. In 1959, an 
organisation was set up to obtain bi-annual chest x-rays 
of the entire population on 55mm film. Also, plans were 
under way to construct a 5,000 bed hospital In Wittenberg 
for the treatment of tuberculosis. Both projects were 
dropped at the commencement of hostilities. 
During the war the incidence of tuberculosis among the 
civilian population rose from 6.5 per 10,000 In 1959 to 15 
per 10,000 In 1942. Beckmann believes that the figure at 
present Is between 20 and 22 per 10,000. In the Luftwaffe 
and Wehrmacht evidence of pulmonary tuberculosis was usually 
associated with extreme physical and mental exhaustion. 
These patients responded very well to conservative treatment, 
viz., rest In bed with high caloric and vitamin diets. All Manner of drugs, particularly the sulfonamides, 
have been tried In the treatment of this disease, but all 
have proved worthless* Occasionally vaccines of tubercle 
bacilli have given encouraging results* Likewise, the 
Intradermal Inoculation of the living organism by the method 
of Kutschera appears to be of definite value In carefully 
selected cases. Surgical Intervention Is limited to pneu- 
molysis with pneumothorax, and thoracoplasty. The suction 
closure of cavities by the method of Monaldl 1s also em- 
ployed. Lobectomy and pneumonectomy, which are being used 
with Increasing frequency In the United States, are not 
practiced In Oermany for the treatment of tuberculosis. 
IV. HAUPTKOHTPni.T.AMT Wfo TUBEHKUL03S FOR THE PROVINCE OF 
TOTRXNaiA AT WEIMAR 
A short Interview with the Chief Clerk of the Office for 
the Study and Control of Tuberculosis for the State of Thtr- 
Ingla, located at Weimar, disclosed the following Interesting 
facts: 
There has been no appreciable Increase In tuberculosis 
among permanent German residents since 1938. The actual In- 
creased prevalence Is said to be due to the Increase of the 
disease among foreigners* 
Using 3t-ray picture as a diagnostic crlterlum, tuber- 
culosis among Russians was ten times as prevalent In 1944 
as It was In 1942* 
Among German bombed-out (evacuated) personnel and 
foreigners, other than Russians, the rate had only Increased 
two or three times* 
Total number of cases of tuberculosis In all of Thdr- 
ingla was: 
In 1942 - 22,964 
1943 - 26,139 
1944 - 30,468 
The new cases of tuberculosis reported In Thdrlngla: 
In 1942 were 922 (of these 106 occurred In 
foreigners) 
1943 were 1153(of these 350 occurred In 
foreigners) 
1944 were 1570(of these 572 occurred In . 
foreigners) Non-Infectious Cases: 
In 1942 there were 4510 cases (of these 814 
occurred In foreigners) 
1943 there we”*e 5735 cases (of these 979 
occurred In foreigners) 
1944 there were 7114 cases (of these 1135 
occurred in foreigners) 
Deaths from pulmonary tuberculosis were: 
In 1942 - 869 
1943 - 898 
1944 - 1084 
Deaths from all other types of tuberculosis (bones. 
Joints, etc.) were: 
In 1942 - 116 
1943 - 118 
1944 - 159 
There is a law requiring the reporting of all new tuber- 
culosis cases and the making of reports of progress every 
three months. Considerable tuberculosis of the glands (neck, 
retroperitoneal arean)ls reported yearly and It is thought 
to be of the bovine type. This office said that It was 
regretted that the diagnosis of bovine tuberculosis was 
made only If present clinically In cows. Tuberculin tests 
would double the number of positive cases. 
ML INTERVIEW WITH PROF. DR. WALTHSR SChAmFELD. DIRECTOR 
OF THE SKIN AND VENEREAL DISEASES DEPARTMENT OF THE 
HpinBT.R'KRft iimtvsrsity MEDICAL SCHOOL 
Prof. 3ch5nfaid was 56 y.ara old, spoke no English but 
was most cooperative. He was trained under Zicler, a world 
famous German dermatologist, at wflrzburg. After returning 
from the 1st World War he was professor at the small univer- 
sity of Greifswald from 1920 until 1935 when he was called 
to Heidelberg as director of the Department of Dermatology 
and Venereal Disease. He has not been a prolific writer and 
is not known outside of Germany for any research work or new 
Ideas. He Is best known for hia hobby, which Is writing on 
the history of Dermatology and its gradual development into 
one of the major branches of medicine. He Is a typical 
example of the academic man fortunate enough to be In a small 
university and offers a sharp contrast to the forceful, 
almost Prussian, type of professor encountered at the head 
of a department In universities located In large metropolitan 
centers. He is the author of a 520 page textbook of dermatology 
and venereal diseases which had gone through four editions 
in five years* It was intended for students and general 
physicians and is a handbook rather than an advanced text- 
book suitable for reference* It first appeared in 1939 and 
the fifth edition is now ready for printing. It was pub- 
lished by Quelle and Meyer whose establishment was complete- 
ly destroyed by the December 1944 bombing of Leipsig* It 
was entitled: "Lehrbuoh der Haut and Geschlectskrankheiten? 
After going over this book it was concluded that it contained 
nothing unusual and gave only an up-to-date synopsis of 
dermatology, syphilis and gonorrhea as taught in Germany. 
The department consisted of a very small (30 x 609) 
one story building used for offices, out-patient clinics and 
laboratories and two pavilion-type wards with a capacity of 
100 beds. In peace time there wore 150 beds devoted to 
these diseases. Doing the war only 50 beds were allowed to 
be used for civilians and the remaining 120 were for troops. 
The main skin diseases among the troops were some forms of 
psoriasis, dermatitis faction (self-induced by application of 
gasoline, motor oil and carbolic acid), gonorrhea and fresh 
syphilis. Soft chancres, granuloma inguinale and granuloma 
venereum had not been seen among the soldiers. These diseases 
are evidently very rare in Germany as the Doctor9 s files 
showed only 3 oases of soft chancre and one of granuloma 
inguinale among the civilian patients in the last ten years. 
In peacetime the staff consisted of one Oberarzt, four 
paid, full-time assistants, two non-paid, part-time clinic 
assistants and various technicians. During the war, there 
were one Oberarzt, three part-time civilian assistants and 
two military medical' officers. No research work or studies 
on these or related subjects was done during the past 6 
years. This department has very little equipment consisting 
of one ultraviolet lamp, one infrared lamp and one Grens ray 
(soft ray) machine of ahoient vintage. 
No penicillin had been available for use or experimen- 
tation. In going over the records of the clinic an inter- 
esting sidelight on medicine in Germany was met with. A 
photostatic copy of an article on penicillin published in 
England in April 1944 and distributed by the German Govern- 
ment in November 1944 was found. Articles from American 
Journals as late as June 1944 were also distributed to the 
Deans of all Medical Schools according to Sohonfeld. 
The following information was obtained about the pm- 
sent day method of treatment of various skin conditions 
in this clinic: 1. Carcinoma. 
Superficial eplthellomata about the eyes were 
treated with Crenz rays while other types were treated with 
prophylactic hard roentgen rays and electro-coagulation. 
Keratosis senilis lesions were handled with thorium plaques 
coid needles. Radium needles were Inserted In elevated fun- 
gating carcinoma. Extensive superficial Ca. was treated 
with the Coutard method while multiple basal celled epl- 
thellomata of the bach and chest were exposed to rear-tar- 
get (4 cm) rays after the method of Chaoul. All x-ray 
and radium therapy was given In the Roentgen Department. 
8. Blastonata. 
Treatment consisted of general support with Intra- 
muscular Injections of Pe. and of As. Roentgen rays were 
used to control tumor growth and prolong life with no hope 
of curing the underlying disease. 
3. Eosema. 
No new therapy - tar locally and roentgen rays 
sparingly - rule out allergy and occupational dlology. 
Many eczemas of the breasts were thought to be due 
to trlchophytlc Infection and were said to respond to 
trlchophytln. Mon-parasltlc eczema of breast responded 
well to aqueous solution of gentian violet. No mention 
was made of diet for the control of this type of nutritional 
eczema. 
4. Psoriasis. 
Arsenic Internally - lenlgallol and chrysarobln 
(antarobln) ointments; hydrarg. ammon. b% In zinc paste 
locally. Roentgen rays to Isolated patches - Fat-free or 
low protein diets of no value. 
5. Lupus Vulgaris. 
Local electro-coagulation of small early lesions; 
Pyfogalllc acid ointment to larger lesions - No roentgen 
ray radiation because of tendency to develop Ca. on edges 
of lesions. 
j 
6. Lupus erythematosls. 
Bismuth Intramuscularly; gold Intravenously with 
caution because of development of nephritis. Removal of all 
fool of Infection. 7. Fungus,Diseases* 
a* Ringworm Infection of scalp In pre—puberty ages 
very rare In Germany, especially In the Heidelberg area. 
Hand epilation for trichophyton Infections and epilation by 
Roentgen ray radiation for mlcrosporon types. Thallium ace- 
tate was found too toxic and Is no longer used even under 
strict weight control. 
b. Epidermophytosis. 
Ringworm Infection of extremities (acromycosls) 
not frequent among clvlllans-often seen In troops returning 
from southern Russia, the Balkans and especially Africa. No 
specific treatment - local applications of aniline dye sol- 
utions such as Castellanos carbo-fuchsln solution and Z% 
aqueous gentian violet solution. Five per cent salicylic 
acid and 5$ benzoic acid (Modified ointment for 
Keratotlc lesions. Epidennophytln found to be of no value. 
Epldermophyton clypelforme found to be the most frequent 
casual type. 
8. Pemphigus. 
All true cases end fatally - treatment Is supportive 
with As. and frequent small blood transfusions. Streptococcic 
etiology not proven. 
9. Syphilis. 
The long standing well known treatment with courses 
of Ncosalvarsan and Bismuth alternating with 6 wee£s rest 
period. Malaria-fever treatment for late stages of systemic 
syphilis. Begin treatment early In pregnancy. This treat- 
ment is the same as that described in detail in the Leipzig 
and the Jena Medical Faculty reports. No pedclllln had been 
available. 
10. Gonorrhea. 
Four day treatment with large doses (total of 28 
grams) of sulfa drugs; repeated after one week if not cured. 
Fever induced by malaria infection if Neisser Infection per- 
sists or If complications arise. See Leipzig report for 
details. 
CONCLUSIONS; 
Nothing new or outstanding in the symptomatology or 
treatment of skin or venereal diseases was leanned. 
VI. NEUROLOGIC DIAGNOSIS Dr. Hermann Regelsberger is Oberstabsarzt and holds the 
position of neurologist at Krlegslazarett 324F in Bamberg. 
In 1935 he divleed an apparatus in which a very weak electric 
current is sent into the skin (flexor surface of the forearm, 
extensor of the thigh) and picked up by a sensitive galvano- 
meter that measures in mill!amperas. It soon became apparent 
that the resistance of the skin was less at mealtimes, giving 
a rhythmic dally pattern. Regelsberger believes that this 
is the result of the increased insensible perspiration which 
occurs at this time. This increased perspiration he feels is 
another manifestation of the rhythmic activity of the auto- 
nomic nervous system, demonstrated for other organs such as 
the liver and pancreas. The method and apparatus used is 
described in his article: "Dae Elektrodermatogramm und die 
Nahrungsreflexe des Mensohen" in Ergeb. f. inn. Med. u. 
Kindhlk. 48: 125-165* 1935. 
During the past four years Dr. Regelsberger has tested 
this nethod in many instances of cerebral lesions and/or 
psychic disturbances. He believes that he can recognize 
five characteristic curves and their associated lesions; 1) 
low amplitude of the peaks a depression. 2) separation of arm 
and leg curves s hypothalamic lesion, 3) one curve of either 
an arm or leg, is of high potential with loss of rhythm s 
lesion of the brain stem on the same side, 4) all curves of 
high potential r thyrotoxicosis, 5) time lag of a curve « 
Interference with cortlco-thalamic pathways. 
Dr. Regelsberger admits that these curves and their 
Interpretation are still in need of much further study. The 
technique may also be of value in the investigation of 
peripheral vascular disease. Dr. A. Bingel of the U. of 
Erlangen has used this method in a series of psychotic pa- 
tients. Rebelsberger's apparatus as first constructed was 
quite large, but as made by the firm P. Gossen of Erlangen, 
the whole will fit into a coat pocket. 
VII. NEUROLOGY AND PSYCHIATRY 
Dr. P. Meggendorfer is director of the psychiatric and 
neurologic clinic of the Unlv. of Erlangen and was consultant 
to the Sanitfttsinspektion. He agrees with the statements of 
other German psychiatrists that during the early years of the 
war, when soldier morale was high, neuroses were uncommon; 
during the past two years they were more frequently seen. 
Hysteria, particularly with paralytic manifestations, was 
seldom observed. The most common form of neurosis was that 
in which the symptoms simulated gastritis or peptic ulcer. 
Cardiac arrhythmias were not infrequent. Schizophrenia and manic-depressive insanity responded 
veil to electric shook therapy* Meggendorfer prefers a 
relatively low current for two seconds, rather than one of 
high potential for 0*2 seconds* The advantage of the former 
is the absence of vertebral and clavicular fractures which 
are not uncommon with the latter* 
Neuroses were uncommon in civilians subjected to air 
bombardment* Dr. Meggendorfer had occasion to examine large 
numbers of patients after the destruction of Ndrnberg. He 
states that they showed marked mental confusion, amnesia, 
and in some instances the so-called pseudopsychosis of dan- 
ser. In this the patient nay say that a ring is triangular 
in shape, that a oat barks, that 2 x 2 • 3* Depressions were 
common, but often accompanied by a strange exaggeration of 
the extent of the loss suffered: a woman Might sob that all 
was gone, that she had lost her husband and her children, 
even though at that very moment they were standing beside 
her* Most of these patients responded well to rest and free- 
dom from fear of air attacks* 
Till. SASTROENTEROLOfrY 
Oberstabsarzt E* Kalpen is a gastroenterologist and 
during 1933 and to 1939 performed 3,000 .gastroscopies* Dur- 
ing the war he was chief of the TOO bed gastrointestinal 
section of a 1200 bed lazarett in Freudenthal, Silesia where 
he personally carried out an additional 6,000 gastroscopies* 
At present he is in the Lazarett Schtlerhelm in Hof. Dr* 
Kalpen emphasizes that the gastroscopic examination is only 
an adjunct to the x-ray study. Its chief usefulness lies 
in the recognition of gastritis, the symptoms of which may 
resemble those of peptic ulcer. In fact, the resurrection 
of the concept of gastritis as a common malady is chiefly 
the result of gastroscopic examinations, since at autopsy 
most of the hyperemia and edema found in the living have 
disappeared. 
All types of gastric disorders, both functional and 
organic, increased during the war* Dr* Kalpen attributes 
this to the great mental and physical strain placed upon all 
classes of the population* The increased stress of the war 
rears became almost unendurable after July 20, 1944 — the 
date of the attempt on Hitler*a life. The food progressively 
deteriorated; the slqgan "gune Instead of butter" best ex- 
presses the general condition. Pats became scarce and many 
unsatisfactory substitutes were introduced. The staple bread 
was a coarse Kommisbrot, in which quantities of adulterants 
were mixed with the flour. However, other exciting factors 
for the production of gastritis and gastric uloer, particu- 
larly alcohol and spices, were ecnsumed in smaller quantities than formerly. Smoking, on the other hand, increased to a 
considerable degree, and Kalpen shares the belief of many 
German physicians that tobacco is associated with an in- 
creased incidence of gastric ulcer. 
Dr. Kalpen is convinced on the basis of his ejqperience 
that there has been an absolute increase in the incidence 
of gastric carcinoma in young individuals. He insists that- 
the methods of examination and diagnosis have remained the 
same during the six year war period, but that the number of 
stomach carcinomas in young persons (18 — 30 yrs.) is greater. 
He can offer no explanation except that it may be related to 
the much greater increase in the frequency of gastric ulcer 
during this same period. 
Whereas formerly the ratio of gastric to duodenal ulcer 
was 1:5, it is now about 1:2.5; however, the incidence of 
duodenal ulcer has likewise increased. Not only are the 
stomach ulcers more frequent, but their average else is much 
greater than formerly. Following treatment even the large 
ulcers often heal quickly. A small caliber rubber tube is 
passed through the patient's nose and allowed to be carried 
as far as the second or third loop of the jejunum. Hourly 
feedings of glucose, and later of cream and eggs are given 
through the tube for 21 days. Anti-spas modi cs such as atro- 
pin are used, and local anesthetics are administered orally 
in the belief that they diminish the irritability of the 
gastric mucosa. Female sex hormones, particularly synthetic 
poduots such as stilbesterol, have been employed with good 
results. The rationale for their use is not wholly clear. 
A patient with gastritis, diagnosed by gastroscopy, is 
given a semi-liquid, high vitamin diet. For the first 21 
days of treatment 200 oc of a 0.silver albuminate or 
1:10,000 silver nitrate solution is given orally before 
breakfast. In many oases of gastritis there is c®siderable 
blood loss due to diapedesis through the capillaries of the 
mucosa. The resultant secondary anemia is treated with 
liver and iron compounds. 
Soldiers afflicted with gastritis or gastric ulcer were 
placed in unite known as Magen-battalions. These battalions 
were given special diets and were used chiefly as 
troops. Occasionally, however, they were equipped with 
ohine guns in fortified positions and then fought quite well. 
Though the gastric neurosis has replaced the tremors of 
ttshell shook* noted in the first world war, mucus colitis 
which is such a common peacetime neurosis of the gastroin- 
testinal traot, has not appeared. However, ulcerative colitis that responded poorly to all forms of treatment was a common 
sequel of bacillary dysentery. The latter disease was fre- 
quently observed in troops stationed In Poland and Russia. 
The mortality from the acute infection was low if transpor- 
tation was reduced to a minimum, body warmth maintained, 
fluid balance preserved, and adequate nourishment provided. 
IX. PSYCHIATRIC THERAPY 
Dr. Pfannmueller was the director of the hospital for 
the insane at Eglflng-Haar when taken into custody. This 
fifty-nine year old psychiatrist has been a party member 
since 1933, at this time he also Joined the S.A. In 1936 he 
was employed at the •Hauptamt fuer Technik", which bureau 
passed on the racial and biological qualification of appli- 
cants for various scholarships. During the years 193Q to 
1940 he became the chief of the Department of Heredity of 
the Augsburg Health Department. Following this he became 
director of the state hospital at Eglflng-Haar. 
The hospital of which Dr. Pfannmueller was the director 
had a capacity of 2,600 beds during peace time which had been 
increased to 3,000 during the war. Admissions varied slight- 
ly above 1,000 per year. These were taken directly from the 
surrounding countryside, or were referred from the Psychia- 
tric Clinic of the Unlv. of Munich. Two types of admissions 
were possible, voluntary and medical. The statement of one 
physician was all that was necessary for a medical admission. 
After admission the patient was given a period of observation 
at the hospital, during which a diagnosis was made. If the 
diagnosis was negative the patient had to be released within 
six weeks after admission. Patients adjudged Insane were 
hospitalized only if they were dangerous to public welfare 
or morale, or were unable to care for themselves, or by 
their relatives. Thus a great part of these hospital cases 
were discharged into the care of relatives or were placed 
on farms dutslde of the hospital boundaries* An active out- 
patient clinic was maintained for such cases. The Inhabi- 
tants of the institution therefore coislsted mainly of 
psychotlcs of the deteriorated kind, of the criminally in- 
sane, and of the extreme feeble-minded. 
In peacetime the staff of the hospital consisted of 
fifteen physicians. This staff was reduced to seven, includ- 
ing two •Hilfsaerzte* during the war. The staff of 300 
nurses and 200 male orderlies was not reduced to any great 
extent during the war. 
The inmates of the institution obtained the same food 
rations from the government as the German civilians, with the 
exception of the periodic supplementary rations. Since however, some of the patients were occupied In rather stren- 
uous labor as a part of the general occupational program. It 
was necessary to dole out a larger ration to the working pa- 
tients, as the ordinary ration would have been insufficient 
In caloric needs. Therefore, It was necessary to cut down 
on the rations of bed and sessile patients. Dr. Pfannmueller 
admits that these bed patients received grossly Inadequate 
nutrition, and that, the Incidence of tuberculosis and the 
general mortality took a sharp rise at this Institution, es- 
pecially during the latter years of the war. 
Therapy carried out at this hospital were those types 
usually carried out at such an Institution. Insulin shock, 
cardlazol, azoman and electric shock treatments was the main 
form of psychiatric therapy at this Institution. This ther- 
apy was found to be of great benefit In cases of the depres- 
sive phase of the manic-depressive psychoses, and In schizo- 
phrenia. 
The routine shock therpay carried out most frequently 
at this hospital consisted of an Initial Insulin shock for 
thirty minutes produced In the early morning, followed by a 
partial revival by glueose. Thereupon the patient was given 
the electrical shock. This procedure was carried out six 
times a week on the same patient, for a'period of a quarter 
year with this therapy routine. Dr. Pfannmueller claims 
very good results In the various depressions for schizo- 
phrenia and he quotes the following figures: 
a. Sixty percent of the patients cured of the condition 
to such an extent that no relapses necessitating subsequent 
hospitalization occur for a period of ten years. 
b. Fifteen percent of the patients showed cures but 
were readmitted within ten years. 
c. The problems of management In the hospital are 
greatly facilitated In all cases. 
Another form of therapy widely used at this hospital 
was that of an organized occupational therapy program, car- 
ried out like those of the American hospitals. This was 
placed under the guidance of trained and government licensed 
technicians. 
Sedative therapy varied from that usually practiced in 
the United States, in that continuous tubs wel*e not used. 
It was felt that hydrotherapy had no advantage over simple 
solitary confinement. However, wet packs were utilized to 
a large extent, never exceeding the maximum time limit of twenty minutes. Psychotherapy was rarely utilized, as was 
hypnotic therapy. 
The various medical treatments such as for Graves di- 
sease or for syphilis were under the direction of Dr. Bumke 
of the Unlv. Medical School at Munich. 
There was a regular system of euthanasia at this hos- 
pital. Although the director states that his admissions only 
slightly exceeded 1,000 per year, about 700 to 800 persons 
were sent away to be gassed every year. Dr. Pfannmueller 
claims that he himself had nothing to do with the actual 
killing of the patients but he says It was his duty to hand 
over "permanently hopeless11 oases of Insanity to the 
"Gemelnndtzlge Krankentransport Oesellschaft" which there- 
after had full control of the patients* Patients thus 
handed over were Judged by a circular which the patient*a 
ward doctor filled out. The director thereupon visited the 
patient on the ward said went over hie case and records, and 
approved or disapproved the ward decision. Neces- 
sary requirements for euthanasia were: 
a. At least five years continued observation of a 
patient at that Institution. 
b. Psychoses only in terminal stages. 
c. Extreme feeble-minded oases only If Institution- 
alization is necessary for life. 
d. The entirely associal. 
♦ 
The National Socialist viewpoint on euthanasia prohi- 
bited the killing of the senile psycho tics because of sen- 
timental reasons. 
When patients were handed over to this "transport 
company" they were shipped to a destination unknown to Dr. 
Pfannmueller. They were kept for a while at this place for 
the purpose of observation and diagnosis, and Dr. Pfann- 
mueller knows of a few cases that were released and dischar- 
ged after being handed over to the company. The remainder 
were killed by gassing. 
It was Sr. Pfannmueller*s Job personally to inform the 
relatives that the patient had been transferred to the 
"transport company." From that moment on he says his re- 
sponsibility ended although he knew of their subsequent fate. 
The "transport company" later notified the relatives that the 
patient had died of a disease, and that the patient*s effects 
and ashes will be forwarded. *here were quite a few provincial institutes for this 
purpose. There was no open euthanasia law* It was all car- 
ried out In extreme secrecy. He states that the civil popu- 
lation knew nothing of this program In the beginning, but 
l*ter on the relatives became suspicious* The entire program 
was abruptly stopped In the winter of 194£, and no euthanasia 
has been practiced since that time* He believes that this 
was due to the protest of relatives and general public feel- 
ing against the program* 
In May IMS, Prof. Schneider of the Heidelberg Univer- 
sity Medical School taught a special course at the universi- 
ty on the diagnosis, therapy, and prognosis of neuropsyohla- 
trlo disease with emphasis on prognosis and the choice of 
subjects for euthanasia* Part of this course ccmsisted lo_tnspeci«en 
of the Institution of Vlesloch In Baden* 
2l QVEOFmSS 
The Sonderfachlasarett ftr Ohnhlnder Is located In 
Alexander Bad, west of Bayreuth. It was designed for the 
treatment and care of soldiers who had lost one hand and 
suffered severe Injury or loss of the other as well* Of the 
90 patients 15 were also blind. Oberstabsarst Walter Roppel 
has charge of their surgical and medical care* During the 
mar he worked with Dr* L* Kreus, professor of orthopedics 
at the University of Berlin, who adopted and modified the 
operation devised by Kruokenberg In 1916* 
In this operation the distal portions of the radius and 
ulna are separated for a distance of approximately 8 Inches* 
The muscles that are attached to the 
radius, as well as their vascular and 
nervous supply, are covered by the skin 
of the cun; the ulna and Its associated 
soft tissues are by a graft obtained from 
the abdominal wall* Amputation of the 
hand Is performed as far die tally as pos- 
sible, since better apposition of the radial and ulnar com- 
ponents of the subsequent •claw8 are obtained; also this skin 
Is particularly rich In tactile corpuscles* 
Where all the fingers and thumb of a hand have been lost, 
the first and fifth metacarpals are dissected free, after 
which they and their muscles are covered by skin (phalangeal- 
1 rati on). This affords the patient grasping power similar 
to that achieved with the radio-ulnar operation 
Herr B* Krusemann, formerly of the orthopedic clinic 
of the U. of Berlin, Is In charge of the training program 
for these patients* By attaching a pencil, shaving brush. razor, ©to. to a small cork wedge, the 
patients readily learn to use these with 
facility. Spoon and fork require only a 
slight alteration to enable the patients 
to use them with skill* Later, he lemma 
to use the regular commercial items. 
Shoes are provided with elastic side walls 
Instead of laces, uniforms have zippers and push buttons in 
place of the usual button and button hole. The patient 
quickly learns to wash, dress, feed himself, and use the toi- 
let without assistance. Many trades are available in which 
the handicap can be reduced to a minimum, e.g., book-keeping 
and farming. 
▲ prosthesis can be fitted in which the hand makes 
grasping movements. However, this is usually worn for cos- 
metic reasons only. The advantage of the Kruckenberg plas- 
tic operation is that a prosthesis is not needed; unlike the 
methods in which ivory pegs are passed through the forearm 
so that the motion of the tendons is Imparted through them 
to an artificial hand. A prosthesis Inevitably becomes 
soiled and cannot be properly cleaned by the patient who has 
last both hands. Another disadvantage of the prosthesis is 
that it is necessary for the wearer to guide its movements 
under direct observation, while with the claw stump he can 
usually tell what he is doing by touch alone. 
Many patients develop surprising skill in the use of 
their stumps - one opened a box of safety matches, removed 
a match, struck it, and lit a oigarett. Two motion pictures 
have been made illustrating the training of these individu- 
als: •Schulung und Arbeltseinsatz nach Hand- und 
Anaverletzungen* and *Wllle zum Lebenf These”'were placed 
in the Relchsanstalt fftr Film und Blld, branches of ihlch 
are in all the large cities. 
As of February 1945 there were 670 German soldiers who 
had suffered the loss of both hands. Of these, 340 had 
undergone plastic operations and training, of the latter, 
9Z% were employed in gainful occupations. 
XI. PATHOLOGY 
Dr. Walther Schwarzacher is now pathologist at the 
Landeskrankenhaus in Salzburg. From 1927-1936 he was pro- 
fessor of forensic medicine at the Univ. of Heidelberg and 
from 1936-1938 held the same position at the U. of Graz. 
Because of his antipathy to the Nazi regleme he was ousted 
from this post and for the past seven years has lived in 
seclusion. Dr, Schwarzacher opposed the sterilization law of 1933. 
He observed many fatalities following operation of women by 
Inexperienced surgeons during the years 1934-35 when mass 
sterilizations were carried out. The relation of forensic 
medicine to the German state, as of 1938, Is detailed In 
Mueller and Walcher's "Oerlchtllche und sozlale Medizln-. 
On pp. 46-52 of this book Is a discussion of the steriliza- 
tion law with a list of the conditions In which sterilization 
was mandatory. 
Dr. Theodor Schmidt, Schwarzacher1s assistant In 
Heidelberg, became chief of an army lazarett In Breslau for 
the treatment of self-inflicted Injuries. Prom him Dr. 
Schwarzacher received work that artificially Induced derma- 
toses were the most common forms of self-injury. They were 
frequently produced by the local application or even subcu- 
taneous Injection of acids, gasoline, or soap. A salicylate 
(Lactophenlne), commonly employed In therapeutic doses of 
0.5 gram, was occasionally used by malingerers. An oral 
dose of 8 - 10 grams produces a very severe Jaundice which 
may readily lead to the* mistaken diagnosis of Well's disease 
or epidemic hepatitis. Patient's who admitted their offense 
were sent to the front in so-called "punishment battalions", 
the others were shot. 
XII. INSECT ATTRACTANTS 
Dr. Adolf Butenandt, director of the Kaiser Wilhelm 
Instltut ftr Blochemle of Berlin, has moved his staff and 
equipment to the Medical School of the U. of T&blngen. 
While In Berlin he extracted a powerful male attractant 
from the "sexual" glands of female silkworm moths. These 
glands lie in the last three abdominal segments of the 
female moth. 
The purified substance Is a solid alcohol, soluble In 
the common fat solvents. For purposes of experimentation It 
is dissolved in benzol. If a glass rod, dipped in the solu- 
tion is brought near the male moths, they are attracted to 
it. Many other species of lepidoptera were tested and failed 
to respond. The same was true of various coleoptera, hamlp- 
tera, orthoptera, etc. The substance Is therefore apparently 
wholly species specific. It is well known, however, that 
most if not all female insects secrete a male attractant. 
Dr. Butenandt believes that some compound may be common to 
all these substances. If this could be isolated from the 
silk moth attractant It might prove of great value for Insect 
control work. 
Technique of extraction: 
* a) The last three abdominal segments of the female 
moths are amputated and about 100 placed in 100 eo of petro- 
leum ether* This is then shaken at room temperature for 10- 
15 minutes* The ether is poured off and the process repeated 
4-5 times until the ether no longer contains any of the 
active substance* This can be determined by dipping a glass 
rod in the ether extract; if the agent is present the male 
moths mill begin to tremble and flutter their wings when the 
red is brought near they* 
b) Evaporate the ether extract in vacua* This leaves a 
waxy residue* 
0) Add enough 2N KOH to the residue to dissolve it* This 
will saponify the fats but will not affeot the attraotant* 
d) Add ether to the KOH solution and shake thoroughly* 
The active agent will be dissolved in the ether* 
e) Distill off the ether; the distillate contains the 
attraotant* 
f) Ssterify with succinic acid anhydride in pyridine* 
g) Shake out with ether; the ether will contain the acid 
esters of the active agent* 
h) Shake with KOH, then heat gently* The esters will 
split leaving all nonsaponifiable alcohols, including 
cholesterol, in solution* 
1) Precipitate the cholesterol with digitonin* Filter* 
J) Evaporate the filtrate in vaoue* The residue will be 
a clear colorless waxy substance - the purified attraotant* 
k) The solid attraotant can be kept for only a few 
weeks, then it deteriorates* For purposes of experimentation 
the substance is dissolved in benzol* 
Jahrbunh ARadentle der Wl88*naehi»rti»n 1959 
Klassensitzung am 23*November 1939* 
Mathematlsch-naturwlssenschaftllche KAasse 
Hr* Butenandt sprach uber "Zur Kenntnis der Sexual-Lock- 
stoffe bei Insekten". (Ersch* spater.) £s wlrd Aber den Stand unserer Kenntnlsse auf den 
Bebiet der Attraktl stoffe 1m Reich der Insekten berlchtct. 
Bel vlelen Insekten, besonders bel Schmetterllngen, son- 
dern die Weibchen in einer HlnterlelbsdrAse Lockstoffe ab. 
Bit deren Hilfe eie MAnnchen aus welter Entfernung anlocken. 
Am Belsplel dee Seldenaplnners (Bombyx morl), der slch fAr 
quantitative Untersuchungen im Laboratories worzAgllch eignet 
(K. GArnltz und H. Schotte), konnte gezeigt werden, dap der 
▼ob Weibchen bereltete Lockstoff elne llpoldlAsllche, neu- 
tral e, unverselfbare Verblndung darstellt, die slch als 
thermostabil und destillierbar erwles. Sie 1st bestAndlg 
gegen verdAnnte SAuren und Alkallen, 1st mlt Lipasen Oder 
durch Erhltzen mlt verd. Alkali Oder verd. SAure nlcht 
spaltbar, aber empflndllch gegen Oxydatlonsmlttel und kon- 
zentrierte SAuren. Unter Ausnutzung der bisher bekannten 
chemischen und physlkallschen Elgenschaften wurde aus dem 
Petrol A therextrakt der Hinterleiber von etwa 1500 Faltern 
(insgesamt 150 bis 160 mg Substanz) in geringer Menge elne 
ketonfrele Neutralfraktlorr gewonnen, die kelne mepbare Menge 
an Stickstoff mehr enthAlt und mlt 0,01 noch elne deutlich 
nachwelsbare Erregungswlrkung auf Bombyx-MAnnchen ausAbt. 
Die farblosen PetrolAtherextrakte zelgen keine charakterls- 
tlsche Llohtabsorption 1m Ultraviolett. Die Untersuchungen 
brlngen den endgAltlgen Nachwels, dap die Welbehen dcs 
Seldenaplnners elnen chemlsch faBbaren Attraktlvstoff abson- 
dern, der nach unserem heutlgen Wissen night zu den 
Kohlenhydraten, Petten Oder Eiwelpstoffen gehSren kann. Die 
chemlsche Charakterlsierung der Attraktlvstoffe der Insekten 
kann grope Bedeutung fAr elne planmAplge SohAdllngsbekAmp- 
fung erlangen. 
XIII. REPORT OF ANINTERVIEW WITH PROF. DR. GERHARD 
KUNTSCHER AT FRANKFURT. GERMANY 
Our attention was called to the presence in Frankfurt of 
Dr. Gerhard KAntscher, Professor of Surgery at the Unlv. of 
Kiel. He Is the originator of the idea of Inserting nails 
Into the bone marrow channel In the treatment of fractures, 
both simple and compound, of the long bones of the extremi- 
ties. He began this type of treatment 6 years ago. He is 
not the originator of the use of nails in bone surgery. He 
is 45 years old, speaks* English fairly well and was very 
cooperative. 
Since this method was first used in 1939, thousands of 
cases have been treated in this manner and more than 200 
publications and two books dealing with the subject have 
appeared. Although most of the reports have been favorable 
and the end results satisfactory, poor results have also beet 
obtained. Dr. KAntscher stressed the point that not only should the operator be a trained orthopedist and surgeon 
but also that It takes considerable time and Instruction In 
the technique of this operation In order to develop the pro- 
per Judgement needed to choose the type and exact size of 
nail best adapted to each case. So many bad results occurred 
in war surgery in Germany that Dr. Ktetscher requested the 
Surge on-General of the Army and Navy to prohibit the use of 
this method except by specially trained men. An order to 
this effect was Issued about 8 months before capitulation. 
Medical officers were sent to Kiel for a two weeks course in 
this technique during 1945 and 1944. Classes were limited 
to 15 officers. 
Major Sloan a trained orthopedist, attached to the 116th 
U.S.A. General Hospital at Frankfurt, was Invited to sit in 
during the interview. His opinion as to the advantages and 
disadvantages of this method will be attached herewith marked 
Appendix 1. 
Dr. Ktetscher* s permanent address is Ortslazarett III, 
Schleswig, about 18 kilometers north of Kiel. It was impos- 
sible to obtain a set of nails from him. He stated that the 
two factories manufacturing them in Kiel had been totally 
destroyed and they had not been made at any other place in 
Germany. However, nails very similar to the Ktetscher nail 
must have been made in other places in Germany as Major 
Sloan said he had seen some that had been removed from frac- 
tures in P.W.s. The Ktetscher nail-set can be obtained from 
a firm in Sweden, Stiffs Mfg. Co., Stockholm 4. It is called 
"MArgsplk" in Swedish. 
In June 1944 at the last orthopedic Congress held in 
Vienna an entire day was devoted to a symposium on the use of 
the Ktetscher method in war orthopedics. It was not known 
by Dr. Ktetscher where or when the report of the meeting was 
published. 
The two books on this method are: 
1. -Technik der Knochenbruchbehandlung 1m Frleden und 
1m Kriege (Die Marknagelung nach Ktetscher)” by Dr. Lorens 
BShler (Professor of Surgery at the Univ. of Vienna). Pub- 
lished in 1945 by Wilhelm Maudrlch, Vienna. This is volume 
3 (570 pages) of a three-volume set dealing with the treat- 
ment of fractures. Other methods are described in Vols. 1 
A 2. 
2. ”Die stabile Osteosynthese (Marknagelung nach 
Ktetscher) bel Schaftbrtehen der langen RShrenknochen, ihre 
Indlkatlon und Technikf By C. HAbler (Chef-Arzt at the 
Krankenhaus Clementinenhaus at Hanover). Published in 1944 by J.P. Lehmann of Mtnchen and Berlin as volume VIII (207 
pages) of the Taschenbtcher dee Truppenarztes. Both of 
these books are profusely Illustrated, 
Indications, contra-lndlcatlons, complications, tech- 
nique and results will be briefly discussed at this point. 
The use of nails to serve as an Internal splint In frac- 
tures of long bones of the extremities Is Indicated In both 
simple, compound and comminuted fractures. It Is also used 
In old, healed, temporarily set cases where considerable 
shortening and overlapping of fragments with hypertrophic 
callus formation occur. In this latter type of case open 
reduction Is done, excess callus removed, a lateral bone 
splint Is placed only on one side of the bone and then the 
nail Is Inserted. No post operative traction, casts or sup- 
portive splints are used. It is Indicated In compound frac- 
tures In the presence of pus and sinus formation at the site 
of the fracture. It was said that the nails which were made 
of steel, chromium and nickel had a sterilizing effect and 
prevented Infection traveling along the bone cavity and 
causing linear osteomyelitis. Dr. Ktntscher stated that pro- 
per alignment of the bone and release of pull on the muscles 
improved circulation and contributed to overcoming the Infec- 
tion. Since no plaster casts or splints are used and since 
the patient becomes ambulatory in 4 or 5 days normal condi- 
tions of muscle tone and viability are quickly restored. 
Evacuation of this type of fracture treated with nails Is 
facilitated and the period of hospitalization is reduced from 
7 weeks to a few days. After x-ray pictures show the bone Is 
completely healed the nail is removed. This Is usually after 
3 to 4 months. In cases where the knee Joint has been des- 
troyed or removed a long mall extending from the trochanter 
of the femur to the lower end of the tibia Is Inserted and 
can be allowed to remain Indefinitely. Patients seem to 
prefer this method of treatment for the complete fixation of 
the fragments causes pain to cease within 36 hours. The 
fact that they do not have to stay In bed for several weeks 
also has served to popularize this method. 
Although the danger of Infection with any operation on 
bones Is always present It was said to occur In less than 
of the cases and never lead to osteomyelitis severe enough 
to result In pseudoarthrosis* This figure le about one-tenth 
of that for the occurrence of Infection when fractures are 
laid open and bone grafts or other types of splints are used* 
A centimeter-long Incision Is made to allow the Introduction 
of the Ktntscher nail. Infection from the outside thereby 
Is reduced to a minimum. 
Aside from surgical skill and selection of oases, suc- 
cess depends entirely upon the choice of the size and length 
of the nail to be used. It must fit the bone marrow sungly In order to prevent rotation of the fragments. The nail has 
& rounded V-shape and impinges on the cavity walls only in 3 
places; thus the blood supply and nutrition of the bone are 
not disturbed. The nails also vary in form and texture ac- 
cording to the location of the fracture. Nalls used in frac- 
tures of the femur and ulna are straight and Don-flexible 
while those used in the other bones of the extremities are 
slightly curved and flexible. In fractures of the tibia in 
order to give more wleght bearing strength two nails, one 
fitted snugly over the other, are used. A wire is introduced 
in the cavity and then the needle is threaded on the wire. 
Traction is exerted and the position of the fragments is 
controlled by x-rays and finally the needle is withdrawn. 
A centimeter of nail is left protruding from the bone to 
allow easy removal and the shin closed over. 
Dr. Kdntscher said that he had never ejqperienced atrophy 
and non-union at the site of the fracture as is so often apt 
to occur in nail surgery of fractures of the neck of the 
femur. He believed such good results were due to the thick 
walls of the shaft of the femur and a better blood supply. 
Since the introduction of these nails causes more or 
less injury to the bone marrow and its vascular supply, the 
possibility of fat embolism with fatal results is always 
to be kept in mind. Ktetscher considers the possibility 
minimal as the V-shape of the nail allows drainage of any 
hemorrhage produced which prevents excess pressure in the 
blood vessels of this area. He feels that the occurrence of 
fat embolism is no more frequent by nail-insertion than by 
other open reduction forms of treatment. Hdbler, reporting 
on 700 cases, encountered 2 fated cases which he thought 
were surely due to fat embolism. Fat embolism caused by the 
injury producing the fracture should not be confused with 
that following nailing. It was also pointed out that fat 
embolism occurred only after inserting nails for fractures 
of the femur. 
Xflntecher has shown experimentally that his nails, be- 
cause of their do not injure, the bone marrow suffi- 
ciently to prevent stimulation of callus formation; on the 
contrary, it acts as a foreign body and results in an irri- 
tative hypertrophy. This callus formation never goes be- 
yond that seeh in fractures treated by open methods* 
Specific figures with reference to the percentage of 
cures, failures, oomplioationa and deaths could not be ob- 
tained from Dr. Mntscher or the publications at the inves- 
tigators disposal* Dr. Rice, a scientific investigator, tried to locate 
Dr. Kdntsober In June. A group of American physicians 
headed by a Dr. Rossman did not find him at home in July. 
Dr. Kdntscher then attempted to contact the American mili- 
tary government. 
He stated to this investigator that he would be will- 
ing to work with our doctors here in Germany or in the U.S. 
or he would even be willing to go to the Pacific Theater as 
he feels his method has- an important place in war surgery 
as well as in peacetime accidents. 
CONCLUSIONS; 
The bone marrcw nail method of fixation of fractures 
of the long bones oi the extremities appears to be of great 
value provided that cases are carefully selected and the 
operation is done by skilled surgeons experienced in this 
special technique. With the latter point in mind it is 
recommended that a certain number of trained orthopedists 
now attached to Army hospitals in France and Germany be 
assigned to take a course of instruction at the Ortalazarett 
III at Schleswig. These men could be used as a nucleus to 
Instruct others. 
APPENDIX I. 
ORTHOPEDIC SECTION 
97TH (U.S.) GENERAL HOSPITAL 
APO 758 US Army DS/ew 
5 August 1943 
SUBJECT: Investigation of a New Method of Intramedullary 
Nailing of Long Bones for Fracture. 
TO : Col. C. L. McCarthy, 
Surgeon*s Office 
12th Army Group, APO 655 
1. On 1 August 1945 I was present, as orthopedic ad- 
visor, at an interview in which Prof. Dr. Gerhard Ktlntscher 
explained his original method of intramedullary nailing for 
fractures of the long bone. 
2. Essentially, the method consists in driving a steel 
rod down the length of the marrow cavity of a long bone in 
order to fix the fracture fragments. This rod is kept in 
place a varying length of time and is then removed. Inser- 
tion was performed under spinal anesthesia. 3. Several rods of various length were demonstrated. 
They were C-shaped In cross-section, about a centimeter In 
diameter, one end sharp for bone penetration, the other 
dull with an eyelet to facilitate removal. 
4. The method was originated about 1939. Prof. Lorenz 
Bohler of Vienna has written a book on the subject. He cites 
many oases but the end result figures were not available to 
us. Prof. Dr. Kdntscher uses this method for both simple 
and compound fractures. He too has no available end result 
statistics. 
5. From the above demonstration and my personal dis- 
cussion of this method with other army surgeons I believe 
that as far as the army is concerned the method Is still on 
trial. It may be useful when a situation arises which 
necessitates having key personnel back at work In a few days, 
but as a matter of routine army use I believe the method 
needs extensive trial in American hands. 
/s/ David Sloane 
/t/ DAVID SLOANE 
Major, MC. 
Chief of Orthopedic Section 
97th General Hospital 
APO 758 
6 August 1945 1st Ind. ODS/ww/ew 
Office, Chief of Surgical Service, 97th General Hospital, 
APO 758, U. S. Army. 
TO. Commanding Officer, 97th General Hospital, APO 758, 
U. S. Army. 
1. Approved. 
/s/ Charles D. Squires 
/t/ CHARLES D. SQJJIRES 
Lt. Col., MC. 
Chief of Surgical Service