ITEM No. 24 
FILE No. XXVII - 96 
COPY No. 21 
OBERFELDARZT PROFESSOR HUGO SPATZ 
THE DEPARTMENT OF BRAIN RESEARCH 
KAISER WILHELM INSTITUTE 
f • ‘ - 
COMBINED INTELLIGENCE OBJECTIVES 
SUB-CO MM1TTEE OBERFELDARZT PROFESSOR HUGO 3PATZ 
THE DEPARTMENT OF BRAIN RESEARCH 
KAISER WILHELM INSTITUTE 
Reported by 
Major tt.E. Smyth, R.A.M.C. 
CIOS Target 24/g2a 
MEDICAL 
COMBINED INTELLIGENCE OBJECTIVES SUB-COMMITTEE 
G-2 DIVISION, SHAEF(REAR), APO 4X3 TABLE OF CONTENTS 
SUBJECT PAGE NO. 
REPORT ON THE KAISER WILHELM INSTITUTE 
("Department OF bRAin reseaR^FT 
Notes on the general scheme for the reception 
and treatment of neurosurgical and neuro- 
logical oases In the German Army and Air 
Force . 3 
Results *4- 
Penlclllln *4- 
Mechanism of closed head Injuries 
Experimental Concussion •• 3 
Mechanism of Concussion • • 5 
Traumatic Epilepsy ... 5 
Treatment of Closed Head Injuries 5 
Vaso-motor Instability in cases of closed 
head Injury 5 
Pathological work at present being undertaken 
by Professor Spatz and his assistant 3 
Impression 6 
REPORT ON INTERVIEW WITH GENERAL ARZT, PROFESSOR 
fQNNlS AND HI3 STAFF At BADI3CHL (NEAR SALZBtfRgT 
3QTH MAfr 19*4-5 
General review of neurosurgical practice In 
Germany as given by Professor Tonnls 6 
The aim of treatment (primary neurosurgical 
Operation) 7 TABLE OF CONTENTS 
(Continued) 
SUBJECT PAGE NO. 
Treatment of Infection In brain wounds . . 7 
Demonstration of surgical technique . S 
Repair to bone defects 5 
Results of surgical treatment of wounds to 
the brain 9 
Disposal of head wounds when treatment 
completed 9 
Excision of cortical scars •••••• 10 
Wounds of the spinal cord . 10 
Peripheral nerve lesions ........ 10 
Impression 10 
PERSONNEL OF TEAM 
Major 0. E, Smith, R.A.M.C. CIOS TRIP NO. 277 
REPORT ON THE KAISER WILHELM INSTITUTE 
(DEPARTMENT OF BRAIN RESEARCH) 
AT PRESENT OCCUFYINO THE PREMISES OF 
THE ItlStlWTE Fpft FSYCHlAtttf IN mMISh 
The Interview took place on the 27th and 2Sth May, 
Personnel interviewed - 
Oberfeldarzt Professor Hugo Spatz - Director 
Stabsarzt Dr. R. Lindenburg - Assistant 
Cooperation - excellent; almost cordial. Our impres- 
sion was that nothing was being held back. 
Notes on the general scheme for the reception and treatment 
of neurosurgical and neurological cases in the German Army 
and Air Force. 
The planning for this, particularly as it affected the 
German Air Force, was directly due to Professor Tonnls. In 
mobile neurological field hospitals were established, 
and these were stationed on the Russian front. Each hospital 
was situated from 60 to 100 kilometres behind the front line. 
Each hospital was a self-contained unit; the personnel con- 
sisted of one experienced neurosurgeon,, two or three assist- 
ant surgeons, one neurologist, one ophthalmologist and usual- 
ly, but not invariably, an aural surgeon and a maxillo-faclal 
surgeon (note - in the German forces a maxiHo-facial surgeon 
appears to undertake all necessary plastic surgery). The 
hospitals were staffed by fully-trained nursing sisters. The 
sick and wounded were transported to the hospital, in prin- 
cipal, by air evacuation. For this purpose each hospital was 
in possession of .3 Stork 'planes. Transport of patients from 
the forward hospitals to the main neurosurgical centre in 
Berlin was carried out by ambulance train. Professor Tonnls 
himself was responsible for all the head injuries in the 
Luftwaffe. When, as often happened, neurosurgical operations 
were undertaken in field hospitals by general surgeons, no 
elaborate neurosurgical operations were carried out, a super- 
ficial toilet was all that was usually done. There was a 
very efficient pathological service, and by this means every 
fatal case admitted to a forward neurosurgical hospital was 
submitted to post mortem examination. The brain, and when 
necessary the spinal cord, were removed and were at once 
fixed In normal saline. They were then sent direct to Prof. 
Spatz at Berlin. Results 
Professor Spatz knew really very little about the clin- 
ical aspects; he referred us to Professor Tonnls for this 
Information. However, so far as he knew, the results were 
roughly as follows - 75 percent of all deaths resulting from 
head Injury were due to frank generalised meningitis. In 
discussing this question at length with Stabsarzt Dr. Linden- 
burg It transpired that the results were really not very much 
better than those obtained during the last war. 
Penicillin 
This was not used until some small amounts were tried 
out In So far as he knew none was used In the neuro- 
surgical hospitals at the front or In Berlin, and he thought 
that when used It was given systematically only. He himself 
had no knowledge at all of penicillin or Its usee. 
Professor Spatz demonstrated many diagrams illustrative 
of the manner of spread of Infection within the brain. Apart 
from the local development of subdural and subarachnoid in- 
fection the most common and deadly sequel of a gunshot wound 
of the brain was a diffuse spreading encephalitis with final 
Involvement of the ventricular and cisternal spaces. Such 
cases of diffuse spreading Infection were. In his experience, 
Invariably fatal. He did not think that any special bacter- 
ial organisms were encountered. The Infections were produced 
by the usual streptococci, staphylococci and pneumococci. 
Their only theraputlc resource for a spreading Intracranial 
Infection was repeated lumbar puncture with replacement by 
air. The rationale of this treatment, apart from the good 
effect produced by the withdrawal of fluid and lowering of • 
intracranial tension, was that an increased production of 
C.S.F. was thereby obtained, and a consequent carrying Into 
the subarachnoid space of an Increased quantity of antibody. 
Mechanism of closed head Injuries 
Their opinions were very much the same as those held In 
England and the U.S.A. They considered that oedema played a 
very minor role and that the symptoms of closed head injury 
were not due to generalised oedema. However, focal oedema 
may be of Importance in the production of focal signs, e.g., 
compression of the third nerve by the swollen uncus. They 
believed that the sympathetic fibres In the third nerve were 
unduly susceptible to compression by oedema, and that in this 
lies the explanation for the persistent mydriasis so often 
seen In severe head Injuries. Experimental Concussion 
They knew little of this personal observation, but they 
had obtained ,an abstract of the paper published by Denny- 
Brown and Richie Russel and they thought that in Germany 
Professor Peters had carried out some similar observations. 
Mechanism of Concussion 
Professor Spatz did not like the division of commotio 
Cerebri on the basis of duration of unconsciousness as was 
being done by some German neurologists. He thought rather 
that concussion was a generalised disturbance of cerebral 
function. Pathologically the brain damage in closed head 
injuries was commonly in the cortex, but concussion was cere- 
bral commotion without demonstrable brain damage. Unconscious 
ness has really nothing to do with lesions in the cerebral 
hemispheres. He has examined many cases in which he has 
found evidence of brain stem damage. But, on the other hand, 
he has examined many cases of closed head injury with pro- 
longed coma in which he was quite unable to find any adequate 
pathological lesion. 
Traumatic Epilepsy 
He had nothing at all to offer. 
Treatment of Closed Head Injuries 
This was stereotyped. As a general routine every case 
of closed head injury in vhlch amnesia occurred was treated 
by 3 to weeks of strict bed rest. Thereafter graduated 
exercises were begun, but the process of rehabilitation ap- 
pears to have been somewhat long. More recently they have 
tended to shorten the treatment, and minor cases of head in- 
jury have been kept in bed for a period of about a fortnight 
only. 
Vaeo-motor instability in cases of closed head injury 
They laid considerable stress on this and believed it 
was the predominating if not sole cause of the commonly ob- 
served post-traumatic syndrome. Professor Spatz believed 
that it is due to a lesion of the brain stem, but he had no 
evidence to substantiate this. Post traumatic vertiginous 
attacks are not epileptic, but he had no notion as to what 
the cause may be. 
Pathological work at present being undertaken by Professor 
Spatz and his assistant This appeared to be almost nil. They abandoned the 
Kaiser Wilhelm Institute In March taking with them to 
Munich the clinical notes and photographs of some 2,000 cases 
of head Injury. The brains were left behind and may or may 
not be now in existence. They did not personally examine any 
typhus brains; these were examined by Professor Hal}evordln. 
When the Kaiser Wilhelm Institute was broken up Professor 
Hallevordln went to Dllllngen (near Frankford A/M) end Pro- 
fessor Spatz thought that some of the typhus brains were In 
his possession. During the course of the war Professor Spatz 
had not seen any cases of unusual encephalitis nor has he 
seen any evidence of the occurence of encephalitis letharglca. 
Impression 
The impression we gained was that the Kaiser Wilhelm 
Institute, or at least that part of It concerned with brain 
research and neuropathology, had spent the whole war collect- 
ing brains, and that they had in fact achieved nothing. In 
any event the material collected has probably been lost for- 
ever. Their work In general seems to have been based on 
rather old-fashioned morbid anatomy and will probably be 
sterile. 
REPORT ON INTERVIEW WITH GENERAL ARZT. PROFESSOR TONNIS 
ANP "Hf3'~g'TOPP AT •BAPiaCHL (NEAR' 3AL2B0M) O'W -50TH kAY 19^5 
The town, and neighborhood of Badlschl has been a hos- 
pital center for neurological and neurosurgical cases since 
The patients have been accomodated In hotels and in 
general they have come from the Russian front. Since January 
a large Increase of cases was received owing to the 
abandonment of the neurosurgical center In Berlin. Professor 
Tonnls has himself been at Badlschl since January Al- 
though he was attached to the German Air Force SO to 90 per- 
cent of his cases were drawn from the Army. The hotels in 
which the German neurological and Neurosurgical cases were 
then accomodated were hardly converted and the conditions 
were and are only Just adequate. There were, at the time of 
our visit, German doctors there. Their work was super- 
vised by an American administrative officer. 
General review of neurosurgical practice in Germany as given 
by Professor Tonnls. 
In he designed k mobile neurosurgical hospitals to 
work behind the Russian front. These hospitals were 5° 100 
kilometres behind the fighting zone, aid transport of wounded 
was, in theory, by air. The interval between wounding and 
the arrival at the forward neurosurgical hospital was too 
variable for him to be able to give any reliable mean figure. It appeared to have been often as long as 3 or days (we 
learnt subsequently that the air transport of wounded was 
almost entirely abandoned after - this was due to short- 
age of petrol). Once admitted to the forward neurosurgical 
hospital cases were detained for some weeks. Indeed It was 
subsequently laid down in a German War Office Order that all 
cases of head Injury in which there was any suspicion of In- 
fection developing would remain in hands of the operator for 
a minimum period of 3 weeks. The evacuation of the wounded 
from the forward hospital to the base hospital In Berlin was 
by ambulance train. There were In Berlin 2,000 neurosurgical 
beds at Professor Tennis* disposal, and when these were full, 
he could transfer patients to other hospitals. They were 
particularly satisfied with their post mortem service. Autop- 
sy was carried out in all cases of death and In every case 
brought In deed to the hospital. From to every 
brain obtained was fixed without cutting and sent to Profes- 
sor Spatz In Berlin. From onwards the brains were pre- 
served only If the cases were considered to be of Interest. 
They kept exact statistics of all the wounded from 'the time 
of up to the final disposal, and thereafter the 
cases were followed up whether or not the man was still In 
the Army. 
The aim of treatment (primary neurosurgical operation) 
The complete exlslon of th° wound; cleansing of the 
track and removal of clot, damaged brain and foreign bodies 
were the ideal.s aimed at. Particular stress was laid on the 
thorough cleansing of the subdural and subarachnoid spaces 
adjacent to the track. The reason for this was their belief 
that subdural abscesses and direct meningitis often took 
their origin In blood clot in these regions. However, the 
greater danger was development of encephalitis spreading 
along the track In the brain with infection of the ventri- 
cular system and a resulting indirect meningitis. This lattei 
was the most common course of an established Infection and 
was almost Invariably fatal. 
Treatment of infection in brain wounds 
»■ 
As soon as there was reason to suspect that infection 
of any degree had set In they employed sulphonabides, the 
favorite being Cibazol (Hoffman la Roche), or Tibltln (Bayer) 
where they suspected streptococcal infection Eubasine was 
used in pneumococcal infection and for meningococcal menin- 
gitis. Their only other line of attack in cases of menin- 
gitis was C.S.F. drainage and air replacement. The criteria 
for this form of treatment were the clinical signs and the 
C.S.F. findings. In any post-operative head wound, If.the 
cells in the C.S.F, ran to 300 or over, C.S.F. drainage and air replacement was begun. This procedure was carried out by 
the lumbar route and with the head and shoulders raised to 
30° from the horizontal. As much C.S.F, as possible was re- 
moved and an equivalent amount of air injected. This pro- 
cedure was carried out dally until the pleocytosis In the 
fluid fell below 300 per cubic millimetre. The rationale for 
this treatment was not so much simple withdrawal of C.S.F. 
and reduction of Intracranial pressure as the belief, held 
by Tonnls, that the Injected air acted as a stimulus to the 
production of C.S.F. 
vDemonstration of surgical technique 
Six cinema films were shown indicating Professor Tonnls* 
technique In traumatic brain surgery. The essential details 
did not differ substantially from those employed In this 
country. Local anaesthesia was always used with, however, 
Hyosclne, Evlpan or Avertin In cases where the patient was 
violent or very excited. Diathermy was not used In order to 
obtain haemostasis; Instead they depended on the application 
of silver clips and gauze pads. The surgical field was kept 
dry by suction and a sucker was also employed to clean out 
the Intracerebral track. It appeared to us, however, that 
the handling of the sucker was anything but gentle, and we 
further noticed that a forceps was usually used In the re- 
moval of Intracranial foreign bodies, and that It was some- 
what roughly introduced and moved about In the brain In order 
to detect their presence. The wound having been cleaned out 
the dura was closed with continuous sutures, and any defect 
whose edges could not be opposed was covered with pedicle 
graft of galea which was swung round and sutured over the de- 
fect. Suiphonamlde powder was very liberally used both Intra- 
and extra-durally, a dessert spoon being the measure used, 
and finally a large rubber drain was laid along the dural tear 
and over this ttye scalp was closed by subcuticular sutures. 
In wounds Involving the paranasal sinuses and orbital cav- 
ities they always attempted to repair the dural defect at the 
time of the primary operation, and to this end they generally 
used a graft taken from the galea or temporal fascia. In 
those cases where a tear had been missed at the time of the 
primary operation they carried out an operation for the re- 
pair of the dural defect later and used either a graft as 
before or a fascia lata graft’. 
Repair to bone defects 
No film of this was shown. Their procedure was to 
close small defects and those covered by the hair with bone 
grafts cut from the tibia. In cases of defect of the frontal 
bones they employed plates made from “pallldon11 (an acrylic 
plastic). Results of surgical treatment of wounds of the brain 
Professor Tonnls stated that about 30»000 oases were 
treated in the neurosurgical hospitals under his Immediate 
supervision. For obvious reasons the final statistics were 
not available, but the end results were approximately as 
follows; 
Died as a direct result of the wound 32 percert 
Requiring further treatment 15 percent 
Fit for work of some kind or another 53 percent * 
However, It appeared to us very doubtful If the real Inci- 
dence of Infection and causes of death was known for the 
whole series. Such statistics as we were able to obtain 
were obviously based on relatively small series of cases. 
Thus, in a series of 929 cases of brain wounds, i.e., cades 
In which the dura was penetrated, the followlrg results were 
obtained - died, 31° (l.e., percent). Of these 31° 
deaths 191 died of meningitis, abscess or encephalitis, end 
*J-6 of progressively Increasing intracranial pressure; 23 
cases were moribund on admission, and In cases death was 
due to causes other than the brain wound. Arguing from a 
different series of cases Professor Tonnls stated that of 
225 cases of Infected wounds of the brain ISO died. Question- 
ed as to whether any Increase of severity or Incidence of 
Infection had taken place during the course of the War he 
said that both had tended to Increase as time went on. He 
attributed this deterioration to the greater number of wounds 
caused by mines and grenades. He did not observe any essen- 
tial differences between the type of wound seen on the 
Western and Eastern fronts except In so far as the severity 
of the Russian winter acted adversely on the general condition 
of the wounded. He had noticed, however, that In warm and 
wet weather they tended to see occasional cases of gas infec- 
tion of the brain. 
Disposal of head wounds when treatment completed 
No fixed Instructions were laid down by the Wehrmacht 
and all cases were treated on their individual merits. In 
general every effort seems to have been made to retain men In 
the service even though a severe penetrating wound had been 
sustained. Of all cases of penetrating wounds about 5° per- 
cent returned to duty. Of a group of cases so wounded early 
in the War 35 percent were still in the Army when followed up 
3 years later, but mostly In low categories. Professor Tonnls 
thought that perhaps 3 to 5 percent at most were fully fit, 
l.e., front-line troops. Excision of cortical scare 
In cases of traumatic epilepsy Professor Tonnls has 
carried out a large number of cortical excisions. He excised 
the scar and track down to the ventricle, and claimed that 
In 75 to 80 percent of cases of traumatic epilepsy he affect- 
ed a cure following cortical excision*. He cannot, however, 
give exact figures nor has he any views on the Incidence of 
epilepsy following head Injuries. 
Wounds ofr the spinal cord 
Spinal wounds were under the control of Oberarzt 
Schmidt, and he had charge of a special hospital for their 
treatment at Dorpat, but Professor Tonnls was Ignorant of 
Its present thereabouts. The Indication for open operation 
on the spine were the presence of metallic or bone foreign 
bodies within the vertebral canal. No formal Instructions 
were laid down as to the management of the bladder. Cystotomy 
was not the rule. Usually a catheter was tied in for the 
first two weeks and thereafter, aided by mechanical expression 
of the urine, they hoped to establish an automatic bladder. 
Tidal drainage was not employed. 
Peripheral nerve lesions 
Wounds Involving peripheral nerves were often, though 
not Invariably, treated in neurosurgical hospitals. Pro- 
fessor Tonnls regarded the most important point In treatment 
of nerve Injuries as being the maintenance of fully mobile 
Joints. When operation was undertaken they attempted to ob- 
tain $n end-to-end anastomosis. Nerve grafts were never em- 
ployed. 
Impression 
In general the value of the Information we have been 
able to obtain le of a negative nature. We were unable to 
collect any evidence which would suggest that the German 
neurosurgeons possessed any general or specific procedure, 
whether surgical or chemo-theraputlc, superior to our own. 
Indeed the truth is, as It appears to us, that their neuro- • 
surgical technique Is somewhat rough and crude, but we think 
It Is to their total Ignorance of the uses of penicillin that 
the high Incidence of Infection and the high mortality must 
be ascribed. It Is perhaps worth pointing out that nothing 
In Professor Tonnls* bearing, and nothing expressed or Im- 
plied by him or his assistants, suggested for a moment that 
they were In any way dissatisfied with their own results. It 
struck us as not the least remarkable indication of this of this attitude of complacency and self-sufficiency that 
no-one ventured to ask for any details or figures relating 
to the treatment and results obtained by us in cases of head 
Injury, Professor Tonnls was very ready to talk and probably 
tended, if anything, to exaggerate rather than hold back in- 
formation. We feel it right to say that we were by no means 
favourably impressed by him. He is clearly a person of strong 
personality, and he has used this and his high rank and posi- 
tion to obtain quite a large measure of local influence. He 
has been aided In this by the presence of a large number of 
German Military hospitals In and around BadIschi, and the 
consequent magnitude of the problems which thus arose; he 
probably feels he is indlspensible to the local allied Mil- 
itary government. In view, therefore, of the special posi- 
tion which he appeared to occupy, we feel it might perhaps 
be advantageous to Investigate his previous political activ- 
ities, 
/&/ G.E. Smyth, 
Major, R.A.M.C. 
Specialist In Neurology, 
Military Hospital (Read 
Injuries), Oxford