Disease researched by 19th century Jews, sidetracked by persecution.
By JUDY SIEGEL
Overt, institutionalized anti-Semitism against Jewish physicians in Europe delayed for decades the recognition, naming, elucidation and treatment of myasthenia gravis (MG), a severe autoimmune neurological disease whose most prominent victim was the late Greek multimillionaire Aristotle Onassis.This is claimed in an article on anti-Semitism and the history of myasthenia gravis just published in the English-language Israel Medical Association Journal by Dr. Stanley Freedman, with an accompanying editorial by Prof. Rael Strous.The careers of four Jewish researchers in particular – Dr. Samuel Goldflam, Dr. Hermann Oppenheim, Dr. Lazar Remen and Dr. Lazar Remen – were sidetracked by anti-Semitism, two of them even before the rise of the Nazis, Freedman notes.Although the clinical signs of MG – with muscle weakness that often prevents victims’ eyelids from remaining open and affects talking, chewing, swallowing and even breathing – were well recognized and described by the end of the 19th century, it took another 80 years for MG’s pathology to be fully understood, he continues.Goldflam, a Polish Jewish neurologist born in 1852, wrote a major paper on the disease and described three patients with it. After studying and working in Warsaw, he moved to Berlin and Paris, but upon return to Warsaw suffered discrimination as a Jew.He was unable to have his own medical service but could treat only outpatients or see patients in the wards of other colleagues, though he did manage to establish a special clinic for poor Jewish patients. Goldflam died in 1932 without the opportunity to pursue his research further.Oppenheim, born in 1858 in Germany, wrote extensively on numerous neurological diseases and wrote a seminal textbook in 1894. He personally identified a 29-year-old MG patient in 1887 and then another in 1899, writing a paper summarizing clinical findings on all of the 58 cases known to medicine until then.But his nomination as head of neurology at the University of Berlin was rejected by the Prussian Ministry of Education because he was a Jew. Asked to accept baptism to promote his career, Oppenheim refused, Freedman writes.His “rejection and his failure to be nominated to a chair affected his work, attitudes and opinions profoundly,” and he died in 1919.Remen, born in 1907, was the first in the world to describe the use of an anti-cholinesterase compound to treat MG; such compounds were the only therapeutic compounds used to treat MG until the 1980s, except for surgery to remove the thymus gland. But in 1932, when he wrote his report, acetylcholine was not known to be involved in neuromuscular transmission, Freedman said. Thus his discoveries did not have much effect.In 1933, with the rise of Hitler to power, Remen’s name disappeared from the medical literature, and he fled Germany. Only in 1964 was it discovered that he was alive and well, working as a general practitioner in Petah Tikva. Although he built and ran an Israeli maternity hospital, he did not pursue his MG research further.Feldberg, who was born in 1900 and worked in Berlin, was a pioneer in the discovery of acetylcholine as a factor in neuromuscular transmission. But in 1933, he was ordered to leave his Institute of Physiology.Fortunately, he was assisted by former colleague Sir Henry Dale, whom he worked with in London, and was given a temporary job at that city’s Medical Research Council labs. After four years in Australia, Feldberg returned at the age of 40 for his first permanent position in England and continued to work on neurotransmission in the brain and muscles.Today, acetylcholinesterase inhibitors and immunosuppressive drugs are the main treatments for MG.In his editorial, Strous notes that the “role of these individuals waspivotal in the description and management of the disease – from thelaboratory to the bedside, and their contribution to the understandingof the disease was immense.”Anti-Semitism did not stymie only research into MG, but also intonumerous other diseases, he said, because numerous other Jewishresearchers in Europe suffered harshly from discrimination, with manylosing their jobs, having to leave the country and even dieing in thedeath camps.
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