History People Hospital staff Professor Sir Ludwig Guttmann Professor Sir Ludwig Guttmann CBE FRS In September 1943 Dr Guttmann was asked if he would like to take charge of the Spinal Injuries Unit at Stoke Mandeville. He wanted to implement his own theories on how best to treat patients who had paraplegia. Rehabilitation through sport was his method and so out of this competitions were held. The competitions grew bigger and bigger into full Paralympic Games. Early years to 1944, from Germany to Stoke Mandeville Ludwig Guttmann was born on 3 July 1899 in Tost, Upper Silesia, Germany (which is now Toszek in Poland), and raised in the Jewish faith. He started studying medicine at the University of Breslau in 1918 after he was turned down for military service on medical grounds. He continued his studies in Würzberg and Freiburg and took his MD degree in 1924, writing his thesis on tumours of the trachea. Return to Breslau Having returned to Breslau, he worked with Europe’s leading neurologist Professor Otfrid Foerster from 1924 to 1928. In 1928, Guttmann was invited to start a neurosurgical unit in Hamburg but this post only lasted a year as Foerster asked him to return to Breslau as his first assistant – a job Guttmann felt he could not refuse. He remained in this job until 1933 when the Nazis forced all Jews to leave Aryan hospitals. Under such oppression, Guttmann became neurologist to the Jewish Hospital in Breslau and was elected Medical Director of the whole hospital in 1937. Image courtesy of The Wellcome Library He took the Gestapo from bed to bed, justifying each man’s medical condition. He pulled faces and grimaced at the patients from behind their back, signalling to them to pull the same expressions and then saying, ‘Look at this man; he’s having a fit!’ Eva Loeffler, daughter On 9 November 1938 (Kristallnacht), Guttmann gave orders that any male person entering the hospital was to be treated, despite the racial laws specifying that Jewish doctors could only treat Jewish patients. The following morning, he had to justify the large number of admissions (64) to the SS and the Gestapo. Like all Jews, Guttmann’s passport had been confiscated and he was not allowed to travel; however in December 1938 he was ordered by von Ribbentrop to travel to Lisbon, Portugal to treat a friend of the dictator, Salazar. On his return he was granted permission to go to England for two days. He was already in contact with the British Society for the Protection of Science and Learning and was offered a grant. He decided to emigrate with his wife and two children. To Oxford and Stoke Mandeville It was 1939 and I was six years old. I remember I was abnormally frightened at the time; I used to cry a lot. Even as a small child I picked up the fear and sadness felt by my parents. Eva Loeffler, daughter. His daughter continues, “Although Jews were allowed to take out some furniture, clothes and linen they were not allowed to take any money, gold silver or jewellery. But the official who was supervising us came round the day before and told my mother ‘I shall be an hour late tomorrow’. It was obviously a hint that we might pack what we wanted; but my mother was too frightened to take anything forbidden as she thought it could be a trap.” The Guttmanns left Germany on 14th March 1939, and went to Oxford where the family found a small house to live in. Guttmann was working at the Radcliffe Infirmary and at St Hugh’s College Military Hospital for Head Injuries. Then in 1943 he was asked by the Government to become Director of the new National Spinal Injury Centre at the Emergency Medical Services Hospital at Stoke Mandeville. He accepted the post on the condition that he could treat patients in his own way with no interference. 1944-66 The National Spinal Injuries Centre The new Spinal Unit was opened at Stoke Mandeville Hospital in February 1944 with Dr Guttmann in charge. It had 24 beds and one patient. It was initially very poorly resourced but the medical need was clear; within six months Guttmann had nearly 50 patients. Treatment for paraplegics in England was still rudimentary. Patients with spinal injuries had a two-year life expectancy. It was not the injury itself that was life-threatening but the twin dangers of pressure sores and urinary tract infections. In The US in the 1930s Dr. Munro had begun to transform the treatment of spinal injuries by ensuring that patients were turned every two hours to prevent bedsores; this was a regime that Guttmann quickly copied. Essentially if they went anywhere else for care, the spinal injuries patients died. He exerted a total, obsessive control over all aspects of care at the hospital, whether it was him coming round in the middle of the night to make sure that the nurses had turned patients, or checking on the quality of the cleaners’ work or that of the food served on the wards. Everything was his responsibility. This was such an enormous contrast with consultants in other hospitals. Dr John Silver Rehabilitation An important part of the treatment was to ensure that patients maintained some hope of making progress and returning to their previous life. Patients took part in activities to keep them active – a social rehabilitation as well as a medical one. Workshops where the patients could do woodwork and clock and watch repairing were set up in the hospital. But it was the encouragement of sporting activities that was to make the greatest impact on the wards. The first sport was a wheelchair polo using walking sticks and a puck, but this was soon replaced by wheelchair basketball. Archery was also popular; it relied on upper body strength which meant that paraplegics could compete with their non-disabled counterparts, and it was archery that was the first competitive sport at the Stoke Mandeville Games in 1948. My eyes were opened when we received one particular patient in 1956… He had had to wait eighteen months before he could get transferred to Stoke; and when he came to us he had every complication in the book; he was covered in pressure sores; his kidneys were full of stones; he was practically dead. And this man, working with poor staff who he had welded into a team that he could rely on (he had done it all himself): he cured him, sent him out into the world and back to a meaningful life. For me it was one of those Damascus moments; The stories about him were true. Dr John Silver 1966-80 Retired but still active Following his retirement from the Spinal Injuries Centre in 1966, Guttmann continued to be heavily involved with the Games and also the national and international organisations, both sports and medical. In 1969, following fundraising in order to cover the costs of the building works, a new sports centre was opened by the Queen on the Stoke Mandeville Hospital grounds (later renamed ‘Ludwig Guttmann Sports Centre for the Disabled’ after his death). As well as the Games side of his work, he continued to travel and lecture on spinal injuries all over the world, continuing to educate and influence others with his theories and methods. However, it was his leadership of the disabled sports organisations that he was involved with that occupied him through the late 1960s and 1970s. It was in the 1970s that Guttmann spear-headed the conversations with the International Olympic Committee about the use of the term ‘Olympic’ and the name of the various organisations – conversations that directly led the way to the close relationship with the IOC and the later establishment of the International Paralympic Committee. An original draft of Dr Guttmann's biography at The Wellcome Library. I think Sir Ludwig just changed the world for us; it was a complete step change… He came in, he had a vision… As far as disability and disabled sport was concerned he did change the world. Caz Walton, patient of Guttmanns and subsequent GB athlete at 5 Paralympic Games. Sir Ludwig Guttmann died on the 18th March 1980 of heart failure following a heart attack some months before. He did not live to see his vision realised, but his work continues through the current disabled sports organisations and through the National Spinal Injuries Centre at Stoke Mandeville, which continues to be a world leader in the treatment of spinal injuries. Professor Sir Ludwig Guttmann's Legacy If I could say anything to Sir Ludwig it would be, “Thank you”… Before he did his rehab work at Stoke Mandeville, if you broke your back or your neck you were just left in hospital to die; it was that simple. Tanni Grey Thompson When Ludwig Guttmann started work at the Spinal Injuries Centre at Stoke Mandeville, life expectancy for paraplegics was only two years from the time of injury. Guttmann refused to accept that a spinal injury was a death sentence, and his advancements in the treatment of paraplegia have revolutionised the field. He influenced and taught a whole generation of physicians from all over the world in his methods, and centres were established worldwide (including those named after him in Barcelona, Heidelberg and in Israel). His philosophy of dedicated management of spinal injury patients from injury to the grave is still credible today and has whenever possible been adopted around the world…Guttmann made Stoke Mandeville into a successful model for others to copy. Professor Wagih El-Masri Sir Ludwig Guttmann’s vision for changing the lives of those with spinal cord injury has achieved so much but his lasting legacy is that you must always ask yourself “What needs to be done now?” That is the challenge he has handed down to each of his successors. Dr. Allison Graham, Clinical Director, National Spinal Injuries Centre, Stoke Mandeville Father of the Paralympic Movement Guttmann was known as “The father of the Paralympic movement”; he was the pioneer who proved that disabled sport could be as competitive and exciting as non-disabled sport. It was his drive and determination to include a section in the Olympics for disabled sportsmen and women that follows through into the provision of the Paralympic Games today. London 2012 will be the closest that the world has ever got to Guttmann’s vision with the Olympic Games and Paralympic Games being organised in tandem. However, there is still a little way to go to see the two events combined together into one sporting festival where disabled athletes compete alongside their non-disabled counterparts. After injury Guttmann focussed an individual’s mind on what they can do rather than regretting what they can no longer do. Through sport Guttmann gave that person back the will to live a full life with pride and self-respect. Bob Paterson, IWAS. The aim of the Stoke Mandeville Games is to unite paralysed men and women from all parts of the world in an international sports movement, and your spirit of true sportsmanship today will give hope and inspiration to thousands of paralysed people. Forty five years on the terminology may have changed but the core message remains the same. That statement of intent was first unveiled for the Stoke Mandeville International Games in 1956; it was then hung in the new sports stadium when it opened in 1969; and it then went to the archery room at the hospital. Ludwig Guttmann once said, “If I ever did one good thing in my medical career it was to introduce sport into the rehabilitation of disabled people”. This is still true today and manifests itself through the organisation WheelPower, the national charity for wheelchair sport whose base is at Stoke Mandeville Stadium, which he established as the British Paraplegic Sports Society and which aims to transform lives through sport. Providing opportunities for young and newly disabled people to benefit from participation in sport is key to their rehabilitation and personal development. Martin McElhatton, Chief Executive, Wheelpower – British Wheelchair Sport Related content: Memories of Professor Sir Ludwig Guttmann The "Poppa" Guttmann Trust The Imperial War Museum, Oral History Collection of Ludwig Guttmann