Ludwig Guttmann
Authors: Rebecca Akkermans
Journal: The Lancet Neurology (2016)

Spinal injuries specialist and founding father of the paralympic movement. Born in Tost, Upper Silesia, Germany, on July 3, 1899, he died on March 18, 1980, in Aylesbury, UK, aged 80 years. In September, 2016, more than 4000 athletes will compete in the 15th Summer Paralympic Games in Rio, Brazil. The paralympic movement has its roots in the ambition and determination of German neurologist Ludwig Guttmann. With his sights set on a career in medicine, a young Guttmann volunteered at the Accident Hospital for Coalminers in Königshütte; what he saw influenced him profoundly. A young coalminer was admitted with a broken back and paraplegia. After the patient's spine had been forcibly realigned, he was put in a plaster cast and separated from other patients. “During the following weeks I saw this fine, strong man rapidly deteriorate and become increasingly emaciated as a result of sepsis from urinary infection and sloughing, multiple bedsores, until he died just 5 weeks after his injury”, Guttmann later wrote. In 1918, Guttmann began his medical studies at the University of Breslau, moving to the University of Freiburg in 1919. After graduating in 1923, Guttmann hoped to specialise in paediatrics, but was advised to visit the Department of Neurology and Neurosurgery at the hospital in Breslau, where there was a vacancy. Guttmann would work here for over a decade, training under eminent neurologist Otfrid Foerster. Although these were happy times for Guttmann and his wife, Else, the political landscape in Germany was changing. In 1933, all Jewish doctors were dismissed from their posts and Guttmann became Director of Neurology and Neurosurgery at the Jewish Hospital in Breslau. On Kristallnacht (Night of Broken Glass) in early November 1938—during which Jewish homes, businesses, schools, and synagogues were looted and destroyed—Guttmann ordered that any person seeking refuge at the Jewish Hospital should be admitted. The next day, Guttmann had to justify these admissions to the Gestapo; with his quick thinking, he saved all but four of the 64 men admitted from being sent to concentration camps. Later that year, Guttmann travelled to Portugal, where his neurological expertise had been requested by dictator Salazar. On his return trip, Guttmann visited London, and learned that visas for him and his family had been organised by the Society for the Protection of Science and Learning. Guttman, Else, and their two children arrived in England on March 14, 1939. For the next 4 years, Guttmann worked as a research fellow in the Nuffield Department of Neurosurgery at the Radcliffe Infirmary (Oxford, UK), but although he enjoyed his research, he felt that his medical skills were wasted. However, in 1943, Guttmann was invited by the British Government to set up a spinal injuries unit at Stoke Mandeville Hospital. Guttmann's enthusiasm for his new appointment baffled his Oxford colleagues; “They could not understand how I could leave Oxford University to be engulfed in the hopeless and depressing task of looking after traumatic spine paraplegics”. When it opened in February 1944, Ward X at Stoke Mandeville had just 26 beds, which were soon occupied by servicemen and women with traumatic spinal injuries. Guttmann instituted a two hourly turning regime for all patients so that their bedsores could heal, introduced intermittent catheterisation using proper aseptic technique, and treated infections with the recently-discovered penicillin. Guttmann's brusque manner and obsessive control over his patients' care did not make him popular, but it did get results. His staff and patients came to know him as ‘Poppa’, but “he retained a very Germanic strain of authoritarianism”, recalled his daughter Eva Loeffler. “It was difficult to disagree or argue with him.” Guttmann was a great believer in the power of sport and competition in physical, psychological, and social rehabilitation. He soon had physiotherapists working with patients so that they could become independent. One day, Guttmann found several patients playing a makeshift game of wheelchair polo on the hospital lawns. Polo was soon abandoned due to the number of injuries it caused, but wheelchair basketball and archery took its place. On July 28, 1948, Guttmann organised an archery competition on the hospital lawns for sixteen spinal injury patients. The following year, 60 competitors took part from five hospitals, and by 1951 the number of competitors had risen to 126. Additional sports were added and in 1952, a team of Dutch paraplegic war veterans came to compete, marking the first International Stoke Mandeville Games. It was no coincidence that the first event was held on the first day of the London Olympic Games; it was always ‘Poppa's’ intention that his Games would one day be held alongside the Olympic Games. In 1960, the International Stoke Mandeville Games were held abroad for the first time, in Rome, Italy, where the Olympic Games were hosted that year. Guttmann's dream had been realised, and the Paralympic Games were born. After his retirement in 1967, Guttmann worked tirelessly to promote disabled sports until his death in 1980. In 2012, 64 years after that first archery competition, the Paralympic Games returned to London. In an interview, Loeffler commented: “To be in the Olympic Stadium and hear the roar of 80 000 people cheering athletes was inspirational. My father would have been thrilled to see the combination of his dreams in the country that gave him refuge.” For more on Guttmann's life and career see Goodman S. Spirit of Stoke Mandeville. London: Collins, 1986. For more on Guttmann's life and career see Goodman S. Spirit of Stoke Mandeville. London: Collins, 1986.