Förster, Otfried

In 1892 he graduated from the school of Mary Magdalene in Breslau . From 1892 to 1896 he studied medicine in Freiburg , Kiel , and then in Breslau. In 1897, he passes state examinations in medicine and receives a doctor’s diploma.

On the advice of Karl Wernicke, at the end of his studies at the university, he undergoes an internship in Paris with the famous doctor Joseph Julius Degerin, where he also met and studied under Pierre Marie and Joseph Babinsky , in Switzerland under the guidance of Heinrich Frenkel. In France and Switzerland, he studies the treatment of nervous diseases. Förster began his medical career at a time characterized by the discoveries of Charcot , William Erb and William Richard Govers , which prompted him to devote his life to neurology .

Working as an assistant at Wernicke in Breslau, Förster defended his thesis on the pathology and physiology of coordination, analysis of movement disorders in diseases of the nervous system and their rational therapy. Together with Wernicke in 1903 he created a photographic atlas of the brain . In 1908, Förster published an article on transection of the posterior roots of the spinal cord to reduce spasticity in cerebral palsy, similar to dorsal rhizotomy for the treatment of severe paroxysmal abdominal pain with tabes dorsalis ( spinal cord with syphilis ). This operation became known throughout the world as the operation of Förster . Förster’s ideas on the theory of pain formed the basis of the “portal theory of pain” by Melzak and Walls.

In 1909 he was awarded the title of Associate Professor (associated professor)), and in 1921 a professor.

Initially, he operated only on the spinal cord , inviting general surgeons for brain surgery . Regardless of Spiller and Martin, Förster proposed the idea of ​​transection of the anterior-lateral columns of the spinal cord. Without surgical preparation, he began to operate a lot, especially during the First World War . He observed 3,724 patients with peripheral nerve injuries, who underwent 523 operations. With nerve defects, their autotransplantation was performed. Reporting in 1934 about the long-term results of treatment of almost 5,000 gunshot wounds of nerves, Förster noted a 45% improvement, and in 52% - restoration of function.

When Lenin became seriously ill, Förster was invited to Moscow . In early June 1922 , he arrived in Moscow, where he was actually the main attending physician of Lenin from December 1922 until his death in January 1924 . It was he who insisted that in the treatment of the patient, preference should be given not to medicines, but to soothing exercises, walks and hiking in the forest. ^[one]

Returning to Breslau in 1924, Förster headed a neurological department with 80 beds, in which he began to operate 1-2 times a week, especially with a head injury . He also dealt with issues of rehabilitation of neurological patients and neuromorphology, working together with the famous pathologist Otto Galel. To further develop the doctrine of localization, Förster irritated the cerebral cortex with an electric shock during surgery. He considered neurosurgical operations always under local anesthesia as neurophysiological experiments aimed at studying the functioning of the human brain under surgical intervention ^[2] .

By the end of the 1920s Förster gained international fame. Well-known neurosurgeons and neurophysiologists came to Breslau - Percival Bailey (who created the first classification of brain tumors), Paul Bucy (who later published a monograph on the motor cortex), Robert Wartenberg, Wilder Penfield , John Fulton. There were visitors from the USSR . Here is how the Moscow neurologist L. O. Korst describes his impressions of the Förster Clinic:

Wanting to get acquainted with the staging of nervous surgery in Germany, I chose the clinic prof. Förster, the only one of its kind in Germany, which combines neuropathology with neurosurgery. Only in Breslavl for Förster a special (optional) department of nervous surgery was created with a clinic for 100 beds ... which he has been managing since 1921. The room is not enough, there is one small operating room, there isn’t even a dressing room and dressings are done in the wards. For 100 patients, there are 3 full-time doctors, one senior assistant and two assistants, heads of departments (one for men, the other for women). They have a full examination of the patient ... that is, maintaining a medical history, lumbar puncture, encephalo- and ventriculography, x-rays, assisting in operations, hospital duty. The doctor spends all day in the clinic from 8 a.m. to 8 p.m. with a lunch break from 3-5 p.m. The X-ray is common with the therapeutic department, and there is no radiologist, but there is only a laboratory assistant for the manifestation of the films, but all the doctors take the pictures themselves. L.O. Korst

Korst was present at 10 operations of Förster and noted in her article the following features of his operational technique:

• thorough hemostasis
• very large trepan windows
• bone is always removed because a “valve” is considered necessary even with normal intracranial pressure
• very delicate and skillful work on brain tissue
• slow operation lengthening operation time up to 2-5 hours
• operations are always under local anesthesia (except for operations in children)

Förster’s open brain surgery under local anesthesia for the treatment of epilepsy using electrical stimulation was subsequently repeated by W. Penfield. Based on the analysis of the results, he carried out mapping of the cerebral cortex ^[3] .

In his memoirs, Penfield describes his impressions of Förster’s operations:

His operative technique is significantly different from that of American neurosurgeons ... He is a slow, zealous operator, although he does not use either bone wax or silver clips to stop bleeding from the vessels, nor does the aspirator perform bone-plastic trepanation, but only resection. He conducts closure of the surgical wound in a manner not permitted by the Cushing School. Despite this, his surgery is good. He is very careful about tissues, especially brain tissue. It perfectly radically removes tumors, acts perfectly in threatening circumstances ... ^[4]

For the first time, he performed an operation to fix an unstable cervical spine in the occipital-cervical region in 1927 in a patient with tuberculous spondylitis ^[5] .

Among the students of Förster, Ludwig Gutmann ( 1899 - 1980 ) is also known, who was forced to emigrate to the UK after the Nazis came to power and created a system for the rehabilitation of spinal patients there.

From 1924 to 1932 - Chairman of the German Society of Neurologists. With the help of the Rockefeller Foundation and with the support of the Government of Prussia in 1934 , he opened a neurological research institute, which later began to bear his name. (University of Breslau's Otfrid Foerster Institut Für Neurologie).

In 1930 , Förster visited Boston , visiting Cushing .

Together at Bumka, he was the editor of the 17-volume Manual of Neurology and Psychiatry, in which he wrote chapters on the motor and sensory cortical centers, spinal cord lesions, and neurorehabilitation.

In 1938 he retired.

He died on June 15, 1941 in Breslau. After 2 days, his wife died of grief ( suicide ?).

The Institute of Neurology in Wroclaw (formerly Breslau) was named after him.

On August 26, 1953 , the German Society of Neurosurgeons created a medal in memory of Otfried Förster, which is awarded for a significant contribution to neurology and neurophysiology ^[6] .

• In 1935, he received the John Jackson Medal, founded in honor of the 100th birthday of this English scientist.
• Also in 1935 he received the Cotenius Medal ^[7] .

The author of many scientific papers. The most famous are:

• Physiologie und Pathologie der Coordination (Physiology and Pathology of Coordination), Jena 1902
• Atlas des Gehirns (Atlas of the brain) with Karl Wernicke, Berlin 1903
• Beitragen zur Hirnchirurgie (Brain Surgery), Berlin 1909
• Die Kontrakturen bei den Erkrankungen der Pyramidenbahn (Contractures for pyramidal diseases) Berlin 1909
• Über die Beeinflussung spastischer Lähmungen mittels Resektion der hinteren Rückenmarkswurzeln (Effect of transection of the posterior roots of the spinal cord on spastic paralysis) in the German Newspaper of Nervous Diseases Volume 41 of 1911, p. 146-171
• Foerster O: On the indications and results of the excision of posterior spinal nerve roots in men. (Indications for cutting the posterior nerve roots and treatment results) Surg Gynecol Obstet 16: 463–474, 1913
• Zur Pathogenese und chirurgische Behandlung der Epilepsie (Pathogenesis and surgical treatment of epilepsy), Leipzig 1925
• Förster O. Zur operativen Behandlung der Epilepsie. (Surgical treatment of epilepsy) Dtsch Zschr Nervenheilk 1926; 89: 137-147
• Bumke H, Foerster O, eds. Handbuch der Neurologie (Textbook of Neurology). Berlin: Springer-Verlag; 1936
• Der Schmerz und seine operative Behandlung (Pain and its surgical treatment), Halle 1935