Introduction
When the original clinical-pathological description of what is now known as Gerstmann-Sträussler-Scheinker disease (GSS) was published in 1936,Reference Gerstmann, Sträussler and Scheinker 1 author I. Mark Scheinker (1902-54) (Figure 1) only used his first initial “I” instead of his full name “Isaac,” because his Jewish-sounding name would have likely prevented its publication in a German journal at the time.Footnote * The Nazi Editor’s Law (Reichsschriftleitergesetz) of October 1933 not only stated that journal editors had to be “Aryan,” but also largely prevented Jewish doctors from publishing their works in German books or journals.Reference Kater 2 This was one of many laws passed by the Nazi government to systematically marginalize the approximately 8000 to 9000 “non-Aryan” (baptized Jews, Mischlinge [part-Jews], and other minorities) and communist physicians in Germany and remove them from professional life.Reference Zeidman and Kondziella 3 The lives of all three GSS authors, along with many other racially and politically persecuted Viennese neuroscientists, dramatically changed on March 13, 1938, following the Anschluss (forced annexation) of Austria by Nazi Germany.Footnote ** Additionally, neurology and psychiatry were not typically distinct until after World War II, separating when diagnostic and therapeutic advancements in neurology made it a more clearly distinct and viable specialty to practice separately [see: Janzen R. Teaching neurology in Germany. Int J Neurol. 1977;11:280-8]. At this time, Austrian Jewish physicians were subjected to all the legal and illegal marginalization and harassment their German colleagues had experienced since 1933.Reference Zeidman and Kondziella 3 Scheinker fled twice from Nazi Europe before ending up as a neuropathologist and neurologist in Cincinnati, Ohio. Though relatively successful in exile, his career was undoubtedly affected by his tribulations in Nazi Europe and the strife he faced later as well. There has never been, to our knowledge, a comprehensive description of Scheinker’s career or his victimization following the Anschluss in the neuroscience or medical literature. The 75th anniversary of the Anschluss was in 2013, thus an analysis of its aftermath on this neuroscientist refugee from Austria seems timely. We analyze Scheinker’s career before and after the Anschluss, and attempt to frame his life in the context of Nazi physician persecution and forced migration (Table 1).
Figure 1 Ilya Mark Scheinker, unknown year, from the collection of the National Library of Medicine. Images from the History of Medicine Collection, order number B023246, portrait number 106114. Available from: https://ihm.nlm.nih.gov/luna/servlet/view/search?QuickSearchA=QuickSearchA&q=scheinker&sort=title%2Csubject_mesh_term%2Ccreator_person%2Ccreator_organization&search=Search. This work is in the public domain.
Table 1 Ilya Mark Scheinker (1902-1954): displaced twice in Nazi Europe but finds some success in America
CGH = Cincinnati General Hospital; MI = myocardial infarction; RF = Rockefeller Foundation.
Methods
We researched primary documents from the University of Cincinnati Winkler Medical Library Archive Files (Charles D. Aring papers), Notre Dame University Archive (Joseph P. Evans papers), the Ohio State Medical Board files, the US National Archives, and primary and secondary articles by or about Scheinker. We were also aided by the New York Academy of Medicine. We were informed by the University of Vienna, the Austrian State, and the Vienna Municipal Archives, along with the Salpêtrière archives (Service des archives de l’AP-HP, Paris) that they have no files on Scheinker.
Results
Scheinker was born in Klemboki, Russia (Moscow was also listed on his later application to the American Neurological Association; of note, his 1929 Medical Diploma from the University of Vienna lists Klemboki as being in Poland), and little is known of his early years beyond spending 8 years of high school in Riga (present-day Latvia) from 1913 to 1921. He then completed 1 year of medical training in Riga (1921-22); 2 years of medical training at the University of Jena, Germany (1922-24); and 5 years at the University of Vienna Medical School, graduating June 23, 1929. 4 After a year in Vienna’s General Hospital as a medicine intern in 1929-30, he completed training at the Viennese Nervenheilanstalt Maria-Theresia-Schlössel (MTS Neurological Institute) and worked under Otto Marburg (1874-1948; who described Marburg variant acute multiple sclerosis [MS]) at the Viennese Neurological Institute for 3 years. (The MTS Neurological Institute, actually named the Nathaniel Freiherr von Rothschildschen Stiftung für Nervenkranke–Nervenheilanstalt Maria-Theresia-Schlössel [The Nathaniel Freiherr von Rothschild Foundation for the Mentally Ill–Mental Hospital Maria-Theresien-Schlössel], was founded in 1914. In 1939, with Vienna’s Nazification, it was renamed Wiener Städtische, nicht öffentliche, Heilanstalt Döbling [Vienna Municipal Private Mental Hospital Döbling] to avoid connections to the Jewish Rothschild family [see: Schnaberth G. Die Neurologie in Wien von 1870 bis 2010. Wien; MEMO: 2010: 129-131.]) Scheinker was an assistant at the MTS under co-GSS author Josef Gerstmann (1887-1969), heading the neuropathology laboratory from 1932 to 1937. From May 1937 to March 1938 he was an assistant and instructor in neuropathology under Otto Pötzl (1877-1962) at the University of Vienna Neuropsychiatric Clinic. 5 Scheinker’s interests included MS pathophysiology, brain tumor pathology, and epilepsy diagnosis and treatment, though he also published about encephalitis and myasthenia gravis. By 1938, Scheinker had published 27 papers, including a 1935 paper with fellow GSS author and pathology head at the University of Vienna’s Neuropsychiatric Clinic Ernst Sträussler (1872-1959) on MS pathology.Reference Scheinker and Sträussler 6 One month before the Anschluss, Scheinker presented a paper to the Viennese Association of Neurology and Psychiatry on the histopathology of brain tumor–associated edema and swelling, published later that year,Reference Scheinker 7 and was listed as associated with the MTS despite working in Pötzl’s University Clinic at that point.
In June 1935Reference Gerstmann, Sträussler and Scheinker 1 in Vienna, Scheinker, along with Gerstmann and Sträussler, presented the case of a 25-year-old female from a southern Austrian family who had begun experiencing profound cerebellar and psychotic symptoms 9 years earlier. Gerstmann had previously published her case,Reference Gerstmann 8 but when she later died, a clinical-neuropathological correlation was possible. Her neuropathological examination revealed significant cerebellar atrophy with molecular layer “senile” plaques, along with cerebral cortex atrophy and atypical ganglion cells. The disorder was thought to be autosomal dominant because the patient had come from three generations who had similar symptoms.Reference Gerstmann, Sträussler and Scheinker 1 Another member of the same family presented in Vienna in 1912 and was misdiagnosed with a hereditary spinocerebellar ataxia,Reference Budka 9 but the clinical-pathological correlation had not been demonstrated before 1935. Despite the fact that the GSS codescription was likely Scheinker’s most significant lasting contribution to neurology, he did not list it on his condensed curriculum vitae as part of his 1947 application to become a member of the American Neurological Association (ANA). 5 Perhaps he did not realize its impact or relevance. GSS was noted to be clinically and neuropathologically similar to kuru (the classic spongiform dementia seen in New Guinea cannibals) in 1962.Reference Budka 9 Likely because the original GSS family members were lost to follow-up and misdiagnosed with other disorders, the discovery of the similarity between GSS and Creutzfeldt-Jakob disease, and its classification as a transmissible spongiform encephalopathy, was delayed until 1981.Reference Budka 9
Scheinker Flees Nazi Europe, Twice
A “search for Jews” by a German nationalist student group at the University of Vienna in 1923 marked the first physical anti-Semitic violence at the medical school. By 1933, there were demands for boycott of Jewish professors and for a quota for Jewish students.Reference Hubenstorf 10 Many Austrian intellectuals disregarded daily Nazi violence,Reference Haag 11 and few neuroscientists emigrated before 1938. After the Anschluss, at the University of Vienna clinic and other hospitals, 77.5% of Vienna medical faculty members were dismissed (153 of 197). Of these 153, four were dismissed for political reasons, 118 for “racial” reasons (e.g. Jewish), and 14 merely because of “unclear origins.”Reference Hubenstorf 10 Ninety-two percent of neurology/psychiatry and neuropathology faculty were dismissed,Reference Hubenstorf 12 making them the hardest hit specialties. Vacant spots were soon taken over only by loyal Nazi and Schutzstaffel (SS, “elite” Nazi paramilitary wing) members,Reference Hubenstorf 13 such as Nazi and SS member Walther Birkmayer (1910-1986, later codiscoverer of levodopa for Parkinsonism in 1961). Birkmayer was praised for having “provided the completely Jew-infiltrated Psychiatric Clinic with reliable illegal physicians shortly before and especially after the [Anschluss],” thereby contributing significantly to the “de-Jewification policy” at the clinic (Nazi party membership was illegal in Austria until after the Anschluss in 1938).Reference Czech 14 By 1945, at least 11 Austrian and Czech neuroscientists were murdered or imprisoned in concentration camps.Reference Zeidman and Kondziella 3 , Reference Zeidman and Kondziella 15
Scheinker’s whereabouts during the Anschluss are unknown, as is his escape route from Austria. He fled to Paris and worked as a research assistant at the Salpêtrière from 1938 to 1940 under Professor Georges Guillain 16 (1876-1961, codescriber of Guillain-Barré syndrome). Despite the Nazi Editor’s Law being in effect in annexed Austria, three more Scheinker papers were allowed to be published in 1938Reference Scheinker 7 , Reference Scheinker 17 , Reference Scheinker 18 ; this is likely due to Scheinker’s use of his first initial again only, or journal editors ignoring Nazi laws and using leeway to continue to publish articles by Jews. During his time at the Salpêtrière, Scheinker was still able to publish at least six papers in the monthly Swiss journal Monatsschrift für Psychiatrie und Neurologie from 1939 to 1940. 5 Documents are mostly silent on when and how Scheinker fled France following the German invasion in May 1940 or what tribulations he had to overcome. He lived in Marseille, France, before his voyage to the United States, and took the SS Nyassa from Lisbon, Portugal, arriving in New York City on April 25, 1941. 19 He settled in the Bronx, living at 1814 Phelan Place. 16 On his 1942 declaration of intent to become an American, he listed his present nationality as Russian. 19 , Footnote *
Scheinker as a Refugee, Still Alive but Facing Many Professional and Personal Difficulties in Exile
After Scheinker arrived in New York in 1941, apparently physically unharmed by his flight from German-occupied France, it took him a half-year to find a position as a neuropathologist in the United States. However, he had wasted little time in seeking help from Tracy Jackson Putnam (1894-1975), the famous American neurologist and codiscoverer of phenytoin treatment for epilepsy in 1938.Reference Rowland 20 Putnam took a strong interest in the plight of immigrant physicians to the United States from Nazi Europe, being vice chairman of the National Committee for Resettlement of Foreign Physicians in New York.Reference Edsall and Putnam 21 Putnam wrote a letter (Figure 2) to Cincinnati General Hospital Neurosurgery Chair Joseph P. Evans (1904-85) on May 12, 1941, stating:
I have recently seen an émigré neuropathologist who might be suitable for the position which you have open. His name is Isaak Scheinker, he is about 35, unmarried, presentable and speaks good English…He has just arrived from France, and is most reasonable and realistic about his prospects.16p.1
Figure 2 Tracy Putnam letter of May 12, 1941, recommending Scheinker to Dr. Joseph Evans, neurosurgery chief at Cincinnati General Hospital. Published with permission from the University of Notre Dame Archives.
Throughout May, Scheinker corresponded with Cincinnati Neurology Chair Charles D. Aring (1904-98), and he finally met with Aring and Evans to discuss the open neuropathology post at Cincinnati at the June 1941 ANA meeting in Atlantic City, New Jersey. On August 8, 1941, Scheinker was appointed for 1 year as neuropathologist at Cincinnati General Hospital to start October 1, 1941, and as “instructor of pathology” at the University of Cincinnati College of Medicine. He finally reattained the teaching rank he had held in Vienna when he was exiled 3 years prior. Scheinker took the spot vacated by Murton Shaver (unknown-1959) who rotated at Cincinnati as a neuropathologist in 1940-41 even though he was based at the Montreal Neurological Institute. 16 Scheinker, without other options, eagerly accepted this 1-year appointment given Evans’ rationale that the position would “…give you more time to look about the country and might conceivably lead to a more permanent opening here.”16p.6
Scheinker’s neuropathology appointment seems to have been quite calculated, and his position was never guaranteed. 16 Because of a shortage of neuropathologists, there had been multiple attempts to fill the opening at Cincinnati before Scheinker was hired. Evans had a personal friendship with another refugee neuropathologist and neuropsychiatrist from Europe, Karl Stern (1906-75, author of Pillar of Fire), who was on staff at the Montreal Neurological Institute where Evans trained in neuropathology (and Evans was friends with Chairman Wilder Penfield [1891-1976]). 22 Stern was offered the post of neuropathologist in Cincinnati in 1940 but was unable to accept the position there because his Canadian citizenship was in limbo, and he still needed to bring his parents over from England to Canada, which he believed he would not be able to do if he moved to the United States. Moreover, the clock would start again and he would have to wait another 5 years for citizenship. 22 Additionally, in 1940, Aring and Evans tried to bring German neuropathologist Hans J. Scherer (1906-45), then at the Bunge Institut for Cancer Research in Antwerp, Belgium, to Cincinnati, but their attempts to acquire a visa for him failed. 23 Aring and Evans also were interested in retaining Shaver, but Shaver was not permitted by Penfield to stay in Cincinnati, despite special requests from Evans, nor was he able to come back in 1942 as Evans and Aring had planned.Reference Joseph and Henry 24 Additionally, Aring wanted a former Cincinnati neurology resident Ephraim Roseman (1913-89), who had worked in the neuropathology laboratory in 1939-40, but who was then finishing his studies in Boston, to be offered the spot in 1942, writing, “Then, if neither Stern or Murton can be obtained we can worry along with Scheinker until Eph will be available.”24p.10 But “Eph” did not take the position then, possibly because of military service or because he wanted to remain in Boston.Reference Joseph and Henry 24
Thus, after several months in limbo, Scheinker was finally offered the position at Cincinnati and was able to keep it even after the provisional 1-year contract was up. The semi-obsequious letters from him to Aring and Evans clearly express his joy at this remarkable stroke of luck. 16 Evans’ correspondence with Stern, however, indicates that he always preferred Stern, and he repeatedly made gestures to him to come to Cincinnati, given that Scheinker’s appointment was year-to-year and never permanent. 22 His position was funded at least initially by Evans and Aring’s Rockefeller Foundation grant, and in addition to being a neuropathologist, Scheinker attended on the neurology ward for 2 months out of the year. 16 , 25
Despite others’ skepticism, Scheinker proved himself by the war’s end and may have been the most successful in exile of all three GSS coauthors. He became a member of the American Association of Neuropathology, Association for Research in Nervous and Mental Disease, and the Cincinnati Society of Psychiatry and Neurology. In 1946, he obtained his US citizenship, stating beforehand in a letter to Aring:
In two weeks I am going to be an American. What a happy and long anticipated day! My ambition is to be one of the best Americans and to repay to this country for all that I found here. I shall never forget it as long as I am alive!5p.36
Also making 1946 a happy year, Scheinker was married 5 to a newspaper reporter named Mary Matthews, who along with Jacob Plaut, an industrial consultant, provided affidavits on his naturalization certificate (Matthews and Plaut had known Scheinker since November 1941). 19 Also in 1946, Scheinker found out that his two sisters in Moscow had survived the war, after not having heard anything from his family in Europe in 5 years. 5 Scheinker had many successful years in Cincinnati (Figure 3). His 1947 ANA member application lists 62 published papers. 5 Because his 1941 curriculum vitae lists 34 publications, this would mean he published 28 papers in 6 years in the United States, with 10 alone in 1943. 16 He also authored three landmark neuropathology books, published from 1947 to 1951. The first book contains a foreword by Putnam, and Scheinker dedicated the book to “My beloved country, the United States of America.”Reference Scheinker 26 He dedicated the second book to his wife, who had assisted him greatly.Reference Scheinker 27 On the title page of the third book, he lists two new affiliations, one as consulting neurologist at the Fort Thomas, Kentucky, Veterans Administration Hospital, and the other as consulting neuropathologist for the Public Health Service in Lexington, Kentucky.Reference Scheinker 28 In November 1946, Evans recommended Scheinker for promotion to assistant professor of neuropathology. The next year, Scheinker obtained his Ohio medical license with support from Evans and Aring. 16 On learning of his licensing, Aring, who was 2 years younger than Scheinker, wrote:
I was glad to learn Mark made it through his State Board examinations all right…It must have represented a rather rigorous effort for him, I know I shouldn’t like to do likewise in Vienna or Breslau at my age.24p.2
Figure 3 Charles D. Aring (back row, left), Joseph P. Evans (back row, middle), I. Mark Scheinker (back row, right). Cincinnati General Hospital neurological-neurosurgical picnic at the Evans farm in Newtown, Ohio, June 2, 1945. Published with permission from the Henry R. Winkler Center for the History of the Health Professions, University of Cincinnati Medical School.
Scheinker wrote to Aring:
The acquired license gave me a wonderful feeling of security and independence. And yet I can’t help thinking that my real place is not in the office ‘doing good business’ but in the medical school in a teaching position.5p.54
Scheinker considered his “real contribution” to be his combination of clinical neurology and neuropathology, which he believed carved him out a “distinct” place as a teacher.5p.54
But Scheinker faced setbacks that eventually drove him from the Cincinnati Medical School. Before securing his promotion and salary guarantee until 1948, he expressed “depression” about his career “uncertainty” and began to look for jobs elsewhere, claiming his “personal life [was] more satisfactory than [his] professional.”5p.28 In a letter to Aring, he sarcastically wrote of his “real friends” in the “unwholesome” Cincinnati denigrating his clinical neurology skills and stating he was only skilled in the laboratory and should not be promoted to an assistant professor of neurology, to which he replied, “My 20-year long experience in clinical neurology is apparently of no value at all!”5p.32 He also wrote that he “was discouraged and disgusted by all the personal intrigues” and needed “a more stimulating and encouraging atmosphere” to work on his third book.5p.34 Scheinker’s assistant professorship lacked tenure and was only guaranteed until the end of the academic year, 1948. He planned to open a neuropsychiatry private practice in 1947-48, despite that not being the role in which he envisioned himself. 16
Evans tried to help Scheinker obtain referrals and wrote a recommendation letter to the Ohio Workmen’s Compensation Board that he was fully qualified to evaluate referrals, and would be entering part-time practice in 1947. But Evans rejected Scheinker’s request in 1947 to establish an MS brain and spinal cord registry in the neuropathology laboratory, mainly because Scheinker was leaving in 1948. Evans thought they needed the laboratory space for other projects and personnel. Scheinker protested, claiming he was assured of the funding. 16 Even before this rejection, Scheinker stated to Aring that at the first meeting of the Medical Advisory Board of the Foundation for Advancement of Research on Multiple Sclerosis in New York, he had garnered wide support for this proposal to centralize MS pathological tissue from all over the country to facilitate research projects. He stated that funds were available and he was encouraged to write a memorandum detailing his proposal, and that he just needed the laboratory space and a technician and secretary, but that “Unfortunately I do not have much to say in Cincinnati. I am still treated here as a laboratory technician….!”5p.55 Beside not feeling as if he had equal respect and status as other neurologists in the department, not obtaining tenure, and not being able to establish his MS registry, Scheinker’s ANA application was not approved, despite being supported by Aring and Putnam along with three others. Aring told Scheinker that the chances had been slim because no memberships were given during the war, and membership was capped at 200, with new members being elected only when another passed away. 5
Though not exactly what he wanted for his career, Scheinker’s private practice at 1106 Cross Lane in Cincinnati was successful to some extent. His MS treatments drew many patients from across Ohio. His theories centered on a clinical-pathological correlation that he praised. 5 He believed therapeutic blood pressure elevation could counteract vasoparalysis of the small veins and capillaries that causes poor flow and thrombogenesis, to prevent MS progression. This theory was recently resurrected with controversial ideas on chronic cerebrospinal venous insufficiency in MS and venoplasty procedures to treat it.Reference Ganesh and Stahnisch 29 In his last publication in 1954, Scheinker detailed how 66.7% of his 237 patients had a partial or complete recovery from MS, and this was correlated closely with increased arterial blood pressure and flow. He noted that because of spontaneous remissions in MS, the “tendency to improvement or alleviation – must be appraised, not without a just proportion of skepticism.”30p.590
A recommendation letter from Aring on behalf of Scheinker to New York neurologist Israel S. Wechsler (1886-1962) in 1952 summarizes that, although Scheinker diligently built a “large following” and filled a need in the Cincinnati community especially for patients with chronic disorders such as MS “while others have largely shunned or neglected this type of patient,” he made enemies who did not appreciate his success.Footnote * Scheinker’s success with these “chronic” patients seems related to his “total push” methods in rehabilitation that he found to be rewarding.5p.13 Aring further commented the following:
Like any of those physicians who have come to us from abroad, he is a controversial figure. There is something about medical training that I will call ‘German’ for want of a term to cover it, that sets these people apart from us.5p.13
Aring mentioned that he understood someone like Scheinker better and got along well with him (especially since Aring had trained partly in Europe), even though Scheinker manifested the “detached from certain feelings” persona that many could not tolerate. Aring wrote how someone like Scheinker could be useful with “guidance,” and though his approach was unorthodox and anxiety-inducing because it was new, he could offer “a different slant to neurological problems.” He concluded “that since [Scheinker] left our Laboratory of Neuropathology it has not been the same place, candidly all the life has gone out of it.”5p.14
After Scheinker suffered a myocardial infarction in 1950, and divorced his wife around whom much of his social circle revolved, he decided to move to New York. In his response to Aring’s letter mentioned previously, Wechsler stated that Aring “gave expression” and “awakened” feelings he already experienced about “our foreign friends” such as Scheinker (Figure 4). Namely, Wechsler thought the difference between refugee European neuroscientists and Americans was that “We do not take ourselves quite so seriously.”5p.12 This response from Wechsler suggests that there were ubiquitous and palpable personality and practice discrepancies that refugee neuroscientists had to overcome to be accepted in the American neurology community. Wechsler’s comment reflects a lack of empathy for the emigrant Scheinker, who perhaps took things more “seriously” because of innate competition with which he was familiar in the European academic environment as well as his experiences in escaping Nazi Europe. 5 Wechsler expressed doubts about Scheinker’s reception in New York:
His enthusiasm about treatment of chronic neurological conditions, especially multiple sclerosis, will probably meet with the same reaction as in Cincinnati.5p.12
Figure 4 Response letter from January 10, 1952, from I.S. Wechsler to Charles D. Aring regarding Aring’s recommendation letter for Scheinker. Published with permission from the Henry R. Winkler Center for the History of the Health Professions, University of Cincinnati Medical School.
In another recommendation letter to New York University neurologist Sam Wortis (1904-69) for a clinical neurological teaching assignment for Scheinker, Aring clarified that “as a citizen of the world” he always liked Scheinker and was not threatened by him, though “some couldn’t take his Continental flavor which does include a certain amount of façade distasteful to most Midwesterners.”5p.15 He emphasized that Scheinker’s divorce “from his socially prominent wife” was the primary reason he was moving to New York in 1952, and not for professional reasons, stating “his move took us all by surprise.”5p.15 Whether Wortis would have believed Aring’s statement is questionable, especially given Aring’s statements about Scheinker’s lack of acceptance in Cincinnati. Aring’s statement about Scheinker’s European “façade” suggests another personality difference that clashed with stereotypical notions of Midwestern openness and honesty. Aring’s statement about personal and not professional reasons for Scheinker’s departure had actually been requested by Scheinker himself, given that Wortis wanted to find out about his personality:
…I explained to [Wortis] that the reason of my move to N.Y. was a personal one (divorce). I hope, Dear Charlie, that you will tell him…that I am not too difficult to deal with and the only thing I desire now is to be able to teach…5p.18
In New York, Scheinker received his medical license without examination and wrote to Aring that he loved it there, having opened a practice at 972 Fifth Avenue, but that he wanted a clinical neurology teaching assignment. 5 He apparently was able to obtain teaching positions at New York Medical CollegeReference Scheinker 30 and at the Flower and Fifth Avenue, Bellevue (New York University affiliate, possibly helped by Wortis), and Montefiore Hospitals. He belonged to the New York County and State Medical Societies, was an American Board of Psychiatry and Neurology diplomate, and a member of the American Academy of Neurology. 31 His talk on vasoparalysis in MS to the New York Academy of Sciences and the National Multiple Sclerosis Society received coverage in April 1953 from the Cincinnati Post: “Treatment that raises the blood pressure and stimulates the circulation was recommended Friday by Dr. I. Mark Scheinker, former Cincinnation[sic]…”5p.1 (Figure 5).
Figure 5 Regarding “former Cincinnation” (sic) Scheinker’s report on MS treatment to the New York Academy of Sciences and the National Multiple Sclerosis Society. Cincinnati Post, April 18, 1953. Published with permission from the Henry R. Winkler Center for the History of the Health Professions, University of Cincinnati Medical School.
Scheinker died prematurely, presumably from cardiac disease, at age 52. 31
Discussion and Conclusions
Though the postemigration story of Scheinker is similar to other physician refugees from Nazi Europe, there are several unique differences. By the end of 1940, 5056 physicians had immigrated to the United States, of whom 60% to 75% were JewishReference Edsall and Putnam 21 and about 65% were between 40 to 55 years old (Scheinker was 38 when he immigrated to the United States). Scheinker contributed to the 35% of registered immigrants (with the Resettlement Committee) who were graduates of Austrian medical schools (second only to German).Reference Edsall and Putnam 21 Overall, 50% of physician refugees fled to America (vs 22% to Palestine and 12% to Britain), and psychiatrist-neurologists made up the largest specialist portion of these (15%) and the largest proportion of physician-immigrants to America (22.3%).Reference Kröner 32 In one study of racially and politically dismissed Austro-German adult neuroscientists with a neuropathology tie (including Gerstmann and K. Stern), 41/46 (89%) were able to find positions abroad.Reference Peiffer 33
Scheinker’s “double emigration” was tragically common, also experienced by the Berlin neuropsychiatrist Lothar Kalinowsky (1899-1992), who emigrated thrice (Italy in 1933, then England in 1940, before America in 1940)Reference Tondo and Lothar 34 ; Berlin neurophysiologist Fritz Buchtal (1907-2003), who fled to Denmark then to Sweden with the Jewish deportations in 1943Reference Kondziella, Hansen and Zeidman 35 ; and Hamburg neuropsychiatrist Victor Kafka (1881-1955), who fled to Norway and then also to Sweden with Jewish deportations in 1942.Reference Peiffer 33 Had he not escaped from occupied France, Scheinker’s fate may have been similar to (same-age) Berlin neuropsychiatrist Hans Pollnow (1902-1943), who fled to France to escape Nazi persecution in 1933 and after the German invasion in 1940 joined the French army. Pollnow was demobilized after the French surrender and fled to southern France, but was arrested by the Nazi secret police in 1943 and deported to the Mauthausen concentration camp in Austria where he was murdered the same year.Reference Neumärker 36
In Ohio, Scheinker found a suitable position despite competition from another Jewish neuroscientist refugee (Stern). The licensing regulations in 1939 only required first papers for naturalization along with an internship,Reference Edsall 37 in addition to the state board examination.
Unlike the physician in charge of New York licensing, Dr. Harold Levi Rypins (1892-1939), who stated that “there were no international boundaries in science generally, and certainly none in medicine,” the Ohio head, Dr. Herbert Morris Platter (1869-1966), was not in favor of refugee physicians. In 1940, Platter attempted to acquire legislation requiring citizenship as a prerequisite for licensure. This was narrowly defeated in the state legislature because of strong lobbying from the Cincinnati Jewish Hospital.Reference Kohler 38 But Platter seems to have succeeded in having citizenship instated as a licensure requirement from 1942 to 1971.Footnote * Thus Scheinker, who came to Ohio in late 1941, narrowly missed the window to obtain a license without citizenship. The citizenship requirement for licensure was not omnipresent in the Midwest. In Illinois in 1941, Governor Dwight Green (1897-1958) vetoed citizenship statutes for medical licensure on the grounds that it was unconstitutional to deprive legal refugees of their livelihood, especially at a time of war between the forces of totalitarianism (from which these emigrants had fled) and democracy.Reference Edsall and Putnam 21
Scheinker published in France and quickly continued his academic productivity once established in Cincinnati. He more than doubled his number of publications post-Anschluss, from 27 to 69, and authored three comprehensive neuropathological textbooks (Scheinker listed 62 publications through 1946 on his 1947 ANA application, and “Ovid OLDMEDLINE 1946-1965” lists six publications from 1947 to 1949, but left out the previously mentioned 1954 paper). But by 1947, Scheinker was disillusioned about the prospect of an academic career in Cincinnati. While attending the 1947 meeting for the National Foundation for the Advancement of Multiple Sclerosis in New York, Scheinker met with noted Philadelphia neurologist Bernard J. Alpers (1900-81), who supported Scheinker’s ANA application, and Alpers asked if he knew any graduating fellows who could take over his neuropathology laboratory at Temple University Medical School, to which Scheinker laughingly and sarcastically replied that instead of recommending his fellow to head Alpers’ laboratory, he himself would have taken the position before his promotion. 5 Alpers replied, “I cannot take it seriously, because I know that you should and soon will have a much more prominent position than being in charge of a laboratory.”5p.56 Scheinker wrote that “His sincere surprise made me feel very good. At least if not in Cincinnati, I am appreciated elsewhere!”5p.56 He also wrote, “It made me feel bitter that I had to go through years of struggle and intrigues to get my final promotion to Asst. Prof. of Neuropath. Well, c’est la vie!!!”5p.56 According to Aring, Scheinker’s lack of tenure in Cincinnati may not have been simply because of coincidental changes in the neurology/neurosurgery and pathology departments, but to his “Continental flavor” and condescending “detachment” that “Midwesterners” could not tolerate. Not only “Midwesterners” but New Yorkers such as Wechsler echoed Aring’s feelings and generalized about a palpable difference between “German”-trained neurologists such as Scheinker in that they took themselves too “seriously.” Besides personality issues, in private practice Aring mentioned that the local neurologists did not appreciate competition from the foreign neurologist Scheinker who offered more treatment to patients with chronic disorders than what they offered, with both rehabilitation and controversial ideas about intentionally induced hypertension in MS. 5
The problem of competition for refugee physicians to establish a successful practice was apparently not unique to Scheinker and Cincinnati, but was well recognized.Reference Edsall and Putnam 21 David L. Edsall (1869-1945) and Putnam wrote the following in 1941:
It is also clear that prejudice is a less hindering factor than competition. Resistance to the establishment of a new practice is not felt alone by aliens (Jewish or non-Jewish), especially in towns where the established doctors have formed a protective clique; disapproval and sometimes open hostility may be the fate of the newcomer, whatever his origin.21p.1883
Similarly to Scheinker as a another young Jewish neuroscientist refugee to the United States from Nazi Europe, Leo Alexander (1905-85), via a different trajectory than Scheinker, faced numerous hurdles including local job competition, personal and professional integration challenges, and pressure to conform to different institutional and cultural traditions and expectations, but found eventual “success.” Alexander, who had been an assistant in the University of Frankfurt Neuropsychiatric Clinic, had been on a Rockefeller fellowship at Peiping Union Medical College in Beijing in 1933 when he was advised not to return to Germany because of the dismissal of non-Aryans in academic positions.Reference Schmidt 39 Never desirous of a permanent position in China, Alexander finally found an unsalaried post at Worcester State Hospital in Massachusetts (only room and board supplied). He immigrated to the United States in 1934.Reference Schmidt 39 By that point, Alexander was under no delusions; writing that Americans hoped to acquire “from the great mass of broken intelligentsia in the middle of Europe, the best for America and for the benefit of their institutions, preferably cheap.”Reference Schmidt 39 Scheinker, applying for positions 7 years later when even more desperate and displaced European refugee neuroscientists were also looking for American posts, experienced this competition even more intensely. Additionally, in his Worcester offer letter, the position was contingent upon Alexander “being of pleasant and cooperative personality” because the department head did not wish to “introduce a disrupting factor.”Reference Schmidt 39 Alexander was under the same pressure to conform to American personality expectations as was Scheinker nearly a decade later. “Team work” and making oneself “as useful as possible” to colleagues were stressed to Alexander as being paramount in AmericaReference Schmidt 39 ; perhaps Scheinker was not advised as such and this led to his struggles. Not only did Alexander have to overcome language and accent issues, apathy to the European political situation, and outright prejudice, but also general complaints from hospitals about the cooperation of émigré physicians. The emigrant’s cantankerousness, likely the normal academic behavior in Europe, was seen as disruptive in America. Alexander wrote that one “who disagrees [is] considered disagreeable.”Reference Schmidt 39 Alexander further lamented about American anti-Semitism in comments he would overhear, and about what he termed “American formalism” that led to “Trivial things, no one in old Europe would bother about…[being] an adequate reason overhere [sic] for dismissing a university professor.”Reference Schmidt 39 He also cynically wrote that “Here in America it is of vital necessity to be in a good mood – smile.”Reference Schmidt 39 The cultural and religious prejudices and differences faced by Alexander were also faced by Scheinker in the 1940s, and his difficulty in adapting likely contributed to his professional dissatisfaction and lack of expected career progression. Given the “coldness of the North Americans” and their apparent lack of cultural understanding, Alexander was depressed and lonely; in his homesickness, he contemplated returning to Europe. This was not atypical for the émigré scientist in America in the 1930s, before the inevitable conclusion of Nazi policies was fully evident.Reference Schmidt 39 Whether Scheinker considered returning to Europe after the war was unclear and not mentioned in any of his letters. Generally, a return to Vienna after the war for neuroscientist refugees was rare; only 3/17 (17.6%) habilitated neuroscientists who were dismissed or had teaching licenses withdrawn returned to their posts.Reference Mühlberger 40
Scheinker maintained several academic affiliations and published articles even after moving to New York and starting a new private practice there. He had more success in terms of numbers of papers and books published in exile than his former Viennese teacher and mentor Gerstmann. This was likely because of Scheinker’s youth, lack of job security, and motivation to advance on the academic ladder. Gerstmann, already mid-career at the time of exile from Austria in 1938, never reacquired a hospital directorship and mainly worked in private practice in New York despite some teaching positions in the 1940s. Gerstmann also had to deal with property, life insurance, and flight tax reclamation battles in ViennaReference Zeidman, Ziller and Shevell 41 with which Scheinker did not seemingly have to contend. Overall, despite the anger, sense of loss, justifiable frustration, and struggles with institutional, intellectual, and cultural adaptation, “emigration” provided unique opportunities. Many neuroscientists found academic appointments abroad, mostly in America, some of whom may not have found appointments even in pre-Nazi Germany or Austria. The American academic establishment was generally less restrictive than its European counterpart. But neuroscientist refugees were forced to be innovative, make profound adjustments in linking old with new value systems, and shift intellectual and scientific perspectives to succeed.Reference Zeidman, Ziller and Shevell 41
In Scheinker’s case, despite his frustrations, our analysis is that via perseverance and taking advantage of opportunities, he prevailed and demonstrated resilience to reestablish his personal life and career. Perhaps without lost time in transit, starting at the bottom of the academic echelon with each emigration, and less psychological trauma from being uprooted twice, he would have flourished even more subjectively and objectively.
Acknowledgments
The authors thank Stephanie L. Bricking (Henry R. Winkler Center for the History of the Health Professions, University of Cincinnati Medical School) for correspondence and all papers regarding Scheinker from the Charles D. Aring papers, Liz Hawk (Ohio State Medical Board) for Scheinker’s Ohio medical licensure application and photographs as well as information about the citizenship requirement for Ohio medical licensure, Kevin Cawley (University of Notre Dame Archives) for help with the Joseph P. Evans papers and other files, Sara Rogers (US National Archives Great Lakes Branch, Chicago), and Arlene Shaner (New York Academy of Medicine) for help with Scheinker’s time in New York and his obituary from the New York State Medical Journal.
Disclosures
LZ has served as a principal investigator and received a university grant from the University of Illinois at Chicago Office of International Affairs and the University of Illinois at Chicago Honors College. MGZ and MS have nothing to disclose.
