Historical Review

Spinal Cord (2004) 42, 55–56. doi:10.1038/sj.sc.3101515

Professor Heinrich Sebastian Frenkel: a forgotten founder of Rehabilitation Medicine

M Zwecker1, G Zeilig1 and A Ohry2

  1. 1Department of Neurological Rehabilitation, Sheba Medical Center, Tel-Hashomer, Israel
  2. 2Department of Rehabilitation Medicine, Reuth Medical Center, Tel Aviv, Israel

Correspondence: M Zwecker, Department of Neurological Rehabilitation, Sheba Medical Center, Tel-Hashomer 52621, Israel

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Abstract

Professor Heinrich Sebastian Frenkel:
A forgotten founder of Rehabilitation Medicine. Frenkel was born and later on practiced medicine in Heiden, Swizerland. This small town became, by his vigilant and innovative work, a place of pilgrimage for neurologists. He was the first to introduce the concept of exercise to restore dexterity and to improve ambulation and so pioneered the specialty of physical medicine and rehabilitation. Frenkel's method and philosophy became the foundation of treatment for many chronic neurological disabling diseases. His personality and work influenced many famous neurologists, worldwide.

Frenkel was born in Heiden on 5 June 1860. Heiden is a small village in Switzerland overlooking Lake Constance at the border of Germany. His relationship to this place was built up quite early in life when his parents took him as a small boy for frequent visits. This small village would evolve later on his account as a famous cure park and landmark for modern Rehabilitation Medicine. He studied medicine in Heidelberg and Leipzig and was the student of the famous neurologists Erb and Kreplin, who stimulated his interest in the field of neurology. After receiving his medical degree from the University in Leipzig in 1884, he returned to the small town of Heiden to practice medicine. Especially during summertime Heiden's population increased markedly since it was a 'whey cure' center and the location of the world's foremost ophthalmologist, Albrecht von Graefe, of Berlin (whey is the serum or watery part of milk, which remains after the separation of the curd by coagulation, especially in the manufacture of cheese).

Frenkel was a very vigilant physician and one day in 1887, while examining a patient with tabes dorsalis, he observed the patient's poor performance of the finger-to-nose test. The patient asked Dr Frenkel about the test and was told what it meant and that he did not 'pass' the test. Several months later, on re-examination, the patient showed extraordinary improvement in coordination. Frenkel was astonished by the improvement. He had never seen such an improvement before, which was contradictory to the teaching of the day. When he asked the patient what had happened in the interval, the patient replied, 'I wanted to pass the test and so I practiced.' This event inspired Frenkel to a general assumption: 'If one patient can reduce his ataxia by practice, why not all? Or at least others?' He immediately started to study the problem in an empiric manner.1 A house was rented in the 'Cure Park' and the rooms were fitted with many exercise devices for improving coordination. He made chalk outlines of shoe prints on the floor for patients to follow as they supported themselves between parallel bars. At first, each patient was given the personal attention of this young, enthusiastic physician, who himself had been disabled by a childhood hip disease and walked with a limp. Later, he trained assistants to take care of the increased patient load. The results were so good that in 1889 he decided to lecture about it at a meeting in Dresden.2 He gained a great reputation and attracted patients to the small village from Russia and Scandinavia, physicians from Italy and the USA. In 1897, an American physician, Bettman,3 described the method in the Journal of the American Medical Association.

Shortly afterwards, even from the Salpétriére, a world-famous hospital, physicians attended his small clinic to learn from his experience. It was in the Salpétriére that Pinel introduced the moral treatment of insanity and psychiatric occupational therapy. It was there that Bourguignon first studied chronaxy in man. It was the hospital of Jean-Martin Charcot (1825–1893), the best known neurologist of his time. When he suddenly died, the Paris faculty of Medicine had to choose his successor. They reviewed the excellent and famous candidates, and the decision was difficult: J Babinski, P Marie, E Brissaud, J Dejerine, L Landouzy were considered and, finally, Fulgence Raymond (1844–1910) was nominated:4,5 he had finished veterinary medicine school and later medical school. He had published hundreds of articles. He made considerable contributions to our knowledge on tabes and general paresis, pseudo-bulbar palsy, hysteria and much more. He had sent his assistant, Rubens Hirschberg (1862–1920), to Heiden to observe Frenkel's work. Hirschberg became so enthusiastic that upon his return he convinced Raymond to establish a gymnasium in the neurology department of the Salpétriére–possibly the first hospital gymnasium. When Raymond witnessed the improvement of ataxic patients, he called the attention of his students to the method, and in his published lectures of 1893, he used the expression 'ré-éducation fonctionelle' to describe the process.

By 1896, Frenkel left Heiden for the larger scene of Berlin. In 1913, Frenkel was appointed professor, while being employed as the head of the serological department at the Psychiatric and Neurological clinic at the Charité Hospital. At the age of 72, after prolonged suffering from severe disease, he died in Dresden-Loschwitz, Germany and was brought to Heiden to be buried.

Frenkel pioneered the specialty of physical medicine and rehabilitation. He was the first to introduce the concept of exercise to restore dexterity and to improve ambulation. This constitutes the basics of function, which is the basis and essence of Rehabilitation Medicine. Prior to his work, exercise had been used therapeutically from time to time since Hippocrates, who learned it from his teacher Heraclides, only to improve strength or endurance foremost in healthy individuals. However, Frenkel was interested only in the rehabilitation of tabetics by exercises, motor skills learning, electrotherapy and massage, in an attempt to lessen neurological impairments. Hirschberg, a French neurologist, extrapolated the philosophy and method of Frenkel to other chronic neurologic disabilities, notably hemiplegia. Hirschberg6 continued his interest in functional re-education, but was glad to relinquish physical therapy to his colleagues at Salpétriére, who kept the flame of rehabilitation alive until after the end of World War I.

We do not know the cause of Frenkel's death: we only know he suffered for a long period from some agonizing chronic disease. Sir Ludwig Guttmann was aware of Frenkel's books and methods. Sir Ludwig's mentor, colleague and friend, Professor Otfrid Foerster (1873–1941) of Breslau, who, in his early stage, was deeply influenced by Carl Wernicke, Dejerine, Marie and Babinski, spent 2 years with Frenkel in Heiden! Foerster gained fame as a neurologist, scientist and neurosurgeon. Foerster had a burning thirst for knowledge that would become the passion of his existence. Age and poor health were no barriers to learning, and new discoveries could arouse boyish excitement. He had arterial insufficiency in his lower limbs, but had trained his body to ignore the pain. During the autumn of his years, he was put under surveillance. Foerster's activities were restricted due to ascending tensions within Germany, his previous association with Russia as Lenin's physician, and his wife Martha's Jewish ancestry... The Foersters spent their last winter undergoing treatment for tuberculosis at a sanatorium in Switzerland. Otfrid Foerster succumbed at home from tuberculosis on 15 June 1941 at the age of 68, and was followed by Martha a day later....7

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References

  1. Frenkel HS. Treatment of Tabetic Ataxia by Means of Systematic Exercise. Blakiston's Sons Co.: Philadelphia 1902, 185pp.
  2. Frenkel HS. Die Therapie atactischer Bewegungsstörungen. Munch Med Wochnschr 1890; 37: 917–920.
  3. Bettman B. Frenkel's treatment of ataxia by means of exercise. JAMA 1897; 28: 5–8.
  4. Goetz CG. The Salpetriere in the wake of Charcot's death. Arch Neurol 1988; 45: 444–447. | PubMed |
  5. Satran R. Fulgence Raymond, the succssesor of Charcot. Bull NY Acad Med 1974; 50: 931–942
  6. Hirschberg R. Manual Practique de Kinesiotherapie. F Alcan: Paris 1912.
  7. Tan TC, Black PM. The contributions of Otfrid Foerster (1873–1941) to neurology and neurosurgery. On: http://www.neurosurgery-online.com/fulltext/4905/1231/NEURO49051231_doc.html