Эдвард Флатау: Жизнь и вклад в неврологию

Polish neurologist (1868–1932)

Edward Flatau (27 December 1868 – 7 June 1932) was a Polish neurologist and psychiatrist. He was a co founder of the modern Polish neurology, an authority on the physiology and pathology of meningitis, co founder of medical journals Neurologia Polska and Warszawskie Czasopismo Lekarskie, and member of the Polish Academy of Learning. His name in medicine is linked to Redlich Flatau syndrome, Flatau Sterling torsion dystonia (type 1), Flatau Schilder disease, and Flatau's law. His publications greatly influenced the developing field of neurology. He published a human brain atlas (1894), wrote a fundamental book on migraine (1912), established the localization principle of long fibers in the spinal cord (1893), and with Sterling published an early paper (1911) on progressive torsion spasm in children and suggested that the disease has a genetic component.

He was born in 1868 in Płock, the son of Anna and Ludwik Flatau of assimilated Jewish family. In 1886, he graduated from high school (gymnasium) in Płock (now Marshal Stanisław Małachowski High School, Płock, also known as "Małachowianka"). From 1886, Flatau attended medical school at the University of Moscow, where he graduated eximia cum laude. In Moscow, he was greatly influenced by the psychiatrist Sergei Sergeievich Korsakoff (1854–1900) and the neurologist Alexis Jakovlevich Kozhevnikof (1836–1902). Flatau became a medical doctor in 1892. He spent the years 1893–1899 in Berlin in the laboratories of Emanuel Mendel (1839–1907) and in the University of Berlin under Wilhelm von Waldeyer Hartz (1836–1921). During that time, he worked together with Alfred Goldscheider (1858–1935), Ernst Viktor von Leyden (1832–1910), Hermann Oppenheim, Louis Jacobsohn, Ernst Remak, and Hugo Liepmann. Though he was offered a position of professorship of neurology in Buenos Aires, he returned to Poland and in 1899 settled in Warsaw. He was married twice. He had two daughters, Anna and Joanna Flatau. His first wife Zofia and daughter Anna are described in a book by Antoni Marianowicz. Some stories about his personal life are printed in reminiscences of Wacław Solski and Ludwik Krzywicki.

In 1894 at the age of 26, he published the influential Atlas of the Human Brain and the Course of the Nerve Fibres, which was published in German, English, French, Russian, and in 1896 in Polish. The Polish edition was dedicated "To the memory of a noble man and an eminent physician Profesor Tytus Chałubiński author dedicates this work." The atlas was based on long exposure photographs of fresh brain sections (up to 10 minutes for flat and 30 minutes for uneven surfaces, by means of small diaphragms). These studies were done in Berlin under Professor Emanuel Mendel. In a review, Sigmund Freud wrote: "The plates with their clarity deserve to be called excellent educational material, suitable as an utterly reliable reference. A schematic plate in the beginning gives an overview of our knowledge on the fibre pathways in the CNS, incorporating the accounts of Mendel, Bechterew and Edinger and continuing with the differing views on the structure of nervous tissue of Camillio Golgi and Santiago Ramón y Cajal. The price of the work is minimal if one considers its completeness and beauty. The author and publisher deserve thanks from the medical community for this valuable work." In 1899, he published the second edition, which was extended and composed of two parts: an atlas and supplement. The preface to the second edition and supplement was written by Edward Flatau in Warsaw. In the second edition, Flatau added the description of his discovery on Das Gesetz der excentrischen Lagerung der langen Bahnen im Ruckenmark. Flatau's brain atlas was published two years before the work
Das Menschenhirn of Gustaf Retzius, but the first publication of images of the brain was work of Jules Bernard Luys in 1873. Sigmund Freud and Edward Flatau were together editors of the magazine Annual report on progress in neurology and psychiatry in 1897. Both were at the time neurologists.

In 1911, Flatau and Wladyslaw Sterling published an article on progressive torsion spasm in children. The authors pointed out that the disease was associated with genetic factors. In the same year, Theodor Ziehen and Hermann Oppenheim published a paper claiming that dystonia is related to a disease of the muscles. However, Flatau and Sterling noted that the intellectual capacity of these patients was higher than average. In 1976, Eldridge suggested that the publication of Flatau and Sterling was one of the first to describe the genetic factors of neurological diseases. In 1927, Flatau, independently of Emil Redlich in Vienna, described the first cases of encephalomyelitis epidemica disseminata (Flatau Redlich disease). Flatau was convinced that this illness is caused by a virus which was later confirmed by Mergulis. In 1925, Flatau described in detail Schilder disease
and suggested new name "encephaloleukopathia scleroticans progressive". Between 1921 and 1923, he described the meningeal symptoms characteristic during tuberculosis related inflammation of meningitis: namely, the pupil extension when bending head and erection of the penis during repeated bending of the torso forward.

In addition to his scientific work, he had a private practice in Warsaw. In 1904, he became head of the Department of Neurology at the Szpital Starozakonnych w Warszawie, which he led for 28 years. There, many of the Polish neurologists were making their first steps. His pupil Eufemiusz Herman recalls:
"Traditionally on Mondays, patient cases were reviewed. At the bedside of each patient, Flatau discussed their cases, he listened to the voice of everyone, even the youngest doctor As a teacher and a boss, he was deeply attached to each and every one who worked with him. They could draw richly from his great experience and extensive knowledge. He was patient, forgiving, always cheerful, treating students as their beloved family. Thinking forehead, deep dark eyes with a keen, yet warm gaze, low voice with a wide range of modulation – these are the features which, apart from the deep knowledge and great experience, attracted and charmed anyone who was in the circle of his indefatigable activity." In 1908, he lived on the Marszałkowska 150 Street in Warsaw on the first floor of the House of Fashion of Boguslaw Herse. He also lived for some time in the apartment on Chmielna Street 60. Other stories associated with Flatau and his Warsaw traces can be found in the articles of Jerzy Kasprzycki

By 1899, Flatau had established a name for himself both in Germany and abroad, and returned to Poland during that year. Flatau was closely associated with attempts to re establish Polish science during and after Russian occupation. After his return, he formed a private microscopy laboratory at his apartments in Warsaw, and worked in Warsaw hospitals as a consultant. In 1911, he established a neurological laboratory in the Warsaw Psychologic Society, and he became in 1913 the first head of the Department of Neurobiology of the Warsaw Scientific Society (Warszawskie Towarzystwo Naukowe)
For many years, he shared his responsibilities as experimentator and neurologist between the laboratory and the hospital. He was influential in establishing Polish medical periodicals Neurologia Polska and Warszawskie Czasopismo Lekarskie. Especially at the beginning of his career, he was involved in popular science activities in Poland. He published in popular medicine journals such as Zdrowie, Gazeta Lekarska, and Nowiny Lekarskie. Flatau's law, originally published in German, was reprinted in Polish in the journal Nowiny Lekarskie together with the basic introduction. His brain atlas and a book about migraine were translated into Polish, as well. He was interested in history of Polish medicine. In 1899, he notes: "Quite important for the history of Polish medicine is the fact that Robert Remak, one of the greatest histologists and neuropathologists, was born in Poznań in 1815 and published his fundamental work in the Polish language. This historical information was communicated to me by his son – Professor Ernst Remak in Berlin. He was also kind enough to give me a copy of this epic work in the Polish language." He was co editor of the German journal Jahresbericht Leistungen und über die Fortschritte auf dem Gebiete der Neurologie und Psychiatrie. Since its inception in 1897 until 1900, and afterwards as a collaborator, he contributed to the journal and was summarizing Polish neurological and psychiatric literature. "Flatau being convicted of the shameful behavior of the German occupying forces during the World War I stopped his friendly relations with Germany, to which scientist he felt deep affection, and moved entirely his scientific affinity towards medical sciences in France " Analysis of his publications in that period indicates that he indeed increased significantly, after the World War I, publications in French journals, but still on occasion published in German. In the same article, Higier writes "In social life, Flatau [had] a sense of responsibility for the state of Polish intellectual culture and the level and extent of Polish research ideas." In the early 20th century, the world neurology was beginning to be organized in international structures. In 1929, Flatau wrote to Henry Riley secretary of the organizing committee of the I International Congress of Neurology which was to be held in 1931 "as a representative of the Polish Committee, I express astonishment and grief that none of the vice presidents of the Congress nor any of the honorary members are from Poland. Polish neurologists were relentless in their efforts during all the years of political dependence and their work has intensified since gaining independence."

In January 1932, he diagnosed himself with a brain tumor. He kept notes about his illness, but they were lost during the war. He died five months later, and he is buried at the Jewish Cemetery in Warsaw (section 10, row 2). At his grave, Dr. A. Goldman said:
Several thousand people came to his funeral. His headstone was done by sculptor Mieczysław Lubelski. He died in 1932, the same year as two other notable Polish neurologists and friends, Samuel Goldflam and Joseph Jules François Félix Babinski (Polish French neurologist).