[page 12]
_Discussions and extracts_
[page 14]
_Surgery_
Ludwig Stumpfegger—Hohenlychen: The free autoplastic bone
transplantation in the restorative surgery of limbs—experiences and
results.
During the past 10 years, 471 free autoplastic bone transplantations
were carried out in Hohenlychen. Recent research results clearly showed
that apart from the osteoplastic activity, a metaplastic formation of
new bone occurs in the tissue. The newly formed bone trabeculae between
transplant and old bone begin to connect with those formed in the
osteoid tissue in the seventh week, and in this way constitute the bone
connection between the graft and the original bone which have completely
grown together in the ninth week. After the twelfth week no old bone can
be detected in the entire region of the original graft, but only new
bone trabecula. The question of the ever present hematoma can be
answered in this way: a blood extravasation, lying in the gap between
the transplant and the old bone, and not being subject to pressure,
represents an adequate stimulation to the mesenchymal germinal tissue
formation, while the large hemorrhage represents a negative stimulation
and permits only a scarry connection of the transplant and the defective
stump. The periosteum is no more important than the other layers, it is
transplanted with the bone, because in connection with the bone it has
osteogenetic properties, but above all it effects a speedy supply from
the surroundings. A careful technique must be employed to spare the
tissue layers, and bleeding must be stanched. Foreign bodies in the
shape of wire slings to hold the transplant usually heal well into the
body. Firm fixation in a plaster cast safeguards the result. When the
graft has taken, a careful start with remedial exercises may be made in
the third or fourth month. The clinical use of free bone
transplantations is discussed with the help of numerous examples and
many X-ray illustrations. The first task of the bone transplant to
bridge over a gap in the bone is to provide sufficient support for the
defective stump and, therefore, it has to be fairly strong. Bone
splinters in the lower arm have roentgenologically completely taken
after 1-1½ years, those in the tibia after 1½-2 years. The free bone
transplant, some distance from the joints, has proved to be particularly
valuable with the usual dislocations of the shoulder and the hip joints.
The overlapping bone ridge prevents the bone from coming out of the
articular cavity. In the course of years, the piece lying in the soft
parts is considerably reduced, so that only a small bone ridge remains.
The graft effects a regeneration of the damaged edge of the articular
cavity and in this way prevents further dislocation. Bone transplants in
bone gaps after removal of growths are subject to special conditions of
taking. Hyperemic phenomena in the zone of the tumor edge in the form of
a mild inflammation, possibly also fermentation processes, accelerate
the taking of the transplant compared with the process in healthy
tissue. Increased local resorption processes, occasionally with
spontaneous fractures, infrequently prevail, but they again are apt to
heal well. In wounds which heal with difficulty owing to suppurative
inflammations, there is a great danger of the transplant being pushed
out. When the whole transplant region is inflamed, total sequestration
cannot be stopped. If suppuration remains localized, partial
sequestration of the transplantation must be awaited. (_German Surgical
Journal, 1944, Vol. 299, H. 9-12. H. Floercken-Frankfurt am Main._)
TRANSLATION OF GEBHARDT, FISCHER, OBERHEUSER
DOCUMENT 21
GEBHARDT, FISCHER, OBERHEUSER DEFENSE
EXHIBIT 20
EXTRACTS FROM AFFIDAVIT OF DR. KARL FRIEDRICH BRUNNER, 14 MARCH 1943,
CONCERNING SCIENTIFIC EXPERIMENTS CONDUCTED AT THE CLINIC OF HOHENLYCHEN
* * * * *
I can state the following regarding the scientific experiments at the
clinic [of Hohenlychen]: It was in accordance with the principles of the
clinic and, therefore, of the chief and his deputy to collect scientific
results arrived at through clinical observations. All reports at
congresses and lectures as well as publications were based on these
results. The scientific work and research were normally determined by
the observations made on the patients. In addition to this, and in order
to clarify the question of surgical treatment of nerve injuries,
experiments on dogs were carried out in close collaboration with
Gebhardt—first by Dr. Koestler in 1939-40, later by myself from 1943 to
the end of the war. I was ordered by Dr. Gebhardt to carry out the
experiments on animals at the training and experimental station for dogs
[Hundelehr- und Versuchsanstalt], which establishment was situated
outside the concentration camp Ravensbrueck, and I was strictly
cautioned not to enter into any kind of contact with the concentration
camp itself. The animal experiments were strictly continued until the
end of the war. The results were never published because of war
conditions.
* * * * *
Regarding Dr. Stumpfegger, I can state that he was an assistant of the
clinic in peacetime, before I arrived. At the outbreak of war in 1939 he
joined the Waffen SS, and was then, as far as I know, from 1942 onwards
an escorting physician of Himmler. I did not see Dr. Stumpfegger on my
return to Hohenlychen in autumn 1943, nor had he any official connection
with the clinic up to the end of the war, either in a medical or in a
military sense. He did not have to report his return or departure to the
chief physician or to his deputy. His family, however, still lived at
Hohenlychen. I still met him occasionally outside the medical sphere. I
emphasize that during my presence at the clinic from 1 September 1943 up
to the end of the war, as far as I know—and finally I was directing the
clinic—no assistant was drafted from Hohenlychen to Ravensbrueck.
I know that the specialist in pulmonary diseases, Dr. Heissmeyer, was
working as an assistant and later as chief physician in the so-called
sanatorium Hohenlychen even before Professor Gebhardt took over
Hohenlychen. This sanatorium was strictly detached from the surgical
wards of the hospital at Hohenlychen and was not under the professional
supervision of the chief physician nor of his deputy; i. e., Dr.
Heissmeyer looked after his patients without any supervision by the
surgeon, he made no reports to the chief or his deputy, he did not
participate in the daily discussions of the physicians, he had his own
staff of assistants and carried out his treatments and operations
independently; he also planned his duty journeys independently and made
these without reporting to the chief or his deputy on departure or
return.
TRANSLATION OF GEBHARDT, FISCHER, OBERHEUSER
DOCUMENT 22
GEBHARDT, FISCHER, OBERHEUSER DEFENSE
EXHIBIT 21
EXTRACT FROM AFFIDAVIT OF DR. JOSE KOESTLER, 27 FEBRUARY 1947,
CONCERNING DR. GEBHARDT’S ACTIVITIES
* * * * *
When Professor Dr. Karl Gebhardt and I, at the Third Conference of
Consulting Specialists of the German Wehrmacht in May 1943, lectured on
surgical aid for peripheral nerve damage, we were, on the one hand,
interpreting the results of animal experiments carried out on dogs from
1938 to 1940 in the Langenbeck-Virchow Hospital, Berlin, and in the
institutes of Professor Holz (Institute for Experimental Hormone and
Cancer Research) and Professor Ostertag (Pathological Institute), and,
on the other hand, announcing surgical methods as they had been
frequently used during the previous years.
Under the title of “Preparatory and Restorative Surgery in cases of
Peripheral Nerve Damage,” I recorded these experiences in the “German
Journal for Surgery,” volume 259, Nos. 1-4, 1943, and in my habilitation
paper (1943, University of Berlin).
I emphasize expressly that this series of experiments was carried out
exclusively on animals.
From 1 July 1938 to 26 August 1939 I was in the Red Cross hospital at
Hohenlychen (Department for Sport and Industrial Injuries). During the
following war years, after I was drafted into the Wehrmacht, I worked
there repeatedly for short periods. I am convinced that the medical care
there was on an especially high level and that Professor Gebhardt as
chief physician did everything possible to improve the treatment and its
results.