Felix Guttmann: Roman (German Edition)

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Amazon Inspire Digital Educational Resources. Amazon Rapids Fun stories for kids on the go. Amazon Restaurants Food delivery from local restaurants. ComiXology Thousands of Digital Comics. The Ministry of Labour allowed a tenth of 1, applications in The professional nursing organisations remained intransigent against the foreigners in terms of qualifications, but qualification in the UK was a possibility. With , nurses and midwives in Britain in , the refugees represented just a small proportion of the labour force.

All those wishing to register their medical degrees had to apply to the Central Medical War Committee. The temporarily registered could not at first open a practice in their own right, although they could work in hospitals and clinics. But these strictures on practice were rapidly relaxed. The initial channelling of refugees to hospitals favoured specialists, given that in the UK specialists were, on the whole, hospital or clinic-based.

Decker gives the impression that this policy was watertight. The Medical Register provides an analysis by street and postal district in London, so indicating the social geography of dispersal in the complex metropolitan setting. What also needs to be taken into account was that London in the Blitz had its dangers, and that many happily settled in the provinces. Decker presents the non-Scottish medical schools as antagonistic to refugee physicians seeking the necessary clinical courses for re-qualification. This antagonism can be modified by evidence from medical school archives, suggesting a need to distinguish between the examination boards and the medical schools, which were hospitable to the refugee students.

A case in point is the Welsh National School of Medicine. Its generous admissions policy is obscured by most students having then taken the Scottish Conjoint examinations, as requiring a shorter course of study. Decker suggests that the concessionary group had to study for at least two years. The Jewish Refugees Committee in London explained to the Welsh School in May the difficulties of placing refugee physicians, so that they might take a recognised UK qualification.

When it came to the emergency of the Austrian Anschluss and the Nazi takeover of Czechoslovakia, the Welsh National School showed itself to be generous in terms of admissions. While most medical schools agreed to take two students from the Austrian and Czech quotas, the Welsh National School took seven Austrians and fifteen Czechs. The Welsh School explained to Edith Hertz that it was instituting a course specifically for refugees.

When the Austrian, Marcell Gang, was allowed to re-qualify in Cardiff, this was on the understanding that he would proceed to Newfoundland, where there was a British government scheme to encourage doctors and dental surgeons to settle. This requirement was never enforced.

Medical Refugees and the Modernisation of British Medicine, 1930–1960

His application to be included on one of the five vacant positions on the quota, which had arisen as a result of emigration, was rejected by the Medical Advisory Committee, and yet he was still granted permission to practise in the UK. The Welsh School was by no means unique, and it is premature categorically to prejudge the situation before every UK medical school archive is scrutinised. The situation in Northern Ireland at first sight appeared restrictive, as at first admission was restricted to students from Northern Ireland during the war.

When it came to opening a practice, the quota categories were losing significance after Decker suggests that there were approximately 80 German medical students by , a sizeable number, and that they were subject to discriminatory restrictions on qualification. Wilfred Harding, born in Berlin in , contributed to public health in the British zone of occupation.

It would also be wrong to assume that, on qualification, the refugees could not practise. The German authorities proceeded to strip Jews of their nationality, and selectively to annul MD degrees. The UK authorities were recognising degrees just when the Germans were vindictively abolishing them. Importantly, Decker considers the Austrian and Czechoslovak concessionary schemes, adding to what is known about their operation.

Similarly, Czechoslovak, Polish and Italian dental surgeons all held medical qualifications. Secondly, Decker overlooks the role of the GMC, and its powers to recognise degrees comparable to those in the UK, a situation which Zamet has explored. Decker explains that the onset of war meant that only 19 Czechs were able to make use of the privileged quota as a route to re-qualification. So far from just 19 quota physicians, we find Czech physicians in the UK in September appearing on the Kapp List, and 52 students granted degrees in Oxford.

The balance of the Czech physicians were on active military service. Military medical service with a fighter squadron as in the case of Arnost Kraus cannot be seen in terms of restriction and exclusion. Moreover, Decker fails to mention the extent of autonomous medical organisation achieved by the Czechs and Poles. The Czech Refugee Trust Fund oversaw a comprehensive system of medical care with its own hospitals. We find rapid integration rather than discrimination. The Aliens Committee encountered significant conflict as regards psychotherapists, and the insistence that any continental psychotherapist had to work under the control of a GP.

Decker overlooks the clash of interest groups evident in the proceedings of the committee. Lay analysts could practice—something which was advantageous for the non-medical Anna Freud. There were at least 32 lay refugee psychotherapists. The point at issue was whether those holding medical qualifications could have these overlooked. For some, like Michael Balint, it meant being relegated to a provincial city in his case Manchester , but it gave him a realistic sense of the problems of general practice.

Decker confuses analysts and medically-qualified psychiatrists; her account overlooks a substantial group of psychiatrists, many associated with the Maudsley Hospital, as well as a stellar group of non-medical psychoanalysts, notably Anna Freud. The clash of interest groups in the proceedings of the committee was evident, when the Tavistock Institute was outraged at what it rightly saw was a massive attack on the status of psychotherapy.

Foreign degrees were recognised in the UK by stages from This was a major step towards inclusion. Just at the point in time when the German universities were withdrawing the degrees of refugees, their continental qualifications gained validity as the basis for practice. The effect of this order was to allow refugees to practise on the basis of their original qualifications. The Order was ambivalent in that the BMA clearly saw it as a limited emergency concession, while others, like Hill, saw it rightly as events turned out , as signifying eventual permanency.

Free Movement of Medical Labour to Corporate Exclusivity

The procedures could at times be bureaucratic, but the acute shortage of practitioners, reinforced by hospital administrators clamouring to fill vacancies, exerted pressure on the Home Office to grant the necessary authorisations. Qualifications were recognised without any further qualifying test. It allowed those hospitals and local authorities so wishing, to offer employment.

The Aliens Acts still applied, giving Czech and Polish displaced practitioners an advantage, and the regulatory structures were open to exercise in an exclusive or permissive manner. But—and here there was a far reaching liberalisation—the practice was permissive, and increasingly so as the war went on.

The most restrictive period covered the acute emergency for the months between the Dunkirk invasion scare, and the end of —only a period of several months. The ensuing seven years, until the introduction of the National Health Service NHS , were marked by progressive liberalisation, so that eventually the emergency recognition of foreign degrees in became the basis for full equivalence.

Psychiatrists benefited as the Order related to any institution under the Mental Treatment Act of , as well as all institutions covered by the Mental Deficiency Act. Although the scheme was far slower to be implemented than its advocates would have liked, by the situation was positive in terms of registrations and vacancies filled. Modernisers, associated with MRC, and with university and research laboratories, saw that the scientifically-trained continental refugees were an opportunity to confront obstructive elements.

Many as Krebs who in Freiburg worked in a clinical laboratory held medical qualifications; although they did not seek clinical employment, they saw their work as clinically relevant. Burn at the Pharmaceutical Society of Great Britain.


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The view that this energetic refugee assistance organisation was narrowly geared to scientists, and was not interested in clinicians is open to question. The SPSL initially was perplexed by clinicians with substantial numbers of research publications. Even so, outstanding clinical innovators such as the neurologist Ludwig Guttmann did have support.

We find a contrast between the Academic Assistance Council from , the Society for the Protection of Science and Learning favouring the bringing of refugees to the UK, and the hostility of British professional medical organisations. Thanks to such medical reformers as Hill, Britain took sizeable numbers of biochemists, physiologists and geneticists.

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It saw, rightly, that once they had a place of safety in the UK, then they would either find an academic or clinical niche, or they would be able to negotiate the more time-consuming American formalities. The SPSL had long been faced with the problem of scientists who had clinically-based positions, and clinicians with an immensity of scientific publications. For some stellar scientists like the biochemist Hans Krebs, arrival in Britain fulfilled the aspirations of a research-based career; Krebs in Germany had a position in a hospital laboratory.

Guttmann found laboratory research too limited, until offered an outstanding clinical opportunity as Director of the Spinal Injuries Unit at Stoke Mandeville in The Austrian brain chemist Efraim Racker worked in the brain research laboratory in Cardiff, but internment prompted his move to the USA where he did well. Similarly, the dermatologist Emil Meirowsky, when released from internment, had his application to open a practice turned down by the BMA in He consequently did not stay in the UK. Mayer-Gross in psychiatry and Guttmann in neurology offer examples of noteworthy success.

The situation was certainly not one of an open door, and there were periods of crisis, but these need to be offset by dynamism and breakthroughs that were achieved. The idea of keeping refugees as clinical assistants became something more dynamic. The LCC favoured the employment of well-qualified German specialists and nurses. The Central Middlesex Hospital was a modern, dynamic institution employing such people as Walter Pagel, the TB pathologist, who continued part-time as a medical historian.

This type of hospital suited the refugees who were used to the dynamic municipal hospitals such as Moabit in Berlin or Lainz in Vienna. Thus, the demeaning and temporary could in fact be a dynamic career opportunity, in a system which came to fruition under the National Health Service NHS.

There were those who sought out innovative alternatives. The paediatrician Anni Noll worked for the Peckham experiment, and Karl Koenig and his medical disciples opted for the Scottish Highlands where they founded the first Camphill village settlement for disabled children. Charles Singer worked tirelessly behind the scenes. Importantly, restrictions were relaxed to support medically-qualified refugees in this crucial year of crisis.

By the time of the Nazi annexation of Austria, the severity of the Nazi persecution was clear. The SPSL became more inclusive, stressing the scientific distinction of clinicians, recognising that the need was to bring people out. The Home Office also veered towards a more open-door policy, contemplating the admission of something like 1, Austrian physicians and dental surgeons, given the emergency.

While the numbers in concessionary schemes were limited by pressure from the BMA and British Dental Associaton to 50 Austrian doctors and 40 dental surgeons, far higher numbers came to the UK. The quota doctors had one great advantage—the Home Office viewed them as likely to be permanently in medical practice in Britain. A total of 53 Czechoslovak students obtained MD degrees at Oxford between and Similarly, Poles qualified at Edinburgh between and Decker suggests that the British never recognised the Czech and Polish schemes for practice in the UK.

Yvonne Kapp, working for the Central Refugees Fund of Woburn House, gives details of 1, doctors and dental surgeons. The Central Office for Refugees estimated there were c. Hill, at the House of Commons in May , spoke of Jewish refugee doctors to mollify the critical lobby of professional monopolists and anti-Semites. Overall, to date, 5, refugee physicians, dental surgeons, nurses, psychotherapists and others involved in health care, research or studies have been identified in the Medical Refugees project, which covers the UK and the handful in the Republic of Ireland.

The project covers to the immediate post-war aftermath when some survivors of concentration camps as the Auschwitz prisoner-doctors Alina Brewda and the notorious Wladislaw Dering and military doctors from locations such as Palestine as Fred Barber and Italy particularly Polish military physicians were admitted. Not everyone wished to settle: Opportunities steadily improved during the war.

In June the LCC agreed a quota of 78 posts for medical refugees. In Britain, specialist posts were generally hospital-based, so that the clinical posts represented a genuine opportunity. Some, like Mayer-Gross, were at the level of consultant. Later, under the NHS specialist appointments, others were hospital or clinic appointments. Here we have not discrimination, as suggested by Decker, but adaptation to an alternative structure of medical care in the UK. Decker confuses stage two validation of qualifications and stage three control on location.

The BMA lobbied for a policy of dispersal, subordination and temporary employment. It protested that there could be no controls on aliens after they were naturalised. Yet this was on 20 December , and by then the new regulations on alien practitioners were prepared. The Home Office recognised that once the war ceased, aliens with British qualifications could remain in the UK, and then the authority lapsed to restrict independent practice.

Härtling, Peter [WorldCat Identities]

The inauguration of the NHS, with its modernised system of specialist health care, meant the former refugees found permanency of employment and professional opportunities. We see that certain specialisms were more open to working with refugees. The vision of the modernisers—that there was a real need to improve the scientific basis of all aspects of health-care delivery—has been vindicated.

Here the dynamic is less formal control by the BMA, but differentiated attitudes within professional specialisms. Ironically, the NHS has suffered from labour shortages throughout its existence. Instead of viewing the successive waves of refugee practitioners as a positive opportunity, they have consistently encountered bureaucratic and professional barriers. The situation became regularised by re-registration with the GMC. Once naturalised, the Home Office controls on aliens ceased to apply. The Aliens Committee indeed made a last-ditch attempt to sustain the Temporary List and encourage re-migration.

Yet, here there was an irony that naturalisation was also in the hands of the Home Office, again evidence of an official doublethink which pursued apparently contradictory policies, but one working in favour of the refugees.

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The post-war situation again meant moderate concessions to medical refugees. The argument has been made here that understanding the situation pertaining to medical refugees requires analysis of the numbers of refugees in the UK and how they arrived and fared in Britain, rather than taking a literal and restrictive approach to the regulations. They also expressed their opinions as to the restructuring of medicine in Britain and Europe, as indicated by the wartime Health Charter movement.

The regulations and procedures were undergoing constant modification and adaptation. What is necessary is to examine life histories and build up a composite picture, in a highly differentiated situation. Specialisms could be more or less hospitable—dermatology appears resistant, whereas psychiatry was proactively hospitable. Whatever the controls, the system was subject to constant modification, exceptions and those who came through alternative routes. One needs to assess any overly rigid administrative approach to these problems by first considering a range of exempt categories—the medically-qualified dental surgeons, the Italian degree-holders, those who were naturalised, and categories beyond medical control such as psychoanalysts.

Second, we need to take account of the actuality of medical careers, and here there were certain hospitable specialisms such as psychiatry and pharmacology, and more welcoming medical institutions. Professional restrictiveness has to be offset by a multiplicity of organisations—scientific, Jewish, Quaker, Anglican, socialist, etc. Naturalisation for most in and , and the launch of the NHS in with its opportunities for clinical specialists as well as in general practice, provided a basis for the full integration of refugees among the 27, doctors entering the NHS.

They lectured on the radio and published extensively. The refugee physicians looked after civilians at a time of upheaval, including a range of fellow refugees, while supporting the medical services of a country at war. After providing a place of safety for more medical refugees proportionally than any other country, and recognising foreign degrees on a large scale from , the former refugees could register with the NHS as long as they were under the statutory retirement age.


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Settlement and onward migration and return of Austrian medical refugees, — The author gratefully acknowledges help with tracing refugee life histories from Liesl Kastner and Paul Samet. Analysis of the Kapp List was funded by the British Academy. The Wellcome Trust has continued generously to support my further research on the medical refugees. The Medical Refugees Database remains an open scholarly resource. Decker , pp.

Correspondence with Central Office for Refugees. Hill, 27 November BMA to Kolmer, 14 November Weindling in Michael and Webster eds Examining Board to Edith Hertz, 27 March Harris and Oppenheimer , pp. Decker , p. Churchill, , pp. Medical Register General Medical Council, , pp. Co-ordinating Committee for Refugees to E. Wellisch, 15 August Medical Register , Foreign List p. Hill, Hill reply 7 July National Center for Biotechnology Information , U.

Author manuscript; available in PMC Jul 9. The publisher's final edited version of this article is available at Soc Hist Med. See other articles in PMC that cite the published article. Summary This paper reappraises the position of medical refugees in Britain between the s and s. Free Movement of Medical Labour to Corporate Exclusivity Whereas until the s, free transnational movement prevailed among students and the medically qualified, by the time of the First World War and its aftermath, regulations conceded only limited reciprocity in foreign medical qualifications. Quotas and Qualifications Decker presents the non-Scottish medical schools as antagonistic to refugee physicians seeking the necessary clinical courses for re-qualification.

Academic Hybrids Modernisers, associated with MRC, and with university and research laboratories, saw that the scientifically-trained continental refugees were an opportunity to confront obstructive elements.