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Free Neuropathology 1:25 (2020) Kurt A. Jellinger doi: https://doi.org/10.17879/freeneuropathology-2020-2945 page 1 of 20 Reflections Neuropathology through the ages My life between neurology and neuropathology 1 Kurt A. Jellinger 1 Institute of Clinical Neurobiology, Vienna, Austria Address for correspondence: Kurt A. Jellinger · Institute of Clinical Neurobiology · Alberichgasse 5/13 · A-1150 Vienna · Austria [email protected] Additional resources and electronic supplementary material: supplementary material Submitted: 12 August 2020 · Accepted: 12 August 2020 · Copyedited by: Katy Lawson · Published: 27 August 2020 Keywords: Neuropathology, Clinical neurology, Vienna, Personal reflections Introduction enced by my late mother, my beloved wife Elisa- beth, colleagues, patients, friends, and students When the editors of Free Neuropathology, whom I met during my professional and private life. Werner and Tibor, approached me about writing an autobiography for the journal, similar in scope to This essay is intended to encourage young col- Sam Ludwin’s excellent piece two years ago [1], I leagues to not concentrate exclusively on experi- confess that I had reservations about writing an mental neuropathology without also considering autobiography, because I never wanted to talk the practical part of the neurosciences since there about myself. However, after a lengthy hesitation is an urgent need to inspire young neurologists to and eager discussions with my wife and my former pursue a double career as both a clinician and neu- scholar and friend, Hans Lassmann, I realized with a roscientist in order to promote progress in the neu- certain degree of doubt that, on the threshold of rosciences. age 90 years, I could perhaps provide some thoughts about the bridges between clinical neu- Why the appeal of clinical neurology rology and neuropathology for those who might be and neuropathology? interested in the experiences of an old neuroscien- tist. There are three principal reasons to try to uni- Thus, in lieu of concentrating on my career as fy these two closely connected fields of neurosci- neuropathologist, I wish to instead write about my ence. First and foremost is the aim to help patients life in the context of unifying these intrinsically suffering from disorders of the nervous system by linked but disparate areas within the rapidly pro- trying to make an early diagnosis, provide effective gressing scientific world: neurology and neuropa- treatment, and promote preventive measures. thology. This long, and not always easy, path Second, is the ongoing need to apply ever-evolving through the wide field of practical and theoretical basic scientific approaches to diseases of the nerv- neuroscience, as well as other interests, was influ- ous system in order to support the clinical neurolo- Copyright: © 2020 The author(s). This is an open access article distributed under the terms of the Creative Commons Attribution 4.0 International License (https://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited, a link to the Creative Commons license is provided, and any changes are indicated. The Creative Commons Public Domain Dedication waiver (https://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated. Free Neuropathology 1:25 (2020) Kurt A. Jellinger doi: https://doi.org/10.17879/freeneuropathology-2020-2945 page 2 of 20 gist in elucidating the pathogenesis of disorders After Austria's “Anschluss” to the German afflicting their patients. Neuropathology should be Reich, I attended a public primary school in Vienna pursued not just for its own sake but to aid the and later, during World War II, a public secondary clinician with the mutual goal to improve diagnoses school (Realgymnasium, also in Vienna), where I and enable successful therapeutic strategies for received basic education in languages, natural sci- many hitherto incurable disorders. Lastly, there is ences, geography, and history. In 1943, to escape inherent fascination and fulfillment in using our from air raids on the city, many children were sent knowledge to elucidate the structure and function to live with farmers in the Batschka, then southern of the nervous system in the healthy and diseased Hungary, now Serbia. Once there, we had a won- human individual. derful and peaceful time, though the atrocity of witnessing the pogroms of Jewish people was never Based on this knowledge, the neuropa- far from sight or mind. thologist is able to elucidate much of the back- ground of disorders of the nervous system using On our way home we passed the then peace- immunohistochemical, molecular, biological, and ful city of Budapest, which I would see again during ultrastructural methods not only in autopsy mate- the Hungarian revolution in 1956. Once returned to rial but also tissues from living patients, including Vienna, in 1944, we had to change school buildings biopsies, cerebrospinal fluid, and blood. Often, due to bombing damages. Air raids were still so these images are comparable to modern art (Fig. frequent that I often did not make it home in the 1). The selective and interdisciplinary application of evenings but had to instead seek shelter along the these methods may enable the neuropathologist to way. not only make a reasonable diagnosis of many, though not all, disorders of the nervous system but In September of 1944, we lost our home due may also provide insight into the complex pathoge- to an air raid and had to wait for a new flat. Around netic cascades that are responsible for the onset this time, I attended one of the last performances and progression of such disorders. In this respect, of Schiller's Wallenstein trilogy of plays featuring the neuropathologist is privileged to act as both a the famous actor Werner Krauss in the Vienna Burgtheater. Soon afterwards, all theaters were physician and a basic scientist. closed. On April 13, 1945, during the battle be- This retrospective will consider highlights and tween German and Russian armies in the city of drawbacks in my 63 years of life between clinical Vienna, I had my first medical “experience” by neurology, neuropathology, and private activities. cleaning up brain tissue of Russian soldiers who Given my many years of work and limited space were killed by the projectile from a German tank. herein, may my friends, scholars, colleagues, and After my father died in a Russian POW camp in co-workers excuse that I regrettably could not con- 1947, my mother and I were left alone to overcome sider all of them in this review. the difficult times after the end of the war. She worked in her former profession as a dressmaker Early life and schooling and I became tutor of children. In 1949, I graduated high school summa cum I was born May 28, 1931 in Vienna, as the only laude. In that final year, our class contained 18 child to Rosa and Alois Jellinger, both with roots boys and, when we had our final exams, I got excel- from Upper Austria and Moravia (near Olomouc). lent marks (Fig. 2). After graduation, our class, led My father was an official in the government of by our Latin teacher, traveled to Rome and Naples, Lower Austria; my mother, a trained dressmaker, where we enjoyed arts, cuisine, and life in Italy. To was a housewife. In the prewar years, I had a won- this day, I remain grateful to my many teachers derful and well-kept childhood filled with summer who encouraged me to liberally approach history vacations in the beautiful surroundings of Vienna and natural sciences. Years later, one of my favorite and in the idyllic countryside, while in the city there high school teachers became a patient in my clinic were increasing tensions, poverty, and changes in with myasthenia gravis, which we treated with the political atmosphere. I remember Kurt success. Over the years, my classmates and I met Schuschnigg's radio speech of March 11, 1938, with several times at reunions to remember and discuss his concluding sentence “May God protect Austria,” previous experiences. The last meeting was 2009 to after which my father commented, “This will be the celebrate the 50th anniversary of our graduation. beginning of the end.” Free Neuropathology 1:25 (2020) Kurt A. Jellinger doi: https://doi.org/10.17879/freeneuropathology-2020-2945 page 3 of 20 Fig. 1. (A) MS-like autoimmune encephalitis after repeated subcutaneous injections of lyophilized calf brain cells in male aged 51 years with hemi-Parkinson syndrome. Left hemisphere with prominent periventrivular demyelinated lesion and multiple demyelinated plaques in cortex and subcortical nuclei. From [2] (B) EM image of focal (core) plaque in hippocampus showing dense accumulation of thick amyloid fiber bundles, surrounded by dystrophic neuritic endings and hyperintense structure of myelinated axon. (x 4000). Photo: K.A. Jellinger. (C) Major histopathological changes in Alzheimer’s disease. (C1) Amyloid deposits in the neuropil (plaques) and vascula- ture (CAA) (congo red stain). (C2) Neuritic plaque with dystrophic neurites (Bodian stain). (C3) Neurofibrillary tangles (large arrows) and neuropil threads (small arrows) (Bodian stain). From [3]. Free Neuropathology 1:25 (2020) Kurt A. Jellinger doi: https://doi.org/10.17879/freeneuropathology-2020-2945 page 4 of 20 Medical school and beyond “Promotio sub auspiciis Praesidentis rei publicae,” the highest possible distinction for academic In 1949, I entered the Medical Faculty of the achievements in Austria, in medicine since the end University of Vienna, where the circumstances of of World War II. In the meantime, I worked as guest medical education were made far more difficult doctor without salary in the Franz Josef Hospital in due to the sequelae of the war. For example, we Vienna, within the department of Internal Medicine worked in the anatomy theater in winter with and Surgery, directed by Prof.