Erwin Deutsch, the Eppinger Clinic and the legacy of the Second Vienna School of Medicine-Continuities of a career

Erwin Deutsch (1917-1992) was an outstanding representative of Austrian internal medicine after World War II. Little is known about his early biography. Considered a "Jewish half-breed" under Nazi racial laws, he was subjected to harassment during his training. Nevertheless, he can be regarded as scientific heir of Hans Eppinger (1879-1946), who enjoyed a worldwide reputation as internist despite his controversial involvement in medical experiments in the Dachau concentration camp.Already declining after World War I, the Viennese Medical Faculty largely lost its international scientific importance with the expulsion of over half its faculty members from 1938, the end of the Second Vienna School of Medicine. Erwin Deutsch significantly contributed to continuity by vehemently calling for the unity of internal medicine after 1945, as it had been practiced in Vienna since the nineteenth century. Discrimination as a "Jewish half-breed" played a paradoxical role in this context-it delayed the start of his independent academic activity and increased his personal dependence on Eppinger; at the same time it spared him military service and enabled him to start his career after 1945 unaffected by denazification measures.Based on unpublished archival material, interviews with contemporary witnesses, and Deutsch's medical publications, this article is the first to offer an account of his early career, from his graduation in 1940, his time at the Eppinger Clinic, compulsory service in Germany during the war and the beginning of his scientific work to his appointment as Ernst Lauda's successor as director of the 1st Medical Clinic in Vienna.

[Ventricular rupture during acute myocardial infarction (author's transl)]

In a series of 523 consecutive patients with acute myocardial infarction (AMI) 112 died; among these were 18 with rupture of the free wall of the left ventricle (HR) (group RU); two other cohorts were formed: one sample of all patients with acute (transmural) myocardial infarction (group KO) and another cohort of death of AMI in 1976 (EX). 1. patients with HR are significantly older than the KO group; there is no difference in age compared to the patients who died of AMI other than HR (group EX). 2. Women with AMI have a higher chance to die of HR than men. 3. The RU group has significantly more often clinical signs of congestive heart failure than the control group. 4. Cardiogenic shock is significantly more frequent in the RU-group than in the control group. 5. All deaths (EX + RU) have worse hemodynamic data than the control group (KO). 6. Elevated blood pressure (before and after AMI) could not be identified as a risk factor for HR in our patients. 7. In the course of AMI, death in pump failure occurs significantly later than heart rupture.

Bacterial contamination of pulmonary artery catheters

The catheter tips of 152 patients, who were haemodynamically supervised by pulmonary artery monitoring or continuous cardiac output determination, were bacteriologically examined. 106 cultures remained sterile, 21 cultures revealed a growth of non pathogenic organisms. Staphylococcus aureus was cultured 15 times, pseudomonas aeruginosa 4 times, Citrobacter as well as Escherichia coli twice, and Klebsiella and Enterobacter once each. There was no statistically significant connection between dwelling period and contamination. Also diabetes mellitus or corticoid medication in high dosage had no significant influence on contamination rate.

[Arrhythmias during catheterization of patients with acute myocardial infarction (author's transl)]

Arrhythmias in forty consecutive patients with acute myocardial infarction during ventricle passage of floating catheters were compared with those in forty patients with chronic heart disease. Lidocaine (1 mg/kg body weight i. v.) as a bolus proved to be effective in reducing the incidence of these arrhythmias, because the number of single ventricular premature beats (VPBs), and the number of VPBs in salves was significantly reduced. Haemodynamic changes due to this bolus are small and short-lasting, so that they are acceptable, especially when continuous monitoring of the patients is attempted. Furthermore dangerous arrhythmias are reported in 1600 cases treated with floating catheters.

[Continuous monitoring of the pulmonary artery pressure in acute myocardial infarction (author's transl)]

The method of continuous pulmonary artery pressure (PAP) monitoring and its use in 66 patients with acute myocardial infarction is described. Measurement of PAP should be the first diagnostic step in hemodynamic monitoring and early recognition of left ventricular failure. In cases of elevated PAP and critical general state of the patient, monitoring should be extended by measuring pulmonary wedge pressure and cardiac output. Hemodynamic monitoring should be continued for 3 to 5 days, since some cases of acute myocardial infarction with increasing PAP up to the 4th day after the onset were recorded. With the safety precautions mentioned, neither threatening, arrhythmia, nor thromboembolic or septic complications were observed.

[Pulmonary artery end-diastolic pressure recordings after myocardial infarction (author's transl)]

29 patients with acute myocardial infarction were subdivided into 3 groups using the information gained by continuous measurement of the pulmonary artery end-diastolic pressure (PAEDP) during a stay of 3 to 5 days in the coronary care unit of this hospital. Group I comprised patients with a PAEDP of below 12 mm Hg (without treatment), group II those with a PAEDP of between 12 and 20 mm Hg and group III those patients with a PAEDP of above 20 mm Hg. 3 to 6 months after rehabilitation and ambulant ""coronary training'' a follow-up control PAEDP measurement was performed at rest and during ergometric stress with the bicycle exercise test. 2 out of the 15 patients in group I had a pathological PAEDP at rest, whilst exercise of 50 watts raised the PAEDP to pathological values in 40% of this group of patients. Group II: 58% of the patients with an initially-raised PAEDP showed a normal value at follow-up examination 3 months subsequently. Exercise of 50 watts raised the PAEDP to pathological values in 66% of the patients in this group. Group III. The pathologically high PAEDP recordings at rest made it impossible to subject these patients to stress with the bicycle ergometer. The prognostic value of the classification of patients with myocardial infarction into pressure groups and the importance of PAEDP follow-up measurements on patients after myocardial infarction at rest and after ergometric stress are discussed.