Albert Eckstein

The German pediatrician Albert Eckstein (1891 – 1950) founded modern pediatrics in Turkey while he was in exile from Nazi Germany.

Early Life

Albert Eckstein was born on 9 February 1891 in Ulm, Germany. He studied medicine in Freiburg. He was called up to serve in the First World War and was awarded the eisernes Kreuz (Iron Cross), the German Honour Cross, First Class, for heroism. Following the war he worked at the Physiology Institute at the University of Freiburg. In 1920, he moved to the University Hospital for Children to work under the pediatrician Carl T. Noeggerath (1876-1952). In 1923 he became a senior lecturer based on his work Influence of natural and artificial light sources with simultaneous living conditions variation on the growth of young rats.

On 1 October 1925 in the city of Düsseldorf he married Erna Schlossmann (1895-1998), a pediatrician and daughter of Arthur Schlossmann (1867- 1932) who too was a pediatrician and head of the Children’s Hospital at the Academy of Medicine in Düsseldorf. In 1926 he was promoted to Professor. After Schlossmann’s death, Dr Eckstein was appointed chief of the department. On 1 July 1935, in his Düsseldorf clinic Dr. Eckstein received an envelope marked ‘Personal'. It said: ‘In the name of the Reich, I relieve you of your duties in the service of the Prussian Government by June 1935 based on the orders dated 12 June 1935. Adolph Hitler, Hermann Göring’.

Through the Emergency Organization for German Scientists Abroad Eckstein received an offer from the Turkish Government to work at the Ankara Numune Hospital. The contract was signed in Berlin on 1 August 1935 by Hamdi Arpağ, Ambassador to Germany.

First years in Turkey

The Ministry of Health and Social Assistance asked Eckstein to undertake a trip accompanied by his assistant Dr Selahattin Tekand during July and August 1937 to investigate children’s diseases and mortality in 13 central and southern Anatolian provinces and villages. Additional aims were to collect information about the fertility of women and the number of surviving children. His wife, Dr Erna Eckstein-Schlossman, accompanied him.

Eckstein’s report was organized under the following headings: Results Obtained, Fish Consumption, Nutritional Situation, Fight against Trachoma and Diarrhoea, Skin Diseases, Fertility of Mothers and Child Mortality, Child Mortality and Villages and the Poorer Classes in Ankara.

Maternal fertility and child deaths

From Eckstein's report:

We have finally reached the most important subjects of our investigations, namely maternal fertility and child mortality. We conducted statistical research on 8,000 women. This corresponds to 1/3 of all the women in the villages we visited. The number of births increased uniformly and steeply until it reached an average of 6.05 births for women aged 40-44. For those over 45, the average number of births was 6.87. This indicates a slight decrease in births in villages during recent years but this cannot be a cause for concern.

With regard to child deaths Eckstein had the following to say:

Since mortality ... by age .... documentation did not exist, it was not possible to determine infant mortality or mortality for other age groups except in the regions where malaria eradication was undertaken. It is [however] possible to calculate child mortality indirectly by finding the average number of dead children for each woman. This is also supported by comparing these results with data collected during the last 6 months in the Ankara polyclinic.

Eckstein then goes on to discuss the general results obtained from visits to villages and from the Ankara polyclinic:

The figure of 3.4 surviving children per woman is accepted to be the international norm. If this number is true, then an increase of population can be expected with certainty. The 3.6 surviving children per woman reached for those aged 35-39 is already above this norm. 3.9 surviving children for older groups are also above this figure. Even groups aged 45 and over surpass the norm with an average of 3.7. In the city, the norm ... is surpassed (3.7) only by women aged 45 and over. The ‘educated class’ is significantly lower with 2.5 children! Hence rural population increase is ensured. Since peasants constitute 80% of Turkey’s population, if our findings are true for all provinces, population increase is also guaranteed for all of Turkey. ... Consequently a sound population policy for the countryside is a necessary and principal cornerstone for auspicious development.

The Turkish Ministry of Health and Social Assistance asked him to go on another investigative trip to the provinces of Isparta, Burdur, Antalya, Denizli, Muğla, Aydın, İzmir, Manisa, Balıkesir, Bursa, Kocaeli and Bolu during July and August of 1938. Again he was accompanied by his paediatrician wife and the Chief Pediatrics Assistant, Dr. Selahattin Tekand. They collected data on the number of households, male and female population, whether there were cases of malaria, enteritis, varieties of water sources, and whether there was a school.

These studies were probably the first attempt to collect statistics on the health and demographics of a major segment of Turkey’s population. Reports and recommendations prepared by Eckstein were passed to the Ministry of Health. At the time of their travels around Anatolia, the campaign against malaria, eradication of tuberculosis and trachoma had already started. Eckstein noted they could see the positive effects of this campaign during their visits to the villages.

During his stay in Turkey (1935-1950), Eckstein worked at the Numune State Hospital of Ankara, the largest hospital of the city at the time. In June 1945 he was appointed Chief of the Paediatric Clinic at the Faculty of Medicine on its establishment.

The 1941 book Çocuk Neşvünema, tegaddi ve metabolizmasının fiziyoloji ve patolojisi was one of his more important contributions to Turkish pediatrics in general and to child development and metabolism in particular. It was distributed to all medical doctors in Anatolia by the Ministry of Health and was used as part of the medical school’s curriculum for many years.

In October 1938 Eckstein organized the first Turkish Pediatrics Congress in Ankara and published two exclusive pediatrics textbooks in Turkish. Eckstein ‘made major contributions to the treatment of children’s illnesses by creating a series of clinics throughout Turkey’.

Albert Eckstein is credited with bringing science to bear on the treatment of noma, a borrelia infection of the oral mucosa appearing in immune compromised and malnourished children.

Preventive Medicine

Eckstein was a proponent of preventive medicine. The Faculty of Medicine in Ankara certainly followed in this tradition. His observations on breastfeeding of infants on demand are in line with modern paediatric practices that now advocate mother’s milk rather than bottle-feeding: Eckstein’s other main research topic was malaria. His paper dealing with Malaria in children had a major impact in preventing and treating that disease in Turkey.

On 18 July 1950 in Albert Eckstein died in Hamburg. His ashes repose at the Crematorium in Cambridge, UK.

References

• Akar N. Anadoluda bir Çocuk Doktoru. [A Paediatrician in Anatolia] Ord .Prof. Dr. Albert Eckstein. Genişletilmiş 2. Baskı, [Expanded Second Printing] (Ankara: Pelikan Yayınları, 2003)
• Akar N. "Albert Eckstein: a pioneer in paediatrics in Turkey." Turkish Journal of Paediatrics 2004;46:295-297
• Moll H. "Emigrierte Deutsche Paediater: Albert Eckstein", Werner Solmitz. Monatsschr Kinderheilkd, 1995;143:1204-07
• Eckstein A, Tekiner H and Özlem, N Çocuk Neşvünema, tegaddi ve metabolizmasının fiziyoloji ve patolojisi. [Physiology and pathology of childhood development, nutrition and metabolism] (Ankara: Sıhhat ve İçtimai Muavenet Vekaleti Neşriyatı.[Ankara:Publication of the Ministry for Health and Social Services] 1941)
• Eckstein A. (1939) "Türkiye'de nüfus siyasetine ve içtimai hijyene ait meseleler ile bunların çocuk hekiminin vazifesi noktai nazarından tetkiki." [Population policy and public hygiene problems in Turkey and their investigation from the viewpoint of a paediatrician’s duties] Birinci Türk Çocuk Hekimliği Kongresi. [First Symposium of Turkish Paediatrics] İstanbul: Ekspres Basımevi. 1938
• Reisman A. TURKEY'S MODERNIZATION: Refugees from Nazism and Ataturk's vision. (Washington, DC: New Academia Publishers, 2006) 150
• Shaw S.J. Turkey and the Holocaust (London: Macmillan Press, 1993), 367
• Akar N Anadoluda bir Çocuk Doktoru. 88-89
• Eckstein A. "Çocukluk Çağında Sıtma." [Malaria in Childhood] Ankara Üniversitesi Tıp Fakültesi Mecmuası, [Journal of the Ankara University Medical Faculty] 1949;3 (1-2):1-19. (Çeviri: D. Güzin Çelikmen)

External links

• For additional reading on Albert Eckstein’s Turkish exile see Arnold Reisman Turkey's Modernization: Refugees from Nazism and Ataturk's Vision [1]

• This article is based on Akar N.. Oral, A. and Reisman, A. (2007) “Modernizer of Turkey’s Pediatrics: Albert Eckstein in exile.” Forthcoming November 2007, Journal of Medical Biography, The Royal Society of Medicine Press. Online