Original Article

Dr Adolf Lukas Vischer (1884–1974) and‘barbed-wire disease’

Avi Ohry and Zahava Solomon

Abstract

The Swiss physician Adolf Lukas Vischer described a psychiatric syndrome among prisoners of war, the ‘barbed-wire

disease’ that follows a long-term incarceration and which involved boredom, confusion, clouding of consciousness and

amnesia. Vischer first identified this as an important clinical issue. Later in life, he became one of the first geriatricians and

gerontologists.

Keywords

post-traumatic stress disorder, shell-shock, AL Vischer, prisoners of wars, ‘Barbed-wire disease’

This debilitation due to institutional life [of prisoners of

war] has also been described as ‘barbed-wire disease’ or

‘metapsychosis’.

AL Vischer1

Post-traumatic stress disorder (PTSD) is defined by theAmerican Psychiatric Association as ‘an anxiety (emo-tional) disorder that stems from a particular incidentevoking significant stress’. PTSD can be found amongsurvivors of the Holocaust, of car accidents, of sexualassaults and of other traumatic experiences includingcombat.2 PTSD symptoms include re-experiencing theoriginal trauma(s) through flashbacks or night-mares,avoidance of stimuli associated with the trauma, andincreased arousal (difficulty falling or staying asleep,anger and hyper-vigilance). In the past this conditionhad other synonyms – shell-shock, traumatic neurosis,war neurosis, neurasthenia, ‘Battle Fatigue’ and others.In 1678 Johannes Hofers (1669–1752) from Basel wasthe first to identify an acute combat reaction and coinedthe term ‘Nostalgia’ which was characterized by melan-choly, incessant thinking of home, disturbed sleep orinsomnia, weakness, loss of appetite, anxiety, cardiacpalpitations, stupor and fever (Mal du Suisse, ‘Swissillness’ or Schweizerheimweh).3

War experience and captivity are widely recognizedas being particularly traumatic experiences, continuousand with immediate and late severe consequences.Traumatic events have consistently been identified aspotential risk factors for a wide range of problemsincluding PTSD, depression and anxiety, somatic

complaints, difficulties in personal relations, maritaland family problems, and impaired work function.The late sequelae of captivity can be pathogenic(PTSD) and salutogenic (post-traumatic growth).

Another interesting step in our understanding ofWorld War Prisoners of War’s (POWs’) immediateand late reactions was made by a Swiss surgeon wholater in his life became one of the first geriatricians,Dr Adolf Lukas Vischer. He described this syndromethat follows long-term incarceration and which involvesconfusion, clouding of consciousness and amnesia.Perhaps this reflects another form of the Ganser syn-drome – the original description by Sigbert Josef MariaGanser (1853–1931) in 1898 included ‘hysteria’, hallu-cinations, inattentiveness and drowsiness.

Dr Arthur John Brock (1878–1947),4 Dr WilliamHalse Rivers (1864–1922) and other psychiatristsworked in Edinburgh at the Craiglockhart Hospitalfor the shell-shocked.5 We may assume that theirexperiences were not yet known to Vischer.Craiglockhart patients included Siegfried Sassoon(1886–1967), Robert Graves (1895–1985) and WilfredOwen (1893–1918). Sassoon’s friend and fellow-officerin C Company, Julian Dadd, son of the painter StephenThomas Dadd (1859–1917), had been severely woundedin the throat at Ginchy and lost his two brothers in war.

Tel Aviv University, Israel

Corresponding author:

Avi Ohry, Sackler Faculty of Medicine, Tel Aviv University, Israel.

Email: aohry@bezeqint.net

Journal of Medical Biography

22(1) 16–18

! The Author(s) 2013

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DOI: 10.1177/0967772013479547

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Years later, after a series of nervous breakdowns,Julian told Sassoon that Ginchy had always been a‘plague spot’ in his mind: ‘my brain is screwed up likea tight wire’, Sassoon noted in his diary.6 Brock wasWilfred Owen’s doctor at Craiglockhart. He was per-ceived by the soldiers as being ‘cold’ because he did notget personally involved with his patients like Dr Rivers(or William H Bryce). Brock’s form of therapy wascalled ‘ergotherapy’ or ‘work cure’.7

Brock believed that soldiers had to help themselvesby taking responsibility for their health both mentallyand physically. He aided them in their physical well-being by instructing them to take cold baths andswim in an unheated pool. Sometimes Brock gatheredthe soldiers together early in the morning, while it wasstill cold and dark, to go for walks aroundCraiglockhart. ‘Work’ was the other vital element inBrock’s therapy and he found jobs for the soldiers todo that would encourage them to take up new interestsor widen a current one. Wilfred Owen for example wasasked to write essays on architecture and epic poetrybased on Greek myths. This is why so many activitieswere offered to the patients – golf, tennis, bowling, bad-minton, swimming and gardening. There were lessphysically demanding activities too such as the naturalhistory society, debating, dark rooms for photography,model yacht making, carpentry and the chance to par-ticipate in the weekly concert or play. The HydraHospital Journal was another opportunity for patientsto showcase their writing and artwork.8

Newman9 wrote during World War II about thePOWmentality, boredom and the ‘barbed-wire disease’:‘In 1919 Dr AL Vischer wrote a small book entitledBarbed-Wire Disease: A Psychological Study of the

Prisoner of War. It deals briefly with the factors produ-cing this ‘‘disease’’ and with the prisoner’s reaction tohis environment during prison life. Dr Vischer was avisiting doctor in German prisoner-of-war campsduring the last war; he drew his conclusions not as aPOW but as a psychologist studying a series of patients’.

Dr Vischer’s experience was vast and his conclusionswere drawn from an immense amount of data. Vischerwas born in Basel and died there. His father was a richsilk merchant and an administrative director of a nuns’house who also was very active in favour of the POWsand the wounded from the German–French War of1870 and for the Bosnian Refugee.

After graduation from the medical faculty in hishometown, young Adoof Lukas went to broaden hisexperience in Munich under Walter Heinrich von Wyss(1884–1970). He returned to Basel and became anAssistant Surgeon to Fritz de Quervain (1868–1940).Vischer also practised in Bern and atSt Bartholomew’s Hospital in London. During the1912 Balkan War he volunteered as a front-line surgeonat Monastir. The Battle of Monastir took place near thetown of Bitola,Macedonia during the First BalkanWar,from 16 to 19 November 1912. After the battle the five-century-long Ottoman rule of Macedonia was over.

During World War I, Vischer and other Swiss sur-geons were sent by the Italian Red Cross (ICRC) toserve at field hospitals.10–12 He visited and worked atPOW camps in Turkey and England and observed thepsychological impact of captivity on the prisoners. Hepublished his observation in a small book, DieStacheldraht-krankheit, published in 1918. After thewar he established a clinic in Basel and married aBernese noble lady, Ms von Bonstetten. He abandonedsurgery in 1924 and shifted his interest to a new spe-cialty, geriatrics and gerontology. In 1953 he establishedthe Swiss Society of Gerontology. He opened andworked for sheltered accommodation for the aged inBasel and he published books on geriatrics. He wonprestigious citations from the ICRC, the SwissScientific Academy and The Basel Academy and hereceived Honoris Causa doctorate in theology andmore. The ICRC sent him with a medical delegationduring World War I to various sites, including Egypt.

Vischer himself had reached his ‘Golden years’ grace-fully. He was regarded as a man of letters, humane andwith the highest moral values. Vischer’s ‘barbed-wiredisease’ is mentioned in many books13–17 and, alongwith his contributions to geriatric medicine,18,19 hisname should be placed with other famous scholars orphysicians whose names are firmly connected withBasel: Paracelsus (Philippus Aureolus TheophrastusBombastus von Hohenheim, 1493–1541) and his rivalThomas Erestus (1524–1583), Casper (Gaspard)Bauhin (1560–1624), Johann Bernoulli (1667–1748)

Figure 1. Dr A L Vischer.

Ohry and Solomon 17

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and Daniel Bernoulli (1700–1782), Albrecht von Haller(1708–1777), Carl Jacob Christoph Burckhardt (1818–1897), Wilhelm His (1831–1904), Carl Gustav Jung(1875–1961) and many more.

Acknowledgements

Our sincere thanks to Yael Carmeli BA, AdministrativeSpecialist at Novartis Pharma AG, Werk Klybeck, Basel,Switzerland, for obtaining original documents from the City

of Basel archives, and Karin Ohry-Kossoy MA, Savyon,Israel, for the translation from the German language.

References and notes

1. Vischer AL. Barbed-wire disease- a psychological study of

the prisoner of war. London: John Bale & Danielson, 1919.2. Bentley S. A short history of PTSD: from Thermopylae

to Hue soldiers have always had a disturbing reaction towar, http://www.vva.org/archive/TheVeteran/2005_03/

feature_HistoryPTSD.htm3. Hofer J. (Translated by Carolyn Kiser Anspach) ‘Medical

Dissertation on Nostalgia’ by Johannes Hofer, 1688.

Bulletin of the History of Medicine 1934; 2: 376–391.4. Brock AJ. Boredom and barbed-wire disease. British

Medical Journal 1940; 1: 744.

5. Webb TEF. ‘Dottyville’ – Craiglockhart War Hospital andshell-shock treatment in the First World War. Journal ofthe Royal Society of Medicine 2006; 99: 342–346.

6. Wilson JM. Siegfried Sassoon-the making as a war poet.

A biography 1886–1918. London: Duckworth, 2004.

7. Crossman AM. The hydra, Captain A J Brock and the

treatment of shell shock in Edinburgh. Journal of the

Royal College of Physicians of Edinburgh 2003; 33:

119–123.8. http://sites.scran.ac.uk/Warp/Brock.htm (accessed 20

April 2012).9. Newman PH. The Prisoner-of-War, mentally its effect

after repatriation. British Medical Journal 1944; 1: 8–10.10. Anon. Nobile officium. National-Zeitung, Basel 1953; 30

December: p.602.

11. Anon. Dr. Adolf L Vischer zum 80. Gerurtstag. Basler

Nachrichten 1964; 30 December: p.554.12. Anon. Dr. Adolf Lukas Vischer 1884–1974. Medizinische

Gesellschaft, Basel, January 1975. Copy seen at the

Schweizeriches Wirtschaftsarchiv in Basel.

13. Rachamimov A. POWs and the Great War: captivity on

the Eastern Front. New York: Berg, 2002.14. Taylor A. The prison system and its effects: wherefrom,

whereto, and why. New Zealand: Nova Science, 2007.

15. Lengyel E. Barbed-wire disease, in ’Siberia’. USA: Garden

City, 1943, p.194.16. Yarnall J. Barbed wire disease: British and German pris-

oners of war, 1914–18. UK: The History Press Ltd, 2011.

17. Morton D. Barbed-wire disease, Chapter 3. In: Silent

Batttle-Canadian Prisoners of War in Germany, 1914–19.

Toronto: Lester Publishing Ltd, 1992.18. Vischer AL. On old age. London: Houghton Mifflin,

1967.

19. Vischer AL, Old age, its compensations and rewards.

London: McGrath, 1947 and 1970.

Author biographies

Avi Ohry, MD, is a Professor of Rehabilitation Medicine, Sackler Faculty of Medicine, Tel Aviv University, Israel.

Zahava Solomon, PhD, is a Professor of Social Work, The Shappell School of Social Work, Tel Aviv University,Israel.

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