Karl Stolte

Karl Stolte, around 1947

Karl Marie August Stolte (born April 15, 1881 in Strasbourg / Alsace ; † September 5, 1951 in Heidelberg ) was a German internist , pediatrician and diabetologist who was director of the children's clinics at the universities of Breslau , Greifswald and Rostock from 1916 until his death worked. He made particular contributions to the further development of the therapy of type 1 diabetes in childhood. In this area, he postulated fundamental principles such as a concept known as a “free diet” with needs-based insulin administration, which, however, only found widespread use after his death and are currently considered the standard in the treatment of type 1 diabetes mellitus.

Life

Karl Stolte was the younger son of the high school councilor Ludwig Stolte (1852–1906) and his wife Caroline, b. Hardt (1856–1931), born in Strasbourg in Alsace. He studied 1899-1904 medicine at the university in his hometown , where he in 1904 with a thesis on animal metabolism of amino acids and a doctorate was. During his studies he became a member of the Academic-Musical Association Alt-Straßburg Freiburg (in the Association of Special Houses ). After graduating, he worked there as an assistant doctor to the biochemist Franz Hofmeister until 1909 . In the clinic in Strasbourg headed by Bernhard Naunyn , where Oskar Minkowski also worked for a time, he first experienced the fate of diabetes patients in the time before the discovery of insulin .

When the pediatrician Adalbert Czerny, who worked in Breslau, was looking for an assistant with biochemical experience, Karl Stolte first switched to the University of Breslau. As early as 1910, he followed Czerny, who moved to the newly established children's clinic at the University of Strasbourg as director, and thus returned to his native city. In 1913 he was with a thesis on diet principles with nutritional disorders in newborns habilitation . and together with Czerny moved to Berlin at the Charité . In 1916 he was appointed director of the children's clinic at the University of Wroclaw. After the Hitler government came to power, many of Stolte's medical employees were exposed to persecution by the Nazi regime and were banned from employment and professions, which led to a staff shortage in his clinic.

In 1933/1934 Karl Stolte was chairman of the German Society for Pediatrics (DGfK ). In this function, on July 14, 1933, he had to accept the integration of the DGfK into the "Reich Central Health Management" and the "Reich Working Group for Mother and Child", which was called for by the Nazi regime . Four weeks later, his deputy Walther Freund (1874–1952) was urged to intervene by the Interior Ministry from the board and the DGfK, and Wilhelm Stoeltzner took over his function . In negotiations with the Ministry of the Interior, Karl Stolte was able to obtain a concession that the Aryan paragraph was not included in the statutes of the DGfK - which he informed the members in a circular dated August 15, 1933 - the expulsion of Jewish members from the DGfK by the NS- However, this did not prevent the regime. Details on Stolte's behavior as chairman of the DGfK can be found in Martin Hofer's dissertation (2006).

After the end of the Second World War and an escape that had led him to his family via Altheide , Illertissen , Dresden and Freiberg, initially to Altentreptow , Karl Stolte took over the management of the children's clinic at the University of Greifswald from September 1946 to 1948 and from 1948 to his Death the same function as full professor at the University of Rostock. He died in 1951 of the consequences of a stroke that he had suffered a few days earlier during the 51st annual conference of the German Society for Pediatrics in Heidelberg in 1951, and was buried in a family grave in the cemetery of Stargard Castle.

Scientific and medical work

During his time at the University of Wroclaw, Karl Stolte began in 1929 to develop a concept for flexible therapy for diabetes mellitus in childhood, which he called a "free diet" and which he presented in several specialist articles at the beginning of the 1930s . Instead of a set meal plan (“diet plan”), it provides for an almost freely selectable normal diet (“regulated normal diet” with certain restrictions in terms of the amount and composition of the individual meals), accompanied by an “adequate” insulin dose tailored to the needs . Looking back on 20 years of experience with "free diet", Karl Stolte stated around 1949:

“What has remained is the free choice of food composition according to appetite, but since the war years it has been associated with the warning against abundant fat (70–90 g max.).

What has remained is the rapid replenishment of the severe weight loss at the beginning of the treatment, but then soon the carbohydrates are also limited to around 300 to a maximum of 350 g, rarely more grams per day.

The avoidance of all diabetic substitute preparations, such as diabetic bread, Sionon, salabrose and saccharin, has also remained.

The ban on eating more than healthy peers has remained.

What remains is the three-time urinary sugar test and the daily re-adjustment of the insulin that this entails.

Sugar and chocolate, however, are still allowed in reasonable quantities.

Extensive adaptation and variation of the insulin preparations (old insulin or depot insulin, depending on lifestyle habits and influences of the various regulators) is permitted.

The variation in the number of insulin syringes is also allowed. "

- Karl Stolte

Stolte's concept was followed by pediatricians in the 1960s, but rejected by adult doctors (internists). It was scientifically investigated and substantiated for the first time in appropriately trained adults with type 1 diabetes in the 1980s by Ernst-Adolf Chantelau and colleagues at the University of Düsseldorf. A previously required medically prescribed diet plan could be omitted, which was criticized by the German Diabetes Society . The meal-related insulin supply, measured in insulin units , is based on the type and amount of carbohydrates to be consumed, measured in bread units , and their glycemic index , as well as the current muscle work to be performed - as so-called "intensified insulin therapy". The patients unanimously welcomed the possible exemption from diet regulations.

Mainly because of the lack of methods for simple, precise and location-independent blood glucose measurement - at that time, the measurement of glucose in the blood or in the collected urine by the medical laboratory was primarily available for metabolic control - Stolte's views at the time could not contradict the prevailing doctrine in diabetology push through. This was based on the principle, represented by the Viennese internist Carl von Noorden and other doctors worldwide, that the diet - in the sense of a meticulously prescribed diet - should be fixed to the effect of the medically determined (depot) insulin dosage.

The principle of the currently practiced basic bolus therapy corresponds to the approach of Karl Stolte, who can thus be described as a pioneer of the intensified conventional insulin therapy (ICT) that is common today.

Except with diabetes mellitus Karl Stolte in more than 100 works scientifically pediatrics deals with various disorders of childhood and problems, including the so-called Mehlnährschaden (1913), diarrheal diseases (1917), Herzbeutelverwachsungen (1919, 1926), meningitis (1927) Kidney Diseases (1929) and Combating Cancer (1932). His assistants at the children's clinic in Breslau, which he directed, including Siegfried Rosenbaum , Karl Franz Klinke , Bruno Leichtentritt and Hans Knauer , were also scientifically active in various fields of paediatrics. His "students" also included Joachim Wolff, Hans Aron, Leo Mendel, Herbert Hirsch-Kauffmann, Hans Opitz, HWOcklitz, HHSchmitz, Hermogenes Zische, Carl Wiener, Richard Gralka, Adalbert Ohr, and Otto Bossert.

Stolte and Gerhardt Katsch

Gerhardt Katsch , an internist and professor of medicine from Greifswald , made a negative statement at a pediatrician congress in Berlin in 1947 about Stolte's concept of adjusted insulin dosage with “free food” within limits. Stolte wanted to settle the controversy around 1949, but was publicly snubbed by Katsch, as the then Katsch employee Volker Schliack recalled in 2009.

Awards

Karl Stolte received the honorary title of Honored Doctor of the People in the German Democratic Republic (GDR) in 1950 and a year later, a few days before his death, was made an honorary member of the German Society for Pediatrics.

Private

Karl Stolte was married from 1921 and was the father of a daughter and a son who died at an early age. His daughter Hermine Stolte studied medicine, received her doctorate from Karl Klinke at the University of Rostock in 1945 and then worked as her father's assistant and as a pediatrician.

literature

• Gerd Winfried Ratzmann, Klaus Jahresig : Karl Stolte in his time and for our time . In: Pediatric Practice . 49th year, issue 12, December 1981, ISSN  0023-1495 , p. 617-627 .
• Michael Berger: Need-based insulin therapy with free food. Karl Stolte's contribution to clinical diabetology . Kirchheim, Mainz 1999, ISBN 3-87-409299-2
• History of insulin treatment in children and adolescents. In: Peter Hürter, Thomas Danne: Diabetes in children and adolescents . Sixth edition. Springer, Berlin and Heidelberg 2005, ISBN 978-3-540-21186-0 , pp. 153-171
• Udo Goecke: The meaning of the life and work of Karl Stolte for modern diabetology. Medical dissertation, Düsseldorf 1987
• Albrecht Scholz, Thomas Barth, Anna-Sophia Pappai and Axel Wacker: The fate of the teaching staff of the Medical Faculty in Breslau after the expulsion in 1945/46. In: Würzburger medical history reports 24, 2005, pp. 497-533, here: pp. 514 and 529
• Hans-Rudolf Wiedemann: The Pioneers of Pediatric Medicine: Karl Stolte (1881-1951) . In: European Journal of Pediatrics . 152/1993. Springer-Verlag, p. 81, ISSN  0340-6199
• Eduard Seidler: Pediatricians 1933-1945 disenfranchised-fled-murdered . Bouvier, Bonn 2000.

Web links

• Literature by and about Karl Stolte in the catalog of the German National Library
• Literature about Karl Stolte in the state bibliography MV
• Entry on Karl Stolte in the Catalogus Professorum Rostochiensium
• diabetes-index.de - Prof. Karl Stolte (with picture)

Individual evidence

1. ↑ Birth certificate 1147/1881 Strasbourg registry office (Carl Marie August Stolte)
2. ^ In the state bibliography MV as Karl Friedrich August Stolte
3. ↑ On the fate of the monamino acids in the animal body after their introduction into the bloodstream. Dissertation. Medical Faculty of the University of Strasbourg 1904
4. ^ Association of Alter SVer (VASV): Address book. Membership directory of all old men. As of October 1, 1937. Hanover 1937, p. 67.
5. ↑ Basics of nutritional therapy for acute nutritional disorders in infants. Habilitation thesis. Medical Faculty of the University of Strasbourg in 1913
6. ^ Eduard Seidler: Paediatricians 1933-1945 disenfranchised-fled-murdered . Bouvier, Bonn 2000, p. 25, 31, 59, 125, 188, 191-195, 279 .
7. ^ Joachim Wolff: The Breslau University Children's Hospital. History and influence on German paediatrics . In: the pediatrician . 15th (32nd) year, No. 1 , 1984, p. 69-82 .
8. ^ Eduard Seidler: Paediatricians 1933-1945 disenfranchised-fled-murdered . Bouvier, Bonn 2000, p. 31-34,192 .
9. ↑ Martin Hofer: Hans Rietschel (1878-1970) - Director of the University Children's Hospital in Würzburg from 1917-1946. (pdf) Dissertation Bavarian Julius Maximilians University of Würzburg. 2006, pp. 79–142 , accessed on February 22, 2017 . 
10. ↑ Albrecht Scholz, Thomas Barth, Anna-Sophia Pappai and Axel Wacker: The fate of the teaching staff of the Medical Faculty in Breslau after the expulsion in 1945/46. In: Würzburger medical history reports 24, 2005, pp. 497-533, here: p. 529
11. ↑ Albrecht Scholz, Thomas Barth, Anna-Sophia Pappai and Axel Wacker: The fate of the teaching staff of the Medical Faculty in Breslau after the expulsion in 1945/46. In: Würzburger medical history reports 24, 2005, pp. 497-533, here: pp. 514 and 529
12. ^ Karl Stolte, Herbert Hirsch-Kauffmann, Erika Schädrich: Free diet in diabetes . In: Medical Clinic . 27th year. Urban and Schwarzenberg, Berlin 1931, p. 831-838 .
13. ^ Joachim Wolff: The Breslau University Children's Hospital. History and influence on German paediatrics . In: the pediatrician . 15th (32nd) year, No. 1 , 1984, p. 69-82 .
14. ↑ Lecture manuscript Rostock winter semester 1949/50
15. ↑ Horst-Günther Krainick, Friedrich Ernst Struwe: On the situation of childhood diabetes mellitus in West Germany. Results of a survey on behalf of the German Diabetes Committee . In: German Medical Weekly . tape 85 , 1960, pp. 1632-1640 .
16. ↑ Ernst Adolf Chantelau, Gabriele Elisabeth Sonnenberg, Irene Stanitzek-Schmidt, Frank Best, Hildegard Altenähr, Michael Berger: Diet liberalization and metabolic control in type-1 diabetic outpatients treated by continuous subcutaneous insulin infusion . In: Diabetes Care . tape 5 , 1982, pp. 612–616 (English, researchgate.net [PDF; accessed January 26, 2017]).
17. ↑ Ernst Adolf Chantelau: Diet liberalization in type 1 diabetes mellitus: results of intensified insulin therapy . Urban Schwarzenberg, Munich-Vienna-Baltimore 1988, DNB  880890878 . Zugl. Habilitation thesis. Medical Faculty University of Düsseldorf 1987.
18. ↑ Diabetes diet: warning against liberalizing carbohydrate intake. Opinion of the 'Committee on Nutrition' of the German Diabetes Society . In: German doctors Journal, Issue A . 82nd volume, 1985, p. 1424–1425 ( aerzteblatt.de [PDF; accessed on January 26, 2017]).
19. ↑ Karl-Heinz Krumwiede: Correctly estimating and assessing carbohydrates. Nutrition for diabetes mellitus. In: MMW advances in medicine . Originals No. II. 149th Volume, 2007, p. 91–96 ( klinikum-nuernberg.de [PDF; accessed on February 1, 2017]). Estimating and assessing carbohydrates correctly. Diet in diabetes mellitus. ( Memento from February 1, 2017 in the Internet Archive )
20. ↑ Bettina Haupt (dpa): Before breakfast comes the blood sugar test . In: Rheinische Post . Düsseldorf 17th August 1988.
21. ↑ Detlef Oyen, Ernst-Adolf Chantelau, Michael Berger: To the history of the diabetes diet . Springer, Berlin-Heidelberg-New York-Tokyo 1985.
22. ↑ HWOcklitz, HHSchmitz: Our teacher Karl Stolte on the 100th birthday . In: Pediatric Practice . tape 49 , 1981, pp. 591-595 .
23. ↑ “He [Stolte] explained to me that he had found that our therapies did not actually differ from each other and that I should intervene with Katsch to resolve this 'formal' dispute. I reported this to K., who promised to do it at the earliest opportunity. He chose the Greifswald conference of the North [west?] German Society for Internal Medicine as an 'opportunity'. I sat next to him in the auditorium and, to my dismay, heard Katsch explain in his opening address: A freedom that is limited is not freedom! A loud applause from the audience, who did not know the background, followed. Prof. Stolte, who had expected a conciliatory statement about his problem, got a red head and demonstratively left the auditorium. Katsch then asked me why is Stolte so sensitive, I'm right! ”Volker Schliack in: Günter Ewert, Ralf Ewert (eds.): Gerhardt Katsch - founder of the first German diabetic home and care for diabetics. Report from Wulf Lübken as a scientific reparation payment to the Soviet Military Administration Germany (SMAD). 1st edition. Pro BUSINESS, Berlin 2010, ISBN 978-3-86805-665-5 , p. 197-199 .