Two significant anniversaries are coming up soon. This November will mark the 50th anniversary of the assassination of John F. Kennedy, an event that anyone born before 1958 likely remembers. The memory of this shock is seared into the consciousness of millions of Americans with feelings of loss, vulnerability, and thoughts of what might have been if Oswald had failed.
The other anniversary arrives in less than one year from now. In August 1914, triggered by another assassination, that of the Archduke Ferdinand, heir to the throne of the Hapsburg Empire, the First World War broke out. This marked the beginning of what some have labeled The Long War that ended only in 1989 with the capitulation of the Soviet Union in Eastern Europe. During this period, the Hapsburg Empire collapsed, Germany suffered defeat, Hitler and National Socialism arose, and Germany suffered another crushing defeat. Meanwhile, millions of lives were lost and many more were displaced.
I mention these two events because of their significance in the life of Dr. Hans Kraus, a medical pioneer previously unknown to me. Kraus came from a wealthy Hapsburg Empire family that moved from Trieste, a multi-ethnic city on the Adriatic, to Vienna, the capital of the Hapsburg Empire, and finally to New York, as refugees from the coming storm led by Hitler. The Kraus family had Jewish forbearers, but they had the wealth and foresight to escape the tide of war and genocide that washed over their native lands.
Kraus was born at the beginning of the century, and his youth was marked by his time in the mountains, introduced to him by a domineering and demanding father. Kraus grew strong and developed a true love for the mountains: for climbing, hiking, and skiing, which provided him spiritual sustenance. But while Kraus grew up in a wealthy household, his youth was marked by two significant influences: his demanding father (similar in many ways to JFK’s demanding father) and the death of a friend during a climb they made as impetuous youths. Despite his father’s protests and derision, Kraus became a physician, and specifically, an orthopedist, in part as a way to atone after the shocking death of his friend.
Many an orthopedist that I know were athletes, and Kraus fits the mold, but his mountaineering hobby, which lasted nearly his whole life, provided him with experiences that would help change medical practice. For Kraus learned from the practical persons of the mountains, not fellow Viennese physicians, how to treat traumatic joint and muscle injuries. He learned to treat such injuries not by immobilization and bed rest, but by movement and muscular development. Over the course of a medical career spanning almost six decades, his treatment recommendations put him at odds with the medical establishment.
After emigrating to NYC, Kraus developed a very successful medical practice as well as establishing himself as a premier American rock climber. He developed a set of tests to measure susceptibility to back pain—a growing epidemic in the U.S.—and he pushed for better physical health among American children, and by his efforts helping to create the President’s Council on Physical Fitness (for what little that was worth). However, his greatest claim to fame came from being asked to treat President John F. Kennedy for his famously bad back. Kennedy had undergone two back surgeries and extended periods of bed rest, and was nearly crippled by his back. Kennedy’s situation was aggravated by his Addison’s disease, a secret guarded as closely, if not closer, than his trysts. Kraus, at the invitation of a couple of JFK’s treating physicians, came in and took control of JFK’s back. Kraus palpated Kennedy’s muscles, tested his strength and flexibility, and then he prescribed the treatment: trigger point therapy, exercise, and relaxation. No surgery, no drugs, and no crutches. (Kraus also opposed JFK’s corset, but JFK held on to its use almost as a psychic crutch, which perhaps cost him his life (read the book).) After a couple of years of the Kraus treatment, people close to him described JFK as his healthiest in memory. JFK continued to have flare-ups of back problems, usually associated with time around family—strong stressors given his domineering father, the competitive family ethos, and his marriage—but his flare-ups were not associated with events like the Cuban missile crisis or other demanding presidential duties. Kraus, making his only exception to requiring patients to come see him in his NYC office, came when needed to help the President. By the time of JFK’s assassination, Kraus had developed a strong relationship with JFK and a high degree of admiration.
Kraus was slow to receive recognition in the medical community for his “old-fashioned” ways of palpating and manipulating patients, usually avoiding surgery, drugs, and hospital stays. In fact, the issue of the reception that Kraus’s insights and treatments received within the medical community is a great issue in this book that the author fails to fully explore. Kraus is quoted as saying “I’d be sued now” for using his ways of diagnosis and treatment, but that suggests that we lawyers are the problem. In fact, lawyers are the least important of three parties to a malpractice claim. The two most important players are patients, who, contrary to myth, are (in my experience) reluctant, frustrated by a lack of candor from treating physicians, and badly injured (or the surviving relatives). The other key players in any malpractice claim are fellow physicians, who offer opinions about the standard of care. Their opinions about the correctness of a course of treatment are the crucial element of any claim.
But step back from any consideration of outright malpractice, because an even greater issue is raised here, that of accepted practice (ortho-practice, if you will) that is actually iatrogenic—injury causing—such as bed rest and immobilization. One AMA president in the 1950s quoted in the book stated that smoking is actually probably good for you! Scientific ignorance, reasoning prejudices and biases, and economic incentives (surgery earns more money than prescribing exercises) all contribute to medical practices that can actually prove harmful, if not fatal. (See Nassim Taleb’s Antifragile for more about this.) I would like the author to have done more with this theme than simply noting Kraus’s battles for acceptance and the intransigence of the medical community toward his insights. I’m not sure that Kraus’s methods have been widely accepted—do you still use RICE (rest, ice, compression, elevation) for a sprained ankle? If so, read this book and think again!
Finally, this book is worthwhile because it can lead you to a better back. For most readers, this alone would prove the value of the book. A YouTube of a Kraus program can be found @ http://www.youtube.com/watch?v=UZziz64PNpY. (Enjoy the vintage workout clothes!)
All in all, an interesting and worthwhile book about a very interesting and little known character. A big shout-out goes to Tanta Rose for bringing this book to my attention.