Physical medicine and rehabilitation
62-457: Paul Wittgenstein (November 5, 1887 – March 3, 1961) was an Austrian-American concert pianist notable for commissioning new piano concerti for the left hand alone, following the amputation of his right arm during the First World War . He devised novel techniques, including pedal and hand-movement combinations, that allowed him to play chords previously regarded as impossible for
124-458: A collection of works by old masters; and prepared editions of the Chopin Etudes , polonaises by Wilhelm Friedemann Bach , and the piano music of Franz Schmidt . Claiming to be respecting the composer's own wishes, he created two-hand redistributions of the left-hand works that Schmidt had written for Paul Wittgenstein, although Wittgenstein evidently voiced strong objections. Besides editing
186-624: A few years later in stereo by Walter Klien , but a third party, Bearac Reissues, appears to have issued compact disc editions of the set copied from LPs. Downloads of the Schubert recordings in .mp3 format are also available through Amazon.com. The following lists contain the bulk of Wührer's recordings. Unless specified otherwise, all 78 RPM discs were 10" discs, and all LPs were monaural 12" discs. The Vox Boxes were all three-record sets. CD issues mostly derive from radio broadcasts; CD releases of material originally appearing on analogue discs are noted in
248-473: A five-fingered pianist. He was an older brother of the philosopher Ludwig Wittgenstein . Wittgenstein was born in Vienna, the fourth son of the industrialist Karl Wittgenstein and Leopoldine Maria Josefa Kalmus. He was raised as a Catholic; three of his grandparents had converted from Judaism as adults. Only his paternal grandmother had no Jewish lineage. His brother Ludwig was born two years later. The household
310-484: A leading Nazi in Austria during World War II. Wührer's students included composers Sorrel Hays , Helmut Bieler , and Richard Wilson ; pianists Geoffrey Parsons , Frieda Valenzi , and Felicitas Karrer (who described him as having an unusually well-balanced left hand); and harpsichordist Hedwig Bilgram . Among Wührer's editorial activities, he wrote Masterpieces of Piano Music (Wilhelmshaven, 1966); compiled
372-543: A man with one arm, but he persevered. He then approached more famous composers, asking them to write material for him to perform. Benjamin Britten , Paul Hindemith , Alexandre Tansman , Erich Wolfgang Korngold , Sergei Prokofiev , Karl Weigl , Franz Schmidt , Sergei Bortkiewicz , and Richard Strauss all produced pieces for him. Maurice Ravel wrote his Piano Concerto for the Left Hand , which became more famous than any of
434-431: A more common term before the 17th century for limb loss or removal), or simply "cutting", but by the end of the 17th century "amputation" had come to dominate as the accepted medical term. Friedrich W%C3%BChrer Friedrich Wührer (29 June 1900 – 27 December 1975) was an Austrian - German pianist and piano pedagogue. He was a close associate and advocate of composer Franz Schmidt , whose music he edited and, in
496-738: A much better known figure, the Polish virtuoso Theodor Leschetizky . He made his public début in 1913, attracting favourable reviews. The following year, however, World War I broke out, and he was called up for military service. He was shot in the elbow and captured by the Russians during the Battle of Galicia , and his right arm had to be amputated. During his recovery in a prisoner-of-war camp in Omsk in Siberia, he resolved to continue his career using only his left hand. Through
558-504: A performer, Wittgenstein's posthumous reputation is mixed. Alexander Waugh comments in The House of Wittgenstein: A Family at War that between 1928 and 1934, Wittgenstein was "a world-class pianist of outstanding technical ability and sensitivity" but that his playing grew increasingly "harsh and ham-fisted". Orchestras and conductors that had invited him once, seldom sought to rebook him. His tendency to alter and rewrite, without authorisation,
620-409: A prosthesis. Another side effect can be heterotopic ossification , especially when a bone injury is combined with a head injury. The brain signals the bone to grow instead of scar tissue to form, and nodules and other growth can interfere with prosthetics and sometimes require further operations. This type of injury has been especially common among soldiers wounded by improvised explosive devices in
682-509: A total value of about US$ 6 billion, which may have been the largest private fortune in Europe. Essentially all family assets were surrendered to the Nazis in return for protection afforded the two sisters under exceptional interpretations of racial laws, allowing them to continue to live in their family palace in Vienna. His wife, Hilde, had been his pupil; they had two children before their marriage,
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#1733085206832744-602: A touring company presenting the work in Spain; and Webern 's Pieces for Cello and Piano, op. 11. Wührer also performed music by Béla Bartók , Igor Stravinsky , Sergei Prokofiev , and Paul Hindemith . On 3 July 1930 he performed Schoenberg student Paul Pisk 's Suite for Piano in the first broadcast of that composer's music by the British Broadcasting Corporation . Wührer made his Salzburg Festival debut in 1938. In 1939, as Paul Wittgenstein , who commissioned
806-462: A war injury. In some cultures and religions, minor amputations or mutilations are considered a ritual accomplishment. When done by a person, the person executing the amputation is an amputator. The oldest evidence of this practice comes from a skeleton found buried in Liang Tebo cave, East Kalimantan , Indonesian Borneo dating back to at least 31,000 years ago, where it was done when the amputee
868-403: Is Aron Ralston , a hiker who amputated his own right forearm after it was pinned by a boulder in a hiking accident and he was unable to free himself for over five days. Body integrity identity disorder is a psychological condition in which an individual feels compelled to remove one or more of their body parts, usually a limb. In some cases, that individual may take drastic measures to remove
930-403: Is carried out on individuals as a preventive surgery for such problems. A special case is that of congenital amputation , a congenital disorder , where fetal limbs have been cut off by constrictive bands. In some countries, judicial amputation is currently used to punish people who commit crimes. Amputation has also been used as a tactic in war and acts of terrorism; it may also occur as
992-491: Is extensive tissue damage and poor circulation also benefit from hyperbaric oxygen therapy (HBOT). The high level of oxygenation and revascularization speed up recovery times and prevent infections. A study found that the patented method called Circulator Boot achieved significant results in prevention of amputation in patients with diabetes and arteriosclerosis. Another study found it also effective for healing limb ulcers caused by peripheral vascular disease. The boot checks
1054-541: Is the Van Nes rotation , or rotationplasty, i.e. the turning around and reattachment of the foot to allow the ankle joint to take over the function of the knee. Types of amputations include: Types of upper extremity amputations include: A variant of the trans-radial amputation is the Krukenberg procedure in which the radius and ulna are used to create a stump capable of a pincer action. Hemicorporectomy , or amputation at
1116-526: Is typically followed with a more time-consuming, definitive amputation such as an above or below knee amputation . Frostbite is a cold-related injury occurring when an area (typically a limb or other extremity) is exposed to extreme low temperatures, causing the freezing of the skin or other tissues. Its pathophysiology involves the formation of ice crystals upon freezing and blood clots upon thawing, leading to cell damage and cell death . Treatment of severe frostbite may require surgical amputation of
1178-558: The Iraq War . Due to technological advances in prosthetics, many amputees live active lives with little restriction. Organizations such as the Challenged Athletes Foundation have been developed to give amputees the opportunity to be involved in athletics and adaptive sports such as amputee soccer . Nearly half of the individuals who have an amputation due to vascular disease will die within 5 years, usually secondary to
1240-607: The Vienna Secession , especially Gustav Klimt . He also owned a number of works by Rudolf von Alt . He also had a large collection of music and musical instruments. John Barchilon wrote a novel based on Wittgenstein's life, called The Crown Prince (1984). An episode of the long-running American television series M*A*S*H , "Morale Victory", featured James Stephens as a drafted concert pianist with debilitating nerve damage in his right hand after being wounded in combat. Charles Winchester ( David Ogden Stiers ) provides him with
1302-524: The Danish Ambassador, he wrote to his old teacher Josef Labor , who was blind, asking for a concerto for the left hand. Labor responded quickly, saying he had already started work on a piece. Following the end of the war, Wittgenstein studied intensely, arranging pieces for the left hand alone and learning the new composition written for him by Labor. Once again he began to give concerts. Many reviews were qualified with comments that he played very well for
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#17330852068321364-556: The Ertl procedure in order to return a high number of amputees to the work force. The Ertl technique, an osteomyoplastic procedure for transtibial amputation, can be used to create a highly functional residual limb. Creation of a tibiofibular bone bridge provides a stable, broad tibiofibular articulation that may be capable of some distal weight bearing. Several different modified techniques and fibular bridge fixation methods have been used; however, no current evidence exists regarding comparison of
1426-981: The Etudes, Wührer wrote 18 Studies on Chopin Etudes in Contrary Motion (1958) as a pedagogical work for equalising the facility of both hands. Wührer also composed and published cadenzas for Mozart 's piano concerti in C ;major , K. 467; C minor , K. 491; and D major , K. 537. In 1935, Wührer performed piano solos for the Carmine Gallone film Wenn die Musik nicht wär , which is also known in Germany as Liszt Rhapsody and in English-speaking countries as If It Were Not for Music . Wührer made numerous commercial phonograph records. While his discography includes 78 rpm records, such releases are outnumbered by his output during
1488-613: The German and Austrian traditions. Later in life, Wührer was a juror at the Second Van Cliburn International Piano Competition in 1966, which awarded first prize to Radu Lupu . Wührer was also a member of the piano jury at the 1968 Queen Elisabeth International Music Competition . Wührer's son, also named Friedrich, was a violinist and conductor who made classical records. He died in Mannheim . Outside
1550-716: The United States in 1941 he set them up in a house on Long Island , which he visited at weekends from his apartment on Riverside Drive . Wittgenstein became an American citizen in 1946 and spent the rest of his life in the United States, where he did much teaching as well as playing. He died in New York City in 1961 and was initially buried on Long Island, but was later disinterred and reburied in Pinegrove Cemetery, South Sterling, Pike County, Pennsylvania , where his widow had moved. Wittgenstein collected artworks by artists of
1612-776: The Vienna Academy in 1915, Wührer continued studying piano with Franz Schmidt , along with taking courses in conducting under Ferdinand Löwe and music theory under Joseph Marx . His performing career began in the early 1920s, and he toured Europe and the United States in 1923. Wührer was a founder of the International Society for Contemporary Music in Vienna. He formed friendships with composers Hans Pfitzner and Max Reger , and became associated with Arnold Schoenberg and his circle, participating in performances of Schoenberg's setting of 15 poems from Das Buch der hängenden Gärten , Op. 15; his Pierrot lunaire as part of
1674-424: The accident, but sometimes a few days later after medical complications. Statistically, the most common causes of traumatic amputations are: The development of the science of microsurgery over the last 40 years has provided several treatment options for a traumatic amputation, depending on the patient's specific trauma and clinical situation: Methods in preventing amputation, limb-sparing techniques , depend on
1736-439: The affected tissue or limb; if there is deep injury autoamputation may occur. Sometimes professional athletes may choose to have a non-essential digit amputated to relieve chronic pain and impaired performance. The punishment of those who wage war against Allah and His Messenger, and strive with might for mischief through the land is execution or crucifixion, or cutting of hands and feet from opposite sides, or exile from
1798-531: The case of the works for left hand alone, revised for performance with two hands; he was also a champion of the Second Viennese School and other composers of the early 20th century. His recorded legacy, however, centers on German romantic literature, particularly the music of Franz Schubert . Born in Vienna , Wührer began piano study at age six with an Austrian teacher named Marius Szudelsky ; after entering
1860-407: The collections The Dream Lover and The Destiny of Natalie 'X' by William Boyd ) features Paul Wittgenstein. Books News Online sources Amputation Amputation is the removal of a limb by trauma , medical illness , or surgery . As a surgical measure, it is used to control pain or a disease process in the affected limb, such as malignancy or gangrene . In some cases, it
1922-410: The composer's sanction but apparently over Wittgenstein's objections, created two-hand arrangements of Franz Schmidt's Wittgenstein-inspired left-hand works. Pianists born after Wittgenstein who for one reason or another lost the use of their right hands, such as Leon Fleisher (although he eventually recovered his right hand's abilities) and João Carlos Martins , also played works composed for him. As
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1984-751: The concert hall, Wührer was a teacher in Vienna, the Hochschule für Musik und Darstellende Kunst Mannheim in 1934, Kiel in 1936, the Salzburg Mozarteum in 1948, and finally at the Staatliche Hochschule für Musik in Munich . He also regularly taught master classes at the Salzburg Mozarteum . He was denied an academy teaching position in East Germany in 1952, however, on grounds that he had been
2046-435: The dedicatee, shortly after its composition in 1943 and in the 1950s, he performed Kurt Hessenberg 's Piano Concerto, Op. 21 (1939). Nonetheless, notwithstanding his pioneering work for music of the Second Viennese School and other moderns of his day, Wührer's principal focus as a performer, his posthumous reputation, and his recorded legacy came to rest on performances of music from the romantic era , particularly works in
2108-429: The different techniques. A 2019 Cochrane systematic review aimed to determine whether rigid dressings were more effective than soft dressings in helping wounds heal following transtibial (below the knee) amputations. Due to the limited and very low certainty evidence available, the authors concluded that it was uncertain what the benefits and harms were for each dressing type. They recommended that clinicians consider
2170-600: The early LP era, which was mostly for the American Vox label. Among his LP recordings was the first nominally complete cycle of Schubert 's piano sonatas . It omitted a few fragmentary works, but it offered Ernst Krenek 's completion of the C major sonata, D. 840 ( Reliquie ), possibly otherwise represented on records only by Ray Lev 's Concert Hall Society account of similar vintage. In recent years, some of Wührer's LP recordings have emerged on compact disc . Vox bypassed his Schubert sonata cycle in favor of one recorded
2232-683: The extensive co-morbidities rather than due to direct consequences of amputation. This is higher than the five year mortality rates for breast cancer, colon cancer, and prostate cancer. Of persons with diabetes who have a lower extremity amputation, up to 55% will require amputation of the second leg within two to three years. The word amputation is borrowed from Latin amputātus, past participle of amputāre "to prune back (a plant), prune away, remove by cutting (unwanted parts or features), cut off (a branch, limb, body part)," from am-, assimilated variant of amb- "about, around" + putāre "to prune, make clean or tidy, scour (wool)". The English word "Poes"
2294-536: The first conceived after the first piano lesson, when Hilde was eighteen years old and Paul was forty-seven. Because Hilde was not Jewish, Paul was open to charges of " racial defilement "; in 1938 he fled to New York. In 1940 he spent seven months in Cuba, attempting to secure permanent visas for Hilde and himself, and it was in Havana , on 20 August 1940, that they married in a Catholic ceremony. When his wife and children arrived in
2356-708: The heart rhythm and compresses the limb between heartbeats; the compression helps cure the wounds in the walls of veins and arteries, and helps to push the blood back to the heart. For victims of trauma, advances in microsurgery in the 1970s have made replantations of severed body parts possible. The establishment of laws, rules, and guidelines, and employment of modern equipment help protect people from traumatic amputations. The individual may experience psychological trauma and emotional discomfort. The stump will remain an area of reduced mechanical stability. Limb loss can present significant or even drastic practical limitations. A large proportion of amputees (50–80%) experience
2418-572: The immediate danger of death from blood loss. Orthopedic surgeons often assess the severity of different injuries using the Mangled Extremity Severity Score. Given different clinical and situational factors, they can predict the likelihood of amputation. This is especially useful for emergency physicians to quickly evaluate patients and decide on consultations. Traumatic amputation is uncommon in humans (1 per 20,804 population per year). Loss of limb usually happens immediately during
2480-412: The inner logic of the work is not clear to me, and, of course I can't play it until it is." He rejected outright Hindemith's Piano Music with Orchestra Op. 29; he hid the score in his study, and it was not discovered until after his widow's death in 2002 (by which time Hindemith himself had been dead for 39 years). He was able to take this approach because he inserted into his contracts with composers
2542-456: The land. As for the thief, male or female, cut off their hands and feet from opposite ends in recompense for what they have committed. Surgeons performing an amputation have to first ligate the supplying artery and vein , so as to prevent hemorrhage (bleeding). The muscles are transected, and finally, the bone is sawed through with an oscillating saw . Sharp and rough edges of bones are filed, skin and muscle flaps are then transposed over
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2604-426: The muscle tendon is attached to the bone. Muscles are attached under similar tension to normal physiological conditions. An experimental technique known as the "Ewing amputation" aims to improve post-amputation proprioception . Another technique with similar goals, which has been tested in a clinical trial, is Agonist-antagonist Myoneural Interface (AMI). In 1920, Dr. Janos Ertl Sr. of Hungary , developed
2666-631: The music for Ravel's Concerto for the Left Hand , tells him Wittgenstein's story and encourages him not to abandon his musical gift. Wittgenstein appears as a character in Derek Jarman 's 1993 film Wittgenstein , about his brother Ludwig. Wittgenstein is referenced extensively in the latter half of Brian Evenson's novel Last Days . Wittgenstein's life is the basis for the Neil Halstead song "Wittgenstein's Arm" on his 2012 album Palindrome Hunches . The short story "Transfigured Night" (found in
2728-417: The offending appendages, either by causing irreparable damage to the limb so that medical intervention cannot save the limb, or by causing the limb to be severed. In surgery , a guillotine amputation is an amputation performed without closure of the skin in an urgent setting. Typical indications include catastrophic trauma or infection control in the setting of infected gangrene . A guillotine amputation
2790-452: The other compositions that Wittgenstein inspired. But when Wittgenstein made changes to the score for the première, Ravel became incensed and the two never reconciled. Wittgenstein did not perform every piece he had commissioned. He told Prokofiev that he did not understand his 4th Piano Concerto but would someday play it; however, he never did so. He later stated that "Even a concerto Prokofiev has written for me I have not yet played because
2852-445: The phenomenon of phantom limbs ; they feel body parts that are no longer there. These limbs can itch, ache, burn, feel tense, dry or wet, locked in or trapped or they can feel as if they are moving. Some scientists believe it has to do with a kind of neural map that the brain has of the body, which sends information to the rest of the brain about limbs regardless of their existence. Phantom sensations and phantom pain may also occur after
2914-474: The problems that might cause amputations to be necessary. Chronic infections, often caused by diabetes or decubitus ulcers in bedridden patients, are common causes of infections that lead to gangrene, which, when widespread, necessitates amputation. There are two key challenges: first, many patients have impaired circulation in their extremities, and second, they have difficulty curing infections in limbs with poor blood circulation. Crush injuries where there
2976-523: The pros and cons of each dressing type on a case-by-case basis: rigid dressings may potentially benefit patients who have a high risk of falls; soft dressings may potentially benefit patients who have poor skin integrity. A 2017 review found that the use of rigid removable dressings (RRD's) in trans-tibial amputations, rather than soft bandaging, improved healing time, reduced edema, prevented knee flexion contractures and reduced complications, including further amputation, from external trauma such as falls onto
3038-456: The recital programmes did not, as Wührer had promised Wittgenstein, make any note of the latter's exclusive rights to the works, and as a descendant of Jews, Wittgenstein had no recourse in Nazi-governed countries. Wührer continued his advocacy for modern works at least into middle age. For instance, he gave the premiere of Pfitzner's Sechs Studien für das Pianoforte , Op. 51, of which he was
3100-424: The removal of body parts other than the limbs, e.g. after amputation of the breast, extraction of a tooth (phantom tooth pain) or removal of an eye ( phantom eye syndrome ). A similar phenomenon is unexplained sensation in a body part unrelated to the amputated limb. It has been hypothesized that the portion of the brain responsible for processing stimulation from amputated limbs, being deprived of input, expands into
3162-497: The stipulation that he held the unique performing rights on a composition during his lifetime. As Wittgenstein explained to Siegfried Rapp on June 5, 1950: You don't build a house just so that someone else can live in it. I commissioned and paid for the works, the whole idea was mine.... But those works to which I still have the exclusive performance rights are to remain mine as long as I still perform in public; that's only right and fair. Once I am dead or no longer give concerts, then
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#17330852068323224-464: The stump, occasionally with the insertion of elements to attach a prosthesis . Distal stabilisation of muscles is often performed. This allows effective muscle contraction which reduces atrophy, allows functional use of the stump and maintains soft tissue coverage of the remnant bone. The preferred stabilisation technique is myodesis where the muscle is attached to the bone or its periosteum. In joint disarticulation amputations tenodesis may be used where
3286-426: The stump. Post-operative management, in addition to wound healing, considers maintenance of limb strength, joint range, edema management, preservation of the intact limb (if applicable) and stump desensitization. Traumatic amputation is the partial or total avulsion of a part of a body during a serious accident, like traffic, labor, or combat. Traumatic amputation of a human limb, either partial or total, creates
3348-553: The surrounding brain, ( Phantoms in the Brain : V.S. Ramachandran and Sandra Blakeslee ) such that an individual who has had an arm amputated will experience unexplained pressure or movement on his face or head. In many cases, the phantom limb aids in adaptation to a prosthesis, as it permits the person to experience proprioception of the prosthetic limb. To support improved resistance or usability, comfort or healing, some type of stump socks may be worn instead of or as part of wearing
3410-788: The time) to leave Vienna, but they demurred: they were attached to their homes there, and could not believe such a distinguished family as theirs was in real danger. Ludwig had already been living in England for some years, and Margaret (Gretl) was married to an American. Paul himself, who was no longer permitted to perform in public concerts under the Nazis, departed for the United States in 1938. From there he and Gretl, with some assistance from Ludwig (who acquired British nationality in 1939), managed to use family finances (mostly held abroad) and legal connections to attain non-Jewish status for their sisters. The family's financial portfolio consisted of properties and other assets in Germany and occupied lands with
3472-417: The waist, and decapitation , or amputation at the neck, are the most radical amputations. Genital modification and mutilation may involve amputating tissue, although not necessarily as a result of injury or disease. In some rare cases when a person has become trapped in a deserted place, with no means of communication or hope of rescue, the victim has amputated their own limb. The most notable case of this
3534-647: The work, had fled Austria, Wührer performed in the premiere of Schmidt's Quintet for piano, violin, clarinet, viola, and cello in A major, albeit in his own arrangement for two hands rather than, as originally written for piano, left hand alone. Thereafter, Wührer performed all the Schmidt left-hand compositions in his own two-hand arrangements. He and Wittgenstein viewed each other with animosity; Wittgenstein accused Wührer of being an enthusiastic Nazi who later tried to cover it up, and Wührer disparaged Wittgenstein's personality and pianism. Whether for this or some other reason,
3596-613: The works he had commissioned have also contributed to his controversial musical status. The Wittgenstein family had converted to Christianity three generations before his birth on the paternal side and two generations before on the maternal side; nonetheless they were of mainly Jewish descent, and under the Nuremberg laws they were classed as Jews. Following the rise of the Nazi Party and the annexation of Austria , Paul tried to persuade his elder sisters Hermine and Helene (69 and 64 years old at
3658-470: The works will be available to everyone because I have no wish for them to gather dust in libraries to the detriment of the composer. (Siegfried Rapp was to premiere Prokofiev's 4th Piano Concerto in 1956, five years before Wittgenstein's death.) Many of the pieces Wittgenstein commissioned are still frequently performed today by two-armed pianists; in particular, the Austrian pianist Friedrich Wührer , claiming
3720-508: Was a young child. Lower limb amputations can be divided into two broad categories: minor and major amputations. Minor amputations generally refer to the amputation of digits . Major amputations are commonly below-knee- or above-knee amputations. Common partial foot amputations include the Chopart , Lisfranc , and ray amputations. Common forms of ankle disarticulations include Pyrogoff, Boyd, and Syme amputations. A less common major amputation
3782-567: Was first applied to surgery in the 17th century, possibly first in Peter Lowe's A discourse of the Whole Art of Chirurgerie (published in either 1597 or 1612); his work was derived from 16th-century French texts and early English writers also used the words "extirpation" (16th-century French texts tended to use extirper ), " disarticulation ", and " dismemberment " (from the Old French desmembrer and
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#17330852068323844-400: Was frequently visited by prominent cultural figures, among them the composers Johannes Brahms , Gustav Mahler , Josef Labor , and Richard Strauss , with whom the young Paul played duets. His grandmother, Fanny Wittgenstein, was a first cousin of the violinist Joseph Joachim , whom she adopted and took to Leipzig to study with Felix Mendelssohn . He studied with Malvine Brée and later with
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