Josef Pflug  Josef J Pflug

Josef J Pflug was an anatomist, doctor and surgeon. He was interested in the mechanisms of leg swelling. The majority of his work focussed on studying the lymphatic system in man. He published “The Normal Anatomy of the Lymphatic System in the Human Leg” together with JS Calnan in the British Journal of Surgery, 1971;58(12):925-30. His passion included research into varicose veins with a leading publication entitled “The Resting Interstitial Tissue Pressure in Primary Varicose Veins” in the Journal of Vascular Surgery, 1990;11(3):411-7. He also co-authored a book entitled “The Swollen Leg – causes and treatment” with JH Daintree in 1975 by Heinemann Medical Books; ISBN: 0433070420 / 9780433070429.

He is listed on PubMed as having published 39 articles in high impact factor journals. These include research into venous ulcers, endoscopic perforating vein ligation, prevention of venous thromboembolism, compression bandages, intermittent pneumatic compression and prostaglandin infusions. His publications on lymphoedema included the role of CT scanning and the clearance of isotopes. There were several papers on lymph composition and its cell growth properties as well as measurements of tissue pressure.

Josef Pflug came from Prague and emigrated to Germany to work in a private practice about half a week in Göppingen from where he always flew to London for the rest of the week. He worked as a consultant at Hammersmith and Ealing Hospitals, UK. He sadly died whilst in post but his inspiration and innovative ideas will remain in many of the students he taught.

The Josef Pflug Vascular Laboratory is located on the 7th Floor of Ealing Hospital, Middlesex, UB1 3HW, where it houses post doctorate researchers and students actively involved in their PhD, MSc, BSc and other degrees on venous, lymphatic and arterial diseases.

GEORGE GEROULAKOS  A personal testimony. In the late 1990’s I approached the head of Surgery and Cancer at the Imperial College, Professor S. Hughes who was an orthopaedic surgeon and we discussed about the need of the establishment of a specialised lymphoedema clinic, as there was an unmet clinical need for the management of these patients. Professor Hughes suggested that I contact Professor Pflug, who had just retired from Hammersmith Hospital and might be interested to help with this project. I invited Professor Pflug to discuss my plans and find  out whether he was interested to help. I was most impressed by his infectious energy and enthusiasm for the management of these patients.

He was based in Stuttgart, but he was happy to come as an unpaid member of staff once every 4 weeks from Germany and see patients with lymphoedema in my clinic at Ealing Hospital. We had many interesting discussions about the best individualised approach to my patients with lymphoedema, he provided me with literature and he invited me to his clinic in Stuttgart to teach me some of his operative techniques in the management of a small number of patients who benefit from surgery. He told me that he is at the end of his career and it is important to transfer his skills to a younger surgeon.

Suddenly one day he did not turn up in my clinic. His wife called me a few weeks later to inform me that he died suddenly while he was watching TV. We were all devastated for the sudden loss of our distinguished friend and colleague. The least we could do is give his name to our vascular lab at Ealing Hospital. This met the approval of the medical director Dr William Lynn. It is almost 10 years since he passed away. He will be always be in my thoughts as one of the brightest examples of the pioneers of the NHS who was prepared to travel on his own expenses from Stuttgart and work at Ealing with no salary and help my patients who had lymphoedema that is a difficult poorly understood chronic condition with limited not very effective treatment options.

JAROSLAV STREJČEK The picture of Josef J Pflug above was provided by Professor Arnost Fronek and his wife Dr Kitty Fronek from La Jolla, San Diego, California. It was taken in their house around 1983. They were both very close friends of Josef Pflug and like myself they are also of Czech origin. They moved to the USA in 1964.

I worked with Arnost Fronek and Josef Pflug for 2 years on a project about non-invasive vascular diagnostics. In particular, it was a collaborative research program on the non-invasive measurement of endothelial activity. Their enthusiasm and inspiration was a significant driving force which led to my position as the President of the Czech Society of Phlebology.

Below is a picture of Josef with Professor J Alexander Schirger (1925-2013). He was born also in Czechoslovakia and emigrated to the USA in 1951 where he achieved the position of Assistant Professor of Internal Medicine at the Mayo Clinic.

Schirger and Pflug

Prof Alexander Schirger (left) with Josef Pflug (right). Both died on 14th February.

MICHAEL BEVERLY  I have been asked to write a few words about my friend and colleague Dr Joseph Johann Pflug MD, FACS now sadly deceased (14/02/2005).

I first met Joe at the Hammersmith Hospital Wellcome Institute in about 1985 when I was a surgical registrar for one year. Joe Pflug was an enthusiastic research scientist interested mainly in the field of circulation, veins and lymphatics. I understand that he ran a swollen limb clinic at the Hammersmith Hospital for many years. He was a founder member of the GEL (Groupement Europeen de Lymphologie).

Joe had an interesting career. As I understand it he came originally from Czechoslovakia and trained in the USA where he obtained a Fellowship of the American College of Surgeons. At Hammersmith Hospital he worked three days a week, always with a significant research interest. He lived in the small town of Göppingen some 40 km east of Stuttgart. He owned a clinic and operated there for the other three days a week mainly on varicose veins, hands and feet, bunions and other minor orthopaedic problems.

My research in 1985 was of interest to him. He encouraged me to visit his hospital in West Germany where patients were selected by him for measurement of intraosseous, subfascial and vein pressures. I had a 4 channel chart recorder. Needles were inserted under local anaesthetic into the proximal tibial cancellous bone or at the ankle with additional needles in the dorsal foot vein, calf muscle and subfascial or epifascial space. We applied tourniquets at various pressures to obstruct arterial or venous flow while the patients were encouraged to stand or walk.

We were excited to find that activity appeared to confirm the existence of a calf muscle blood pump and possibly a subchondral venous pump activated by weight bearing and exercise. Two visits of a few days each were carried out in March and June 1986. Around a dozen patients in all were assessed and of these 5 or 6 gave useful recordings. As a result of the work a paper was given at the British Orthopaedic Association meeting in 1986 in Edinburgh. It won the Mukherjee Prize. Over the years there have been various other abstracts accepted but no definitive publication.

I lost contact with Joe within a few years of leaving the Hammersmith Hospital but believe that he continued to work for several years. I would frequently acknowledge his considerable support for my work and enthusiasm for basic vascular science in venous and lymphatic problems. I would be interested in knowing more of his life and work.