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Doctor Bluma Tischler pushed for screening of newborns

Bluma Tischler with Premier Bill Bennett in May, 1978, when the B.C. government created a postdoctoral medical fellowship in her name.

Courtesy of the Tischler family

If ever anyone had a calling to be a physician, it was Polish-born Bluma Tischler. Through luck, courage and persistence, she vaulted over all obstacles in her path to study medicine, including poverty, war, anti-Semitism and the postwar confusion of Europe. She began her medical education in Russian in Tajikistan, continued it in Polish in her homeland, then in German in Munich and finally in English in Montreal, where she did her pediatric residency.

A job offer to her psychiatrist husband, Isaac Tischler, took the couple to Vancouver in 1955. There, she was hired as the first pediatrician at the Woodlands School in nearby New Westminster, founded five years earlier as a progressive place to care for British Columbia's mentally handicapped. She expected to stay for a year, but remained for 33, becoming medical director of the institution, which in its peak years in the 1960s had 1,400 residents and a waiting list of 800.

Dr. Tischler co-authored 36 papers in peer-reviewed scientific and medical journals, adding by increments to the overall knowledge of the complex causes and prevention of mental retardation, a condition that began to be understood only in the middle of the last century.

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Due in part to her work, Vancouver became an important centre for research into mental retardation, attracting top minds working in this area from around the world.

Dr. Tischler died, at the age of 90, on May 16 at the Weinberg Residence in Vancouver, where she lived for the past five years. According to her eldest son, Aron Tischler, she had stopped eating, then drinking.

"She was a lovely person and dedicated physician," said HilaryVallance, director of the B.C. Newborn Screening Program, whose earliest iteration in 1964 owed much to Dr. Tischler's forceful advocacy.

"Bluma was at the vanguard of 'knowledge translation' and 'knowledge implementation' long before these became popular terms in medicine," said Howard Feldman, a neurologist and associate dean of the University of British Columbia, where she was a clinical professor.

Bluma Gorfinkel was born on June 20, 1924, in Baranowicze, in northeastern Poland, the youngest of three children of Aron and Stera Gorfinkel. Her father ran a bank for the town's Jewish community; her mother was a dentist.

In September, 1939, the German army invaded Poland from the west and the Soviets from the east, dividing the country according to the then-secret Molotov-Ribbentrop pact. Two years later, the Nazis attacked the eastern half of Poland. Bluma's elder brother and sister were away studying engineering in Lwow, and she and her parents soon fled their home. They headed south and eastward by any means possible – mostly walking. At some point, Stera and Bluma became separated from Aron and never saw him again.

Mother and daughter kept moving, travelling an astonishing 3,700 kilometres before reaching Stalinabad, capital of Tajikistan. According to Bluma's younger son, Fred Tischler, the two made stops along the way so Stera could earn money as a dentist. Bluma's brother and sister eventually joined them in Stalinabad, where 17-year-old Bluma finished high school and began to study medicine.

The Leningrad medical school had been evacuated to Stalinabad and was training doctors to send to the front. As part of the curriculum, Bluma and her fellow students (almost all female) were taught to assemble and use a rifle. In her class she met a handsome Red Army soldier, Isaac Tischler, who had been wounded in the battle for Kiev. They began studying together and fell in love.

When the war ended, they married in a civil ceremony and headed back to Poland. In Lwow, they found a synagogue still standing and approached the rabbi to marry them. According to family legend, the absence of sacramental wine almost prevented the exchange of vows, until Isaac found some kvass, a fermented local tipple made from bread, and tinted it with beet juice.

The couple were continuing their studies in a Catholic hospital in Breslau when news came, a year after war's end, of the Kielce Pogrom in which 42 Jews were murdered while police stood by. "My parents and grandmother saw they couldn't live there. The hatred for the Jews was so strong," explained son Fred.

Using fake papers, they made their way to Munich where Isaac and Bluma were accepted into Ludwig Maximilian University, provided that Bluma learn German, which she did. They did their internships at a Munich hospital but when they learned that Bluma's siblings had made it to Montreal, they worked as cleaners to pay their passage across the Atlantic to join them in 1950. (All of Isaac's siblings died in the Holocaust.)

Once in Montreal, Bluma had to repeat her internship to qualify as a doctor before doing her pediatric residency at Childrens' Hospital. When she and Isaac moved west, her mother stayed in Montreal with Bluma's siblings. Vancouver was the end of the rainbow for the couple. Their two sons were born there, in 1955 and 1957.

"My father was thrilled to discover the ocean in any direction, mountains, parks. They became huge fans of Vancouver," Fred recalled.

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Dr. Tischler began working at Woodlands at a time of ferment and discovery, as people grasped that impairments had multiple causes. In 1959, a French team discovered the extra chromosome that results in Down syndrome.

At Woodlands, she became interested in the metabolic errors that resulted in retardation, particularly phenylketonuria, or PKU, a condition in which a child is born normal but soon develops severe intellectual impairment, motor problems and skin abnormalities. In 1943, a Norwegian researcher identified the syndrome in two boys and devised a urine test for it.

In the next decade, J.H. Quastel at England's Cardiff City Mental Hospital gave the condition its name and explained the brain chemistry involved. PKU is caused by an amino acid, phenylalanine, present in meat, milk, eggs and other proteins, that can't be metabolized in the bodies of those affected. The buildup of this amino acid in the blood irreversibly damages the brain.

In the mid-1950s, at the Birmingham Children's Hospital in England, German physician Horst Bickel and British biochemist Louis Woolf figured out how to filter the fatal amino acid from milk, using activated charcoal. It became possible to nourish a PKU infant without damaging the brain.

At Woodlands, Dr. Tischler applied the Birmingham team's findings. She was eager to try anything to improve the condition of the low-IQ children in her care.

She put her nutrition department to work to devise safe nourishment for PKU children, and dispensed it free at the outpatient clinic. She did her own study of residents who tested positive for PKU to try to determine up to what age the special diet might be useful. Half the group ate a normal diet, the other the filtered diet. She found that the special diet had some positive effects up to the age of six, but none thereafter.

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The breakthrough in prevention came in 1961, when American physician Robert Guthrie came up with an easy, reliable blood test for PKU, based on a pinprick of a newborn's heel.

Dr. Tischler's sons recall that she went to Victoria and Ottawa to urge health officials to make the Guthrie test mandatory for all newborns. Screening for PKU was introduced in British Columbia in 1964, four years earlier than in England.

"Hundreds of children and adults in B.C. have benefited from newborn screening and treatment of PKU," Dr. Vallance said, noting that newborn screening has since expanded and "now tests for 22 treatable disorders," including cystic fibrosis and sickle-cell disease.

In 1961, Dr. Tischler was appointed to the medical faculty at UBC. Her reputation grew through her publications in peer-reviewed journals and many first-rate specialists were attracted to Woodlands, along with medical students who wanted to understand the management and prevention of developmental disabilities.

Dr. Woolf, from England, became her colleague at UBC in the 1970s, as did Dr. Quastel, who became the school's first professor of neurochemistry.

Dr. Tischler worked regularly at the biochemical diseases clinic at B.C. Children's Hospital, and concluded her career as professor emerita of pediatrics at UBC.

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In 1977, she received the Queen's Jubilee Medal, and in 1978 was honoured by the province with a postdoctoral fellowship in biochemistry and genetics, created in her name.

That same year, the Denver-based American Association on Mental Retardation (now the American Association on Intellectual and Developmental Disabilities) gave her its annual research award.

By the time she retired in 1988, large, costly institutions such as Woodlands were being dismantled across Canada, and their residents reintegrated into the community. Not all had severe handicaps, and some came forward to describe abuse they had suffered at Woodlands. One man who was in residence in the 1960s said he was wrongly labelled as having PKU, and that Dr. Tischler had experimented unethically on her charges without obtaining their consent.

On the basis of public complaints, the province commissioned a report that described overcrowding, understaffing and incidents of physical and sexual abuse by Woodlands staff. The 2001 report did not mention Dr. Tischler.

"It was a challenging time for her," recalled her son Aron, an ophthalmologist. "Woodlands got a lot of bad press which she felt was unjustified, taken out of context. She felt she and her team did everything to the best of their ability," he said.

"What she emphasized (to us) was that what they did was acceptable at the time," said Fred, a lawyer. "She was never defensive. There may have been inappropriate actions by staff, and they were disciplined."

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A 2002 class-action suit launched against the province by former Woodlands residents was settled out of court in 2009. Woodlands, which had closed in 1996, was demolished in 2011.

Dr. Tischler, whose husband died in 2003, leaves sons Aron and Fred, their wives and five grandchildren.

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