The Auriculotemporal Nerve Syndrome,Lucja Frey,and the Holocaust

Frey Syndrome

Before Frey syndrome was Frey syndrome, European neurologists had described gustatory sweating as a complication of trauma to the parotid area. ¹ However, it was not until 1923 that a 34-year-old Dr Lucja Frey described the pathophysiology ² : Presynaptic parasympathetic fibers leave the inferior salivary nucleus. Their downstream postsynaptic continuations leave the otic ganglion to join the auriculotemporal nerve—a division of the mandibular nerve. In its route to the parotid and mucus glands, the auriculotemporal nerve travels laterally (out) and superiorly (up) between the mandibular joint and the external auditory canal. Meanwhile, postganglionic sympathetic fibers—en route to facial subcutaneous vessels and sweat glands—form a plexus around the internal and external carotid arteries. Frey explained that gustatory sweating arose from misdirection of the auriculotemporal nerve after trauma and included her elegant diagram of the innervation to the parotid gland (Figure 1). ³

Figure 1.

Dr Lucja Frey’s diagram of the innervation to the parotid gland. Published in 1923 with her explanation of the pathophysiological re-innervation of the gland. ³

Lucja Frey^2,4,5

Lucja Frey was born November 3, 1889 in what is now called Lviv, Ukraine, but was then part of the Austro-Hungarian empire. (The city’s name has toggled between Lwow, Lvov, Lviv, and Lemberg, depending on politics.) Her father was a building contractor, and although they were Jewish, her family lived in an affluent section of Lwow, outside the Jewish quarters. Lucja attended a Christian elementary school, had a Polish first name, and Polish was her mother tongue. She attended a private Jewish high school and entered the University of Lwow in Mathematics. Reports differ which subjects she passed through (mathematics, mathematical natural science, and philosophy) and which degrees she actually received. Her own details report passing the examination for secondary teachers of mathematical science in 1913 at 24 years old. She started studying with the Medical Faculty at the University of Lwow in 1917 when she would have been almost 28 years old. One of the few photographs of her dates from approximately 1918 (Figure 2). ⁴

Figure 2.

Lucja Frey in 1918 at 29 years old.

In 1918 to 1919, the aspiring Dr Frey interrupted her studies due to the war between Poland and Ukraine, and worked for a well-known Jewish Polish neurologist, Professor Kazimierz Orzechowski, at the State Hospital in Lwow. Thereafter, she transferred to the University of Warsaw and received her medial diploma on June 2, 1923 at the age of 34. She became accredited in neurology June 25, 1925. Dr Frey then worked in the neurology clinic at the University of Warsaw from 1921 until 1928. Her pioneering description of the misdirection of the auriculotemporal nerve appeared in 1923. ² She only published medical articles between 1923 and 1928; she published 43 of them on topics including brain topology, effects of poisons on spinal cord degeneration, hereditary diseases of the nervous system, and anatomical changes of in Charcot joints. ⁴

The Holocaust^3-6

With the rise of antisemitism, Dr Frey moved back to her hometown of Lwow and began working at the Hospital of the Jewish Religious Commune in 1929 ⁵ or 1936. ⁶ After September 1939, the Soviet Army occupied then-Lviv and Dr Frey’s husband was arrested by the Soviet secret police for anticommunist activities and was never seen again. ⁵

In June 1941, the German army occupied then-Lemberg. Dr Frey and her children, along with 136,000 Jewish nationals, were relocated to the “Ghetto Lemberg.” There, she worked in the ghetto clinic, called the “Second Jewish Clinic” (Figure 3). On April 4, 1942, she received “green card” number 144, indicating that as a doctor she was still deemed “useful,” rather than “useless.” ⁴ This card is the last record that she was still alive. However, by August of the same year, physicians too were regarded as “useless.”

Figure 3.

Dr Lucja Frey in 1941, age 52, around the time of the German occupation of Lwow.

On August 20, 1943, approximately 400 people, comprising all the staff and patients of the “Second Jewish Clinic” were shot.^2,5 Dr Frey was probably either murdered in that action or was deported to the Nazi death camp in Belźec (now in Poland) between August 10 and August 20, 1943.^2,5

When the Soviet Army recaptured Lvov on July 27, 1944, 823 of the original 250,000 Jews were still alive, but Dr Lucja Frey and her family were not among them. ⁴ Dr Frey’s mentor, Kazimierz Orzechowski, died in the Warsaw ghetto on February 5, 1942, on his 65th birthday. ⁴ As for Lucja Frey, a Colleague recalled her as “extraordinarily modest, quiet, and as hard-working as an ant. She was distinguished by. . . an exceptional creativity. All her works were characterized by an exceptional accuracy.” ⁷