Pioneers of Neurosurgery in Germany



Ernst von Bergmann

Ernst von Bergmann (1836 – 1907) was one of the most famous and successful surgeons in Europe at the end of the 19th century.  He developed procedure for the treatment of gunshot wounds, particulary of the joints and the skull. As professor and head of the surgical department at the Universities of Dorpat (1871-1878), Würzburg (1878-1882) and Berlin (1882-1907), he published a huge number of internationally approved scientific articles. In addition to his very time-consuming clinical activities von Bergmann became initiator of the surgical asepsis and developed operative methods valid up to this day in traumatology, abdominal, tumour and, above all, in neurological surgery. Being member or chairman of different medical associations and editor of prestigious periodicals, he started an effective post-graduate training for interested colleagues and arranged the first qualified exhaustive rescue service in the German capital.

In 1880, he authored 1st Textbook on surgery on nervous system, which  described missile ballistics and animal experiments first demonstrating the physiological response later known as "the Cushing reflex" and advocated meticulous intracranial debridement with thorough closure after cranial trauma. Twenty years later, as senior editor of the massive System of Practical Surgery, his contributions included pediatric neurosurgery, successful treatment of abscesses and tumors, diagnostic radiography, and cerebral localization using external landmarks and the neurological examination. 

 

Fedor Krause (1857-1937)

Fedor Krause

Within a few months of Wilhelm Conrad Röntgen's discovery of x-rays in 1895, Fedor Krause acquired an x-ray apparatus and began to use it in his daily interactions with patients and for diagnosis. He was the first neurosurgeon to use x-rays methodically and systematically. In 1908 Krause published the first volume of text on neurosurgery, Chirurgie des Gehirns und Rückenmarks (Surgery of the Brain and Spinal Cord), which was translated into English in 1909.  This was the first published multivolume text totally devoted to neurosurgery. He devised neurosurgical approaches (the "Krause operations)  for exposure of the trigeminal ganglion and root, of the cerebellopontine angle, and of the pituitary (transfrontal) and the pineal (supracerebellar) regions.

 

Otfried Foerster (1873-1941): German neurologist, neurosurgeon and system physiologist.

Otfrid Foerster was a neurosurgeon, an innovative experimental neurophysiologist and a neurologist.  His contributions included description of the dermatomes , conceptualizing rhizotomy as a cure for spasticity, anterolateral cordotomy for pain, the hyperventilation test in epilepsy, Foerster's syndrome, and the first electrocorticogram of a brain tumor. Foerster was able to excise intraventricular, hypophyseal, and quadrigeminal lesions and to perform epilepsy surgery under primitive conditions without clips, diathermy, or suction. He published more than 300 scientific monographs encompassing every aspect of the nervous system, including tabes, movement disorders, spasticity, extrapyramidal diseases, dermatomes, epilepsy, cortical localization, brain tumors, peripheral nerve injuries, and pain.

Following Fedor Krause and Otfrid Foerster, pioneers of neurosurgery in Germany, Emil Heymann was one of the outstanding promoters of the young surgical section, before it emerged as an independent specialty. As successor to Fedor Krause at the Augusta-Hospital, Berlin, he consistently improved techniques of investigation and operative treatment of intracranial and spinal tumors.

Fritz König (1866-1952), pioneer of modern neurosurgery in Germany.  Fritz König  enabled his resident Wilhelm Tönnis to be educated by Herbert Olivecrona in his Department of Neurosurgery in Stockholm. After his return from Sweden the first independent Department of Neurosurgery was founded for Wilhelm Tönnis in Würzburg. His scientific journal, "Zentralblatt für Neurochirurgie" was founded in 1936, which consolidated the scientific bond between all neurosurgeons of the world.

Klaus Joachim Zülch (1910-1988) as head of a department of the German Max-Planck-Society, deeply influenced the neurological sciences in post-war Germany. The department with the name Abteilung für allgemeine Neurologie (i.e. department of general neurology) constituted a section of the renowned Max-Planck-Institut für Hirnforschung (i.e. institute for brain research). At the same time he was in charge of the local neurology unit of the municipal Cologne hospital. He worked on  raised intracranial pressure, brain swelling and edema, brain and spinal chord circulation disturbances, head injuries and - in the first line - tumors of the central nervous system. His first contact with neurology specialty took place in Otfrid Foersters neurological clinic in Breslau, today in Poland, before World War II. Otfrid Foerster, a neurological encyclopedist, exerted a deep influence upon Klaus Joachim Zülch lifelong. Here he also came in contact with Percieval Bailey with whom he shared the obsession to classify brain tumors since then. This preoccupation became fruitful when he started collaboration with Wilhelm Tönnis . His association with Wilhelm Tönnis may well be compared to the team formed by Harvey Cushing and Percieval Bailey. Their respective philosophies were equally identical, namely to classify tumors of the central nervous system through a pragmatic approach that would facilitate the communication between neuropathologist, neurosurgeon, neurologist and of course be ultimately as helpful as possible to the patient.

Resources

PubMed abstracts, Wikipedia

Zimmermann  M.   Life and work of the surgeon Ernst von Bergmann (1836-1907), long-term editor of the "Zentralblatt für Chirurgie". Zentralbl Chir. 2000;125(6):552-60.

Hanigan WC, Ragen W, Ludgera M.Neurological surgery in the nineteenth century: the principles and techniques of Ernst von Bergmann. Neurosurgery. 1992 May;30(5):750-7.


Wallesch CW. Otfrid Foerster (1873-1941): German neurologist, neurosurgeon and system physiologist.Cortex;43:4 2007 May pg 491-3

Kuhlendahl H. Beginnings of neurosurgery in Germany: Fedor Krause. With comments on the understanding of medical history. Zeitschrift für Neurologie 204:3 1973 May 17 pg 159-63


Rosegay H. The Krause operations. Journal of neurosurgery 76:6 1992 Jun pg 1032-6