Prof. Dr. med. habil. Georg Merrem (1908–1971) – A Historical Vignette

September 21st 2008 is the 100^th anniversary of Georg Merrem's birthday. He was born in Königsberg in Eastern Prussia, now Kaliningrad, the son of the high ranking military physician Dr. Karl Merrem. He grew up with three siblings, went to school in Danzig (now Gdansk) and later to the “Gymnasium” in Berlin, finishing that with the school leaving examination (Abitur) in 1927. Whereas both his brothers went into law, Georg followed the path of his father and started his medical studies 1927 in Tübingen, soon to change to Berlin in 1928. Among his teachers and professors were famous people like Bier, Sauerbruch, von Bergmann, Stoeckel, Rössle and others. He finished his studies with the final state examination in 1932 with “very good” success. His initial work as a junior doctor was done at the Hedwigs-Krankenhaus and later on the deciding period of his education took place in the Augusta-Hospital in which Fedor Krause was working. The successors of Krause were Emil Heymann and Carl Max Behrend. This was the time of the first contact to neurosurgery, an event which fascinated him from then on. 1933 Merrem finished his dissertation with the title “The treatment of multiple sclerosis with Germanin (Bayer 205)” supervised by Emil Heymann.

Georg Merrem married the ophthalmologist Dr. Anni Hagedorn, which might explain his later interest for neuroophthalmology. When Merrem was drafted to do his military service in August 1939 he already had two children: Gisela and Bernd. His daughter Gisela, the oldest of his children later married the surgeon and neurosurgeon Dr. Wolf-Eberhard Goldhahn. In 1938 Merrem had received the degree of “specialist for surgery”, supplemented with a note “special knowledge in neurosurgery”.

At the begin of the war Merrem was referred to a medical unit very soon specialising in the treatment of injuries of the brain, spinal cord and peripheral nerves. This brain surgical group was led by Wilhelm Tönnis (serving in the airforce) and Herbert Peiper (serving in the army). Tönnis certainly had the largest influence on Merrem's activity in military surgery. Merrem was made the leader of a brain surgery group in field hospitals which consisted of one chief, three surgeons, two neurologists, one ophthalmologist, maxillofacial surgeon, otologist and pathologist each. One administrative assistant, two nurses, 57 military medical personnel and 35 drivers were also attached to such a unit.

After the war Herbert Peiper tried to convince Merrem to come to him in the city of Mainz where he had in the meantime become the Chairman of the Department of Surgery at the university. This, however, failed due to the lack of money on the side of the hospital. Finally, Merrem was offered a senior position at the surgical hospital in Dresden-Johannstadt by Dozent Dr. Sprung who was then the director of the surgical department. He agreed and started his work in June 1947 as “Oberarzt” and deputy to Doz. Sprung. The general surgical part of his work (500 beds) did not leave him any possibility to work in the neurosurgical field. Thus, at this time he only had the choice to give up neurosurgery or to find a more suitable working place.

Having kept up his contacts to Tönnis, Peiper and other neurosurgeons, he learned that the then Director of the University Department of Neurology and neuroscientist Prof. Richard Arwed Pfeifer wanted to create a department of neurosurgery in Leipzig. This way neurosurgery became a section within the Department of Neurology. Working conditions however, were difficult. For example since there was no elevator, patients needed to be carried by hand one flight of stairs up and down on the way to the operating room. In the era before the introduction of intubation anaesthesia all surgical interventions even in infants were done in local anaesthesia with the occasional use of barbiturates. Today this may appear unbelievable and it certainly is not necessary to discuss details of the problems arising from this constellation.

In 1950 Merrem submitted his thesis for the “Habilitation” on “Die Chirurgie des Ventrikelsystems als Ergebnis histopathologischer Beobachtung und neurochirurgischer Erfahrungen (Surgery of the ventricular system and the result of histopathological considerations and neurosurgical experiences)”to the medical faculty. The reviewers of his thesis were professors Uebermuth, Buzello and R. A. Pfeifer.

Until 1950 Merrem was the only neurosurgeon in that hospital. From October 1950 onward soon the facilities at the department no longer could keep up with the requirements brought about by the patient load. 1952 the department moved to another facility at Johannisalle 34. This house had been until 1932 the private hospital of the famous surgeon and late Chairman of the University Department Erwin Payr. Neurosurgery separated finally from the Department of Neurology and became an independent university hospital department, for many years to be the only one in East Germany. H.-G- Niebeling helped Merrem with his organisational talent to which the hospital in Leipzig owes a lot. The department developed quickly to a respected specialised unit. Many new surgeons, many of them later chairpersons themselves, were disciples of Merrem: Weickmann, Niebeling, Hübner, Krumbholz, Fried, Dietrich, Goldhahn, Skrzypczak, Kretschmer and Schöche. On top of that numerous neurologists and orthopaedic surgeons collected experience in the neurosurgical discipline working in this department frequently for several years. Merrem took great care to teach his neurosurgical fellows and co-workers a subtle neurological education, because neurology had an important place in diagnostics. After all, this was the time when CT scan and MRI were unknown. Angiography and pneumoencephalography or vertriculography besides the EEG were the only diagnostic procedures available. For that reason careful history taking and exact neurological examination were of great value. Again and again it was surprising to which precise results these two techniques could lead.

Merrem's national and international reputation was growing. From 1959 to 1961 he was dean of the Medical Faculty at the University of Leipzig. In this time he produced his manual of neurosurgery (“Lehrbuch der Neurochirurgie”) where this author had the pleasure to collaborate for the second printing. Besides being the chief at the unit in Leipzig Merrem was also covering in the nineteen-fifties for the neurosurgery department in the city of Halle. Between 1960 and 1962 he was the vice president of the German Society of Neurosurgery (president being W. Tönnis) and since 1969 he was an honorary member of the Deutsche Gesellschaft für Neurochirurgie. Due to the isolation caused by the political constellation the founding of a “Society of Neurosurgery in the German Democratic Republic” became necessary. One of his successors in this office, from a different hospital, later on removed the word “in” from the name of the society. The erection of the wall made travelling to “non-socialist” foreign countries impossible. For that reason he could not receive in person the Fedor Krause-medal which had been bestowed on him in 1969 by the German Society in West Germany, instead it was received by his twin brother Hans. His lecture on “The parasagittal meningiomas. In memory of the founder of German Neurosurgery Prof. Fedor Krause 1857–1937” (Die parasagittalen Meningeome. Zum Gedächtnis des Begünders der Deutschen Neurochirurgie Prof. Fedor Krause 1857–1937) was read by one of his friends, Prof. Peter Röttgen, Professor and Chairman at the Department of Neurosurgery at the University in Bonn. The medal which came with this honour reached Georg Merrem only one year later hidden in the underwear of a lady! He could, however repeat his honorary lecture at a meeting of the Saxonian Academy of Science in Leipzig which had made Merrem a member in 1960. Also the Academy of Science in Berlin had made him a member. In 1960 he received the Hufeland medal, 1961 he received the honour of “Verdienter Arzt des Volkes”. A famous price in the German Democratic Republic was the National Price. In 1958, 1962 and 1968 several renowned scientific societies had proposed Merrem to receive this price in recognition of his merits in the introduction of neurosurgery, but this was prevented by political functionaries because of a “lack of socialist attitude“.

When already showing signs of his severe illness, his family only suspecting something similar since Merrem had chosen not to inform them, he more and more realised the restrictions of his functionality. As usual in his attitude, personal complaints where silently taken, but not complained about ,following his old principle that personal problems should not be a discomfort to others. Georg Merrem died on July the 8^th 1971 in his own hospital. His burial took place on July the 13^th. On this occasion high party officialists and high administrative personalities again showed their rigid inhuman facet by not allowing his West German friends and colleagues to attend the memorial services. Prof. Kuhlendahl was refused the permission to enter the German Democratic Republic although being the president of the German Society of Neurosurgery at the time. Prof. Kuhlendahl wrote a letter to the director of the university telling him about the great loss, and concluding his letter with: “With great sorrow we learned that even at the open grave the political decision making was not willing to hold back and refused us to honour the dead with whom many of us were united in friendship for more than 40 years.” Interestingly, this letter was lacking in his chart kept at the university and was only available as a copy to his family.

The memorial service impressively reflected on the appreciation and popularity of Georg Merrem. A large number of his disciples, co-workers, friends and also patients accompanied him on his last way. Speaking at the grave, Prof. Matzen, Chairman of the Department of Orthopaedics in Leipzig and a good friend praised the human values of Merrem: “He was respected by his students and faculty colleagues due to his honesty, his convictions and the credibility of his judgement. He was not a friend of pompous talking and held the opinion, that a physician has to prove himself by his deeds. He did not trust “professional” morale preachers and people claiming to improve the world. He lived a life without compromises and lived it courageously to the very end.

Merrem's grave can be found on the Southern Cemetery in Leipzig. It is a family burial site together with his wife and the son who passed away only a few years after him.

Merrem was an excellent teacher, a compassionate human being and an important representative of the specialty of neurosurgery. He never bowed to the political system, instead courageously defended his opinion. This was possible for him last but not least due to the high reputation of his person. To keep the memory of him alive should be a duty for all neurosurgeons in particular for his disciples. In doing so let us follow the poet Hans Sachs who says: Honour your great masters.

The author was happy to have lived in a close relationship to the family of Georg Merrem, owing to the fact that he was a pupil at the same high school like Bernd Merrem, Georg Merrem's son. Prof. Merrem exposed both of them already at high school to occasional visits at the hospital in Halle, early awaking the interest for their later profession. Due to the integration in Merrem's family he was allowed to have a profound insight into the personality of Georg Merrem. His early death in 1971 constitutes a painful loss not only for his family, his friends, but also for neurosurgery.

Correspondence