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Fritz Rehbein, MD 1911–1991
Journal of Pediatric Surgery VOL 27, NO 5
MAY 1992
In Memoriam
Fritz Rehbein, 1911-1991 ROFESSOR Dr Med h.c. Fritz Rehbein died suddenly and unexpectedly on September 7, 1991 while vacationing in the Austrian Alps. His loss is felt by his wife Ruth, three children, four grandchildren, and friends world wide. Only 5 months earlier, on the occasion of his 80th birthday, a celebration in his honor was held in the venerable city hall of the Hanseatic city of Bremen. In this touching tribute, colleagues and friends from Europe and abroad recounted the numerous contributions of this towering figure of pediatric surgery. Fritz Rehbein was born in Westuffeln, Hessen, Germany on April 8, 1911. He studied medicine in Munich, Bonn, Hamburg, and Heidelberg, and began his postgraduate education at the University of Gottingen in 1936 under the well-known general surgeons Rudolf Stich, Ewald Herlyn, and Hans Hellner. This
P
JournalofPediatric
Surgery, Vol 27, No 5 (May), 1992: pp 545-547
MD
training was interrupted by the second world war, which he spent as a surgeon in a field hospital. After the war he had the opportunity to work as chief of the pediatric ward of the clinic in Gottingen. This experience made clear to him the very special surgical needs of children. In Germany at that time only one surgeon, Anton Oberniedermayr, had dedicated himself entirely to pediatric surgery. Severe malformations of the gastrointestinal tract, an area to which Rehbein later devoted great effort, were rarely operated upon. Thus, he initially focused on the repair of nonlethal congenital anomalies, such as cleft lip and palate. He gradually expanded his surgical expertise in children to the correction of aortic stenosis, patent ductus arteriosus, and BlalockTaussig anastomoses. Encouraging results convinced him that major surgical interventions were well toler545
546
ated by children and that complex congenital anomalies were amenable to repair in an appropriate setting. In 1951 he became director of the surgical clinic of the children’s hospital in Bremen, a position he held until his retirement in 1976. The surgical activity of the hospital at that time was limited to small routine procedures. Rehbein recognized that a much stronger infrastructure was needed in order to fulfill the needs of what should become a new surgical specialty. Unable to obtain financial support for study abroad, he became a self-taught pediatric surgeon. His knowledge was derived from a broad general surgical education and experience which included thoracic, urologic, and orthopedic surgery. In the course of a few years he transformed his small division into a world renown pediatric surgical center. On October 17, 1951, he did the first successful repair of esophageal atresia in Germany. The procedure was done under open drop ether anesthesia given by a surgical assistant. Rehbein used an extrapleural approach and resected four short posterior rib segments. The postoperative course was complicated by a recurrent tracheoesophageal fistula that closed spontaneously after a couple of months. The patient ultimately did well and is now 40 years old and in excellent health. This was the first of over 500 esophageal atresias he repaired during his career. After the difficult early years fulfillment followed, parallelling the growth and acceptance of pediatric surgery as a specialty. Fritz Rehbein had a decisive input into this development. In 1953, shortly after the foundation of the British Association of Paediatric Surgeons, he was invited by Peter Rickham to participate in that association’s first clinical congress. This event marked the beginning of his active participation in international pediatric surgery. It is one of his great merits that, although he had strong links to the western medical world, he built bridges to Asia, South America, and the Near East and he systematically offered support and help to colleagues in Eastern Europe. His clinical acumen and concern for perioperative care were surpassed only by his attention to technical detail in the operating theater. His ideas are amply discussed in the more than 300 publications he authored. He is best known, however, for the pioneering operative methods he introduced. In 1953 he developed the procedure for Hirschprung’s disease that bears his name. When he first presented his results at the BAPS meeting in 1959, his method was rejected because it was not fully understood. Too modest to claim full originality, he presented his operation as an evolution of the State procedure,
IN MEMORIAM
when in fact what he performed was a very low anterior resection, helped by special sutures that lifted the perineal floor into the field. Fortunately his coworkers insisted that he not abandon his approach, but rather develop it further. During his career he successfully used this operation on nearly 400 children. His procedure remains the operation of choice in many pediatric surgical centers world wide. In 1957 he presented his innovative QUII through technique for high imperforate anus and his operation for pectus excavatum. He then introduced multiple techniques to handle intestinal atresias. In the late 1960s he developed several ingenious methods for the management of long gap esophageal atresia. An example of this is the “string and olives” method. A tireless worker, he did most of his academic work between 5 and 7 AM, before engaging in a full operative schedule. Rehbein’s vast operative experience is condensed in his “Kinderchirurgische Operationen” (Pediatric Surgical Operations). Published in 1976, this book is still up to date and is an outstanding example of didactic clarity. Depicted on the dust cover of that book is another of his valuable contributions: an operating table designed specifiCdy for pediatric surgery. Being a skilled technician Rehbein performed each procedure with extreme precision and efficiency in an unhurried, elegant manner. His operative dissections were as clean and neat as his thought process. His scrub nurse of many years, Sister Maria, knew how to keep the flow of instruments in unison with the operation. There was also a harmonious and often humorous interaction with his anesthetists, led by Dr Nellie Schweder. The atmosphere in the operating room was unhurried, quiet, friendly, and there were almost always surgical guests from all corners of the world. Over the years a respected and influential surgical school developed. Several generations of pediatric surgeons have trained at the Kinderchirurgische Klinik in Bremen and many are now in leading positions in Germany, throughout Europe, and other continents. Fritz Rehbein was one of the first to recognize that our evolving specialty, pediatric surgery, needed its own publication. Thus in 1964 he founded Zeitschtift fur Kinderchirurgie (now the European Journal of Pediatric Surgery), 2 years before his friends C. Everett Koop and Stephen L. Gans first published the Journal of Pediattic Surgery on the other side of the Atlantic. He remained as Editor in Chief of the European journal until 1983. During his distinguished career, Professor Rehbein held office in several professional societies and received numerous accolades and awards. Among these
IN MEMORIAM
are: Presidency of the Deutsche Gesellschaft fur Kinderchirurgie (German Society of Pediatric Surgeons) from 1964 to 1970; honorary membership in the Austrian, French, Hungarian, and Swiss Societies of Pediatric Surgery, the Surgical Section of the American Academy of Pediatrics, the German and the Northwest German Societies of Surgery; corresponding membership in the German and Scandinavian Societies of Pediatrics, and the Argentine Society of Pediatric Surgery; membership in the German Academy of Nature Scientists and the Leopoldina Society in Halle. In 1986, he was elected lifelong honorary president of the German Society of Pediatric Surgeons. He received an honorary doctorate of the University of Graz, Austria and was made Officer des Palmes Academiques France. He delivered the first Isabella Forshall Lecture and was the recipient of the Denis Brown Medal of the BAPS, the Paracelsus Medal of the Association of German Physicians, the Per Dubbs Medal of the Medical Society of Goteborg, Sweden, the Medal of Honor of the German Society of Pediatric Surgeons, and the Medal of the Senate of the City of Bremen for Art and Science. The Federal Republic of Germany bestowed on him the Grand Cross of the Order of Merit. In 1967 he hosted the BAPS congress and in 1976 pediatric surgeons again convened in Bremen for the International Symposium on Esophageal Atresia. These two memorable events were a strong tribute to him and were among his most cherished accomplishments. At age 65 he retired from his clinical activities. Although this was by no means an easy step for him,
547
he quickly channeled his energy to his other areas of interest, notably art, philosophy and theology. He pursued these activities with his beloved wife of 56 years. He and Ruth, also a physician, attended lectures at the University of Hamburg, a reminiscence of their medical school days. This time, however, the topics were different and centered around archeology, Byzantine art, and the life and works of Paracelsus. The Rehbeins’ hospitality continued over the years and many of us had the opportunity to visit their home and discuss themes ranging from medicine to philosophy, accompanied by traditional coffee and cake. Despite all the recognition received during his life, Fritz Rehbein remained exceptionally modest. His great personal warmth together with his tolerance, his enthusiasm, and his creativity determined the unique fostering atmosphere of his clinic. His concern for fellow physicians, hospital staff, and guests alike was remarkable. He was never hurtful-even criticism or disapproval were presented in such caring terms that they were often understood only by those who knew him well. He knew how to be a chief, a guide, a mentor, and a friend. Whether in meetings, discussions, informal get togethers, or in his letters, his positive attitude and willingness to contribute evoked respect and admiration. Although pediatric surgery lost one of its great pioneers, his legacy continues unaltered. Wolfgang Lambrecht, MD Dietrich Kluth, MD Michael W.L. Gauderer, MD
MAY 1992
In Memoriam
Fritz Rehbein, 1911-1991 ROFESSOR Dr Med h.c. Fritz Rehbein died suddenly and unexpectedly on September 7, 1991 while vacationing in the Austrian Alps. His loss is felt by his wife Ruth, three children, four grandchildren, and friends world wide. Only 5 months earlier, on the occasion of his 80th birthday, a celebration in his honor was held in the venerable city hall of the Hanseatic city of Bremen. In this touching tribute, colleagues and friends from Europe and abroad recounted the numerous contributions of this towering figure of pediatric surgery. Fritz Rehbein was born in Westuffeln, Hessen, Germany on April 8, 1911. He studied medicine in Munich, Bonn, Hamburg, and Heidelberg, and began his postgraduate education at the University of Gottingen in 1936 under the well-known general surgeons Rudolf Stich, Ewald Herlyn, and Hans Hellner. This
P
JournalofPediatric
Surgery, Vol 27, No 5 (May), 1992: pp 545-547
MD
training was interrupted by the second world war, which he spent as a surgeon in a field hospital. After the war he had the opportunity to work as chief of the pediatric ward of the clinic in Gottingen. This experience made clear to him the very special surgical needs of children. In Germany at that time only one surgeon, Anton Oberniedermayr, had dedicated himself entirely to pediatric surgery. Severe malformations of the gastrointestinal tract, an area to which Rehbein later devoted great effort, were rarely operated upon. Thus, he initially focused on the repair of nonlethal congenital anomalies, such as cleft lip and palate. He gradually expanded his surgical expertise in children to the correction of aortic stenosis, patent ductus arteriosus, and BlalockTaussig anastomoses. Encouraging results convinced him that major surgical interventions were well toler545
546
ated by children and that complex congenital anomalies were amenable to repair in an appropriate setting. In 1951 he became director of the surgical clinic of the children’s hospital in Bremen, a position he held until his retirement in 1976. The surgical activity of the hospital at that time was limited to small routine procedures. Rehbein recognized that a much stronger infrastructure was needed in order to fulfill the needs of what should become a new surgical specialty. Unable to obtain financial support for study abroad, he became a self-taught pediatric surgeon. His knowledge was derived from a broad general surgical education and experience which included thoracic, urologic, and orthopedic surgery. In the course of a few years he transformed his small division into a world renown pediatric surgical center. On October 17, 1951, he did the first successful repair of esophageal atresia in Germany. The procedure was done under open drop ether anesthesia given by a surgical assistant. Rehbein used an extrapleural approach and resected four short posterior rib segments. The postoperative course was complicated by a recurrent tracheoesophageal fistula that closed spontaneously after a couple of months. The patient ultimately did well and is now 40 years old and in excellent health. This was the first of over 500 esophageal atresias he repaired during his career. After the difficult early years fulfillment followed, parallelling the growth and acceptance of pediatric surgery as a specialty. Fritz Rehbein had a decisive input into this development. In 1953, shortly after the foundation of the British Association of Paediatric Surgeons, he was invited by Peter Rickham to participate in that association’s first clinical congress. This event marked the beginning of his active participation in international pediatric surgery. It is one of his great merits that, although he had strong links to the western medical world, he built bridges to Asia, South America, and the Near East and he systematically offered support and help to colleagues in Eastern Europe. His clinical acumen and concern for perioperative care were surpassed only by his attention to technical detail in the operating theater. His ideas are amply discussed in the more than 300 publications he authored. He is best known, however, for the pioneering operative methods he introduced. In 1953 he developed the procedure for Hirschprung’s disease that bears his name. When he first presented his results at the BAPS meeting in 1959, his method was rejected because it was not fully understood. Too modest to claim full originality, he presented his operation as an evolution of the State procedure,
IN MEMORIAM
when in fact what he performed was a very low anterior resection, helped by special sutures that lifted the perineal floor into the field. Fortunately his coworkers insisted that he not abandon his approach, but rather develop it further. During his career he successfully used this operation on nearly 400 children. His procedure remains the operation of choice in many pediatric surgical centers world wide. In 1957 he presented his innovative QUII through technique for high imperforate anus and his operation for pectus excavatum. He then introduced multiple techniques to handle intestinal atresias. In the late 1960s he developed several ingenious methods for the management of long gap esophageal atresia. An example of this is the “string and olives” method. A tireless worker, he did most of his academic work between 5 and 7 AM, before engaging in a full operative schedule. Rehbein’s vast operative experience is condensed in his “Kinderchirurgische Operationen” (Pediatric Surgical Operations). Published in 1976, this book is still up to date and is an outstanding example of didactic clarity. Depicted on the dust cover of that book is another of his valuable contributions: an operating table designed specifiCdy for pediatric surgery. Being a skilled technician Rehbein performed each procedure with extreme precision and efficiency in an unhurried, elegant manner. His operative dissections were as clean and neat as his thought process. His scrub nurse of many years, Sister Maria, knew how to keep the flow of instruments in unison with the operation. There was also a harmonious and often humorous interaction with his anesthetists, led by Dr Nellie Schweder. The atmosphere in the operating room was unhurried, quiet, friendly, and there were almost always surgical guests from all corners of the world. Over the years a respected and influential surgical school developed. Several generations of pediatric surgeons have trained at the Kinderchirurgische Klinik in Bremen and many are now in leading positions in Germany, throughout Europe, and other continents. Fritz Rehbein was one of the first to recognize that our evolving specialty, pediatric surgery, needed its own publication. Thus in 1964 he founded Zeitschtift fur Kinderchirurgie (now the European Journal of Pediatric Surgery), 2 years before his friends C. Everett Koop and Stephen L. Gans first published the Journal of Pediattic Surgery on the other side of the Atlantic. He remained as Editor in Chief of the European journal until 1983. During his distinguished career, Professor Rehbein held office in several professional societies and received numerous accolades and awards. Among these
IN MEMORIAM
are: Presidency of the Deutsche Gesellschaft fur Kinderchirurgie (German Society of Pediatric Surgeons) from 1964 to 1970; honorary membership in the Austrian, French, Hungarian, and Swiss Societies of Pediatric Surgery, the Surgical Section of the American Academy of Pediatrics, the German and the Northwest German Societies of Surgery; corresponding membership in the German and Scandinavian Societies of Pediatrics, and the Argentine Society of Pediatric Surgery; membership in the German Academy of Nature Scientists and the Leopoldina Society in Halle. In 1986, he was elected lifelong honorary president of the German Society of Pediatric Surgeons. He received an honorary doctorate of the University of Graz, Austria and was made Officer des Palmes Academiques France. He delivered the first Isabella Forshall Lecture and was the recipient of the Denis Brown Medal of the BAPS, the Paracelsus Medal of the Association of German Physicians, the Per Dubbs Medal of the Medical Society of Goteborg, Sweden, the Medal of Honor of the German Society of Pediatric Surgeons, and the Medal of the Senate of the City of Bremen for Art and Science. The Federal Republic of Germany bestowed on him the Grand Cross of the Order of Merit. In 1967 he hosted the BAPS congress and in 1976 pediatric surgeons again convened in Bremen for the International Symposium on Esophageal Atresia. These two memorable events were a strong tribute to him and were among his most cherished accomplishments. At age 65 he retired from his clinical activities. Although this was by no means an easy step for him,
547
he quickly channeled his energy to his other areas of interest, notably art, philosophy and theology. He pursued these activities with his beloved wife of 56 years. He and Ruth, also a physician, attended lectures at the University of Hamburg, a reminiscence of their medical school days. This time, however, the topics were different and centered around archeology, Byzantine art, and the life and works of Paracelsus. The Rehbeins’ hospitality continued over the years and many of us had the opportunity to visit their home and discuss themes ranging from medicine to philosophy, accompanied by traditional coffee and cake. Despite all the recognition received during his life, Fritz Rehbein remained exceptionally modest. His great personal warmth together with his tolerance, his enthusiasm, and his creativity determined the unique fostering atmosphere of his clinic. His concern for fellow physicians, hospital staff, and guests alike was remarkable. He was never hurtful-even criticism or disapproval were presented in such caring terms that they were often understood only by those who knew him well. He knew how to be a chief, a guide, a mentor, and a friend. Whether in meetings, discussions, informal get togethers, or in his letters, his positive attitude and willingness to contribute evoked respect and admiration. Although pediatric surgery lost one of its great pioneers, his legacy continues unaltered. Wolfgang Lambrecht, MD Dietrich Kluth, MD Michael W.L. Gauderer, MD