Waldemar Hecker on the Occasion of His 80th Birthday

On February 15, 2002, Waldemar Hecker celebrated his 80th birthday. The German Society for Paediatric Surgery, the Ludwig-Maximilian University of Munich, the Dr. von Hauner Children's Hospital - his former clinic - and his students and friends honoured him in an academic ceremony.

Waldemar Hecker is one of the most important trailblazers of paediatric surgery in Germany - an indefatigable promoter working in the interests of paediatric surgery and still active today, for example as a member of the managing committee of the German Society for Paediatric Surgery, whose president he was from 1973 to 1976, and of the managing board of the Children's Clinic St. Augustin, Bonn. An independent medical field of paediatric surgery would be unthinkable without Hecker's work. It is due to his tireless political exertions that paediatric surgery finally became an independent medical field in Germany in 1994. Based on his own surgical experience, which he presented energetically and convincingly for many years at the Annual Meeting of the German Medical Association and in many academic publications, Waldemar Hecker was convinced that general surgical training was not what was required to become a paediatric surgeon, that the most important surgical interventions in children were better learnt under the auspices of paediatric surgery itself, and that the field of paediatric surgery could only really move forward if it freed itself from the “domination” of general surgery and associated medical fields. This concept was drawn from Hecker's own life. For that reason some of the main outlines of his life are given below.

Waldemar Hecker was born on February 15, 1922. He came from a family of physicians. His father had already been director of a surgical clinic and he influenced his son in this direction. Hecker says that among other things the sacral gathering of the rectum in anal and rectal prolapse was a concept he acquired from his father. Waldemar Hecker began his surgical training at the Surgical University Clinic Hamburg-Eppendorf under Lezius and Konjetzky. The most decisive influence, however, was provided by his work in the surgical department of the Children's Hospital Hamburg Altona under Kluth, where he began work in September 1953. The hospital, founded in 1869, had expanded to include a separate department for paediatric surgery in 1901, one of the earliest separate paediatric surgical departments to be created in the 19th and early 20th century; others include the Paediatric Surgery Department of the Hannoversche Heilanstalten (1867), the Paediatric Surgery Department in Stuttgart (1882), the Paediatric Surgical Department in the Abraham von Oppenheim Children's Hospital in Cologne (1883), the Surgical Department in the Dr. von Hauner Children's Hospital in Munich (1886) and the Paediatric Surgery Department in Leipzig (1891), all established independent paediatric surgical departments which were created long before the field of surgery was subdivided into specific medical fields. Waldemar Hecker was also a pioneer in this field and he still enjoys talking about his first independent steps in this as yet unknown and in many aspects unexplored area. In Altona too, the young Hecker has not been forgotten. You must imagine that in 1953 there was as yet no journal for paediatric surgery - the first number appeared in August 1964 - and the Study Group of German Paediatric Surgeons, which would later in 1963 become the German Society for Paediatric Surgery, was only founded in 1958. Children requiring surgical treatment were treated according to protocols which had been developed for adult patients or in accordance with the special procedures developed for paediatric surgery by the paediatric surgeons Drachter, Denis Browne, Ladd, Gross, Swenson, Ombredanne and others. However, much was still unknown and much was yet to be discovered and tested.

In 1957 Waldemar Hecker became assistant physician, later senior physician under Linder at the Surgical Clinic of the Free University Berlin, and once again his main focus was on paediatric surgery. When Linder was offered a chair at the University of Heidelberg in 1962, Hecker followed him and laid the foundations for the creation of a department of paediatric surgery at the University of Heidelberg, of which he was later head. In 1969 he was called to the first chair for paediatric surgery in Germany at the Ludwig-Maximilian University of Munich. The sixties, seventies and eighties of the last century were the formative years in the development of paediatric surgery in Germany. Hecker did not just help shape the developments taking place, but was also active in fashioning today's training guidelines, establishing the current relationship between paediatric surgery and other medical specialities as well as the structures in many facilities for paediatric surgery still prevailing today. The Common Trunc course of training, which has lately been the subject of much discussion, consisting of a general 2-year surgical basic training course for almost all surgical fields followed by a later specialisation goes back basically to a modification of the training principles postulated by Hecker. These consisted of an entire 6-year surgical training course in paediatric surgery alone. General surgical training was only considered acceptable in as far as it was necessary within the guidelines for the training courses. Hecker was able to offer very good reasons for his demands. The birth rate was soaring with 1.2 million births per year in the seventies; special focus on paediatric fields including paediatric urology, paediatric neurosurgery or paediatric traumatology was lacking and the development of many new operative techniques by important paediatric surgeons such as Rehbein, Grob, Duhamel, Soave, Stephens, Ravitch, to name just a few, concurred to give an enormous impetus to paediatric surgery, also in Germany. Neurosurgeons, urologists and traumatologists referred newborn patients and small children to paediatric surgery wards for surgical treatment. Today, nobody is prepared to admit this and the individual departments for paediatric urology and paediatric neurosurgery which were set up 20 to 30 years ago, for example in Freiburg, have with only a few exceptions been abolished by professors in the various medical fields. It would appear that with the decline in the birth rate and increased economic cutbacks, children are being pushed more and more not just to the periphery of our society, but also to the fringe of the various medical fields.

Hecker was deeply affected by this development: he who up to the present day had always energetically given his full support to the interests of children, who had described himself as a “paediatrician with a knife” and who had always placed the well-being of children above his own interests or the wishes of his colleagues, the administration or society. With Hecker, a selection debate in Lorber's sense concerning the treatment of lumbar myelomeningocele with severe associated disease could never have taken place, and only once were the basic ethical rules subjected to scrutiny when discussing with the dean of Munich University the eventual possibility of removing organs from anencephali for organ donation. Hecker is also a devoted father to his four children, as his students could personally verify when one of his children had to be treated in the clinic. He was happily married to Wilma, who sadly died far too young. Hecker was able to make use of the favourable times and in the almost 50 years of his commitment has done more than anybody in the service of paediatric surgery and for the propagation of this medical field in Germany.

However, Waldemar Hecker was not just active politically, but also a committed researcher. More than 400 publications, contributions to books and two monographs have issued from his pen. Together with Rickham and Prevot he has edited the English language periodical Progress in Paediatric Surgery from 1970 on with over 27 volumes to date. He has trained four university professors and 5 directors with habilitations of large municipal paediatric surgery facilities. The number of assistant and guest physicians which he influenced is very large. If Waldemar Hecker was presented with a medical problem he considered worth examining, he helped find the necessary money, the resources, personnel and rooms for the requisite scientific research. He set up a laboratory for experimental paediatric surgery for his pupil Hollmann, helped Urban, later a heart surgeon, to procure a heart-lung machine with the hope of possibly establishing a paediatric cardiosurgery department in the Hauner Children's Hospital and helped many students complete their habilitation which, without Hecker's energetic sternness, they might otherwise never have achieved. Hecker tolerated no stagnation. Occasionally, he registered a student to present a paper at an academic conference even before the results of the planned study were ready. Many suggestions and ideas for practical day-to-day work in paediatric surgery can be traced back to Hecker, forming a school of thought which includes influences from K. H. Bauer, Linder and Hecker's own innovations. For his students, training under Hecker was additionally attractive as they were thereby also able to become acquainted with the school of Anton Oberniedermayr in the person of Prof. Klaus Devens and Ms. Ilse Coerdt, the heads of the departments for paediatric urology and plastic paediatric surgery. Hecker had come to realise early on that only by focusing on certain medical specialities within paediatric surgery would it be possible to secure the continued existence of these medical fields and had therefore assigned these areas - as they were not integrated into general paediatric surgery in Heidelberg - to certain co-workers of his predecessor Oberniedermayr. One of the great opportunities for paediatric surgery in Germany lay in the continued development of these special fields. The structure of large Anglo-American children's clinics was behind this concept, as Hecker was able to satisfy himself of on the occasion of the farewell symposium of Bill Kiesewetter in Pittsburgh.

Many qualities make Waldemar Hecker an outstanding personality. Hecker was not just an excellent academic teacher, a brilliant surgeon and continually politically active on behalf of his chosen medical field, for his students he was and is a paternal friend. Indeed it is this balance between uncompromising severity in his day-to-day work at the clinic - “the effort is not what counts, only success counts” - and a generous understanding of the problems of his students which is particularly characteristic of his personality. Hecker has received many honours and awards for his work, the last one on the occasion of his 80th birthday when he became honorary member of the Germany Society of Paediatric Surgery. This laudation would like to pay tribute to his human qualities. Even if - due to the drop in the birth rate, the consequences of prenatal diagnostics, the ongoing economic cutbacks and unfortunately also because of conflicts of competence concerning the responsibility for surgically ill children - not all of Hecker's hopes and wishes for the field of paediatric surgery have been fulfilled, nevertheless the example of Hecker himself should act as an inspiration to continue to fight for the interests of surgically ill children and thereby for paediatric surgery in all of Europe and all over the world.

Alexander M. Holschneider