In Memoriam

From 1962 to 1990 (Figure 1), Marco Mumenthaler served as a professor of neurology and head of the Neurological Department at the Inselspital Berne, Switzerland. Marco Mumenthaler was born on July 25, 1925, in Berne, and died on January 30, 2016, in Basel.

Figure 1.

Prof. Marco Mumenthaler 1990.

Marco Mumenthaler, professor emeritus of neurology at the University of Bern, died in his 91st year in the retirement home in Basel, where he lived since November 2012. He is survived by two divorced wives, a life partner, four daughters, and four grandchildren. With his death, the neurological community lost the most brilliant clinician and inspiring academic teacher.

As the author of 13 monographs, some of it in numerous editions and with translations in multiple languages, the positive effects of Marco Mumenthaler’s work were felt not only in German-speaking Europe but also in the entire globe. From 1974 to 1985, he was a highly successful editor in chief of the Journal of Neurology, which he transformed from the German-language “Zeitschrift für Neurologie” (formerly “Deutsche Zeitschrift für Nervenheilkunde”) to the present international format. He served as the rector (principal) of the University of Berne (1989–1991) and chaired many academic boards including the Swiss Neurological Society (1969–1971) for which he was appointed as the honorary president. He was the corresponding or honorary member of numerous European and American neurological societies, senator of the Leopoldina, and affiliated to the Royal Society of Medicine.

Marco Mumenthaler’s parents Hans Mumenthaler, a merchant, and Lydia Piccoli were expatriate Swiss living in Milan. Marco Mumenthaler was educated first in a rural area of Italian-speaking southern Switzerland, where he lived with his farming grandparents, and then from age 9 to 18 in the German School of Milan where he initially had to learn German language. Here he completed the grammar school with the “Abitur” (qualification for university entrance) in 1943. However, because of war in Italy, a few weeks before his final exam, the German School of Milan was bombed, and the final school lessons and examination had to be displaced to the South Tyrolean mountains. In autumn 1943, he started his studies in medicine at Zürich, where he worked in the experimental laboratory of the anatomist Professor Gian Töndury and wrote a doctor of medicine (MD) thesis on the influence of sex hormones on the cleavage of salamander eggs. He also received undergraduate training at Paris, Amsterdam, and finally at Basel, where he received his MD in 1950. In Paris at the Salpetrière, Professor Georges Guillain seemed to have developed a preference for the Swiss student and frequently challenged him with neurological questions. Conversely, the renowned neurologist left an indelible impression on Mumenthaler which might have influenced his final specialty choice.

Mumenthaler began his clinical training in the cardiology department of Professor Jean Lenègre at Hôpital Boucicaut in Paris. Eager to embark on research activities, he got engaged in a study of the cardiac gallop rhythm. Subsequently, he turned to psychiatry as his specialty choice and got trained in the psychiatric hospital at Münsingen near Berne headed by Professor Max Müller, the later full professor (ordinarius) and chair at the Psychiatric University Hospital, Waldau. Working in a nonacademic hospital, Mumenthaler’s scientific ambition resulted in the use of a vacuum chamber at the military airport where he had to do his army rank promotion service. The air force was interested in cognitive effects of hypoxia. Hence, Mumenthaler did a study on the psychological “Rorschach Test” under hypoxic conditions. In summer 1953, he went to Zürich to get trained at the Neurological Outpatient Clinic headed by Prof. Mieczyslaw Minkowski. Here the knowledgeable and enthusiastic senior neurologist Dr Ernst Baasch was his teacher, and Mumenthaler mastered the clinical diagnosis practice. His further clinical training stations included the University Department of Neurosurgery in Zürich (Prof. Hugo Krayenbühl), the Department of Internal Medicine at Winterthur ZH (Prof. Ferdinand Wuhrmann), and again the University Department of Neurology at Zürich, now headed by Prof. Fritz Lüthy. Fritz Lüthy was an excellent neuropathologist and a nobel, rather distant academic who did not directly supervise the residents. It was the famous neurosurgeon Krayenbühl, noticing his talent, who persuaded Mumenthaler to focus on neurology rather than psychiatry, and later advised him to pursue an academic career. Mumenthaler threw himself into clinical research with admirable diligence, without a direct scientific mentor. He met several interesting patients and conducted several systematic studies, particularly in peripheral neurology. Clinically his great talent got around, making him a much demanded consulting neurologist already at a young age.

In 1957, Mumenthaler was licensed as neurologist and appointed head assistant of the research division of the neurological department (University Hospital, Zurich). This gave him the chance to do more scientific projects and also include anatomic–pathological studies. In 1960 (Figure 2), he presented a comprehensive 400-page habilitation thesis on the ulnar palsies, where not much can be added to even nowadays. ¹ Incited by his students, Mumenthaler then wrote his legendary textbook on neurology “Neurologie für Ärzte und Studenten,” which was since then reprinted in 13 revised and extended editions and was translated into 10 languages. ²

Figure 2.

Prof. Marco Mumenthaler 1960.

In the same year, he went on a scientific study leave to delve into myology. For 10 months, he went as the visiting associate of the National Institutes of Health (NIH) (United States) to the National Institute of Neurological Diseases and Blindness headed by Prof. George Milton Shy. He did histological studies on end plates in chicken embryos together with Dr W. King Engel who later became a famous expert in myasthenia. During this study leave, Mumenthaler was quite unexpectedly officially informed about the sudden death of the neurological head physician Prof. Rolf Magun in Berne on the July 5, 1960 and asked to take over the lead of the division. Mumenthaler readily affirmed his interest.

Back in Switzerland, he was additionally offered the analogous post in Lausanne, but Mumenthaler’s choice was Berne, where he started on 1 April 1962 as full extraordinary professor (with faculty seat) and head of the neurological department at the Inselspital. Mumenthaler found a 12-bed neurological division with one senior physician and three assistant doctors (residents). The neurological division still belongs to the University Department of Internal Medicine headed by the influential Prof. Walter Hadorn.

Under Mumenthaler’s direction, the rise of the neurological unit was meteoric. By systematic promotion of talented young academics combined with establishing necessary facilities for diagnostic workup and research, he developed an exemplary department. At a time when no international diagnostic International Classification of Disorders (ICSD) code existed, he established an elaborate and very detailed neurological diagnostic code to be used by all physicians of his department for the purpose of clinical research. When his chief Walter Hadorn retired in 1966, Mumenthaler was appointed ordinarius for the newly established chair in neurology, and the neurological unit was given the status of an independent university department, which continued to grow. The rising demand for neurological service combined with abundant public funds at that time certainly helped. Mumenthaler soon was a key opinion leader in the medical faculty, in the hospital governing board, and at the national level in the educational boards of Swiss doctors, for instance, and he held numerous influential positions. Throughout his career he was greatly wanted and appreciated expert in medical insurance assessments. In the army he attained the rank of a sanitary major and remained an active officer up to the age of 63 years. He was also engaged in the International Red Cross and participated in several missions to conflict areas.

Mumenthaler’s primary scientific interest was clinical. Starting with peripheral neurology and having first focused on the ulnar nerve (habilitation thesis), he subsequently studied lesions and dysfunctions of the entire peripheral nervous system including entrapment syndromes, radicular compression, muscular compartment syndromes, muscular dystrophy, and myasthenia. In 1965, along with Dr Hans Schliack of Berlin (later chair of neurology), he published a textbook on peripheral nerve lesions titled Läsionen peripherer Nerven. Diagnostik und Therapie. ³ It became a benchmark standard work for neurologist and later was translated into Spanish, Italian, and English. Till date, the book has seen 10 updated editions with new coeditors and authors. In the 1970s, he published large monocentric cohorts, also paediatric ones, with acute Guillain-Barré syndrome and pointed to the frequent long-term sequelae and absent efficacy of steroids. ⁴ Likewise, with regard to myasthenia, he published large monocentric and bicentric cohorts including pediatric and geriatric patients, and he strongly advised for thymectomy in all myasthenia patients, with the exception of those with pure ocular forms and advanced age. ⁵

His scientific interest also included central nervous system disorders such as the transient global amnesia, where he favored a vascular hypothesis, and the tonic seizures, ⁶ also called (kinesiogenic) paroxysmal tonic spasms, where, using the term “Hirnstammanfälle,” he suggested a brain stem origin. Stroke was also a topic of interest from the very beginning of his career; he was among the first to stress the increased risk of oral contraception and migraine for thrombosis and ischemia in young women. ⁷ Headache and migraine was the topic of several studies including a pioneering study on migraine with aura in children. ⁸ Together with his friend and colleague Franco Regli, full professor and chair of the neurological department of Lausanne, he published a much respected monograph on headache in 1981. ⁹ His monograph on differential diagnosis ¹⁰ also became a great success and saw several thoroughly revised editions with additional coeditors. It was soon followed by a richly illustrated clinical atlas ¹¹ and a book on syncope and drop attacks. ¹² Mumenthaler wrote on many more topics including functional disorders, coma/brain death, narcolepsy, neurosyphilis, giant cell arteritis, neurorehabilitation, and dementia. ^{13 –15} Finally, we will not be doing justice to Marco Mumenthaler if we do not emphasize on his great commitment to the history of Swiss neurology which he experienced, actively influenced and accompanied him for over 60 years, allowing him to write down what nobody else could witness. ^{16 –20}

Clearly, his main effort was devoted to education, which resulted in an enormously productive and successful teaching and publishing activity, shaping a whole generation of neurologists in Switzerland. His legendary lectures, seminars, and numerous textbooks have helped generations of students and residents in Switzerland and abroad. And here his unsurpassed command of languages served him well: Apart from his Italian mother tongue, he mastered German, French, and English. He cultivated linguistic correctness and precise wording and implacably demanded the same from his collaborators. Upon his retirement, he handed over a perfectly organized and meticulously documented department to his successor, offering his help when needed, without ever interfering unasked.

He continued for another year as rector of the university. Afterward, he remained very active working in a private praxis near Zürich (1991–2012) giving lectures, and doing editorial work for his books. He was granted the grace of an alert mind to the very end.

Those who had the privilege to work under his guidance, including both authors of this writing, experienced Marco as a strict and demanding but always fair chair. His human approach to the patients, his precision in the clinical observation, and clarity in diagnostic reasoning were associated with great correctness, generosity, open-mindedness, and efficiency. With his passing away, we not only lost a marvelous teacher and role model, but also lost a dear friend.