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The growth of neurosurgery
257 ELSEVIER
HISTORICAL
VIGNETTE
When one hears people moaning about the confusion of some of the problems of daily life, particularly in medicine, it is common to hear the statement, "Let's go back to the good old days." The good old days may mean the horse and buggy, the outdoor privy, the lack of good communication, and the lack of almost any good treatment of a disease except perhaps for digitalis, morphine, and a few drugs of that sort. I was struck, therefore, in reading a book that I had obviously admired when I had it bound in 1948. This was the American Journal of Surgery that published an editorial by the then ChiefofNeurosurgery in Brooklyn, Jefferson Browder, a distinguished leader in neurosurgery at that time. He had been asked to accumulate a series of articles by leaders in neurosurgery and he wrote an editorial, "The Growth of Neurosurgery," which is hereafter reprinted with permission. More revealing, however, is the list of titles including the list of the authors of this 268-page volume, the last article of which was "Section of the Fibers of the AnteReprinted with permission from the publisher of "The Growth of Neurosurgery" Editorial, by Jefferson Browder, M.D., American Journal of Surgery, LXXV: 1-2:3-268. Copyright 1948, by Yorke Publishing Co., now a Division of Reed Publishing.
rior Limb of the Internal Capsule in Parkinsonism" by Dr. Browder himself. Our colleagues of today will marvel at the main things done then, which were the best that were available, but are not d o n e - - o r even thought--about in the present day. On the other hand, some of the very significant papers are still significant, such as by Winchell Craig on "Tumors of the Spinal Cord" and Leo Davidoff's article on Pituitary Tumors. James B. Campbell's, "Congenital Anomalies of the Neural Axis" was very much up-todate for that time and, although much has been done since then, it is full of a great many facts that were not well-known at that time. A demonstration in this paper of a patient with diastematomyelia in the lumbar region is significant for that day. One cannot comment on all the effort that went into the preparation of this article, and the progress that has been made since that day, both by the authors mentioned here and their residents as they spread out to do further research. To my mind, this is the most optimistic consideration, and if one can simply project to another period 45 years from now, we would probably be much more astonished at the progress.
Eben Alexander, Jr., M.D.
The Growth of Neurosurgery
Neurological surgery has come to age as a specialty in most of the large communities of the United States. This maturity has not been attained without certain vicissitudes during the adolescent stage of development. Throughout this period of growth the preeminence of Harvey Cushing as a scholar, teacher and surgeon was the guiding influence in the furtherance of high ideals in those engaged in this particular field of surgical endeavor. In addition, the teachings of a host of eminent neurologists, the ever-widening sphere of experimental © 1994 by Elsevier Science Inc.
investigation and the contributions of many ingenious surgeons, notably Walter Dandy, have been determinants in the establishment of the enviable standards set for this specialty. The amalgamation of these, as well as other distinctive features of neurology and surgery with particular emphasis on practical approach to diagnosis and scrupulous adherence to Halstedian surgical technic, bids fair to promote teaching that will produce more efficient neurosurgeons for the future. The gradual formation of national, regional and local 0090-3019/94/$7.00
258
Surg Neurol 1994;41:257-8
neurosurgicai societies attests to the serious intent of the increasing numbers of young men entering this field. The senior organization, the Society of Neurological Surgeons, was founded in 1920 and now has sixty-three members. The Harvey Cushing Society was founded in 1931 and now has 140 members. The American Academy of Neurological Surgeons was founded in 1908 and now has forty-three [sic] members. Now a local organization, the New York Neurosurgicai Society, was founded in 1946 and has twenty-seven members. In addition to these organizations the American Board of Neurological Surgery was established in 1940 and to date has certified approximately 250 candidates. Medical schools have recognized the importance of the teaching of neurosurgery and many of them given departmental status to this specialty. It has now come to pass that in most schools, instruction concerning diagnosis and treatment of diseases of the nervous system amenable to surgical therapy is being given by the neurosurgeon. Medical graduates of the past decade should therefore be reasonably familiar with our accomplishments as well as our limitations. There are physicians, however, throughout the country who, for one reason or another, have not kept abreast of the advancements being made in this particular field; and it was with the thought that this special number would aid in the dissemination of such knowledge that these eminent authors were asked to contribute to this number. Only pathologic or pathophysiologic states of the nervous system that lend themselves to surgical therapy have been given consideration. Other related subjects might have been included; however, it seemed best to limit controversial issues as well as the results of many interesting experimental problems. A major portion of neurosurgical practice, namely, lesions resulting from trauma, has not been properly allocated to those most fitted to assume this responsibility, the trained neurosurgeon. The care of patients with lesions of the brain, spinal cord and peripheral nerves caused by contact trauma should be carried out by those especially trained in this field. During the recent war, a successful attempt was made to segregate the patients with such lesions and the surgical assessment and treatment of these was assigned for the most part to medical officers with neurosurgical training. These gathered about them younger officers who acquired experience and training especially concerning injuries of the nervous system. As these young medical officers adjust themselves to civil practice, the medical profession at large should recognize the value of their war-time experiences and give them an opportunity to apply this recently acquired knowledge.
Historical Vignette
While this symposium does not cover the entire field of neurosurgery, it is expected that the reader will find in these articles information of practical value and that this issue will serve as an aid in correctly advising patients regarding surgical treatment of diseases herein discussed. I wish to extend a word of thanks to each author for his prompt acceptance of the invitation to participate in this symposium.
Jefferson Browder, M.D. Original Articles 1. "Rehabilitation of Veterans Paralyzed as the Result of Injury to the Spinal Cord and Cauda Equina" Donald Munro, M.D. Pages 3-18. 2. "Acute Abdominal Emergencies in Paraplegics" Thomas I. Hoen, M.D., and Lieut. (J.G.) I. S. Cooper. Pages 19-24. 3. "Exophthalmos. Some Principles of Surgical Management from the Neurosurgical Aspect" Howard C. Naffziger, M.D. Pages 25-41. 4. "Complications Accompanying Surgical Relief of Pain in Trigeminal Neuralgia" Francis C. Grant, M.D. Pages 42-47. 5. "Hypertension and its Surgical Treatment by Bilateral Supradiaphragmatic Splanchnicectomy" Max Minor Peet, M.D. Pages 48-68. 6. "Tumors of the Spinal Cord" Winchell McK. Craig, M.D. Pages 69-81. 7. "Traumatic Intracranial Hemorrhage" E. S. Gurdjian, M.D. and J. E. Webster, M.D. Pages 82-98. 8. "Surgical Treatment of Tumors of the Pituitary Body" Leo M. Davidoff, M.D. and Emanuel H. Feiring, M.D. Pages 99-136. 9. "Lateral Rupture of Cervical Intervertebral Discs. Incidence and Clinical Varieties" R. E. Semmes, M.D. Pages 137-139. 10. "Ruptured Intervertebral Discs in the Lower Lumbar Regions" R. Glen Spurling, M.D. and Everett G. Grantham, M.D. Pages 140-158. 11. "Meniere's Disease.. Its Surgical Treatment by Division of Acoustic Nerve" Bronson S. Ray, M.D. Pages 159-170. 12. "Abscess of the Brain" Edgar F. Fincher, M.D. Pages 171-177. 13. "Diagnosis of Intracranial Aneurysms" James L. Poppen, M.D. Pages 178-186. 14. "Intractable Pain Due to Cancer. Treatment by Neurosurgical Methods" Olan R. Hyndman, M.D. Pages 187-199. 15. "Surgical Treatment of Epilepsy" A. Earl Walker, M.D. and Herbert C. Johnson, M.D. Pages 200-218. 16. "Fractures and Dislocations of the Spine" W. Gayle Crutchfield, M.D. and E. C. Schultz, M.D. Pages 219-226. 17. "Prefrontal Lobotomy. Indications and Results in Schizophrenia" James W. Watts M.D. and Walter Freeman, M.D. Pages 227-230. 18. "Congenital Anomalies of the Neural Axis. Surgical Management Based on Embryologic Considerations"James B. Campbell, M.D. Pages 231-256. 19. "Cortical Extirpation in the Treatment of Involuntary Movements" Paul C. Bucy, M.D. Pages 257-263. 20. "Section of the Fibers of the Anterior Limb of the Internal Capsule in Parkinsonism" Jefferson Browder, M.D. Pages 264-268.
HISTORICAL
VIGNETTE
When one hears people moaning about the confusion of some of the problems of daily life, particularly in medicine, it is common to hear the statement, "Let's go back to the good old days." The good old days may mean the horse and buggy, the outdoor privy, the lack of good communication, and the lack of almost any good treatment of a disease except perhaps for digitalis, morphine, and a few drugs of that sort. I was struck, therefore, in reading a book that I had obviously admired when I had it bound in 1948. This was the American Journal of Surgery that published an editorial by the then ChiefofNeurosurgery in Brooklyn, Jefferson Browder, a distinguished leader in neurosurgery at that time. He had been asked to accumulate a series of articles by leaders in neurosurgery and he wrote an editorial, "The Growth of Neurosurgery," which is hereafter reprinted with permission. More revealing, however, is the list of titles including the list of the authors of this 268-page volume, the last article of which was "Section of the Fibers of the AnteReprinted with permission from the publisher of "The Growth of Neurosurgery" Editorial, by Jefferson Browder, M.D., American Journal of Surgery, LXXV: 1-2:3-268. Copyright 1948, by Yorke Publishing Co., now a Division of Reed Publishing.
rior Limb of the Internal Capsule in Parkinsonism" by Dr. Browder himself. Our colleagues of today will marvel at the main things done then, which were the best that were available, but are not d o n e - - o r even thought--about in the present day. On the other hand, some of the very significant papers are still significant, such as by Winchell Craig on "Tumors of the Spinal Cord" and Leo Davidoff's article on Pituitary Tumors. James B. Campbell's, "Congenital Anomalies of the Neural Axis" was very much up-todate for that time and, although much has been done since then, it is full of a great many facts that were not well-known at that time. A demonstration in this paper of a patient with diastematomyelia in the lumbar region is significant for that day. One cannot comment on all the effort that went into the preparation of this article, and the progress that has been made since that day, both by the authors mentioned here and their residents as they spread out to do further research. To my mind, this is the most optimistic consideration, and if one can simply project to another period 45 years from now, we would probably be much more astonished at the progress.
Eben Alexander, Jr., M.D.
The Growth of Neurosurgery
Neurological surgery has come to age as a specialty in most of the large communities of the United States. This maturity has not been attained without certain vicissitudes during the adolescent stage of development. Throughout this period of growth the preeminence of Harvey Cushing as a scholar, teacher and surgeon was the guiding influence in the furtherance of high ideals in those engaged in this particular field of surgical endeavor. In addition, the teachings of a host of eminent neurologists, the ever-widening sphere of experimental © 1994 by Elsevier Science Inc.
investigation and the contributions of many ingenious surgeons, notably Walter Dandy, have been determinants in the establishment of the enviable standards set for this specialty. The amalgamation of these, as well as other distinctive features of neurology and surgery with particular emphasis on practical approach to diagnosis and scrupulous adherence to Halstedian surgical technic, bids fair to promote teaching that will produce more efficient neurosurgeons for the future. The gradual formation of national, regional and local 0090-3019/94/$7.00
258
Surg Neurol 1994;41:257-8
neurosurgicai societies attests to the serious intent of the increasing numbers of young men entering this field. The senior organization, the Society of Neurological Surgeons, was founded in 1920 and now has sixty-three members. The Harvey Cushing Society was founded in 1931 and now has 140 members. The American Academy of Neurological Surgeons was founded in 1908 and now has forty-three [sic] members. Now a local organization, the New York Neurosurgicai Society, was founded in 1946 and has twenty-seven members. In addition to these organizations the American Board of Neurological Surgery was established in 1940 and to date has certified approximately 250 candidates. Medical schools have recognized the importance of the teaching of neurosurgery and many of them given departmental status to this specialty. It has now come to pass that in most schools, instruction concerning diagnosis and treatment of diseases of the nervous system amenable to surgical therapy is being given by the neurosurgeon. Medical graduates of the past decade should therefore be reasonably familiar with our accomplishments as well as our limitations. There are physicians, however, throughout the country who, for one reason or another, have not kept abreast of the advancements being made in this particular field; and it was with the thought that this special number would aid in the dissemination of such knowledge that these eminent authors were asked to contribute to this number. Only pathologic or pathophysiologic states of the nervous system that lend themselves to surgical therapy have been given consideration. Other related subjects might have been included; however, it seemed best to limit controversial issues as well as the results of many interesting experimental problems. A major portion of neurosurgical practice, namely, lesions resulting from trauma, has not been properly allocated to those most fitted to assume this responsibility, the trained neurosurgeon. The care of patients with lesions of the brain, spinal cord and peripheral nerves caused by contact trauma should be carried out by those especially trained in this field. During the recent war, a successful attempt was made to segregate the patients with such lesions and the surgical assessment and treatment of these was assigned for the most part to medical officers with neurosurgical training. These gathered about them younger officers who acquired experience and training especially concerning injuries of the nervous system. As these young medical officers adjust themselves to civil practice, the medical profession at large should recognize the value of their war-time experiences and give them an opportunity to apply this recently acquired knowledge.
Historical Vignette
While this symposium does not cover the entire field of neurosurgery, it is expected that the reader will find in these articles information of practical value and that this issue will serve as an aid in correctly advising patients regarding surgical treatment of diseases herein discussed. I wish to extend a word of thanks to each author for his prompt acceptance of the invitation to participate in this symposium.
Jefferson Browder, M.D. Original Articles 1. "Rehabilitation of Veterans Paralyzed as the Result of Injury to the Spinal Cord and Cauda Equina" Donald Munro, M.D. Pages 3-18. 2. "Acute Abdominal Emergencies in Paraplegics" Thomas I. Hoen, M.D., and Lieut. (J.G.) I. S. Cooper. Pages 19-24. 3. "Exophthalmos. Some Principles of Surgical Management from the Neurosurgical Aspect" Howard C. Naffziger, M.D. Pages 25-41. 4. "Complications Accompanying Surgical Relief of Pain in Trigeminal Neuralgia" Francis C. Grant, M.D. Pages 42-47. 5. "Hypertension and its Surgical Treatment by Bilateral Supradiaphragmatic Splanchnicectomy" Max Minor Peet, M.D. Pages 48-68. 6. "Tumors of the Spinal Cord" Winchell McK. Craig, M.D. Pages 69-81. 7. "Traumatic Intracranial Hemorrhage" E. S. Gurdjian, M.D. and J. E. Webster, M.D. Pages 82-98. 8. "Surgical Treatment of Tumors of the Pituitary Body" Leo M. Davidoff, M.D. and Emanuel H. Feiring, M.D. Pages 99-136. 9. "Lateral Rupture of Cervical Intervertebral Discs. Incidence and Clinical Varieties" R. E. Semmes, M.D. Pages 137-139. 10. "Ruptured Intervertebral Discs in the Lower Lumbar Regions" R. Glen Spurling, M.D. and Everett G. Grantham, M.D. Pages 140-158. 11. "Meniere's Disease.. Its Surgical Treatment by Division of Acoustic Nerve" Bronson S. Ray, M.D. Pages 159-170. 12. "Abscess of the Brain" Edgar F. Fincher, M.D. Pages 171-177. 13. "Diagnosis of Intracranial Aneurysms" James L. Poppen, M.D. Pages 178-186. 14. "Intractable Pain Due to Cancer. Treatment by Neurosurgical Methods" Olan R. Hyndman, M.D. Pages 187-199. 15. "Surgical Treatment of Epilepsy" A. Earl Walker, M.D. and Herbert C. Johnson, M.D. Pages 200-218. 16. "Fractures and Dislocations of the Spine" W. Gayle Crutchfield, M.D. and E. C. Schultz, M.D. Pages 219-226. 17. "Prefrontal Lobotomy. Indications and Results in Schizophrenia" James W. Watts M.D. and Walter Freeman, M.D. Pages 227-230. 18. "Congenital Anomalies of the Neural Axis. Surgical Management Based on Embryologic Considerations"James B. Campbell, M.D. Pages 231-256. 19. "Cortical Extirpation in the Treatment of Involuntary Movements" Paul C. Bucy, M.D. Pages 257-263. 20. "Section of the Fibers of the Anterior Limb of the Internal Capsule in Parkinsonism" Jefferson Browder, M.D. Pages 264-268.