Hopkins Neurosurgery: A Brief History
The
specialty of neurosurgery was born at Johns Hopkins. In 1900, Harvey Cushing
completed his surgical training. After the European grand tour and a year
in Kocher's laboratory in Bern where he studied the effects of head injury,
Cushing returned to the surgical faculty. In the ensuing 12 years, he founded
the specialty of neurosurgery and established the characteristics of the
field which endure to this day.
By the time Cushing accepted the Harvard Chair of surgery in 1912, his work
at Johns Hopkins had established him as the outstanding young surgeon in
the United States. Cushing brought Halsted's meticulous surgical technique
to the new field and added Osler's careful clinical observation and his
own penchant for accurate documentation. His clinical contributions are
legendary: the use of x-rays in surgical practice, physiological saline
for irrigation during surgery, understanding the pituitary's function, founding
the clinical specialty of endocrinology, the anesthesia record, the use
of blood pressure measurement in surgical practice, and the physiological
consequences of increased intracranial pressure.
One of the principal inducements for Cushing to stay in Baltimore upon completion
of his residency was his appointment as Director of the Hunterian Laboratory.
Our concept of the clinician/scientist in medicine largely derives from
Cushing's vision of the Hunterian as a place for young physicians to learn
to do research.
One
of the earliest products of the Hunterian experience was Walter Dandy. During
the two years after medical school, Dandy completed his monumental work
on cerebrospinal fluid production, judged by many to be the finest piece
of surgical research ever accomplished. While still a house officer, he
devised pneumo-encephalography, which was the basis of neurological imaging
for nearly 50 years. Dandy went on the be the most famous surgeon of his
generation and the greatest technician the field has known. His innovations
introduced surgery for disc disease, surgery for aneurysms and arteriovenous
malformations as well as surgery for functional disease. The modern scope
of neurosurgery was encompassed by Dandy.
Dandy's successor was A. Earl Walker, who established the first neurosurgery
residency program at Johns Hopkins and emphasized research training during
residency. It was his vision of the academic neurosurgeon as a researcher
that kept neurosurgery within the National Institutes of Health programs.
With a few other equally informed leaders, he contested the decision of
organized neurosurgery to reject government aid for research and neurosurgery
assumed the important role it has continue with the NIH.
In
1973, Donlin
M. Long succeeded Walker and the organization of the current program
began. In 1982, the Adolf Meyer Center for Psychiatry and the Neurosciences
opened. His vision helped form the philosophical basis for the amalgamation
of psychiatry, neurology and Neurosurgery and the development of a neuroscience
center. The conceptual and practical base for neurosurgeons is no longer
general surgery, but the neurological sciences. Investigators interested
in similar diseases work together without regard to their specialty training.
Most neurological diseases are better treated by teams of specialists representing
all of the medical expertise the patients need than through individual departments.
Neurosurgeons now need education in related fields such as otolaryngology,
neuro-ophthalmology, and orthopaedics, which are beyond the boundaries of
the traditional specialty. Dr. Long's legacy is alive and well not only at Hopkins, but in neuroscience center's of excellenc worldwide.
Dr. Henry Brem has recently succeeded Dr. Long as the Chairman of Neurosurgery.
He is continuing the clinician-scientist tradition that started with Cushing
over 100 years ago. The department has now grown to over 30 full time faculty
and approximately 4,000 surgeries are performed each year. Neurosurgery
at Hopkins remains one of the most well funded departments in the country
in terms of research dollars and perennially ranks among the best in the
country clinically. We expect the Johns Hopkins Department of Neurosurgery
to continue its legacy of expert patient care and innovation well into the
forseeable future.
