History of Modern Neurosurgery

Nineteenth century witnessed the beginning of specialization in neurosurgery. The surgical personalities of the 19th century were varied and talented. Three important developments had contributed to the advancements:
1. Anesthesia:
                  Horace Wells, Morton, Warren and Simpson are credited for inventing anesthesia and patients freedom from pain during procedure.
2. Neurology: 
                  Fritsch, Hitzig, Paul Broca, Wernicke, Ferrier, John Hughling Jackson ( father of modern neurology), Hutchinson, William Gower, Bennet, Allen Starr had contributed immensely to neurological localization.
3. Antisepsis:
                Lord Lister introduced antisepsis in operation theater. Joseph Lister( 1872-1912) was born at Upton in the county of Essex and is considered as one of the greatest figures in  the history of surgery. He is best known for his antiseptic principles including introduction of carbolic acid sprays in the operating rooms , the result of which were published in the Lancet in 1967. The antiseptic principles described by Lister in 1867 reduced the infection rate significantly and gave a boost to the surgeons to proceed beyond the dura mater.
4. Development of Neurosurgical techniques &  Neuroradiology:
                  In 1884, Sir Rickmann Godlee operated upon a brain tumor for the first time solely on the basis of clinical localization by Hughes Bennet.
Sir William Macewen carried out his first surgery on brain abscess in 1881.
William Sharp ( 1840) : "Practical observation on injuries of the head"
Sir Charles Bell ( 1774-1842):  surgical drawings and illustrations.
Sir Victor Horsley, in 1892, invented bone wax which was initially made of bee's wax.
William W. Keen: " An American Textbook of Surgery" in 1890.
Sir Charles Ballance performed the first successful removal of an acoustic neuroma in 1894.
Fedor Krause
W.S.Halsted ( 1852-1922) was the first Professor of surgery at John Hopkins. Halsted was the first surgeon to introduce the use of gloves. Halsted's scrub nurse & wife was allergic to carbolic acid and he devised the glove primarily for her.
Harvey Cushing ( 1869-1939)- was perhaps the greatest neurosurgeon of all times.

Harvey Williams Cushing (April 8, 1869 – October 7, 1939)  is often called the "father of modern neurosurgery." He was the founder of American neurosurgery.

He studied medicine at Harvard Medical School at received degree in 1895. He did residency in surgery under the guidance of  famous surgeon , William  Halsted at John Hopkins Hospital, Baltimore. Cushing learned meticulous surgical technique from his mentor. As was standard then, Cushing spent time in Europe ; he worked in the laboratories of Theodore Kocher in Bern, where he investigated the physiology of CSF. He described Cushing reflex, relationship between blood pressure and intracranial pressure. 

While traveling through Europe , he met several important surgical personalities , including Victor Horsley.  

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.

He described endocrine syndrome due to basophilic adenoma of pituitary gland ( Cushing disease).

With Percival Bailey in 1926, Cushing introduced the first rational approach to the classification of brain tumors. 

At age of 32 , he became associate professor of surgery at John Hopkins Hospital and was in full charge of cases of surgery of the central nervous system.

He made (with Kocher) a study of ICP and (with Sherrington) contributed much to the localization of the cerebral centers. 

In 1911, he was appointed surgeon-in-chief at Peter Bent Brigham Hospital in Boston. He became a professor of surgery at the Harvard Medical School starting in 1912. From 1933 to 1937, when he retired, he worked at Yale University School of Medicine.

In the beginning of the 20th century he developed many of the basic surgical techniques for operating on the brain. This established him as one of the foremost leaders and experts in the field. Under his influence neurosurgery became a new and autonomous surgical discipline.

He considerably improved the survival of patients after difficult brain operations for intracranial tumors. He used x-rays to diagnose brain tumors. He used electrical stimuli for study of the human sensory cortex. He had operated more than 2000 cases brain tumors.

Cushing was also awarded the Pulitzer Prize of biography in 1926 for a book recounting the life of one of the fathers of modern medicine, Sir William Osler.

He developed many surgical instruments that are still in use today, most notably the Cushing forceps, He also developed a surgical magnet while working with the Harvard Medical Unit in France during World War I to extract bullets from the heads of wounded soldiers.

Sources: Wikipedia
               Y. Neurological surgery  ( H.R. Winn ) Elsevier Saunders
              http://www.hopkinsmedicine.org/neurology_neurosurgery

1891 Quincke described lumbar puncture for relief of raised intracranial pressure.Heinrich Irenaeus Quincke (26 August 1842 - 19 May 1922) was a German internist and surgeon. His main contribution to internal medicine was the introduction of the lumbar puncture for diagnostic and therapeutic purposes (source: wikipedia).

                                                            Professor Heinrich Quincke (Source: wikipedia)




Roentgen discovered x-rays in 1896.
Walter Dandy described pneumoencephalography and pneumoventriculography in 1918.
In 1921, myelography was introduced when jean Sicard a French clinician and his pupil Jacques Forestier injected analgesics into the spine of a patient suffering from low back pain and subsequently found that the oil they used as a carrier for the analgesic, lipiodol, was radio-opaque.
The invention of myelography encouraged the Portuguese neurologist Egas Moniz to develop ' Arterial Encephalography'.
CT scan- 1967 Godfrey Hounsfield
MRI- Nobel Prize winning work of Block & Purcell in the 1940s, which was applied to medical imaging in 1970s.