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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.

Walter Dandy
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 
Donlin Long
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 excellence 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 foreseeable future.


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