Childs Nerv Syst (2015) 31:355–358 DOI 10.1007/s00381-014-2543-z
BIOGRAPHY
Charles Harrison Frazier (1870–1936) and his legacy to neurosurgery Yasemin Kaya & Levent Sarikcioglu
Received: 11 August 2014 / Accepted: 1 September 2014 / Published online: 7 September 2014 # Springer-Verlag Berlin Heidelberg 2014
Abstract Charles Harrison Frazier (1870–1936) was a visionary neurosurgeon of his time. He devoted himself almost exclusively to neurosurgery based on his training in Germany on neurology, surgery, and surgical pathology and his accomplishments as a military physician during war years. The authors reviewed his life with a special emphasis on his legacy to neurosurgery. Keywords Charles Harrison Frazier . Neurosurgery . Rhizotomy . Trigeminal neuralgia Charles Harrison Frazier (1870–1936) was an outstanding neurosurgeon of his time. He made important contribution to treat several neurological disorders.
His life Charles Harrison Frazier was born in Philadelphia on April 19, 1870 as a third child of W.W. Frazier and Harriet Morgan Harrison. After graduating from the Episcopal Academy in Philadelphia in 1886 and receiving his bachelor’s degree from the University of Pennsylvania in 1889, his mother insisted him on choosing a profession. He agreed to enter the Medical School of the University of Pennsylvania for a year to Y. Kaya : L. Sarikcioglu (*) Department of Anatomy, Faculty of Medicine, Akdeniz University, 07070 Antalya, Turkey e-mail: [email protected] L. Sarikcioglu e-mail: [email protected] Y. Kaya e-mail: [email protected]
discover whether or not he found medicine sufficiently interesting to pursue it further [6]. Although his first 2 years passed unhappy, he graduated from the medical school in 1892. After his graduation, he studied as an intern in the Episcopal and University Hospitals under Dr. John Ashhurst (1839–1900) and Dr. J. William White (1850–1916) [6]. On the suggestion of Dr. J. William White, Dr. Frazier moved to Germany and spent 2 years there to study on neurology, surgery, and surgical pathology under the supervision of Dr. Ernst von Bergmann (1836–1907) and famed pathologist Dr. Rudolph Ludwig Karl Virchow (1821–1902) at the University of Berlin. He was heavily influenced by his teachers. Dr. Ernst von Bergmann served as a military surgeon in the Prusso-Austrian War (1866) and the Franco-Prussian War (1870–71) and gained experience treating cranial trauma and neurological disorders [8, 1, 7]. Additionally, Ernst von Bergmann was known as a pioneer of aseptic surgery [8, 9]. In 1896, he returned to Philadelphia and was appointed as an instructor in surgical pathology. In 1898, Dr. Frazier was elected a member of the Philadelphia Academy of Surgery. He was elevated to clinical professor of surgery in 1901 [2]. In 1903, at age 33, he was appointed Dean of the Medical School and he spent ten hard years as dean of the faculty [5]. During that period, the first laboratory of purely surgical pathology in this country was established at the University Hospital, and the University of Pennsylvania Medical Magazine was started with Dr. Frazier as editor [2]. In 1912, he was elected vicepresident and, in 1916, president of the Philadelphia Academy of Surgery. During his practice on general surgery, he gave particular interest to neurosurgery and thyroid surgery. During the World War I, he was appointed as neurosurgical consultant to the Surgeon General in charge of the Neurosurgical Service at Base Hospital No. 11 at Cape May and No. 41 at Fox Hills, Staten Island. He represented the Surgeon General at the Interallied Surgical Conference in Paris in 1920, with a paper on
356
the results of the treatment of injuries to the peripheral nerves [4]. In 1922, Dr. Frazier succeeded John B. Deaver as the John Rhea Barton Professor of Surgery and was appointed the Chairman of the Department of Surgery at the University of Pennsylvania School of Medicine. Dr. Frazier was a member and founder of numerous societies. He was a Fellow of the College of Surgeons, a founder and president (1925–1927) of the Society of Clinical Surgeons, a founder and president (1922–1923) of the Society of Neurologic Surgeons, president of the American Neurologic Association (1928–1929), a member of the American Surgical Society and of the American Society for the Study of Goiter, and an honorary member of the Deutsche Akadamie der Naturforcher and of the British Neurosurgical Society. He received the degree of Doctor of Science from the University of Pennsylvania in 1925 and was elected one of its Trustees in 1934 [5]. Dr. Frazier died in North Haven, Maine, July 26, 1936.
His achievements Through his association with leading neurologists—including S. Weir Mitchell (1829–1914), Charles K. Mills (1845–1931), and especially his classmate in the Medical School, William Gibson Spiller (1863–1940)—Dr. Frazier made important contributions to neurosurgery. In 1900, with Dr. Spiller, he performed preganglionic sectioning of the sensory root of the trigeminal nerve in animal and showed that the preganglionic section of the sensory root of the trigeminal nerve was never followed by regeneration of the nerve [6]. In 1901, he operated a patient with trigeminal neuralgia and performed retroresection of the trigeminal ganglion to relieve the pain [6]. This operation was found not only technically possible but also easier than ganglionectomy [2]. It was the first successful operation since Sir Victor Horsley may have cut the root prior to this date, but his patient did not survive [6]. At that time, surgeons resected the entire trigeminal ganglion resulting in several postoperative complications [2]. The Spiller-Frazier approach led to safer intervention for trigeminal neuralgia and fewer complications [2]. In his time, there were some attempts to cure intractable pain. Spiller’s idea was to cure intractable pain by sectioning the anterolateral column of the spinal cord. Posterior rhizotomies had also been usually performed in the 1880s, but according to Frazier, this operation gave relief to only 19 % of the patients since anatomy of the tracts conveying pain impulses had not been fully understood [3]. Spiller urged Fig. 1 Schematic drawing of the transposition of the nerves to treat athetosis. In original drawing, the radial nerve was known and appeared as musculospiral nerve. Redrawn from original article of Frazier [13]
Childs Nerv Syst (2015) 31:355–358
Childs Nerv Syst (2015) 31:355–358
357
Dr. Frazier that severing the anterolateral tracts could relieve lower body pain. Dr. Frazier refused to attempt such an experimental operation, but Edward Martin performed this operation in 1911. In 1914, Dr. Frazier described a more practicable approach of cordotomy and soon placed the cordotomy among routine surgical procedures. In 1920, he reported that the optimal site for cordotomy was in the upper thoracic region [2]. Additionally, Dr. Frazier’s attempts on the surgical removal of tumors of the cerebellum, managing the problems of pituitary and parasellar tumors and neoplasms of the sphenoidal ridge, should not be overlooked [2, 10].
operation, the target was the axillary and musculocutaneous nerves. In their article, the idea behind these operations was written [12] as follows:
Athetosis and Frazier’s approach
Additionally, they described several surgical techniques and advocated these techniques to modulate the activity of the specific motor nerves that were felt most involved in the expression of athetosis [11, 12]. They reported that “The operation performed in this case of athetosis shows convincingly that when the peripheral end of a healthy nerve is inserted into another healthy nerve by a longitudinal and not transverse incision in the latter, return of function may occur in the inserted nerve” [12]. Although such operations have not been performed in modern treatment of the athetosis, attempts of Dr. Frazier and his colleagues made important contribution to our modern understandings on nerve reconstruction and regeneration.
A variety of invasive and risky surgical procedures were developed to treat athetosis, generally with little justification and no experimental support, and typically with serious secondary morbidity [11]. Some of the choices of surgical therapies were trephining (also known as trephination or trepanning), excision of the precentral gyrus, posterior rhizotomy (and sometimes concomitant anterior rhizotomy), peripheral nerve cut and coaptation (or transposition), alcohol neurolysis of peripheral nerves, and even amputation of the most affected limb [11]. Athetosis had also been regarded as a form of cortical discharge, and stretching the brachial plexus above the clavicle had also been attempted but no benefit was provided by famed neurosurgeon Sir Victor Horsley (1857–1916) [11]. Another surgical procedure first performed for athetosis was sectioning of posterior nerve roots (and sometimes concomitantly selected anterior nerve roots). Dr. Frazier also used posterior rhizotomy in a case of athetosis after the persistent suggestions of Spiller. Some years later, despite Spiller’s continued advocacy of the procedure, Charles A. Elsberg (1871–1948) and Moses Allen Starr (1854–1932) concluded that posterior rhizotomy does not appear to have had any permanent beneficial effect [11]. Frazier and his colleagues also studied on a case with athetosis to treat him with nerve transposition procedure [12]. A 19-year-old male patient was selected for this operation. He had undergone an unsuccessful Horsley’s operation. Then, he underwent three further nerve transposition procedures of Frazier’s group. The first operation was performed by Frazier in 1905. Dr. Frazier coaptated the left median and ulnar nerves to the side of the intact radial nerve (Fig. 1 and cover figure). Under the direction of Frazier, the second operation was performed on the same side of the patient by Jean Jacques Abram Van Kaathoven (1877–1928), assistant instructor of Department of Surgery [11, 12]. In the second
“…if we could switch off, so to speak, some of this excessive innervation of the flexors into the extensors by nerve transplantation, we might be able to establish a more nearly normal relation between certain groups of muscles and their opponents, and by division of nerves be able to lessen the athetoid movements probably permanently. It hardly seemed likely that the restoration of function would be so perfect as to permit a return of athetoid spasms.”
Acknowledgments The authors thank Akdeniz University Research Project Unit for their support. Conflict of interest The authors declare no conflict of interest.
References 1. Blair JS (2006) Ernst Von Bergmann. J R Army Med Corps 152(2): 108–109 2. Boockvar JA, Virella A, Kotapka M, Flamm ES, Grady MS (2000) Neurosurgery at the University of Pennsylvania Medical Center. Neurosurgery 46(5):1223–1228 3. Cooper DY, Ledger MA (1990) Innovation and tradition at the University of Pennsylvania School of Medicine: an anecdotal journey. University of Pennsylvania, Philadelphia 4. Frazier CH (1920) Surgical problems in the reconstruction of peripheral nerve injuries. Ann Surg 71(1):1–10 5. Grant FC (1937) Charles Harrison Frazier 1870–1936. Ann Surg 105(4):638–640 6. Grant FC (1951) Charles Harrison Frazier: tangibles and intangibles. J Neurosurg 8(2):135–142. doi:10.3171/jns.1951.8.2.0135 7. Hall DP (1962) Our surgical heritage. Europe: Ernst von BERGMANN. Am J Surg 104:913–914 8. Hanigan WC, Ragen W, Ludgera M (1992) Neurological surgery in the nineteenth century: the principles and techniques of Ernst von Bergmann. Neurosurgery 30(5):750–757
358 9. Kyle RA, Shampo MA (1987) Ernst von Bergmann: pioneer of aseptic methods. Mayo Clin Proc 62(3):222 10. Langfitt TW (1990) Charles Harrison Frazier: his influence on the development of early neurosurgery in America and on the development of the University of Pennsylvania School of Medicine. Surg Neurol 34(2):129–131 11. Lanska DJ (2013) Early Controversies Over Athetosis: II. Treatment. Tremor Other Hyperkinet Mov (N Y) 3
Childs Nerv Syst (2015) 31:355–358 12. Spiller WG, Frazier CH (1905) The treatment of cerebral palsies and athetosis by nerve anastomosis and transplantation. J Nerv Ment Dis 32:310–317 13. Spiller WG, Frazier CH, Van Kaathoven JJA (1905) The treatment of selected cases of cerebral, spinal, and peripheral nerve palsies and athetosis by nerve transplantation: with the report of a case of athetosis benefitted by operation. Trans Stud Coll Phys Phila 27: 180–212
BIOGRAPHY
Charles Harrison Frazier (1870–1936) and his legacy to neurosurgery Yasemin Kaya & Levent Sarikcioglu
Received: 11 August 2014 / Accepted: 1 September 2014 / Published online: 7 September 2014 # Springer-Verlag Berlin Heidelberg 2014
Abstract Charles Harrison Frazier (1870–1936) was a visionary neurosurgeon of his time. He devoted himself almost exclusively to neurosurgery based on his training in Germany on neurology, surgery, and surgical pathology and his accomplishments as a military physician during war years. The authors reviewed his life with a special emphasis on his legacy to neurosurgery. Keywords Charles Harrison Frazier . Neurosurgery . Rhizotomy . Trigeminal neuralgia Charles Harrison Frazier (1870–1936) was an outstanding neurosurgeon of his time. He made important contribution to treat several neurological disorders.
His life Charles Harrison Frazier was born in Philadelphia on April 19, 1870 as a third child of W.W. Frazier and Harriet Morgan Harrison. After graduating from the Episcopal Academy in Philadelphia in 1886 and receiving his bachelor’s degree from the University of Pennsylvania in 1889, his mother insisted him on choosing a profession. He agreed to enter the Medical School of the University of Pennsylvania for a year to Y. Kaya : L. Sarikcioglu (*) Department of Anatomy, Faculty of Medicine, Akdeniz University, 07070 Antalya, Turkey e-mail: [email protected] L. Sarikcioglu e-mail: [email protected] Y. Kaya e-mail: [email protected]
discover whether or not he found medicine sufficiently interesting to pursue it further [6]. Although his first 2 years passed unhappy, he graduated from the medical school in 1892. After his graduation, he studied as an intern in the Episcopal and University Hospitals under Dr. John Ashhurst (1839–1900) and Dr. J. William White (1850–1916) [6]. On the suggestion of Dr. J. William White, Dr. Frazier moved to Germany and spent 2 years there to study on neurology, surgery, and surgical pathology under the supervision of Dr. Ernst von Bergmann (1836–1907) and famed pathologist Dr. Rudolph Ludwig Karl Virchow (1821–1902) at the University of Berlin. He was heavily influenced by his teachers. Dr. Ernst von Bergmann served as a military surgeon in the Prusso-Austrian War (1866) and the Franco-Prussian War (1870–71) and gained experience treating cranial trauma and neurological disorders [8, 1, 7]. Additionally, Ernst von Bergmann was known as a pioneer of aseptic surgery [8, 9]. In 1896, he returned to Philadelphia and was appointed as an instructor in surgical pathology. In 1898, Dr. Frazier was elected a member of the Philadelphia Academy of Surgery. He was elevated to clinical professor of surgery in 1901 [2]. In 1903, at age 33, he was appointed Dean of the Medical School and he spent ten hard years as dean of the faculty [5]. During that period, the first laboratory of purely surgical pathology in this country was established at the University Hospital, and the University of Pennsylvania Medical Magazine was started with Dr. Frazier as editor [2]. In 1912, he was elected vicepresident and, in 1916, president of the Philadelphia Academy of Surgery. During his practice on general surgery, he gave particular interest to neurosurgery and thyroid surgery. During the World War I, he was appointed as neurosurgical consultant to the Surgeon General in charge of the Neurosurgical Service at Base Hospital No. 11 at Cape May and No. 41 at Fox Hills, Staten Island. He represented the Surgeon General at the Interallied Surgical Conference in Paris in 1920, with a paper on
356
the results of the treatment of injuries to the peripheral nerves [4]. In 1922, Dr. Frazier succeeded John B. Deaver as the John Rhea Barton Professor of Surgery and was appointed the Chairman of the Department of Surgery at the University of Pennsylvania School of Medicine. Dr. Frazier was a member and founder of numerous societies. He was a Fellow of the College of Surgeons, a founder and president (1925–1927) of the Society of Clinical Surgeons, a founder and president (1922–1923) of the Society of Neurologic Surgeons, president of the American Neurologic Association (1928–1929), a member of the American Surgical Society and of the American Society for the Study of Goiter, and an honorary member of the Deutsche Akadamie der Naturforcher and of the British Neurosurgical Society. He received the degree of Doctor of Science from the University of Pennsylvania in 1925 and was elected one of its Trustees in 1934 [5]. Dr. Frazier died in North Haven, Maine, July 26, 1936.
His achievements Through his association with leading neurologists—including S. Weir Mitchell (1829–1914), Charles K. Mills (1845–1931), and especially his classmate in the Medical School, William Gibson Spiller (1863–1940)—Dr. Frazier made important contributions to neurosurgery. In 1900, with Dr. Spiller, he performed preganglionic sectioning of the sensory root of the trigeminal nerve in animal and showed that the preganglionic section of the sensory root of the trigeminal nerve was never followed by regeneration of the nerve [6]. In 1901, he operated a patient with trigeminal neuralgia and performed retroresection of the trigeminal ganglion to relieve the pain [6]. This operation was found not only technically possible but also easier than ganglionectomy [2]. It was the first successful operation since Sir Victor Horsley may have cut the root prior to this date, but his patient did not survive [6]. At that time, surgeons resected the entire trigeminal ganglion resulting in several postoperative complications [2]. The Spiller-Frazier approach led to safer intervention for trigeminal neuralgia and fewer complications [2]. In his time, there were some attempts to cure intractable pain. Spiller’s idea was to cure intractable pain by sectioning the anterolateral column of the spinal cord. Posterior rhizotomies had also been usually performed in the 1880s, but according to Frazier, this operation gave relief to only 19 % of the patients since anatomy of the tracts conveying pain impulses had not been fully understood [3]. Spiller urged Fig. 1 Schematic drawing of the transposition of the nerves to treat athetosis. In original drawing, the radial nerve was known and appeared as musculospiral nerve. Redrawn from original article of Frazier [13]
Childs Nerv Syst (2015) 31:355–358
Childs Nerv Syst (2015) 31:355–358
357
Dr. Frazier that severing the anterolateral tracts could relieve lower body pain. Dr. Frazier refused to attempt such an experimental operation, but Edward Martin performed this operation in 1911. In 1914, Dr. Frazier described a more practicable approach of cordotomy and soon placed the cordotomy among routine surgical procedures. In 1920, he reported that the optimal site for cordotomy was in the upper thoracic region [2]. Additionally, Dr. Frazier’s attempts on the surgical removal of tumors of the cerebellum, managing the problems of pituitary and parasellar tumors and neoplasms of the sphenoidal ridge, should not be overlooked [2, 10].
operation, the target was the axillary and musculocutaneous nerves. In their article, the idea behind these operations was written [12] as follows:
Athetosis and Frazier’s approach
Additionally, they described several surgical techniques and advocated these techniques to modulate the activity of the specific motor nerves that were felt most involved in the expression of athetosis [11, 12]. They reported that “The operation performed in this case of athetosis shows convincingly that when the peripheral end of a healthy nerve is inserted into another healthy nerve by a longitudinal and not transverse incision in the latter, return of function may occur in the inserted nerve” [12]. Although such operations have not been performed in modern treatment of the athetosis, attempts of Dr. Frazier and his colleagues made important contribution to our modern understandings on nerve reconstruction and regeneration.
A variety of invasive and risky surgical procedures were developed to treat athetosis, generally with little justification and no experimental support, and typically with serious secondary morbidity [11]. Some of the choices of surgical therapies were trephining (also known as trephination or trepanning), excision of the precentral gyrus, posterior rhizotomy (and sometimes concomitant anterior rhizotomy), peripheral nerve cut and coaptation (or transposition), alcohol neurolysis of peripheral nerves, and even amputation of the most affected limb [11]. Athetosis had also been regarded as a form of cortical discharge, and stretching the brachial plexus above the clavicle had also been attempted but no benefit was provided by famed neurosurgeon Sir Victor Horsley (1857–1916) [11]. Another surgical procedure first performed for athetosis was sectioning of posterior nerve roots (and sometimes concomitantly selected anterior nerve roots). Dr. Frazier also used posterior rhizotomy in a case of athetosis after the persistent suggestions of Spiller. Some years later, despite Spiller’s continued advocacy of the procedure, Charles A. Elsberg (1871–1948) and Moses Allen Starr (1854–1932) concluded that posterior rhizotomy does not appear to have had any permanent beneficial effect [11]. Frazier and his colleagues also studied on a case with athetosis to treat him with nerve transposition procedure [12]. A 19-year-old male patient was selected for this operation. He had undergone an unsuccessful Horsley’s operation. Then, he underwent three further nerve transposition procedures of Frazier’s group. The first operation was performed by Frazier in 1905. Dr. Frazier coaptated the left median and ulnar nerves to the side of the intact radial nerve (Fig. 1 and cover figure). Under the direction of Frazier, the second operation was performed on the same side of the patient by Jean Jacques Abram Van Kaathoven (1877–1928), assistant instructor of Department of Surgery [11, 12]. In the second
“…if we could switch off, so to speak, some of this excessive innervation of the flexors into the extensors by nerve transplantation, we might be able to establish a more nearly normal relation between certain groups of muscles and their opponents, and by division of nerves be able to lessen the athetoid movements probably permanently. It hardly seemed likely that the restoration of function would be so perfect as to permit a return of athetoid spasms.”
Acknowledgments The authors thank Akdeniz University Research Project Unit for their support. Conflict of interest The authors declare no conflict of interest.
References 1. Blair JS (2006) Ernst Von Bergmann. J R Army Med Corps 152(2): 108–109 2. Boockvar JA, Virella A, Kotapka M, Flamm ES, Grady MS (2000) Neurosurgery at the University of Pennsylvania Medical Center. Neurosurgery 46(5):1223–1228 3. Cooper DY, Ledger MA (1990) Innovation and tradition at the University of Pennsylvania School of Medicine: an anecdotal journey. University of Pennsylvania, Philadelphia 4. Frazier CH (1920) Surgical problems in the reconstruction of peripheral nerve injuries. Ann Surg 71(1):1–10 5. Grant FC (1937) Charles Harrison Frazier 1870–1936. Ann Surg 105(4):638–640 6. Grant FC (1951) Charles Harrison Frazier: tangibles and intangibles. J Neurosurg 8(2):135–142. doi:10.3171/jns.1951.8.2.0135 7. Hall DP (1962) Our surgical heritage. Europe: Ernst von BERGMANN. Am J Surg 104:913–914 8. Hanigan WC, Ragen W, Ludgera M (1992) Neurological surgery in the nineteenth century: the principles and techniques of Ernst von Bergmann. Neurosurgery 30(5):750–757
358 9. Kyle RA, Shampo MA (1987) Ernst von Bergmann: pioneer of aseptic methods. Mayo Clin Proc 62(3):222 10. Langfitt TW (1990) Charles Harrison Frazier: his influence on the development of early neurosurgery in America and on the development of the University of Pennsylvania School of Medicine. Surg Neurol 34(2):129–131 11. Lanska DJ (2013) Early Controversies Over Athetosis: II. Treatment. Tremor Other Hyperkinet Mov (N Y) 3
Childs Nerv Syst (2015) 31:355–358 12. Spiller WG, Frazier CH (1905) The treatment of cerebral palsies and athetosis by nerve anastomosis and transplantation. J Nerv Ment Dis 32:310–317 13. Spiller WG, Frazier CH, Van Kaathoven JJA (1905) The treatment of selected cases of cerebral, spinal, and peripheral nerve palsies and athetosis by nerve transplantation: with the report of a case of athetosis benefitted by operation. Trans Stud Coll Phys Phila 27: 180–212
