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THE DEVELOPMENT OF NEUROSURGERY IN NEW YORK CITY* BRONSON S. RAY, M.D. Emeritus Professor of Surgery (Neurosurgery) New York Hospital-Cornell Medical Center New York, New York

IGGINGS in Manhattan Island and its environs have never uncovered trephined skulls, as has occurred in so many parts of the world, to document the beginnings of neurosurgery in the dim past. But neurosurgery had a beginning in New York City nearly 100 years ago. Recounted in a short history by Charles Elsberg1 in 1942 and again by Byron Stookey in the second Elsberg Lecture2 28 years ago, it deserves to be reviewed and brought up to date to remind us of the many worthy people who have contributed to our present position. History tells us that, until the 14th century, surgery of the head was largely restricted to trephining and to treatment of acute head injury and its complications. Sparse references exist to other indications for the trephine employed by more venturesome physicians, such as for epilepsy, headache, and mania, but all writings caution avoidance of opening the dura. During the Renaissance there were few fundamental advances in surgery-due largely to the lack of knowledge about anatomy, physiology, and pathology of the brain and spinal cord or of the significance of manifestations of diseases of the nervous system. Probably the change can be said to have started with Vesalius' diligent pursuit of anatomy in the 16th century. In the succeeding 300 years, many physicians-working often in isolation-made important discoveries, to some of which we still attach their names, as Aqueduct of Sylvius, Circle of Willis, Pacchionian Bodies, Meckle's Cave, Foramina of Lushka and Magendi, Isle of Reil, and Tract of Vicq d'Azyr. One could go on at length with these euphonious names. In pathology we recognize the fundamental contributions of Morgagni and later those of Virchow, and of such microscopists as *The Charles A. Elsberg Lecture, presented at a meeting of the New York Neurosurgical Society and held at Rockefeller University May 15, 1979. Address for reprint requests: 178 East 70th Street, New York, N.Y. 10021.

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Waller, Weigert, Golgi,3 and Cajal.4 The experiments of Fritsch and Hitzig5 and of Ferrier6 on the responses resulting from electrical stimulation of the brain led many to pursue this means of functional identification, and the effort continues into the present. Clinicians began to correlate evidence of disease with specific areas of the brain and cord, and present day eponyms recall the names of some of them, such as Broca, Babinski, Jackson, and Romberg. While all of these advances were fundamental and exciting, the surgeon had no effective part to play until means of anesthesia were developed in the middle of the past century, followed within a few years by the bacteriological studies of Pasteur and others, leading to methods to avoid the dreaded infections that had always given pause to innovative surgery. And there is no doubt that Roentgen's discovery of the use of x rays provided the means, crude as they were in the beginning, to see below the surface. Witness now the amazing refinements that have so effectively advanced diagnosis and treatment. The history of what went on in medicine from the dark ages to the beginning of the 20th century is like a fairy tale, known to all, but often refreshing in the retelling. The story can be told simply or in depth, for the lives of many are bound up in the heritage we have acquired. The popular occupation of seeking "fathers" in any branch of medicine can be unfair to those unsung or unrecalled members of society, not always physicians, who have had parts in the evolution of medicine. The question of who was the first pioneer in neurosurgery has often been discussed, but few would deny the acclaim for Victor Horsley."8 There were others of his time, one of whom was Sir William MacEwen,9 whose prodigious achievements in surgery, particularly with brain abscess,'0 are outstanding. In this country, W. W. Keene of Philadelphia (1887) probably performed the first complete removal of an intracranial tumor (a large tentorial meningioma), followed by recovery of the patient. "I Stookey made the significant observation that "neurosurgery flourished in centers of surgical renown where neurology was already pre-eminent," and New York was one such place near the latter part of the 19th century. Indeed, those sound but bold physicians placed this city in the vanguard of our specialty. Among the neurologists who sought the aid of surgeons, we find such familiar names as William A. Hammond 12 and his son Graeme M. Vol. 55, No. 10, November 1979

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Hammond, who collaborated in the standard text Diseases of the Nervous System. The elder was Union Surgeon General for a time during the Civil War, professor of neurology at the College of Physicians and Surgeons, and prime mover in organizing both the New York Neurological Society (1874), the first of its kind in America, and the American Neurological Association a year later. Edward Constant Seguin was hailed as one of the best clinicians of his time because his concise teaching advanced diagnosis and treatment, especially of diseases of the cord.'4 Moses Allen Starr,15 who succeeded Seguin in the chair of neurology at Columbia, was author of one of the first monographs on brain surgery, and his book will receive subsequent comment. Charles L. Dana, professor of neurology at Cornell, proposed resection of posterior paralysis'6 many years before Otfried Foerster's work.'7 And Bernard Sachs, chief of neurology at the Mt. Sinai Hospitial,'8 was of particular assistance to surgeons, one of whom was his nephew Ernest Sachs, St. Louis' pioneer in neurosurgery, and another was Charles Elsberg. The distinction of these neurologists is evident in that of six who founded the American Neurological Association four were from New York City and, of those attending the first meeting, nearly one half were from New York. The first 11 meetings of the association were held in this

city. The names of some of the New York surgeons of the 1880s and 1890s are legendary for their enterprising surgery on the brain and cord, although such operations were done occasionally in most of the city's hospitals and by a number of different surgeons. All of them and their successors for years thereafter were general surgeons, for it would have been difficult to make a living just from operations on the nervous system. Victor Horsley, who is sometimes believed to have restricted his work to neurosurgery, is reported by W. Jason Mixter,'9 who for a time worked with Horsley, to have performed general surgery in 40% of his operations. Each of seven eminent surgeons whose names appear in medical literature and in archives of the city's hospitals as having participated in the neurosurgery of that day deserves to be recalled briefly. Each served a term as president of the New York Surgical Society. Robert Fulton Weir (1838-1927),20 born in New York, was graduated from City College and from the College of Physicians and Surgeons in 1859. In his graduating year he won first prize for his essay on "Hernia Bull. N.Y. Acad. Med.

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Cerebri," showing his early interest in a problem that can still haunt the surgeon over a century later. A surgeon in the Civil War for four years, at Frederick, Md., he was in charge of one of the North's largest general hospitals. After the war, as a general surgeon, he worked at St. Luke's, Roosevelt, and New York Hospitals. He brought into association in his surgical work Frank Hartley and then Alfred Taylor, and these three comprise a sequence of succession of the principal surgeons doing neurosurgery at the New York Hospital before it moved to its present site in 1932. Dr. Weir was highly regarded and a distinguished looking man, an honorary member of the College of Surgeons and at one time president of the American Surgical Association and of the New York Academy of Medicine. The detailed account of his performance of the first operation in New York for total removal of a brain tumor (1887) before a distinguished group of physicians is commendable reading.21 The tumor was a large posterior falx meningioma, which continues to be a surgical challenge. The patient regained consciousness but died several hours later, probably from hemorrhage. Access to blood transfusion was at least 30 years away. Henry Berton Sands (1830-1888),22 a member of a prestigious New York family, acquired his medical degree from the College of Physicians and Surgeons, followed by surgical training at Bellevue Hospital. Eminently practical, intolerant of theories, suspicious of authority, a remorseless critic, he quickly gained a position of respect and authority in the city. He was a busy surgeon and probably did the first appendectomy for acute appendicitis in New York. Although on the staff of several of the leading hospitals, he became surgeon-in-chief at the Roosevelt Hospital where in the last five years of his life he had the largest surgical service in the city. He had helped to found and was the first president of the New York Surgical Society (1879), which was comprised of an array of remarkable men. His interest and participation in surgery of the brain is evident in one of the early reports of operation for brain tumor.23 Charles McBurney (I845-1913)24 was born in Roxbury, Mass., was graduated from Harvard College and in medicine from the College of Physicians and Surgeons in 1870. He won his appointment to a Bellevue internship in competition, for that hospital was the best equipped in New York City 100 years ago. After two years in several European clinics, he returned to New York, where he became a demonstrator in anatomy under Sands, and lectured on the anatomy of the nerves. On Sands' retirement at the Roosevelt Hospital, where he had established "the most notable Vol. 55, No. 10, November 1979

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surgical service in the country," he inspired the selection of McBurney to succeed him as a "tribute to McBurney's character and professional attainments.' McBurney, best remembered for promoting operations for acute appendicitis,25 for emphasizing the local point of tenderness in the disease, and for the muscle-splitting incision, was nevertheless an early surgeon of the nervous system. Ten of his more than 100 medical publications deal with neurosurgery. One of his biographers, James J. Walsh, characterized him as "more widely and favorably known than any other surgeon in the land. " Arpad Geyza Gerster (1848-1923) was born into a Catholic Hungarian family, graduated from the University of Vienna in 1871, and came as an immigrant to New York two years later. He was already an experienced surgeon, having trained with Theodor Billroth, and soon found his skills frequently requested. The German Hospital (now the Lenox Hill Hospital) had recently opened, and he became a member of the surgical staff (1877). He also joined the staff at Mt. Sinai Hospital, where his responsibilities increased, and, beginning in 1880, he was chief of the surgical service for nearly 35 years until he retired in 1914. Dr. Elsberg learned his surgery largely through him and is mentioned warmly in Gerster's excellent autobiography.26 Gerster's participation in neurosurgery seems to have resulted from a close and respected relation at the Mt. Sinai Hospital with Bernard Sachs, who headed the first neurological division in New York. Robert Abbe (1851-1928) graduated from the College of Physicians and Surgeons in 1874, interned, and then was appointed to the surgical staff at St. Luke's Hospital, then at 54th Street and Fifth Avenue, where the University Club now stands. His many publications indicate his diverse interest in surgical problems and reflect his foresight in initiating new procedures. Although he operated in a number of hospitals, he concentrated his work at St. Luke's when the hospital moved to its present location on Morningside Heights. His initial interest was in operations for lesions of the spinal cord, and he is credited with the first removal of an extradural tumor (1888). That same year, at Dana's suggestion, he performed the first of a number of posterior rhizotomies for relief of pain, and his reputation grew with his reports of operations for other conditions, including syringomyelia, spina bifida, traumatic epilepsy, and tic douloureux. A summary by him of his experiences appeared in 1903.27 Herbert Parsons compiled an admirable discourse on Robert Abbe in 1956.28 Bull. N.Y. Acad. Med.

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Andrew J, McCosh (1858-1908) graduated from the College of Physicians and Surgeons in 1880, and seven years later was appointed to the highest position on the surgical staff at Presbyterian Hospital, which he maintained for the next 20 years of his life. A note in the minutes of the hospital board refers to his having become famous throughout the medical world for his original techniques and difficult operations.29,:3() He was regarded as one of New York's ablest surgeons, a rapid and precise operator, a forceful and outspoken leader, said to have "no enemies among his colleagues" (sic). When he was fatally thrown from his carriage as his frightened span of horses bolted through 55th Street, among those who stood at his bedside were Ellsworth Eliot, George Brewer, William Bull, Allen Starr, and Frank Hartley-all leading physicians of that day. Those who frequent the Presbyterian Hospital may recall that for some years there was a McCosh surgical teaching amphitheatre which, like most such anachronisms, has disappeared, but his bronze memorial is still to be seen in one of the main operating rooms. Frank Hartley (1856-1913) was born in Washington, D.C., where his father was for many years assistant secretary of the United States Treasury. His medical degree was obtained at the College of Physicians and Surgeons in 1880, followed by two years at Bellevue and the usual two years of study in Europe. He became professor of surgery at the College of Physicians and Surgeons and associated in private practice with Henry Sands. His staff appointments were at Bellevue, Roosevelt, and New York Hospitals, at the last of which he was attending surgeon from 1890 for the next 23 years. Famed among his confreres for his proficiency in anatomy and for his bold, skillful operative technique, he was said to be a surgeon particularly able in neurosurgical problems, to whom physicians looked for help in difficult cases. He was best known for his description (1892) of the first extradural temporal approach to the gasserian ganglion, resection of the second and third divisions of the fifth nerve with the ganglion, and division of the root of the nerve.31 This became the operation of choice for years thereafter, and in my opinion is still useful in selected cases. Princeton, where he had received his baccalaureate, gave him an honorary Doctor of Laws degree in 1909. Moses Allen Starr's book, Brain Surgery (1893), 15 one of the first of its kind, gives a good summary of the state of operations on the brain in the chapter headings (see table). Starr, professor of Diseases of the Mind and Nervous System at the College of Physicians and Surgeons, was not a Vol. 55, No. 10, November 1979

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CHAPTER HEADINGS IN BRAIN SURGERY by Moses Allen Starr, 1893 I. II. III. IV. V. VI. VII. VIII. IX. X.

The Diagnosis of Cerebral Disease Trephining for Epilepsy Trephining for Imbecility Due to Microcephalus Trephining for Cerbral Hemorrhage Trephining for Abscess of the Brain Trephining for Tumor of the Brain Trephining for Hydrocephalus and for the Relief of Intracranial Pressure Trephining for Insanity Trephining for Headache and Other Conditions The Operation of Trephining

surgeon but was assisted in the purely surgical aspects of his dissertation by McBurney. Starr analysed 600 autopsied cases of brain tumor, including solitary tuberculomas and gummas, and concluded that many could have been diagnosed and localized clinically but could not have been removed. Others could have been removed but signs did not point well enough to the lesion to give adequate guidance to the surgeon. His estimate was that about 37 (6%) of the 600 tumors could have been removed. When the book was published in 1893, from the world literature and his own cases he collected 97 cases of brain tumor for which surgery had been performed. There were 81 cerebral and 16 cerebellar tumors, and the operative mortality was 54%. Starr believed that, considering the novelty of these operations, 46% successful results by virtue of survival was both "interesting and encouraging.' This, I believe, must have been an unusual neurologist. In this book amusing and interesting comments about operative techniques include: deploring the surgeon who adjusts his glasses or blows his nose without washing his hands afterward; the use of ergot to contract brain vessels that tend to bleed; the preference for chloroform over ether as an anesthetic agent; the advantage of skin preparation with corrosive sublimate (bichloride of mercury) which, incidentally, Cushing followed to the end; and, finally, a recipe for making Horsley's bone wax (seven parts beeswax, two parts oil, and one part carbolic acid). At this time no hospital in America had special wards for patients suffering from diseases of the nervous system, and both neurologists and surgeons were called as consultants when the need arose. In 1909 three neurologist (Joseph Collins, Pierce Bailey, Sr., and Joseph Fraenkel) organized a hospital for the "study and treatment of nervous diseases.'" They readily agreed that there was a field for a surgeon and added Charles Bull. N.Y. Acad. Med.

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A. Elsberg. The new hospital was to be the Neurological Institute of New York, and a building was obtained on East 67th Street, which still stands next to the Police Station and the Fire House. There were 54 beds for ward and semiprivate patients but none specifically for surgical patients, and endless trouble arose over assignment of beds as the number of operations increased. In the second year after the hospital opened, there were 1,163 admissions and 89 operations (7.5%): 31 brain, 24 spinal cord, 21 perphiral nerves, and 13 miscellaneous. After five years the number of operations performed was 128, an increase principally from a greater number of brain operations, and thereafter the total number of operations increased to about 10% of the hospital admissions. When the institute outgrew its limited quarters, affiliation was formed in 1925 with Columbia-Presbyterian Medical Center, and the present institute opened in its new quarters in 1929. Elsberg has written a valuable account of the growth of the Institute from its inception through the years when neurological surgery itself was developing.32 Charles A. Elsberg (1872-1948),33 who, along with Harvey Cushing and Charles Frazier, is usually regarded as one of the progenitors of neurosurgery in this country, was born in New York City, graduated from City College (1890) and from the College of Physicians and Surgeons (1893). As an intern at the Mt. Sinai Hospital he came under the direction of Arpad Gerster, by then one of New York's ablest surgeons. From here he went to Breslau, where he studied under Von Mikulicz. Returning to the Mt. Sinai Hospital he became an assistant pathologist, and for a time devoted his efforts to the developing field of bacteriology. He had already decided to be a surgeon, and his early papers indicate his occupation experimentally as well as in the operating room with subphrenic abscess, pneumothorax, heart wounds, blood, transfusion, and intratracheal anesthesia. But he showed interest also in neurosurgery by describing two cerebello-pontile angle tumors in a 1904 report.34 When he joined the new Institute in 1909 he quickly set about organizing the operating room, and a month later operated successfully on a woman physician for a spinal cord tumor. This was one of the first operations within the substance of the cord, and he remarked that she lived for many years thereafter. Although he came to employ a variety of operations on the nervous system, his chief interest was in surgery of the spinal cord. In 1913 he reported his series of 60 laminectomies (believed to Vol. 55, No. 10, November 1979

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be the largest then), and three years later he published his classical monograph Diseases of the Spinal Cord and Its Membranes.35 He was a sound clinician and, according to Pool, a "swift and nononsense surgeon" who zealously set the pattern of high surgical standards at the Institute. He enjoyed teaching, and wrote many papers in addition to the three monographs on spinal cord surgery in which his scholarly and precise manner is manifest. The regard of his colleagues is clear in his presidency of the American Medical Association and office in a number of other societies. He was acclaimed at the 100th anniversary celebration of City College, when he received an honorary degree of Doctor of Science. I can lay claim to personal contact with him on but two occasions. Once, when I was a young neurosurgeon, he came in consultation and offered several suggestions of which I had not even thought. His parting words were of encouragement and he said, "I wish I were young again." The other time was when I submitted my thesis for admission to the American Neurological Association (1939) on arteriovenous anomalies of the brain and he was assigned to review it. He told me he felt like rejecting my offering for he had intended to write it himself, but added graciously that at his age he knew he never would. Alfred Taylor joined the Neurological Institute as an assistant surgeon soon after it was established. He was said by Elsberg to be a skillful operator, and to have contributed to the development of the surgical service. Later Elsberg recorded that "to do justice to the ability of Dr. Taylor, the position of Visiting Surgeon was created." This made him next in line of seniority to Elsberg. Alfred Simpson Taylor (1868-1942)36 was born in South Manchester, Conn., graduated from Brown University in 1891, and in medicine from the College of Physicians and Surgeons in 1895. After two years of internship at New York Hospital, he associated with Robert Weir, one of the city's noted surgeons. At the same time he was closely associated with Frank Hartley and William T. Bull, all of whom influenced his developing interest in the surgery of the nervous system. Although never completely divorced from general surgery, he became best known for his increasing accomplishments in neurosurgery. He was a pioneer in the surgical treatment of brachial plexus palsies,37 more common then than today, and the procedure was popular for many years. His method of reduction of dislocations of the cervical spine, in which he was skillful, probably saved many from paralysis, although it is rarely used now and usually conBull. N.Y. Acad. Med.

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demned. The method employed the use of a bed sheet which he wrapped around the waist and attached to a halter on the patient. He exerted traction by leaning back slowly while manipulating the head to reduce the dislocation.38 He also described and urged hemilaminectomy instead of complete removal of laminae in operations on the cord, particularly in the cervical and lumbar regions. At the Society of Neurological Surgeons' meeting in New York in 1928 he demonstrated the technique of the operation, and appears to have operated for a ruptured cervical disk.39 Although few of his more than 70 published papers deal with brain tumors, a review of the operative records at the Neurological Institute (through the assistance of Dr. Edward Schlesinger) and at the New York Hospital shows that craniotomy was commonly on his schedule. He was also visiting surgeon at 10 other hospitals, which indicates the need not only for surgeons to travel among several hospitals, but the limited number of neurosurgeons available during the first 30 years of this century. Taylor joined the Cornell Medical College faculty in 1911, where he was successively lecturer in surgery, assistant professor, and professor of surgery from 1914 to 1930. He was an accomplished, industrious man of quiet manner, widely respected by confreres and by students. Byron Stookey was high in his praise of Dr. Taylor, and left me the legacy of acquainting the present generation of neurosurgeons more fully with the successive professors at Cornell: Robert Weir, Frank Hartley, and Alfred Taylor. Byron Polk Stookey (1887-1966)40 for 40 years was recognized as one of the leading neurosurgeons of this city. Not only was he an accomplished surgeon but he also stood out physically, for he was a large imposing man with a commanding presence. He had graduated from Harvard Medical School in 1913, and after two years at the Boston City Hospital he began practice in Los Angeles, but discontinued it with the advent of World War I. First in the British, then in the American Army Medical Corps, he gained experience in neurosurgery and developed a lasting interest in the surgery of peripheral nerve injuries. He joined the Neurological Institute after the war, and in 1923 was designated as professor of neurological surgery; he was chief of the department for a time after Dr. Elsberg resigned. At the celebration of the 50th anniversary of the Institute he was awarded Sc.D (Hon.) degree by Columbia University in recognition of his contributions. John E. Scarff (1898-1978),41 historian and one of the principal members of the surgical staff at the Institute, commented in his memorial to Dr. Vol. 55, No. 10, November 1979

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Stookey that he was a "master surgeon with superb technique, a keen and decisive mind, exceptional initiative and resourcefulness, great courage and absolute integrity." While he was highly regarded generally, there were those who objected to his insistance on discipline and on his sometimes ready tendency to question others' integrity. Besides his contributions to the treatment of nerve injuries,42 Dr. Stookey is remembered for an early description of ruptured cervical disk,43 third ventriculostomy for aqueductal obstruction," his partiality to hemilaminectomy proposed by Dr. Taylor, and for his attention to surgical management of tic douloureux.45 He did not always see eye to eye with Dr. Elsberg, but he was loyal to the Institute, and undoubtedly he became an increasing factor in establishing the high reputation in neurosurgery that it enjoyed during his tenure. Through his family's generosity, the Byron P. Stookey Chair of Neurosurgery was established, with Edward B. Schlesinger (1913- ) as its worthy first encumbant. Wilder Graves Penfield (1891-1976)46 came to New York in 1921 and left in 1928 to join the faculty at McGill University, where he later became director of the new Institute of Neurology at Montreal. Although he had obtained his M. D. degree at Johns Hopkins in 1918, most of his medical education had been in England. When he joined the newly organized surgical staff at Presbyterian Hospital under Dr. Allen Whipple in 1921, he had had a year's surgical internship at the Peter Bent Brigham Hospital in Boston. By his own account, he had first to learn general surgery before assuming responsibility for neurosurgery. He set up a cytology laboratory using the new gold and silver stains he had learned about during a visit to Madrid in 1924, and processed the neurosurgical material from both the Institute and the Presbyterian Hospital, where a limited neurosurgical service developed with the aid of Dr. William Cone. At about the same time, the monograph by Bailey and Cushing set the new standard for classification of gliomas. Though Penfield also had an appointment at the Institute for five of his seven years in New York, his role in neurosurgery in this city was limited. Tracy Jackson Putnam (1894-1975), member of a notable Boston medical family, was persuaded in 1939 to move from that city to become director of the New York Neurological Institute. Both Stookey, as director of surgery, and Henry Alsop Riley, director of the neurological service, "relinquished their positions with the assurance that Dr. Putnam's appointment would ensure substantial contributions from several foundaBull. N.Y. Acad. Med.

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tions.'47 Dr. Putnam's shyness was almost uninformly regarded as aloofness, and he did not easily fit into his medical surroundings in New York. During the seven years he was here his impact on neurosurgery was probably not great, and the unfortunate intramural difficulties that arose during his tenure were sufficient for him to resign and move on to Los Angeles. Others who contributed importantly to neurosurgery at the Institute beginning in the 1920s were John E. Scarff, Clement Masson, Leo Davidoff, Edwin Deery, and Fritz Cramer. Dr. Putnam was replaced by J. Lawrence Pool and H. Houston Merritt, directors of their respective departments, who made the Institute busy with commendable activity for the next 25 years. J. Lawrence Pool (1906- ) was appointed director of the neurosurgical service in 1949 and continued for 24 years, until 1973. Among his diverse interests, several will be recalled in particular. For looking into the spinal canal he devised an unique endoscope48 which had a passing vogue. He participated in the Columbia-Greystone Project49 to learn whether selective cortical ablation, called topectomy, might relieve psychoses. About 100 such operations did not indicate an advantage over other methods of lobotomy, and at about the same time all psychosurgical procedures became less frequent. His subsequent interests were chiefly in the surgical treatment of intracranial aneurysms, which he admirably reviewed in the last Elsberg lecture.50 In a recent publication he compiled a most readable and instructive report of the Institute,51 supplementing Dr. Elsberg's history.32 Pool had an envious war record, followed by his busy and productive years at the Institute, where young neurosurgeons came in increasing numbers for training. As his contemporary and friend, I welcome this opportunity to express my esteem. During his years as chairman of the department he was ably assisted by Lester A. Mount, Thomas J. Bridges, James W. Correll, Edgar M. Housepian, and others. When the Institute moved to its new quarters, Dr. Elsberg left the Mt. Sinai Hospital, where he had continued as chief of neurosurgery in addition to his other responsibilities. He was succeeded there by Dr. Ira Cohen (1887-1957), a general surgeon who had worked with Dr. Elsberg in neurosurgery. Dr. Cohen, as I recall him, had many of the quiet and efficient attributes of his predecessor, and his writings, many of which appear in the Journal of the Mt. Sinai Hospital, are models of knowledgeable surgery of the nervous system. During the six-year period from 1929 Vol. 55, No. 10, November 1979

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to 1935, when he was neurosurgeon-in-charge, he served the hospital well, assisted by Abraham Kaplan and Sidney Gross. Thereafter, Sidney W. Gross (1904- ) became first acting chief, then chairman of the Department of Neurosurgery at the Mt. Sinai Hospital until he retired in 1970. Dr. Gross was an enthusiastic surgeon, outgoing by nature, considerate of patients and colleagues, soundly trained at the Institute and by Ernest Sachs in St. Louis. He was one of the founders of this Society and an arduous supporter of its existence. He began a resident training program and now Leonard I. Malis (1919- ), his competent successor, conducts a busy department, part of the city's newest medical school. Eli Jefferson Browder (1894-1976),52 a graduate of the Johns Hopkins University School of Medicine (1920), was trained in general surgery at Long Island College (changed to State University of New York College of Medicine in 1952) by Dr. Emil Goetsch, professor of surgery, himself a former resident of William S. Halsted and an assistant in 1910 to Harvey Cushing. As occurred with many young surgeons in the 1920s, Dr. Browder was encouraged by his senior to pursue and develop neurosurgery in his institution and affiliated hospitals. At Kings County Hospital, where he was chief of the department of neurosurgery from 1932 to 1959 (27 years), he established a training program and developed one of the foremost services in the world for neurosurgical trauma. A friendly, warm man, a sound neurologist and surgeon, he carried for years the responsibility of providing an example of good medicine in Brooklyn, that large section of the city, and he encouraged a number of young men who came under his influence in the same principles. That he kept busy and interested until the age of 82 was evident in a paper on the intracranial venous system, published posthumously with an associate, Harry Kap-

lan.53 Browder's capable successor was Albert W. Cook (1922- ), who now directs neurosurgery as a division of the Department of Neurosciences at Long Island College Hospital. At Kings County Hospital, William Shucart, I learn, is bringing credit to the department inaugurated by Dr. Browder. Others have made contributions in neurosurgery in this growing city. One of these was William Sharpe (1882-1960), who seems not to have been much a part of the fraternity of neurosurgeons, such as it was, but who nonetheless was busy in the specialty and whose work was respected abroad. Bull. N.Y. Acad. Med.

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After graduating from Harvard Medical School (1908), he spent six months in the Hunterian Laboratory at Johns Hopkins prior to a two-year service at Roosevelt Hospital. The next year was spent working with Cushing, and thereafter he became head of surgery at the Harvard China Medical School in Shanghai. On his return to New York, he became an active member of the Polyclinic Medical School and Hospital, which was instituted in 1882 especially for postgraduate teaching. He also had appointments at the Manhattan Hospital and at a number of others where he sometimes operated. He shared an office with Foster Kennedy in a building occupied by Frederick Peterson and Ramsey Hunt on the second and third floors, respectively. That building was razed to make way for Rockefeller Center. His surgery was limited to the nervous system but his interest appears to have been with congenital defects, hemorrhagic diseases of the brain, birth palsies, hydrocephalus, and epilepsy. He was prominent in forming the Pan American Medical Association, and after retirement he wrote his biography,54 in which appear some strange accounts of his encounters. A brother, Norman Sharpe, who had become a surgeon associated with John Chalmers DaCosta in Philadelphia, joined him in New York in 1915 and performed mostly spinal cord surgery. Together they published in 1928 a 762-page book, Neurosurgery, Principles, Diagnosis and Treatment.55 Another man of that period was Karl Winfield Ney (1882-1948), a graduate of Louisville Medical School (1908). Information on him is scanty and his publications relatively few, but he served as a neurosurgeon first in the French and then in the American Medical Corps during World War I, and collaborated in compiling the medical history of the war. At one time he was dean of the Polyclinic Medical School and clinical professor of neurosurgery at the New York Medical College and Flower Hospital, which had opened in 1890 at 63rd Street and York Avenue. I became aware of Dr. Ney when in the 1930s two of his patients treated for epilepsy by removal of the calvarium to relieve traction on the brain and insertion of a celluloid plate came for revision of chronically infected wounds. Ney wrote of his mechanical theory of epilepsy and the results of treatment in 1933.56 I believe few of the patients treated, in this country and in Europe, by various types of "releasing" craniotomy were relieved of epilepsy. But strange things sometimes happened, and I recall Dr. Foster Kennedy's urging me merely to turn down a bone flap and close it in a patient with Vol. 55, No. 10, November 1979

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poorly controlled Jacksonian fits. One did not often argue with Dr. Kennedy and, to my surprise, after I performed the operation, the patient went some years with rare minor attacks. At one time, cecopexy was performed in this city to cure epilepsy and when Dr. Heuer found it was being done at the New York Hospital in the 1930s he put a stop to it. No discussion of neurosurgery in New York would be complete without remarks about Joseph Eggleston Johnston King (1886-1972), fondly remembered as "Uncle Joe,'" who, with his colorful personality, left an impact on colleagues wherever he went. Dr. King was a general surgeon graduated from the University of Tennessee and his southern origins were never in question. He became interested in surgical cases of injury to the nervous system during World War I. On discharge from the army, he returned to Bellevue Hospital, where he had interned, and became a neurosurgeon on the Cornell Division. Bellevue neurosurgery was then divided between Cornell and Columbia, and the staffs serving each alternated every six months, with Foster Kennedy directing neurology for both services. Byron Stookey, assisted by John Scarff, followed Alfred Taylor, and continued the Columbia service with the help of J. Lawrence Pool until it was relinquished. The many who worked there included Frank Echlin, Abraham Kaplan, Juan Negrin, Ernest Matthews, Robert Shick, and others. When Dr. King retired, Dr. Wingebach carried on for a short time and was replaced by Herbert Parsons, assisted by Howard Dunbar. Dr. King is remembered for his method of treating the then relatively common brain abscess by marsupialization57 and for an unique operation of morselation of the skull in cases of premature closure of the cranial sutures.58 Dr. King's associate, Dr. Wilfred Davies Wingebach (1905- ), became a busy neurosurgeon in Westchester and though his friends in neurosurgery were aware of the excellent work he was performing in that community, he was seldom seen in this city after he left Bellevue Hospital in 1950. Leo Max Davidoff (1898-1975)59 graduated from Harvard Medical School (1922) and spent most of the next four years at the Peter Bent Brigham Hospital, followed by study in Hamburg and in London. He was the first of the Cushing residents to come to New York.* Here he joined *Other residents in neurosurgery at the Peter Bent Brigham Hospital who came to New York were Tracy Putnam, John Scarff, Thomas Hoen, Carlos De Guiterrez-Mahoney (known as Will Mahoney prior to World War II), and Bronson Ray. Edwin Deery, Abraham Kaplan, and Benno Schlesinger were volunteer assistants for a year. Ignatius N.W. Olninck (1888- ), known as Ignatz Oljenick when a volunteer assistant, migrated from Amsterdam in 1942. There were others who had spent shorter periods as volunteer assistants or as observers. Richard Meagher, who had been a general surgical resident, indicated his intention of becoming a neurosurgeon but died in 1936.

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the staff at the Institute, and made a working affiliation with Cornelius G. Dyke, radiologist, leading to one of the early monographs on pneumoencephalography.60 Dissatisfied with his role at the Institute, he left in the mid 1930s and became successively associated with several hospitals, first at Brooklyn Jewish Hospital and then at the Montefiore Hospital, where his proficient associate and successor was Emanuel H. Feiring (1913- ). But Dr. Davidoff's most important work took place with the founding of Albert Einstein College of Medicine in the Bronx. Here he established a department as he wished it to be (1959) and a training program. The young men who trained with him are leaving their mark in neurosurgery. Dr. Davidoff became a friend through our common ties of early training at the Peter Bent Brigham Hospital. We often consulted each other and found occasion for mutual support. I watched his advancing importance in neurosurgery with interest and felt deeply honored, while he was alive, to give the first annual Davidoff Lecture. He was succeeded at Albert Einstein College of Medicine by Kenneth Shulman (1928- ), who gives every evidence of leaving his own mark on the advance and education in neurosurgery. Dr. Francis Echlin (1906- ), second president of this Society, a Canadian, graduated from McGill University Medical School in 1931. During the next eight years he worked in neurology, neurosurgery, and neurophysiology at Bellevue, both the New York and Montreal Institutes, and in France and England. He was asked by Dr. King to join the Lenox Hill Hospital Staff in 1939, and succeeded him when he retired as director of the neurosurgical service in 1951. During the next 20 years Dr. Echlin organized a laboratory with facilities for about 30 monkeys and, with the aid of several technicians, he carried on investigations, principally in epilepsy. He maintained an appointment at New York University, although he was not successful in obtaining a formal affiliation for his department at the Lenox Hill Hospital or certification for a training program. But his clinical and investigative work came to be recognized as equal to that in a major medical center. The beginning of the neurosurgical department at New York University Medical School seems somewhat obscure, but during the early 1940s, when the city was shorthanded in neurosurgeons, patients coming to the New York University division of neuropsychiatry at Bellevue who proved to have neurosurgical lesions were often operated on without referral to the. Vol. 55, No. 10, November 1979

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hospital's neurosurgical division. By the end of World War II there was need for a neurosurgical staff, and Thomas Hoen was named as the first director of the department of neurosurgery at New York University (1951) and for the next 10 years. Dr. Thomas Irving Hoen (1903-1978) graduated from Johns Hopkins in 1928 and trained at both the Peter Bent Brigham Hospital and at the Neurological Institute in Montreal. He continued for a while in Montreal, then came to New York in 1939 and obtained an appointment at New York University. During World War II he was chief of neurosurgery at St. Albans Naval Hospital. As director of the department at New York University, he established a certified program that included the Bellevue and Postgraduate Hospitals, the latter having been established by New York University for postgraduate teaching in 1882. Dr. Hoen's special interests included spinal cord injuries, peripheral nerve repair, and rehabilitation. From our early house-officer days in Boston and for nearly 50 years he was a generous and affable friend, sometimes with divergent ideas from mine, but one with whom I could argue without rancor. Those who worked with him include Arthur MacLean, Thomas Garvey, Francis Echlin, Irving Cooper, Arthur Battista, Jack London, and others. In 1961 Joseph Ransohoff 11 (1915- ) became the department head as the school was reorganized, and plans were made for the New York University Medical Center. Projects under Dr. Ransohoff's enthusiastic and untiring direction include federally funded Centers for Research in Cord Injury and in Head Injury, and participation in the study of braintumor treatment. In addition to the University Hospital, the department includes Bellevue, Veterans Administration, and St. Vincent's Hospitals. St. Vincent's Hospital after World War II underwent reorganization, including establishment of a neurosurgical department with GutierrezMahoney as the first director. Dr. Carlos Guillermo DeGutierrezMahoney (1904- ), one of the founders and former president of this Society, was known before World War II and by his early friends as Will Mahoney. Born in Mexico, he graduated from Harvard Medical School (1929), and spent his resident years at Peter Bent Brigham and New York Hospitals, where we became friends and worked together as colleagues. There followed a period with Foerster in Breslau and at other European centers, and practice in Nashville, interrupted by the war in which he was the ranking officer in neurosurgery in the U.S. Air Force. On joining St. Vincent's Hospital after the war, he established a busy service with a Bull. N.Y. Acad. Med.

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certified training program, which he continued until he retired in 1966 because of ill health. Dr. Richard L. Rovitt (1924- ), who succeeded him at St. Vincent's Hospital, re-established the training program for a while but then joined the department at New York University under Dr. Ransohoff. Although he continues to head a busy service at St. Vincent's Hospital, he also finds time to participate in socioenconomic problems of medicine and, at present, to occupy the presidency of the New York State Neurosurgical Society. Dr. Irving S. Cooper (1922- ) left active membership in the New York University service to devote his work at St. Barnabas Hospital (1954) to stereotaxic methods of treatment of disorders of voluntary movement. More recently he has promoted the use of cerebellar stimulation in the treatment of epilepsy,61 and directs a department for physiologic neurosurgery at Westchester County Medical Center, now a part of New York Medical College. The New York Medical College began as the Homeopathic Medical College in 1860, over a grocery store in Gramercy Park. Through its varied and turbulent history, which is graphically told by Dr. L. P. Wershub,62 the school, by joining the Fifth Avenue Hospital in 1939 and the new Metropolitan Hospital in 1955, became another of the city's medical centers, although unaffiliated with a university. In its most recent move, the school has gone to Valhalla, where its connection with Westchester County Hospital constitutes a new medical center. It was in 1939, at the time the school joined the Fifth Avenue Hospital, that a joint department of neurology and neurosurgery was initiated under the direction of Tarlov. Dr. Isador Max Tarlov (1905-1977) graduated from Johns Hopkins (1930), and was one of the first residents at the Neurological Institute in Montreal. His coming to New York and his appointment at New York Medical College may have been encouraged by Hoen, who headed a service at the affiliated Metropolitan Hospital and who had been acquainted with Dr. Tarlov in Montreal. Through the 26 years (1939-1965) in which he was chairman of the department, his main interest was in the surgery of spinal disorders. During World War II he had developed plasma clot suture techniques,63 and he is remembered particularly for his scholarly monograph dealing with sacral cysts.64 Dr. Tarlov was succeeded by Dr. Allen B. Rothballer (1926- ), who joined the staff at Albert Einstein Vol. 55, No. 10, November 1979

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College of Medicine in 1956 after training in Montreal. His interests have been chiefly in disorders of the neuroendocrine system and, as continuing director of neurosurgery, he anticipates the advantages afforded by a revitalized school and hospital in Westchester. With the opening of the New York Hospital-Cornell Medical Center in 1932, there was a formal union of the hospital and school. Harold G. Wolff headed a neurological service in the Department of Medicine. Neurosurgery was an integral part of the Department of Surgery, headed by Dr. Heuer, and neurosurgical patients were dispersed in the surgical wings of the hospital. Dr. George Julius Heuer (1882-1951) is remembered in this city mostly as professor of surgery at Cornell and promoter of long resident training in surgery. However, he was also one of the early neurosurgeons of this country and member of the Society of Neurological Surgeons. He had graduated from Johns Hopkins and, in 1907, entered a seven-year resident training program under William S. Halsted, who reluctantly released him to become Cushing's first personal assistant.* It was anticipated that Heuer would replace Cushing,65 who moved to Boston for the opening of the Peter Bent Brigham Hospital (1914) but World Was I changed matters and, after Heuer's return from the war, he went to Cincinnati as professor and chairman of surgery at the newly reorganized medic41 school. During the next 10 years he not only directed and performed general surgery, but also was the principal neurosurgeon in that city. When he came to New York (1932) he continued to perform numerous types of surgery, including those on brain and spine, and with consummate skill. But gradually his participation in neurosurgery diminished as the specialty developed. I consider him one of the great surgeons of his area, versed in all types of operations, an untiring teacher, who organized and fearlessly promoted the best principles in surgery. After a general surgical resident training, during which I worked with Allen Kanavel, Loyal Davis, Harvey Cushing, and George Heuer, I began in 1936 gradually to develop neurosurgery at the New York HospitalCornell Medical Center, and was joined several years later by Herbert Parsons (1909- ). It was not until after World War II that a separate neurosurgical ward was inaugurated, and a training program recognized by the Board of Neurosurgery, with Charles Neill as the first resident and *Cushing listed his resident assistants at Johns Hopkins successively as: George Heuer, Sam Crowe, Emil Goetsch, William Sharpe, Walter Dandy, and Howard Naffziger.65 Bull. N.Y. Acad. Med.

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Howard Dunbar (1919- ) as the second. Parsons came to assume the direction of neurosurgery at St. Luke's Hospital and Dunbar at Roosevelt Hospital. Both for a while assumed responsibilities for Cornell's participation in neurosurgery at Bellevue and at Memorial Hospitals while continuing as active members of the department at New York Hospital-Cornell Medical Center. It hardly seems necessary to point out what an important contribution each made, or how much every resident in training made to a happy and productive department, in which in 1971 I was pleased to be replaced by Russel H. Patterson, Jr. (1929- ). At present, we have six great medical schools in New York City, each affiliated with universities and large hospitals with departments of neurosurgery and training programs. It is nearly 100 years since the first brave efforts at operating on the nervous system in the United States and in New York and 60 years since the specialty began to overcome lay and professional resistance. Much attention has necessarily been devoted to the technical and procedural aspects of neurosurgery, and it no doubt will continue, in keeping with scientific and mechanical advances. Greater thought and effort now go into seeking answers to basic problems that cannot always be solved except in a laboratory or at a specialized center, and the journals in which neurosurgeons write are usually first-class sources of information. We are almost supersaturated with upto-date medical education and yet the whole of medicine is being challenged for its preoccupation with its own interests, while specialties such as neurosurgery are said to be not only self-serving but overpopulated as well. It would be interesting-perhaps unexpectedly revealing-to be here 100 years hence or even in 25 years (as some of you will be), to be brought up-to-date on what has gone on. In the meantime, neurosurgery will have the advantage of having had a good heritage provided by earlier and resolute stalwarts in New York City. ACKNOWLEDGEMENTS I thank the following for providing information that is included in this paper: Mrs. C. Mifflin Frothingham (Gelsay Taylor), Miss Doris Lowe (reference librarian at Cornell University Medical College), Mrs. E. Jefferson Browder, Mrs. Thomas I. Hoen, and Doctors Albert Cook, Irving Cooper, Francis Echlin, Eugene Flamm, Sidney Gross, George Humphreys, Harry Kaplan, David Klein (secretary of Neurosurgical Certifying Vol. 55, No. 10, November 1979

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Board), Juan Negrin, J. Lawrence Pool, Joseph Ransohoff II, Alan Rothballer, Sanford Rothenberg, Richard Rovitt, Edward Schlesinger, Edward Tarlov, Walter Wichem, and Wilfred Wingebach. REFERENCES

1. Elsberg, C.: The development of neurological surgery in New York City during the past twenty-five years. With remarks on advances due to experiences in the first world war. Bull. N. Y. Acad. Med. 18:654-664, 1942. 2. Stookey, B.: Early neurosurgery in New York: Its origin in neurology and general surgery. Bull. Hist. Med. 26:330-59, 1952. 3. Garrison, F. H.: An Introduction to the History of Medicine, 4th ed. Philadelphia, Saunders, 1929, pp. 539, 573, 525. 4. Cannon, D. F.: Explorer of the Human Brain. The Life of Santiago Ramon y Cajal (1852-1934). New York, Schuman, 1949. 5. Fritsch, G. and Hitzig, E.: Ueber die elektrische erregbarkeit des grosshims. Arch. Anat. Phys. Wiss. Med. 300-32, 1870. 6. Ferrier, D.: The Localization of Cerebral Disease, Being the Gulstonian Lecture of the Royal College of Physicians for 1878. New York, Putnam, 1879. 7. Paget, S.: Sir Victor Horsley. A Study of His Life and Work. New York, Harcourt, Brace & Howe, 1920. 8. Horsley, V.: The Structure and Functions ofthe Brain andSpinal Cord, being the Fullerian Lectures for 1891. London, Griffin, 1892. 9. Bowman, A. K.: The Life and Teaching ofSir William MacEwen. Chapter in the History of Surgery. London, Edinburgh, Glasgow, Hodge, 1942. 10. MacEwen, W.: Pyogenic Infective Diseases of the Brain and Spinal Cord. Meningitis, Abscess of the Brain, Infective Sinus Thrombosis. Glasgow, Maclehose, New York, MacMillan, 1893. 11. Keene, W. W.: Three successful cases of cerebral surgery including (1) the removal of a large intracranial fibroma, (2) exsection of damaged brain tissue, and

(3) exsection of the cerebral centerforthe left hand. Am. J. Med. Sc. 96:329-57, 452-65, 1888. 12. Van Ingen, P.: The New York Academy of Medicine. Its First 100 Years. New York, Columbia University Press, 1949. 13. Hammond, W. A. and Hammond, G.: Diseases of the Nervous System. New York, Appleton, 1891. 14. Seguin, E. C.: Opera Minora. A Collection of Essays, Articles, Lectures and Addressesfrom 1866 to 1882, Inclusive. New York, Putnam's Sons, 1884. 15. Starr, M. A.: Brain Surgery. New York, William and Wood, 1893. 16. Dana, C.: The experimental study of the seat of cutaneous sensation. Med. Rec. 43:578-79, 1893. 17. Zulch, K. J.: Otfried Foerster: Physician and Naturalist, Rosenaur, A. and Evans, J. P., translators. New York, Springer-Verlag, 1969. 18. Sachs, B.: The first neurological division in New York City at the Mount Sinai Hospital. J. Mt. Sinai Hosp. 9:292-95, 1942. 19. Horrax, G.: Neurosurgery, an Historical Sketch. Springfield, Thomas, 1952, p 60. 20. Walsh, J. J.: History of Medicine in New York. Three Centuries of Medical Progress. Robert Fulton Weir, 4:27-28, 5:350-51. New York, National America Society, 1919. 21. Weir, R. F. and Seguin, E. C.: Contribution to the diagnosis and surgical treatment of tumors of the cerebrum. Amer. J. Med. Sci. 96:25-28, 109-28, 219-32, 1888. 22. Walsh, J. J.: History of Medicine in New York. Three Centuries of Medical Progress. Henry Berton Sands, 5:460-61. New York, National Americana Society, 1919. 23. Sands, B. S.: Phil. Med. News, 1883.

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Quoted by Starr (reference 15), p 253. 24. Peck, C. H.: Master surgeons of America: Charles McBurney. Surg. Gyncol. Obstet. 36:430-32, 1923. 25. McBurney, C.: Experience with early operative interference in cases of diseases of the vermiform appendix. N. Y. Med. J. 49:676-84, 1889. 26. Gerster, A. G.: Recollections of a New York Surgeon. New York, Hoeber, 1917. 27. Abbe, R. and Schley, W. S.: Surgery of the brain and spinal cord. Int. Med. Ann. 21:89-91; 615-23, 1903. 28. Parsons, H.: Robert Abbe: Pioneer in neurosurgery. Bull. N. Y. Acad. Med. 32:57-75, 1956. 29. Minutes of Meeting of Board of Managers of The Presbyterian Hospital, December 8, 1908. 30. McCosh, A. J.: Report of four cases of brain surgery. Amer. J. Med. Sci. /07:235-45, 1894. 31. Hartley, F.: Intracranial neurectomy of the second and third divisions of the fifth nerve. N.Y. Med. J. 55:317-19; also Ann. Surg. /7:511-26, 1893. 32. Elsberg, C. A.: The Story ofa Hospital: The Neurological Institute of New York /909-1 938. New York, Hoeber, 1944. 33. Cohen, I.: Dr. Charles Elsberg. J. Mt. Sinai Hosp. 15:267-69, 1948. 34. Elsberg, C. A., Frankel, J., and Hunt, J. R.: Report of two cases of tumor of the ponto-medullo-cerebellar space (acoustic neuroma) with operation. J. Nerv. Ment. Dis. 31:468-73, 1904. 35. Elsberg, C. A.: Diagnosis and Treatment of Surgical Diseases of the Spinal Cord and Its Membranes. Philadelphia, Saunders, 1916. 36. Taylor, A. S.: Nat. Encyl. Amer. Biog. 34:211, 1938. 37. Taylor, A. S.: Results from surgical treatment of brachial birth palsy with note on pathology by T. P. Prout. J.A.M.A. 6:96-104, 1907. 38. Taylor, A. S.: Fracture dislocation of the neck; a method of treatment. Arch. Neurol. Psych. 12:625-39, 1924. 39. Taylor, A. S.: Unilateral laminectomy. J. Nerv. Ment. Dis. 37:257-58, 1910. 40. Scarff, J. E.: Byron Stookey. J.

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Neurosurg. 26:3-5, 1967. 41. Scarff, J. E.: Fifty years of neurosurgery, 1905-1955. Int. Abs. Surg., Surg. Gynecol. Obstet. 101:417-513, 1955. 42. Stookey, B. and Scarff, J. E.: Injuries to Peripheral Nerves. In: Neurosurgery and Thoracic Surgery. Philadelphia, 1943, pp 81-184. 43. Stookey, B.: Compression of the spinal cord due to ventral extradural cervical chondromas. Diagnosis and surgical treatment. Arch. Neurol. Psych. 20:275-90, 1928. 44. Stookey, B. and Scarff, J. E.: Occlusion of the aqueduct of Sylvius by neoplastic and non-neoplastic process with a rational surgical treatment for relief of the resultant obstructive hydrocephalus. Bull. Neurol. Inst. N.Y. 5:348-77, 1936. 45. Stookey, B. and Ransohoff, J.: Trigeminal Neuralgia; Its History and Treatment. Springfield, Thomas, 1959. 46. Penfield, W. G.: No Man Alone. A Neurosurgeon's Life. Boston, Little, Brown, 1977. 47. Riley, H. A.: The Neurological Institute of New York. The first hospital in the western hemisphere for the treatment of disorders of the nervous system. The intermediate years. Bull. N. Y. Acad. Med. 42:654-87, 1966. 48. Pool, J. L.: Direct visualization of dorsal nerve roots of the cauda equina by means of a myeloscope. Arch. Neurol. Psych. 39:1308-12, 1938. 49. Pool, J. L., Heath, R. G., and Weber, J.: Topectomy: Surgical technique, psychiatric indications and postoperative management. J. Nerv. Ment. Dis. 110:464-77, 1949. 50. Pool, J. L.: The development of modem intracranial aneurysmal surgery. Neurosurgery 1:233-37, 1977. 51. Pool, J. L.: The Neurological Institute of New York, 1909-1974, with Personal Anecdotes. Lakeville, Conn., Pocket Knife Press, 1975. 52. Ray, B. S.: E. Jefferson Browder. Memoirs. Trans. Am. Surg. Assoc. 96:59-60, 1978.

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53. Kaplan, H. A. and Browder, E. J.: Importance of veins in partial cerebral lobectomy. J. Neurosurg. 41:360-66, 1974. 54. Sharpe, W.: Brain Surgeon. An Autobiography. New York, Viking, 1952. 55. Sharpe, W. and Sharpe, N.: Neurosurgery, Principles, Diagnosis and Treatment. Philadelphia, Lippincot, 1928. 56. Ney, K. W.: Epilepsy. A mechanical theory and results of treatment. J. Am. Inst. Homeopathy 26:241-48, 1933. 57. King, J. E.: Treatment of brain abscess associated with extracapsular necrosis and suppuration. Arch. Surg. 34:631-49, 1937. 58. King, J. E.: Oxycephaly; new operation and its results (Preliminary report). Arch. Neurol. Psychiat. 40:1205, 1938. 59. Ransohoff, J.: Leo M. Davidoff, 1898-

1975. J. Neurosurg. 45:1-2, 1976. 60. Davidoff, L. M. and Dyke, C. G.: The Normal Encephalogram. Philadelphia, Lee & Febiger, 1937. 61. Cooper, I. S.: Cerebellar Stimulation in Man. New York, Raven, 1978. 62. Wershub, L. P.: One Hundred Years of Medical Progress. A History ofthe New York Medical College Flower and Fifth Avenue Hospital. Springfield, Thomas, 1967. 63. Tarlov, I. M.: Plasma Clot Suture of Peripheral Nerves and Nerve Roots; Rationale and Technique. Springfield, Thomas, 1950. 64. Tarlov, I. M.: Sacral Nerve-root Cysts; Another Cause of Sciatica or Cauda Equina Syndrome. Springfield, Thomas, 1953. 65. Fulton, J. F.: Harvey Cushing. A Biography. Springfield, Thomas, 1946, p 29.

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