The Special Field of Neurological Surgery After Another Interval

Abstract

Those engaged in scientific or professional pursuits have need of a periodical accounting of stock no less than those engaged in business. The results of such an inventory may sometimes be of more than personal interest, especially when projects have been undertaken which are in a measure novel or special, for their success or failure may encourage others or may deter them from similar adventures. SPECIALIZATION IN GENERAL In a sense, I suppose, every medical graduate tends in time to particularize to a certain extent, and through liking or opportunity comes to be known as more expert or better informed than his fellows in one thing or another. He may have had an unusual experience in relation to childbirth , shown unusual skill in dealing with the ailments of children or with the maladies to which their mothers are heir. He may have a mechanical bent and be particularly apt as a setter of broken bones or a corrector of deformities. He may be a particularly good microscopist or show greater facility than his contemporaries in the use of some other precise instrument of importance in diagnosis. He may have become engrossed in some special disease, indeed of some particular organ, or what is more, of some special form of treatment for a particular disease of a particular organ. His interests may become purely scientific or purely sociological and take him away from the bedside entirely. Of all this there is no end or ever will be. For there are ways innumerable in science or practice in which we as individuals or groups of individuals come to particularize in our work. The participant in this subtle process of specialization may not always be conscious of it, or, if he is conscious of it, may not wish to admit the fact even to himself, and would encourage his employers, *This address was made to do double duty before the Tri-State District Medical Society at Waterloo, Iowa, Oct. 7, 1920, and the Cleveland Academy of Medicine. Oct. 8, 1920.

Harvey Cushing's Early Operative Treatment of Skull Base Fractures

“…The vascular anatomy traversed in these operations required meticulous hemostasis to maintain adequate visualization, to prevent intraoperative mortality, and to promote adequate postoperative wound healing. 1,3,4 Although the mortality rate in the cases presented here remains high (48%), it is perhaps surprisingly low when the nature of the patients' injuries, the challenges of neuro-trauma cases, and the mortality rate of >50% for neurosurgical procedures performed under the best of circumstances by Cushing's contemporaries. 1,[3][4][5][6][7] Although the lack of postdischarge follow-up makes an assessment of long-term outcomes impossible, the favorable condition at the time of discharge in all 12 surviving patients indicates that Cushing's operative interventions were at least temporarily successful.…”

Harvey Cushing's Early Operative Treatment of Skull Base Fractures

“…The vascular anatomy traversed in these operations required meticulous hemostasis to maintain adequate visualization, to prevent intraoperative mortality, and to promote adequate postoperative wound healing. 1,3,4 Although the mortality rate in the cases presented here remains high (48%), it is perhaps surprisingly low when the nature of the patients' injuries, the challenges of neuro-trauma cases, and the mortality rate of >50% for neurosurgical procedures performed under the best of circumstances by Cushing's contemporaries. 1,[3][4][5][6][7] Although the lack of postdischarge follow-up makes an assessment of long-term outcomes impossible, the favorable condition at the time of discharge in all 12 surviving patients indicates that Cushing's operative interventions were at least temporarily successful.…”

Challenges in early operative approaches to intramedullary spinal cord tumors: Harvey Cushing’s perspective

“…Cushing summarized his early experience with spine lesions: "My personal experience with spinal tumors has been small"-mainly trauma cases, an enucleable tumor (aka meningioma), a fibroma, a dermoid cyst, and invasion of the spinal canal by malignant disease. 13,14 The cases reported in this paper, treated in 1908 and 1910, represent Harvey Cushing's first documented attempts at IMSCT resection at Johns Hopkins.…”

“…There are more things, possibly, to retract than to add." 14 Although Cushing's attempts at exploration and resection as described here demonstrated only limited success in treating IMSCTs, his ability to manipulate the spinal cord during these exploratory procedures without the patients incurring permanent neurological damage, as well as the absence of postoperative infection or complications, is a testament to his meticulous operative technique and his surgical skills.…”

Harvey Cushing's Early Operative Treatment of Skull Base Fractures

“…The cases described here demonstrate Cushing's commitment to transforming the field of neurosurgery into a viable surgical subspecialty; moreover, they document Cushing's extensive work in the field of neuro-trauma, an arena rife with complicated anatomy and operative technique but without the opportunities for remuneration and academic glory presented by Cushing's beloved neurooncology and neuroendocrine pursuits. 1,3,4,[8][9][10]…”

Harvey Cushing's Early Operative Treatment of Skull Base Fractures

“…The vascular anatomy traversed in these operations required meticulous hemostasis to maintain adequate visualization, to prevent intraoperative mortality, and to promote adequate postoperative wound healing. 1,3,4 Although the mortality rate in the cases presented here remains high (48%), it is perhaps surprisingly low when the nature of the patients' injuries, the challenges of neuro-trauma cases, and the mortality rate of >50% for neurosurgical procedures performed under the best of circumstances by Cushing's contemporaries. 1,[3][4][5][6][7] Although the lack of postdischarge follow-up makes an assessment of long-term outcomes impossible, the favorable condition at the time of discharge in all 12 surviving patients indicates that Cushing's operative interventions were at least temporarily successful.…”

Challenges in early operative approaches to intramedullary spinal cord tumors: Harvey Cushing’s perspective

“…Cushing summarized his early experience with spine lesions: "My personal experience with spinal tumors has been small"-mainly trauma cases, an enucleable tumor (aka meningioma), a fibroma, a dermoid cyst, and invasion of the spinal canal by malignant disease. 13,14 The cases reported in this paper, treated in 1908 and 1910, represent Harvey Cushing's first documented attempts at IMSCT resection at Johns Hopkins.…”

“…There are more things, possibly, to retract than to add." 14 Although Cushing's attempts at exploration and resection as described here demonstrated only limited success in treating IMSCTs, his ability to manipulate the spinal cord during these exploratory procedures without the patients incurring permanent neurological damage, as well as the absence of postoperative infection or complications, is a testament to his meticulous operative technique and his surgical skills.…”

Harvey Cushing's Early Operative Treatment of Skull Base Fractures

“…The cases described here demonstrate Cushing's commitment to transforming the field of neurosurgery into a viable surgical subspecialty; moreover, they document Cushing's extensive work in the field of neuro-trauma, an arena rife with complicated anatomy and operative technique but without the opportunities for remuneration and academic glory presented by Cushing's beloved neurooncology and neuroendocrine pursuits. 1,3,4,[8][9][10]…”

Harvey Cushing's Early Operative Treatment of Skull Base Fractures

“…The vascular anatomy traversed in these operations required meticulous hemostasis to maintain adequate visualization, to prevent intraoperative mortality, and to promote adequate postoperative wound healing. 1,3,4 Although the mortality rate in the cases presented here remains high (48%), it is perhaps surprisingly low when the nature of the patients' injuries, the challenges of neuro-trauma cases, and the mortality rate of >50% for neurosurgical procedures performed under the best of circumstances by Cushing's contemporaries. 1,[3][4][5][6][7] Although the lack of postdischarge follow-up makes an assessment of long-term outcomes impossible, the favorable condition at the time of discharge in all 12 surviving patients indicates that Cushing's operative interventions were at least temporarily successful.…”

Challenges in early operative approaches to intramedullary spinal cord tumors: Harvey Cushing’s perspective

“…Cushing summarized his early experience with spine lesions: "My personal experience with spinal tumors has been small"-mainly trauma cases, an enucleable tumor (aka meningioma), a fibroma, a dermoid cyst, and invasion of the spinal canal by malignant disease. 13,14 The cases reported in this paper, treated in 1908 and 1910, represent Harvey Cushing's first documented attempts at IMSCT resection at Johns Hopkins.…”

“…There are more things, possibly, to retract than to add." 14 Although Cushing's attempts at exploration and resection as described here demonstrated only limited success in treating IMSCTs, his ability to manipulate the spinal cord during these exploratory procedures without the patients incurring permanent neurological damage, as well as the absence of postoperative infection or complications, is a testament to his meticulous operative technique and his surgical skills.…”

Harvey Cushing's Early Operative Treatment of Skull Base Fractures

“…The cases described here demonstrate Cushing's commitment to transforming the field of neurosurgery into a viable surgical subspecialty; moreover, they document Cushing's extensive work in the field of neuro-trauma, an arena rife with complicated anatomy and operative technique but without the opportunities for remuneration and academic glory presented by Cushing's beloved neurooncology and neuroendocrine pursuits. 1,3,4,[8][9][10]…”