Surgery of the head and 70-day brain surgeons

IN 1917, THE SURGEON GENERAL of the United States Army, William Gorgas, learned that almost 15% of the casualties of the Western Front sustained intracranial injuries. Soon after the United States declared war in April 1917, the Council of National Defense established a General Medical Board and attached a brain surgery subsection to its Committee of Ophthalmology. Postcards were sent to experts around the country, asking for the names of individuals who had specialty training or practice in brain surgery. In August, Gorgas assumed control of this subsection and created a Army Medical Department, with Division of Surgery of the Head in the American Army Medical Department, with additional sections for plastic surgery, ophthalmology, and otolaryngology. He needed almost 300 brain surgeons; he received 50 names. As Harvey Cushing, Gilbert Horrax, and others went to France, neurosurgeons at home trained student officers. Schools were established in Philadelphia (Charles Frazier), Chicago (Dean Lewis), New York City (Charles Elsberg), St. Louis (Ernest Sachs), and Camp Greenleaf in Georgia (Claude Coleman), with 10-week intensive courses for selected candidates. Basic science and x-ray classes and operative clinics addressed most aspects of neurosurgical care. An army manual outlined clinical diagnoses and surgical techniques. Lewis H. Weed established a laboratory at Johns Hopkins Hospital, staffed by volunteers such as K.D. Blackfan and W.E. Dandy, to investigate infections of the central nervous system. By the time of the armistice, Gorgas had his complement of brain surgeons. The newly trained brain surgeons and their mentors gradually made their way to the Western Front during the summer of 1918. Plans for a neurosurgical school in France were quickly discarded as the American Army Medical Department changed the specialized assignments to front-line general surgical care. Some of the 190 brain surgeons in the American Expeditionary Forces, notably Gilbert Horrax, Charles E. Dowman, and Charles Neuhoff, treated head injuries exclusively, whereas others, such as Eustace Semmes and Howard Naffziger, treated all battle casualties depending on the tactical circumstances. The rational but naive recommendations for coordinated care made by Cushing, as senior consultant in neurosurgery, were hindered by the confusion of the St. Mihiel and Meuse-Argonne offensives and the chaos of war. Only three 70-day brain surgeons participated in the postwar development of the specialty. However, 9 of 10 original members of the Neurosurgical Club, which was established 18 months after the armistice, taught in American Army Medical Department courses or served on the Western Front. The schools and their teachers emphasized a growing recognition of neurosurgical expertise in the early 20th century.