The neurosurgical service of Washington University is internationally recognized for clinical excellence, an emphasis on basic and clinical research in the neurosciences, and the training of a large number of leaders in academic neurosurgery. The neurosurgical service began with the establishment of a modern medical school at Washington University early in the 20th century. Washington University established a medical department in 1891, when the St. Louis Medical College, founded in 1842, became part of the university. In 1899, the Missouri Medical College, founded in 1840, joined the university. In 1910, after the publication of Abraham Flexner’s report to the Carnegie Foundation,1 the Washington University Medical School was reorganized. Outstanding new faculty members were recruited during this time, and plans were made to move inadequate clinical and hospital facilities from downtown St. Louis to a new hospital financed by the estate of Robert Barnes. This facility and a new Children’s Hospital were constructed next to Forest Park at what was then the western edge of the city. Both opened just prior to World War I.
In 1910, Ernest Sachs, MD, was recruited as a member of the Department of Surgery. His task was to develop neurosurgery in an area of the country where “no one south of Chicago had attempted to enter the field.”2 Ernest Sachs was the nephew of Bernard Sachs, a distinguished neurologist in the late 19th century.3 Ernest Sachs graduated from The Johns Hopkins School of Medicine in 1904. After three years of residency at Mt. Sinai Hospital in New York, he spent three years in London with Sir Victor Horsley, a pioneer in the field of neurosurgery. In 1919, his title was changed from professor of surgery to professor of neurosurgery, the first professorship in the world in this developing specialty. In 1921, Sachs established a training program in neurosurgery at Washington University. Many of his trainees became outstanding teachers and clinicians. Ernest Sachs was recognized as one of the pioneers in neurosurgery in the United States and had a major role in the development of this specialty. He was a founding member of the Society of Neurological Surgeons in 1920, serving as the first secretary-treasurer of this organization from 1920 to 1924 and president from 1925 to 1927. He was an original director of the American Board of Neurological Surgery, which was established in 1940, and president of the American Neurological Association in 1943.
In 1946, Sachs retired as chief of Neurosurgery and was succeeded by Henry G. Schwartz, MD. Schwartz was a superb clinical surgeon who was extremely interested in the training of residents. He fostered strong ties to the neurology service and the basic neuroscience programs, and under his leadership the neurosurgical program developed a strong commitment to basic and clinical research. Many of his trainees continued in academic neurosurgery and became leaders in the specialty. Schwartz was a prominent leader of national neurosurgical organizations, serving as president of the American Association of Neurological Surgeons, the Society of Neurological Surgeons and the American Academy of Neurological Surgeons, vice president of the American College of Surgeons, and chairman of the American Board of Neurological Surgery. After his retirement as chairman, he was the editor of the Journal of Neurosurgery from 1975 to 1985. During his career he received numerous honors, including Honored Guest, Congress of Neurological Surgeons in 1973; the Harvey Cushing Medal of the American Association of Neurological Surgeons in 1979; and the Honorary Presidency of the World Federation of Neurological Surgeons in 1985.
In 1974, Neurosurgery, which had previously been a division of the Surgery Department, became a joint department with the Neurology Department. With the retirement of Schwartz as chairman in that year, Sidney Goldring, MD, became chairman of Neurosurgery and co-head of the new Department of Neurology and Neurological Surgery. Goldring had a lifelong interest in neurophysiology and in the experimental and clinical aspects of epilepsy. Under his leadership, the emphasis on basic and clinical research in the neurosurgical department continued, and the longstanding excellence on the clinical service remained unchanged. Goldring, following in the footsteps of his predecessors, became a leader in the specialty. He served as president of the American Association of Neurological Surgeons, the Society of Neurological Surgeons and the American Academy of Neurological Surgery, and chairman of the editorial board of the Journal of Neurosurgery and the American Board of Neurological Surgery. He was the Honored Guest of the Congress of Neurological Surgeons in 1985 and received the Harvey Cushing Medal of the American Association of Neurological Surgeons in 1993.
In 1989, Ralph Dacey, MD, succeeded Goldring as chairman of the Neurological Service and co-head of the Department of Neurology and Neurological Surgery. Under his superb guidance, there was a marked expansion of the department’s clinical and research activities during the 1990s. The emphasis on excellence in clinical training and neurosurgical investigation continued during this time.
Throughout the 20th century, the neurosurgical service was fortunate to have excellent faculty members in addition to the superb leadership of its chairmen. Two of these faculty members spent their entire neurosurgical careers at Washington University. Leonard T. Furlow, MD, was a distinguished member of the neurosurgical faculty from 1932 to 1967. He was an excellent clinician and teacher, and was a major leader of American neurosurgery. During his career, he served as president of the American Association of Neurological Surgeons, president of the Society of Neurological Surgeons, chairman of the American Board of Neurological Surgery and governor of the American College of Surgeons.
William S. Coxe, MD, was a venerable member of the neurosurgical faculty from 1957 to 1997. During his long career, he was an outstanding clinician who played a leading role in the education of neurosurgical trainees. He also was very active in national neurosurgical organizations and served as vice president of the Congress of Neurological Surgeons. He was honored with the Distinguished Practitioner Award of the Southern Neurosurgical Society in 1999.
Soon after neurosurgery was established as a separate specialty at Washington University, a close relationship developed between it and the basic neurosciences and the neurology service. The neurosurgical service continues to have a commitment to research. Many of its trainees go into academic neurosurgery and carry out research. Two men in particular greatly influenced many neurosurgery trainees to pursue a career in academic neurosurgery. George Bishop, MD, a pioneer in the development of modern neurophysiology, was associated with the neurology and neurosurgical services from 1923 to 1973. He had wide-ranging scientific interests, including the correlation of nerve fiber conducting velocities and nerve fiber diameters and the analysis of the basis of cortical evoked potentials. Bishop made essential contributions to experiments investigating nerve compound action potentials for which Joseph Erlanger and Herbert Gasser of Washington University were awarded the Nobel Prize in Physiology in 1944. James O’Leary, MD, who was chairman of the Department of Neurology for many years, was an outstanding neuroanatomist and clinician. During his career, he made many contributions to the understanding of the basic anatomy of the nervous system. In 1970, he retired as chairman of Neurology and was made professor of experimental neurological surgery. The creation of this position formalized the commitment of neurosurgery at Washington University to basic neuroscience research.
Neurological surgery at Washington University has entered the 21st century with a tradition of clinical excellence and outstanding programs in basic and clinical research. The commitment to state-of-the-art personalized care of patients, the superb training of residents and leadership within the specialty of neurosurgery will continue throughout the century.
- Flexner, A: Medical Education in the United States and Canada. New York: Carnegie Foundation for the Advancement of Teaching Bulletin No. 4, 1910.
- Sachs, E.: Fifty Years of Neurosurgery. New York: Vantage Press, 1958, p. 58.
- Schwartz, H.G.: Historical Vignette: Barnes Hospital and the Washington University Medical Center. J Neurosurg 77: 318-320, 1992.