The Pioneers of Neurology and Neurosurgery in the world and Their Contributions：A Lecture for Young Japanese Neurosurgeons

　A boy was born in Macedonia over two thou-sands years ago．And in a short time he became a great leader, a great general, a greatsoldier．This man who died when he was onlythirty two, conquered all of Greece, the Balkans，the Middle East, Egypt, Persia, India．He thencried as he sat down on a rough and wet rock．Why？ Because there were no more worlds toconquer．This man was a fool．Why？ Because he could see only the dirt under his feet．He had no vision of the future．It is importantthat you have a vision of the future．Becauseonly by research and work can we increase thefield of neurological surgery． Many years agoa philosopher remarked that those who wereignorant of the mistakes of the past are condemned to repeat them. We must not do that.We must go ahead but not make the samemistakes as those who went before us. Neurological surgery is now just over onehundred years old. In 1879 a young man atabout thirty removed the first brain tumor.His name was William MacEwen. And he livedin a small, unimportant city in Scotland, Glasgow. This was not at that time a medicalcenter and yet this man began neurological surgery there and continued to do neurologicalsurgery both on the brain and on the spinalcord. He became one of the most successfulsurgeons ever in the treatment of brain abscesses. Five years later, another surgeon removed a brain tumor in England, in London.His name was Rickman Godlee. But we neverhear of Rickman Godlee again. He removedone tumor and quit. A short time later, another man who was not a surgeon but a physiologist began doing brain surgery and surgeryfor spinal cord tumors. His name was VictorHorsley. Victor Horsley was not a good surgeon. When Harvey Cushing decided to become a neurological surgeon he went to London to learn neurolcgical surgery from Horsley.He watched Horsley operate. But Horsley wassuch a poor surgeon that Cushing became discouraged and decided not to do neurologicalsurgery and left England. He went to Switzerland and worked in physiology and while theredeveloped the knowledge, which we now have, of the symptoms of increased intracranial pressure, the effects on the pulse, the respiration andthe blood pressure. On his way home HarveyCushing stopped again in England but not tovisit Horsley. This time he visited Sherrington, another physiologist. Sherrington was operatingupon monkeys and apes. He asked Cusing toexpose the brains of these experimental animals. And it was this experience with Sherringtonwhich changed Cusing's mind to become a neurological surgeon. I told you that Horsley wasnot a good surgeon. His results were poor. One of his friends once asked him, "Victor, with such bad results as you have, why do you continue to operate ?" And Horsley answered, "If I don't continue, those who conie after mewill do no better." and he was right. Theearly surgeons in the 1800's had such bad results that neurological surgery was about to disappear. Fedor Krause, working in Germany hada post operative mortality of 65%. As a result, neurologists, physicians in general did not continue to refer their patients for neurosurgicaloperations. The change in the risks of neurosurgical operations was brought about by Harvey Cushing. He had an excellent training insurgery. He was trained by one of the mostfamous surgeons that we ever had in the UnitedStates, William Halsted at the Johns HopkinsUniversity. His technique was meticulous, verycareful. He took great pains with tissues andhad good results. Cushing learned this technique from Halsted and adopted it for neurological surgery. For the first 12 years from1900 to 1912 Harvey Cuhsing trained one neurological surgeon. His name was Harvey Cushing. He trained himself.