Neurosurgery

by

Delia Gavrus

• LAST MODIFIED: 17 April 2025
• DOI: 10.1093/obo/9780197768723-0042

Introduction

Neurosurgery’s inception as a medical specialty has its roots in the late nineteenth and early twentieth century. Opening the skull, however, which is inextricably connected to neurosurgery in both practice and historiography, has had a global presence over a long history. There exists evidence from all over the world since the Neolithic period that human skulls were sawed or cut into, although the motivations behind the earlier surgeries are often difficult to ascertain. Trepanation has been present in learned medical traditions from Antiquity: a Hippocratic text makes specific recommendations for opening the skull while noting its dangers, while Buddhist medical texts from northwestern India describe the physician Jīvaka performing such operations. Although over the ensuing centuries popular tropes and representations of opening of the skull were prominent (see paintings depicting the cutting of the stone of madness in the Late Middle Ages), surgeons generally avoided this perilous surgery, unless their patients were suffering from serious skull fractures. The second half of the nineteenth century was a turning point. After the lessons of the germ theory of disease seeped into surgical practice in the form of antiseptic and later aseptic techniques, and after the adoption of anesthetics, surgeons became more willing to engage in such potentially dangerous surgical procedures. In addition, historians have argued that scientific work on the localization of function in the second half of the nineteenth century—the identification of particular areas of the cortex as mediating various functions (motor, sensory, language)—played another important role in surgeons’ willingness to operate on the skull and brain. In theory, now they could avoid areas leading to catastrophic injury, and they could more easily pinpoint the location of tumors. In fact, in the late nineteenth century, there was a surge in practice, with some general surgeons embracing an ethos of surgical intervention to the alarm of colleagues. In the late nineteenth and the beginning of the twentieth century, a few general surgeons began to train their practice more narrowly on the brain, spinal cord, and the rest of the nervous system. Neurosurgery as a medical specialty emerged in the beginning of the twentieth century. The American surgeon Harvey Cushing is often credited with an oversized role in this emergence, as he was involved in refining techniques, introducing instruments, convening a specialist society, and training many of the next-generation neurosurgeons. Specialist certification boards and neurosurgical journals constituted the next steps in cementing this specialty. The twentieth century saw a steep decrease in post-operative deaths, collaboration and competition with related medical specialties (neurology, psychiatry), horrific and contested procedures (psychosurgery), and the impact of technology (functional imaging, deep-brain stimulation, gamma knife). In terms of historiography, the history of neurosurgery is fairly small, with contributions from historians and from many more neurosurgeons interested in the history of their specialty. Historically, practitioners were the first to write about the history of their specialty; there is a relative abundance of biographical-style narratives that celebrate the lives and accomplishments of neurosurgeons and of explorations of the history of neurosurgical techniques and conditions. Since the 1990s, there is a growing body of analyses of interest more broadly to historians of science and medicine. The sections below reflect the historiographical questions and interests of this diverse community of writers and scholars, including biographical explorations, the emergence of neurosurgery as a medical specialty in various institutional and national contexts, the ways in which professional identity intersected with gender, patient narratives and perspectives, and neurosurgery’s presence in scientific debates. Acknowledgments: This research was supported by a SSHRC Insight Development Grant and by the University of Winnipeg’s Chancellor’s Research Chair. For assistance with compilation and citation of some of the sources, the author thanks Danijela Saric. For bibliographical research and copyediting assistance, this author is grateful to Madison Herget-Schmidt.

Handbooks and Broad Overviews

Greenblatt, et al. 1997 is exclusively devoted to the history of neurosurgery, and this voluminous edited book is a good place to start for many related topics. Arnott, et al. 2003 likewise provides a good start for topics related to the global history of trepanation from an interdisciplinary perspective (history, archaeology, anthropology). There are a few handbooks listed in this section that, while still dealing meaningfully with neurosurgery in some form, are focused on broader issues in the history and philosophy of the neurosciences (Finger 2000, Journal of the History of the Neurosciences, Stahnisch 2020). It is important to include these texts, as they can help situate neurosurgery in the context of related issues in science and medicine, as well as within related history and philosophy scholarship. For instance, Clausen and Levy 2014 covers neuroethics from a variety of perspectives, including topics relevant to the history of neurosurgery. Overviews of closely connected medical specialties such as neurology do sometimes, but not always, cover neurosurgical topics as well (Rose 2012). Though published in the middle of the twentieth century, Walker and Green 1951 and Scarff 1955 are included here because they give a comprehensive and detailed overview of techniques and individuals’ contributions to neurosurgery up to that point in time. These latter sources can, of course, also be read as primary sources, giving historians a glimpse into how practitioner-historians understood their own developing medical specialty in light of their particular telling of neurosurgery’s longer history.

• Arnott, Robert, Stanley Finger, and C. U. M. Smith, eds. Trepanation: History, Discovery, Theory. Lisse, The Netherlands: Swets & Zeitlinger, 2003.

  This edited collection brings together twenty-five chapters on the global history of trepanation written by scholars with expertise in history, medicine, anthropology, and archaeology. A good starting point for any research on the topic.

• Clausen, Jens, and Neil Levy, eds. Handbook of Neuroethics. Dordrecht, The Netherlands: Springer, 2014.

  This handbook contains 117 entries related to ethics in mind and brain scientific research, philosophy, and medical practice. Neurosurgery is represented in various entries such as: “Ethics of Epilepsy Surgery,” “Neurosurgery: Past, Present, and Future,” “Ethics in Functional Neurosurgery,” “Informed Consent and the History of Modern Neurosurgery,” “Ethical Implications of Brain Stimulation,” and many others.

• Finger, Stanley. Minds Behind the Brain: A History of the Pioneers and Their Discoveries. Oxford: Oxford University Press, 2000.

  Surgery is covered in this book as a part of a broader focus on the history of discoveries related to the neurosciences and medicine from Antiquity to the twentieth century. Finger organizes the research chronologically into chapters devoted to individuals who made contributions to this field.

• Greenblatt, Samuel H., T. Forcht Dagi, and Mel H. Epstein, eds. A History of Neurosurgery: In Its Scientific and Professional Contexts. Park Ridge, IL: American Association of Neurological Surgeons, 1997.

  At 626 pages long, this edited collection is a very rich resource on a myriad topics related to the history of neurosurgery, constituting a good starting point for research on the history of neurosurgery. Topics covered include technology and technical issues in neurosurgery, the beginnings of specialization, and professional organization. Greenblatt’s opening chapter establishes some broad historiographical and methodological guidelines for writing the history of neurosurgery. The appendix has a bibliography that includes secondary sources and biographical works.

• Journal of the History of the Neurosciences.

  This journal publishes peer-reviewed scholarship in the history of the neurosciences, broadly construed. There are many articles on aspects of the history of neurosurgery in the archives of the journal, which makes this a very useful resource for interested researchers.

• Rose, F. Clifford. History of British Neurology. London: Imperial College Press, 2012.

  This book is a broad survey of the history of British neurology and is arranged in chapters that focus on individuals who have contributed to it. There are references to surgery throughout, and neurosurgery is the topic of chapter 9, where the contributions of five surgeons are detailed.

• Scarff, J. E. “Fifty Years of Neurosurgery, 1905–1955.” International Abstracts of Surgery 101.5 (1955): 417–513.

  Written by a neurosurgeon who trained with Harvey Cushing and later worked in the Department of Neurological Surgery at Columbia University in New York City, this article summarizes technical developments in neurosurgery over a period of fifty years, from the early twentieth century when general surgeons engaged in this surgery to the middle of the century, when neurosurgery was an established medical specialty. Various individuals, techniques, and conditions are covered (trigeminal neuralgia, different kinds of brain tumors, hydrocephalus, etc.).

• Stahnisch, Frank. A New Field in Mind: A History of Interdisciplinarity in the Early Brain Sciences. Montreal: McGill-Queens University Press, 2020.

  DOI: 10.2307/j.ctv10kmfd5

  Neurosurgery is treated in this book as a part of the broader interdisciplinary entanglements between neuro disciplines from the 1880s to the 1960s in Germany, Austria, and Switzerland. Stahnisch contextualizes scientific and medical developments in their sociopolitical and cultural contexts, including the forced migration of doctors and scientists during the 1930s and 1940s.

• Walker, Earl, and Robert E. Green. A History of Neurological Surgery. Baltimore: Williams & Wilkins, 1951.

  An edited collection with contributions from neurosurgeons, many of whom were practicing during the middle decades of the twentieth century. Chapters cover the history of various surgical techniques; biographical sketches of neurosurgical figures such as Clovis Vincent, Fedor Krause, and Harvey Cushing; as well as descriptions of surgeries involving the brain, spinal cord, and peripheral nervous system.