History of Neurosurgery

Origins of Neurosurgery at Yale

The initiation of an academic program in neurological surgery at Yale University School of Medicine and New Haven Hospital occurred in 1918 when Joseph Flint, M.D., Professor, Chairman and Chief of Surgery, recruited Samuel Harvey, M.D., as Chief Resident and Instructor in Surgery. Harvey received his degree from Yale College in 1907 and his M.D. from Yale Medical School in 1911. After an internship in Pathology at Columbia, a year in Loomis Sanitarium to control pulmonary tuberculosis, and a medical residency at Columbia, Harvey went to the Peter Brent Brigham Hospital in Boston for surgical training. 

Dr. Samuel Harvey

There, from 1913 to 1917, he was a research fellow and a surgical resident under the direction of Harvey Cushing. In 1917, he joined the army and was assigned to the Base Hospital 5 Medical Staff that Cushing made famous with the treatment of nervous system wounds. On discharge from the army, Harvey accepted the Chief Residency in Surgery at New Haven Hospital and the appointment as Instructor in Surgery at Yale University School of Medicine. As in most hospitals in the United States at the time, neurosurgery was performed by general surgeons and New Haven Hospital was not an exception. Harvey, because of his experience with Cushing, had considerably more experience and knowledge concerning neurosurgical problems than did most general surgeons. 

As Chief Resident, he introduced neurosurgery as part of the General Surgery program and over the next few years developed a relatively active practice in surgery of the nervous system along with his general surgery practice. Cushing's recognition of Harvey's expertise in neurosurgery is demonstrated by his invitation to Harvey in 1922 to become a member of the first neurosurgical society in the world, the Society of Neurological Surgeons. Harvey became the Professor and Chairman of Surgery at Yale in 1924 and established a combined surgical-neurosurgical training program.

New Haven Hospital (circa 1920)

In 1928, William German, M.D., was recruited as the first student devoted to neurosurgery. German, a 1926 graduate of Harvard Medical School, had completed a surgical internship under the direction of Cushing at the Peter Brent Brigham in 1927 and a Plastic Surgery fellowship at the Johns Hopkins Hospital in 1928. The combined surgery-neurosurgery program did not include a dedicated neurosurgical residency but rather a general surgery training program with an emphasis on the nervous system under the direction of Harvey.

On completing his training in 1931, German was appointed as Instructor in Surgery with the assignment to continue the development of neurosurgery at Yale. By 1933, he was promoted to Assistant Professor in Surgery and Chief of Neurosurgery at New Haven Hospital. During this time period, the combined surgical-neurosurgical program trained another surgeon with emphasis on the nervous system, Dr. Albert D'Errico, who later became the Professor and Chief of Neurosurgery at Baylor.

Portrait of Dr. William German by Deane Keler, 1963 (left to right: Dr. Lycurgus Davey, Dr. Benjamin Whitcomb, Dr. William German, Dr. Stevenson Flanigan, Elsie McIntyre, Dr. John German, Dr. Saul Frankel

Cushing joined the Yale faculty in 1934 as Sterling Professor of Neurology. He was offered the position of Professor of Neurosurgery but declined. Cushing transferred his personal collection of brain tumor specimens from the Peter Brent Brigham Hospital to Yale shortly after his arrival. In addition, he recruited Dr. Louise Eisenhardt to join him in New Haven to continue their collaboration in classifying the extensive tumor collection. Eisenhardt arrived at Yale with gross specimens and histological slides representing Cushing's collection on unique neurological diseases, including over 2000 brain tumors. Initially housed in the Department of Pathology, these specimens were moved to the basement of the Harkness Medical School dormitory along with thousands of glass plate photographs of Cushing's patients during his active clinical years, depicting the spectrum of neurological disease at the beginning of this century. This collection of specimens and dramatic photographs are now emerging from storage and will be partially housed in John and Lucia Fulton's home under the auspices of the Axion Foundation.

The Yale Historical Library (circa 1945) houses the libraries of Harvey Cushing, Arnold Klebs, and John Fulton

Cushing had initiated discussions with Dr. Percival Bailey to continue this work after Cushing's death and to transfer the tumor collection to Chicago. Fortunately for Yale, these arrangements were never formalized and after Cushing's death in 1939, his extensive collection of books, together with the collections of Arnold Klebs and John Fulton, were housed in the Yale Historical Library. This invaluable collection, as well as a recreation of Cushing's office, remain today in the Historical Library.

Evolution of a Neurosurgery Program at Yale

Dr. William F. Collins

Dr. William F. Collins

The neurosurgical service continued to grow, and by 1940, when the American Board of Neurological Surgery was incorporated, the Yale program had trained five more neurosurgeons. Within the next few years, the American Board of Neurological Surgery defined what constituted an accredited residency program and a 3-year training residency was established at New Haven Hospital. As the program grew, German received recognition for his clinical and academic accomplishments. He became Secretary-Treasurer of the American Board of Neurological Surgery and President of the Harvey Cushing Society (now the American Association of Neurological Surgeons) and was chosen as honored guest by the Congress of Neurological Surgeons. Neurosurgery remained in the Department of Surgery but became a separate section with its own clinics, inpatient ward, and operating room. The Yale training program was combined with Hartford Hospital in the 1940s. Under the direction of Drs. William Scoville and Benjamin Whitcomb, Yale residents gained extensive experience with all forms of spinal surgery.

During the 1940s, a sufficient number of surgeons specialized in the practice of neurosurgery to support a publication devoted to this emerging subspecialty. The concept of a journal devoted to neurosurgery was initiated by Dr. John Fulton, a neurophysiologist at Yale, who in collaboration with Spurling, McKenzie, Craig, and Horrax, published the Journal of Neurosurgery in 1944. Eisenhardt became the journal's first Managing Editor, a position that she held until 1965.

The medical community in New Haven grew significantly during this time. To accommodate the need for additional hospital beds, construction of the Memorial Unit, a dedicated community physician inpatient facility within Yale-New Haven Medical Center, was completed in 1951. The clinical neurosurgery service at Yale solicited expertise from community neurosurgeons committed to neurosurgical resident training. These individuals continue to provide important clinical training. Dr. Lycurgus Davey (Clinical Professor) devoted his entire career to clinical teaching and resident education at the Yale program.

Yale-New Haven Medical Center

Yale-New Haven Medical Center

In 1967, German retired and his successor, Dr. William Collins, was appointed as Cushing Professor of Surgery Neurosurgery and Chief of Neurosurgery. The New Haven Hospital was now formally affiliated with Yale Medical School and renamed the Yale-New Haven Hospital. Under the direction of Collins, the residency training program took a different direction with the development of programs that were designed to permit neurosurgical residents to prepare for a career not only in clinical neurosurgery but also in original basic investigation in neuroscience related to neurosurgery. The concept was based on the development of subspecialty areas in neurosurgery with integrated programmatic laboratory investigation. The first program was an integrated laboratory and clinical program for the study of chronic pain. The investigative aspects of that program began with Collins' seminal work on C fibers, and it remains in the Section of Neurosurgery to the present. The next program was devoted to neuroendocrine study that focused on pituitary tumors. During this time, collaborative research was developed with the Section of Endocrinology and the Department of Obstetrics and Gynecology. A joint pituitary tumor clinic was organized, and a considerable portion of the investigative research was developed in combination with the laboratory staff of the three departments. The principles of collaborative research between Neurosurgery and other clinical and research departments within the University was started by Collins and continues to be a fundamental method for maintaining the high standards for resident education and academic growth.

In 1968, it was apparent that the volume of cases at Yale-New Haven Hospital, including spinal surgery, was more than adequate for a residency training program and with the development of the Medical School at the University of Connecticut, plans were made to separate the two programs with Hartford Hospital affiliated with the University of Connecticut and the Yale program affiliated with the Yale-New Haven and West Haven Veterans Administration Hospital. Residents from both the Yale and Hartford programs shared rotations until 1978, when the two became separate programs. In 1973, a dedicated Neurosurgery Intensive Care Unit was opened at Yale-New Haven Hospital for critical care management of patients with neurological disease and trauma. This unit, in part, was organized to develop the next two subspecialty programs, surgery for epilepsy and acute management of traumatic spinal cord injury. During this time, pediatric neurosurgery was developed at Yale under the direction of Dr. Joan Venes, and the National Acute Spinal Cord Injury Study was established under the direction of Collins and Dr. Michael Bracken (Professor of Epidemiology and Public Health).

In 1982, Yale-New Haven Hospital opened a new 900-bed inpatient facility with a dedicated 10-bed Neurosurgical Intensive Care Unit and three operating rooms dedicated to neurosurgery procedures. In 1984, Collins was appointed Chairman of the Department of Surgery at Yale. In addition to his responsibilities as Department Chairman, Collins also served as Editor of the Journal of Neurosurgery from 1985 to 1990.

Dr. Dennis Spencer was appointed acting and then Chief of the Section of Neurosurgery in 1987. Under Spencer's leadership, the Section of Neurosurgery continued with the development of programs in epilepsy surgery, neuro-oncology, neurovascular surgery, pediatric neurosurgery, and functional/stereotactic neurosurgery. In December of 1996, the Section of Neurosurgery was granted Departmental status and in January of 1997 Dr. Dennis Spencer was appointed the first Chairman of the Department of Neurosurgery.

In October 2014, Murat Günel, MD, was appointed chair of the Department of Neurosurgery at Yale School of Medicine and chief of the Department of Neurosurgery at Yale-New Haven Hospital. In addition to those roles, Dr. Günel is the Nixdorff-German Professor of Neurosurgery and professor of genetics and neurobiology. He is also the director of the Yale Program in Brain Tumor Research, co-director of the Yale Program on Neurogenetics, and chief of the Section of Neurovascular Surgery.