Neurosurgery in Chicago: Allen Buckner Kanavel Revisited

The area of neurosurgery is so well developed in Chicago, as in other parts of the United States, that one has trouble reconstructing the stepby-step progress by which it reached its present pinnacle. If one accepts the statement of Percival Bailey that neurosurgery should be called surgical neurology, one realizes that the development of neurology and the development of surgery, both in their infancy in the latter part of the 19th century, were both essential to the development of the full field of neurosurgery. In 1873, there were only 149 hospitals in the United States, whereas 61 years later in 1934 there were 6,334, and in 1876, Samuel Gross, who wrote the first Systems of Surgery, said “There is not a medical man on this continent who devotes himself entirely to the practice of surgery” [1]. Neurology was not without its distinguished early pioneers, of whom there were many by 1876, when the American Neurological Association was formed with Dr. James Jewell being the first president. Four years later, the American Surgical Association was formed. Both of these distinguished organizations not only have held leadership positions in the two fields, but also have enabled some other specialties to develop. Many of the early neurologists were really psychiatrists who had been trained in what were called “insane asylums” or “psychiatric hospitals,” and it was only slowly that neurology achieved its own persona separate from that of psychiatry. There were distinguished neurologists and surgeons in England and on the continent of Europe, and, in fact, most of the distinguished beginners of neurology and surgery in the United States studied first in Europe. There had been individual attempts at brain tumor removal, operations on brain abscesses (Macewen in Scotland), and many other isolated procedures. Horsley could be considered an early neurosurgeon in England, but he left no trainees and no disciples, and really did not establish neurosurgery. There were, however, a great many extremely competent surgeons in the United States who did all sorts of surgery well, and one of the most important of these, particularly in Chicago, was Allen Buckner Kanavel, who was born in Sedgewick, Kansas in September 1874. He eventually came to Chicago where, for the rest of his life, he was associated with the Northwestern Hospital University Medical School. Dr. Kanavel was initiated into surgical practice at a time when medical specialties were barely dawning. However, rather than speak of him as an able and skilled general surgeon, it would be more correct to call him a specialist in many fields of surgery. He was keenly interested in neurologic surgery: he developed a method of approaching the pituitary fossa through the nose [3]; he skillfully performed operations on the trigeminal nerve for the relief of tic douloureux; and he operated for pathologic conditions involving the spinal cord pathways. He prepared the section on neurologic surgery in Ochsner’s Surgical Diagnoses and Treatment published in 1922 [5]. It seems as though everyone at Northwestern University or Wesley Hospital who was confronted with some unusual or difficult problem turned to Dr. Kanavel for help, whether it was a patient with a serious burn requiring plastic work, a woman desperately ill with thyroid intoxication, a man with a long-continued drainage from an empyema, or a child with a congenital deformity of the face, lip, or hand. For all, Dr. Kanavel seemed to come first to Address reprint requests to: E. Alexander, Jr., Department of Neurosurgery, Bowman Gray School of Medicine of Wake Forest University, Medical Center Boulevard, Winston-Salem, NC 27157. Received December 18, 1996; accepted January 18, 1997.