In 1879 a Scottish surgeon found a brain tumour using only the patient's symptoms
With no scanners of any kind, William Macewen pinpointed a tumour in 1879 purely from neurological signs, then removed it successfully. Five years later Rickman Godlee went a step further and operated directly on the exposed brain itself, the first removal of a primary brain tumour.
Cutting into the head is ancient, even if the big advances are barely a century old. Roman doctors treated depressed skull fractures, and the Incas practised trepanation before Europeans arrived. In Al-Andalus, Al-Zahrawi treated head wounds, spinal injuries and hydrocephalus in the late tenth and early eleventh centuries, while in China Hua Tuo devised an anaesthetic called mafeisan for brain operations. When King Henry II of France was wounded in a joust in 1559, Ambroise Paré and Andreas Vesalius both tried to save him and failed.
The modern era began with the tumour cases. The 1884 operation, on November 25, relied on the physician Alexander Hughes Bennett applying Macewen's localising method before Godlee cut. In 1907 the Austrian Hermann Schloffer removed a pituitary tumour for the first time. Not every innovation aged well. António Egas Moniz, who devised lobotomy, shared the 1949 Nobel Prize in medicine, but frequent and sometimes severe harm made the operation controversial from the start, and it is now largely rejected.
Electrodes tell a stranger story. Richard Caton detected electrical signals in an animal brain in 1878. In 1950 Jose Delgado implanted an electrode in a bull and used it to make the animal run and turn. Cochlear implants reached the market in 1972, and in 1998 Philip Kennedy placed the first brain-computer interface in a human. Today even ordinary instruments are made to within a millimetre of the desired precision, and the University of Utah has built an image-guided system that plots the path for a robotic skull drill.
Becoming one of these surgeons takes stamina. American trainees typically spend four years in college, four in medical school and seven in residency, and neurosurgeons make up only 0.5 percent of US physicians. India offers fewer than 200 training seats a year, and the World Federation of Neurosurgical Societies, founded in Switzerland in 1955, represents about 50,000 neurosurgeons worldwide.
Source: Neurosurgery
