Boston children’s hospital and the origin of pediatric neurosurgery

Childs Nerv Syst Boston children's hospital and the origin of pediatric neurosurgery Alan R. Cohen 0 ) Department of Neurosurgery, Boston Children's Hospital, Franc D. Ingraham Professor of Neurosurgery, Harvard Medical School , 300 Longwood Avenue, Boston, MA 02115 , USA The Department of Neurosurgery at Boston Children's Hospital (BCH) has had a rich and sustained tradition of excellence over the years. This review traces the history of neurosurgery at BCH and the seminal role the department has played in advancing the field of pediatric neurosurgery worldwide (Fig. 1). - The Peter Bent Brigham Hospital (PBBH) opened its doors in 1913. Peter Bent Brigham, a self-made millionaire, restaurateur, railroad executive, and philanthropist, had left a $1.3 million bequest to establish a hospital to provide care for the sick and indigent population of Suffolk County. The funds were not to be used for 25 years after his death, and ultimately went to the purchase of the Ebeneezer Francis estate, which became the site not only of PBBH, but also Boston Childrens Hospital (BCH) and Harvard Medical School (HMS), institutions that have maintained their close geographic and medical alliance to this day. PBBH recruited Harvey Cushing, a young 44-year-old graduate of Yale College and HMS who was working at Johns Hopkins Hospital at the time, to be its inaugural Surgeon-inChief. Cushing was also named the Moseley Professor of Surgery at HMS. The opening of the Brigham was an historic event, and Cushings friend and mentor from Hopkins, Sir William Osler, traveled to Boston to join him for the celebration. Cushing had served his residency training at Hopkins under William Stewart Halsted and remained on the faculty there, where he focused on surgery of the central nervous system and laid the foundation for the practice of neurological surgery as we know it today. By the time Cushing was 32 years old, he held the rank of Associate Professor of Surgery at Hopkins. When Cushing came to PBBH in 1913, he began operating on children with neurosurgical disorders. The children would come from BCH over to PBBH where Cushing would carry out the surgery, and then be transferred back to BCH for their postoperative care. By 1926, Cushing had operated on over 1,000 brain tumor patients, and more than 150 of them were children under the age of 15. With great vision, he recognized the need for a dedicated service to care for children with surgical disorders of the nervous system. In 1929, Cushing directed his disciple, Franc D. Ingraham, to begin a Department of Neurosurgery at BCH. Thus began the first pediatric neurosurgical service in the world. Ingraham was a gifted technical surgeon and a shy, humble man. He was born in Minneapolis, Minnesota in 1898 and received his undergraduate training at Harvard, initially showing an interest in philosophy and music. He went on to graduate from HMS, where he had developed a fascination with surgery of the central nervous system. Ingraham served his surgical residency at PBBH, where he came under the influence of Cushing. After spending a year with Cushing, Ingraham went to Hopkins to work with Walter Dandy. Cushing, who himself had spent a year studying in Europe before joining the faculty at Hopkins, was a strong advocate for the Wanderjahr, the precursor of todays traveling fellowship. But Ingrahams trip to Baltimore was aborted early, because Dandy and Cushing were at odds and Dandy would not Fig. 1 (Figure 1 is also the cover illustration): Watercolor of the Hunnewell Building, Boston Childrens Hospital, which opened in 1914 and still stands today. Artist: Mark Waitkus, commissioned by Boston Childrens Hospital, 2006. Courtesy of the Archives Department, Boston Childrens Hospital. On the cover (same illustration as Figure 1): Watercolor of the Hunnewell Building, Boston Childrens Hospital, which opened in 1914 and still stands today. The Department of Neurosurgery is situated on the second floor of this building allow Ingraham in the operating room. So Ingraham subsequently went to Oxford as a Brigham Traveling Fellow to work in the physiology laboratory of Sir Charles Sherrington. In Sherringtons lab, he collaborated with John Farquhar Fulton, who would later become the Sterling Professor of Physiology at Yale, Cushings biographer and Ingrahams brother-in-law through marriage to Lucia Wheatland, the sister of Martha Wheatland, Ingrahams wife. Sherrington commented that Ingraham was the finest technical surgeon ever to work in his lab. It was on his return to Boston from Oxford that Ingraham founded the neurosurgery service at BCH, which quickly gained respect nationally and internationally. Ingraham was able to attract an assembly of talented neurosurgeons to train with him, including Donald Matson, Eben Alexander, Edgar Bering, Robert McLaurin, Bruce Hendrick, John Shillito, Ernest Matthews, and Larry Page. Ingraham made substantial contributions to pediatric neurosurgery with publications on infantile subdural hematoma, craniosynostosis, hydrocephalus, spina bifida, and brain tumors. In 1954, he and his protg, Donald Darrow Matson, published the Neurosurgery of Infancy and Childhood, which became the first pediatric neurosurgery textbook in the world. Although he shunned the spotlight, Ingraham served in numerous leadership capacities throughout his career. From 1944 until his retirement in 1964, he was Chief of Neurosurgery at Childrens and also Chief of the Adult Neurosurgical Service at PBBH. He was a charter member of the Harvey Cushing Society (later renamed the American Association of Neurological Surgeons) and served as its president from 19441946. He was a director of the American Board of Neurological Surgery and served on the Study Section of the National Institute of Neurological Disorders and Blindness. He was a member of the editorial board of the Journal of Neurosurgery for 9 years. On a personal note, Ingraham was an avid athlete who enjoyed figure skating, horseback riding, and tennis. He loved sailing and was often out at sea with family and friends, including the Nobel laureate John Enders. Ingraham frequently sailed with his neighbor, General George S. Patton, who served as commander of the Seventh United States Army and the Third United States Army in the European Theater during World War II. Ingraham suffered from serious illness throughout his life. He developed severe bronchial asthma as a child and underwent a radical paranasal sinus exenteration in Baltimore in the early 1930s, just after beginning his academic career. Because of this illness, he subsequently did no academic work for 9 years. He also suffered from chronic recurrent back pain related to a gymnastics injury as an undergraduate at Harvard with an exacerbation years later when he fell off a horse. Ingraham suffered a serious myocardial infarction in 1962 and retired in 1964. He died of a second myocardial infarction in 1965 at the age of 67 years [1, 2 (...truncated)