Joseph Murray: Pioneering Plastic Surgeon and Father of the First Organ Transplant

Dr. Joseph Murray was a plastic surgeon who is best known for performing the first successful human organ transplant. After graduating from Harvard Medical School and completing a surgical internship at Peter Bent Brigham Hospital, Murray enlisted in the US Army Medical Corp and spent 5 years at Valley Forge General Hospital treating World War II soldiers injured in combat. He treated hundreds of burn victims with skin grafts and took an interest in the variable process of graft rejection based on both the patient’s relation to the graft donor and the patient’s level of immunocompetency. His work at Valley Forge set the stage for his research investigating the feasibility of kidney transplantation and immunosuppression. He went on to perform the first successful kidney transplant between identical twins in 1954, between fraternal twins in 1959, and between an unrelated donor and recipient in 1962. For his efforts, he was awarded the 1990 Nobel Prize in Medicine.

Bench to Bedside Discovery, Innovation, Global Health Equity, and Security

Dr Dzau was born in Shanghai. He received his Bachelor of Science in Biology and his MD degree from McGill University. He was a medical resident, Chief Resident, and the founding Chief of the Division of Vascular Medicine at the Peter Bent Brigham Hospital (now the Brigham and Women’s Hospital). He moved to Stanford in 1990 as the Chief of the Division of Cardiovascular Medicine and later became Chairman of the Department of Medicine. Six years later, he returned to Harvard Medical School as the Hersey Professor of the Theory and Practice of Medicine and as Chairman of the Department of Medicine at Brigham and Women’s Hospital. He then became the Chancellor for Health Affairs, President, and CEO of the Duke University Medical Center. In 2014, he was elected to become the President of the Institute of Medicine (now the National Academy of Medicine). He is a member of the National Academy of Medicine, the American Academy of Arts and Sciences, and the European Academy of Sciences and Arts.

Harvey Cushing’s international visitors

Harvey Cushing is considered the father of neurosurgery, not just for his work within the United States, but also for his global influence through international visitors and trainees. Starting in 1920, the neurosurgical clinic at the Peter Bent Brigham Hospital in Boston, led by Cushing, trained surgeons from all over the globe, many of whom returned home to establish neurosurgical departments and become neurosurgical pioneers themselves. The objective of this vignette is to highlight the importance of Cushing’s international trainees, describe their contributions, and discuss how each had an impact on the development of the practice of neurosurgery worldwide. The authors demonstrate how Cushing provided the impetus for a movement that revolutionized neurology and neurosurgery worldwide. Even today, international cooperation continues to shape the success of our delicate specialty.

Percival S. Bailey: eminent scholar of neurosciences who revealed the workings of the hypothalamus through clinicopathological research on craniopharyngiomas

Percival S. Bailey (1892–1973) was a scholar, neuroscientist, neuropathologist, and neurosurgeon who made decisive contributions in the field of neuro-oncology. Far less known are his groundbreaking insights into understanding hypothalamic physiology through the study of craniopharyngiomas. As one of Harvey W. Cushing’s most talented trainees, Bailey was instrumental in developing Cushing’s project of a histologically based prognostic classification of brain tumors. He worked at Peter Bent Brigham Hospital on and off between 1919 and 1928, owing to frequent clashes with his mentor. A major cause of this long-term conflict was Bailey’s 1921 experimental demonstration of the hypothalamic origin of diabetes insipidus and Fröhlich’s syndrome. This finding challenged Cushing’s view that both alterations were due to pituitary gland insufficiency. In a seminal monograph written with John F. Fulton in 1929, both authors provided the first comprehensive account of the specific hypothalamic disturbances caused by tumors that originated within the infundibulum and third ventricle. The methodical study of Cushing’s craniopharyngioma specimens allowed Bailey to recognize the close contact between these lesions and hypothalamic nuclei, a key concept that Bailey originally advanced for proper surgical planning. This article aims to credit Bailey for his pioneering definition of craniopharyngiomas as tumors with a true intrahypothalamic position.

Dr. Orvar Swenson and the Pull-Through

Dr. Orvar Swenson is best remembered for developing the Swenson pull-through, a technique he developed to treat Hirschsprung's disease. After graduating from Harvard Medical School and beginning his residency at Peter Bent Brigham Hospital, Dr. Swenson observed that patients with Hirschsprung's disease and toxic megacolon resumed normal bowel function after placement of transverse colostomies. His observation led to studying the patency of his patients’ colons using barium enema contrast studies. At the collapsed portion of the colon, he performed rectal biopsies leading to the discovery that the cause of Hirschsprung's disease is that the collapsed portion of the colon lacks the Auerbach plexus. The Swenson pull-through removes this aganglionic portion of the colon and cures the patient. His career grew from there as he traveled to academic institutions teaching his technique. He is remembered fondly for his contributions to pediatric surgery through the restructuring of pediatric surgery departments, pediatric surgery research, and writing and editing multiple volumes of Pediatric Surgery, the standard textbook for pediatric surgeons. He died peacefully in 2012 at the age of 103 years.

The Untold Story of the First Hand Transplant: Dedicated to the Memory of one of the Great Minds of the Ecuadorian Medical Community and the World

Background In 1964, faced with the challenge of traumatic amputation, a team of surgeons at Clinica Guayaquil was convinced that the transplantation of a hand could significantly improve function and quality of life for the recipient. With a current but basic understanding of immunosuppression, the surgeons identified a recipient and waited for the correct donor. A human hand transplant had never been performed to date. Methods The surgeons' criteria for the recipient included a young healthy individual who had sustained a traumatic amputation at the distal forearm level with full motion of the proximal joints. Communication with receiving hospitals and military facilities identified what they perceived to be a feasible donor for an allograft transplantation. Consent was obtained from the family in conjunction with the local military medical authorities and the clergy. Iced saline solution and Heparin irrigation were to be used to prepare the donor extremity. The immunosuppression regimen, limited at the time, consisted only of intravenous cortisone, Imuran, and a single dose of radiation. Results A member of the Ecuadorian marine sustained a limited blast injury that amputated his dominant hand but spared the forearm. He was transferred to the emergency department of Clinica Guayaquil. A donor who had recently died in a nearby hospital was identified not long after. A successful technical surgical transplantation was achieved. Consultants from major hospitals around the world (including Peter Bent Brigham Hospital) convened at the patient's bedside to observe the results. Despite all efforts, the patient suffered an irreversible rejection at 21 days post-transplant. Conclusion This was the first allograft transplantation of a hand. The surgeons embarked on an intervention never tried before, firmly believing that better function and quality of life would result. The bravery of this surgical team was commendable. This early surgical endeavor opened the way for future successes in transplant surgery today.

A Tribute to Dr Robert J. White

Robert J. White is probably best known as the first neurosurgeon to perform successful “cephalic exchange” on monkeys in 1971. However, he was also a pioneer in the field of neurosurgery and contributed tremendously to the field of neuroanesthesia and bioethics. White received medical training at the University of Minnesota, Harvard University, Peter Bent Brigham Hospital, and Mayo Clinic before becoming the first Chief of Neurosurgery at Metrohealth Hospital in Cleveland, Ohio. He made significant strides in the field of spinal cord cooling and hypothermia. White and his team was also the first to successfully isolate the monkey brain with retention of biological activity. In 2004 and 2006, White and colleagues were nominated for the Nobel Prize in Physiology and Medicine, with Harvey Cushing and Wilder Penfield being the only other 2 neurosurgeons ever to be nominated for the award. Aside from his career as a neurosurgeon, he was also an advisor to 2 popes and an advocate for animal research. By the end of his career, White performed over 10 000 brain operations and published over 1000 articles, which has pushed the frontiers of neurosurgical research.

Norman M. Dott, master of hypothalamic craniopharyngioma surgery: the decisive mentoring of Harvey Cushing and Percival Bailey at Peter Bent Brigham Hospital

Norman McOmish Dott (1897–1973) developed surgical neurology in Edinburgh, Scotland, and was a scholar of worldwide renown. One of Dott's most notable contributions to neurosurgery was his understanding of hypothalamic physiology, mostly acquired through the comprehensive study of patients with lesions involving this region of the diencephalon, particularly craniopharyngiomas (CPs). Recognition of symptoms caused by hypothalamic disturbances allowed him to predict the accurate anatomical relationships between CPs and the hypothalamus, despite the rudimentary radiological methods available during the 1930s. His sophisticated knowledge permitted Dott to perform radical removals of CPs originating within the third ventricle floor with acceptable success. Between 1934 and 1937, he operated on 4 CP cases originating in the hypothalamus, achieving a satisfactory postoperative outcome in 3 of the 4 patients. Aware of the strong attachment of hypothalamic CPs to the infundibulo-tuberal area, Dott used a double transbasal and transventricular approach to these lesions, a strategy providing an optimal view and control of the tumor boundaries. The decisive mentorship of several legendary figures of physiology and neurosurgery greatly influenced Dott's surgical evolution. The experimental pituitary gland work he performed with Sir Edward Sharpey-Schäfer at the beginning of his career stirred Dott's curiosity about the issue of hypothalamus-pituitary relationships. As a result, he decided to move to Peter Bent Brigham Hospital (Boston, Massachusetts) in 1923, to train in neurosurgery and neuropathology under the guidance of the leaders in these fields, Harvey Williams Cushing (1869–1939) and Percival Sylvester Bailey (1892–1973). They inspired the young Dott and shared with him their clinical and pathological expertise, in addition to their surgical strategies for best approaching and removing these challenging tumors. In time, Dott would come to surpass his mentors. This paper aims to credit Norman M. Dott for his decisive, modern contributions to hypothalamic CP surgery.

Unsung hero: Donald Darrow Matson’s legacy in pediatric neurosurgery

Donald Darrow Matson made seminal contributions to the field of pediatric neurosurgery. Born in 1913 in Fort Hamilton, New York, Matson was the youngest of four sons of an army colonel. He graduated from Cornell University and, years later, from Harvard Medical School. Matson selected Peter Bent Brigham Hospital for his neurosurgical training, which was interrupted during World War II. As a neurosurgeon, he worked close to the front lines under Brigadier General Elliot Cutler in Europe, earning a Bronze Star. Matson returned to Boston to become Franc Ingraham’s fellow and partner. He was a masterful surgeon and, with Ingraham, published Neurosurgery of Infancy and Childhood in 1954, the first pediatric neurosurgery textbook in the world. Upon Ingraham’s retirement, Matson became chairman of the department of neurosurgery at Boston Children’s Hospital and Peter Bent Brigham. In 1968, he became the inaugural Franc D. Ingraham Professor of Neurological Surgery at Harvard Medical School. Among his neurosurgical accomplishments, Matson served as President of the Harvey Cushing Society, later known as the American Association of Neurological Surgeons. He was unable to preside at the 1969 meeting that marked the 100th anniversary of Cushing’s birth, having contracted Creutzfeldt-Jakob disease. Matson died at the age of 55, surviving his mentor Ingraham by only 4 years.