The Hunterian Neurosurgical Laboratory: The first 100 years of neurosurgical research

MODERN NEUROSURGERY HAS long had a strong laboratory foundation, and much o f this tradition can be traced to the Hunterian Neurosurgical Laboratory of the Johns Hopkins Hospital. Founded with the basic goals of investigating the causes and symptoms of disease and establishing the crucial role that s urgeons may play in the treatment of disease, the Hunterian laboratory has adhered to these tenets, despite the dramatic changes in neurosurgery that have occurred in the last 100 years. Named for the famous English surgeon J ohn Hunter (1728-1793), the Hunterian laboratory was conceived by William W elch and William Halsted as a special laboratory for experimental work in s urgery and pathology. In 1904, Harvey Gushing was appointed by Halsted to d irect the laboratory. With the three primary goals of student education, ve terinary surgery that stressed surgical techniques, and meticulous surgical and laboratory record-keeping, the laboratory was quite productive, introd ucing the use of physiological saline solutions, describing the anatomic fe atures and function of the pituitary gland, and establishing the held of en docrinology, in addition, the original development of hanging drop tissue c ulture, fundamental investigations into cerebrospinal fluid, and countless contributions to otolaryngology by Samuel Crowe all occurred during this "c rucible" period. in 1912, Gushing was succeeded by Waiter Dandy, whose work on experimental hydrocephalus and cerebrospinal fluid circulation led to t he development of pneumoencephalography, The early days of neurosurgery evo lved with close ties to general surgery, and so did the Hunterian laborator y. After Dandy began devoting his time to clinical work, general surgeons ( first Jay McLean and then, in 1922, Ferdinand Lee) became the directors of the laboratory. Between 1928 and 1942, more than 150 original articles were issued from the Hunterian laboratory; these articles described significant advances in surgery, including pioneering research on calcium metabolism b y William MacCallum and Carl Voegtlin and seminal preclinical work by Alfre d Blalock and Vivian Thomas that led to the famous "blue baby" operation in 1944. With the introduction of the operating microscope in the 1950s, much of the focus in neurosurgical science shifted from the laboratory to die o perating room. The old Hunterian building was demolished in 1956. The Hunte rian laboratory for surgical and pathological research was rebuilt on its o riginal site in 1987, and the Hunterian Neurosurgical Laboratory was reesta blished in 1991, with a focus on never treatments for brain tumors. The str ong tradition of performing basic research with clinical relevance has cont inued.