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Walter Dandy
Walter Edward Dandy (April 6, 1886 – April 19, 1946) was an American neurosurgeon and scientist. He is considered one of the founding fathers of neurosurgery, along with Victor Horsley and Harvey Cushing. Dandy is credited with numerous neurosurgical discoveries and innovations, including the description of the circulation of cerebrospinal fluid in the brain, surgical treatment of hydrocephalus, the invention of air ventriculography and pneumoencephalography, the description of brain endoscopy, the establishment of the first intensive care unit, and the first clipping of an intracranial aneurysm, which marked the birth of cerebrovascular neurosurgery.
During his 40-year medical career, Dandy published five books and more than 160 peer-reviewed articles while conducting a full-time, ground-breaking neurosurgical practice in which he performed during his peak years about 1000 operations per year. He was recognized at the time as a remarkably fast and particularly dexterous surgeon. Dandy was associated with the Johns Hopkins University School of Medicine and the Johns Hopkins Hospital his entire medical career. The importance of his numerous contributions to neurosurgery in particular and to medicine in general has increased as the field of neurosurgery has evolved.
Dandy was the only son of John Dandy, a railroad engineer, and Rachel Kilpatrick, who were immigrants from Lancashire, England, and Armagh, Ireland, respectively. Dandy graduated in 1903 from Summit High School in Sedalia, Missouri, as class valedictorian, and then graduated in 1907 from the University of Missouri. In September 1907, he enrolled in the Johns Hopkins School of Medicine as a second year student. (He had started medical studies during his junior year in college and accumulated enough credits to skip the first year of medical school at Johns Hopkins.) Dandy graduated from Johns Hopkins School of Medicine in the spring of 1910 at the age of 24, and became the sixth appointee to the Hunterian Laboratory of Experimental Medicine under Harvey W. Cushing from 1910 to 1911. In 1911, he earned a Master of Arts degree for his work in the Hunterian Laboratory, and went on to join the Johns Hopkins Hospital surgical housestaff for one year as Cushing's Assistant Resident (1911–1912). Dandy completed his general surgery residency at the Johns Hopkins Hospital under William S. Halsted in 1918. (He had been appointed Halsted's Chief Resident in 1916.) While Dandy was introduced to the nascent field of neurosurgery by Cushing, it was George J. Heuer who completed Dandy's neurosurgical training after Cushing's departure for the Peter Bent Brigham Hospital in Boston in September 1912. Heuer had graduated from the Johns Hopkins University School of Medicine in 1908, worked as Cushing's first Assistant Resident from 1908 to 1909, and served as Halsted's Chief Resident from 1911 to 1914.
Dandy joined the staff of the Johns Hopkins Hospital in 1918 and immediately focused his energies on the surgical treatment of disorders of the brain and spinal cord. When Heuer left Hopkins in 1922 to become the head of surgery at the University of Cincinnati, Dandy remained as the only neurosurgeon at the Johns Hopkins Hospital until his death in that hospital in 1946.
Dandy's first scientific contribution was the detailed anatomical description of a 2 mm human embryo in Franklin P. Mall's collection. This paper was published in 1910, five months before he graduated from medical school. In 1911 and 1913, he described the blood supply and nerve supply, respectively, of the pituitary gland. In 1913 and 1914, Dandy and Kenneth D. Blackfan published two landmark papers on the production, circulation, and absorption of CSF in the brain and on the causes and potential treatments of hydrocephalus. Hydrocephalus is the buildup of CSF within the brain, an often lethal condition if left untreated. They described two forms of hydrocephalus, namely "obstructive" and "communicating," thus establishing a theoretical framework for the rational treatment of this condition. This work is regarded by many as one of the finest pieces of surgical research ever done. Indeed, Halsted reportedly told Edwards A. Park that "Dandy will never do anything equal to this again. Few men make more than one great contribution to medicine." Dandy, however, would prove to be one of these "few men." Modern pediatric neurosurgeons devote most of their time to the management of hydrocephalus.
The Dandy–Walker malformation is a congenital malformation associated with hydrocephalus. In 1921 Dandy reported a case of hydrocephalus caused by obstruction of outflow of CSF from the fourth ventricle. In 1944 A. Earl Walker (who eventually became chairman of neurosurgery at Johns Hopkins) described a similar case of congenital closure of the outflow of the fourth ventricle. This congenital anomaly became known as the Dandy-Walker cyst. It is associated with closure of the foramina of Luschka and Magendie (the outflow openings of the fourth ventricle), atrophy of the cerebellum and cerebellar vermis, dilation of the fourth ventricle, hydrocephalus, and often atrophy of the corpus callosum.
In 1918 and 1919 Dandy published his landmark papers on air ventriculography and the associated technique of pneumoencephalography. For this contribution he was nominated for the Nobel Prize in 1933 by Hans Christian Jacobaeus, Chairman of the Nobel Committee of the Karolinska Institute. Ventriculography and pneumoencephalography allowed neurosurgeons for the first time to visualize brain lesions on x-rays. To accomplish this, CSF in the ventricles and subarachnoid space was replaced with air injected either directly into the ventricles (ventriculography) or into the lumbar subarachnoid space (pneumoencephalography). As a general surgeon, Dandy was aware of the ability of free air in the peritoneal cavity to outline the abdominal contents. He published a paper on this radiographic phenomenon ("pneumoperitoneum") in 1919 based on a clinical observation he had made in 1917. In 1918, the year that he finished his residency, he published the paper on air ventriculography. Samuel J. Crowe described it as "the greatest single contribution ever made to brain surgery." Gilbert Horrax stated:
The importance of this diagnostic method, ... for the more accurate localization of many growths whose situation could not be ascertained with absolute exactness, can hardly be overemphasized. It brought immediately into the operable field at least one third more brain tumors than could be diagnosed and localized previously by the most refined neurological methods.
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Walter Dandy
Walter Edward Dandy (April 6, 1886 – April 19, 1946) was an American neurosurgeon and scientist. He is considered one of the founding fathers of neurosurgery, along with Victor Horsley and Harvey Cushing. Dandy is credited with numerous neurosurgical discoveries and innovations, including the description of the circulation of cerebrospinal fluid in the brain, surgical treatment of hydrocephalus, the invention of air ventriculography and pneumoencephalography, the description of brain endoscopy, the establishment of the first intensive care unit, and the first clipping of an intracranial aneurysm, which marked the birth of cerebrovascular neurosurgery.
During his 40-year medical career, Dandy published five books and more than 160 peer-reviewed articles while conducting a full-time, ground-breaking neurosurgical practice in which he performed during his peak years about 1000 operations per year. He was recognized at the time as a remarkably fast and particularly dexterous surgeon. Dandy was associated with the Johns Hopkins University School of Medicine and the Johns Hopkins Hospital his entire medical career. The importance of his numerous contributions to neurosurgery in particular and to medicine in general has increased as the field of neurosurgery has evolved.
Dandy was the only son of John Dandy, a railroad engineer, and Rachel Kilpatrick, who were immigrants from Lancashire, England, and Armagh, Ireland, respectively. Dandy graduated in 1903 from Summit High School in Sedalia, Missouri, as class valedictorian, and then graduated in 1907 from the University of Missouri. In September 1907, he enrolled in the Johns Hopkins School of Medicine as a second year student. (He had started medical studies during his junior year in college and accumulated enough credits to skip the first year of medical school at Johns Hopkins.) Dandy graduated from Johns Hopkins School of Medicine in the spring of 1910 at the age of 24, and became the sixth appointee to the Hunterian Laboratory of Experimental Medicine under Harvey W. Cushing from 1910 to 1911. In 1911, he earned a Master of Arts degree for his work in the Hunterian Laboratory, and went on to join the Johns Hopkins Hospital surgical housestaff for one year as Cushing's Assistant Resident (1911–1912). Dandy completed his general surgery residency at the Johns Hopkins Hospital under William S. Halsted in 1918. (He had been appointed Halsted's Chief Resident in 1916.) While Dandy was introduced to the nascent field of neurosurgery by Cushing, it was George J. Heuer who completed Dandy's neurosurgical training after Cushing's departure for the Peter Bent Brigham Hospital in Boston in September 1912. Heuer had graduated from the Johns Hopkins University School of Medicine in 1908, worked as Cushing's first Assistant Resident from 1908 to 1909, and served as Halsted's Chief Resident from 1911 to 1914.
Dandy joined the staff of the Johns Hopkins Hospital in 1918 and immediately focused his energies on the surgical treatment of disorders of the brain and spinal cord. When Heuer left Hopkins in 1922 to become the head of surgery at the University of Cincinnati, Dandy remained as the only neurosurgeon at the Johns Hopkins Hospital until his death in that hospital in 1946.
Dandy's first scientific contribution was the detailed anatomical description of a 2 mm human embryo in Franklin P. Mall's collection. This paper was published in 1910, five months before he graduated from medical school. In 1911 and 1913, he described the blood supply and nerve supply, respectively, of the pituitary gland. In 1913 and 1914, Dandy and Kenneth D. Blackfan published two landmark papers on the production, circulation, and absorption of CSF in the brain and on the causes and potential treatments of hydrocephalus. Hydrocephalus is the buildup of CSF within the brain, an often lethal condition if left untreated. They described two forms of hydrocephalus, namely "obstructive" and "communicating," thus establishing a theoretical framework for the rational treatment of this condition. This work is regarded by many as one of the finest pieces of surgical research ever done. Indeed, Halsted reportedly told Edwards A. Park that "Dandy will never do anything equal to this again. Few men make more than one great contribution to medicine." Dandy, however, would prove to be one of these "few men." Modern pediatric neurosurgeons devote most of their time to the management of hydrocephalus.
The Dandy–Walker malformation is a congenital malformation associated with hydrocephalus. In 1921 Dandy reported a case of hydrocephalus caused by obstruction of outflow of CSF from the fourth ventricle. In 1944 A. Earl Walker (who eventually became chairman of neurosurgery at Johns Hopkins) described a similar case of congenital closure of the outflow of the fourth ventricle. This congenital anomaly became known as the Dandy-Walker cyst. It is associated with closure of the foramina of Luschka and Magendie (the outflow openings of the fourth ventricle), atrophy of the cerebellum and cerebellar vermis, dilation of the fourth ventricle, hydrocephalus, and often atrophy of the corpus callosum.
In 1918 and 1919 Dandy published his landmark papers on air ventriculography and the associated technique of pneumoencephalography. For this contribution he was nominated for the Nobel Prize in 1933 by Hans Christian Jacobaeus, Chairman of the Nobel Committee of the Karolinska Institute. Ventriculography and pneumoencephalography allowed neurosurgeons for the first time to visualize brain lesions on x-rays. To accomplish this, CSF in the ventricles and subarachnoid space was replaced with air injected either directly into the ventricles (ventriculography) or into the lumbar subarachnoid space (pneumoencephalography). As a general surgeon, Dandy was aware of the ability of free air in the peritoneal cavity to outline the abdominal contents. He published a paper on this radiographic phenomenon ("pneumoperitoneum") in 1919 based on a clinical observation he had made in 1917. In 1918, the year that he finished his residency, he published the paper on air ventriculography. Samuel J. Crowe described it as "the greatest single contribution ever made to brain surgery." Gilbert Horrax stated:
The importance of this diagnostic method, ... for the more accurate localization of many growths whose situation could not be ascertained with absolute exactness, can hardly be overemphasized. It brought immediately into the operable field at least one third more brain tumors than could be diagnosed and localized previously by the most refined neurological methods.
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