In Context

Book
The trailblazer Sir Victor Horsley: a celebration
Michael Aminoff, a British-American neurologist, is one of this preference might be expected of a future surgeon.
the best (and certainly one of the most engaging) neurology So, when neurologist and animal researcher David Ferrier
history writers today. His brilliant biographies on Charles urged surgeons to translate the information gained from
Edouard Brown-Séquard and Charles Bell are now followed animal experimentation to localise and remove focal
by a major work on the British scientist Sir Victor Horsley. abnormalities in the human brain, that is what Horsley did.
At first glance, the subtitle The World’s First Neurosurgeon With his surgical skills, Horsley developed new approaches
and His Conscience might seem like a double error. Wasn’t to experimenting on animals and human cadavers before
Harvey Cushing one of the first neurosurgeons? Isn’t social operating on patients. Aminoff emphasises that he was
conscience a bit of an unusual attribute of this specialty? not only a skilled operator but also a “surgical neurologist
Yet this book, which I could not put down and read in one who thought deeply about matters of the brain”. Moreover,
sitting, brims with wonderful information and details that Horsley offered something original in each surgical
fully justify the subtitle—Sir Victor Horsley has a prodigious approach. The neurologist Hughlings Jackson discovered Published Online
legacy. Aminoff’s multilayered book condensing a lifetime of that focal seizures came from the cortex and not the July 13, 2022
https://doi.org/10.1016/
troubles and triumphs is not only for neurosurgeons, but also brainstem, and removing a scar was his first intracranial S1474-4422(22)00292-7
for anyone interested in the evolution of the neurosciences. surgery in 1886, making him, with hindsight, the pioneer Victor Horsley: The World’s
Aminoff’s biography neither venerates nor places Sir Victor of surgical treatment of epilepsy. In 1890, Horsley reported First Neurosurgeon and
on a pedestal. In fact, Aminoff devotes a separate chapter to on 44 brain surgeries marking the beginning of the specialty His Conscience
Michael J Aminoff
“the measure of the man”. A boon for biographers, Horsley of academic neurosurgery. Horsley basically invented Cambridge University Press
was quite a character, imposing and sometimes fanatical stereo­tactic surgery. With Brisitsh surgeon, anatomist, ISBN 978-1316513088
(“peaceful disagreement was difficult for him to accept”). and physiologist Robert Henry Clarke, he described their £64·79

A non-smoking teetotaler since medical school, he quickly stereotactic apparatus using Cartesian coordinates in a nearly For more on experiments of
the prefrontal cortex see
became agnostic too. Descriptive factuality was what he 80-page manuscript in Brain. When his earlier biographer Philos Trans 1888; 179B: 1–45
sought and he felt that Christian concepts did not overlap John B Lyons called him “the father of neurosurgery”, the For more on brain surgeries see
with scientific ones. Early in his career, he managed to create Americans became annoyed. Cushing was unimpressed by BMJ 1890; 2: 1286–92
rows with a few researchers, including the future Nobel Horsley’s skills and felt that he was technically sloppy and too For more on the stereotactic
laureate Charles Scott Sherrington, and he could go directly fast. Some of these stories and personal feuds are based on apparatus see Brain 1908;
31: 45–124
to the jugular. All true but, for me, Horsley emerges from collective memory, but that is how history is written.
For Lyon’s biography of
the pages not as a derring-do surgeon but rather as a deeply Horsley also believed that physicians must advocate for
Victor Horsley see Lyons JB.
involved, conscientious physician lacking the ruthlessness of improvement in the social conditions that lead to disease. Citizen Surgeon. A Life of
some of his later peers. He was knighted in 1902. In middle He was convinced of the dangerous effects of alcohol and, Sir Victor Horsley. 1st edn.
London: Peter Dawnay Ltd; 1966
age, he volunteered for military service and was posted to in 1907, he published Alcohol and the Human Body. For him,
Mesopotamia. He did not safely lock himself up in a military whisky was “the most popular poison in the world”. Also,
hospital but went to the trenches. Tragically, he died there in Aminoff retells the classic “Brown Dog affair” and Horsley’s
1916 from “heat stroke” while walking the desert to see a sick involvement as a witness; he railed against antivivisectionists
officer on a humid day. mostly because they claimed that animals suffered from
I first became aware of Sir Victor Horsley’s work when I insufficient anaesthesia (he thought they did not and invited
learnt that he was the first to note that ventilated animals journalists to his laboratory). Horsley considered animal
cannot die from increased intracranial pressure. This finding experimentation an important path to scientific truth, but
was a major insight at the time, although we now know it he was also deeply upset when experimentation caused pain
is not entirely true. Horsley did essential work on the effects to his animal subjects. Contestably, Horsley said that just as
of intracranial pressure on heart rate, blood pressure, and it was not immoral to sacrifice animals for food, it was also
respiratory rhythms, which antedated Harvey Cushing’s reasonable and permissible to do so to gain knowledge.
findings by a decade. Cushing later claimed these changes In concluding his superb book, Aminoff states: “Sir Victor
as his reflex. Horsley became interested in localisation of Horsley remains one of the most outstanding personalities
abnormalities in the brain and worked with Edward Schäfer of his times, at once a pioneering neuro­surgeon, effective
at the physiologic laboratory of University College London researcher, inspiring teacher, and principled social reformer,
to characterise the motor system. With Schäfer, he also thereby exemplifying the modern ideal of the medical doctor
found that lesions in the prefrontal cortex created “idiocy” and university professor.” I am glad he had his due.
but not weakness. Schäfer felt that Horsley preferred surgery
to careful, time-consuming observation, and indeed, Eelco Wijdicks

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