Historical marker for Egyptian Building

History of neurosurgery at VCU

The Medical College of Virginia was founded in 1838 after the arrival of Augustus Warner from Charlottesville, Va. under a charter of Hampden-Sydney College. Charles Brown-Sequard was among the early faculty and likely wrote his landmark paper on the spinal cord and performed experiments for his treatise on the function of the adrenal gland while in Richmond.

The outbreak of the Civil War transformed the city into a major hospital center for the treatment of war casualties and MCV was the only Southern medical school to remain open during the conflict. Numerous accounts of the treatment of head injuries at the hospitals in Richmond appear in the Confederate Medical and Surgical Journal.

The arrival of C.C. Coleman in Richmond marked the foundation of neurosurgery in Virginia and Richmond at MCV, as well as the Department of Neurosurgery at the University of Virginia. During his 32-year tenure as chairman at MCV, Coleman continued to build the department’s faculty and established an increasing commitment to research.

During more recent years, Dr. Donald Becker has further opened the doors of research, particularly in the area of severe head trauma, which remains a major thrust of the department’s scientific mission. In 1985, Dr. Harold Young was appointed chairman, along with J. Paul Muizelaar, M. Ross Bullock, John Povlishock and Anthony Maramarou, and has continued the tradition of clinical and basic science investigation in traumatic brain injury while reinforcing Coleman’s dedication to clinical excellence and resident education.

Founding of MCV

MCV’s origin can be traced back to the arrival of Augustus L. Warner from the University of Virginia in 1838. He had studied at the University of Maryland Medical School for two years, completing the medical curriculum. He began as a lecturer in Baltimore before becoming a professor of Anatomy, Physiology and Surgery at the University of Virginia in 1834, where one of his more interesting duties was to manage the departmental distillery.

Warner’s department at UVa consisted of two other instructors and approximately 30 students, as the academic pursuit of surgery was in its infancy. The lack of dissection material led him to organize student “anatomical expeditions,” which were essentially body-snatching missions, a common practice at the time. His response to the lack of “living” clinical material was a proposition to move the department to Richmond, which had a population of 20,000, but the Board of Visitors and other faculty opposed the move. Warner left Charlottesville after just three years due to a lack of anatomic dissection material and a salary dispute.

Egyptian Building

Following his departure, Warner opened an office for the “reception of private pupils for medical education” for a $20 fee. His original plans provided access to medicinal preparations and a library, anatomic dissections and lectures. Since other Richmond physicians had similar interests, the medical school was organized under the Charter of the Hampden-Sydney College in 1838. At the time, medical education consisted of attendance at two five-month sessions, “satisfactory preliminary education,” and payment of $20 to each professor. As part of the curriculum, each student was assigned to one of three hospitals in the Richmond area: the City Hospital, the Penitentiary and the Armory. In addition, the Egyptian building on Shockoe Hill was constructed and at that time was unique in that it housed the laboratories, lecture theaters and hospital patients.

On May 6, 1847, Warner developed what was described as abdominal neuralgia and a few days later died from what was surely a ruptured appendix.

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Charles Brown-Sequard

Charles Brown-Sequard

Among MCV’s early faculty was Charles Edouard Brown-Sequard who was selected as professor of Physiology and Medical Jurisprudence in 1854. Born in Paris, Brown-Sequard was the son of an American sailor who died when he was a boy, and a French mother, who he honored by switching his surname from Sequard-Brown.

Brown-Sequard’s appointment was bold for a newly formed medical school since many American professors, including those in Richmond, were content with teaching accepted facts, rather than engaging in experimental investigation. Although his appointment was controversial to many in Virginia, the editor of the Virginia Medical and Surgical Journal stated:

“We are striving to build a great College in Virginia, not to make fat offices to put our friends in. We look around for the best man to fill a professorship, and we take him, whoever he is.”

His appointment was similarly lauded by Paul Broca in Paris.

“Your young and great nation throws aside the prejudices which oppress old Europe. The narrow questions of nationality and boundary occupy you much less than the true merits of the man. How long before we dare to follow your example? ……M. Sequard himself, is he not an instance of what I have said?….He is not a Frenchman, although educated in Paris, and speaking the language like one of us; although acknowledged to be possessed of eminent talent; yet he has been unable to attain any official position because he was a foreigner.”

Due to an administrative oversight, Brown-Sequard was not given a laboratory with animals and thus his students resorted to searching the city for specimens, including dogs, cats, raccoons or other suitable animals for study. The resulting cacophony from the Egyptian building eventually caused discord among Richmond citizens and the medical staff who found it hard to reconcile these strange sounds with the university as a place of higher learning.

While in Richmond, Brown-Sequard continued his practice of using himself as an experimental subject. On one occasion he covered himself in waterproof varnish to “discover certain facts concerning human sweat,” and was barely rescued by a medical student after documenting in a notebook that “he was beginning to die.” He also performed a self-experiment on digestion using sponges onto which a string was attached. He is credited with successfully implanting a dog tail onto a rooster’s comb only to have it torn from its head in a cockfight. Another account tells of a medical student holding a cat by the tail while he explored its abdomen.

Brown-Sequard left Richmond in 1855 after only one year as a professor. During his brief stay, he published details of the autonomic innervation of the heart and lungs in the Virginia Medical and Surgical Journal. He also likely wrote his famous paper on the spinal cord, Experimental and Clinical Researches on the Physiology and Pathology of the Spinal Cord (1855), and performed experiments for his later publication on the adrenal glands, Experimental Researches on the Physiology of the Suprarenal Capsules (1856).

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MCV and the Civil War

The medical school remained operational during the Civil War and is the only Southern medical school still in existence that graduated students during that period. Just prior to the outbreak of the war, Hunter Holmes McGuire led 300 fellow Southern medical students from the Jefferson Medical School in protest for the way they were treated and 140 students subsequently enrolled at MCV. During the Civil War, McGuire also distinguished himself both as a humanitarian and surgeon to Confederate General Thomas “Stonewall” Jackson. At the war’s end in 1865, he became the chairman of the department of surgery.

The capital of the Confederacy had numerous hospital facilities, many of which were among the largest hospitals in the South. Among them was Winder Hospital with a capacity of 3,000 beds, and Chimborazo Hospital that, with 8,000 beds, was the largest and most famous hospital in the South. Opened in 1861, Chimborazo Hospital was led by James McCaw and was the largest military hospital on the continent at that time. Some estimates claim that 75,000 patients were treated there during the Civil War with an overall mortality of only 9 percent. Most of the records relating to medical care in Richmond were burned in the great Richmond fire just before its fall in April 1865. Richmond citizens set the fires themselves to prevent seizing of alcohol, tobacco, and other valuable pillory.

The Confederate States Medical and Surgical Journal includes numerous accounts of head injuries from shrapnel and bullet wounds that were treated at Chimborazo Hospital, including the following:

Case 4. Private O. Ayres, company “A,” 22nd regiment Virginia volunteers
Aged 21; occupation a farmer; wounded November 27th, 1863. Admitted November 30th, with V.S. of right side of head, fracturing outer table of right parietal bone. When admitted the following symptoms presented, viz.: slow pulse, slight fever with coma, leading us to suspect fracture of both tables of parietal bone and pressure upon the brain; but upon closer examination, it was discovered that the outer table only was fractured to the extent of one and a half inches.

Treatment: Bowels were well opened with calomel and gambage, followed by a large dose of castor oil.

November 30th—Bowels having been well moved, patient was better.

This article recognized the possibility of meningitis if the inner table of the skull were fractured and readers are referred to two excellent papers on the treatment of head injures during the Civil War by Kaufman and Zellum.

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Society of Neurological Surgeons - New York City

The beginning of neurosurgery in Richmond

In 1919, Richmond’s and Virginia’s first neurosurgeon, Claude C. Coleman, arrived. Born on July 21, 1879 and raised in Virginia’s Caroline county, he attended the College of William and Mary. Following graduation in 1898, he taught school on the eastern shore of Virginia in fulfillment of his scholarship. After a few years, he enrolled at MCV, from which he graduated in 1903. He spent the next several years in New York at the Polyclinic Hospital and in Richmond with J. Sheldon Horsley, a general surgeon with an interest in facial reconstructive surgery. At some point during his travels, he became interested in the surgery of the central nervous system. With the outbreak of WWI, he became chief of brain surgery at Fort Oglethorpe, Georgia. At that time, he also developed a special interest in the surgery of peripheral nerves while treating many of the war-related hand and peripheral nerve injuries.

On his return to Richmond in 1919, Coleman began a distinguished 32-year career at MCV at Memorial Hospital. He was professor of Neurosurgery at MCV from 1924 to 1949 and the University of Virginia from 1937 to 1941, as well as the founder of both departments in 1919 and 1937, respectively. In addition, he was professor of Anesthesia and Oral Surgery at MCV and a charter member of the Society of Neurological Surgeons and the Harvey Cushing Society. He was granted an honorary D.Sc. from the College of William and Mary in 1949 and served on the Board of Visitors from 1941 to 1950.

Tongs

Coleman established a residency program in neurological surgery in 1928, one of the first of its kind. His trainees included Frank H. Mayfield and W. Gayle Crutchfield at MCV in 1932. At Coleman’s suggestion, Crutchfield developed cervical tongs for a young woman with a fractured mandible and cervical spine fracture, which is considered by some to be the single most important advance in spine trauma. Crutchfield also became the second chief of the University of Virginia’s Department of Neurological Surgery while Mayfield went on to a private practice in Cincinnati where he founded the Mayfield Clinic. In addition, he is famous for the “Mayfield Proclamation,” which served to strengthen the role of the American Association of Neurological Surgeons as a unified voice for neurosurgeons.

In the literature, Coleman’s main contributions were in the treatment of brain abscesses, trigeminal neuralgia and spasmotic torticollis. He was by all accounts a great teacher of the practice of medicine and surgery.

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C.C. Coleman, Walter Dandy and Charles Troland

Frank H. Mayfield

Claude C. Coleman was a good friend of Walter Dandy, who operated on Coleman’s first wife when she suffered from a brain tumor. With a growing practice at the new MCV Hospital, Coleman asked Dandy to “send him his best man,” who at that time was Charles Troland.

While the war efforts delayed Troland’s arrival in Richmond, he quickly established a thriving private practice while affiliated with the university.

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C.C. Coleman retires

With more than 30 years at MCV, C.C. Coleman’s retirement party was a who’s who of neurosurgeons, university administrators and politicians. Those in attendance included former residents W. Gayle Crutchfield and Frank H. Mayfield, Gilbert Horrax and Frank Naffzinger, who trained Coleman’s son in head and neck surgery. Senator Harry F. Byrd of Virginia referred to him as “the embodiment of everything that makes this country great.”

Group photo

After receiving Coleman’s recommendation, John Meredith was appointed chairman of the department in 1951. Originally from Pennsylvania, Meredith received his AB and M.D. degrees from the University of Pennsylvania in 1927 and 1930 respectively. He spent two years at the Lahey clinic in 1932 under Horrax, a personal friend of Coleman’s. He came to Richmond in 1935 as an assistant resident in Neurological Surgery, finishing in 1937. He then accompanied Crutchfield to Charlottesville in 1937 where he was assistant clinical professor of Neurological Surgery. He returned to Richmond in 1941 as associate professor and ultimately became the head of the department in 1951.

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Hume’s arrival marks changes in surgical divisions

Dr. David Hume, a former Cushing Fellow at Brigham Hospital and an early pioneer of transplantation, arrived in 1956 as head of the Department of Surgery. His arrival was marked with bitter fighting with Dr. John Meredith over matters such as the appointment of clinical faculty, resident applicants, and resident and faculty research. He was critical of the emphasis Drs. Meredith and Charles Troland, who was a part-time faculty member, placed on their private practices, as well as their lack of basic research. Hume wanted every faculty member to work for the university full-time, with an emphasis on basic research.

Following Meredith’s death in 1962 of a pulmonary embolus after removing a benign lung tumor from a patient at the Lahey Clinic in Boston, Troland expected to be named the next chairman. However, Hume selected William Collins, Jr., then at the Western Reserve with Dr. Frank Nulsen. Both Collins and Hume had a particular interest in pituitary function.

Collins was originally from New Haven, Conn., where he received his B.S. and M.D. degrees from Yale. He then trained in neurological surgery at Barnes Hospital in St. Louis and finished in 1952. Following a fellowship in neurophysiology from 1953 to 1954, he became an assistant professor of Neurosurgery at the Western Reserve University. Collins formed the Neurosurgical Society of the Virginias, an early state-level neurosurgical society which lobbied for legislative issues important to neurosurgeons. However, his stay in Richmond was brief, lasting only from 1963 to 1967, when he moved to New Haven as chairman of Yale’s Department of Neurological Surgery in 1963. He retired in 1993 as neurosurgeon-in-chief and chairman of the Department of Surgery.

Collins was followed by another of Hume’s recruits, John Alksne. After receiving his bachelor and medical degrees from the University of Washington, Alksne moved to Richmond from the University of California in Los Angeles. He had been studying the function of arachnoid villi and stereotactic magnetic thrombosis of aneurysms just before accepting the chairmanship at MCV. His studies were just beginning to enter clinical trials and he attracted patients nationwide to Richmond. After his brief stay in Richmond, he accepted a position in California as head of the neurosurgery department of a newly formed medical school at the University of California at San Diego in 1971, where he is now dean of the School of Medicine.

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The modern era

The modern era of neurosurgery at the VCU Medical Center began with the arrival of Donald Becker, who was an assistant professor of Neurosurgery at Harbor General Hospital in California. Becker attended Williams College in Massachusetts and Western Reserve Medical School in Cleveland, Ohio. Following medical school, he received training in Cleveland under Frank Nulsen at Western Reserve. He then accepted an appointment at the University of California – Los Angeles as assistant professor and chief of neurosurgery at Harbor General Hospital.

Supplementing his early work with Nulsen on hydrocephalus, Becker began to explore and rethink the role of cerebrospinal fluid in head injury while in California. His move to Richmond was a productive and beneficial one for patients, the university, the department and the residents. During Dr. Becker’s tenure, the mortality as a result of severe head trauma went from 45 percent to approximately 30 percent. His contribution to the systematic study and treatment of head injury remains a major thrust of the scientific mission of the department to this day with more than 60 full-time researchers, clinicians, and ancillary staff.

Drs. Harold Young and J. Douglas Miller were recruited shortly after Becker’s arrival in 1971. Young, who was appointed chairman in 1985, along with J. Paul Muizelaar, M. Ross Bullock, John Povlishock, and Anthony Maramarou, has continued the tradition of clinical and basic science investigation in traumatic brain injury. In addition, the same qualities personified by C.C. Coleman of friendship, clinical excellence, and resident education have been reinforced.

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