History of Medicine

         A SAN FRANCISCO NEUROSURGICAL FIRST.

                                   by Arthur Lyons, MD

     In the fall of 1884 the news here was that Grover Cleveland, a Democrat from New York won the first of what would turn out to be his two elections as President of the United States but in Britain there was a major medical event to be reported. To the consternation of vocal and often violent English anti-vivisectionists, a neurologically diagnosed brain tumor was successfully diagnosed operated upon for the first time in history. It was removed from a 25-year-old farmer at the Maida Vale Hospital, London.  The case was diagnosed and the tumor localized in the brain based primarily on experimental work on dogs and monkeys carried out over the previous decade by Dr. David Ferrier (1843-1928) augmented by the clinical investigations of epileptic seizures

David Ferrier    (from Wikipedia)

by Dr. John Hughlings Jackson (1835-1911). Ferrier had used electrical stimuli as well as localized ablations to determine the main motor and sensory areas in monkeys, the findings published in a book, The Localization of Cerebral Disease, in 1879. Although the man’s tumor was highly malignant and the patient did not survive more than a few months, it was hailed as a remarkable achievement and widely reported in the medical as well as in popular press. Cerebral localization was still being argued and prominent investigators continued to hold that the brain acted as a whole and that localization of the various brain functions was largely a myth.  The patient’s personal physician was Alexander Hughes Bennett MD (1848-1901) whose father also a prominent doctor had died of a potentially removable brain tumor.  It was he who made the clinical diagnosis and urged surgery. The reputation

Rickman Godlee     (from Wikipedia)

of the surgeon, Rickman Godlee (1849-1928), lent legitimacy to the case. He was nephew of the famous Joseph Lister, his office partner, future president of the Royal College of Surgeons and ultimately was knighted by King George. The significance of the Godlee-Bennett case was well appreciated. Besides being an example of the then recent remarkable advances in surgical technique, it was tangible evidence of the concept of brain localization and it particularly dramatized the value of animal experimentation.

     In San Francisco in early 1886, two years later, a young man was admitted to the Lane Hospital on Clay and Webster Streets suffering from severe headache and focal epileptic seizures,

progressing in severity over eighteen months. Joseph Oakland Hirschfelder MD (1850-1922), the admitting physician made the diagnosis of brain tumor near the contralateral motor strip.  All the tools that we now consider routine in such cases, lay far in the future. X-Rays for example, had to wait another ten years before Wilhelm Roentgen made their discovery.  Hirschfelder depended on clinical signs alone. Like Bennett in London he relied on the character his poor patient’s seizure disorder and his post-ictal palsy. The San Francisco surgeon involved was Hirschfelder’s colleague John F.

Morse MD (1856-1898). The finding of the tumor in their case after opening the intact skull, again helped vindicate the still controversial concept of cerebral localization. The description of the tumor, soft and infiltrating was consistent with a glioblastoma as fatal now as it was then. Their patient died three weeks later of post-operative infection, a not uncommon outcome at the time in spite of the stifling carbolic acid mist of antiseptic surgery. Hirschfelder and Morse were aware of the Bennett-Godlee surgery as a first. The Hirscfhelder-Morse case was the second successful attempt at removal of a non-apparent tumor from the brain and the first in the United States. It was to become the forerunner of many such cases in this country.

     Joseph O. Hirschfelder, born in Oakland, was a well-known highly trained San Francisco doctor. A U.C. graduate, he took his

J. Hirschfelder (top), Levi Cooper Lane (bottom
courtesy Art Lyons

medical training in Germany and was Professor of Clinical Medicine at the Cooper Medical College, recreated as Stanford after the 1906 earthquake.  Among other things he was one of many investigators who carried out early laboratory experimentation on tuberculin in hopes of finding a cure for the scourge of tuberculosis.  He was the first of at least three generations of men who became prominent in American science. A son, Arthur, was the first to use the electrocardiogram in the U.S. Hirschfelder was also a president of the San Francisco Medical Society.

     John F. Morse was born in San Francisco, the son of a pioneer physician. He graduated from the Medical College of the Pacific

courtesy Art Lyons

and from the Frederich Wilhelm University in Berlin, subsequently spending a year in Heidelberg. With that extensive training behind him he established his surgical practice in San Francisco in 1882.  Beside his pioneering brain tumor surgery he carried out many of the earliest appendectomies here and was the first in this country to successfully operate on abdominal aortic aneurism utilizing copper wire. He was very active in medical politics and he too was a president of the San Francisco Medical Society. Surgery lost a giant when he died suddenly of apoplexy at 41.

     Although far from what were considered the medical centers of the world at the time: Philadelphia, New York London, Paris and Berlin, San Francisco had a remarkably sophisticated medical community in the late19th Century. In spite of the presence of many quacks and unlicensed practitioners most doctors had a good education for the time and many of the physicians here had extensive European training. The HIrschfelder-Morse case is a good early example of pioneering skilled medical and surgical practice in San Francisco. The groundbreaking step in the practice of neurosurgery carried out here in 1886 is a case in point.

                                                          Arthur E. Lyons MD

Sources:

Bennett, A. H. & Godlee, R. Case of Cerebral Tumor. Med.-chir. Trans. 1885, 68: 243-75

Hirschfelder,, J. O. Removal of a Tumor of the Brain. Pacific Med.and Surg. J. 1886, 29:210-16

Thorwald, Jürgen. The Triumph of Surgery. Pantheon Books. 1987, 434 pp.

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