神外风云人物志--George J. Heuer教授

Portrait of George Julius Heuer (1882–1950). Reprinted with permission from the George J. Heuer Birthday Volume. Surgery 23:320–321, 1948. Permission granted by Mosby, Inc.

文章George J. Heuer: forgotten pioneer neurosurgeon at The Johns Hopkins Hospital, J Neurosurg 96:1139–1146, 2002，是一篇非常好的研究额颞入路的史学文章。让我们从这篇文章的摘要读起：

George J. Heuer was a pioneer in neurosurgery at The Johns Hopkins Hospital in the early 20th century; he trained under Harvey Cushing and acted as a mentor to Walter Dandy. In his early career, Heuer focused on research and clinical work in the field of neurosurgery and temporarily led the neurosurgery section at Johns Hopkins. One of his most important contributions to neurosurgery was the modern frontotemporal craniotomy. This elegant craniotomy, which initially was used to approach chiasmal tumors, developed into the modern frontosphenotemporal craniotomy, which neurosurgeons use to approach numerous tumors as well as most aneurysms. Although Dandy is frequently credited with inventing this operation, his article detailing the new approach clearly attributes its origin to Heuer, who was serving in World War I when the new technique was presented.

Although he had hoped to lead the neurosurgical section at Johns Hopkins permanently, he returned from military service to find that Dandy had been appointed to this position. Heuer subsequently advanced to a distinguished career in general surgery as the chairman of surgery at two institutions, and was known for his contributions to surgical education. Throughout his academic years, Heuer continued to operate on the nervous system and to perform spinal cord and peripheral nerve surgery. He played an important role along with Cushing and Dandy in the creation of neurosurgery as a specialty, but he is rarely given credit for this accomplishment. The authors describe Heuer’s contributions to neurosurgery as well as his distinguished surgical career.

笔者无意在这里翻译以上文字，仅想谈几点读后感：

1. 约翰霍普金斯医院，The Johns Hopkins Hospital，是北美地区现代神经外科的主要发源地之一。熟悉医学史的同道，大家都知道，Johns Hopkins，其实也是现代医学的圣殿之一。大名鼎鼎的William Halsted，曾在该院任外科主任。腹股沟疝修补术，加强后壁修补之Halsted法，这在医学生的大学时代、芳华时期，是必学、必考、必须会的内容之一。

Harvey Cushing，在William Halsted教授指导下，完成住院医师培训。Harvey Cushing，在神经外科声名早著，是与William Halsted教授的支持，密不可分的。

2. Walter Dandy教授，与Harvey Cushing教授，在工作上存在竞争关系，在相处中存在关系紧张。从师承Harvey Cushing着眼，Walter Dandy，可以被视为George J. Heuer的师弟。但是，Walter Dandy与George J. Heuer，亦是存在工作竞争、相处紧张。

1912年，Harvey Cushing教授，离开巴尔的摩，赴波士顿履新。

1912年至1914年，George J. Heuer，执掌约翰霍普金斯神经外科。两年，确实短暂。

1914年，第一次世界大战爆发，George J. Heuer，远赴欧洲战场。

1918年，第一次世界大战结束。

1919年，George J. Heuer，返回约翰霍普金斯，其内心期望重新执掌神经外科。

叹，时过境迁！George J. Heuer在欧洲战场时期，Walter Dandy已被任命为科室主任。

3. 额颞开颅。

如，文章The history of neurosurgery and its relation to the development and refinement of the frontotemporal craniotomy, Neurosurg Focus 36 (4):E12, 2014

Heuer’s approach was initially described by Walter Dandy (1886–1946) to speed its publication (at the insistence of William Halsted [1852–1922]), because Heuer was in France during World War I.

又如，在文章George J. Heuer: forgotten pioneer neurosurgeon at The Johns Hopkins Hospital, J Neurosurg 96:1139–1146, 2002里说：

Although Heuer and Dandy worked closely during the years of 1912 to 1914 and later produced two papers together, there was a rivalry between the two surgeons.

两篇文章，引发George J. Heuer与Walter Dandy关系紧张、甚至敌意（rivalry）。

是哪两篇文章呢？正文中没有说明。笔者认为，应是附录文章：

Heuer GJ: An operation of hypophyseal tumors. Exhibition of case. Bull Johns Hopkins Hosp 26:54, 1915

Dandy WE: A new hypophysis operation. Bull Johns Hopkins Hosp 29:154–155, 1918

纵观人类科技史，牛顿与莱布尼茨，有关微积分创立优先权之争，是一场著名的学术专利权之争。Walter Dandy与George J. Heuer，围绕额颞入路，产生分歧、隔阂，甚至敌意。

先前，笔者在神经外科手术入路（十）--手术入路之学习与研究，曾表达这样的观点：手术入路的首先报告者，不一定是该手术入路的首创实践者。

Walter Dandy，是额颞入路的首先报告者；George J. Heuer，是额颞入路的首创实践者。

笔者学习后认为，Walter Dandy，在George J. Heuer额颞开颅的基础上，将其骨瓣缩小，切口隐于发际内，是额颞入路发展史上的大事件。Walter Dandy，拉开了额颞入路之整形美容方面的序幕。接下来，Gazi Yaşargil教授，将在面神经额支保护、颞肌处理等方面，继续做文章。

笔者斗胆，将Harvey Cushing、George J. Heuer、Walter Dandy，称为“Johns Hopkins Neurosurgery 三人行”。1912年，当Harvey Cushing，作为冉冉升起的明星，离开Johns Hopkins，履新波士顿时，George J. Heuer与Walter Dandy都表达了跟随老师Cushing一同前往的良好意愿。这两位学生，未能如愿。“三人行”，最终解体。

倘若“三人行”一直抱团走下去，或许，北美神经外科的历史，将是另一番景象。或许，也将不会有Harvard神经外科系统与Johns Hopkins神经外科系统的彼此警惕。其实，是一家人。

学科历史，神经外科那些事儿，其实很有趣，很玄妙。今晚，没有当年明月，只有Neurosurgery。

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