A History of the Neurological Institute of New York and Its Department of Neurological Surgery
Donald O. Quest, M.D., J. Lawrence Pool, M.D.
THE NEUROLOGICAL INSTITUTE of New York was founded in 1909 as the first hospital in North America devoted exclusively to the care of patients afflicted with neurological diseases. The Institute amalgamated with Columbia University’s College of Physicians and Surgeons and The Presbyterian Hospital in New York City in 1928. The Department of Neurological Surgery developed under the successive leadership of Charles Elsberg, Byron Stookey, J. Lawrence Pool, Edward Schlesinger, Bennett Stein, and Robert Solomon each of whom brought unique qualities to the role of Department Chairman. This article traces the history of the Institute and its affiliates, present activities, and future plans.
In 1908, two New York City neurologists, Joseph Collins and Joseph Fraenkel, began to discuss forming a hospital devoted solely to the care of those afflicted with neurological diseases. At that time, such patients were cared for by internists on general medical wards and neurologists were called in for consultations. General surgeons were asked to administer to those deemed treatable by surgery. Virtually all neurological illnesses were thought of as incurable and, to many physicians, not even considered respectable. There were no hospitals devoted exclusively to the care of patients with neurological diseases. Pearce Bailey, another prominent New York neurologist, joined the formative group in 1909, and Charles Elsberg was invited to provide a surgical point of view. These men were enthusiastic about the prospects of establishing a neurological institute and thought they might be providing a model for other such institutes throughout the world. Their institution was incorporated as The Neurological Institute of New York in April 1909. A building at 149 East 67th Street in New York City was immediately leased and eventually purchased in 1920; it was six floors high and had 57 patient beds (Pic. 1). Four weeks later, the first operation at the new Institute was performed by Elsberg. The operation was the removal of a spinal cord tumor with subsequent cure.
It took several years for the Institute to acquire radiology and pathology facilities, but the number of admissions and operations grew steadily. The first medical students came for training from Cornell University, and Columbia University began sending medical students to the Institute in 1921.
AFFILIATION WITH COLUMBIA COLLEGE OF PHYSICIANS AND SURGEONS AND WITH PRESBYTERIAN HOSPITAL
In 1925, the Neurological Institute and Columbia-Presbyterian Medical Center decided to join forces. Columbia University had previously amalgamated with Presbyterian Hospital in 1911. Columbia University, originally called King’s College, was established by royal charter from King George II of England in 1754. The Medical School of King’s College was founded in 1767 and was the first medical school in America to grant the degree of Doctor of Medicine. King’s College was closed during the American Revolution, because it was not a favored institution (too much sympathy for the British cause) and it did not have a favored name. It reopened as Columbia University in 1787 (Columbia was a common appellation for the New World in the 18th century). The College of Physicians and Surgeons was an entirely separate institution, established by the Regents of the University of the State of New York in 1807. It was organized similarly to the present American College of Surgeons in that it was at first an organization of practicing physicians and surgeons. The College of Physicians and Surgeons soon developed an instructional course for students, acquired a faculty, and began functioning as a medical school. The faculty at the College of Physicians and Surgeons came primarily from Columbia University; because of academic politics, many faculty members became disenchanted with Columbia University and switched allegiance to the College of Physicians and Surgeons. One of these was David Hosack, a distinguished and prominent physician of the time, who attended Alexander Hamilton (a Columbia University graduate) after his duel with Aaron Burr. Columbia University’s medical school soon closed, and the College of Physicians and Surgeons gained strength and eventually became the medical school of Columbia University in 1860, formally merging in 1891. Throughout the 1800s, the College of Physicians and Surgeons intermittently relocated from sites in lower Manhattan northward to 23rd Street and then to 59th Street next to Roosevelt Hospital, which is an eminent private hospital that was founded in 1863. In the early 1900s, Columbia University sought an affiliation with Roosevelt Hospital but, partially because of a personal dispute between the heads of the two institutions, Roosevelt Hospital turned Columbia University down and Columbia University went on to affiliate with Presbyterian Hospital. Edward S. Harkness, son of one of the founders of the Standard Oil Company and a trustee at Roosevelt Hospital, became so disenchanted that he switched allegiance to Presbyterian Hospital and subsequently donated many millions of dollars to Columbia-Presbyterian Medical Center, including the site for a new medical center. Presbyterian Hospital was founded in 1868 by James Lenox who spearheaded a group of trustees who sought a philanthropic cause for Presbyterians in New York City to match the Catholics (St. Vincent’s Hospital), the Episcopalians(St. Luke’s Hospital), and the Jews (Mount Sinai Hospital).The hospital was first located at Park Avenue and 70th Street. The site of the new Columbia-Presbyterian Medical Center, with the associated Neurological Institute, was between Broadway and Riverside Drive, from 165th to 168th Street, the location of a former ball park for the New York Yankees (Pic. 2). The new building for the Neurological Institute was completed in 1929. Doctors’ offices were included in the building, and the radiology suite was located on the same floor as the operating rooms. The building, with a yellow brick facade, was 14 stories high and had 191 patient beds (Pic. 3). From its founding in 1909 until 1941, The Neurological Institute had its own Medical Board and Board of Trustees. After affiliation with Columbia University in 1921 and association with the Columbia-Presbyterian Medical Center in 1928, there was increasing integration with Presbyterian Hospital until, eventually, the Institute’s Medical Board merged with that of Presbyterian Hospital, the independent Board of Trustees was dissolved, and full amalgamation into the corporate structure of Columbia-Presbyterian Medical Center occurred in 1943.
In 1989, The Milstein Pavilion of the Presbyterian Hospital was completed and in-patient care for Neurosurgery and Neurology moved to that facility (Pic. 4). Neuroradiology, previously located in the basement of the Columbia-Presbyterian Medical Center, moved to Milstein with the clinical services and now has two modern suites for diagnostic and interventional angiography, a suite for myelography, and one positron emission tomographic, three magnetic resonance imaging machines, and four computed tomographic scanners. The physical structure of the present Institute encompasses 14 floors. The Neurological Institute basement now houses a prototype 4.5-tesla magnetic resonance imaging scanner for research and clinical use. The first floor encompasses resident on-call rooms, the entrance lobby, and a small auditorium. Doctors’ offices are located on the second floor. The 3rd through 12th floors, which formerly housed the neurosurgical operating rooms, intensive care unit, and neurology and neurosurgery patient rooms, have been converted for research and administrative use. The 13th floor is devoted to clinical electrophysiology laboratories. From the 14th floor, with its several offices and a library, there is a beautiful view of the downtown Manhattan skyline.
Neurologists at the Institute during its formative years included Collins(Chairman, 1909-1919), Frederick Tilney (Chairman, 1920-1935), Henry Riley, Foster Kennedy, Oliver Strong (neuroanatomist), Adolph Elwyn (embryologist and neuroanatomist), and Israel Wechsler of intelligence quotient test fame. In 1939, Tracy Putnam was named Chairman of the Departments of Neurology and Neurosurgery. This arrangement did not work out well, and Putnam resigned. In 1948, Houston Merritt became Chairman of Neurology. Merritt greatly expanded the neurology service, wrote his classic Textbook of Neurology, and served as Dean of the College of Physicians and Surgeons from 1958 to 1970. Merritt was a clinician, teacher, scientist, author, and administrator. He was one of the investigators directly responsible for the introduction of diphenylhydantoin as an anticonvulsant. In 1974, the incumbent Chairman of the Department of Neurology, Lewis P. Rowland, began his tenure (see Table 1)
The first Chief of the Division of Pediatric Neurology, which was formed in 1933, was Bernard Sachs of the eponymic Tay-Sachs Disease. In 1952, Sidney Carter took over as Chief of Pediatric Neurology and established child neurology as an independent service, provided guidelines and initiated federal funding for training programs, and developed the process for becoming credentialed for certification in this subspecialty. Upon Carter’s retirement in 1984, Darryl DeVivo became the Chief of Pediatric Neurology (see Table 1).
Cornelius Dyke joined the Institute in 1929 and became the first full-time radiologist on the staff. He became Director in 1940 and had the singular honor, as a non-neurosurgeon, of being named President of the Harvey Cushing Society (now the American Association of Neurological Surgeons) that same year. Dyke and Leo Davidoff wrote several classic texts on pneumoencephalography. Juan Taveras became Head of Neuroradiology in 1952 and established the first training program in this subspecialty. He collaborated with his successor, Ernest Wood, on the textbook, Diagnostic Neuroradiology. Sadek Hilal became Director of Neuroradiology in 1975, leading neuroradiology with his in-depth knowledge and foresight into new developments in his specialty and pioneering in embolization techniques for arteriovenous malformations as well as early technological developments in computed tomography and high-strength magnetic resonance imaging (see Table 1). John Pile-Spellman is the first Director of Interventional Neuroradiology and is active in the treatment of arteriovenous malformations, aneurysms, fistulae, and tumors.
Wilder Penfield brought contemporary pathological staining methods, which he learned in Madrid from Ramon y Cajal, to the Institute during his tenure from 1923 to 1928. Penfield performed surgery at the Presbyterian Hospital (a separate entity from the Neurological Institute at that time) and functioned as a neuropathologist for the Institute. In 1928, he resigned to become the Director of the Montreal Neurological Institute, which he was instrumental in founding. Abner Wolf was the first Director of Neuropathology, serving from 1930 until 1967, and was the Editor of the Journal of Neuropathology and Experimental Neurology for many years (see Table 1).
Columbia was one of the first universities to develop a major research commitment to the neural sciences. Some of this effort was and still is centered at The Neurological Institute, and some is spread throughout the Columbia-Presbyterian complex. Fundamental discoveries were made into the mechanism of the action potential, the development of the iontophoretic technique, and the characterization of the molecular nature of acetylcholinesterase and the acetylcholine receptor. Neuroanatomy was initially taught in the medical school by members of the Institute. Strong and Elwyn coauthored a well-known textbook, Human Neuroanatomy. A more formal course, developed in 1959 by Malcolm Carpenter and Harold Noback, was very popular among the medical students and inspired many to pursue training in neurology and neurosurgery. In 1975, Columbia established the Center for Neurobiology and Behavior, an interdisciplinary and comprehensive enterprise, under the direction of Eric Kandel. The goal was to bring together a group of investigators experienced in the major disciplines of neural science to further the understanding of neurobiology at the cellular and molecular levels. Currently, there are 28 faculty members, 91 postdoctoral fellows, and 28 graduate students working in laboratories to study development, motor control, and learning. The first laboratory for neurosurgical research was established in 1949. Dominick Purpura, now Dean of the Albert Einstein College of Medicine, began his distinguished career in neuroscience in this laboratory. At present, one area of research in the neurosurgical laboratories is directed toward clinical applications of molecular biological techniques for the treatment of brain tumors, analyzing oncogenes and growth factors as targets for therapeutic intervention. Another major thrust involves approaches to cerebral protection, including the study of hypothermia, leukocyte adhesion molecules, and excitatory transmitters in a small animal stroke model. Other investigative efforts in the Department of Neurology include research activity in Movement Disorders, Muscular Dystrophy and Related Diseases, Epilepsy, Neurometabolic Diseases, Behavioral Disorders, and Dementia.
Elsberg was the first Chairman of the Neurosurgical Department (Pic. 5). He was an eminent member of the fraternity of first-generation pioneers of American neurosurgery and, along with Cushing, Frazier, and Sachs, founded the Society of Neurological Surgeons. He was expert at the diagnosis and treatment of the spine and spinal cord disease. Elsberg was succeeded in 1937 by Byron Stookey, a stern taskmaster respected for his insistence on perfection. He was a superb teacher, with expertise in peripheral nerve surgery and the treatment of tic douloureux.
In 1947, John E. (Teddy) Scarff became Acting Chairman and served until 1949 when J. Lawrence Pool became the Chairman of the Neurosurgical Department. Famed for his work with aneurysms, arteriovenous malformations, and acoustic tumors, Pool led the department for 23 years, until 1972. Lester A. Mount, known for his meticulous surgical technique in dealing with aneurysms and brain tumors, served as Acting Director for 1 year after Pool. He was succeeded in 1973 by Edward B. Schlesinger, who had a particular interest and expertise in spinal disorders.
In 1980, Bennett M. Stein became Chairman. With his bold and innovative surgical skills, deep interest in teaching, and superb leadership abilities, he has positioned the department well for the future (see Table 1). There are currently 11 fulltime members of the department, with all subspecialties represented, performing over 2200 neurosurgical operations annually (see Table 2).
There are many distinguished alumni of the Neurological Institute of New York, in academia and in private practice, and many leaders in American neurosurgery have come from the Institute. Over 140 neurosurgeons have completed residency training at the Neurological Institute. Thirty have become department chairmen, and 25 have gone on to become presidents of the various national neurosurgical societies. There are more graduates of Columbia’s College of Physicians and Surgeons in neurosurgical residencies throughout the country than from any other medical school. The Neurological Institute of New York looks back on a proud and distinguished tradition and forward to a bright future.
REFERENCES1. Dalton JC: History of the College of Physicians and Surgeons. 1888.