Author: William Lloyd Fox
Overview
Walter Dandy, the subject of this biography, was the pioneering neurosurgeon who the author depicted as ‘truly a man of significance in medicine and history’, and as ‘a brilliant mind who had the courage and skill’ to meet the challenges of the then ‘young specialty of neurosurgery‘. Just as the book provides a comprehensive account of Dandy’s surgical acumen and mechanical creativeness, it also reveals his non-surgical qualities, from his frugality and admirable public speaking skills at medical meetings, to his ‘lifelong loyalty and unremitting support‘ for the residents he trained. The book helpfully sets his achievements on the background of an enlightening account of the history of brain surgery which it tracked from the trephination procedures of prehistoric times, through the pioneering works of Victor Horsley, William McEwan, and Rickman Godlee, right up to the ‘modern school of neurosurgery developed by the likes of Harvey Cushing and Geoffrey Jefferson (pages 1-6, 39, 79, 83, 230, 131-132, 203-205 and 230).
Synopsis
The book’s biographical portrait of Dandy chronicled the migration of his parents from Barrow-in-Furness in England, to Sedalia, Missouri where he was born and remained their only child. This narrative highlighted the remarkable closeness of Dandy to his parents, what the author symbolised as ‘the deep devotion that father, mother, and son had for one another’. The book also chronicled Dandy’s courtship and marriage, describing him as ‘a devoted husband and father who thoroughly enjoyed his home’. Dandy’s personal habits also featured prominently, the book painting a portrait of a heavy smoker who loved big cars and train travel, and a life-long sports enthusiast who particularly liked to play golf. In recounting his medical training, the author noted that Dandy’s performance as a medical student, both at the University of Missouri and then at the Johns Hopkins Hospital, ‘stood among the top ten in his class’. The author also praised ‘his ability and interest in research in anatomy’, a quality that caught the attention of Franklin Mall, the professor of anatomy under whom he carried out embryologic research, and under whose tutelage he published his first article as a medical student. The author remarked that it was ‘his ability in anatomy and surgery‘ that attracted the attention of the neurosurgeon Harvey Cushing under whom he investigated the pituitary bodies of cats and dogs (pages 10-17, 21-25, 30, 83, 115-117, 127, 130 and 182-183).
Dandy’s successful career rested largely on his neurosurgical research, and the biography chronicled this from his early involvement in the study of hydrocephalus with Kenneth Blackfan, work that the author said was his ‘first major accomplishment in his chosen field’. Among the advances this experimental research made, and which the book profiled, are the demonstration that cerebrospinal fluid is formed in the ventricles, and that it is ‘almost entirely absorbed in the subarachnoid space‘. The research also confirmed that a variety of lesions can obstruct the flow of cerebrospinal fluid and result in hydrocephalus. The book also chronicled Dandy’s ground-breaking research which resulted in the introduction of ventriculography, what is perhaps his most important contribution to neurosurgery at the time. The author however pointed out that Dandy had wider research interests beyond hydrocephalus, and these included his studies of epilepsy which ‘established a pathological foundation’ for the disease, thereby ‘removing it from the catalog of idiopathic diseases’. Another was his collaborative work with surgeon Dean DeWitt Lewis which established that the facial nerve subserved the sense of taste to the anterior two-thirds of the tongue (pages 35-36, 43-48, 57-59 and 134).
Dandy’s clinical qualities as a doctor formed the most instructive theme of the book, and the author described how these established his fame as an ‘able diagnostician‘, and an ‘efficient’ operator. For example, the author pointed out that Dandy was ‘a good listener, a clear thinker, and a relentless investigator who only spoke or wrote when he was sure that he was right’. He also referred to Dandy’s ‘relentless desire to excel‘, his ‘incessantly active mind’, his energy in the operating theatre, his ‘power of intense concentration’, and his ‘constant curiosity about the nervous system’. And whilst the author admitted that Dandy drove his residents quite hard, he nevertheless argued that he was fond of them and ‘took a personal interest‘ in their lives and careers. Another notable quality which contributed, albeit circuitously, to Dandy’s clinical effectiveness was his ‘competitive streak‘, an attribute which the author said drove him to strive for ‘superiority‘ in everything he did. Dandy however also had less admirable qualities which the author detailed, and these included his ‘abruptness of speech at times’ which he said may appear ‘discourteous‘ (pages 17, 23, 34, 71-72 and 154-167).
Dandy’s surgical practice was as important to establishing his reputation as was his research, and the biography documented how this made him ‘among the leading neurosurgeons of the country’ by the age of 35 years. In illustrating this, the author highlighted his peerless surgical skills in such operations as ‘the extirpation of tumors in various areas of the brain’, and to his innovative procedures for the surgical relief of such disorders as trigeminal neuralgia, Ménière’s disease, cerebrospinal fluid leak, and cerebral aneurysms. The author also speculated that Dandy ‘introduced what may well have been the first postoperative recovery room in the history of surgery’. The book however also portrayed Dandy as a demanding surgeon who had a tendency to throw tantrums in the theatre ‘when he became upset’. He also depicted him as an independent practitioner who ‘had little use for many of his fellow neurosurgeons‘ because of what he saw as ‘their blindness and obstinacy‘. Indeed, this was the reason the author said Dandy resisted joining professional associations, serving only once as an officer of any professional body (pages 60-63, 72-73, 82, 134-140, 189-190, 212 and 230).
An engaging theme of the book was its exploration of Dandy’s long-standing rivalry with Harvey Cushing, a discord that the author attributed to Cushing’s ‘quick temper and searing tongue‘. Starting as ‘unpleasant encounters‘ when Dandy was still a medical student, the author said the contention carried on even after Dandy graduated and became Cushing’s assistant resident. The book noted that their antagonism flared up when Cushing left the Johns Hopkins to Boston but did not take Dandy along as he had promised him – a decision which the author said left Dandy’s career in limbo. Referring to the ‘the Dandy-Cushing quarrel as ‘one of the most bitter in the annals of American medicine’, the author illustrated it with such examples as when Cushing criticised Dandy’s ventriculography, a deed that the author said ‘stung‘ Dandy. Even more blistering was when Cushing became ‘greatly annoyed‘ and ‘vented his feelings’ about Dandy’s ‘rather dramatic breakthrough’ in the total removal of tumours of the cerebellopontine angle tumours – an act that the author said offended Dandy who saw it as an ‘attack on his professional conduct and manners‘ (pages 29-34, 46 and 73-78).
Opinion
This complete portrait of a great surgeon and dedicated family man is supplemented with countless illustrative photographs that captured his character and diverse qualities. The well-researched biography reveals the mind behind the remarkable and lasting breakthroughs in a specialty in which he played a defining role. The author did a remarkable job of condensing Dandy’s wide clinical and research output, and in presenting it in an easily accessible form even for the lay reader to appreciate.
Overall assessment
The life of Dandy this biography sets out expounds invaluable lessons for all doctors, and these included his committed and goal-directed research, and his finely-tuned and disciplined practical skills. In the unfortunate rivalry with Cushing are also lessons in how to relate with professional colleagues, a relevant theme across the spectrum of medicine. The book projects the highest values of medicine as manifested in a remarkably efficient life, and I recommend it to all doctors.
Book details
Publisher, Place, Year: Williams and Wilkins, Baltimore, 1984
Number of chapters: 11
Number of pages: 293
ISBN: 978-0-683-04903-8
Star rating: 4
Price: £77.52
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