Introduction. On forging a new specialty from the crucible of war

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  • 1 Department of Neurological Surgery, University of Cincinnati College of Medicine, Cincinnati, Ohio;
  • | 2 Department of Neurological Surgery, Barrow Neurological Institute, Phoenix, Arizona;
  • | 3 Department of Neurological Surgery, Mayo College of Medicine and Science, Rochester, Minnesota;
  • | 4 Division of Neurological Surgery, Walter Reed Medical Center, Bethesda, Maryland; and
  • | 5 Department of Neurosurgery, Alfred Hospital, Melbourne, Victoria, Australia
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Over the course of history, human conflict has been responsible for immeasurable loss of life. Care for the wounded evolved desultorily during this time, and though many believe that war has accelerated medical and surgical progress to the benefit of both military and civilian lives, many believe that the benefit may not be as significant as one might hope or believe. One cannot deny, however, that war has influenced medicine in many ways. From the evolution of the ambulance, triage medicine, and ventilated, open-spaced "hospitals," to the development of antibiotics, mobile x-ray units, and concepts in wound care, military medicine was borne from the dire circumstances of the wounded and the desire and need to heal and maintain a healthy fighting force. More recent military medical advancements in trauma systems, prehospital resuscitation, hemostatic agents, damage control surgery, burn care, endovascular stents, and many others have influenced civilian practice. The field of neurological surgery experienced a similar revolution during years of war.

This issue of Neurosurgical Focus highlights original contributions to the progress of neurosurgery forged from war. The reader will learn about the legacy and contributions to trauma surgery and neurosurgery during the Renaissance by Paré and Dalla Croce. Brief biographical histories of Hooker, Shrapnel, Cushing, Meirowsky, and Cloward are presented, bringing the reader closer to the challenges faced in caring for the sick and injured in war. Wartime developments in the care of spine and nerve injury are detailed, demonstrating the surgeons’ growing understanding of pathology through careful observation. This remains one of the core skills required of any physician. Although infection was not unique to war, the development of antibiotic use for trauma was heavily influenced by the lessons of war. Personal experiences are shared in some unique manuscripts that serve as both archive and historical narrative. A rather interesting look at history through the "genealogy" of war neurosurgery helps the reader to appreciate, at least in part, whence we came to practicing neurosurgery as we do today.

Much has been learned, yet much remains. The conflicts of today will doubtless engender new knowledge and new advancements in healing. We hope the reader will appreciate and benefit from the many lessons that were learned in battlefields over the centuries, in the hope that wars will never be repeated and their lessons never needed.

Disclosures

The authors report no conflict of interest.

Captain Benny Brandvold stands "at the ready" outside of Dhahran, Saudi Arabia, during the early phase of Operation Desert Shield, fall of 1990. © Benny Brandvold, published with permission. See the article by Martin et al. (E16).

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