Ernest Sachs

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It is with the greatest possible pleasure that the Journal of Neurosurgery together with his many friends salute Ernest Sachs on the occasion of his seventieth birthday. That he has been one of the outstanding pioneers in our specialty very nearly contemporaneous with the trio of Cushing, Frazier and Elsberg is well known to us all. What is perhaps not so widely appreciated, however, is that unlike the men just mentioned Ernest Sachs set about his training to be a neurosurgeon in an orderly and planned manner, and thus doubtless became the first man to be

It is with the greatest possible pleasure that the Journal of Neurosurgery together with his many friends salute Ernest Sachs on the occasion of his seventieth birthday. That he has been one of the outstanding pioneers in our specialty very nearly contemporaneous with the trio of Cushing, Frazier and Elsberg is well known to us all. What is perhaps not so widely appreciated, however, is that unlike the men just mentioned Ernest Sachs set about his training to be a neurosurgeon in an orderly and planned manner, and thus doubtless became the first man to be regularly trained for this specialty with the idea of making it his life's work.

Being the son of a professor and the nephew of an outstanding neurologist it was natural for Dr. Sachs to look forward to a university career and, in medicine to have a particular interest in neurology. He was likewise influenced greatly in his earlier years by Professor George Parker, the biologist at Harvard. Later, in medical school, he was further stimulated by the teaching of Osler at Johns Hopkins and during his surgical internship in New York, by Dr. Arpad Gerster whom he, among others, has always regarded as an inspiring teacher and master surgeon.

Sachs' formal training in neurosurgery was with Sir Victor Horsley in London, and he thus learned of the trials as well as of the possibilities of this newest branch of surgery from the man who created it as a specialty. It was during his year with Horsley that he was asked by Cushing to come to Baltimore as his first resident, but under the circumstances he could not accept this offer which he greatly regretted. However, upon his return to this country he made a point of visiting Cushing's clinic on frequent occasions, and in the matter of surgical technic he quickly adopted more of the latter's methods than those he had seen employed by Horsley. It may be said, therefore, that he was a pupil of both.

After an early start in practice in New York Dr. Sachs was asked to organize a neurosurgical service at Washington University, St. Louis in 1911, and this service together with its teaching of students and training of young neurosurgeons has constituted his life's work. During World War I he was likewise acting professor of general surgery. This he was particularly fitted to do since he had had a broad experience in many surgical fields and had always kept up his interest in general surgery by having a weekly class in surgical diagnosis—a class which was frequently voted by the students to be the best course in the medical school. At the end of World War I he was made Professor of Clinical Neurosurgery, the first professorship with this title in the world.

In addition to membership in numerous medical, surgical and neurosurgical societies in this country Dr. Sachs has been made an honorary member of the Section on Neurology of the Royal Society of Medicine (England) and of the Deutsche Akadamie der Naturforscher. In 1943 he was president of the American Neurological Association, being the fourth neurologic surgeon to hold this office. He was a founder member of the Society of Neurological Surgeons and its first secretary, later serving as president.

It has been one of Dr. Sachs' great contributions that he has trained a considerable number of young men and that all of those who are practising neurosurgery hold important positions. No less than seven of these hold professorships in this specialty.

His written contributions include two books: “The Diagnosis and Treatment of Brain Tumors” and “The Care of the Neurosurgical Patient,” in addition to a long list of articles published in diverse medical, surgical and pathological journals. Some of his early experimental work was concerned with important investigations in connection with the functions of the optic thalamus in Sir Victor Horsley's laboratory. Later important contributions had to do with anatomic and physiologic studies on the eighth cranial nerve and studies on cerebrospinal fluid circulation.

His clinical papers have dealt with a great variety of neurosurgical subjects among which the diagnosis of brain tumors looms large, but there are also important observations on large series of cases of spina bifida and of internal hydrocephalus. He was quick to take up the use of the electrosurgical unit as a valuable adjunct in operations on the brain, and also detailed his experiences with direct radiation of brain tumors during operation, being the first person to employ this method. Another important contribution was concerned with the results and technic of subpial cortical resections for Jacksonian epilepsy.

But this tribute to Dr. Sachs is not meant to be concerned solely with his various honors and written contributions, valuable as many of the latter may be. Rather, we salute some of his personal characteristics which have always stood out so prominently to those who knew him best. From the professional standpoint there are perhaps two things which make their impress more than any others, namely, his diligent, continual concern with the teaching and training of young men, and secondly his unwearying and devoted attention to every detail connected with his patients—preoperative, at the operating table, and during their entire postoperative period. Students always had ready access to him as his office door was always open. Like many great teachers, he was ready to learn from them as well as to teach them.

So far as patients are concerned nothing is too much trouble for him if they can be benefited. He visits sick patients several times a day and never hesitates to come to the hospital at night to learn at first hand about any possible complication. All patients are at all times given the benefit of possible operative relief, often when their situation looks hopeless and when the result might affect his operative mortality adversely.

He has a healthy skepticism regarding newer methods and technics, yet does not hesitate to adopt them when convinced of their value. His discussions at medical meetings are always frank and to the point in spite of the fact that they might entail personal criticism.

Such an appreciation as this would be quite incomplete without a word concerning Mrs. Sachs. In addition to the quite obvious, and perhaps unusual devotion between them, there is mutual inspiration and understanding to a rare degree, which in turn cannot help but be reflected upon all those with whom they come into contact.

Ernest Sachs has lived through nearly the whole era of modern neurosurgery. He helped to develop his specialty in its infancy and toiled with other pioneers through the days in which the rewards of long and exhausting hours were few and far between. He has accepted and utilized the newer methods and made the most of them, and his clinic has always been a mecca for men from all countries who have wished to see the best in neurosurgery. He has been an inspiration to a host of students as well as to his contemporaries, and has shown extreme fortitude and devotion to his work in the face of varied vicissitudes, including long periods of physical pain.

We pay this simple but sincere tribute to one who has done much to further the best interests of our specialty and to whom neurosurgery and neurosurgeons owe much.

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