Neurologists vs. neurosurgeons

“The neurosurgeons believed therapy to be the critical organizing principle of specialization, while the neurologists, arguing that both organic and functional disorders ought to be belong to neurology, based specialization on a focus on the nervous system broadly defined (Gavrus, 59-60). . . . the self-fashioning of neurologists and neurosurgeons had a distinct performative dimension, and the language used was calibrated specifically for this purpose (61) . . . . these exchanges played out first as performances to an audience. This oral genesis provides insight into the manner in which the doctors’ rhetoric worked to persuade by means of entertainment while creating and perpetuating particular narratives of professional identity. . . . For instance, the attempt to invoke a fundamental difference in temperament between physicians and surgeons by locating the neurologist’s supposedly reflective nature in a historical past in which physicians were characterized as contemplative learned gentlemen while simultaneously dismissing the n neurosurgeon as an unthoughtful man of action allowed neurologists to frame a response to the neurosurgeons’ challenge of therapeutic superiority [cf. 79-81, where the temperamental difference is cast in terms of Shapin’s and C. Lawrence’s use of the term “repertoires”]. This was a rhetorical strategy deployed in rousing speeches to which the professional audience could contribute communally. . . . the critical role that rhetoric and performance may play in the fashioning of medical identity” (62, 75, 79, 81-83). E.g., the private correspondence between Wilfred Penfield and British clinical neurologist Francis Walsh (65-68). E.g., the way all published documents began as oratory (performances) followed by entertainment (“When the sessions filled with clinical and scientific papers were over, the doctors literally put on costumes to sing and dance . . . the content of their plays . . . blurred the edige between the entertaining and the professional” (82). Beginning in late 1930s, “the neurosurgeons’ prominence on the medical scene eclipsed that of their clinical neurologist colleagues” (77), but the loss of authority led to a counterattack in 40s when neurologists appealed to Fulton’s notion of “dynamic neurology” and attacked neurosurgeons’ claims of therapeutic superiority, invoking new drugs (Prostigmin for myasthenia gravis) and claiming that previous surgical treatment approaches (e.g., of glioma or hemorrhage) would give way to medical management (79). Fundamental change in late 40s & early 50s, when the debate shifted from antagonism tow. neurosurgery to internal organization (via newly formed American Academy of Neurology and its new journal, Neurology).) and development of a new revisionist narrative in which the neurology of the past had never achieved professional autonomy, which now fell to the younger neurologists (86), who were bolstered by the new neurological service under the VA (87). “In order to argue that neurology was undergoing a period of progress, [Pearce] Bailey reread the past in a way that suggested a break with neurology’s present focus on therapy. This narrative does not, however, reflect the past faithfully. Early neurologists such as Dana were deeply invested in therapy, as were the physicians who established the Neurological Institute of New York in 1909” (87, 90).