Walter E. Dandy

1984, New York

Walter E. Dandy was born on April 6, 1886 in Sedalia, Missouri. His father was an engineer on the Missouri-Kansas-Texas Railroad. Dr. Dandy was an only child and maintained a close emotional relationship with his parents throughout his life. He was valedictorian of his high school class and the title of his commencement address was "Education." Dr. Dandy attended the University of Missouri where he was introduced to golf at the "near cow pasture golf course." Dr. Dandy developed a love for golf and played until the end of his life. However, Dandy had little time for recreation at the University. He helped defray his college expenses by working during the summers. He worked as a barn painter one summer and was a conductor and a motorman on a trolley line other summers.

Dr. Dandy enrolled in the University School of Medicine in his junior year and made straight As. He served as a student assistant to Dr. Jackson in the anatomy laboratory during his junior and senior years. He was elected to Phi Beta Kappa and also to Sigma Xi, the National Scientific Honorary Society. He graduated second in his class of more than 100 students on June 5, 1907.

Dr. Dandy applied to The Johns Hopkins School of Medicine for admission with advanced standing and was accepted into the second-year class beginning in the fall of 1907. Drs. Thomas Grover Orr and Raphael Eustace Semmes, Jr. were his classmates. The annual tuition was $200.00. Professor Franklin P. Mall was so pleased with Dandy's ability that he recommended him for membership in the American Association of Anatomists which was quite an honor for a second-year medical student. Dr. Dandy sought and obtained Harvey Cushing's consent to do research in the Huntarian Laboratory during his senior year in medical school. Following his graduation from Hopkins Medical School in 1910, Dr. Dandy became a Cushing Huntarian appointee for the year 1910 to 1911. Dandy became interested in the pituitary body and in 1911 he published an article with Dr. Emil Goetsch on "Blood Supply of the Pituitary Body." The beautiful drawings in this paper were made by Dandy, himself, under the coaching of Mr. Max Broedel, a renowned medical illustrator. Dandy received the master of arts degree in 1911 for his postgraduate work. He then entered the residency program at The Johns Hopkins Hospital as one of Dr. Cushing's assistant residents along with Howard C. Naffziger. Dr. Cushing was invited to become the professor of surgery at Harvard and surgeon-inchief at the Peter Bent Brigham Hospital. Dr. Dandy had expected to be invited to go with Dr. Cushing. However, shortly before Cushing was to leave for Boston he came to the Huntarian Laboratory and asked to see Dandy's results on experiments with hydrocephalus. Dr. Dandy showed his work to Cushing and Dr. Cushing put it in a box of materials to take to Boston with him. Dandy took his work out of Dr. Cushing's box and told Cushing that the material was his and it was going to stay with him. Cushing then remarked that the work probably did not amount to anything anyhow. Shortly thereafter Dandy was informed that he was not being invited to go to Boston with Dr. Cushing.

Dr. William Halstead found a place on his staff for Dandy as an assistant resident surgeon as he was quite impressed with the research work that young Dr. Dandy and Dr. Kenneth Blackfan, a resident in pediatrics, were doing on hydrocephalus. Dandy performed his first craniotomy in 1912 while still on Dr. Cushing's service and he acquired considerable training and skill in general surgery. He felt that the best preparation for one wishing to become a neurosurgeon was to get a thorough training in general surgery first. Dandy's training at Hopkins lasted 8 years after his graduation from medical school. He undoubtedly contributed more to neurosurgery during his training period alone than any other neurosurgical resident.

Drs. Dandy and Blackman published their classical article on the origin, circulation, and absorption of cerebrospinal fluid and the production of experimental hydrocephalus in December 1913. Halstead stated that "Dr. Dandy will never do anything equal to this again. Few men make more than one great contribution to medicine." However, Dandy proved Dr. Halstead wrong. While still a surgical resident in 1918, Dandy introduced pneumoventriculography which became the most accurate diagnostic test for brain tumors for the next 50 years. Dr. Cushing's famous monograph on acoustic tumors was published in 1917 and he reported a case mortality rate of 18.1% and an operative mortality rate of 13.9% in 33 patients in whom he had performed a subtotal intracapsular removal. In that same year, Dandy performed his first successful total excision of an acoustic tumor. He later reported that in his last 41 cases of total extirpation by a unilateral approach, he had reduced his mortality to 2.4%. This was before the use of the surgical microscope. Dandy was the first to successfully remove a benign lateral ventricular tumor, an ependymoma localized by ventriculography. In October 1921 Dr. Dandy localized and successfully removed a colloid cyst of the third ventricle.

Dandy first performed section of the sensory root of the trigeminal nerve at the pons in 1925. He stated in his 1945 revision of Surgery of the Brain that 10% of his patients had either a tumor or an aneurysm as the cause of their tic douloureux. He stated that when a tumor was not present the etiology was almost always an arterial loop compressing and at times grooving the sensory root. Dr. Dandy performed this operation in more than 500 patients with less than an 0.5% mortality and with excellent and permanent relief of pain. Dandy felt that the attacks of vertigo in Meniere's syndrome were similar to the paroxysmal attacks that came with tic douloureux. He reported total section of the 8th nerve for Meniere's syndrome in nine cases in 1928 with the first case operated on in 1924. During his lifetime he did a total of 692 operations for Meniere's disease with only two fatalities and both of these were due to infection.

In 1929 Dandy reported two cases of L3 disc extrusion with back pain, bilateral sciatic pain, and cauda equina syndrome. A cisternal lipiodol myelogram was performed in both cases which demonstrated a complete block just above the L3 disc. Dandy operated on both patients, removed the fragments of disc, and both patients experienced excellent relief of pain. However, he did not pursue this subject further until after the famous contribution of Mixter and Barr in 1934. After that he became very enthusiastic about performing surgery on patients with herniated lumbar discs and operated upon more than 2000 patients without preoperative myelography.

In March of 1937, Dr. Dandy was the first to cure an internal carotidposterior communicating artery aneurysm by occluding the neck of the aneurysm with a silver clip. His classic monograph Intracranial Arterial Aneurysms first appeared in 1944. He documented 133 aneurysms verified by operation or autopsy.

- Dandy recognized the advantage of team work and he developed a "brain team." The 8-year surgical residency at Hopkins included 2 years of neurosurgery rotations until 1941. Dr. Hugo Rizzoli reported that the members of the "brain team" held Dr. Dandy in awe and respect.

Dr. Dandy met Sadie Estelle Martin, a young attractive dietitian at The Johns Hopkins Hospital and after a 1-year romance married her on October 1, 1924. Dandy was 38 years old at the time and his bride was 23. During the first year of their marriage they took an art history course together at Goucher College. Besides operatic and symphonic performances, the Dandys enjoyed attending football games or baseball games. Exactly one year from the day of their marriage a son, Walter, Jr. was born. Walter Jr. was a medical student at The Johns Hopkins when Dr. Dandy died on April 19, 1946. The other children were Mary Ellen Dandy, born on July 22, 1927, Kathleen Louise Dandy, born August 29, 1928, and Margaret Martin Dandy, born January 21, 1935. The editorial in the Baltimore Evening Sun at the time of his death, summarizes well Dr. Dandy's contribution to neurological surgery: "He had imaginative genius to conceive of new and startling operative techniques, courage to try them, and skill, superb skill to make them successful."