Do we have enough neurosurgeons to care for people around the world?
More than ten years ago, neurosurgeon Robert F. Spetzler was asked to comment on the issues recruiting and retaining women in neurosurgery. “It would be one of my fondest hopes that such a discussion would no longer be necessary a decade into the no-longer quite-so-new millennium,” he wrote. “Sadly, that is not the case despite the progress women have made in medicine overall.”
Twelve years later, the number of women in neurosurgery is just as dire with recent statistics citing that only 8% of neurosurgeons are female.
And while Harvey Cushing, Walter Dandy, and other founding fathers of neurosurgery are well known, the pioneering women of neurosurgery still exist in the shadows of the modern surgical subspecialty.
Here are 10 females who paved the way for both women in neurosurgery as well as notable neurosurgical innovations:
1915: Louise Eisenhardt
An editorial assistant to Harvey Cushing, Dr. Louise Eisenhardt was a neuropathologist and the first editor of the Journal of Neurosurgery, a position she held for 22 years. She moved to Yale University with Cushing, and helped to establish the Brain Tumor Registry, a collection of 2,000 specimens and 50,000 pages of case records. After Cushing’s death in 1938, she became curator of the registry. Eisenhardt is also known for her supravital technique for immediate diagnosis of surgical biopsies taken from intracranial tumors.
1928: Dorothy K. Nash
Dr. Dorothy K. Nash was considered to be the only female neurosurgeon in the U.S. from 1928 to 1960. She was senior surgeon and head of the Department of Neurologic Surgery at St. Margaret Memorial Hospital and on staff at West Penn and Children’s Hospitals in Pittsburgh. She was also an instructor in neurosurgery at the University of Pittsburgh. Her achievements included advocating for the use of bedside lumbar manometry for differentiation of spinal cord tumors and disproving that there was a singular anatomical “convulsogenic zone.”
1943: Diana Beck
During World War II, when women took over traditionally male jobs as brothers and sons went to war, Dr. Diana Beck was appointed consulting neurosurgeon at London’s Royal Free Hospital in 1943, making her the first female neurosurgeon in Western Europe. Prior to that appointment, Beck, the daughter of a tailor, apprenticed with Hugh Cairns who had trained with Harvey Cushing and William Halstead.
After the war, Beck set up the neurosurgical unit at Frenchay Hospital in Bristol before becoming a consultant at The Middlesex Hospital in London in 1947. She is known for pioneering procedures for spontaneous intracerebral hematomas, including a life-saving operation she performed on Alan Alexander Milne, author of Winnie the Pooh, who had suffered a stroke.
Unfortunately her fate met that of many women through history—she was incorrectly diagnosed with “hysteria” and her ability to continue performing surgery was called into question. In reality, Beck suffered from the autoimmune disorder myasthenia gravis, eventually dying from pulmonary embolism after thymectomy in 1956.
1959: Ayisima Altinok
Admitted to the University of Istanbul Medical School with the third-highest score at the admission exam, Dr. Ayisima Altinok served as the chief of neurosurgery in a hospital in Istanbul for 24 years and helped found the Turkish Neurosurgical Society. She was known for a novel technique to treat syringomyelia as well as for modernizing neurosurgery in her country, for example, ensuring that the latest operating instruments and microscopes were available in the operating room so that microneurosurgery could be performed properly.
1959: Ruth K. Jakoby
Dr. Ruth Kerr Jakoby was the first woman Diplomate of the American Board of Neurological Surgery in 1961. She had a private practice in neurological surgery in Washington, D.C. from 1959 to 1975, something she says she was able to develop by covering the emergency room at a busy hospital in July and August, the months her counterparts were on vacation.
She wasn’t interested in taking time off to have her children and went into labor with her first son while operating on an epidural hematoma. As her private practice became increasingly busy, she took on another neurosurgeon just back from Vietnam, who told her the amount of trauma she was operating on was worst than what he saw at war.
With the idea of having more time with her family, she transitioned to become the Chief of the Spinal Cord Injury Service at the Veterans Administration Hospital in Houston, Texas. During this period, she was Associate Professor of Neurosurgery at Baylor College of Medicine and had a joint appointment at Baylor and the Texas Institute of Rehabilitation and Research as Associate Professor of Physical Medicine and Rehabilitation Medicine.
Jakoby was also the first woman neurosurgeon to become a lawyer.
1968: T. S. Kanaka
Thanjavur Santhanakrishna Kanaka is considered to be Asia’s first female neurosurgeon. She is also credited as the first Indian team member to pioneer functional neurosurgery in 1960–1970 as part of the earliest team to carry out stereotactic surgical procedures in India.
Her achievements include fabricating deep-brain-stimulation kits by Indian biomedical engineers at an affordable price, and establishing a hospital for the needy endowed by her own earnings.
1974: Joan Venes
The first person in her neighborhood to go to college, Joan Venes became an emergency room nurse only to realize she wanted to do a lot more than the administrative tasks of nursing. Ultimately, she became the first female neurosurgery resident at Yale University, and the third woman to be admitted to the American Board of Neurological Surgery. In 1973, Dr. Venes was awarded the Van Wagenen Fellowship, which she used to travel to various centers in Europe and America to study seminal work on intracranial pressure monitoring and control.
After an experience with a fatal case of hydrocephalus during her surgical residency, Venes was determined to develop the pediatric neurosurgery specialty. She was a founding member secretary of the American Society of Pediatric Neurosurgery and chairperson of the pediatric section of the American Association of Neurological Surgeons.
1975: Carole Ann Miller
Dr. Carole A. Miller was the fourth woman to become board certified in neurosurgery in the U.S. Following her residency, Miller joined the faculty of neurosurgery at the University of Michigan as the first woman on the surgical faculty. She was also the first woman neurosurgeon to become president of a national neurosurgical organization, the Neurosurgical Society of America, in 1988.
With more than 60 peer-reviewed publications, Miller was a prolific contributor to neurosurgical research on vasospasms related to aneurysmorrhaphy, cerebellar neurophysiology, spinal cord stimulation, peripheral nerve regeneration and spinal trauma.
1977: Frances Conley
Dr. Frances Conley became the fifth woman to be board certified by the American Board of Neurological Surgery. She was also the first woman to be a tenured full professor of neurosurgery at a medical school in the United States. Yet in June 1991, she publicly resigned from Stanford University in protest over a work environment that she said included sexist attitudes and outright sexual harassment.
“In all these years, I wanted to be ‘one of the boys.’ Had I yelled and screamed about these things 25 years ago, I undoubtedly would not have been taken into training programs because I would have been labeled ‘difficult,’” she recalled about her experience as a woman in neurosurgery.
Conley returned to her faculty position after the university committed to addressing workplace sexism. “It’s a remarkably satisfying profession,” she said about her passion for neurosurgery. “You take people who are maimed or dying in front of you, and you return them to functioning life.”
1981: Alexa I. Canady
Dr. Alexa Canady became the first African-American female neurosurgeon in 1981, almost 30 years after the first male African American neurosurgeon, Dr. Clarence Sumner Greene. On her first day as an intern, she was told that “you must be our new equal-opportunity package.” Yet even in the hostile environment, she was voted one of the top residents by her fellow physicians.
“The greatest challenge I faced in becoming a neurosurgeon was believing it was possible,” she remembers. At the age 36, she became the Chief of Neurosurgery at Children’s Hospital of Michigan, where she cared for young patients facing life-threatening illnesses, gunshot wounds, head trauma, hydrocephalus, brain tumors and spine abnormalities.
Canady retired from her position in 2001 and relocated to Florida with her husband. Her retirement was short-lived, however, when she learned there were no pediatric neurosurgeons in her immediate area and began to practice part-time at Pensacola’s Sacred Heart Hospital.
1984: M. Deborrah Hyde
Born in the Jim Crow south, Dr. M. Deborrah Hyde is the second African-American woman to become a board-certified neurosurgeon. She began neurosurgery residency at Case Western under Dr. Robert A. Ratcheson and Dr. Robert F. Spetzler, finishing as the program’s first female graduate.
A Century Later
Almost 100 years after Dr. Dorothy K. Nash was performing lumbar manometries as a senior neurosurgeon at Pennsylvania hospitals, the number of women in neurosurgery has not caught up to the percent of female physicians across all specialties, which averages at 35%.
And considering the U.S. faces a projected deficit of 1,200 neurosurgeons by 2025, the pronounced absence of women in the specialty could be key in addressing the looming neurosurgeon shortage.