Emergence and early development of Russian neurosurgery (1890s-1930s).

This paper is a case study of specialization in clinical medicine - it is a story of the difficult and complicated birth of a neurosurgery clinic in Russia and the Soviet Union. It demonstrates the futile attempt to institute a new specialty as surgical neurology advocated by neuro(patho)logist V.M. Bekhterev (1857-1927) and implemented by his pupils L.M. Pussep (1875-1942) and A.G. Molotkov (1874-1950). However, surgical neurology was gradually replaced by neurological surgery performed by general surgeons N.N. Burdenko (1875-1946), A.L. Polenov (1871-1947), and V.N. Shamov (1882-1962). Part of my paper is dedicated to the institutional history (emergence of the Institute of Surgical Neurology in Leningrad (in 1926) and the Central Institute of Neurosurgery in Moscow (in 1934). The Moscow Neurosurgical School was focused on lesions of the central nervous system whereas the Leningrad neurosurgical school dealt primarily with peripheral nerve surgery. In the 1930s neurosurgical clinics were established beyond the two capitals - in Rostov-on-Don, Kharkov, and Gorky. Similar to the centralized five-year planning in the Soviet economy, a new discipline of neurosurgery was also centralized and planned from Moscow in the 1930s. It was characterized by kompleksnost' - concentration of several auxiliary disciplines (neuroradiology, neuroophthalmology, neurophysiology, etc.) within neurosurgical research institutions in Leningrad and Moscow. Particular stress was made on the experimental nature of a new discipline, which was viewed as a sort of applied neurophysiology.