A man for all seasons: W.W. Keen

William Williams Keen was the catalyst for the advent of neurosurgery in the United States. He served in the Civil War and collaborated with Silas Weir Mitchell in studying injuries sustained to the nervous system. These studies culminated in the publication in 1864 of "Gunshot Wounds and Other Injuries of the Nerves and Reflex Paralysis," which first described causalgia, reflex sympathetic dystrophy, and secondary paralysis. His most monumental accomplishment undoubtedly was being the first surgeon in the United States to successfully remove a primary brain tumor (1887) and have the patient survive for more than 30 years. As the editor of "Surgery, Its Principles and Practice," Keen invited Harvey Cushing to write the section on surgery of the head, which propelled Cushing to international recognition and provided a foothold for the new specialty of neurosurgery. Multiple sources were reviewed to prepare this comprehensive biographical account of Keen's contributions. Emphasis is placed on those achievements that furthered the discipline of neurosurgery. Although a general surgeon, Keen had a special interest in the nervous system. He treated patients with trigeminal neuralgia, performed cortical excisions for patients with epilepsy, and devised the procedure of posterior upper cervical root sections for spasmodic torticollis. He was the first surgeon to perform and advocate ventricular punctures. He served as a consultant and surgeon to both Grover Cleveland and Franklin Delano Roosevelt.