When Nordic neurosurgery was still in its infancy

Olof af Acrel, the father of Swedish Surgery, operated in 1768 upon a young nobleman who had experienced an increasing swelling on the skull, due to a tumour which also turned out to be growing deep into the brain parenchyma. The patient survived the operation for 3 days. Edvard Bull in 1877, after diagnosing a ruptured internal carotid artery aneurysm in a young female who temporarily recovered after her first hemorrhage, emphasised that the risk of a second, fatal haemorrhage--which in fact occurred--was immediate. He predicted that carotid ligation might be a way to reduce the risk of repeated haemorrhage from such aneurysms. Virtually unknown to modern neurosurgeons are many remarkable Nordic pioneers who, in the 1800's and early 1900's, rendered major contributions to the birth of modern neurological surgery. Thus early neurosurgical operations were performed by Carl Daniel von Haartman in Finland and by Christopher Withusen and Gundelach Møller in Denmark. von Haartman and Withusen had both visited Sir Astley Cooper in London in 1816. Vilhelm Magnus of Oslo was a neurosurgical giant, who had been trained by Victor Horsley during visits to London in 1903 and 1904. Magnus performed his first two-stage operation for a tumour located deep in the left cerebral hemisphere in 1903. By 1921, he had operated upon 112 cases of intracranial tumour with an 8.1% surgical mortality. His results were certainly fully comparable with those of his contemporary American pioneer--Harvey Cushing. Vilhelm Magnus, who worked alone under primitive conditions in small private hospitals, published altogether 70 scientific papers. In 1925 his series comprised 189 patients operated upon for brain tumours with 7.7% surgical mortality in supratentorial, and 17.8% mortality in infratentorial tumours. Magnus was congratulated on his brilliant achievements by a Swedish colleague 20 years his junior, Herbert Olivecrona, the man who was to carry on his pioneering work in Sweden.