Elsevier

World Neurosurgery

Volume 109, January 2018, Pages 377-380
World Neurosurgery

Historical Vignette
The History of Neurosurgery in the Hawaiian Islands

https://doi.org/10.1016/j.wneu.2017.10.065Get rights and content

The field of neurosurgery has a rich and fascinating history. The development of the specialty in Hawaii has been particularly unique, given the state's remote location, indigenous population, and military presence. The life of Dr. Ralph B. Cloward, Hawaii's most noted neurosurgeon, has received some attention in the literature. However, a comprehensive review of this history, including the pre-Cloward and post-Cloward era, is lacking. This article will review and chronicle the development of neurosurgery in Hawaii with special attention to 3 topics: the traveling neurosurgeons of the early 20th century, such as Dr. Frederick Reichert; Hawaii's first full time neurosurgeon, Dr. Cloward; and finally, the current state of neurosurgery in Hawaii.

Introduction

Since its formal inception in the early 20th century, the field of neurologic surgery has experienced rapid growth. This development has been traced on a variety of scales, including individual hospitals, universities, and states.1, 2, 3, 4, 5, 6, 7 The history of neurosurgery in the Hawaiian Islands is particularly unique, given the state's remote location, indigenous population, and military presence. Documentation of this history has been limited. There was a brief personal reflection published by the noted Dr. Ralph B. Cloward, Hawaii's first full-time neurosurgeon, in the late 20th century.8 However, a more comprehensive review of neurosurgical history in Hawaii has not been conducted. Notably, there has been no consolidated effort to detail the pre-Cloward era or the trends in neurosurgical care at the University of Hawaii in the modern era. To help fill this gap in the literature, this article will review and chronicle the development of neurosurgery in Hawaii. This analysis includes 3 major topics: a review of Hawaii's first neurosurgeons, with special attention to Dr. Frederick Reichert; a comprehensive review of Dr. Cloward's contributions to the field; and finally, a brief review of the current state of neurosurgery in Hawaii and the Pacific islands.

Section snippets

Early 20th Century

Information is relatively sparse on neurosurgical efforts in the Hawaiian Islands before Dr. Cloward. The limited neurosurgical care available during this period came in the form of traveling surgeons, who would come to the islands for brief periods to provide desperately needed services. A notable example is Dr. Frederick Reichert (Figure 1). Dr. Reichert trained under the prominent surgeon Walter Dandy, at Johns Hopkins, before moving to Stanford University to serve as faculty. He was

Hawaii's First Full-Time Neurosurgeon

Any discussion of neurosurgery in the Hawaiian Islands would be incomplete without an in-depth review of Dr. Cloward (Figure 3), arguably the most influential neurosurgeon to practice in the state.8, 11, 12, 13, 14, 15, 16, 17, 18, 19, 20, 21, 22 He made extensive contributions to neurosurgical clinical knowledge, surgical techniques, and operative instrumentation. In his personal reflection, written in 1984, Dr. Cloward provides valuable insight into his own career and the development of

Military Medicine

The early years of neurosurgery in Hawaii also had a large military component, much like the rest of the field. Recall, the founder of formalized neurosurgery, the esteemed Harvey Cushing, had practiced throughout World War I.8, 10 Dr. Cloward faced a similar situation with the onset of World War II, soon after his arrival in Hawaii. It began on December 7, 1941, with the Japanese attack on Pearl Harbor.8, 20, 21 In his memoir, Dr. Cloward recalls that he began operating soon after the attacks

The Leprosy Colony

Dr. Cloward's unique experiences in the Hawaiian Islands were not limited to military endeavors. Throughout the 1940s, he saw a variety of unique neurosurgical conditions at the Kalaupapa settlement, the leper colony in Hawaii.8 He describes multiple afflictions of the nervous system secondary to leprosy. These afflictions frequently included leprous granulomas of the peripheral nerves, which produced both paralysis and pain in the victims. Fortunately, these tumors, he recalls, were often

The Legacy of Cloward

The field of neurosurgery grew rapidly in Hawaii in the 1940s. In addition to his work at Pearl Harbor and Kalaupapa, Dr. Cloward treated many other conditions during his first decade of practice, including poliomyelitis, hypertension, syphilis, stroke, subdural hematomas, and hyperhidrosis.8 The 1940s also saw the arrival of additional neurosurgeons, including Dr. Thomas Bennet in 1948 and Dr. John Lowrey in 1950. Cloward states that this group of 3 surgeons worked together to provide

The Modern Era

Neurosurgery has continued to develop in Hawaii since the retirement of Dr. Cloward. The John A. Burns School of Medicine at the University of Hawaii was founded in 1965 and named after the former Governor. It has a Division of Neurosurgery consisting of 7 clinical faculty. The current chief, Dr. William Obana, was appointed in 1994 and has held the position continually since. The faculty operate at hospitals throughout Hawaii and the Pacific, including The Queen's Medical Center and Straub

Conclusion

From its humble beginnings in the early 20th century to the present day, neurosurgery has a rich and fascinating history in the state of Hawaii. The field first came to Hawaii in the form of travelling surgeons from California, such as Dr. Reichert. Then, in 1938, Dr. Cloward became the first full-time surgeon in the islands. Dr. Cloward made substantial contributions to the field and worked in many unique environments while in Hawaii. Neurosurgery has continued to grow at the University of

Acknowledgment

We would like to thank Dr. E. Howard Klemmer, Chief of Emergency Medicine at Queens Hospital, for his insight on Dr. Reichert.

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