PDF(Pubmed)
Abstract：
OBJECTIVE: To uncover the context that allowed for the vestibular neurectomy to grow in favor and practice at the Johns Hopkins Hospital in the early 20th century, and the reasons for its broad abandonment since.
METHODS: The Walter E. Dandy (1905-1946) and Samuel J. Crowe collections (1905-1920) at the Alan Mason Chesney Medical Archives were reviewed, as well as the Samuel J. Crowe and Stacy Guild Temporal Bone Collection.
RESULTS: Speculation on the etiology of Menière\'s disease (MD) has been countless, as have the medical and surgical interventions aimed at treating it. At the Johns Hopkins Hospital, Walter Dandy popularized the neurectomy for MD and performed 692 procedures from 1924 to 1946, believing it to be a curative therapy for vertigo. When he later modified the procedure from a total cranial nerve section to a partial vestibular neurectomy preserving auditory function, surgical candidacy expanded to include nearly any patient with vestibular symptoms. After his passing, trainees\' attention shifted to traumatic injuries, likely influenced by WWII. This left the procedure scarcely used until third parties rekindled interest decades later.
CONCLUSIONS: Neurectomy as the preferential treatment for MD at the Johns Hopkins Hospital was not driven by pure scientific reasoning but was rather contingent on historical context and sponsorship by a prominent figure like Walter Dandy. Appreciation of MD\'s natural history has since curtailed the favorability of destructive procedures in preference for conservative management.
METHODS: The Walter E. Dandy (1905-1946) and Samuel J. Crowe collections (1905-1920) at the Alan Mason Chesney Medical Archives were reviewed, as well as the Samuel J. Crowe and Stacy Guild Temporal Bone Collection.
RESULTS: Speculation on the etiology of Menière\'s disease (MD) has been countless, as have the medical and surgical interventions aimed at treating it. At the Johns Hopkins Hospital, Walter Dandy popularized the neurectomy for MD and performed 692 procedures from 1924 to 1946, believing it to be a curative therapy for vertigo. When he later modified the procedure from a total cranial nerve section to a partial vestibular neurectomy preserving auditory function, surgical candidacy expanded to include nearly any patient with vestibular symptoms. After his passing, trainees\' attention shifted to traumatic injuries, likely influenced by WWII. This left the procedure scarcely used until third parties rekindled interest decades later.
CONCLUSIONS: Neurectomy as the preferential treatment for MD at the Johns Hopkins Hospital was not driven by pure scientific reasoning but was rather contingent on historical context and sponsorship by a prominent figure like Walter Dandy. Appreciation of MD\'s natural history has since curtailed the favorability of destructive procedures in preference for conservative management.
摘要：
目的：为了揭示20世纪初约翰·霍普金斯医院前庭神经切除术的发展和实践的背景，以及此后广泛放弃的原因。
方法：对AlanMasonChesney医学档案馆的WalterE.Dandy（1905-1946）和SamuelJ.Crowe（1905-1920）的收藏进行了审查，以及塞缪尔·J·克劳和史黛西公会颞骨收藏。
结果：关于梅尼埃病（MD）病因的猜测不计其数，以及旨在治疗它的医疗和外科干预措施。在约翰霍普金斯医院，WalterDandy推广了MD的神经切除术，并于1924年至1946年进行了692次手术，认为这是眩晕的治愈性疗法。当他后来将手术从全颅神经部分修改为保留听觉功能的前庭神经部分切除术时，手术候选资格扩大到几乎所有有前庭症状的患者。他过世后,学员的注意力转移到外伤上，可能受到二战的影响。这使得该程序几乎没有使用，直到几十年后第三方重新燃起兴趣。
结论：作为约翰霍普金斯医院医学博士的优先治疗的神经切除术并不是由纯粹的科学推理驱动的，而是取决于历史背景和像WalterDandy这样的杰出人物的赞助。此后，对MD自然史的赞赏削弱了破坏性程序的积极性，而偏爱保守管理。
方法：对AlanMasonChesney医学档案馆的WalterE.Dandy（1905-1946）和SamuelJ.Crowe（1905-1920）的收藏进行了审查，以及塞缪尔·J·克劳和史黛西公会颞骨收藏。
结果：关于梅尼埃病（MD）病因的猜测不计其数，以及旨在治疗它的医疗和外科干预措施。在约翰霍普金斯医院，WalterDandy推广了MD的神经切除术，并于1924年至1946年进行了692次手术，认为这是眩晕的治愈性疗法。当他后来将手术从全颅神经部分修改为保留听觉功能的前庭神经部分切除术时，手术候选资格扩大到几乎所有有前庭症状的患者。他过世后,学员的注意力转移到外伤上，可能受到二战的影响。这使得该程序几乎没有使用，直到几十年后第三方重新燃起兴趣。
结论：作为约翰霍普金斯医院医学博士的优先治疗的神经切除术并不是由纯粹的科学推理驱动的，而是取决于历史背景和像WalterDandy这样的杰出人物的赞助。此后，对MD自然史的赞赏削弱了破坏性程序的积极性，而偏爱保守管理。
