One hundred years of epilepsy surgery: Sir Victor Horsley's contribution.

"If you can meet with Triumph and Disaster And treat those two impostors just the same" (Kipling, "If', 1910)' On May 25th, 1886, Victor Horsley, then aged 29 years, another brilliant recent recruit to the burgeoning National Hospital for the Paralysed and Epileptic in Queen Square, performed his first brain operation on a patient.2 There was no tradition of neurological surgery, so there could be no apprenticeship, and although Macewen in Glasgow (1879),' Rickman Godlee in London (1884) and Durante in Italy (1884), had operated on the brain, their operations passed largely unnoticed. Horsley's facilities, in a converted day-room off a ward, were primitive but his personal preparation was extensive. He had already engaged upon a very large amount of experimental brain surgery on animals from which he derived experience which could be wedded to his extraordinary dexterity, technique, and an astounding knowledge of the kind of anaesthesia required. Horsley was also a man given to zealous crusades and one of his crusades was about antisepsis. His techniques of sealing the bone edge with antiseptic wax,4 and turning a comma-shaped flap instead of the old cruciform incision, both assisted in the control of infection. Moreover, his characteristic optimism was reinforced by remarkable luck. His first patient, James B, then aged 22 years, suffered epilepsy from the age of 15 following a severe head injury received in a road traffic accident at the age of seven.5 At that age he had been in the Edinburgh Royal Infirmary with a depressed comminuted fracture. Debridement was performed but the wound suppurated and the brain herniated. His hemiplegia cleared after seven weeks. In 1886 he was