Division of Labor or a New Discipline? The Troubled Emergence of Neurosurgery in the Netherlands, 1890–1929


In the early twentieth century, Amsterdam neuropsychiatrist Louis Muskens (1872–1937) asserted that surgery of the human central nervous system ought to be performed by neurologists rather than surgeons. Only neurologists, he believed, possessed the knowledge, skills, and experience to safely perform these operations. Muskens practiced what he preached, by himself taking up the practice of nervous system surgery. In the Netherlands, however, a strict division of labor had already emerged between surgeons and neurologists. Both regarded surgical performance as an activity to be reserved for surgeons, requiring specific skills, experience, and innate qualities, whereas the diagnosis and localization of nervous system disorders was seen by both as belonging to the domain of neurology, whose practitioners possessed a comprehensive, dynamic, scientific understanding of the nervous system, observational skills, and expertise in diagnostic technology. Even though Muskens’s views and surgical practices were ultimately rejected by both his surgical and neuropsychiatric colleagues, his controversial campaign against the existing division of labor between surgeons and neurologists was an important catalyst for the emergence of neurosurgery as a medical specialty in the Netherlands, one performed by a specially trained “neurosurgeon” exclusively dedicated to nervous system surgery. The case of Muskens provides a striking example of the ways in which professional identities shaped medical practice and the formation of a new discipline.