Raymond Madiford Peardon Donaghy, M.D.

The Division of Neurosurgery at University of Vermont was founded in 1946 by Dr. R. M. Peardon Donaghy. It was at the microneurosurgical laboratories of this division that many of today's most gifted practitioners of Neurosurgery learned their skills. Dr. Donaghy's Vermont laboratory provided the first course in microvascular surgery. Nothing describes Donaghy's legacy better than the following historical piece written by late Dr. Cordell E. Gross (past chairman of the division and Professor of Neurosurgery) and Dr. Lester J. Wallman (retired faculty member and Professor of Neurosurgery) for 1992 New England Surgical Society meeting.

Dr. Raymond Madiford Peardon Donaghy died at age 81, November 26, 1991, in Montpelier, Vermont from complications of Alzheimer's Disease. Our world is a lesser place for his passing and a better place for his being.

Peardon Donaghy, known in his youth as "Pede" and to his adult friends as "Pete"., was born in Eastman, Quebec, Canada, on August 18, 1911. The American side of his family, Royalists in conflict with the institution of slavery, found their way from Virginia, through New England to finally settle in Quebec. His Canadian forebears had immigrated from Ireland and Scotland to Ontario and ultimately to Quebec in the early 19th Century. In 1922, Dr. Donaghy's father, unwilling to compromise his principles, left a managerial position in the asbestos industry which was being used to frustrate prohibition in the States, to manage a granite business in Plainfield, Vermont. Here Pete Donaghy distinguished himself in high school on the basketball team and academically by finishing first in his class. During this period of his life he also set his sights on medicine and entered the University of Vermont in 1929 during economic hard times. He defrayed his dormitory costs by proctoring and the story has it he had access to all the milk he could possibly want through the dairy school. Whatever sustained him, he successfully completed his Bachelor of Science work and entered medical school at the University of Vermont in 1933. He achieved his childhood goal of becoming a doctor when awarded the M.D. degree from the University of Vermont College of Medicine in 1936.

In those days medical students were taught clinical medicine by preceptorship. Dr. Donaghy became fascinated with the nervous system and while preceptoring with Dr. Leon Sample in St. Albans, Vt., encountered a woman with a complicated neurologic disorder. Because of his growing interest, he had extensively prepared the case for presentation to a visiting Montreal neurologist, Dr. McKaye who was so impressed with the work of this rural medical student that he offered Pete Donaghy a position as intern at the Montreal General Hospital. The obvious expectation was that Pete would go into neurology. Au contraire. Even though he was filling a dual role when he went to Montreal, that of intern and resident in Neurology (because the current resident was ill), he was able to find time to observe the pioneering work of Wilder Penfield, who became an advisor and one of Pete's foremost medical heroes. The year following his internship and a second year of neurology residency his surgical aspirations started to solidify and he served as resident in surgery at the Children's Hospital in Montreal.

Dr. Donaghy had decided on a career in neurosurgery and Dr. Penfield advised him to push forward with his surgical training so that he would be in a position to provide neurosurgical care in the case of war, which was threatening. With this advice, Dr. Donaghy suspended his plans to visit Queen's Square in 1939 and started his Fellowship in Neurosurgery at the Leahy Clinic and later became Resident in Neurosurgery under Jason Mixter at MGH. The story has it that Dr. Donaghy's deductive skills, demonstrated at rounds one day, prompted the attending to give him his reflex hammer, saying, "You can obviously make better use of this than I". He spent time on psychiatry and time as the Dalton Scholar in neuropathology where he studied brain abscesses with Dr. Kubic who Dr. Donaghy added to his list of medical heroes. Penfield, Mixter and Kubic: do luminaries beget luminaries?

Drs. Lester Wallman and RMP Donaghy in uniform

At the same time that Dr. Donaghy was finishing his neurosurgical training in Boston, Dr. Lester Wallman, after a year in neurosurgery with Scoville in Hartford decided to pursue general surgery at Wilmington, Delaware when the war brought these two individuals together at Fort Sam Houston. A Neurosurgical Unit was established, and, because of Dr. Wallman's year in neurosurgery and the limited number of neurosurgeons available, he was incorporated into this unit. It was obvious to Wallman that Pete knew a hell of a lot more than he did about and Les was a willing student. They hit it off immediately. Shortly thereafter the unit went to England.

Drs. Donaghy and Wallman were originally stationed at Oxford where they were investigating the efficacy of sympathectomy for frostbite and Donaghy also spent time in Bristol where brachial plexus injuries were a focus. The group followed the invasion of France as a mobile Neurosurgical Unit, headed by Donaghy. They provided Neurosurgical care to the war wounded, Americans and Germans alike, close to the action during multiple battles in France and ultimately, in Germany. At war's end Dr. Donaghy had contracted a viral pneumonia and was hospitalized in France when word came that the whole unit was to be shipped stateside. Dr. Wallman commandeered a car, found Donaghy, still "sick as a dog", and at Pete's insistence, got him discharged from the hospital, and bundled him back to Cologne so he could make the ship home.

Donaghy and Wallman both left the service with the rank of captain in 1946. Looking for an academic position, Dr. Donaghy came back to his alma mater, the University of Vermont, still a small country medical college without a department of neurology, neurosurgery or psychiatry. The only neurologic teaching and practice available at the time was the contribution of an internist with a special interest in neurology and psychiatry and from visiting professors from Montreal and New York. At the end of WWII, William E. Brown left an outstanding career as a Military Specialist in Public Health to assume the deanship at the University of Vermont College of Medicine. He welcomed Dr. Donaghy, who was well trained in Neurosurgery and conversant with Neurology and Psychiatry from his previous experiences. Dean Brown thought that he could probably guarantee Donaghy $5,000 a year with the hope that a large portion of that might be made up from professional fees. There was even some talk of providing vegetables and other foodstuffs from the Agricultural College to supplement his salary. Dr. Donaghy was offered the chairmanship of the department of the Nervous System to include Neurology, Neurosurgery and Psychiatry. After considerable reflection Dr. Donaghy refused, pointing out that in places where this system has been tried, one discipline or the other had become preeminent according to the interests of the chairman and the other disciplines were seldom of first-rate quality. He did, however, accept the chair in Neurosurgery.

Newspaper photograph of the new Neurosurgery staff: Drs. Misuo Numoto, Lester Wallman, RMP Donaghy, Martin Flanagan, and Bruce Chafee

When Dr. Wallman left the service he went back to Yale where he was told that he could finish his surgical training at that institution, however, he had to guarantee that he would not set up practice in New Haven, an exclusion agreement which he found somewhat less than appealing. Instead he returned to Wilmington to finish his general surgical training. However, before the year was finished Dr. Donaghy had called his war-time compatriot with the offer that "if there is enough work for one neurosurgeon in Vermont there ought to be enough for two". Dr. Wallman joined Dr. Donaghy as a fellow in Neurosurgery, meeting the requirements for Neurosurgical certification in a year, and then joined the UVM faculty to continue what would ultimately be a very special 40 year long collaboration and friendship.

Drs. Donaghy and Yasargil in the Vermont Microneurosurgery Lab

By 1948, though there was little time, Donaghy felt that he must begin a research program in his fledgling department. The Dean regretfully reported that there was no money, but that there was a quonset hut in the back of the medical college for housing animals used by the physiology and pharmacology departments, and he might have a corner for his research and have access to the animal operating room. It was suggested that $25 might be an appropriate budget for the first year, and that if the investigator provided the money himself it would, of course, be tax deductible. One of those deals you can't refuse. In this way some rats were bought, discarded suture and instruments form the operating room were secured, and an experiment was done in 1948 on peripheral nerve repair.

Throughout the fifties, Donaghy would slowly perfect microsurgical techniques and begin to concentrate his activity in cerebrovascular disease. His interest was spurred on by a patient with a middle cerebral occlusion which Pete knew in his heart should be amenable to surgery but the wherewithal was just not available at the time. Dr. Donaghy never failed to credit Dr. Julius Jacobson, a general vascular surgeon, with the suggestion that the microscope might be of some use to him in his work. In 1960 a failed attempt to open an occluded middle cerebral artery prompted further technical refinement and perseverance which, by 1962, was rewarded with 2 of 9 attempted middle cerebral endarterectomies remaining patent. Finer and finer instruments, sutures and needles and modification of the microscope by Dr. Littman of Zeiss, much of which was championed and guided by Dr. Donaghy, resulted in his recognition as the founder of Microvascular Neurosurgery and his founding and editing the journal MICROSURGERY. Dr. Wallman credits Donaghy, more than anyone else, with being responsible for introducing the operating microscope to Neurosurgery which is certainly a landmark in the history of our specialty.

Dr. Gazi Yasargil

The following decade was incredibly productive in Dr. Donaghy's laboratory with the addition of Dr. Mitsuo Numoto as assistant professor of experimental neurosurgery. With Dr. Numoto's background in biomechanics, the collaboration reinforced Dr. Donaghy's belief that cross fertilization of skills and knowledge was a rich source for advancing science and surgery. In addition to perfecting microsurgical techniques, the laboratory was responsible for producing micro-sensors for measuring intracranial pressure, one of which ultimately became the Ladd epidural monitor. By 1966, when Dr. Yasargil joined the group from Krayenbuhl's program in Zurich, Dr. Donaghy and company were achieving a 66% patency rate in experimental microvascular anastomotic techniques. 1967 saw the first successful extracranial to intracranial bypass surgery for cerebrovascular insufficiency.

This procedure, though shown not to be of greater benefit than antiplatelet therapy for occlusive cerebrovascular disease, is still used by neurosurgeons in selected situations for revascularization. What was learned through the evolution of this technique in anastomosis and reanastomosis of the microcirculation is used throughout the world today in microvascular procedures. Many of today's most gifted practitioners of the art learned their skills in Donaghy's Vermont laboratory, which provided the first course in microvascular techniques. His legacy can only grow.

For Pete Donaghy, the patient always came first; he was ever available to meet his patient's needs and virtually indefatigable in meeting this responsibility. His dedication to Neurosurgery limited his access to skiing the Mountains of Vermont, his favorite pastime. There was always the hope that "next winter there will be more time". Dr. Donaghy was noted to say on several occasions that if he died in the winter he would like his ashes scattered at the top a slope so that when the spring thaw came he would have "one last run down the mountain".

He was a private man, a humane man, a gentle man, a skillful and visionary neurosurgeon, and a physician of the first order. A consummate teacher of enormous wit and dedication, Donaghy left his mark on his students, the world, and Neurosurgery. Were he to be remembered for nothing else, let him be remembered for his admonition to his students and colleagues, "Handle tissue as you do people; gently and with respect"."

Recent History and Accomplishments

In 1976, Dr. Donaghy stepped down as the chair of neurosurgery and Dr. Lester Wallman, his close associate, took over the responsibility as the Division chief until 1978. In 1978, Dr. Henry Schmidek was appointed chief of neurosurgery, a position he held until 1986. Dr. Flanagan, UVM's first neurosurgical residency graduate took over this position as acting chief until Dr. Cordell Gross' recruitment in 1988.

Dr. Cordell Eugene Gross' career as Professor and Chairman of Neurosurgery at the University of Vermont was cut short when he died on April 3, 2000 after a long and brave struggle with metastatic colon cancer. Dr. Gross chose a career in academic neurosurgery and was driven to become a technically superb surgeon, a caring physician, an innovative researcher and a role model for his neurosurgery residents.  The following is an excerpt from the obiturary of our friend, mentor and father Dr. Gross by Dr. Bruce Tranmer (chairman of the Division of Neurosurgery):

Dr. Cordell Gross was born in Hartford, Connecticut on May 2, 1942, A strong interest in science brought him to the University of Florida where he earned a Bachelor's of Science degree in Biology in 1965, a Master's of Science degree in Radiation Biophysics in 1967 and finally an M.D. in 1971. From 1971 to 1972, Dr. Gross was a surgical intern at Yale-New Haven Hospital, New Haven, Connecticut. He then entered the Neurosurgery Residency at Upstate Medical Center in Syracuse in 1972 and successfully completed his residency in 1977 under the tutelage of Dr. Robert King. While a resident, he furthered his strong interest in basic research. In the laboratory of Dr. Mahlon Krebel, Dr. Gross performed important work on neuromuscular miniature end plate potentials.

In 1977, he was appointed Assistant Professor of Neurosurgery at the University of Iowa. It was here that he developed his clinical interest in Cerebrovascular Neurosurgery. As the designated EC - IC Surgeon at the University of Iowa, he contributed to the International Study of this operation. He began his work and published on Carotid Endarterectomy at this time as well.

In 1982, he moved on to become Associate Professor at the University of Colorado where he joined Glenn Kindt, M.D.. It was with Dr. Gross's strong efforts that Dr. Kindt was able to bring back the Neurosurgery Residency to the University of Colorado. Over the next few years, Doctors Kindt and Gross rebuilt the Neurosurgery Residency Program as well as the Cerebrovascular Research Program. It was my great fortune, to join Doctors Kindt and Gross at the University of Colorado and become a member of this great Neurosurgery team. As Dr. Glenn Kindt said later the three of us did more Neurosurgery and had more fun doing it than he ever thought possible.

Inspired to become a Chairman of Neurosurgery, Dr. Gross accepted a position as Professor and Chairman of the Division of Neurosurgery in 1986 at Loma Linda University, School of Medicine. This was followed in 1987 by his appointment as Professor and Chairman of the Division of Neurosurgery at the University of Vermont. In 1990, he became Director of Surgical Research at the University and Vice Chairman of the Department of Surgery.

At the University of Vermont, he quickly became the busiest Neurosurgeon in the region. He became nationally known for his efforts in the field of Cerebrovascular Research and held NIH and AHA funding for his laboratory work in Cerebral Ischemia. He continued his interest and publication in Carotid Endarterectomy. As well, he published new work on CT Angiography in Cerebrovascular Disease with Dr. Pedro Vieco in Radiology. Dr. Gross felt strongly that the Neurosurgeon should play a role in Endovascular Surgery, and took time for a sabbatical at the University of Vienna to study these techniques. His efforts to bring Endovascular Surgery to Vermont, within the section of Neurosurgery, were unfortunately cut short by his untimely illness.

During his Neurosurgical professional career, Dr. Gross was a member of numerous national societies including the AANS, the Senior Society of Neurosurgeons, executive committee of the joint section on Cerebrovascular Disease [AANS/CNS], Chairman of the AANS - RNP Donaghy Society, as well as co- director of the RUNN course. He was the contributing author on seventy peer- reviewed publications.

It is as a role model that we will best remember Dr. Cordell Gross. Dr. Gross was avid and enthusiastic in everything he attempted. He had a remarkable and sheer determination to make things better in this world. It was not unusual to see Dr. Gross in his research lab on the weekends with a crowd of medical students and residents around him trying to seek new ways to solve an old problem. Dr. Gross was also known on more than one occasion to take his residents to the hardware store to purchase simple equipment to modify the already present lab equipment just to make it "work better". He took great care and delight in nurturing his young residents and teaching them the fine art of neurosurgery. It was mostly by example that he taught his high standards of Neurosurgical patient care. More than one resident has remarked on his gifted dexterity in the operating room and his always-innovative ideas at the time of crisis. His compassion and loyalty to his patients are legendary at the University of Vermont. Long after other physicians wearied of a difficult clinical problem in a patient, Dr. Gross would stay at the bedside or in the clinic trying to alleviate his patient's suffering. Sometimes compassion and attention was all that Dr. Gross could offer patients, but for them that was enough as they would travel many long miles and sit for many long hours in the waiting room just to see him. There are many examples of Dr. Gross's sacrifice of his time, money and effort to bring forth the best qualities in the people he taught and cared for. He was loved by all who knew him and will be greatly missed.

Following Dr. Gross' resignation, due to his untimely illness, Dr. Bruce I. Tranmer was named the new Chair of Neurosurgery. With only one neurosurgeon on the academic staff of University of Vermont (Dr. Paul Penar), Dr. Tranmer was faced with the difficult task of rebuilding the division and the residency program. Within the period of one year Dr. Tranmer recruited Dr. Michael Horgan (Skull base and Cerebrovascular Surgery) and Dr. Todd Maugans (Pediatric Neurosurgery). Through an aggressive campaign of introducing the new UVM Neurosurgery to the neighboring communities and lectures by neurosurgery faculty aimed at educating health care providers in Vermont, Dr. Tranmer succeeded in re-establishing the referral patterns.  The neurosurgical operative case numbers soon doubled and are continuing to increase under Dr. Tranmer's leadership.