Pain treatment pioneer Donlin Long, first head of Johns Hopkins Medicine's neurosurgery department, dies at 89

Donlin M. Long, a masterful neurosurgeon, a pioneer in the treatment of chronic pain, a savvy mentor to a generation of neurosurgery leaders, and the founding chair of the Johns Hopkins Department of Neurosurgery, died Sept. 19 while fishing on a trout stream, pursuing a sport he had loved since childhood. He was 89.

Highly regarded for his uncommon skill at performing virtually every kind of neurosurgical procedure, as well as for his enormous impact on pain reduction research and neurological studies, Long was widely considered to be one of the best surgeons of his generation. He also possessed an uncanny eye for recognizing talented medical students, residents, and fellows, who became his protégés as clinician-researchers and went on to achieve acclaim in neurosurgery nationwide and overseas.

Dozens of the residents and faculty members who were brought into the Johns Hopkins neurosurgery department under Long between 1973 and 2000 became full professors, heads of their own neurosurgery departments or divisions, and leaders in the field. Three became presidents of international neurosurgical associations and others were considered major national leaders in neurosurgery in more than a dozen different countries.

"Don Long was a true renaissance man and an innovative master neurosurgeon who nurtured generations of neurosurgical leaders who have transformed our field," said Henry Brem, Long's successor as head of Johns Hopkins neurosurgery and acclaimed for developing a chemotherapy-infused polymer wafer, Gliadel, which in 1996 became the first new FDA-approved treatment for brain cancer in 23 years. "Dr. Long was compassionate and a great role model."

The list of those whom Long brought into the Johns Hopkins Department of Neurosurgery includes many other future leaders.

Among them is Ben Carson, the first Black neurosurgeon at Johns Hopkins and former secretary of the U.S. Department of Housing and Urban Development. He became famed as the pediatric neurosurgeon who made hemispherectomy, the surgical removal of half of a child's brain, a leading method for curing intractable seizures. He also was the first to successfully separate twins conjoined at the head. Long assisted him during the surgery.

Other Long trainees include George Allen, later named the founding head of the first full-time department of neurological surgery at Vanderbilt, who discovered while at Johns Hopkins that an existing drug, nimodipine, would prevent arterial spasms; Reid Thompson, who succeeded Allen as head of neurosurgery at Vanderbilt; and James Campbell, who fundamentally changed the field of pain research.

Additional Long protégés include Matthew Ewend, who became head of neurosurgery at the University of North Carolina; Maciej Lesniak, now head of neurological surgery at Northwestern University; and Bob Carter, chair of neurosurgery at Massachusetts General Hospital.

Long "wanted to attract talented people and immediately empower them to do great things, and he was not someone who needed the spotlight always to be shining on him," said Allen Sills, a 1990 graduate of the Johns Hopkins medical school who did his internship, residency, and neurosurgery fellowship under Long and now is the NFL's chief medical officer.

"In many areas of the country, surgeons have the reputation for being quite temperamental and quick to anger and really downright difficult in the operating room," Sills said in a 2015 history of neurosurgery at Johns Hopkins titled The Special Field. "That was never Dr. Long. He was always calm, respectful, predictable, and very much about who the entire team was."

Although the field of neurosurgery was founded at Johns Hopkins in the early 20th century by Harvey Cushing—who insisted that it become a surgical specialty—and Walter Dandy, who developed spectacular advances in its practice, neurosurgery was not made a distinct division of the Department of Surgery until 1947, and it was not elevated to its status as a separate department until 1973. Creation of the separate Department of Neurosurgery was something that Long insisted upon when he was being recruited to come to Johns Hopkins from the University of Minnesota.

When he arrived as the new department's first head in 1973, he had specific plans for enhancing and enlarging Johns Hopkins neurosurgery, which at that time had just five full-time faculty members, who performed only 125 operations annually—or 25 apiece. Part-time faculty brought the total yearly caseload to just 698 operations.

To Long, such a pace of activity no longer would do.

"I wanted a full-time faculty of busy clinicians," he recalled in a 2013 interview.

He also wanted "full-time researchers, serious researchers," and creation of what he called "centers of expertise," linking "related specialists, neurology, neurosurgery, orthopedics—whatever it took—to be sure that the patient had one-stop shopping, would come and be seen by everybody who might be interested in that area, all in one place, all together, so that they did not go from referral to referral to disconnected referral."

Long was a visionary educator who popularized the concept of competency-based training for neurosurgeons. By the time he stepped down as department director in August of 2000, the full-time neurosurgical faculty had more than doubled; the surgical caseload had escalated substantially—rising to some 3,500 annually at The Johns Hopkins Hospital and Johns Hopkins Bayview Medical Center—seven centers of expertise had been created, bringing together experts on everything from chronic pain and vascular diseases to skull base surgery and spinal diseases; and research funding had grown exponentially to $5.5 million a year.

Virtually all of the goals he had set for the department were met during his 27 years at its helm. "What I wanted to happen, happened," he said.

Descended from New England Quakers, one of whom blazed the Cumberland Gap with frontiersman Daniel Boone, Long was born on April 14, 1934, in Rolla, Missouri, a small southwest Ozarks city. His father was a chemist for the state health department and his mother was a schoolteacher. The family soon moved to Jefferson City. He obtained his undergraduate degree in 1955 and his medical degree in 1959 from the University of Missouri.

As an intern at the University of Minnesota, Long originally planned to become a cardiac surgeon, but changed to neurosurgery after watching pioneer neurosurgeon Lyle French operate.

As a resident at Minnesota, Long and fellow resident Joseph Galicich did the research that led to the now-universal use of steroids to reduce postoperative brain swelling. While earning his 1964 doctorate in neuroanatomy, he also did landmark research on the biological structure of the blood vessels in the brain.

Using a then-new device, the electron microscope, he was able to make the first photographs of the cells that form the inner lining of the brain's blood vessels, providing images that revealed why brain swelling led to a breakdown of what is known as the blood/brain barrier. This is a special system of cells that form the lining of the brain's tiniest blood vessels and separate the brain from the central nervous system, protecting it from harmful substances in the bloodstream.

Once he came to Johns Hopkins, Long continued his groundbreaking research into chronic pain, begun in Minnesota, where he designed the first external transcutaneous electrical nerve stimulator—now universally known simply as TENS—for stimulating peripheral nerves to ease pain. In 1981, he and Johns Hopkins colleagues announced the invention of the first battery-powered, rechargeable, implantable electronic stimulator. It became a standard tool in pain management around the world.

In addition, Long collaborated with colleagues at the Johns Hopkins Applied Physics Laboratory to invent an implantable medication pump, now a standard device used for the administration of insulin in the treatment of patients with diabetes.

Long also was instrumental in Johns Hopkins' decision to erect the Adolf Meyer Center in 1981, uniting the departments of neurosurgery, neurology and psychiatry in one building, thereby facilitating unprecedented collaboration among the specialties.

With a deep, resonant voice—which young colleagues enjoyed imitating, to his amusement—Long maintained an almost unwaveringly calm demeanor. He casually displayed a vast knowledge of his field and its practitioners, as well as a ready sense of humor and a positive, can-do attitude. He often told his children and grandchildren, "There is no try, only did and did not."

He regaled family members with a seemingly inexhaustible supply of genealogic history and anecdotes, and was an omnivorous reader of everything from history and medicine to science fiction and westerns. He loved life in all of its dimensions, and brought his enthusiasm to everything he did. He was an avid gardener whose extensive garden featured blooms every month of the year, a keen sportsman, a lover of the outdoors, an opera fan, and an inveterate traveler. Long also was an avid movie-watcher, knew the plots of countless classic films, and easily quoted dialogue from them.

Long is survived by his wife of 64 years, Harriett Page Long; three children, Dr. Kimberley Page Riley and her spouse Dr. Lee Hunter Riley, III, Elisabeth Merchant Long, and David Bradford Long and his spouse Dr. Elizabeth Selvin; and four grandchildren, Lauren Palmer Riley, Thomas Hunter Riley, Benjamin Logan Selvin Long and Eli Duncan Selvin Long. Dr. Long was proud that all of his children and their spouses are either currently working or have worked as faculty or administrators at Johns Hopkins University, at the School of Medicine, the Krieger School of Arts and Sciences, the Whiting School of Engineering, the Bloomberg School of Public Health, or the Sheridan Libraries.

_Donations in honor of Donlin Long may be made to the Donlin Long Resident Educational Fund in care of the Department of Neurosurgery, The Fund for Johns Hopkins Medicine, 550 North Broadway, Suite 722, Baltimore, MD 21205. Checks should be made payable to Johns Hopkins University and reference the Donlin Long Resident Educational Fund. For information, contact Flor Hiponia at fhiponia@jhmi.edu or (443) 287-7942. Donations may also be made online at the Department of Neurosurgery philanthropic giving website; click the gift designation menu, scroll down to Special Projects, then select the Donlin M. Long Resident Educational Fund.