LEGACY

AN ACCOUNT OF THE LIFE AND ACHIEVEMENTS OF

MISS DIANA BECK, NEUROSURGEON (1902–1956)
Catherine E. Gilkes, M.R.C.S.
Department of Neurosurgery,
Frenchay Hospital,
Bristol, England
Reprint requests:
Catherine E. Gilkes, M.R.C.S.,
Department of Neurosurgery,
Frenchay Hospital,
Bristol, BS16 1LE, England.
Email: Katie@katiegilkes.com
Received, May 9, 2007.
Accepted, October 24, 2007.
DIANA BECK (1902–1956) WAS probably the first female neurosurgeon in the world
and played a large part in establishing neurosurgery in the United Kingdom. She served
as the consultant advisor in neurosurgery for the Emergency Medical Service in the
southwest region during the Second World War and subsequently set up the neurosur-
gical unit at Frenchay Hospital in Bristol before becoming a consultant at The Middlesex
Hospital in London in 1947. There, she was the first woman to be given charge of men
in a consultant capacity in a major London teaching hospital. During her 31-year career,
she was the only female neurosurgeon in Western Europe and the United States.
Miss Beck came to the attention of the general public when she operated on Alan
Alexander Milne in 1952. However, she was better known in neurosurgical circles for
her interest in intracranial hemorrhage. In this article, some of her original research,
case reports, and her seminal paper on the surgical treatment of intracerebral hemor-
rhage are presented. They are a stark reminder of the limited investigations available
at that time.
In addition to her neurosurgical achievements, Miss Beck was a remarkable character
and teacher. Her Saturday ward rounds proved so popular that they competed success-
fully with the students’ weekend plans. In a specialty in which women continue to rep-
resent a disproportionately small percentage of the workforce, Miss Beck was one of
our earliest role models.
KEY WORDS: Diana Beck, Neurosurgical history, Women in neurosurgery

Neurosurgery 62:738–742, 2008 DOI: 10.1227/01.NEU.0000297112.95496.68 www.neurosurgery-online.com

N
eurosurgery has always been dominated by men. In
the United States, approximately 5.9% of practicing
neurosurgeons and 10% of neurosurgical residents are
women (19, 20), with the rate of increase in female trainees lag-
ging behind that seen in most other specialties (10). The figures
are similar in the United Kingdom. Women account for 4.5% of
the consultant members of the Society of British
Neurosurgeons and 11.8% of the trainees. Therefore, on begin-
ning my training at Frenchay Hospital in Bristol, England, it
came as something of a surprise to find that one of the found-
ing consultants was female. According to Sir Geoffrey Jefferson
(14, 15), Diana Beck was the only female neurosurgeon of her
era and probably the first in Western Europe or North
America.
Early Career
Diana Jean Kinloch Beck (Fig. 1) was born in 1902 in the his-
toric city of Chester in northwest England. The daughter of a
tailor, she spent her childhood in Chester and was educated at
The Queen’s School before going on to study medicine in
London. She completed her undergraduate and postgraduate
general surgical training at the Royal Free Hospital and then
attended the London School of Medicine for Women. During
this time, she earned many prizes, distinctions, and fellow-
ships of the English and Edinburgh Royal Colleges and devel-
oped a flair for teaching.
Unusual for the time period, Miss Beck chose to specialize in
neurosurgery and took up an apprenticeship with Sir Hugh
Cairns in Oxford in 1939, shortly before the start of the Second
World War. Cairns, one of the founders of British neurosurgery
had been trained by Harvey Cushing and William Halstead; he
passed his “Halstead Cushing Technique” on to his appren-
tice. In Miss Beck, Cairns found a very able and experienced
surgeon who was devoted to him and became a lifelong friend
to both himself and his family (15). He acknowledged her
teaching ability, putting her in charge of the introductory
course in clinical surgery, and she was one of the few col-
leagues with whom he would “let his hair down” (13). At
Diana Beck’s invitation, Cairns delivered his final lecture to
the students of The Middlesex Hospital.

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FIGURE 1. Miss Diana Beck (from, Jefferson G,
Emergency Medical Service, Anonymous: Diana JK
Beck, MB., FRCS: Obituary. BMJ 1:634–635, 1956
[15]). Reproduced with permission from the BMJ
Publishing Group.
Research
During her time in Oxford, Miss Beck undertook a period of
research funded by a William Gibson Research Scholarship
from the Royal Society of Medicine in 1939. This allowed a suc-
cessful and productive collaboration with the pathologist
Dorothy Russell (7, 8, 9, 16, 17). Their publications included an
article in a very early edition of the Journal of Neurosurgery
describing animal experiments in which various methods were
used to induce venous sinus thrombosis to decipher the etiol-
ogy of benign intracranial hypertension, or “otitic hydro-
cephalus,” as it was then known (8).
At that time, cranial defects were repaired via large iliac crest
grafts. Russell and Beck also experimented with alternative
materials, including acrylic resin, and determined that “this
substance may be suitable for the repair of defects of the
human skull. The plastic excites a foreign body reaction. It is
not obviously cytotoxic” (9, p 86).
Consultant Practice
Upon completing her training in Oxford, Miss Beck was
appointed consultant neurosurgeon at the Royal Free Hospital
in 1943. She was unable to assume this appointment because
World War II was underway and her services were called upon
by the Emergency Medical Service. Initially, she was briefly
posted to Chase Farm Hospital in Enfield, north of London,
before being made consultant advisor in neurosurgery for the
NEUROSURGERY
THE LIFE AND ACHIEVEMENTS OF MISS DIANA BECK
Emergency Medical Service in southwest England, based in
Bristol. Here, quite fortuitously, there was a vacant neurological
hospital with neurosurgical facilities, which had been built with
the intention of treating children with epilepsy. The Emergency
Medical Service took it over during the war as a venue for man-
aging neurosurgical casualties from the region. After the war,
the neurosurgical service was transferred to Frenchay Hospital,
creating the unit that continues to thrive today.
However, Miss Beck was soon lured by London, the British
“Mecca” of clinical medicine at the time. Her appointment as
consultant at The Middlesex Hospital in 1947 was the pinnacle
of her career. She was the first woman and first neurosurgeon
to join the staff and successfully created and ran the neurosur-
gical service there.
It was while at the Middlesex that she became something of
a household name when she operated on Alan Alexander
Milne of Winnie the Pooh fame, saving the life of the childrens’
author (1, 18). Milne had experienced a stroke in October 1952;
2 weeks later, he was transferred to The Middlesex Hospital,
where he improved over the course of a month. Miss Beck
operated on him in late December, but the exact procedure is
not entirely clear. Certainly, The Times was impressed and pub-
lished daily reports on his progress and later described “a
remarkable piece of surgery” in his obituary (1, 15). However,
his biographer reports that postoperatively he became “partly
paralyzed…for three years he could only move in a wheel
chair.” There was a “distinct change in character” and he
became “coarse, vulgar, irritable, and perverse” (18, p 481).
Milne survived the operation and lived for another 3 years
before he died in January 1956. His death certificate listed cere-
brovascular degeneration, brain abscess, and pneumonia as
causes of death.
In May 1952, Miss Beck presented her experience to the
Society of British Neurosurgeons in Zurich (5) and subse-
quently on a lecture tour of the United States and Canada. Her
paper comprised a series of six detailed case reports of patients
aged 35 to 56 years with spontaneous intracerebral hematomas.
All patients presented with neurology compatible with the
hematoma site (four dominant hemisphere, two nondominant
hemisphere) and one had a depressed conscious level at the
time of surgery. All made an excellent postoperative recovery,
with five of the six achieving independent functional status.
The conclusions were as follows:
1) “I believe the method of choice is complete removal of the
hematoma.”
2) “Life is saved by operation and, of perhaps even greater
importance, there is much less disability and a shorter recov-
ery period.”
3) “As to the time to operate, I can see no justification for wait-
ing, once the patient has recovered from the first shock of
hemorrhage, especially when the signs suggest increasing
intracranial pressure” (5, p 160).
While Miss Beck advocated early surgery, the delay between
ictus and operation in her series ranged from 2 days to more
than 2 weeks. This reflected the difficulty in diagnosis, which
was based on history, examination (including percussion of
VOLUME 62 | NUMBER 3 | MARCH 2008 | 739
GILKES
the cranium), and limited investigations (i.e., lumbar punc-
ture, direct carotid/vertebral arteriograms, and air ventriculo-
grams). One must also remember that neurosurgery was in its
infancy and a patient with a probable intracerebral hemor-
rhage may not have prompted an automatic neurosurgical
referral. Miss Beck would have had to educate and inform
local physicians of her service.
Neurosurgical Practice in the Mid-20th Century
Surgical practice in the 1940s and 1950s was essentially based
on anecdote and past experience. Diana Beck’s later publica-
tions (3, 4, 6, 11), such as her seminal paper on the management
of intracerebral hematomas, essentially comprised detailed case
reports illustrated with angiograms and pictures of surgical
approaches. They act as a stark reminder of how our specialty
has changed. These accounts would have been a much easier
read with the benefit of the Glasgow Coma Scale and highlight
the dramatic development in neuroradiology.
This is well illustrated in one of Miss Beck’s case reports of
a 29-year-old clergyman who initially presented in 1931 with
attacks in which he “lost the thread of what he was saying,
and at times saw lights on the right hand side and experi-
enced an unpleasant taste” (7, p 352). By 1934, he was experi-
encing headaches lasting up to 18 hours and associated with
nausea, vomiting, unpleasant taste sensations, difficulty with
word finding and reading, and a tingling sensation in the
mouth and hands. When he had a generalized seizure in 1935
and his symptoms were so bad that he was forced to stop
preaching, he was referred to the neurosurgical unit at Oxford.
A thorough examination by Mr. Cairns and Dr. Riddoch, who
later became chief consultant neurologist to the War Office,
revealed some relative anosmia of the left nostril and a right
facial weakness. A lumbar puncture revealed a “resting pres-
sure” of more than 300 mm and a high cerebrospinal fluid
protein level of 200 mg percent. A subsequent ventriculogram
showed dilatation of the third and lateral ventricles and an
indentation of the lower border of the body of the left ventri-
cle, which was interpreted as an inoperable tumor. This
prompted a subtemporal decompression followed by “peri-
odic courses of deep x-ray treatment,” which seemed to
improve the situation. During the subsequent year, the clergy-
man had only one attack of headache with vomiting and
returned to work. However, by 1937, his sermons deteriorated
and another ventriculogram showed that the ventricular defect
had enlarged. On this occasion, he had a severe reaction to the
procedure and became aphasic, with a right hemiparesis,
reduced conscious level, and bradycardia. Fortunately, he
improved over the subsequent 2 days but was left with persist-
ing dyslexia, mental dullness, and an attention defect in the
left lower temporal quadrant of the visual field.
With what appeared to be an expanding intraventricular
tumor, a “left posterior osteoplastic exploration” was per-
formed in November 1937. The tumor could not be located,
and the patient developed global aphasia with apraxia and a
right homonymous hemianopia postoperatively. This was suc-
cessfully treated with daily lumbar punctures of bloodstained
740 | VOLUME 62 | NUMBER 3 | MARCH 2008
cerebrospinal fluid at high pressure; the patient was discharged
symptom-free 4 weeks after his surgery.
By October 1938, he was experiencing severe hydrocephalic
attacks with headaches, vomiting, neck stiffness, bradycardia,
increased tension at the subtemporal decompression, agitation,
and generalized seizures that were followed by a temporary
left hemiplegia. Repeated ventricular and lumbar punctures
were performed. The cerebrospinal fluid became increasingly
bloodstained with an intracranial pressure of 600 mm. The cler-
gyman died in November 1938, and an autopsy revealed a
1.5-cm mixed glioma/oligoastrocytoma with a central area of
anaplastic change in the ventromedial wall of the left ventricle.
There were tumor nodules throughout the lateral ventricles,
fourth ventricle, and spinal canal. It is not surprising that there
was evidence of raised intracranial pressure with brain herni-
ation and flattening of the sulci.
Diana Beck: Surgeon and Lady
It is easy to be critical of what seems to be such primitive
practice from the perspective of neurosurgery in the 21st
century. However, this was heroic, groundbreaking surgery
at the time. As a surgeon, Diana Beck was well respected by
her colleagues. Accounts in her obituaries (2, 14, 15) describe
an original, confident, sound, gifted, professional surgeon
and an excellent doctor who retained her poise and was
always considerate.
In one of his contributions, Sir Geoffrey Jefferson wrote:
“She was not a brilliant operator, but then brilliance has fortu-
nately departed from our operating rooms” (15, p 635). By
brilliance, he meant “showy amateur.” In fact, this was one of
many compliments. Jefferson was particularly impressed with
the way she took on and won the respect of the male enclave
that was the Middlesex Hospital. “Had Diana been other than
she was, she might have overplayed her hand, have showed
triumphant signs of a militant feminist. The case was far from
otherwise, she used her opportunities with modesty and good
sense and rapidly became a favorite of staff and students” (15,
p 635). She was so popular, in fact, that her Saturday rounds
allegedly competed with the weekend plans of her students at
The Middlesex Hospital (15).
Rather than a bullish feminist, the accounts talk of “fastidious
femininity” and a lady of small stature, whose “surroundings
were as elegant and tasteful as her own personal attire” (14).
Her secret seemed to be an infectious, enthusiastic personality
mixed with a genuine interest in people and a remarkable
capacity for friendship, which won the confidence of her
patients, colleagues, and students. However, she was no
walkover: “she did not hesitate when the occasion arose to
express her views forcibly and fearlessly” (15, p 635). An anes-
thetist reports going to “extraordinary lengths” to avoid leaving
her operating theater during long procedures (D Cope, personal
communication, 2007). Although she was felt to have done an
excellent job managing the clinical surgery course at Oxford, the
Oxford students allegedly hated her “martinet ways” (13).
Diana Beck never married. She was devoted to her two broth-
ers and their families and was severely affected when her favorite
www.neurosurgery-online.com

nephew developed a high spinal injury 2 years before her death.
Outside of her work, she was a Catholic reader, created exquisite
needle work, and enjoyed flowers and art. However, her work
and her patients were her priorities (15).
It is a cruel twist of fate that someone who contributed so
much to the development of neurosurgery in the United
Kingdom should develop a neurological disease. Her myas-
thenia gravis was initially diagnosed as “hysteria” (R Maurice-
Williams, personal communication, 2005). With such a condi-
tion, there were some skeptics “who doubted whether her
stamina was sufficient to stand the rigours of the creation and
running of a neurosurgical service” (15, p 635). There is men-
tion of her finding long cases an increasing physical strain, and
her physical tiredness after her North American tour. However,
her ill health did not seem to compromise her ability to fulfill
her responsibilities. At the beginning of 1956, Miss Beck had a
myaesthenic crisis. A thymectomy was performed, from which
she made a good recovery before she developed a pulmonary
embolism and died on March 3, 1956.
Was Diana Beck the first female neurosurgeon? She was cer-
tainly the first and only female neurosurgeon in Western
Europe and North America (14, 15), and it appears from
searching the literature that she was probably the first in the
world. Sofia Ionescu (nee Ogrezeanu), the first female neuro-
surgeon in Romania, has been reported as possibly the first
female neurosurgeon in the world (12). However, she followed
Miss Beck by almost a generation, qualifying from medical
school in 1945.
CONCLUSION
Since the mid-20th century, the roles of and opportunities
for women have changed dramatically. Despite this, however,
very few enter the demanding subspecialty of neurosurgery.
Diana Beck’s achievements are astonishing from today’s per-
spective. Despite suffering from myasthenia gravis, she
achieved many firsts: she was the first neurosurgeon at The
Middlesex Hospital and the first woman to break into the male
enclaves of The Middlesex Hospital and the field of neuro-
surgery in Western Europe, North America, and possibly the
world. This was accomplished by single-minded determina-
tion and devotion to her work and patients, which won the
admiration and respect of her colleagues.
REFERENCES
1. Anonymous: AA Milne: Obituary. The Times. February 1, 1956.
2. Anonymous: Miss Diana Beck: Obituary. The Lancet 270:323, 1956.
3. Beck DJ: Upper parietal meningioma showing Foster Kennedy Syndrome.
Bristol Med-Chir J 64:11–12, 1947.
4. Beck DJ: Malignant dumb-bell neurofibromata. Arch Midd Hosp 2:88–97,
1952.
5. Beck DJ: The surgical treatment of intracerebral haemorrhage. Arch Midd
Hospital 3:150–160, 1953.
6. Beck DJ: Intracranial haemorrhage in closed head injuries. Arch Midd
Hospital 4:231–255, 1954.
7. Beck DJ, Russell DS: Oligodendromatosis of the cerebrospinal pathway. Brain
65:352–372, 1942.
NEUROSURGERY
THE LIFE AND ACHIEVEMENTS OF MISS DIANA BECK
8. Beck DJ, Russell DS: Experiments on thrombosis of the superior longitudinal
sinus. J Neurosurg 3:337–347, 1946.
9. Beck DJ, Russell DS, Small JM, Graham MP: Implantation of acrylic-r discs in
rabbits’ skulls. Br J Surg 33:83–86, 1945.
10. Brotherton SE, Rockey PH, Etzel SI: US graduate medical education,
2003–2004. JAMA 292:1032–1037, 2004.
11. de Donnan FS, Beck DJ: Diagnostic problems: Subarachnoid haemorrhage
and hypertension in a case of coarctation of the aorta. Arch Midd Hosp
4:144–146, 1954.
12. Duncan N: Caring Physicians of the World. New York, Pfizer Medical
Humanities Initiative, 2005, pp 44–45.
13. Fraenkel GJ: Hugh Cairns, First Nuffield Professor of Surgery, University of
Oxford. New York, Oxford University Press, 1991, pp 145, 162.
14. Jefferson G, Anonymous: Miss Diana Beck: Obituary. The Times. March 6,
1956.
15. Jefferson G, Emergency Medical Service, Anonymous: Diana JK Beck, MB.,
FRCS: Obituary. BMJ 1:634–635, 1956.
16. Russell DS, Beck DJ: Histological effects of sulphonamide-proflavine mix-
tures in the rabbit: Some experimental observations. BMJ 1:112–113, 1944.
17. Russell DS, Beck DJ: Local action of penicillin and sulphamezathine and a
penicillin-sulphamezathine mixture on rabbit brain. Lancet 1:497–498, 1945.
18. Thwaite A: AA Milne: His Life. London, Faber and Faber, 1990, pp 480–484.
19. Ullman JS: A balanced workforce, a balanced life. WINS newsletter, Spring
2007. http://www.neurosurgerywins.org/news/newsletter/wins_spring
2007.pdf. Accessed 2/2/08.
20. Woodrow SI, Gilmer-Hill H, Rutka JT: The neurosurgical workforce in North
America: A critical review of gender issues. Neurosurgery 59:749–755, 2006.
Acknowledgment
I thank Jane Sweetland, M.S., librarian, for her enthusiastic assistance.
COMMENTS
T his is an informative and interesting historical vignette about an
obscure pioneer in the field of neurosurgery. The author provides a
concise, well-written biographical note on Miss Diana Beck, who is
recognized here as the first female neurosurgeon in the world. As a
woman neurosurgeon myself, I read this biography with great interest,
wishing that some of the details of her personal life were described in
more depth. It is clear from reading this article that Miss Beck was not
just “a first” in a male-dominated profession, but was, above all, a ded-
icated and highly respected neurosurgeon who “won the respect of
the male enclave” that was neurosurgery in the 20th century. Rather
than being a “militant feminist” who overplayed her hand, she “used
her opportunities with modesty” to gain the respect of her male col-
leagues. Her achievements serve to remind us that hard work and ded-
ication, not gender, should be the determining factors of success in the
field of neurosurgery.
Linda M. Liau
Los Angeles, California
T his contribution is of considerable interest to the history of neuro-
surgery in the United Kingdom in the mid-20th century. Two of my
older colleagues, who were trainees at the time, remember Miss Beck
while she was a consultant neurosurgeon at the Middlesex Hospital,
London, in the early 1950s with great respect. Although it is difficult
to prove, she may have been the first qualified female neurosurgeon in
the world.
David G.T. Thomas
London, England
W omen in neurosurgery in the mid-portion of the last century
were truly a rare phenomenon. As the author has pointed out,
VOLUME 62 | NUMBER 3 | MARCH 2008 | 741
GILKES
even in the 21st century the numbers remain less than 10%. In review-
ing this article, the author brings to our attention a clearly gifted lady
who went on to become a full-time neurosurgical consultant in
England, a task that would prove to be quite daunting, but having said
that, she clearly accomplished her goals and became part of main-
stream neurosurgery in England. I particularly enjoyed the insights
into this woman’s personality and relationship with her peers and
family. In a review of Ms. Beck’s contributions to the literature and
neurosurgery, she was clearly a woman of significant achievements.
An additional insight was knowing that Ms. Beck trained under Hugh
Cairns, one of the giants in neurosurgery, so being able to read his
comments was most interesting. In this article, the author has pre-
sented an interesting contemporary picture of what it was like to be
the first “female” neurosurgeon in England and how well she handled
the various challenges; hence, she should be credited as being the
“first female neurosurgeon.”
James T. Goodrich
Bronx, New York
I n this article, Gilkes presents us with an account of the life and
achievements of Ms. Diane Beck, who is most likely the first woman
to have been called a neurosurgeon. This article provides a nice review
of her life and times, and one can only imagine the exceptional strength
of character Dr. Beck demonstrated to become a neurosurgeon. By all
742 | VOLUME 62 | NUMBER 3 | MARCH 2008
accounts she was intrepid in undertaking complex cases and was
respected by her colleagues.
As our profession slowly grows older, remembering the origins of
the young specialty of neurosurgery becomes increasingly important.
Ms. Beck chose the field of neurosurgery at a time when there were few
neurosurgical role models. Her apprenticeship with Dr. Hugh Cairns
was obviously crucial to her development as a neurosurgeon, and it
was probably this mentorship that allowed her to thrive and succeed.
I suggest that at a time when we are increasingly asking ourselves
about the 52% of the medical school class that are women, we should
remember the role that mentoring plays in the development of young
neurosurgeons. As we seek to diversify and expand the talent pool for
neurosurgery, it is usually mentorship that inspires and leads individ-
uals from diverse backgrounds to consider a career in neurosurgery.
This article reminds us that neurosurgery is certainly not for the
faint of heart and that Ms. Beck continued the traditions of most pres-
ent-day, able neurosurgeons. Her publications regarding intracerebral
hematomas suggest that she was appropriately aggressive and always
thinking about the final outcome for the patient. She was also strong
willed in her governance over her service, and by all accounts did an
excellent job with respect to such governance. Her career reminds us
once again that diversity in the neurosurgical workforce is best
achieved by teaching and mentoring and not mandate.
Karin Muraszko
Ann Arbor, Michigan
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