Dr. Harvey Williams Cushing

Dr. Harvey Williams Cushing

• http://en.wikipedia.org/wiki/Harvey_Cushing
• https://www.findagrave.com/memorial/5372/harvey-williams-cushing

Harvey William Cushing, American physician and neurosurgeon, was born in Cleveland, Ohio, on April 8, 1869. He received the degree of A.B. from Yale University in 1891, and those of A.M. and M.D. from Harvard Medical School in 1895. He was a graduate of the Massachusetts General Hospital, Boston, 1896. He moved to Baltimore to work at the Johns Hopkins Hospital where he stayed for 15 years, mostly at the Faculty of Surgery under the guidance of another famous surgeon, William Stewart Halstead. In 1912, he returned to Harvard as Professor of Surgery and also was surgeon-in-chief at the Peter Bent Brigham Hospital (1913-1932) in Boston. In 1933, he became Sterling Professor of Neurology at Yale, a position he held until 1937. Considered a pioneer of Neurosurgery, he made several fundamental discoveries about the pituitary gland.

Beginning in 1905, Dr. Cushing started to develop many of the basic surgical techniques for operating the brain, thus establishing neurosurgery as a new and autonomous surgical discipline. He improved considerably the survival of patients after difficult brain operations for intracranial tumors, an area where he became one of the foremost leaders and experts of all times. He was also the first to use x-rays to diagnose brain tumors and to stimulate electrically the sensory cortex of a human being. He established an international reputation as a teacher of neurosurgeons, with many followers and students, many of whom became also world famous. In his honor, one of the first medical associations in neurosurgery was formed (the Harvey Cushing Society, later absorbed into the American Association of Neurological Surgeons).

His name was also immortalized in the history of medicine, by his discovery, in 1912, of Cushing's disease, an endocrinological syndrome caused by a malfunction of the pituitary gland. This discovery was described in detail in "The Pituitary Body and its Disorders". Bibliophile and an earnest collector of books, he published many essays and other literary works, among them the 1926 Pulitzer prize-winning biography of William Osler, one of the "fathers" of modern medicine.

For all this, he is considered the greatest neurosurgeon of the 20th century. He died in 1939, in New Haven, Connecticut.

---

Harvey Cushing was the first full-time neurosurgeon. Towards the end of the 19th century, when anaesthesia and antisepsis had enabled surgery to advance dramatically, operations on the brain and spinal cord were performed by general surgeons, with a very high mortality. Cushing established neurosurgery as a specialty, trained many of the future neurosurgeons, experimented in the laboratory, wrote many papers and four authoritative books and accumulated an impressive library. He was both a neurologist and a neurosurgeon.

Cushing came from a family of doctors. His great-grandfather David practiced in Boston, his grandfather Erastus trained initially in New York then moved to Cleveland, Ohio in 1835 where he had a thriving practice in the centre of town and his father, Henry Kirke Cushing, attended Cleveland Medical College, joined his father and became a successful and highly respected physician. Harvey Cushing was the last of 11 children, brought up in a cheerful family with Presbyterian principles.

While Cushing was “the worst speller in the school”, his mother excelled in French, Latin and Greek, which she instilled into her youngest child. He had a quick temper, not shown in later years except by a measure of intolerance. Aged 18, he enrolled at Yale, changing from languages to chemistry, physics and zoology in his second year, when he decided on a career in medicine. He graduated in the upper third of his class in 1890. He was accepted into Harvard Medical School, where he was greatly influenced by Osler’s “Principles and Practice of Clinical Medicine”, published in 1892 and to become the standard medical text for the next 40 years. As an intern in 1894 he rarely left the hospital – in a letter home (he wrote one each Saturday) he said “the hospital is a great place to grow hair and wear out shoes”. In that year he witnessed his first brain operation.

At Harvard, he had decided to train in surgery, obtaining a position as assistant to William Halstead at Johns Hopkins Hospital which had opened its doors in 1889. William Osler, a Canadian, was the professor of medicine and Halstead the professor of surgery; these were the pre-eminent men of their time in their respective specialities. Both gave every encouragement to Cushing. In 1985 he wrote his first medical report, on the wife of a brawling bartender; she was shot in the neck, with signs indicating that one side of the spinal cord had been damaged.

Cushing’s interest in books was stimulated by visits to Osler’s library; after Osler became Regius Professor of Medicine in Oxford in 1905, Cushing visited him on each possible occasion and was at Osler’s son’s deathbed in France in 1917 which was a great consolation to Lady Osler (Osler had been created a baronet in 1911).

By 1900, Cushing had performed a few operations on the Gasserian ganglion for trigeminal neuralgia and also on the brain. He then increased his experience by visiting all of the European surgeons performing brain surgery, as well as Sir Victor Horsley in London, who performed the first neurosurgical procedure there in 1886. Cushing commented that “his technique is execrable”. He also spent time with Sherrington (a Nobel Laureate in neurophysiology) in Liverpool and met many of the leading neurologists. He maintained correspondence with Sherrington, who stayed with Cushing in Baltimore in 1927.

On returning to Johns Hopkins, he restricted his surgery to the nervous system. In 1904 he reported 20 operations on the trigeminal ganglion for neuralgia and correctly diagnosed and removed a spinal cord tumour. He was meticulous (and therefore slow) in operating, in contrast to the quicker-the-better approach of most surgeons, with operations lasting 4-6 hours. His operative mortality was strikingly less than other surgeons. He introduced anaesthetic operative records and the routine intra-operative recording of blood pressure (1905). He raised funds to establish an experimental laboratory, reducing the dog population of Baltimore! In 1912 he obtained a $100,000 grant from the Rockefeller Foundation for his Hunterian Laboratory.

It is recorded that before an operation he was “as keyed up as a racehorse”; no conversation was allowed while he scrubbed up and he insisted on absolute quiet in the operating room. He was sharp with assistants and did not get on well with his colleagues and surgical subordinates.

In 1908 he wrote a systematic treatise on brain surgery; around this time his interest in the pituitary gland was raised by Professor Sir Edward Sharpey Schafer, a renowned Scottish physiologist (after whom the Schafer method of artificial respiration, replaced by the Holger Nielsen system in 1946 and more recently by mouth-to-mouth resuscitation, was named). Cushing wrote a book on the pituitary gland in 1912. He later wrote extensively on the physiology of the pituitary gland and its surgery and in 1932 described what is now known as Cushing’s disease (see below). By 1910, improved techniques had resulted in a dramatic reduction in operative mortality – Cushing had only three operative deaths in his last 50 cases.

He had several offers of professorships but in 1912 he took the position of Surgeon-in-Chief at the Peter Bent Brigham Hospital in Boston, with a professorship at the Harvard Medical School, where he worked until reaching retirement age of 63.

Cushing wrote extensively on tumours of the brain; in 1926 he wrote a volume on tumours of the glioma group. He coined the term meningioma (a benign tumour arising from the coverings – meninges - of the brain) with a definitive monograph on meningiomas sent to the press in 1938, just a year before he died. One of his famous patients was Major General Leonard Wood. Cushing removed Wood’s meningioma in 1910 with no complications. Wood became Chief of Staff of the US Army during the Great War and was later twice nominated for President. Unfortunately the meningioma recurred in 1928 and he died the day after a 7-hour re-operation by Cushing.

Cushing was a bibliophile with a particular interest in Vesalius, a 16th century anatomist who published beautifully detailed anatomic studies. He donated his extensive and valuable library to Yale, having been appointed Professor of Neurology at Yale in 1932 after he had retired from Harvard. His extensive writings were not only on the nervous system – in 1919, Lady Osler asked him to write the biography of her husband, Sir William. He also wrote a book on his experiences in France when serving in a military hospital during the Great War.

His own medical history is interesting – in 1896 he had his appendix removed by Halstead, when mortality of this procedure was alarmingly high. He was a smoker, with circulatory problems in the legs threatening gangrene at the age of 62. He had a gastric ulcer at 64 and the following year had a gangrenous toe amputated. He died aged 70 with angina and heartblock. Autopsy showed no significant cerebrovascular disease but he had an asymptomatic 1 cm colloid cyst of the third ventricle.

He had little time for sport, but at school he excelled on the horizontal bars, at college he played competitive baseball and later he enjoyed golf and tennis. He sacrificed his family for his profession: his wife was very good at defusing his moods and entertained his guests admirably when he was called back to the hospital. He was devastated when one of their two sons was killed in a motor vehicle accident in 1924; they also had three daughters.

Cushing was awarded many honours, with honorary degrees from most of the great universities of Europe and from Washington University, Western Reserve, Yale, Dartmouth, Harvard and others. He was the first surgeon to be made a Fellow of the Royal College of Physicians (London).

Other References

• Biographical index of former fellows of the Royal Society of Edinburgh, 1783-2002, pt. 1. A-J, page 229