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Dr. Harvey Williams Cushing (1869-1939)
Dr. Cushing was born in Cleveland Ohio. The fourth generation in his family to become a
physician, he showed great promise at Harvard Medical School and in his residency at Johns
Hopkins Hospital (1896 to 1900), where he learned cerebral surgery under William S. Halsted.
After studying a year in Europe, he introduced the blood pressure
sphygmomanometer to the U.S.A. He began a surgical practice in Baltimore while teaching at
Johns Hopkins Hospital (1901 to 1911), and gained a national reputation for operations such as the
removal of brain tumors. From 1912 until 1932 he was a professor of surgery at Harvard Medical
School and surgeon in chief at Peter Bent Brigham Hospital in Boston, with time off during World
War I to perform surgery for the U.S. forces in France; out of this experience came his major
paper on wartime brain injuries (1918). In addition to his pioneering work in performing and
teaching brain surgery, he was the reigning expert on the pituitary
gland since his 1912 publication
on the subject; later he discovered the condition of the pituitary
now known as
"Cushing's disease".
On retiring from Harvard he spent his final years at Yale as professor of neurology and
director of studies in the history of medicine; his bequest of his books on this latter field form the
basis of Yale's medical history library.
America's most admired surgeon in his day, he was a man of many talents, even winning the Pulitzer Prize (1926) for his biography of the man who had
greatly influenced his career, The Life of Sir William Osler.
From: Microsoft® Encarta® Online Encyclopedia 2000
Cushing, Harvey Williams
Cushing, Harvey Williams (1869-1939), innovative American brain surgeon. Born in Cleveland, Ohio, and educated at
Harvard and Yale universities, Cushing was associate professor of surgery at Johns Hopkins University from 1902 until 1912.
He then served as professor of surgery at Harvard and surgeon in chief at the Peter Bent Brigham Hospital in Boston
until 1933, when he became professor of neurology at Yale.
Cushing originated new techniques of brain surgery and made
valuable contributions to the operative treatment of facial paralysis, cerebral tumors, and intracranial hemorrhage of
newborn babies. He was also a pioneer in the use of X-rays and in the monitoring of blood pressure, and he drastically
reduced the incidence of mortality in brain surgery. The
extensive library that he bequeathed to Yale served as the
nucleus for an outstanding collection of books on medical history. His writings include The Life of Sir William Osler
(1925), which won the Pulitzer Prize, and 1915-1918 (1936).
HOW TO CITE THIS ARTICLE
"Cushing, Harvey Williams," Microsoft® Encarta® Online Encyclopedia 2000
http://encarta.msn.com © 1997-2000 Microsoft Corporation. All rights
reserved.
Harvey Williams Cushing
From http://www.whonamedit.com/doctor.cfm/980.html
Used with the permission of Ole Daniel Enersen, editor of whonamedit.com, a biographical dictionary of medical eponyms on the Internet.
American neurosurgeon, born April 8, 1869, Cleveland, Ohio; died October
7, 1939, New Haven, Connecticut.
Associated eponyms:
Bailey-Cushing
syndrome
A syndrome affecting both sexes with unsteadiness in balance, disturbed
coordination of the body in space, walking very poor, good coordination
when lying or with body well braced.
Cushing's clip
A small silver clip developed by Cushing in 1910.
Cushing's law
Increase in intracranial pressure causes compression of the cerebral
blood vessels and cerebral ischemia.
Cushing's
symphalangism
A syndrome of symphalangism with fusion of the midphalangeal joints,
fusion of elbow and carpal and tarsal bones; absence of the normal
articular folds.
Cushing's
syndrome I
Glucocorticoid excess syndrome in which the hypersecretion of
glucocorticoids is secondary to hypersecretion of adrenocorticotrophic
hormone from the pituitary.
Cushing's syndrome
II
A syndrome of multiple tumours of the spinal nerve roots and auditory
nerves.
Cushing's syndrome
III
A syndrome of bitemporal hemianopsia and associated primary optic
atrophy
Cushing's triad
Signs of increased intracranial pressure.
Launois' syndrome
Syndrome that presents the characteristics of primary pituitary
gigantism.
Neurath-Cushing
syndrome
A syndrome combining the features of prepuberal adiposogenital dystrophy
and gigantism.
Rokitansky-Cushing
ulcer
Eponym used to indicate the gastrointestinal hemorrhagic complication
arising after head injury or neurosurgery.
Slocumb's
syndrome
A condition resulting from prolonged therapy of rheumatoid arthritis
with corticoid steroids.
Biography:
Career
Harvey Williams Cushing was born in Cleveland, Ohio, the sixth
son and the tenth child (seven lived to maturity) of Henry Kirke Cushing
and Betsey Maria Williams Cushing. The Cushing family on the paternal
side originated from Gravesend, England. Matthew Cushing, a deacon,
emigrated to Boston in 1638. His great grandfather David (1768-1814) was
country doctor, his grandfather Erastus (1802-1893) was also a general
practitioner. His father, a stern puritanical doctor, combined a large
practice with the professorship of midwifery, diseases of women, and
medical jurisprudence at Cleveland Medical College and was also for many
years a trustee of Case Western Reserve University. Reserved with his
children, he left much responsibility for their upbringing to his wife,
a gracious, highly intelligent woman quite capable of the task. He
imposed strict discipline in his household and provided comfortably for
physical needs - generously for education. Harvey’s mother came from a
pioneer mid-western stock. One son entered the law, another geology; two
became physicians. They attended the Presbyterian church, public schools
in Cleveland, and eastern universities for their college and
post-graduate training.
Student years
At the age of 18 Harvey Cushing went to Yale College, where four years
nurtured an abiding loyalty to his alma mater, largely through the close
friendships formed there and maintained and treasured all his life.
After receiving his A.B. at Yale University in 1891, he followed his
brother Edward into Harvard Medical School in 1891, becoming the fifth
Cushing to enter medicine. Before enrolling at Harvard he was directed
by his father to abstain from smoking, drinking, boating, baseball and
other forms of intemperance. In 1894, the year before graduation, he
visited London for the first time, meeting Jonathan Hutchinson
(1828-1913) at his rooms and Thomas Barlow (1845-1945) at Great Ormond
Street Hospital.
He received his MD cum laude in 1895 and became a surgical house officer
at the Massachusetts General Hospital, Boston. Here he collaborated with
Ernest Amory Codman (1869-1940), with whom he had devised the first
anaesthetic chart, “The ether chart” in 1894, while still a student,
prompted by the death of a patient during surgical procedure. This gave
brief details of the patient and the operation and allowed both the
anaesthetist and the surgeon to follow the condition of the patient
throughout the operation by recording pulse, respiration and
temperature. This innovation led to a considerable reduction in
mortality rate from anaesthesia. Cushing and Codman now collaborated on
the clinical use of X-rays, whose discovery had only been made in
December the previous year by Röntgen. Even at this early stage in his
career Cushing’s driving energy and his taskmaster attitude to his
junior were becoming apparent.
Johns Hopkins
In 1896, at the age of 27, Cushing went on to become assistant resident
at the newly founded Johns Hopkins Hospital where for four years he
worked under William Stewart Halsted (1852-1922), the pre-eminent among
American surgeons. Cushing was unimpressed both by the city of Baltimore
and the hospital - "the hospital is a very sloppy place and the work of
everyone most unsystematic, i.e. on the surgical side. Dr. Hallsted has
only operated once this month and rarely appears. Hope things clear out
or I can't stand it" - an extract from a letter he wrote home. He lived.
However, next door to William Osler and a great friendship developed.
The first professors at the newly established medical school were men of
extraordinary high calibre, among them, besides Osler, was William Henry
Welch (1850-1934) in the chair of pathology, and Howard Atwood Kelly
(1858-1943) in charge of obstetrics.
Stimulated by these men, Cushing’s restless and inquiring mind and
enormous capacity for work found full expression. Their interest in
medical history spurred him in his collection of medical books; he was
also encouraged by his father, who passed along volumes from his own
library that also often carried the signatures of his grandfather and
great-grandfather.
In 1898 Cushing had his first experience of military medicine and in
surgery in dealing with soldiers, mostly suffering from typhoid fever,
who were evacuated to Baltimore during the Spanish-American war in Cuba.
From this resulted two of his early papers, on the treatment of typhoid
perforation of the intestine.
Europe calls
After completing his time at Johns Hopkins, Cushing went to Europe and
in Bern where he experimented under the direction of Theodor Kocher
(1841-1917) on the relationship between systolic blood pressure and
cranial pressure. In Bern he also worked with Hugo Kronecker (1839-1914)
on the effects of raised intracranial pressure and noted the rise in
blood pressure that accompanies it. From Bern he went to England,
working with Victor Horsley in London, and during a month in Liverpool
took part in Sir Charles Scott Sherrington's (1857-1952) experiments on
the ape motor cortex. Perhaps the most important aspect of his visit was
that William Osler, too, was spending the summer of 1900 in England, and
it was during this period that Cushing began the firm friendship with
Osler that was to continue until Osler’s death. Much of the success of
this European visit was due to the numerous introductions that Osler
could make for his young colleague. On this trip Cushing also visited
surgical centres in France, Germany and Italy.
After spending the year 1900-1901 in Europe, Cushing in 1902 returned to
Johns Hopkins, where he ran courses in surgical anatomy, and organized
an experimental surgical laboratory in which junior students carried out
operative surgical procedures on dogs. It was at this time that he began
to move toward neurological surgery, particularly turning his attention
during the next three years to patients with pituitary tumours. He was
the first American to devote full time to the development of
neurological surgery.
Family life
In 1902 Cushing married Katharine Stone Crowell, a Cleveland childhood
friend. They had five children: William Harvey, Mary Benedict, Bestey,
Henry Kirke and Barbara. The situation in his fathers household was
repeated in his: he spent long hours at the hospital, then devoted
evenings to writing. Yet many house officers and students remember the
warm hospitality of a friendly family and Dr. and Mrs. Cushing as
gracious hosts. Their elder son, William, a Yale student, was killed in
an automobile accident in 1926, and Cushing's sorrow was deepened
because he had only begun to know him.
Into neurosurgery
Cushing’s first experience of pituitary disease was in 1901, when he
carried out a decompression of a girl aged 14 who had complained of
headaches and visual failure. She was fat and sexually immature. At post
mortem she was found to have a large pituitary cyst, In the same year,
Alfred Fröhlich (1871-1953) reported a similar case from Vienna, a boy
of 15 with headache, failure of vision, obesity and sexual immaturity.
The patient was operated on by Anton von Eiselsberg (1860-1939), who
drained a cystic tumour of the pituitary. Fröhlich syndrome passed
eponymously into medical terminology. In this work it has been entered
as Babinski-Fröhlich syndrome, named for Joseph Babinski (1857-1932) who
described the condition in 1900, one year before Fröhlich.
Pity the pituitary
In March 1909 Cushing carried out his first operation for acromegaly.
The patient was a 38-year old farmer referred by Charles Mayo. The
approach to the pituitary was via a frontal flap opening the frontal
sinuses. The patient made a remarkable recovery and lived until 1930.
This was only the second successful case, the first having been operated
by Herman Schloffer (1868-1937), then professor of surgery at Innsbruck,
in 1907. Between 1909 and 1911, Cushing collected 46 patients with
lesions involving the pituitary and most of these were subjected to
surgery. The dangers and difficulties of these early operations are
demonstrated by the fact that of three patients in this series with
acromegaly who were operated upon, two died.
Cushing was associate Professor of Surgery at Johns Hopkins from 1903 to
1912. In 1910 he had accepted the appointment as Mosley Professor of
Surgery and chairman of the department at Harvard Medical School, and
Surgeon-in-Chief at the Peter Bent Brigham Hospital on the Harvard
Medical School campus. He entered his new tenure when the new school
opened in 1913, and remained until his retirement in 1932. The first
patient to enter the surgical service – a woman with varicose veins of
the legs – was admitted on January 27, 1913.
During World War I he was briefly in France in 1915 at the military
hospital established at Neuilly outside Paris in the converted Lycée
Pasteur, and again from 1917 to 1919 as chief of Base Hospital No. 5.
During this time he had a brush with the military hierarchy. As a
Colonel with a Harvard Unit serving with the British Expeditionary
Forces, in a letter to his wife which was intercepted by French sensors,
he made some harsh criticism of a British surgeon. The letter was handed
over to the British government and he was threatened with a court
martial. The matter was smoothed over eventually by him being
transferred to an American command.
In 1936 he published From a Surgeons Journal, 1915-19 of his experiences
in World War I which gives poignant descriptions of the wounded and a
sad account of the death of Osler's only child Revere, at whose side he
stayed until he died. He comments on the irony of a grandchild of the
famous American patriot, Paul Revere, being buried wrapped in a Union
Jack.
The roaring twenties
The 1920’s were a particularly fruitful period for Cushing. His clinical
output was prodigious, and he trained a series of remarkable men, both
from the USA and Europe, who themselves and, in turn, through their
trainees spread the Cushing technique throughout the world. Among the
most distinguished of those from the USA was Walter Edward Dandy
(1886-1946), who introduced ventriculography and the radical excision of
acoustic tumours.
Cushing's perhaps most important work in the 1920’s was in the problem
of haemorrhage. One of the major technical problems that Cushing had to
overcome in the development of surgery of the central nervous system was
haemorrhage. The scalp itself is particularly vascular. In 1910 he
developed a small silver clip (Cushing’s clip). Suction was introduced
to deal with bleeding in deeply placed recesses of the skull. Most
important, however, was his work on the application of electrical
coagulation to neurosurgery. A large part of this was done with the
physicist Dr. William Bovie. In 1926 he used the high-frequency current
to remove a vascular myeloma invading the scalp. A previous attempt by
Cushing to excise the tumour had failed because of haemorrhage. On this
occasion, Cushing’s operation notes read,
”With Dr Bovies help I proceeded to take off most satisfactorily the
remaining portion of the tumour with practically none of the bleeding
which was occasioned in the preceding operation. The loop acted
perfectly and blood stilling was almost complete but whether we would
venture to use anything of this kind in the brain tissue itself I am at
a loss to know because almost certainly it would cause convulsion.”
As he gradually solved the problems of brain surgery, patients and young
physicians came to his clinic from all over the world. The results of
his labours are recorded in 330 books and papers. In 1932, at the
retirement age of 63, Cushing retired as Mosley professor, after
occupying the chair for 20 years. He was replaced by Elliott Carr Cutler
(1888-1947), who had been one of the early members of Cushing's house
staff at the Bingham. In 1933 Cushing moved to Yale as Sterling
Professor of Neurology from (1933-1937) and also was made Director of
Studies in the History of Medicine. There he published selections from
his war diaries, completed an extensive monograph on the meningiomas,
and made plans for leaving his library of some 8.000 items, many of
great rarity, to Yale University. The establishment of the Medical
Library at Yale in 1941 was largely due to the efforts of Cushing and
his friends, Dr. Arnold Carl Klebs (1870-1943) of Switzerland and John
Farquhar Fulton (1899-1960), a Yale physiologist. Calling themselves
“The Tritarians” these three great figures of twentieth-century
medicine, together with other friends with smaller collections, gave
their extensive library collections to Yale to form the nucleus of one
of the great medical historical libraries of the world. John Fulton
later received the Pulitzer Prize for his biography of Cushing.
Honours
The list of Cushing's honours, honorary doctorates and other
distinctions fills several pages. He was awarded honorary degrees from
nine American and thirteen European universities; several decorations:
Distinguished Service Medal, Companion of the Bath, Officier de la
Légion d’Honneur, and order of El Sol del Perú; and many prizes and
awards. He was a member of the American Philosophical Society, the
National Academy of Sciences, and the American Academy of Arts and
Sciences; a foreign member of the Royal Society; and a member, often
honorary, of more than seventy medical, surgical, and scientific
societies in the United States, South America, Europe, and India. Some
thirty-five of his young associates formed the Harvey Cushing Society in
1932; it is now called the American Association of Neurological Surgeons
In 1939, as a surgeon, he was made an Honorary Fellow of the Royal
College of Physicians in London. Cushing wrote and thanked. This is from
a letter written by the secretary of the Royal College in reply to
Cushing's letter:
"I had a fleeting glance at your welcome reply to the President, and saw
that you were interested to know whether a surgeon had ever before
enjoyed the honour. No, the distinction is yours alone. King Edward VII,
when Prince of Wales, was elected an Honorary Fellow in 1897; and in
1928, to mark the auspicious occasion of the Tercentary of the
publication of Harvey's De motu cordis, the College elected four
Honorary Fellows, namely, Lord Balfour, Lord Rutherford, Professor
Pavlov and Professor Wenckebach. Of these, professor Wenkebach is
happily with us. You are the only other Honorary Fellow.
It will be an additional interest to you to know that, including
yourself, only six individuals have enjoyed the distinction of Honorary
Fellowship in the course of two and a half centuries."
The four honorary fellows referred to are the then former British
foreign minister Arthur James Balfour, 1st Earl of Balfour (1848-1930),
the physicist Ernest Rutherford (1871-1937), the Russian experimental
physiologist Ivan Petrovich Pavlov (1849-1936), and the Dutch-born
Austrian internist Karel Frederik Wenckebach (1864-1940).
Greatest of neuro surgeons
In the USA Cushing is generally recognised as a pioneer, maybe the
greatest in neuro surgery. Although he improved and developed several
surgical procedures, there is no particular "Cushing surgical
procedure", but it is obvious that he, more than any other, proved the
feasibility of intracranial surgery. Besides, he was exceptionally
considerate to his patients, which came from all over the USA and from
Europe, some of them prominent figures. He seems to have spent an
enormous lot of time on his surgical activities, for periods operating
every day, and, to the despair of his staff, not infrequently even on
Saturdays and Sundays.
Cushing contributed to the study of blood pressure during surgery and
developed the method of local anaesthesia during surgery. He improved
techniques and introduced, among others, the transphenoidal method of
operation. His most brilliant achievements, however, were in the
treatment of brain tumours, operations that had previously almost
invariably led to the death of the patients. Cushing's neurosurgical
skills reduced the rate of mortality at brain surgery from some 90 % to
approximately 8 %, skills brilliantly demonstrated when, in 1910, he was
called upon to operate on Major General Leonard Wood, Chief of Staff of
the U.S. Army, to remove a large meningioma. The general returned to his
official duties within a month and served throughout World War I and
finally became Governor of the Philippines.
Cushing’s extraordinary achievement (based on a series of more than
2.000 verified cases of tumor) of reducing mortality from almost 100
percent to less than 10 percent would have been impossible without early
and continuing recourse to the experimental laboratory. He was
responsible for establishing the Hunterian Laboratory at Johns Hopkins
in 1905 and also the Laboratory of Surgical research at Harvard. Not
only did they afford a place for his own investigations, but his course
in operative surgery for students, begun in 1902, was basic to another
of his important contributions - the training of a generation of
surgeons who have extended the boundaries of neurosurgery. From these
laboratories came more than 325 papers by his pupils.
Cushing was highly estimated by his colleagues in neuro surgery, and at
the gatherings of the Harvey Cushing Society, established 1932, brought
together several of the world's greatest neuro surgeons.
In September 1926, occasioned by Cushing receiving the prestigious
Cameron Prize for 1924-1925, and giving his three obligatory lecture at
the University of Edinburgh, London Hospital gazette wrote:
"There can be few more interesting figures in the surgical world of
today than Professor Harvey Cushing. Starting out some twentyfive years
ago to specialize in the surgery of the brain, Dr. Cushing rapidly
attained a position of great distinction. The way in which it was done
can be gathered from a study of his Cameron Lectures, now issued in book
form ... His distinction is - and it is a distinction which places him
for all time in the front rank of scientific investigators, and his
almost unique position among surgical specialists - his distinction is
that he has regarded and studied his specialty from every conceivable
angle ... Here is the right kind of specialist fit to join such former
Cameron Prizemen as Pasteur, Lister, Horsley. Si sic omnes!"
Certain technical problems had to be solved before brain surgery could
be successful. In Switzerland in 1900-1901 Cushing studied the
blood-pressure-spinal-pressure problem and demonstrated in a classic
experiment that as the spinal fluid pressure of a dog is increased,
there is initially a vagal effect with bradycardia followed by a high
rise in arterial blood pressure. This finding started physiologists such
as Walter Cannon on years of further study; for Cushing it made possible
safer craniotomes.
In 1901 Cushing visited the University of Pavia, where he met Scipione
Riva-Rocci (1863-1937) and became familiar with Riva-Rocci’s apparatus –
the mercury sphygmomanometer. He took back to America a model of the
apparatus, and was instrumental in its adoption.
The management of haemorrhage was most important, and for this Cushing
devised silver clips still used to control bleeding. In 1925 he
introduced electrocautery in brain surgery and was able to call back
many patients whose tumours he had not dared earlier to attack.
The man and the physician
With his patients Cushing was almost charming, friendly and
compassionate, never in a hurry of any kind. To his fellow workers,
however, Cushing could be an extremely exasperating and hard task
master. His sarcasm and stormy outbursts occurred most frequently in the
operating theatre when he would reduce student nurses to tears
(sometimes he apologised).
One frequently told story about Cushing is that during his Johns Hopkins
days when exchanging stories on Paris with William George MacCallum
(1874-1944), Cushing casually remarked "let us meet at the top of the
Eiffel Tower ten years from now on July 4th at 2.00 in the afternoon,
and continue this conversation". The incident was not mentioned again.
MacCallum went to Paris and went to the top of the Eiffel Tower but
could not find Cushing; he then noticed an iron staircase which went up
to the very top; on clambering up, he was greeted from a small lookout
with "Well, Willy, I had almost despaired of you getting here."
In his time, the Mecca of neuro surgery was in his clinics. His social
circle and his correspondence with colleagues all over the world were
intense - the majority of them also being his students. Numerous travels
helped to uphold the contact.
Cushing's unique position in medical establishment is even more
conspicuous when judged from his circle from outside neuro surgery. He
was visited by Ivan Pavlov (1849-1936), Theodor Kocher (1841-1917),
Archibald Vivian Hill (1886-1977) and Lord Charles Sherrington
(1857-1952), all recipients of the Nobel Prize for Physiology or
Medicine, and he also visited some of them in their own countries. His
correspondence with them often lasted for many years. Fulton's detailed
account of Cushing's circle in this respects reads like a "Who is who in
science?". His broad knowledge of many fields of medicine, maybe most of
all the history of medicine, contributed to this standing.
Even outside medicine he devoted himself to wide interests giving
incitements to visits and correspondence. He was an excellent
illustrator, leaving a large collection of drawings of people he had
met. He was also an accomplished writer, and many consider his book Life
of Sir William Osler (1925) his most brilliant work. It is one of the
finest works in medical biography, and won him the Pulitzer Prize for
1926. He was also a great collector of books, and his large and valuable
book collection, particularly on the history of medicine, was to become
the basis for the Historical Library at Yale. This was taken over by
John Fulton after the death of Cushing.
Cushing died while working on a monograph on the 1600th century
anatomist Andreas Vesalius, in which he took a great interest through
most of his active life. The heart attack which killed him was triggered
as he lifted a heavy folio volume of Vesalius's work.
Handsome and of wiry grace, Harvey Cushing maintained his slight figure
through life by moderate participation in sports - baseball in college,
tennis in later years. Cushing contracted influenza during the pandemic
of 1918 and thereafter suffered from chronic disability, which prevented
him from taking more than a few steps at a time.
Cushing died on October 7, 1939 at the age of 70 of myocardial
infarction. Autopsy showed a posterior coronary occlusion, complete
occlusion of the femoral artery on both sides and, in line with the
belief that doctors often develop the disease in which they have
specialized, a 1 cm colloid cyst of the third ventricle.
A 1988 United States stamp and postcard feature a portrait of Harvey
Cushing, the first person in the United States to use X rays for the
diagnosis of neurological problems.
Some quotations
"His death was not the end. Harvey Cushing, like a truly great teacher,
had merely turned over his work to his pupils in clinics and operating
rooms the world over.
“He was recognised as perhaps the ablest man in his class at the medical
school and was an extremely hard worker. As house officer I was his
junior and suffered severely in that position for a year. He was an
extremely hard man to work with, whether one was over him or under him,
as his tremendous ambition for success made it impossible for him to
allow anyone else to get any credit for work done. As you know, when he
wanted to be he was one of the most charming people in the world, but
working with him I found that he couldn’t tolerate anyone else in the
limelight.”
Franklin S. Newell, who served under Cushing at the Massachusetts
General Hospital, and later became professor of obstetrics at Harvard.
1942.
“As a research man he was of the deductive type of mind. Some
investigators gather their data and try to draw their conclusions from
them. He was inclined to have a theory and then use all of his efforts
and ingenuity to prove the validity of it...
Cushing's interpretation of certain facts which were produced
experimentally under his direction undoubtedly has been rather too
enthusiastic and has been and will be questioned. When he was reminded
of these facts by some of his contemporaries, he usually remarked: 'I
never expected to settle these things; I had set others thinking about
them and this is the main purpose, after all'."
Cushing's associate and admirer, Conrad Jacobsen, on Cushing as a
research scientist.
"As an investigator Harvey Cushing had conspicuous faults as well as
obvious virtues. In the papers on posterior pituitary secretion he had
been led astray, but despite an imposing array of evidence to the
contrary, he never really admitted that he had been wrong; in addition,
he unfortunately caused a number of his junior associates to waste
valuable time and effort in attempting to establish his original
contention. It was a curious foible in a man who had achieved so much in
so many directions."
John Fulton
«To the medical profession, if not to the community in general, The
Dispensary [by Samuel Garth, 1661-1718] must always remain of historic
import, commemorating as it does the first attempt to establish those
out-patient rooms, which since have become such a universal charity.»
Quoted by Mary Lou McDonough in Poet Physicians
«We are tending to become a standarized country, and it is perhaps on
standardization that industrial progress is founded. But standardization
of our education system is apt to stamp out individualism and defeat the
very ends of education by leveling the product down rather than up. The
qualities that really count in this world are quite beyond pigeonholing,
quite beyond measurement by scales, tape, or mental tests, quite beyond
rating by any known system of examination, all of which fail in giving
us an estimate of that most precious of all qualities, personality.
The capacity of the man himself is only revealed when, under stress and
responsibility, he breaks through his educational shell and he may then
be a splendid surprise to himself no less than to his teachers.»
Consecratio Medici, Ch. 1.
«Who have made the greatest gifts to their fellow man? Those who have
left an idea that has supplied, like the utterances of Christ, what
minds have yearned for? Those who have added to his physical comforts
and have found ways to lessen hunger and want? Those who have added to
his conveniences and devised means to lighten his labor? Those who have,
like Lincoln, freed him from bondage and like Lister released him from
the horror of suppuration? One answer certainly can be made: that only
when the gift requires self-denial and only if the giver be one that
walketh uprightly, and worketh rigteousness and speaketh the truth in
his heart, will he, like Saint Francis, come to be canonized and forever
blest.»
Consecratio Medici, Ch. XIV.
«A physician is obligated to consider more than a diseased organ, more
even than the whole man - he must view the man in his world.»
Quoted by René J. Dubos in Men Adapting, Ch. XII.
There is only one ultimate and effective preventive for the maladies to
which flesh is heir, and that is death.»
The Medical Career and Other Papers, «Medicine at the Crossroads.
«In spite of all the discouraging things they are permitted to learn
about the units composing society, the doctor and the priest continue to
have not only hope for but faith in their fellow men, and expect them,
in spite of their frailties, to be unselfish and honest till they prove
themselves otherwise; whereas in trade, politics, and the law, we are
told, a man is primarily taken to be self-seeking until he proves the
contrary.»
The Medical Career and Other Papers, «Medicine at the Crossroads.
«Why not put the surgical age of retirement for the attending surgeon at
sixty and the physician at sixty-three or sixty-five, as you think best?
I have an idea that the surgeon’s fingers are apt to get a little stiff
and thus make him less competent before the physicians cerebral vessels
do. However, as I told you, I would like to see the day when somebody
would be appointed surgeon somewhere who had no hands, for the operative
part is the least part of the work. Then, of course, many of us may get
vascularly speaking, a little inelastic well on this side of sixty, or
may remain in this respect as youthful at seventy as are others at
fifty. This is all a lottery of inheritance and habits, and I shall be
very glad, for one, to have legislated to stop active work at sixty.»
Letter to Dr. Henry Christian, November 20, 1911.
«In these days when science is clearly in the saddle and when our
knowledge of disease is consequently advancing at a breathless pace, we
are apt to forget that not all can ride and that he also serves who
waits and who applies what the horseman discovers.»
Consecratio Medici, Ch. 1
We thank Roberto Knerich for correcting an error in the original entry.
Bibliography:
A full bibliography of Cushing’s publications was published anonymously
by the Harvey Cushing Society in 1939. A reference copy is in the
library of the Royal College of Surgeons of England, inscribed and
presented by Harvey Cushing. It is entitled A Bibliography of the
Writings of Harvey Cushing Prepared on the Occasion of his Seventieth
Birthday April 8, 1939 by the Harvey Cushing Society. Attached to
the RCS copy is a letter from John Fulton noting that the anonymous
compilers were, in fact, Louise Eisenhardt, Madeline Stanton and John
Fulton Himself.
- A method of total extirpation of the Gasserian ganglion for
trigeminal neuralgia, by a route through the temporal fossa and
beneath the middle meningeal artery.
Journal of the American Medical Association, Chicago, 1900, 34:
1035-1041.
- On the avoidance of shock in major amputations by cocainization
of large nerve-trunks preliminary to their division.
Annals of Surgery, Philadelphia, 1902, 36: 321-345.
- On routine determination of arterial tension in operating room
and clinic.
Boston Medical and Surgical Journal, 1903, 148: 250-256.
- Pneumatic tourniquets: With special reference to their use in
craniotomies.
Medical News, 1904, 84: 577-580.
First report of tourniquet with pneumatic pressure of measurable
degree. This inflatable cuff was the forerunner of the modern
technique used generally in surgery.
- Concerning surgical intervention for the intracranial
hemorrhages of the new-born.
The American Journal of the Medical Sciences, Phildelphia,1905, 130:
563-581.
Successful operative intervention in intracranial haemorrhage of the
new-born.
- The establishment of cerebral hernia as a decompressive measure
for inaccessible brain tumors.
Surgery, Gynecology and Obstetrics, Chicago, 1905, 1: 297-314.
- Sexual infantilism with optic atrophy in cases of tumor
affecting the hypophysis cerebri.
Journal of Nervous and Mental Disease, Chicago, 1906, 33: 704-716.
- Surgery of the head.
In: Surgery, Its Principles and Practice, edited by William Williams
Keen, 3: 17-276. Philadelphia, W. B. Saunders, 1908.
Cushing's first treatise on neurosurgery. “As a result of this
detailed monograph, neurological surgery became almost at once
recognized as a clear-cut field of surgical endeavour” (J. F. Fulton,
Harvey Cushing [1947] 268).
- Some aspects of the pathological physiology of intracranial
tumors.
Boston Medical and Surgical Journal, 1909.
- The functions of the pituitary body.
American Journal of the Medical Sciences, Philadelphia, 1910, 139:
473-484.
- The special field of neurological surgery: Five years later.
Bulletin of the Johns Hopkins Hospital, Baltimore, 1910, 21: 325-339.
- The Pituitary Body and its Disorders. Clinical States produced
by Disorders of the Hypophysis Cerebri.
Philadelphia, J. B. Lippincott, 1912.
350 pages with 319 figures and detailed reports on 50 patients with
endocrine disturbance of the gland. The textual matter, case
histories, and illustrations in this pioneer work have scarcely been
improved upon to this day. This landmark in endocrinology also
includes Cushing’s pioneering method of operating on tumours of the
pituitary.
- Tumors of the Nervus Acusticus and the Syndrome of the
Cerebello-pontile Angle.
Philadelphia, W. B. Saunders, and London, 1917. Reprinted 1963.
This book consists primarily of detailed and well-illustrated case
histories of patients with surgically challenging lesions of the brain
stem. It reveals the carefully documented case histories Cushing kept
and the self-discipline with which he worked.
- A study of a series of wounds involving the brain and its
enveloping structures.
British Journal of Surgery, London, 1918, 5: 558-684.
- The special field of neurological surgery after another
interval.
Archives of Neurology and Psychiatry, Chicago, 1920, 4: 603-637.
- The Life of Sir William Osler. 2 volumes. Oxford, Clarendon
Press, 1925.
- Studies in Intracranial Physiology & Surgery. London, 1926.
Cushing delivered the three papers in this book as the Cameron Prize
Lectures at the University of Edinburgh in October 1925.
The three lectures were:
1. The third circulation and its channels.
2. The pituitary gland as now known.
3. Intracranial tumours and the surgeon.
Very little is known about the founder of these lectures, Andrew
Robertson Cameron. He was born in Torland, Aberdeenshire, and
completed his medical studies at Edinburgh in 1861. He emigrated to
Australia, settled in New South Wales, and died there in 1878.
- A Classification of the Tumors of the Glioma Group on a
Histogenic Basis with a Correlated Study of Prognosis. Written
with Percival Bailey.
Philadelphia, London and Montreal, J. B. Lippincott Company, 1926. 121
pages. With 108 illustrations.
First German translation by A. Cammann: Die Gewebsverschiedenheiten
der Hirngliome und ihre Bedeutung für die Prognose. Jena, Gustav
Fischer Verlag, 1930.
- The Meningiomas Arising from the Olfactory Grove and their
Removal by the Aid of Electro-surgery. Glasgow, 1927.
- Tumors Arising from the Blood-Vessels of the Brain: Angiomatous
Malformations and Hemangioblastomas. With Percival Bailey.
Springfield, Illinois and Baltimore, C.C.Thomas, 1928.
This monograph contains the first extensive classification and
description of angiomatous malformations and hemangioblastomas. The
detailed and profusely illustrated case reports are, like all of
Cushing's case reports, a course of instruction in themselves.
- Electro-surgery as an aid to the removal of intracranial
tumors. With a preliminary note on a new surgical-current generator by
W. T. Bovie.
Surgery, Gynecology and Obstetrics, Chicago, 1928, 47: 751-784.
Bovie is the physicist Dr. William Bovie, who in 1926 worked with
Cushing when the latter used the high-frequency current to remove a
vascular myeloma invading the scalp.
- Consecratio Medici and Other Papers. Essays, Boston, 1928.
- The basophil adenomas of the pituitary body and their clinical
manifestations (pituitary basophilism).
Bulletin of the Johns Hopkins Hospital, Baltimore, 1932; 50: 137.
- Intracranial Tumors. Springfield, Illinois, C. C. Thomas,
1932.
Cushing’s operating technique reduced the mortality rate dramatically
in intracranial surgery. This was his last published report on the
statistical results of brain tumours as a whole.
- Papers Relating to the Pituitary Body, Hypothalamus and
Parasympathetic Nervous System.
Springield Illinois, C. C. Thomas, 1932.
The four papers in this volume were "brought together for the
convenience of those whom the general theme might interest." The
papers had all been published elsewhere and were the basis for four
different lectures Cushing had given in England, Canada and America
during the years 1930 to 1932.
- Intracranial Tumours; Notes upon a Series of Two Thousand Cases
with Surgical-Mortality Percentages Pertaining Thereto.
Springfield, Illinois, 1932.
The material covered in this book formed the basis of a report Cushing
made to the International Neurological Congress in Berne, Switzerland
on September 1, 1931.
- From a Surgeon’s Journal, 1915-1918. Boston, 1936.
- Meningiomas. Their Classification, Regional Behaviour, Life
History and Surgical End Results.
With the collaboration of Louise Charlette Eisenhardt (1891-1967).
Springfield, Illinois, Charles C. Thomas, 1938.
Reprint in two volumes: New York, Hafner, 1962.
"The present treatise was commenced in 1915 soon after the completion
of his volume on the pituitary disorders, and it therefore represents
nearly twenty-five years of work; by common consent it is regarded as
Dr. Cushing's greatest clinical monograph. It is the embodiment of all
the things he has stood for during his career as a clinician: his
painstaking case records and photographs, his unusual artistic ability
evident in his own numerous operative sketches, and his extraordinary
knowledge of the day to day life of his patients" (Harvey Cushing
Society).
Dr. Eisenhardt, nurse, physician, brilliant neuropathologist, and
devoted friend and colleague of Dr. Cushing, collaborated in the
publication of the work, and her microphotographs easily support the
classification used in this most exhaustive work on the subject of
intracranial meningiomas.
- Bibliography of Andreas Vesalius.
1943. 2nd edition, Hamden, Connecticut, 1962. A third edition has
later appeared.
- The Harvey Cushing Collection of Books and Manuscripts.
New York, Schuman’s, 1943.
Catalogue, without annotations, of the books and manuscripts
bequeathed by Cushing to the Historical Library in the Cushing/Whitney
Medical Library at the Yale University School of Medicine.
Harvey Cushing and E. C. Streeter edited a facsimile edition of
Giovanni Battista (Giambattista) Canano’s (1515-1579) work
Musculorum humani corporis picturata dissectio, first printed
(probably) in Ferrara, 1541. Facsimile edition, Florence, 1925.
With John Homans (1877-1954), Cushing was co-author of Samuel James
Crowe’s (1883-1955) article Experimental hypophysectomy. Johns
Hopkins Hospital Bulletin, 1910, 21: 127-169. This book gave the first
experimental evidence of the relationship between the pituitary and
the reproductive system.
See also:
- H. Schloffer:
Erfolgreiche Operation eines hypophysen Tumors auf nasalem Wege.
Wiener klinische Wochenschrift, 1907, 20: 621-624, 670-671, 1075-1078.
Schloffer’s operation by the nasal route.
- John F. Fulton:
Harvey Cushing. A biography. Springfield, Illinois, C. C.
Thomas, 1946.
- R. M. Goldwyn:
Bovie: The man and the machine.
Annals of Plastic Surgery, Boston, 1979, 2: 135-153.
- Jeremiah A Barondess:
Cushing and Osler: The Evolution of a Friendship. Transactions
and Studies of the College of Physicians of Philadelphia, 1985, 7:
79-112.
- N. P. Hirsch, G. B. Smith:
Harvey Cushing: his contribution to anaesthesia.
Anesthesia and Analgesia, New York, 1986, 65: 288-293.
- Peter M. Black, editor:
Harvey Cushing at the Brigham.
American Association of Neurological Surgeons, 1993.
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