Neurophilosophy

Harvey Cushing photo journal

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Harvey Cushing (1869-1939) is considered to be the father of modern neurological surgery. In the early part of the 20th century, he developed basic techniques and instruments for operating on the brain and, as a result, founded the discipline as a distinct surgical speciality. Before Cushing began his career, brain tumours were considered to be inoperable, and the mortality rate for any surgical procedure which involved opening the skull was around 90%. Early in his career, Cushing dramatically reduced the mortality rate for neurosurgery to less than 10%, and by the time of his retirement in 1937, he had successfully removed more than 2,000 tumours.


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Cushing was a true pioneer who was not afraid to improvise to achieve the results he wanted. The main reason that mortality rates had been so high before Cushing was blood loss. The brain contains approximately 600km of blood vessels, some of which would invariably be broken when surgeons tried to gain access to the organ. In the majority of cases, patients therefore bled to death. Among Cushing’s significant achievements are the methods he developed to stem this blood loss. At first, he fashioned small hooks from pieces of wire that he found around the home. In the operating theater, he would place these improvised clips around arteries, so that if one were to break, he could minimize blood loss by quickly pinching the ends of the wire together.

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Subsequently, Cushing would use large arrays of artery clamps to reduce blood loss during his operations (as seen above). In 1911, he invented the first vascular clip. Also known as the “silver clip” or Cushing clip, it was designed for “placement on inaccessible vessels, which, though within reach of a clamp, are either too delicate or in a position too awkward for safe ligation.” However, Cushing never actually used the clip; ironically, the first person to use the device to clip an aneurysm was his former student and then competitor Walter Dandy, in 1937, the year of Cushing’s retirement. By excluding an aneurysm from the rest of the circulation, Dandy ushered in a new era of aneurysm surgery.

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Cushing is today regarded as the greatest neurosurgeon of the 20th century, but his reputation was internationally recognized during his lifetime. At the height of his career in the 1920s, he was visited by other luminaries from around the world. One of these was the great British physiologist Sir Charles Sherrington; Cushing had previously travelled to Liverpool, U.K. in 1901, to assist Sherrington on the functional mapping of the motor cortex of great apes. Another was the Russian physiologist Ivan Pavlov, who attended the 13th International Physiological Conference in Boston in 1929. During his trip, Pavlov observed Cushing perform an operation and visited his laboratory, inscribing a piece of meat with Cushing’s new electrosurgical knife while he was there.

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As well as being an outstanding surgeon and scientist, Cushing was an accomplished writer and a gifted artist. While at Johns Hopkins medical School, Cushing became close friends with Sir William Osler, who was the first professor of medicine there. Cushing later wrote a biography of Osler, for which the was awarded the Pulitzer Prize in 1926. His artistic talents were encouraged Max Brodel, a medical illustrator at Johns Hopkins. As a result, Cushing would make drawings immediately after an operation (above and below), which contained information about how the procedure had been performed, and soon became a central part of his surgical reports.

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Cushing was also interested in the history of medicine, and frequented antique bookshops to acquire volumes for his collection. In particluar, he was interested in the work of Andreas Vesalius, the 16th century Belgian anatomist and physician who revolutionized medical illustration. Cushing died on October 7th, 1939, as the result of a myocardial infarction. At the time, he was researching a book about Vesalius. His heart attack was triggered while he was lifting one of Vesalius’s tomes.

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The photographs in this post were found at the Cyber Museum of Neurosurgery. They are among a collection of 28, which together constitute a fascinating photo journal documenting Cushing’s work. The photographs were taken between 1928 and 1932 by Dr. Richard Light, one of Cushing’s last residents, and donated by him to the American Association of Neurological Surgeons, in the form of a bound book. The Cyber Museum of Neurosurgery also has a short film clip of Cushing’s 2,000th operation to remove an intracranial tumour, which I have uploaded to YouTube.

Cushing’s drawing comes from an online exhibit called Harvey Cushing: A Journey Through his Life, at the Yale School of Medicine’s Medical History Library. Some believe that the man in the drawing was modelled on Osler; Michael Bliss, author of the recent biography Harvey Cushing: A Life in Surgery, believes it was actually Cushing’s brother Ned.

Comments

  1. #1 Anibal
    August 23, 2008

    Fantastic post on neurohistory! and Cushing an outstanding man.

  2. #2 Robyn McIntyre
    August 23, 2008

    Wow. What talent! Thank you for introducing me to this interesting person.

  3. #3 Robin
    August 23, 2008

    Thank you for sharing this. I am a Cushing’s Disease survivor and Dr. Cushing’s work has fascinated me. Because the disease is named for him, many folks don’t realize the magnitude of his work beyond that.

  4. #4 Mick
    August 28, 2008

    I just recently saw a BBC special on Cushing at mindhacks.com, but, I learned more from this post than the video. Thanks.

  5. #5 Mo
    August 28, 2008

    Mick: I saw that programme too – it’s actually what inspired me to see what I could find out about Cushing on the web.

    The programme was intereting, but I was very surprised that it did not include the work of Wilder Penfield, who was one of Cushing’s students, and who went on to revolutionize neurosurgery.

  6. #6 Steve Elliot
    September 4, 2008

    The programme mentioned above (BBC TV “Blood and Guts” episode 1) made no mention of Victor Horsley, a British contemporary of Harvey Cushing, also a neuro pioneer. Indeed, Horsley was the first clinician in the world to be given the title “brain surgeon”. Please be sure that I do not wish to diminish Cushing or his work- he was truly a giant of neurosurgery. For a bit more about Horsley try this link. http://www.bmj.com/cgi/content/full/333/7582/1317

  7. #7 Roberta Turner
    March 30, 2009

    Just thought you might want to know a little, very old, story about my father and Dr. Cushing. When my Dad was born
    his doctor didn’t expect my father to live so my grandmother told her doctor that “if her baby (my father) lived, you(the doctor) can name him.” To make a long story short, of course my father lived, and the doctor named my father HARVEY CUSHING TURNER, that was in the year 1923, April.

    Thank you for allowing me to share.
    Roberta Turner

  8. #8 Ana Julia
    April 8, 2009

    For all neurosurgeons, Dr. Cushing is an example to follow… he`s the Father of the neurosurgery and his work is still in use (even his instrument’s are in every OR!)

  9. #9 Ruth N. Ayala
    February 16, 2010

    I am a grateful Cushing’s survivor. My adrenalectomy was in
    1969 (Houston, Texas)..to my knowledge I am the longest
    living Cushing’s patient alive (overactive adrenals removed)…I am soon to be 76years old…doing well so far!

  10. #10 Gail Holst
    July 14, 2011

    Harvey Cushing is very impressive and to see his old photos and history I admire him even more . .I’m very glad to know a remarkable person like him. . .