Harvey Cushing: 1869-1939
A towering figure in American medical history, Harvey Cushing went where few physicians dared in the operating room; and as a physician, surgeon, professor, artist, historian, biographer and bibliophile, his life’s work extended far beyond contributions to medicine.
Harvey Cushing is frequently referred to as the father of neurosurgery. The leading neurosurgeon of the 20th century, Cushing established the field as its own distinct specialty and dramatically decreased the mortality of patients undergoing brain surgery.
Source: Yale University, Harvey Cushing/John Hay Whitney Medical Library
Around 1906, William Williams Keen invited Cushing to contribute 80 pages on neurological surgery to a five-volume edition of Surgery. Cushing, frequently described as a workaholic and a perfectionist, submitted 800 typed pages. His submission was eventually edited to a 276-page monograph with 154 illustrations drawn by Cushing.
The publication of this monograph in 1908 solidified neurosurgery as a recognized specialty and Cushing’s reputation in the field. Slowly, students began to seek out Cushing to learn the techniques and procedures of the specialty.
“Cushing is a transitional figure. Whereas before Cushing, physicians went to Europe to sit at the feet of the master surgeons, in Cushing’s day, Europeans began coming to America to sit at the feet of the young American masters,” Michael Bliss, PhD, University Professor Emeritus at the University of Toronto and author of Harvey Cushing: A Life in Surgery, told Endocrine Today. “They wanted to see Cushing operate. He taught the world the techniques of neurosurgery. There are few people who dominate a field the way that Cushing dominated neurosurgery.”
In addition to neurosurgery, late in his career, Cushing was also able to make a name for himself in another emerging field — endocrinology — with his classification of a new disease entity, soon after called Cushing’s syndrome.
Cushing was born on April 8, 1869, in Cleveland, Ohio, to Henry Kirke Cushing and Betsey Williams. He was the youngest of 10 children and a fourth-generation physician.
After earning a Bachelor of Arts degree from Yale University in 1891, Cushing followed in his brother’s and father’s footsteps and enrolled in Harvard Medical School.
He received his medical degree from Harvard in 1895 and completed his internship at Massachusetts General Hospital where Cushing began making his first contributions to the medical field. Together with fellow student Ernest Amory Codman, Cushing developed a chart to record temperature and respiration during surgery. The chart was a novel idea that helped surgeons monitor patients under anesthesia.
In 1896, Cushing joined The Johns Hopkins Hospital under the direction of William Stewart Halsted. Halsted’s surgical techniques emphasized gentle tissue handling and attention to detail — things that would eventually influence Cushing, who became a meticulous surgeon, taking hours to do operations that other physicians completed in minutes. While at Hopkins, he also met and worked with William Osler.
From 1900 to 1901, Cushing traveled to Europe to observe prominent surgeons overseas. While in Pavia, Italy, he acquired a sphygmomanometer recently improved by Scipione Riva-Ricci with the addition of a pneumatic cuff. Cushing brought this innovation back to Johns Hopkins and began to use it during surgery as an additional measurement to monitor patients under anesthesia.
Improving brain surgery
By 1910, Cushing had accepted a position as chief of surgery in Harvard’s Peter Bent Brigham Hospital. During this time, he began to focus his attention on the nervous system and brain surgery.
At the time, bleeding was the major problem presented by brain surgery. Even the most skilled surgeons had mortality rates of about 50%.
In 1910, Cushing developed a silver wire clip to control hemorrhages of the scalp during surgery and made improvements to burrs and saws used to access the brain. Cushing’s technical contributions such as these continued: In 1926, he worked with physicist William Bovie, PhD, to develop a machine that applied electrical stimuli to the exposed surface of the brain, helping coagulate bleeding points.
These innovations, in addition to the careful monitoring of temperature, blood pressure and breathing during surgery, allowed Cushing to operate on previously inoperable cases.
“Cushing was a slow, meticulous operator who understood that with anesthesia, you could take your time as a surgeon and make sure that you didn’t have bleeding or infection. This enabled him to come and go through the cranium virtually at will,” Bliss said.
Scientifically, Cushing’s intensive study of brain tumors allowed him to recognize which tumors would have more favorable surgical outcomes and which would not.
“What surgeons marveled at with Cushing was that, without X-rays, he was able to work from just signs and symptoms. It was remarkable that he was able to locate as many tumors as he did,” Bliss said.
By the end of his career, Cushing completed more than 2,000 procedures with an unprecedented mortality rate of about 10%.
The pituitary body
Because of his technical proficiency, Cushing was one of the first surgeons to be able to reach the pituitary quickly and safely.
In 1912, he published The Pituitary Body and its Disorders — a book that he claimed was written in a rush — that served as the foundation for serious research into the pituitary gland and its functions.
He is credited for introducing the terms hypo- and hyperpituitarism and for suggesting that the pituitary controlled growth, advances which would eventually lead to the discovery of growth hormone.
Cushing’s interest in the pituitary continued during the next 20 years. In 1932, at the age of 63 and just a few years from retirement, Cushing recognized a cluster of symptoms linked to basophilic cells in the pituitary. He hypothesized that in some cases, this cluster of symptoms was due to an adenoma, which caused excess secretion of growth hormone. In 1932, he published The Basophil Adenomas of the Pituitary Body and Their Clinical Manifestations (Pituitary Basophilism).
“When he published this paper, he only had seen a few cases. It was a daring hypothesis,” Bliss said. “Immediately, there was a rush to see if he was right. There was a lot of skepticism. It turned out he was right, and people named the clinical condition Cushing’s syndrome. It was a quick use of an eponym in endocrinology and has lasted since that time.”
Cases where the cluster of symptoms is due to an adenoma are called Cushing’s disease.
Cushing retired from surgery in 1931 but remained at Harvard Medical School until 1933. He was then named Sterling Professor of Neurology at Yale University, where he remained until 1937.
A bibliophile, Cushing eventually donated about 8,000 books on medicine and physiology to Yale Medical School. He is also widely recognized for his biography The Life of Sir William Osler, 2 vols., which won The Pulitzer Prize in 1926.
Cushing died on October 7, 1939, of a coronary occlusion. His biography of Andreas Vesalius was published posthumously in 1943.
“Some endocrinologists are surprised to learn that Cushing did some surgery and wasn’t just an endocrinologist, but endocrinology was just a side life for Cushing,” Bliss said. “He was simply so talented that, in passing, he became a great figure in the field.” – by Leah Lawrence
For more information:
- Bliss, M. Harvey Cushing: A Life in Surgery. New York, 2005.
- Fulton JF. Harvey Cushing: A biography. Springfield, Illinois: C. C. Thomas; 1946.
- Jay V. The legacy of Harvey Cushing. Arch Pathol Lab Med. 2007;125:1539-1541.
- Simmons JG. Doctors and Discoveries: Lives That Created Today’s Medicine. Boston, Massachusetts: Houghton Mifflin; 2002.