Harvey Williams Cushing

1869-1939

American Neurosurgeon

Harvey Cushing was generally acknowledged during his lifetime as the world's greatest brain surgeon. He invented many basic neurosurgical procedures, operated on tumors previously considered inoperable, and worked closely with pathologists, endocrinologists, and other medical specialists to understand and classify various brain lesions and their outcomes.

Cushing was born in Cleveland, Ohio, the youngest of ten children of Betsey Maria Williams Cushing and Henry Kirke Cushing. His father, grandfather Erastus Cushing, and great-grandfather David Cushing were all physicians.

He received his A.B. from Yale University in 1891 and his M.D. from Harvard Medical School in 1895. After a one-year internship at Massachusetts General Hospital, he became a resident surgeon at the Johns Hopkins Hospital and an instructor in surgery at the Johns Hopkins School of Medicine. He studied under William Stewart Halsted (1852-1922) at Hopkins from 1896-1900, then under Emil Theodor Kocher (1841-1917) and Karl Hugo Kronecker (1839-1914) in Berne, Switzerland, and Sir Charles Scott Sherrington (1857-1952) in Liverpool, England, from 1900-1901.

Cushing returned to Hopkins in 1901. The following year he married Katharine Crowell in Cleveland. He was Associate Professor of Surgery at Hopkins from 1903 until 1912, when he became jointly the Moseley Professor of Surgery at Harvard and Surgeon-in-Chief at the Peter Bent Brigham Hospital in Boston. He held both these posts until 1932, with the exception of the time he spent in volunteer surgical service in World War I. He commanded the U.S. Army Base Hospital No. 5 in France and was discharged in 1919 at the rank of colonel.

Among Cushing's major books are Surgery of the Head (1908), The Pituitary Body and its Disorders (1912), Tumors of the Nervus Acusticus and the Syndrome of the Cerebellopontile Angle (1917), Studies in Intracranial Physiology and Surgery: The Third Circulation, The Hypophysis, The Gliomas (1926), Consecratio Medici (1928), Intracranial Tumours (1932), Papers Relating to the Pituitary Body, Hypothalamus, and Parasympathetic Nervous System (1932), and several memoirs. With neurosurgeon Percival Bailey (1892-1973) he wrote A Classification of the Tumors of the Glioma Group on a Histogenetic Basis with a Correlated Study of Prognosis (1926) and Tumors Arising from the Blood-Vessels of the Brain: Angiomatous Malformations and Hemangioblastomas (1928). With neuropathologist Louise Charlotte Eisenhardt (1891-1967) he wrote Meningiomas: Their Classification, Regional Behaviour, Life History, and Surgical End Results (1938).

His pet project was the "Brain Tumor Registry." His idea was to preserve and document every brain lesion that he personally obtained either in the operating room or at autopsy and to chart the life expectancies of all his surviving patients. After workers in the pathology laboratory at Hopkins lost a pituitary cyst that Cushing had removed in 1902, he always demanded to manage his pathological specimens himself. By the early 1930s the result was a collection of over two thousand brain lesions and a year-by-year account of over a thousand brain surgery survivors. Shortly after Cushing became Sterling Professor of Neurology at Yale in 1933, Yale appointed Eisenhardt to oversee the registry. She continued this task long after Cushing's death. In 1945 she was still tracking about 800 of his survivors.

Besides being a skilled clinician, Cushing was also an expert on medical history. He lectured frequently on that subject; directed history of medicine studies at Yale from 1937 until his death; wrote the standard bibliography of the founder of the modern science of anatomy, Andreas Vesalius (1514-1564); and won the Pulitzer Prize in 1926 for his biography of Sir William Osler (1849-1919).

Even though Cushing was universally respected and sometimes deified, he was not easy to like. He was a bad-tempered, self-certain show-off who displayed nearly constant scorn for his colleagues and subordinates. Nevertheless, he could occasionally be gracious and even charming. Bailey expressed the thoughts of many when he said of Cushing: "One forgave him much because of his accomplishments." Evidence of the extent of this forgiveness is that the American Association of Neurological Surgeons was known from its founding in 1931 until 1967 as the Harvey Cushing Society.

ERIC V.D. LUFT