Harvey Cushing: A Biography

"Pre-neuroimaging (and pre-antibiotic) neurosurgery at the close of the 19th century “lay under a shadow” and brain tumor cases were turned over to neurosurgeons “with reluctance and only as a last resort,” as Cushing recalled in 1931. At Johns Hopkins, Cushing’s surgical mentor W.S. Halstead encouraged his resident to go into orthopedics! On his wanderjahr in Berne, Cushing resolved to devote himself “should opportunity arise, to the surgery of this special field”—the nervous system. There is no more compelling or eloquent evidence of Cushing’s impact on his special field than the timeline of his surgery on 2000 intracranial tumors. In 1901 after operating three times on a woman with failing vision, headaches, and a pituitary tumor, the patient died. By 1931 Cushing had operated on 360 patients with pituitary tumors, and many had Cushing’s disease with weight gain, cutaneous striae (stretch marks), a ‘moon-like’ face, and a ‘buffalo hump’—that is, fat deposits on the back of the neck. Cushing did not know the hormonal cause—pituitary overproduction of adrenocorticotropic hormone, which was isolated in 1933—but his refined surgical technique with transsphenoidal removal of pituitary tumors through the nasal cavities was a success. His 2000th patient, who also had a pituitary tumor, made a perfect recovery. As a 30-year-old Fulton became a Sterling Professor at Yale and authored the first textbook of neurophysiology. During his training he spent a year on Cushing’s surgical service. Although Cushing was an uncompromising taskmaster, they got along famously, and it has been said that Fulton was the son Cushing never had. After Cushing died in 1939, WWII intervened and Fulton was unable to complete this magisterial biography of his clinical doktorvater until 1946. “We’re still wrestling with the marvelous complexity of the 86 billion neurons we carry inside our heads” Cushing as much as anyone embodied the cultural icon of the ‘brain surgeon’ and created the modern specialty of neurosurgery. His pursuits included writing a two-volume Pulitzer Prize-winning biography of his own mentor and pole star, Sir William Osler. At age 46, during the First World War, he sailed to Europe “through the Lusitania wreckage … steamer chairs, oars, boxes, overturned boats – and bodies” to become a US Army surgeon operating “under canvas” on casualties during the battles of Ypres. Interspersed along the page margins are pen-and-ink sketches by Cushing who could draw craniotomies, landscapes, and people with equal facility."