 |
Harvey Cushing: A Life in Surgery, by Michael Bliss, 2005, Oxford University Press 591 pp., $40 ($26.40 for AANS members in the Online Marketplace). |
Bliss based this book on a host of Cushing family papers unavailable to earlier biographers. As a result, this is a less constrained and more personal biography. Cushing still comes through as a daring innovator and icon, but he is also revealed as a real person with many foibles.
Born in Cleveland in 1869, Cushing graduated from Yale in 1891 and Harvard Medical School in 1895, staying in Boston for an internship at Massachusetts General Hospital. Then Baltimore beckoned with its new, graciously endowed Johns Hopkins Hospital and Medical School. Halsted, Welch, Kelly and Osler all influenced Cushing, although during his training Cushing had limited contact with Halsted, but it was Osler who quickly became a surrogate father figure for the young surgical pioneer.
| He was the kind of man you would work with admire and respect, but not one you would like. |
A most significant part of Cushing’s development then followed in his “Wanderjahr” of 1900-01, when he visited Europe. There, Cushing was shocked by the lack of surgical asepsis, concern for the feelings of the patients and consistency of surgical techniques. He also did the research that led to elucidation of the “Cushing reflex.”
The next year, Cushing married Kate Crowell and they moved into the house next to the Oslers in Baltimore. Cushing was declared the neurosurgical specialist among the Hopkins surgeons. His interest in brain surgery resulted from his ability to successfully treat trigeminal neuralgia by gasserian ganglionectomy. As a result, he began to do brain tumor operations, and in 1902 performed a successful nerve anastamosis.
Before 1900 more than 500 general surgeons in the United States had done operations on the brain. Cushing, however, brought to the then-dismal field a highly developed set of techniques to control bleeding, crucial knowledge of and sensitivity to the problem of intracranial pressure, an awesome dexterity, and an equally awesome combination of enthusiasm and determination to succeed.
During the first decade of the 20th century, Cushing established neurosurgery as a specialty. He developed subtemporal decompression as his basic intracranial operation. It was his all-purpose response to any cerebral symptomology. Halsted is said to have commented during these years that he didn’t know whether to refer to “poor Cushing’s patients or Cushing’s poor patients.”
But he also increasingly dedicated himself to the pituitary toward the end of that decade. By 1912 he had data on 48 patients and wrote The Pituitary Body and Its Disorders. It was not until many years later that he described the syndrome of hypersecretion due to a basophilic adenoma that came to be known as Cushing’s syndrome.
Cushing is not presented in this book as the well-rounded person we would like our residents to become. He was not a good husband; he was an absentee father, and in the operating room he could be peevish and mean. One Hopkins resident said, “He was the kind of man you would work with, admire and respect, but not one you would like.”
World War I, in which Cushing served two tours of duty, definitely took its toll. While in France he probably had the dreadful influenza and then post-flu Guillain-Barre syndrome. This, combined with Berger’s disease made worse by his smoking, resulted in significant pain and lower extremity disability. He also learned something from the war, however — how to operate more rapidly. By the time the war ended, he was able to do eight major cases in a day.
I particularly enjoyed the portions of this book that deal with the relationship between Cushing and Osler. The book’s most moving scene is the death of Osler’s son, Revere, on the operating table in Flanders. William Osler himself died in December 1919, and within a few months his widow asked Cushing to write his biography. Cushing responded by doubling his workload to write more than a million words about his mentor. The final work was edited down to the two-volume The Life of Sir William Osler, published in 1925. One year later Cushing was awarded the Pulitzer Prize in biography for this work.
Bliss refers to Cushing as “the Babe Ruth of his game.” Interestingly, his subject enjoyed the athletic analogy, too. Cushing wrote to his oldest son, who was struggling with his studies, “Life all round is a kind of sporting event and the best any of us can do is to try continually to improve our game.”
Reading this book will help you improve your own game.
Gary Vander Ark, MD, is director of the Neurosurgery Residency Program at the University of Colorado. He is the 2001 recipient of the AANS Humanitarian Award.