AANS Neurosurgeon | Volume 29, Number 1, 2020

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Connecting the Dots: The Influence of Harvey Cushing

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Proudly sporting a new mustache, a young Harvey Cushing stood on a pier in New York City, where the SS Servia made final preparations for Liverpool.2 From the banks of the Hudson, the ascendant surgeon embarked on his expedition, a pilgrimage to discover the marvels of European medicine. It was the summer of 1900, the dawn of a new era for medicine. Cushing had already facilitated the introduction of the X-ray at Massachusetts General Hospital during his surgical internship only a few years prior. Now, at the outset of his great journey across the Atlantic, he was eager to venture forth and rediscover other jewels of the Old World. He would return to Johns Hopkins Hospital 14 months later with a multitude of knowledge and a renewed perspective on laboratory experimentation.

Osler’s Sponsored Year in Europe

Cushing’s sponsor in this endeavor was none other than the world-renowned Sir William Osler. Under the tutelage of Osler and other physicians at Hopkins, Cushing had already demonstrated the beginnings of an extraordinary career. This new journey would serve as an opportunity for Osler to introduce his mentee on the world stage. Once they arrived in Europe, Osler shepherded the young debutante into the meetings of the premier medical societies of London and Paris. Cushing eagerly learned from the preeminent surgeons and researchers of his time before traveling to Switzerland to further develop his own acumen.

At the University of Bern, Cushing undertook his own research projects in the laboratory of Theodor Kocher, a Swiss surgeon destined to win the Nobel Prize for his work on thyroid surgery. Cushing worked diligently to study the effects of head injuries. He observed that an increase in intracranial pressure results in a corresponding increase in blood pressure, a phenomenon later coined as the eponymous Cushing reflex.

Cushing’s year in Kocher’s laboratory produced essential medical knowledge that is still taught today. In Bern, he was connected to researchers such as Hugo Kronecker; these introductions engendered further collaborations and discoveries. After his time abroad, Cushing came back to America with a stack of papers for publication, a sphygmomanometer he picked up in Italy and a keen appreciation for the value of laboratory science in advancing medical care.

Returning to Baltimore

Upon his return to Baltimore, Cushing joined the Johns Hopkins Hospital faculty and was soon appointed by William Halstead to run the Hunterian Laboratory, America’s first experimental surgical laboratory.3 The Hunterian Lab expanded under Cushing’s leadership, and a Hunterian Building was constructed in 1904. Its state-of-the-art teaching methodologies allowed medical students to practice surgical techniques on anesthetized dogs and simulate operations. The lab soon became dedicated to studying the intricacies of the central nervous system. During this time, Walter Dandy trained in the Hunterian Lab as a medical student. He would soon run the lab following Cushing’s departure. Cushing’s advancement of Osler’s legacy and Dandy’s advancement of Cushing’s underscore the importance of mentorship within the neurosurgical field and the duty of leaders to train and inspire future generations.

From Cushing to Me and Beyond

This past summer, I had the pleasure of working in the historic product of Cushing’s European expedition. In 1984, Dr. Henry Brem reestablished the defunct laboratory at its original site in the Hunterian Building. It later moved to the Koch Cancer Research Building in 2006, where it is now, home to many of Hopkins’ aspiring and accomplished researchers. During my time there, I would often come across evidence of the lab’s generations of trainees. Decades of research notebooks can be found in a file cabinet, each filled with carefully detailed experiments and the excited scrawl of discovery.

Cushing’s vision for the Hunterian Laboratory is very much alive today. My experiences with translational research in the summer of 2019 were highly formative. The lab enabled me to further hone the basic science skills I had developed before medical school and apply them to research questions relevant to neurosurgery. I studied a novel potential therapy for triple-negative breast cancer in the context of spinal metastatic disease. The tribulations and eventual triumphs of performing murine intracardiac inoculations and other challenging new techniques were shared between students and researchers from around the world. I gained mentors and friends who bolstered my interest in the field.

The spirit of international collaboration is echoed in the 1916 sketch of Cushing by John Singer Sargent. Both Americans were trained by a variety of international mentors before rising to the forefront of their respective fields. The elegant charcoal portrait was featured on the Cushing stamp in 1988 by the United States Postal Service and can be seen in the logo of the AANS.1 The surgeon Cushing and the painter Sargent drew great inspiration from their travels. Cushing returned to instill the traditions of mentorship and collaboration in the Hunterian Laboratory, which fosters the careers of hundreds of trainees to this day.

References

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1. Art “of” and “by” Neurosurgeons Gallery. (n.d.). Retrieved from https://www.neurosurgery.org/cybermuseum/artgallery/neuro/room2.html

2. Bliss, M. (2007). Harvey Cushing: a life in surgery. Toronto: Univ. of Toronto Press.

3. Sampath, P., Long, D. M., & Brem, H. (2000). The Hunterian Neurosurgical Laboratory: The First 100 Years of Neurosurgical Research. Neurosurgery, 184–195. doi: 10.1097/00006123-200001000-00036

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