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B OOKSHELF G ARY V ANDER A RK, M D
A Tale of Neurosurgery’s Founder
A Compelling Cushing Inspired a Specialty
Harvey Cushing:
A Life in Surgery,
by Michael Bliss,
2005, Oxford
University Press,
591 pp., $40
($26.40 for AANS
members).
Canadian historian Michael Bliss,
MD, author of William Osler: A Life
in Medicine, has written a new book
about neurosurgery’s founder, Harvey
Cushing. It is a book that everyone
should read.
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.
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
He was the kind of man
you would work with,
admire and respect, but
not one you would like.
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. 3
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.
Volume 14, Number 4 • AANS Bulletin 41