Guest post from Kristopher T. Kimmell, MD
Neurosurgical Resident, University of Rochester Medical Center
Did you know that August is AANS Neurosurgery Awareness Month?
This year, for Neurosurgery Awareness Month, the American Association of Neurological Surgeons is bringing attention to the role of neurosurgeons in the treatment of stroke. Materials include a review of current apps designed to support stroke diagnosis and treatment, a look at pioneers in the treatment of cerebrovascular disease and several inspiring patient stories. In addition to the AANS effort, Neurosurgery Blog will publish various items during August to promote Neurosurgery Awareness Month, including videos that highlight the tremendous accomplishments of neurosurgery’s founding fathers. As the founder of modern neurosurgery, no one is more responsible for the specialty of neurosurgery than Harvey Cushing.
Harvey Williams Cushing, MD, was born in Cleveland, Ohio, in 1869. He had a rich cultural and educational heritage, having descended from Puritans on both sides of his family as well as being a fourth generation physician in his family. After undergraduate training at Yale University, Cushing attended Harvard Medical School. Upon finishing medical school, he went to Johns Hopkins Hospital, where he came under the influence of two giants of early modern medicine. William Halsted, whose seven principles of surgery are the bedrock of modern surgical technique, was Cushing’s surgical mentor, and from him, Cushing would learn the meticulous tissue handling that was one of the hallmarks of his career. Sir William Osler was also a tremendous influence on him, and Cushing wrote a biography of Osler, for which he received a Pulitzer Prize in 1926.
Early in his career, Cushing spent time in Europe under the tutelage of two influential European physicians, Sir Charles Sherrington in England and Emil Kocher in Switzerland. It was in Switzerland where Cushing conducted experiments describing the so-called “Cushing reflex” — a physiologic triad of hypertension, bradycardia and irregular breathing associated with increased intracranial pressure. Cushing’s advances in the understanding of intracranial pressure would impact his clinical practice. He developed a palliative surgical technique known as subtemporal decompression, by which a small portion of the skull is removed to allow brain swelling through the aperture in cases of severe raised intracranial pressure as in traumatic head injuries and brain tumors. He left his practice to serve in the American Expeditionary Force as a surgeon during World War I. During his time at battlefield hospitals, Cushing advanced the practice of management of head injuries including the closure of complex head wounds.
Using his tremendous understanding of the nervous system coupled with his meticulous surgical technique, Cushing developed a neurosurgical practice that raised neurosurgery from a crude, barbaric practice to a refined specialty with acceptable morbidity and mortality. By the 1920s he had decreased the mortality of cranial procedures from near 100 percent to a respectable 11 percent. During his career, Cushing would operate on over two thousand brain tumors. His volume and results were more than enough to earn the praise of his colleagues, but his reputation was enhanced by his successful operation on a high profile patient. General Leonard Wood, was a high-ranking military officer who served as governor of Cuba and the Philippines and was a close friend and advisor of President Theodore Roosevelt. Wood was diagnosed with a benign meningioma in 1910 and shortly after that, Cushing successfully removed the tumor.
Cushing’s contributions to modern medicine, neuroscience, and, especially to neurosurgery, are countless. He developed the anesthesia chart, by which patient’s vital signs — including heart rate, blood pressure and respiratory rate — are routinely monitored and documented during surgery. He was the first to use the electrocautery device invented by W. T. Bovie and for whom the instrument is still named. Before the utilization of the electrocautery, Cushing developed silver hemostatic clips to limit blood loss during cranial surgery. Cushing was also a pioneer in the understanding of diseases of the pituitary gland, in particular, tumors of the pituitary. Cushing’s disease, which bears his name, is a characterized by excess cortisol caused by a hormonally active tumor of the pituitary gland. In keeping with his meticulous nature, Cushing kept specimens from many of his brain tumor patients. His vision was to have all of these specimens cataloged and available for future analysis, a sort of registry of brain tumors. This vision anticipated modern tumor and tissue banking efforts. Today many of Cushing’s brain tumor specimens, as well as his extensive medical text library (he was an avid bibliophile and collector), are on display at the Cushing Center at Yale University.
Neurosurgery today owes a great deal of its success and reputation to the herculean efforts of forebears such as Dr. Cushing. Today we honor him as one the Faces of Neurosurgery’s Founders.