Harvey Williams Cushing (1869–1939)

Sir William Macewen (1848–1924) of Glasgow was the first practitioner of modern neurosurgery, but he didn’t devote the majority of his time and energy to this field. In 1888 he published his report on 21 operations with 18 recoveries, thus demonstrating the possibility of operating safely on the brain. In 1886, Victor Horsley (1857–1916) was appointed surgeon to the National Hospital for the Paralysed and Epileptic at Queen Square, London. This was the first neurosurgical appointment anywhere. In the first year of his appointment he performed 10 cranial operations. Horsley operated only by invitation. He had no beds of his own, no surgical service and no laboratories.

One of the most important figures in the early development of neurosurgery was Harvey Cushing who arrived at The Johns Hopkins Hospital and Medical School in the autumn of 1896 as William Stewart Halstead’s assistant resident in surgery. Cushing subsequently worked out an arrangement with Halstead whereby he handled the neurological cases. By 1904 when he delivered a paper before the Cleveland Academy of Medicine on The Special Field of Neurological Surgery his enthusiasm for the field was well established. During his surgical residency at Johns Hopkins he learnt the delicate handling of tissue in the Halstead tradition. Cushing was largely responsible for neurosurgery being recognised as a distinct entity. Important technological advances, such as the discovery in 1895 of x rays by Roentgen, Walter Dandy’s invention in 1918 of air encephalography and, in 1919, pneumoencephalography, assisted the development of the speciality. Dandy, with whom Cushing had a strained relationship, was his assistant resident from 1911–12.

Cushing’s first article described the case of a gunshot wound to the cervical spine. In the paper was a reproduction of an x ray he had taken himself, which showed the bullet in the spinal canal. He pioneered several important techniques in neurosurgery, relating especially to the control of blood pressure and haemorrhage during surgery, the improved understanding of raised intracranial pressure, and the natural history and pathology of lesions of the central nervous system. His research on brain stem control of systemic blood pressure during raised intracranial pressure lead to what is known as the Cushing Response. In 1901 he assisted Charles Sherrington in mapping the motor cortices of anthropoid apes. Cushing identified several varieties of brain tumours and made great advances in their treatment. He also made substantial contributions to understanding of the separate functions of the anterior and posterior lobes of the pituitary, and was the first to associate pituitary adenoma with Cushing’s syndrome. Following his suggestion in 1919, the Society of Neurological Surgeons was formed. By 1930 the society had become very restricted in its membership. In 1931, with Cushing’s permission, the Harvey Cushing Society was formed by a group of young neurosurgeons.

As a soldier during World War I, he designed a base hospital that could be mobilised at short notice. He had a lifelong interest in the history of medicine. Halstead was the first professor of surgery at Johns Hopkins, but, professionally, Cushing’s most important friendship was with Osler. His Life of Sir William Osler won him the Pulitzer Prize in 1926. During his career, Cushing published 13 books and 300 scientific articles. His large collection of books and papers was donated to the Yale medical Library, which he helped to plan. The destroyer USS Cushing launched on 31 December 1935, and completed on 10 December 1936, was named in his honour.

Cushing was honoured philatelically on a stamp issued by the United States in the series honouring Great Americans. The first day of issue of the Harvey Cushing stamp was 17 June 1988 (Stanley Gibbons 2129, Scott 2188).