Dr. Harvey Cushing, the Father of Neurosurgery
With brief notes on Bovie, Riva-Rocci and Korotkov
Harvey Cushing, the Father of Neurosurgery, was born the son of a third-generation physician, Dr. Henry Kirke Cushing, on April 8, 1869, in Cleveland, Ohio, USA. He studied Medicine at Harvard Medical School, Boston, Massachusetts. In 1895 he qualified as a medical doctor and, later, trained under the renowned surgeon, William Halsted at Johns Hopkins, Baltimore.
Halsted was a great influence on Cushing. When he spent two years in Europe, he also worked under titans in Surgery like Theodor Kocher in Germany, albeit for a short while. Returning from Europe in 1901, Cushing joined Johns Hopkins during which time he developed a special interest in Neurosurgery.
It was while he was in Johns Hopkins, during the first decade of the 20th century, that he became renowned as a pioneer of Neurosurgery.
In 1912, he joined as Professor of Surgery at Harvard Medical School and Chief Surgeon at Peter Bent Brigham Hospital, Boston, Massachusetts. Subsequently, Cushing served as an army surgeon in Europe during World War I and held the rank of Colonel. After the war, he returned to Harvard. It was while working at Harvard in the 1920s that he rose to international fame as the world’s leading Neurosurgeon.
Cushing is best known as the pioneer of Neurosurgery and the greatest Neurosurgeon of the Twentieth century. He was the first to put X-Rays into medical use as a diagnostic tool, and used it especially to diagnose tumours of the pituitary gland by looking for changes in the sella turcica, a saddle-like bony structure in the lower part of the human skull.
Cushing was also the person who introduced electrocautery to Surgery, without which it is difficult to think of surgical operations these days. The surgical electrocautery is an instrument used during surgical operations and helps to reduce and control bleeding during surgery. He developed the surgical electrocautery in association with William Bovie, a physicist, in 1924. (The name ‘Bovie’ is used synonymously with electrocautery by many surgeons even today, although it is more commonly called diathermy or cautery).
Cushing also improved the BP apparatus, or sphygmomanometer, developed by Scipione Riva-Rocci, an Italian Paediatrician. Riva-Rocci devised a practical sphygmomanometer using, among other things, a bicycle tube. Cushing visited Riva-Rocci in Italy to learn about his sphygmomanometer and, later, simplified it for everyday use.
To Cushing goes the credit for making BP measurement in clinical practice a routine procedure. He was also the first to make it a practice to record intra-operative BP and monitor other vital signs during surgery.
The intra-operative vital signs record was developed by Cushing in 1901 in association with a friend and colleague, Dr. Ernest Codman, after one of their patients to whom ether anaesthesia was administered died intra-operatively. They developed a graphical record with time plotted on the X- axis and pulse, breathing and, later on, BP as well, continuously monitored and plotted on the Y-axis during anaesthesia and surgery and named it the ‘Ether chart’. It was this that became the forerunner of the anaesthesia charts used across the world today which made anaesthesia monitoring a reality and helped significantly reduce anaesthetic mortality.
Incidentally, Riva-Rocci’s sphygmomanometer permitted the measurement only of systolic blood pressure (the upper figure in a BP measurement). It was a Russian Surgeon, Nikolai Korotkov, (see picture below) who, in 1920, introduced the auscultatory method of BP recording (using a stethoscope) which enabled diastolic blood pressure (the lower figure in a BP reading) measurement. This now-commonly-used method of BP measurement is known eponymously as the ‘Korotkov’s method’ of BP measurement.
Cushing was also responsible for introducing autotransfusion of blood, the use of cotton patties in surgery as well as the use of metallic arterial clips.
He is reputed to have believed in doing meticulous, unhurried surgery, taking time.
Doctors of Modern Medicine, of course, know his name in association with the Cushing Reflex, Cushing’s Triad, Cushing’s Disease and Cushing’s Syndrome. He had an intense interest in diseases of the difficult-to-access pituitary gland, located on the undersurface of the brain, and made its surgery a feasible proposition. Through his interest in the pituitary, he also helped develop the field of Endocrinology. Acoustic tumours (tumours affecting the nerve of hearing and balance) were another area of his interest.
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He performed more than two thousand operations on patients with brain tumours. There is an old video recording of him performing his 2000th brain tumour operation in 1929 (to watch this, click YouTube link below). It is a fascinating experience to watch this great surgeon operating nearly a century ago. He maintained meticulous and detailed operative notes and was quite good at drawing surgical illustrations as well.
He maintained a close relationship with his patients and stayed in touch with them even after they left hospital. He loved and truly cared for his patients. He encouraged them to write to him regularly so that he could follow their progress long after they had been discharged.
Cushing was a very good writer and a prodigious author and published over 300 scientific articles and authored over a dozen books. He was so good an author that he won the Pulitzer Prize in 1926 for his biography of the great Sir William Osler, well-known physician and one of the founders of the Johns Hopkins Hospital who was also his close friend and mentor.
Interestingly, it was Osler’s wife herself who asked Cushing to write her husband’s biography. He was to note at one time that “The pen is more difficult to wield than the scalpel.” Cushing was a bibliophile and had a large collection of books. He was greatly interested in the history of Medicine and was working on the biography of the great physician of the medieval era, Andreas Vesalius, when he passed away.
Cushing was an accomplished public speaker as well and was greatly sought after for addressing gatherings of medical professionals across the US. During a graduation speech in a medical college he once noted, “If a doctor’s life be not a divine vocation, then nothing is divine and nothing is a vocation.” He was also a sportsman and an athlete (he loved tennis and baseball too) and an artist as well. He was, truly, a multifaceted genius.
The list of honours that were accorded to him is too long to be mentioned here and included, among several others, Fellowship of the Royal Society, membership of the Royal Swedish Academy of Sciences and the Lister Medal from the Royal College of Surgeons of England. He was nominated for the Nobel Prize in Medicine 38 times, but never won it.
This extraordinary surgeon also had the singular honour of a postage stamp bearing his picture being issued by the US government and even a US battleship, SS Harvey Cushing, being named in his honour.
Cushing was the quintessential workaholic and devoted all his time and energy to serve his patients. He is reported to have said that “No one has any right to undertake the care of any patient unless he is willing to give that patient all of the time and thought that is necessary and of which he is capable.” His intense passion for Surgery had its inevitable adverse fallout on his family life. His wife, Katharine Crowell, whom he married in 1902, was his childhood sweetheart and they had five children.
He was a heavy smoker and, hence, suffered from Buerger’s Disease (Thrombo Angitis Obliterans), a distressing and disabling disease caused by smoking that impairs blood supply to the limbs and causes excruciating pain. He also suffered, and survived, an attack of Guillain-Barre Syndrome (a condition leading to paralysis of the respiratory and other muscles).
Cushing retired from active surgical practice in 1932. After retirement, he took up the prestigious post of Sterling Professor of Neurology at Yale, New Haven, and devoted his time to writing and medical history and organising his famous brain tumour registry.
He passed away in New Haven on October 7, 1939, aged 70, after a myocardial infarction (or ‘heart attack’). He was buried in the Lake View Cemetery in his hometown, Cleveland, Ohio, US. His priceless legacy lives on eternally as the specialty of Neurosurgery that he fathered, his various other pathbreaking contributions to Modern Medicine, the legion of Neurosurgeons whom he inspired and trained as well as their successors who serve humanity across the world and the countless fortunate patients who have been saved from their afflictions thanks to them.
