Harvey Williams Cushing (April 8, 1869 – October 7, 1939) was an American neurosurgeon, pathologist, writer, and draftsman. A pioneer of brain surgery, he was the first exclusive neurosurgeon and the first person to describe Cushing's disease. He wrote a biography of physician William Osler in three volumes.
Cushing was born in Cleveland, Ohio. His parents were Elizabeth Maria "Betsey M." Williams (sister of Edward and Charles Williams) and Henry Kirke Cushing,[1] a physician whose ancestors came to Hingham, Massachusetts, as Puritans in the 17th century.[2] Harvey, the fourth generation of a line of physicians founded by his great-grandfather Dr. David Cushing (1768–1814), was the youngest of ten children.[3]
As a child, Cushing attended the Cleveland Manual Training School, which expanded his interest in science and medicine. The school's emphasis on experimental training and a "physics-focused" approach to education played an important role in influencing Cushing toward a career in medical surgery. The school's manual dexterity training program also contributed to Cushing's future success as a surgeon.[4]
Cushing began his career in private practice in Baltimore. During his time with Kocher, he first encountered the Cushing reflex, which describes the relationship between blood pressure and intracranial pressure. At the age of 32, he was made associate professor of surgery at Johns Hopkins Hospital and was placed in full charge of cases of surgery of the central nervous system. He wrote numerous monographs on surgery of the brain and spinal column and made important contributions in bacteriology. He conducted (with Kocher) a study of intracerebral pressure and (with Sherrington) contributed much to the localization of the cerebral centers.
Shortly after the entry of the United States into the World War I, Cushing was commissioned as a major in the U.S. Army Medical Corps on May 5, 1917. He was director of the U.S. base hospital attached to the British expeditionary Force in France. Cushing also served as the head of a surgical unit in a French military hospital outside of Paris. During his time at the French military hospital, Cushing experimented with the use of electromagnets to extract metallic shrapnel fragments that were lodged within the brain.[8] He was mentioned in a dispatch by Field Marshal Sir Douglas Haig in November 1917.[9][10]
On June 6, 1918, he was promoted to lieutenant colonel and was assigned as senior consultant in neurological surgery for the American Expeditionary Forces in Europe. In early October, while in France, he came down with what he described as "the grippe,"[11] which was probably the Spanish flu. He would never fully recover.[12] He attained the rank of colonel (O-6) on October 23, 1918.[5] In that capacity, he treated Lieutenant Edward Revere Osler, who was fatally wounded during the third battle of Ypres. Lieutenant Osler was the son of Sir William Osler.[13]
Cushing returned to the United States in February 1919 and was discharged on April 9, 1919. In recognition of his service during the war, Cushing was invested as a Companion of the Bath by the British government.[9] In 1923, he was awarded the Distinguished Service Medal by the U.S. Army.[14]
Cushing married his Cleveland childhood friend Katharine Stone Crowell (1870–1949), granddaughter of Ohio congressman John Crowell, on June 10, 1902. They had five children, including three daughters famed for their beauty and collectively known as the 'Cushing sisters':
William Harvey Cushing (1903–1926) (died in an automobile accident while a student at Yale University)
At the beginning of the 20th century, Cushing developed many of the basic surgical techniques for operating on the brain. This established him as one of the foremost leaders and experts in the field. Under his influence, neurosurgery became a new and autonomous surgical discipline.
He was the world's leading teacher of neurosurgeons in the first decades of the 20th century.
Arguably, Cushing's greatest contribution came with his introduction to North America of blood pressure measurement. Upon visiting colleague Scipione Riva-Rocci, an Italian physician, Cushing was astonished by Riva-Rocci's non-invasive way of measuring intra-arterial pressure. In 1896, Riva-Rocci developed a wall-mounted mercurymanometer linked to a balloon-inflated cuff that would measure the pressure needed to compress arterial systolic pressure, i.e. systolic blood pressure measurement. Riva-Rocci's design was based on a more primitive version developed by French physician Pierre Potain. Cushing returned to the US with a sample of Riva-Rocci's sphygmomanometer and blood pressure measurement became a vital sign. The use of the Riva-Rocci sphygmomanometer as a diagnostic tool rapidly spread across the US and Western world, a direct contribution by Harvey Cushing. The device's use continued until Russian physician Nikolai Korotkov included diastolic blood pressure measurement in 1905 (after he discovered the famed "Korotkoff sounds") with his improved sphygmomanometer, which also replaced the mercury manometer with a smaller, round dial manometer.[22]
Cushing's name is commonly associated with his most famous discovery, Cushing's disease. In 1912 he reported in a study an endocrinological syndrome caused by a malfunction of the pituitary gland which he termed "polyglandular syndrome." He published his findings in 1932 as "The Basophil Adenomas of the Pituitary Body and Their Clinical Manifestations: pituitary Basophilism".[23]
Cushing developed many surgical instruments that are in use today, most notably Cushing forceps and the Cushing ventricular cannula. The forceps instrument is used to grasp the thick tissues of the scalp during cranial surgery and the cannula is used to enter the brain ventricles for CSF drainage. He also developed a surgical magnet while working with the Harvard Medical Unit in France during World War I to extract shrapnel from the heads of wounded soldiers.
The Harvey Cushing/John Hay Whitney Medical Library[34]atYale University contains extensive collections in the field of medicine and the history of medicine. Cushing's long-time personal secretary, Madeline Stanton, played a major role in organizing his rare book donations, along with those from John F. Fulton and Arnold C. Klebs, to form the library.[35] In 2005, the library released portions of its collection online, including the Peter Parker Collection which consists of a collection of portrait engravings and 83 mid-19th-century oil paintings rendered by artist Lam Qua of Chinese tumor patients, and a biography of Harvey Cushing by John F. Fulton. In 2010, Yale placed on display Cushing's collection of brain specimens.[36] There is also a collection of his papers at the National Library of Medicine.[37]
^Wisoff HS (2012). "Leo Max Davidoff: his formative years and participation in the MacMillan Arctic Expedition". J. Neurosurg. 117 (3): 447–54. doi:10.3171/2012.4.JNS111211. PMID22725989.
