Late on a Friday afternoon in May 1984, seventy-five-year-old Betsey Whitney, the last of the three Cushing sisters whose photos had appeared on so many society pages earlier in the century, sat in rapt attention as her father’s many contributions to medical science were described to an audience of about 150 fascinated listeners. The occasion was the annual Meeting of the Associates of the Yale Medical Library, and the speaker was Dr. Jeremiah Barondess, professor of medicine at Cornell and, coincidentally, her own personal physician.
Flanked by her two daughters in the high-vaulted, balcony-rimmed Medical Historical Library, Mrs. Whitney was surrounded on all sides by shelves containing hundreds of the valuable books collected by her father during his lifetime. Two floors of stacks lay below, holding many hundreds more from his collection, adding up to thousands. To enter the library, the three women had passed through the two-storied Cushing Rotunda, presented to the university by the Yale class of 1891, in honor of their most distinguished classmate. As they were being escorted through that lofty—in both senses of the word—space that has been a source of inspiration to several generations of medical students and faculty, the three women paused to look up at its circular walls, which displayed fourteen steel crests representing the European honorary degrees awarded to Harvey Cushing. No graduate of the Yale School of Medicine would disagree that the symbolic focal point of the two-hundred-year-old institution is that magnificent rotunda.
Sitting near Mrs. Whitney was a friend of many years, Elizabeth Thomson, a former editor of the Journal of the History of Medicine and Allied Sciences and one of Cushing’s biographers. Though Mrs. Whitney had often traveled to the New Haven suburb of Hamden to visit Miss Thomson, she would later tell her that she had never come close to grasping the full range of her father’s vast accomplishments until that day, as she listened to Dr. Barondess and heard others describe his work. He was for the most part a distant and even imperious figure to his own family, frequently off doing something that seemed far more important than being at home with his wife, Kate, and their five children.
What was it that Harvey Cushing had been doing in all those years of busy inattention to those who should have been closest to him? Betsey Whitney was well aware, of course, that her father was commonly referred to as the father of neurosurgery, and that he had, during an unimaginably productive career, operated on the seemingly impossible number of two thousand patients with tumors of the brain. She also knew, though hardly to the extent that she became aware of it that day, that he was a pioneer in the research that elucidated the functions of the pituitary, the small structure lying at the base of the skull that has so strong a controlling influence on other hormonal secretions of the body that it is commonly known as the master gland. And she had since childhood heard tales of his legendary technical prowess in the operating room. But as the story of his career unfolded during Barondess’s talk and the ensuing discussion, she came to realize, she later said, that the sheer magnitude and originality of his contributions had elevated him to a level of accomplishment matched by few men in the entire long history of surgery.
It was Harvey Cushing who, while still in his early thirties, introduced the notion of routinely monitoring the blood pressure during operations, something that had never been done before. This innovation was presented at about the same time that he undertook the difficult treatment of tic douloureux—a debilitating form of facial neuralgia—by the exquisitely delicate maneuver of removing the mass of nerve tissue at the very edge of the brain, called the Gasserian ganglion, through which the agonizing pain passed.
There was a reason he could do this successfully when others had not dared to make the attempt, and it was the same reason for which he was soon thereafter able to overcome the brain’s reputation as an organ so dangerous to operate upon that the great majority of patients died after attempts to do so, or were considerably worsened. This was his development of precise techniques to control the intense bleeding that usually accompanied such operations, as well as his methods of preventing or dealing with the swelling of the brain that they caused. Much of his success was owing to minutely meticulous technologies for dissecting and handling tissue, and the painstaking ways in which he accurately controlled the multitude of small blood vessels in the area of the operation.
The new methods meant that his patients lived, while the patients of others died; he taught a generation of young surgeons to operate as he did, and they in turn became the teachers of those that followed. No neurosurgeon of today can escape the influence of the Cushing approach to the brain that he or she has been taught, without which all efforts to treat the brain would be doomed to failure.
For such towering contributions, Harvey Cushing was laden with honors by a grateful profession and even a grateful world, and was celebrated during his life in ways that his children knew about only in part. But the work and the worldliness separated him from other rewards much closer to home, though he seemed scarcely to notice what was missing. The story of his daughter’s incomplete knowledge of all that her father had been is a metaphor of sorts for the way he chose to live his life. It provides the background for Michael Bliss’s absorbing chronicle of the career of one of the greatest medical innovators ever produced by the US—or any other country. In some ways, Cushing exemplifies a familiar kind of gifted, driven, single-minded, and enormously ambitious person. In others he was a unique figure at a unique historical moment, who combined inborn talents and fortunate circumstances in ways that were so distinctive one could, in his presence, feel engulfed by the man’s radiating energy.
Such a person is difficult to live with. From at least his late teens, Cushing seems to have been increasingly aware of his remarkable gifts, whether natural or acquired. He lived as though determined not only to foster his brilliance but also to guard it against any possibility that it might not reach the fullness that was to be its destiny. Not only that, but he recorded every step of his lifelong efforts to enlighten the medical science and practice of his era. He seems to have known from the beginning that he would grow up to be Harvey Cushing: everything was documented, everything was kept.
As a result we possess recorded evidence of one of the most extraordinary lives any biographer might wish to study. Cushing was the first resident in a Johns Hopkins program that would become the model upon which every other surgical training plan in the United States would be built; he was the founding professor of surgery at Harvard’s Peter Bent Brigham Hospital, one of the world’s leading medical research and clinical institutions; he served his country bravely and indefatigably as the commanding officer of US Army Base Hospital No. 5 in the combat zones of France during World War I; he won the Pulitzer Prize in 1926 for his biography of William Osler, America’s greatest medical teacher; his collection of rare books became the core of one of the foremost libraries of medical history in the world.
As a working surgeon, he introduced a series of diagnostic and therapeutic techniques that profoundly affected surgery; he was not only the pioneer researcher into the physiology and surgery of the pituitary gland, but developed the first safe methods of operating on it. As for postoperative treatment, Bliss writes,
Cushing virtually invented the concept of intensive care in an age before the intensive care unit. Patients were observed on the operating table for hours after recovery, sometimes in the operating room for days. Special nursing was supplied to charity patients out of a special fund, and in Cushing’s final years special nurses were hired to oversee the whole neurosurgical ward. “Unquestionably many lives have been saved in this way,” he wrote, “for less experienced nurses or junior house officers can hardly be expected to appreciate the significance of symptoms which indicate that something is going wrong with a patient recently operated on for brain tumor.”
In addition to all of this, his was among the most colorful of the many charismatic medical personalities who became well-known public figures during the first decades of the twentieth century, a period when the idealized image of the physician was widely circulated in America.
But the very vastness of achievement and the thoroughness of record-keeping pose a problem for the biographer. With so many letters written and received, so many histories of patients, so many newspaper clippings, so many diary entries, so many annotated photographs and pen-and-ink sketches drawn by Cushing, so many anecdotes and comments by others, so many personal scribblings in the margins of book pages—with such a plenitude of available material, how is a clear narrative to be constructed?
I know about these difficulties because I have been studying Cushing’s life for almost thirty years, sometimes deliberately and sometimes accidentally. I’ve come across many of my discoveries while looking into the holdings of the Yale Medical Historical Library, which is part of his heritage. I’ve also done research on some of his accomplishments in the university’s Sterling Library, where so much of his archive is stored. His renown looms over the school where I have spent the past half-century; I wrote much of my first book—a biographical history of medicine—in the reconstructed Cushing office that contains many of his personal effects and memorabilia, some of them in the desk I worked at, its drawers still crammed with all kinds of stuff he left in them on the day he fell victim to the coronary occlusion that killed him at the age of seventy. Both Elizabeth Thomson and Madeline Stanton, Cushing’s loyal secretary and later director of the library, who figures so prominently in Michael Bliss’s book, were women whom I knew well; they both had much influence on my writing and thinking.
It is precisely for thes e reasons that I applaud Bliss’s magisterial accomplishment. Somehow, he has been able to find a way through the mass of Cushingiana, and show the reality of a brilliant and deeply flawed man. For all of his greatness, Harvey Cushing was not a person easily liked, and few have written of him with affection. He could be, and often was, imperious, insensitive, and on occasion downright cruel, especially to assistants judged to be delivering anything less than the perfection he demanded of them. But it was not his vanity that drove him; nor was it his self-absorption, though he had plenty of both. Rather, it was the intensity of the mission he set for himself very early in his career, which was, quite simply, to become the best at everything he tried, if that goal could be attained by hard work. Anything or anyone in his way was pushed aside or ignored if they were not part of the process in which he meant to excel as no surgeon had excelled before him. Several generations of American neurosurgeons took him as a model and, in one way or another, they are his direct professional heirs.