Rx for modern medicine: 3 doctors who paved the way

By CURT SCHLEIER
Special to the Journal Sentinel

Last Updated: Dec. 17, 2005

Harvey Cushing: A Life in Surgery. By Michael Bliss. Oxford University Press. 591 pages. $40. ($26.40 at Amazon.com)

There's no telling what modern trauma centers might have looked like if not for John Hunter. But as Wendy Moore's fascinating biography of the 18th-century surgeon makes clear, everything, including hospital survival rates, would likely be different.

Hunter (1728-1793) was born in Scotland and didn't take well to schooling. He left home to join a much older brother, William, in London. William was a prominent obstetrician who'd started an anatomy school, and he needed help - mostly in procuring bodies.

Hunter found he had a gift for anatomy and quickly took on more and more responsibilities at the school. He was soon named a house surgeon at St. George's Hospital, where he received most of his practical training. Hospitals at the time were mostly for the indigent. Wealthy people were treated in their homes.

Medicine was so primitive, it's amazing that any sick person survived. It was practiced separately by physicians and surgeons. Physicians still followed the teachings of Hippocrates, who believed that all illnesses were due to an imbalance of the four "humors"- blood, phlegm, black bile and yellow bile. They rarely if ever touched patients, but nevertheless regularly prescribed cures such as bloodletting, blistering by heated glass cups and toxic elixirs.

Surgeons were little better. They were usually barbers, as well. Operations were conducted without anesthesia, and the use of antiseptics was still about 100 years away. Hunter refused to accept the status quo. He saw patients dying and "set out systematically to question every established process."

He made the study of anatomy a part of the medical learning process and he used his extensive knowledge of the human body to improve surgical procedures. He encouraged his students (including Edward Jenner and James Parkinson) to question everything, "to ask the reason."

He considered surgery the last option, preferring to let nature do its healing work first.

On the subject of firsts, he was the first doctor to successfully artificially inseminate a woman, the first to use a placebo and control group in experiments and he did early transplants.

His curiosity was not limited to medicine. His dissection of animals convinced him there was a relationship between them and humans 100 years before Darwin's "Origin of the Species."

In short, Hunter was a genius and his fascinating life has been largely overlooked by contemporary scholars. Thanks to Wendy Moore's extremely well researched and highly readable book, that is no longer the case.

Harvey Cushing is considered the father of modern neurosurgery. He created life-saving techniques and surgical tools (including the Cushing clip, which ties off blood vessels). He also won the Pulitzer Prize for his two-volume biography of one of his mentors, Sir William Osler.

The massive book was almost 1,400 pages, which prompted this comment from Michael Bliss, author of "Harvey Cushing:" "Cushing had learned that shorter biographies are often harder to write than longer ones, and take longer."

It's something that Bliss should have taken to heart. Bliss, author of several biographies (including one of Osler) has written an excellent book. Or, more accurately, he's overwritten an excellent book. It's just too long. If only someone had applied a blue pencil to the manuscript. Did we really need a description of his ice skating on the Charles River during Christmas vacation, 1892? Did we need the menu of a fancy dinner he was invited to six years later?

Still, this is an extraordinary piece of scholarship that draws an amazing word picture of a doctor so obsessed with improving his craft, he bribed a mortuary attendant to allow him to sneak in at night to take the brain and pituitary gland of a diseased 8-foot patient whose family had refused a post-mortem.

Considered the premiere surgeon of his time, Cushing was not above washing patients and changing their bedpans when hospital staff was busy elsewhere. He was truly a giant who deserves a big biography - just not this big.

The book "Maimonides" is part of a still relatively young trend in publishing: the short biography. But it's written (more accurately overwritten) in an old-fashioned way - that is, with frequently long cumbersome sentences and look-at-how-smart-I-am words.

Rabbi Moshe ben Maimon (1135-1204) was a physician and philosopher and extremely influential in both roles.

He wrote influential texts that simplified and made accessible the written (Torah) and oral (Mishna) laws of the Jews. In the Medical Aphorisms of Moses, he does the same for medical knowledge of the time.

If only Nuland had taken the same approach.

Yale hopes to put neurosurgical pioneer's collection on exhibit
 

By KIM MARTINEAU The Hartford Courant

NEW HAVEN, Conn. – In 1902, Dr. Harvey Cushing sent a pituitary cyst to the pathology department at Johns Hopkins Hospital for analysis.

But the specimen got lost.

Dr. Cushing vowed to never let it happen again. He started to save and catalog tumors himself, dropping them into gallon jars of formaldehyde. The neuropathology – meningiomas, gliomas and others – accumulated by the hundreds as his career flourished. Dr. Cushing would become the father of brain surgery, and the Cushing Brain Tumor Registry, as his collection is called, would become an odd footnote in an extraordinary legacy.

Sometime after Dr. Cushing's death, in 1939, the tumors and brains were shuffled off to a bomb shelter in the bowels of a medical school dormitory at Yale University, where Dr. Cushing had finished his career. There the orphaned collection stayed, visited occasionally by curious medical students.

"It was just a bunch of old brains," said Dr. Dennis Spencer, Yale's chief of neurosurgery. "People forgot about them."

Now, Dr. Cushing's contributions are being revisited, and his specimens at last might claim their place in medical history. A Toronto historian has just published a biography of Dr. Cushing, and Yale has put Dr. Cushing's diaries, photographs and even his surgical scrubs on display in the medical school rotunda. As for the brains, Yale hopes to soon put them on permanent exhibit, joined by Dr. Cushing's haunting patient portraits.

A pioneer in neurosurgery, Dr. Cushing perfected techniques for cutting the brain while controlling bleeding and thwarting infection. He became an expert on the pituitary gland, which secretes hormones and regulates growth, making him an early authority in endocrinology – a specialty Dr. Cushing derisively called "endo-criminology" for its quack practitioners. A rare hormonal disorder even bears his name – the ultimate medical glory – after he traced the disease to a pituitary tumor.

Michael Bliss' new biography, Harvey Cushing: A Life in Surgery, puts it all in context. Dr. Cushing's innovations came at a time when movies had no sound, telephones and light bulbs were just coming on the market and the sun still did not set on the British Empire. There were no CT scans or MRIs to capture images of the brain, and X-rays were little help in illuminating the soft folds of gray matter below the skull.

Apart from advancing the science, Dr. Cushing had his faults. He worked as many as 16 hours a day – a punishing schedule that took a heavy toll on his family. His critical, obsessive nature made him come off, at times, as unkind and egotistical. He used ethnic slurs to describe Jews and blacks and did not believe women should vote. Nonetheless, he showed extraordinary compassion to his patients and operated without regard to race or gender. "Open the skull, and a brain is a brain is a brain," Mr. Bliss writes.

Dr. Cushing was one of the first brain surgeons to do more good than harm, and death rates fell from 90 percent to 10 percent during his era. His conservative, puritanical values propelled Dr. Cushing to greatness, Mr. Bliss argues, as he brought caution and meticulousness to a field marked by sloppy hygiene and brash cutting. Raised in Cleveland, Dr. Cushing went to Yale, then Harvard Medical School, following his brother, to become the fourth generation of Cushing doctors.

At the turn of the century, Johns Hopkins Hospital was the pinnacle of American medicine, and there Dr. Cushing learned his trade. Johns Hopkins' chief of medicine, Dr. William Osler, mentored Dr. Cushing. Dr. Cushing later won a Pulitzer Prize for his biography of Dr. Osler.

At Johns Hopkins, he successfully treated a patient with an agonizing facial nerve disorder. In 1910, he operated on his most famous patient, Leonard Wood, a top-ranking Army general who had become debilitated after bumping his head on a chandelier. Dr. Cushing cut away a potato-size tumor and, in the acclaim that followed, took a job as chief surgeon at Harvard-affiliated Peter Bent Brigham Hospital in Boston.

Dr. Cushing started saving his brain specimens in 1902, after the pathology lab at Johns Hopkins lost a pituitary cyst. He often had permission to keep the brains, but not always. His loyal assistant, Louise Eisenhardt, managed the collection while keeping score of Dr. Cushing's "wins" in a small black book. Ms. Eisenhardt surrendered the book after Dr. Cushing removed his 2,000th tumor – no longer worried he might cheat.

Dr. Cushing came to Yale in 1933 to head the neurology department, after reaching Harvard's mandatory retirement age. Ms. Eisenhardt and the brains soon followed. Dr. Cushing died six years later, at 70, and his collection landed in the basement of Edward Harkness Memorial Hall.

"That was 25 years ago," said William Collins, Yale's former chief of neurosurgery. "The neuropathology was starting to get moved around. I decided we were going to keep it."

One night in 1991, Christopher Wahl, a first-year medical student, broke into the so-called brain room with some friends. They found the specimens riveting, and then Mr. Wahl spotted the glass plate negatives. Thousands of them, stacked nearby. In the dim light, Mr. Wahl realized they were pictures of Dr. Cushing's patients. Some were nude. Many looked frightened. Some of those people, Mr. Wahl realized, must certainly have owned the brains in the nearby jars.

"The hair stood up on the back of our necks," he remembered.

He brought the plates to Terry Dagradi, a photographer in Yale's media services. She still remembers the first image she printed: a man bowing his head to reveal a thick, throbbing vein. "They captured a time in medical history," she said.

Yale hopes to put the brains on display, along with Dr. Cushing's photos, once the basement of the original Yale pharmacy building is renovated.