Harvey Williams Cushing (1869-1939)

Harvey Williams Cushing (1869-1939)

Neurosurgery had its antecedents in some interventions on the
peripheral nerves, but we can not consider it as such until the
surgeon intentionally addressed the skull cavity with therapeutic
intent. Technically she was only possible anesthetic and aseptic
surgery. The pathology and clinical neurological diagnosis should
allow on scientific grounds. These conditions began to be fulfilled
in the last two decades of the nineteenth century, but the
neurosurgery reach maturity in the twentieth century. The
American Harvey Cushing was perhaps the most prominent figure
of the founding of modern neurosurgery. It combines two general
features of surgery of his time: the passage of America at the forefront of surgical expertise and
professional.

Harvey Williams Cushing (1869-1939) was born in Cleveland, Ohio, into a wealthy family of several
generations and numerous doctors. His father combined the practice with the teaching of nursing,
obstetrics and forensic medicine. A poor student who preferred sport, the technical and art
books. He bowed late in the medicine, which began to interest after entering Yale University. In
1891 he was admitted to Harvard Medical School where he graduated cum laude in 1895. He
began his surgical training at the General Hospital in Boston, but he learned modern surgery of
William S. Halsted, the outstanding figure of the moment, who was an assistant since 1896 at the
Johns Hopkins Hospital, founded in 1889 in Baltimore on the model of German leading clinics of the
time. He received the influence of modern medicine through, among others, William Welch and
William Osler, which also aroused a lasting interest in the history of medicine and he became a
bibliophile.
During the years he dedicated to complete their training in Europe (1900-1901), with Kocher at
Berne and Sherrington in Liverpool, began to lean to the neurosurgical expertise which would
enshrine the rest of his life. On his return won for him the creation of a specialized post in Baltimore,
though there was hardly sick at that time to justify it. In short, patients who could benefit from
increased Cushing neurosurgery at a number largely guaranteed the continuity of the field. In 1905
he founded the Hunterian Laboratory at Johns Hopkins, to develop experimental research which led
to its practice and teaching.
The diagnosis of neurological injuries based on objective signs had achieved great progress during
the nineteenth century. Suffice it as an example the reading of the speech disorder to accurately
locate the brain injury, or Romberg's sign on physical examination to demonstrate a cerebellar
lesion. In the last third of the nineteenth century began to be published monographs on surgical
pathology brain. The first maneuver was an actual neurosurgical trepanation skull to drain a brain
abscess previously localized by clinical diagnosis. It was the work of Paul Broca.From the middle of
the 1880s were successful the first cortical ablations to treat traumatic Jacksonian epilepsy
(Horsley, 1883), and brain tumors (and Godel Bennet, 1884) and medullary (Horsley, 1888). In
1885, the Italian F. During successfully removed a brain tumor. Before the end of the century was
possible intracranial neurectomy and trigeminal ganglion resected (Krause, 1899).
In the first decade of the twentieth century ventriculography was designed and developed spinal
surgery and sympathetic. In Europe, highlighted the contributions of Kocher, T. Martel and
Jaboulay. However, as we said, the weight of the development of neurosurgery was moved to the
United States, where he stood and the work of Halsted.
Harvey Cushing devised decompressive operations, such as hydrocephalus, lumbar drain, but
stands his dedication to the pathology and treatment of intracranial tumors. With its superb medical
training and its extreme technical skill opened pituitary surgery and contributed to endocrinology. In
1912 he published The pituitary body and Its disorders, the result of experimental and clinical
investigations of the anatomy, physiology and pathology of pituitary.Of particular note on their
childishness hallagzos pituitary basophilic adenoma of the pituitary gland and the metabolism of the
body in various physiological and pathological conditions.
That same year he held the chair of surgery at Harvard and led the surgical clinic of the Peter Bent
Brigham Hospital since its foundation in 1913 until 1932. Among its more than 300 publications
include the monographs in collaboration with a disciple of Cajal, Percival Bailey, while he headed
the Laboratory of Surgical Research that Cushing had been created at Harvard.The first,
Classification of the gliomas (1926), was dedicated "to Professor S. Ramn y Cajal and the
disciples of his illustrious Spanish neurohistological school. " After retirement he taught neurology at
Yale and emeritus (1933-1937), and this university, he bequeathed his library of over 8,000.
In addition to attracting many students from around the world, received distinctions in life more than
twenty European and American universities, as well as numerous awards for his professional work,
but also the 1926 Pulitzer for his famous biography of Osler. More than 60 scientific societies in
various countries had with the Board members. The Harvey Cushing Society in 1932 that his
disciples founded Harvard, is now the American Association of Neurological Surgeons.
Has given its name to the syndrome of hyperadrenocorticism may be due to a neoplasm of the
adrenal cortex or anterior lobe of the pituitary gland, or excessive and prolonged intake of
glucocorticoids for therapeutic purposes, and when results from excessive secretion of
adrenocorticotropic hormone in the anterior pituitary, with the existence of an adenoma in the
pituitary-called "Cushing's disease." But he also leaves his eponymous a phenomenon and the law
that governs: the increase in blood pressure as a result of increased intracranial pressure, and to a
degree slightly higher than the pressure exerted against the medulla. Two operations and a reaction
also led her name.
For all its exquisite specialization, Cushing was a physician at the height of the times and he
recognized the great advances of social medicine and representing new hope in the fight against
disease. This is attested by his famous statement in 1913: "The Doctor Libra Avenue Cure has
been replaced by Dr. Ounce of Prevention alley."
Carla P. Aguirre, Institute of History of Science and Documentation (CSIC-Universidad de
Valencia), Spain. (October 1999)

Bibliografa

Semblanza del doctor Harvey Cushing. Maestro del bistur. (1972). MD en espaol, 10, 147-162.

Fulton, J. F. (1946) Harvey Cushing: A biography. Springfield, Il. C.C. Thomas.

Gillispie, C. C. Dictionary of scientific biography. New York, Schribners sons (1971) vol. 3, pp.
516-20.

Lan Entralgo, P. (1978) Historia de la medicina, Barcelona, Salvat.

Obrador, S. (1975) Neurociruga. En: P. Lan Entralgo, dir. Historia universal de la medicina, vol.
VII, introduccin, pp. 376-378.