Harvey Cushing – A life in surgery – A Review (Day -266)

Dr Harvey Cushing - A Life in Surgery

As the first biography I have ever read cover to cover this book was absolutely gripping with me wanting to find out what happened next.

Many people may have heard of Cushings Syndrome or Disease which is where the pituitary gland often has a tumour which increases the amount of hormone released from it. This increased secretions has a big effect on the rest of the body and was defined by Dr Harvey Cushing. However in addition to this Dr Cushing was also the founder of modern brain surgery.

Back in 1887 when Cushing looked to train as a surgeon there was no such thing as neurosurgery – actually there were no requirements other than money for the fees to get into medical school. The medical schools were run by practicing doctors from the local area that did it to supplement their income. Surgery back then however was only an emergency last attempt – there was no elective surgery – and when it happened the odds of the patient surviving were tiny. Not just from the actual surgery itself which was often only amputations but from the infections that occurred afterwards.

Dr Cushing started his studies at Yale before moving to Harvard and in 1896 was planning to travel to Europe to study when instead he was offered a place to study with Dr Halsted at the new John Hopkins Hospital after being initially denied. Learning from Dr Halsted the techniques of haemostasis, good surgical dissection and aseptic surgery.

When the skull was opened here the patient in most cases suffered from something called fungus cerebri which is infection of the brain. In 2016 there are neurosurgeons that have had entire careers without seeing such a thing. This is largely thanks to the careful use of aseptic technique that Dr Cushing had learned from Dr Halsted.

Something that really interested me was the use of dogs within the surgery training courses at these medical schools. Initially they started as just using dogs for trying out new techniques, then for the training of new surgeons, however these training centres evolved into the first veterinary hospitals with human doctors treating dogs for surgical diseases not treated before. Some of the research that evolved from dogs has been instrumental in developing modern neurosurgery.

For example the Cushing reflex which says that when the pressure inside the skull raises, then the blood pressure will rise as well to compensate and keep the brain oxygenated. Dr Cushing investigated this by opening a dogs skull and replacing a section with glass so that he could see the vessels of the brain as he increased the pressure in the skull. He noticed that as he increased the pressure the vessels initially became compressed, however then the blood pressure of the body increased to force blood back into these brain vessels.

The thing that Dr Cushing is most known for however is that of Cushings syndrome or disease which is where a tumour on the pituitary gland at the base of the brain causes excess hormone release into the rest of the body causing clinical signs. Dr Cushing did a range of experiments here both on dogs and with human patients looking for a way to treat those suffering from acromegaly which is increased growth. At the time the function of the pituitary gland was unknown, so this work was ground breaking.

I would highly recommend that anyone interested in the history of surgery reads this book.