Harvey Cushing: A Life in Surgery
http://www.100md.com
《新英格兰医药杂志》
The first four lines of this fine biography summarize the man: "Harvey Cushing (1869–1939) was one of the first American medical men to be the world leader in his field. He was one of the first great surgeons produced by the United States, and in the early years of the twentieth century he became the world's first successful brain surgeon."
(Figure)
Harvey Cushing.
Wellcome Library, London.
That he was, but he was also much more. Through his work on the pituitary gland, Cushing was also one of the founders of endocrinology. A well-read man who wrote a phenomenal amount throughout his long career (winning a Pulitzer Prize in 1926 for his hagiography of Sir William Osler), Cushing was also a noted bibliophile, a decent amateur medical historian, and a war hero.
Michael Bliss — the author of the recent magisterial biography of Osler (William Osler: A Life in Medicine. Toronto: University of Toronto Press, 2002) — has done it again, explaining that he came to know Cushing through writing about Osler. The subjects of Osler, a Canadian physician, and Cushing, an American surgeon, complement each other in many ways. Osler was Cushing's senior and his valued and beloved mentor. Their careers were intimately entwined. Cushing was even present when Osler's only son was killed on the Western Front. Bliss planned and wrote this biography of Cushing as a sequel to the Osler biography. Of course, each book can be read without recourse to the other. However, for a broad-ranging, sociologically and historically complete view of North American medicine and surgery from the late 19th century to the beginning of World War II, I recommend both books.
Born into a well-placed medical family of white Anglo-Saxon Protestants, Cushing left his native Cleveland to study first at Yale and then at Harvard. He moved on to Johns Hopkins to work under the world-famous but drug-addled William Halsted, continuing his long-standing friendship and collaboration with Osler.
At first Cushing was a very general surgeon, as was typical at that time, operating in the fields we would today call gastrointestinal, gynecologic, orthopedic, and plastic surgery. Neurosurgery, then in its infancy, did not interest him until he seemed fortuitously to drift toward peripheral-nerve surgery through his successful attempts at surgically treating trigeminal neuralgia. Soon he was moving more toward the center of the brain, and by the end of his long career he had operated on more than 2000 intracerebral tumors. Cushing invented the term "meningioma."
Later, Cushing became intrigued by that most fascinating and miraculous of nubbins, the pituitary gland. Although he did not always get it right, he did make groundbreaking discoveries (for example, that pituitary adenomas could cause hypersecretion by the adrenal glands).
However, unlike Osler, Cushing was no saint. Although Bliss could find no evidence that the surgeon was anything other than a paragon with regard to the doctor–patient relationship (including consistently undercharging even the wealthy), he was a holy terror toward his staff. He seemed to delight in what we would today call "pimping" his residents and operating-room nurses by insulting them for their errors and blaming them for his. In the spirit of the time, he firmly believed that this kind of treatment built character. Cushing could be downright abusive. As one of his residents recalled, "He cursed me in front of everyone in the operating room . . . for doing something he had told me to do the previous day, and when I protested hotly . . . he lied promptly and with perfect technique." However, Cushing frequently apologized the next day for such egregious behavior. Above all, he was self-critical and would mope for days after a patient died, blaming only himself.
Cushing was also a bad husband and not much of a family man, preferring the pleasures of work to the pitter-patter of little, or even big, feet. Although apparently faithful to his wife, he was not very kind to her and seemed to have no patience with women — either in medicine or at the ballot box. Furthermore, although he was probably no worse than most of his contemporaries, Cushing shared the common prejudices against minorities, lacing his speech and correspondence with racial and religious epithets.
Cushing was, of course, a man of his time, but with respect to surgery he was above and even beyond his time. Almost single-handedly, he invented modern neurosurgery: the approach, the techniques, and the philosophy. This excellent and well-written biography is truly a life and times of Cushing. Anyone with an interest in how medicine and surgery developed in the first third of the 20th century will surely enjoy it.
A. Mark Clarfield, M.D.
Ben-Gurion University of the Negev
Beer-sheva 84101, Israel
markclar@bgu.ac.il(By Michael Bliss. 591 pp.)
(Figure)
Harvey Cushing.
Wellcome Library, London.
That he was, but he was also much more. Through his work on the pituitary gland, Cushing was also one of the founders of endocrinology. A well-read man who wrote a phenomenal amount throughout his long career (winning a Pulitzer Prize in 1926 for his hagiography of Sir William Osler), Cushing was also a noted bibliophile, a decent amateur medical historian, and a war hero.
Michael Bliss — the author of the recent magisterial biography of Osler (William Osler: A Life in Medicine. Toronto: University of Toronto Press, 2002) — has done it again, explaining that he came to know Cushing through writing about Osler. The subjects of Osler, a Canadian physician, and Cushing, an American surgeon, complement each other in many ways. Osler was Cushing's senior and his valued and beloved mentor. Their careers were intimately entwined. Cushing was even present when Osler's only son was killed on the Western Front. Bliss planned and wrote this biography of Cushing as a sequel to the Osler biography. Of course, each book can be read without recourse to the other. However, for a broad-ranging, sociologically and historically complete view of North American medicine and surgery from the late 19th century to the beginning of World War II, I recommend both books.
Born into a well-placed medical family of white Anglo-Saxon Protestants, Cushing left his native Cleveland to study first at Yale and then at Harvard. He moved on to Johns Hopkins to work under the world-famous but drug-addled William Halsted, continuing his long-standing friendship and collaboration with Osler.
At first Cushing was a very general surgeon, as was typical at that time, operating in the fields we would today call gastrointestinal, gynecologic, orthopedic, and plastic surgery. Neurosurgery, then in its infancy, did not interest him until he seemed fortuitously to drift toward peripheral-nerve surgery through his successful attempts at surgically treating trigeminal neuralgia. Soon he was moving more toward the center of the brain, and by the end of his long career he had operated on more than 2000 intracerebral tumors. Cushing invented the term "meningioma."
Later, Cushing became intrigued by that most fascinating and miraculous of nubbins, the pituitary gland. Although he did not always get it right, he did make groundbreaking discoveries (for example, that pituitary adenomas could cause hypersecretion by the adrenal glands).
However, unlike Osler, Cushing was no saint. Although Bliss could find no evidence that the surgeon was anything other than a paragon with regard to the doctor–patient relationship (including consistently undercharging even the wealthy), he was a holy terror toward his staff. He seemed to delight in what we would today call "pimping" his residents and operating-room nurses by insulting them for their errors and blaming them for his. In the spirit of the time, he firmly believed that this kind of treatment built character. Cushing could be downright abusive. As one of his residents recalled, "He cursed me in front of everyone in the operating room . . . for doing something he had told me to do the previous day, and when I protested hotly . . . he lied promptly and with perfect technique." However, Cushing frequently apologized the next day for such egregious behavior. Above all, he was self-critical and would mope for days after a patient died, blaming only himself.
Cushing was also a bad husband and not much of a family man, preferring the pleasures of work to the pitter-patter of little, or even big, feet. Although apparently faithful to his wife, he was not very kind to her and seemed to have no patience with women — either in medicine or at the ballot box. Furthermore, although he was probably no worse than most of his contemporaries, Cushing shared the common prejudices against minorities, lacing his speech and correspondence with racial and religious epithets.
Cushing was, of course, a man of his time, but with respect to surgery he was above and even beyond his time. Almost single-handedly, he invented modern neurosurgery: the approach, the techniques, and the philosophy. This excellent and well-written biography is truly a life and times of Cushing. Anyone with an interest in how medicine and surgery developed in the first third of the 20th century will surely enjoy it.
A. Mark Clarfield, M.D.
Ben-Gurion University of the Negev
Beer-sheva 84101, Israel
markclar@bgu.ac.il(By Michael Bliss. 591 pp.)