Author: Michael Bliss 

This biography of Harvey Cushing is an eloquent testimony to his zealous work ethic and practical creativity, factors that enabled him to push the boundaries of brain surgery to the limits of the technology of his time. Crediting him as ‘one of the first American men to be the world leader in his field’, the book narrates the outstanding feats that made him universally acknowledged as the father of modern neurosurgery. Describing Cushing as ‘a driven man, lacking a sense of balance in life’, and as a man with an ‘addictive personality’ and the ‘stamina and genius of macho supermen’, the book portrays how these characteristics influenced his personal and family life, and determined all facets of his career – as ‘surgeon, researcher, teacher, author, administrator‘. The book is also a revealing portrait of Cushing’s achievements, from his early classification of brain tumours with pathologist Percival Bailey, to his establishment of the Hunterian Laboratory as ‘an innovative center for both teaching and research’. The book’s wider remit also covered Cushing’s sterling wartime service, his ‘sustained medical writing‘, his Pulitzer prize-winning biography of William Osler, and his rivalry with Walter Dandy (pages ix, 93-103, 195, 236-246, 268-271, 280-294, 302-357, 363-382, 390-401 and 499).

In its comprehensive biographical narrative, the book started with Cushing’s birth into a family of ‘high expectations‘ and a long heritage of churning out physicians. The book painted a psychological portrait of Cushing’s relationship with Kirke, his ‘reserved, stern’ and strict physician father, and with Bessie, his ‘perfectly wonderful mother’ whose love for her children was ‘boundless‘. It depicted Cushing as a child who had a quick temper and was accident prone, and as a student who was ‘a good scholar, socially popular, and athletically gifted‘. The biography also charted Cushing’s journey to becoming a doctor at Harvard Medical School where he got ‘nearly the best medical training America could offer’. Asserting that Cushing ‘showed professional pre-eminence from the start’ of his medical training, the book referred to his punishing study regime, his regular assistance in theatre, and his ‘constantly taking on work in the hospital’. It is pertinent therefore that the author said Cushing ‘would not let up on himself’ even after achieving excellent grades in his courses (pages 11-12, 24-25, 29, 34-35, 72 and 57-68).

Cushing’s formative years as a doctor formed a major theme of the book, and it chronicled this from his time at Massachusetts General Hospital where he was ambitious, demanding‘, hard-working, but also ‘hard to work with’. Cushing’s foresight was particularly evident at this early stage, and the book illustrated this with how he helped the hospital to secure an X ray machine – an emerging technology at the time. The book also described how Cushing emerged as a technician, as a researcher, as a tough senior resident…and as an operating surgeon‘, and how he built his career on such experiences as witnessing the uniform mortality and morbidity of brain tumour patients operated on by his mentor J.W. Elliot. In narrating his early general surgical experience, the book described how he became proficient in such operations as herniorrhaphy, radical mastectomy, splenectomy, and typhoid perforation repair, and how he became familiar with cocaine and ether anaesthesia. Cushing’s ‘growing interest in the nervous system‘ also drove him to develop ganglionectomy, an innovative treatment for trigeminal neuralgia which the author said was ‘the opening of a new page‘ which ‘took him literally to the edge of brain surgery’ (pages 87-90, 102, 107-110, 126-130 and 134-151).

The most defining theme of the book is undoubtedly its depiction of how Cushing ‘founded neurosurgery’ and became ‘the father of effective neurosurgery’. Arguing that Cushing was the ‘first surgeon in history’ to operate on the brain ‘with a reasonable certainty of doing ‘more good than harm‘, the author asserted that it was ‘his deliberate concentration on the brain’ that ‘marked the founding of a new surgical specialty’. Furthermore, the author contended that ‘Cushing brought to the dismal field of brain surgery a highly developed set of techniques to control bleeding, crucial knowledge of and sensitivity to the problem of intracranial pressure, his awesome dexterity, and his equally awesome combination of enthusiasm and a determination to succeed’. Amongst the surgical principles that enabled Cushing to make his mark were ‘the need to abandon the fetish of haste‘; ‘the need to perfect every detail of the surgical experience’; ‘the need to learn from mistakes‘; and ‘the need for careful attention to detail’. As Cushing ‘continued to broaden his work’, the book described how he famously got interested in the pituitary, asking ‘every anatomical and physiological question he could think of’ about the gland, and devising effective surgical approaches to its lesions. The author however pointed out that in the process, Cushing had ‘a tendency to overclaim for the organ’, ‘tended to jump to conclusions’, and ‘made significant mistakes‘ (pages 163, 166, 172, 176, 180-181 and 202-220).

Cushing is best known for his work on brain tumours, research he carried out initially at the Johns Hopkins in Baltimore, and then at Harvard in Boston – a place the author referred to as ‘an intellectual and critical centre in ways that Baltimore would never be’. The author remarked that Cushing would eventually operate ‘on more patients with verified and suspected brain tumors than any other North American surgeon, probably any surgeon in history’. Boston was where the author said he perfected his skills, deviced new surgical approaches, and developed expertise in wider fields such as cerebellopontine angle acoustic tumours. In this way, the author said, Cushing made neurosurgery ‘the one specialized field in which the Peter Bent Brigham Hospital was renowned’. The book also described Cushing’s prominent cases, particularly that of Leonard Wood, a famed army General with a right sided brain tumour which Cushing operated on, saving his life with ‘the techniques that made him the father of twentieth-century neurosurgery’. Referring to this operation as one of his ‘finest pieces of surgical service’, the author contended that ‘only a handful of surgeons in the world’ at that time could have performed it without killing the patient (pages 3-8, 246, 251, 271 and 299-301).

A revealing theme of the book is its critical appraisal of Cushing’s complex personality which explored both his positive and negative qualities. For example, the author referred to him favourably as ‘ambitious‘ and ‘perfectionist‘, and less flattering as being ‘at times hard–driving, egotistical, and mean‘. And just as the narrative complimented him as an insightful, reflective and intensely self-critical man who ‘never held a grudge’, it also depicted him as a person who ‘could get upset about unimaginably petty details’. A driven surgeon who ‘expected high performance from everyone who worked with him’, the book noted that his co-workers found him to be ‘an almost impossibly exacting and demanding taskmaster’. It was therefore not surprising when the author said that ‘he had never been an easy doctor for nurses to get along with’, and that his ‘outspokenness sometimes sparked resentment to the point of rebellion‘. Cushing’s relationship to his patients was however different to the one he often had with his colleagues, the author noting that ‘throughout his career he had excellent relations’ with them, worrying about their health as he ‘sacrificed free time to care for them’ and ‘mourned those he lost’ (page ix, xi, 105-106, 159, 220, 297, 338 and 421).

This biography of a leading historical medical figure is comprehensive and perhaps included many insignificant details of his life. The picture it paints however gives revealing insights into the qualities and habits that determined his success as a pioneer of modern neurosurgery. With many illustrative photographs, the biography vividly captured the personality of its subject and his determining role in establishing an intricate surgical specialty. With detailed depictions of his family life and non-medical practices, the book is an invaluable account. Barring some repetition of themes, the content of the book is appropriate and relevant.

This excellent biography is not just the portrayal of a pioneering neurosurgeon, but a masterclass in the personal qualities that advance medical fields and drive success in both clinical and academic endeavours. With a clear delineation of Cushing’s excellent surgical practice and guiding principles, the biography serves as a lesson of contemporary relevance all doctors and to healthcare as a whole. The book is well-written and researched, and I recommend it to all doctors.

Publisher, Place, Year: Oxford University Press, Oxford, 2005

Number of chapters: 15

Number of pages: 591

ISBN: 978-0-19-532961-2

Star rating: 5

Price: £19.49