Harvey Cushing in NYROB
It was Harvey Cushing who, while still in his early thirties, introduced the notion of routinely monitoring the blood pressure during operations, something that had never been done before. This innovation was presented at about the same time that he undertook the difficult treatment of tic douloureux-a debilitating form of facial neuralgia-by the exquisitely delicate maneuver of removing the mass of nerve tissue at the very edge of the brain, called the Gasserian ganglion, through which the agonizing pain passed.
There was a reason he could do this successfully when others had not dared to make the attempt, and it was the same reason for which he was soon thereafter able to overcome the brain’s reputation as an organ so dangerous to operate upon that the great majority of patients died after attempts to do so, or were considerably worsened. This was his development of precise techniques to control the intense bleeding that usually accompanied such operations, as well as his methods of preventing or dealing with the swelling of the brain that they caused. Much of his success was owing to minutely meticulous technologies for dissecting and handling tissue, and the painstaking ways in which he accurately controlled the multitude of small blood vessels in the area of the operation.
The new methods meant that his patients lived, while the patients of others died; he taught a generation of young surgeons to operate as he did, and they in turn became the teachers of those that followed. No neurosurgeon of today can escape the influence of the Cushing approach to the brain that he or she has been taught, without which all efforts to treat the brain would be doomed to failure.
For such towering contributions, Harvey Cushing was laden with honors by a grateful profession and even a grateful world, and was celebrated during his life in ways that his children knew about only in part. But the work and the worldliness separated him from other rewards much closer to home, though he seemed scarcely to notice what was missing. The story of his daughter’s incomplete knowledge of all that her father had been is a metaphor of sorts for the way he chose to live his life. It provides the background for Michael Bliss’s absorbing chronicle of the career of one of the greatest medical innovators ever produced by the US-or any other country. In some ways, Cushing exemplifies a familiar kind of gifted, driven, single-minded, and enormously ambitious person. In others he was a unique figure at a unique historical moment, who combined inborn talents and fortunate circumstances in ways that were so distinctive one could, in his presence, feel engulfed by the man’s radiating energy.
Only six years ago, Michael Bliss published a biography of William Osler that exceeds in quality and literary style even the one for which Cushing won the Pulitzer Prize. In the preface to that book, he describes how, for all his trying, his research had revealed nothing to so much as weaken the reputation of his subject as a veritable saint of medicine and private life. With the present volume, he has found a subject with many failings. It is Bliss’s great accomplishment that he has made accessible not only the science, medicine, and professional atmosphere of Cushing’s career, but also the character and personality of the man justly praised for so many years as a medical innovator. He has made good on the aim he announces in his preface to follow Walt Whitman, who wrote that the poet “drags the dead out of their coffins and stands them again on their feet… He says to the past, Rise and walk before me that I may realize you.”
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