The Johns Hopkins Years and Becoming a Neurosurgeon
After a trip to Baltimore with his brother, Ned, Cushing wrote to William Stewart Halsted, professor of surgery at Johns Hopkins to inquire about a position as assistant resident at Johns Hopkins. Eccentric in his personal habits, Halsted was an outstanding surgeon, known for his long, careful, and innovative operations. He was especially at pains to control bleeding in surgery. Cushing’s early surgery focused on abdominal work, but by 1899 he had become especially interested in the nervous system and had developed a new operation for trigeminal neuralgia, a disorder of a facial nerve. Though Cushing benefited greatly from working with Halsted, he formed a much closer personal bond with William Osler, Johns Hopkins professor of medicine, who became his mentor and role model.
After a Wanderjahr abroad in 1900-1901, Halsted offered Cushing a position as an "Associate" in surgery working in neurology and neurosurgery, and teaching surgical anatomy and operative surgery to medical students. In addition to treating charity patients in the wards, Cushing would have the opportunity of earning fees from private patients. It was during the first decade of the new century that Cushing rose to international fame as the first specialist in neurosurgery and an expert on the pituitary gland. Patients came from far away to be operated on for brain tumors.
Johns Hopkins Hospital Staff, ca. 1897
Johns Hopkins was an exciting place to be when Cushing arrived in 1896. The new medical school had just opened in 1893, led by the "big four:" William Osler, William S. Halsted, William Henry Welch, and Howard A. Kelly. The medical school, emphasizing research, was the first to require a bachelor’s degree for entrance, was open to women, and required a four year-curriculum, not yet standard. Osler and Halsted headed departments in the Medical School and were also Chiefs of Service in the Hospital.
First row: William S. Thayer, Lewellys F. Barker, William Halsted (professor of surgery), William Osler (professor of medicine), Howard A. Kelly (professor of gynecology), Hunter Robb, John M.T. Finney, Joseph C. Bloodgood
Second row: G.B. Block, G.W. Dubbin, Harvey Cushing, Thomas Futcher, Hugh Young, …. At the end of second row is Norman Gwyn, Osler’s nephew. Next to the last on the top row is Jesse W. Lazear, who died in Walter Reed’s yellow fever experiments.
Photo by James F. Mitchell, M.D.
Johns Hopkins Hospital, ca. 1900
The Johns Hopkins Hospital, opened in 1889, four years before the Medical School. At the time, Johns Hopkins was one of few medical schools that controlled their own hospital. Because the hospital and school were so interrelated, William Osler was able to establish the first clinical clerkship for medical students.
Copy of a photograph taken by Harvey Cushing.
Surgical Resident Staff, Johns Hopkins Hospital, 1899
From left: James F. Mitchell, Harvey Cushing, M.B. Clopton.
Cushing’s proud image of himself as one of a long line of Cushing doctors is illustrated by the bookplate he sketched for his growing library in 1897. Engraved from Cushing's drawing by designer Edwin Davis French, it featured the Cushing family crest and motto, which translates “by valor and divine aid.” Along the sides were the initials of the Cushing doctors and the years they received their degrees: David, Erastus, Henry Kirke, Edward F., and Harvey Williams Cushing. The bookplate on display is a later revision adding Kirke W. Cushing, son of HC’s brother Harry. The smaller version is found in most of Cushing’s books donated to Yale. Fascinated by books and history from the beginning of his medical education, Cushing became a serious collector under the tutelage of his mentor, William Osler
Harvey Cushing, Medical Illustrator, 1900
In the Hopkins years, Cushing drew a number of his medical illustrations that were published in medical journals. No doubt he perfected his skill under the informal tutelage of his friend, Max Brödel, the celebrated professional medical illustrator at Johns Hopkins. This original drawing, signed and dated 1900, had as caption: "Showing relations of the middle meningeal artery to the operative foramen before and after elevation of the dura and exposure of the ganglion."
Travel Abroad, 1900-1901
Ambitious young physicians often took a year to visit medical clinics, operating theaters, and laboratories in Europe and, possibly, to engage in a special research project with a preceptor. Because he was needed at Hopkins, Cushing put off his Wanderjahr until 1900. Under the surgeon Theodor Kocher at Berne, Cushing undertook an experimental animal study of blood pressure in a compressed brain.
Harvey Cushing is pictured here in 1900 during his time in Switzerland. During his year abroad, he grew a mustache that disappeared before he returned to Baltimore.
He also spent three weeks with Charles Sherrington at Oxford. By the time he returned, Cushing was ready to specialize in brain surgery. In this page of his travel diary, on May 6, 1901, Cushing, visiting Italy, sketched Riva Rocci’s new blood-pressure apparatus. He brought a blood pressure instrument back with him and used it in his surgery, keeping careful patient records of blood pressure, as he had previously for temperature and pulse.
Next Door to Osler
This photograph shows No. 1 (left) and No. 3 West Franklin St., Baltimore. William Osler and his wife Grace Revere Osler lived at No. 1. In 1901, Cushing and two other bachelor physicians moved into No. 3. They all were given “latchkeys” to Osler’s house. When Harvey Cushing married Kate Crowell in 1902, the couple took over No. 3. Cushing saved a brick from Osler’s home that is now in the Historical Library.
The "All-Star Operation," 1904
A new surgical amphitheatre at Johns Hopkins Hospital was formally opened on October 5, 1905. Halsted was persuaded by his staff to inaugurate the new facility by operating in it with all of his senior staff, rather than the usual residents. Cushing labeled a version of this picture with the names and roles of the participants without clearly identifying where they stood: Dr. Halsted – operating, Dr. Finney – 1 st assistant, Dr. Cushing – 2 nd assistant, Dr. Young -- instruments, Dr. Mitchell – anesthetist, Dr. Follis – leaving, Dr. Baetjer -- seated, Miss Hampton – operating nurse. This was early in the use of rubber gloves, a practice which began at Johns Hopkins.
Harvey Cushing at His Desk, 1907
Images of Cushing’s mentors are on the walls.
Diary of the Society of Clinical Surgery Trip to Europe, 1912
The Society of Clinical Surgery, that Cushing had helped to found in 1903, was a club for younger surgeons to meet at different medical centers and watch each other operate. In 1912, the Society arranged through Thomas Cook’ and Son, a tour of operating theaters in Germany and Austria.
First Monograph, 1912
In the Hunterian Laboratory, named after the eighteenth century surgeons and anatomists, William and John Hunter, Cushing performed animal experiments on the function of the pituitary gland, located deep in the brain. This experimental data was combined with detailed histories, including photographs, of 48 of his cases. Michael Bliss writes, “His genius was to have grasped the concept of the pituitary as the gland whose secretions control growth.” Tumors could cause under- or over-secretion leading to acromegaly (a form of excessive growth), gigantism, or sexual infantilism. In order to operate on the pituitary, Cushing developed an innovative new route for instruments to reach the pituitary. Shortly before retirement, Cushing delineated the syndrome of pituitary basophilism, which was almost immediately called "Cushing’s disease."
Harvey Cushing, The Pituitary Body and Its Disorders: Clinical States Produced By Disorders of the Hypophysis Cerebri. Philadelphia: J.B. Lippincott, 1912. Cushing’s copy of the first printing.