A Diligent Effort
in 1897 to treat trigeminal neuralgia—a nerve disorder that causes intense pain in the face. His subsequent concentration on brain surgery firmly established him as the "father of neurosurgery"—together with, arguably, Dr. Ernest Sachs of Washington University, who was the father of Dr. Ernest Sachs, Jr., the longtime chief of neurosurgery at Mary Hitchcock Memorial Hospital.
By 1902, Cushing had developed an interest in the pituitary gland. An organ the size of a pea at the base of the brain, it secretes hormones that control numerous bodily functions. Cushing called it the "stowaway gland." He performed his first transsphenoidal removal of a pituitary tumor—through the sphenoid sinus, behind the nose—in 1909. That patient had acromegaly, an overproduction of growth hormone by the pituitary. In 1910, he improved on the technique by using a sublabial approach—entering through the upper lip instead.
In 1912, Cushing published a book titled The Pituitary Body and Its Disorders: Clinical States Produced By Disorders Of The Hypophysis Cerebri, which remains a triumph of American medical literature. It gives case histories of 48 patients with pituitary tumors. Among them was Minnie G., a 23-year-old female with a "syndrome of painful obesity, hypertrichosis [excessive body hair], and amenorrhea [absence of menstruation], with overdevelopment of secondary sexual characteristics accompanying a low grade of hydrocephalus [enlargement of the brain due to an abnormal accumulation of cerebrospinal fluid] and increased cerebral tension." Describing her condition as a "polyglandular syndrome," Cushing speculated that it might be "attributable to disordered pituitary, adrenal, pineal, or ovarian influences."
It was only much later—in 1932—that Cushing concluded, by analogy to other cases, that Minnie G.'s condition had been due to a basophilic pituitary tumor which caused an overproduction of cortisol by the adrenal gland. That was
the first description of a condition that is now commonly called "Cushing's disease." Yet ironically, Harvey Cushing never operated on the pituitary gland of a patient with the disease that bears his name. (See pages 7 and 8 for more about Cushing's disease.)
The same year that he described the case of Minnie G.—1912—Cushing moved from Baltimore to Boston, joining the staff of Peter Bent Brigham Hospital and becoming the Moseley Professor of Surgery at Harvard. He remained there until 1933, when he retired and moved to Yale. He was named the Sterling Professor of Neurosurgery at Yale but never performed surgery, taught a course, or did any research in New Haven.
Nevertheless, Cushing's move there was significant in view of his interest in Nathan Smith, given Smith's role in the founding of the medical school at Yale. Early evidence of Cushing's admiration for Smith can be found in a 1924 address to the Congress on Medical Education, titled "The Clinical Teacher and the Medical Curriculum." In it, Cushing railed against the standard
medical curriculum and championed the apprenticeship model that was central to Smith's vision of medical education. "There is much that a present-day medical student might envy in the opportunities offered to a young man of a century ago, apprenticed to such a person, let us say, as Nathan Smith," Cushing stated. "In our present-day schools . . . the Nathan Smiths, if there are any, scarcely know even the names of their many pupils, whom perforce they meet in a classroom so crowded that the elbow-to-elbow method of teaching and learning is no longer possible."
Four years after that talk, Cushing was invited to visit Dartmouth—the place that had given Smith his start in medical education. During the 1928-29 academic year, Dartmouth's Department of Biography (yes, there truly was such a department) offered a course called Representative American Careers. Its aim, according to Ambrose White Vernon, the department's chair, was "to orient students of the senior class in what might be called the realm of vocations." The course included public lectures by individuals of, as Vernon put it, "high