LEGACY

HARVEY CUSHING’S CANADIAN CONNECTIONS

William Feindel, O.C.,
M.D.C.M., F.R.C.S.C.
Montreal Neurological Institute
and Hospital, McGill University,
Montreal, Quebec, Canada
Reprint requests:
William Feindel, O.C., M.D.C.M.,
F.R.C.S.C., Montreal Neurological
Institute and Hospital, 3801
University Street, Montreal,
Quebec, Canada H3A 2B4.
Email: wfeindel@bic.mni.mcgill.ca
Received, June 5, 2002.
Accepted, August 13, 2002.
DURING HIS SURGICAL career between 1896 and 1934, Harvey Cushing made eight
visits to Canada. He had a broad impact on Canadian medicine and neurosurgery.
Cushing’s students Wilder Penfield and Kenneth McKenzie became outstanding lead-
ers of the two major centers in Canada for neurosurgical treatment and training. On his
first trip to Canada, shortly after completing his surgical internship in August 1896,
Cushing traveled with members of his family through the Maritime Provinces and
visited hospitals in Quebec and Montreal. Eight years later, in February 1904, as a
successful young neurosurgeon at the Johns Hopkins Hospital, he reported to the
Montreal Medico-Chirurgical Society on his surgical experience in 20 cases of removal
of the trigeminal ganglion for neuralgia. In 1922, as the Charles Mickle Lecturer at the
University of Toronto, Cushing assigned his honorarium of $1000 to support a neu-
rosurgical fellowship at Harvard. This was awarded to McKenzie, then a general
practitioner, for a year’s training with Cushing in 1922–1923. McKenzie returned to
initiate the neurosurgical services at the Toronto General Hospital, where he devel-
oped into a master surgeon and teacher. On Cushing’s second visit to McGill Univer-
sity in October 1922, he and Sir Charles Sherrington inaugurated the new Biology
Building of McGill’s Medical School, marking the first stage of a Rockefeller-McGill
program of modernization. In May 1929, Cushing attended the dedication of the Osler
Library at McGill. In September 1934, responding to the invitation of Penfield, Cushing
presented a Foundation Lecture—one of his finest addresses on the philosophy of
neurosurgery—at the opening of the Montreal Neurological Institute. On that same
trip, Cushing’s revisit to McGill’s Osler Library convinced him to turn over his own
treasure of historical books to Yale University.
KEY WORDS: Edward Archibald, Harvey Cushing, Kenneth McKenzie, McGill Medical School, Montreal
Neurological Institute, Osler Library, Wilder Penfield

Neurosurgery 52:198-208, 2003 DOI: 10.1227/01.NEU.0000039100.19138.FE www.neurosurgery-online.com

FAMILY TRIP TO CANADA, 1896 view of Ned in plus-fours, the Château in the background (Fig.
2), with the note, “The rescue of the prunes—a familiar atti-

I
n August 1896, Harvey Cushing went by boat to the Mar-
itime Provinces, Quebec, and Ontario with his brother
Ned, his cousins Mr. and Mrs. Edward Harvey, and their
daughter Melanie (who later became Ned’s wife). At age 26,
having just finished a slogging but satisfying year’s internship
at the Massachusetts General Hospital, for the first few days of
the trip he felt lost, desolate, and restless (37). But then he took
on a more cheerful mood, as evident from the entries in his
Diary of the Ready Shifters (4), a notebook with lively annotated
sketches of the troupe and their escapades on the Canadian
tour (Fig. 1).
After stopovers in the Maritimes, their tour included Qué-
bec City, where they booked in at the Château Frontenac,
which had opened in December 1893, only a few years earlier.
One of Cushing’s cartoons depicts an unflattering posterior
tude.” Another one, titled “We cheer up at the Frontenac,”
shows champagne being opened and spraying one of the
party out of his chair (Fig. 3).
The names of the Cushings and Harveys with their assigned
rooms were recorded by the hotel clerk in the guest register for
August 13, 1896 (Fig. 4). Almost 60 years later, in 1955, when
the American Association of Neurological Surgeons, origi-
nally the Harvey Cushing Society, met at the Château, the
assistant manager kindly put on display this page of the hotel
register for 1896.
In Montreal, Cushing visited the Hôtel-Dieu, founded in
1646; the Montreal General Hospital, where for 10 years Sir
William Osler had taught on the large open wards; and the
Royal Victoria Hospital (RVH), which had opened in 1893 as
one of the continent’s showpieces of hospital architectural

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FIGURE 1. The Cushing-Harvey troupe about to set off on their Cana-
dian tour (from, Cushing H: Diary of the Ready Shifters [Journal of a
trip to Canada, August, 1896, unpublished (4)]; courtesy, Yale University,
Harvey Cushing/John Hay Whitney Medical Library).
FIGURE 2. A posterior view of brother Ned with the Château in the
background (from, Cushing H: Diary of the Ready Shifters [Journal of
a trip to Canada, August, 1896, unpublished (4)]; courtesy, Yale Univer-
sity, Harvey Cushing/John Hay Whitney Medical Library).
design (36) (Fig. 5). Cushing noted that Sir William Macewen
of Glasgow was visiting the RVH at the same time; apparently
they did not meet.
The RVH became the first site of neurosurgery in Canada.
Edward Archibald, after 6 months of study with Sir William
Gowers and Sir Victor Horsley, started his neurosurgical prac-
tice there in 1904 (19). Four years later, in 1908, he produced a
monograph titled “Surgical Affections and Wounds of the
NEUROSURGERY
CUSHING’S CANADIAN CONNECTIONS
FIGURE 3. “We cheer up at the Frontenac”: the explosive effect of cham-
pagne (from, Cushing H: Diary of the Ready Shifters [Journal of a trip
to Canada, August, 1896, unpublished (4)]; courtesy, Yale University,
Harvey Cushing/John Hay Whitney Medical Library).
Head,” published in Bryant and Bucke’s American Practice of
Surgery (1). The same year, the excellent although shorter
review on surgery of the head by Harvey Cushing was pub-
lished in William W. Keen’s System of Surgery (7). These were
the two most useful works in English at that time dealing with
advances in cranial surgery. Archibald’s survey, although less
well known today, stands out as a substantial landmark in
neurosurgical literature by its well-ordered, scholarly consid-
eration of intracranial pathophysiology, illustrated by many
clinical cases from the RVH. Archibald, a founding member of
the Society of Neurological Surgeons, argued effectively in
1935, as president of the American Surgical Association, for an
American Board of Surgery. He thus made a most significant
contribution to surgical education in North America. And as
Professor of Surgery at McGill University in 1927, Archibald
enjoyed the support of a vigorous dean, Charles Martin, to
persuade Wilder Penfield and William Cone to move from
New York. At the RVH, between 1928 and 1934, Penfield and
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LEWIS REFORD AND

THE PITUITARY
During 1907–1908, another Mon-
trealer, Lewis Reford, as surgical
assistant in the Hunterian Labora-
tory at Hopkins, carried out with
Cushing the removal of the pitu-
itary gland in dogs. Their report
titled “Is the pituitary gland essen-
tial to life?” appeared in the Johns
Hopkins Hospital Bulletin for 1909. It
was the first of many experimental
projects on the pituitary to come
from Cushing’s laboratory.
Reford returned to Montreal but
never took up neurosurgery seri-
ously. But he offered generous finan-
cial support to Penfield and Cone
after their move from New York to
the RVH, donated his Zeiss micro-
scope for their laboratory, and pro-
vided a scholarship for young neu-
rosurgeons. His comfortable lifestyle
included a keen interest in salmon
FIGURE 4. Guest register of Château Frontenac, Thursday, August 13, 1896, with the names of Dr. H.W.
Cushing; his brother, Dr. E.F. Cushing; and the Harveys (courtesy, Canadian Pacific Railway Archives). fishing and stamp collecting (31).

Cone expanded the departments of neurosurgery and neuro-

pathology before founding the Montreal Neurological Insti-
tute (MNI) (21).

A MONTREAL OPERATION, 1904

In February 1904, Cushing, now a budding neurosurgeon at
the Johns Hopkins Hospital, went to Montreal on a consulta-
tion, referred by his most supportive mentor, Dr. William
Osler (25). One of Cushing’s medical colleagues in Canada
wrote Osler, “If Baltimore is the home of many men like Dr.
Cushing, I don’t wonder at your being so anxious to leave
Montreal to go ‘home.’ Dr. Cushing is a charming personality,
a most intellectual surgeon [and] an extremely skilled opera-
tor. He condescended to operate on the case I wanted you to
see with so much of that grand simplicity so rarely seen.” The
Montreal Gazette for February 6 carried the following note: “A
case of great interest to the medical profession at large will
come before Dr. Cushing’s attention today, and it is probable
that he will operate upon it. It is a case of lesion involving all
the branches of the Gasserian ganglion. The case is the first of
its kind in Montreal.” During this visit, at a meeting of the
Montreal Medico-Chirurgical Society on February 5, Cushing
spoke on the surgical aspects of trigeminal neuralgia. He
reported on 20 cases, with anatomic and physiological notes
on the consequences of its surgical removal (6). He had first FIGURE 5. Drawing by the architect, H. Saxon Snell, of the RVH, Montreal, as it
reported on his experience with this operation in 1900 (5). would have appeared at the time of Cushing’s visit (from, Terry N: The Royal Vic:
Twenty years later, he summarized his results in more than The Story of Montreal’s Royal Victoria Hospital, 1894–1994. Montreal,
332 cases (10). McGill–Queen’s University Press, 1994 [36]; courtesy, RVH Archives).

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FIGURE 6. Dr. Kenneth McKenzie, a student of Cushing at Harvard,
began neurosurgery as a specialty at Toronto in 1924 (courtesy, Wilder
Penfield Archive) (portrait by Frederick H. Varley, ARCA, 1952).
CUSHING AND MCKENZIE
In February 1911, Harvey Cushing presented a paper titled
“Brain tumors and their surgical treatment” to the Toronto Acad-
emy of Medicine (8). Again in Toronto, in 1922, as the Charles
Mickle Lecturer, he assigned his honorarium of $1000 to provide
a year for a surgical resident to train with him at Harvard. This
was awarded to Kenneth McKenzie, who had returned from
service overseas and had been in general practice for 4 years.
McKenzie declared later that he was probably too independent
by that time to accommodate to Cushing’s all-demanding ser-
vice. He fretted also that Cushing had insisted that McKenzie’s
wife and two children must remain in Canada. After working
with Cushing in 1923, he established the neurosurgical unit at the
Toronto General Hospital and became renowned as a master
surgeon and teacher (3, 19, 22) (Fig. 6).
McKenzie made good use of his period with Cushing at the
Peter Bent Brigham Hospital. He published one article on
section of the anterior spinal nerves for treating torticollis, a
topic he pursued throughout his career, and another with
Sosman on the x-ray diagnosis of craniopharyngiomas. Dis-
cussing the operation on the fifth nerve for tic douloureux,
McKenzie said in later years, “Certainly it was a difficult
NEUROSURGERY
CUSHING’S CANADIAN CONNECTIONS
FIGURE 7. Program for the Inauguration of the Biological Building,
McGill University, October 1922 (courtesy, McGill University Archives).
procedure as I saw it with Dr. Cushing. On his service, a
resident never got very far with the case before it was taken
out of his hands and a 3-or-4-hour operation was finished by
the chief. Yet I knew this operation to be one of my first
responsibilities on returning to Canada. Fortunately, before
coming home, a visit to Dr. Adson of the Mayo Clinic proved
most helpful. He had been through the fire and took me under
his wing. For the first time I could see what was being done
and felt that his particular technique could be duplicated” (28,
p 27).
McKenzie’s sound program of neurosurgical training pro-
duced men who served in universities and hospitals across
Canada. His first trainee, William Keith, became Canada’s first
pediatric neurosurgeon, and his next, Frank Turnbull, devel-
oped the neurosurgical unit in Vancouver. Other students
included Harry Botterell, who succeeded McKenzie in head-
ing the Toronto unit; Charles Drake, who became recognized
for his innovations in cerebrovascular surgery at London,
Ontario; and William Stevenson, who first headed up neuro-
surgery in the Maritimes. Thus, these second-generation stu-
dents, through McKenzie, spread the Cushing tradition across
Canada.
McKenzie was elected president of the Harvey Cushing Soci-
ety, an honor and distinction he held during Cushing’s lifetime.
In 1948, he became president of the Society of Neurological
Surgeons. A man of originality and laconic humor, he favored
clinical analyses with an anatomic bent, such as his critical as-
sessments of the value of the intracranial division of the vestib-
ular nerve for vertigo and of trigeminal tractotomy for pain, or
the role of psychosurgery in mental illness (3, 22, 28).
In April 1929, at the celebration of Cushing’s 60th birthday,
Kenneth McKenzie presented Cushing with a tie “that would
out-dazzle his bright orange favorite.” As Fulton notes (25),
McKenzie read a ditty titled “The tie that blinds,” which paro-
died Cushing’s choice of cravats and went, in part:
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FIGURE 8. Harvey Cushing and Charles Sherrington shown at the Royal
College of Surgeons in 1938. Photograph taken by Dr. John Beattie (from,
Preul MC, Feindel W: “The art is long and the life short”: The letters of
Wilder Penfield and Harvey Cushing. J Neurosurg 95:148–161, 2001
[34]; courtesy, Wilder Penfield Archive).
The book I read and the life I lead,/ Are sensible, sane
and mild,/ I like calm hats and I don’t wear spats,/ But
I want my neckties wild. (25, p 572)
Cushing defended his array of “wild” neckties by explain-
ing that they came from grateful patients.
On April 8, 1931, Cushing made his last visit to Toronto to
give the fourth Balfour Lecture, on the subject of peptic ulcer
and the interbrain, which he published in 1932 (13).
CUSHING AND SHERRINGTON AT
MCGILL, 1922
On October 5, 1922, Cushing took part in the inauguration of
the Biological Building at McGill’s Medical School (Fig. 7). He
was joined by Sir Charles Sherrington, Wayneflete Professor of
Physiology at Oxford and then president of the Royal Society of
London. Handsomely designed and equipped for preclinical lab-
oratories, the building heralded the first stage of a $2,000,000
Rockefeller-McGill program for a sweeping reorganization
of staffing and resources for medical teaching at McGill.
Sherrington, in his lecture, emphasized the value of these new
laboratory services, saying that the task we all have is to teach
students to teach themselves. Cushing then pointed out Osler’s
influence with the Rockefellers that eventually made the McGill
program possible. Like Sherrington, he mentioned the impor-
tance of laboratory studies, but in the Oslerian tradition, he also
emphasized the significance of bedside teaching in clinical sur-
gery. In a slightly perverse mood, however, he said that “brains
not bricks made possible the advance of medical science.” He
was afraid that this palatial laboratory and these elaborate build-
ings were likely to become a hindrance to science instead of a
help. He cited, as an argument, how Pasteur, Lister, Bernard,
202 | VOLUME 52 | NUMBER 1 | JANUARY 2003
Hunter, and McGill’s Osler had all done great work under much
more modest conditions.
Cushing continued, “In the four years’ course a division is
very properly made between the preparatory or scientific
branches and the practical; the one taught in the school or
college, the other in the hospital.” He concluded, “Not that
there is any difference; there may be as much science taught in
a course of surgery as in a course of embryology” (11, p 60).
This historical meeting of these two leading world figures in
their fields—Sherrington in physiology of the nervous system
and Cushing in brain surgery (Fig. 8)—presented an interesting
coincidence; both had been influential teachers of Wilder Pen-
field, the young neurosurgeon who 6 years later would appear
on the McGill scene (20, 21, 31).
McGill’s principal, Sir Arthur Currie, who welcomed the
guests (Fig. 7), had played a critical role in garnering funds to
match the $1,000,000 offer of the Rockefeller Foundation in
1920 to initiate this project; he would repeat his critical role a
decade later as the protagonist for further Rockefeller support
to establish the MNI of McGill University.
MCGILL AND THE OSLER LIBRARY
On May 29, 1929, Cushing was back at McGill for the opening
of the Osler Library, a ceremony close to his heart, at which,
much to his delight, he had been asked to represent the Osler
Club of London (25). Designed by McGill’s Professor of Archi-
tecture, Percy Nobbs, in close collaboration with Lady Osler, the
library elegantly housed Osler’s munificent gift of almost 8000
rare books in the history of medicine and science. Cushing’s
signature appears in the guest book among a strong representa-
tion of Lady Osler’s Revere relatives from New England, includ-
ing her sister, Susan Chapin (Fig. 9). Cushing’s monumental
two-volume biography, The Life of Sir William Osler, published in
1925 (12), had won a Pulitzer Prize. He had done much of his
research and writing for this in Oxford at Osler’s home, sur-
FIGURE 9. Guest book for the opening of the Osler Library, May 29,
1929, with signatures of Harvey Cushing and some relatives of Lady
Osler (courtesy, Osler Library Archives).
www.neurosurgery-online.com
 CUSHING’S CANADIAN CONNECTIONS

rounded by this unique collection before it had been shipped to

Canada.

CUSHING AND PENFIELD: A

LONG FRIENDSHIP
Wilder Penfield interned in 1918–1919 (18, 31) on the sur-
gical service at the Peter Bent Brigham Hospital at Harvard.
He first met Cushing in February 1919, when Cushing re-
turned from 4 years of service overseas in World War I. It was
the beginning of a long association. Between 1921 and 1928,
while he was at the Columbia-Presbyterian Hospital with
Allen Whipple, Penfield made five more visits to Cushing’s
unit at Brigham. As Penfield noted later to Fulton (25), “I was
very greatly influenced in the development of my own par-
ticular technique by the Cushing ritual [which, in turn, was
based on the fastidious operating techniques of his surgical
teacher, William Halsted]. I made drawings of every instru-
ment and listed the routine steps of every operation.” Penfield
went on, “It seems fair to say, therefore, that throughout my
surgical career I have used Cushing’s method as a sort of
classic and have constantly referred to the general principles
which he laid down in neurosurgical operating” (25, p 646).
The Penfield-Cushing correspondence during the course of
2 decades ran to 130 letters (34). It is evident from them that
Cushing always accepted Penfield as being one of his trainees
(33).
When in 1928, at the invitation of Edward Archibald,
Penfield moved from the Columbia-Presbyterian Hospital to
the RVH and McGill University (20, 31), he received a note FIGURE 11. Wilder Penfield and William Cone at the RVH (1932)
from Harvey Cushing written on February 4, 1928, which read (courtesy, Wilder Penfield Archive).
in part:
I am delighted that you are going to be in Montreal and a comfortable night trip, so I shall hope that we may
though it is a hard blow for New York. . . . Montreal, I see much of you.
am glad to say, is almost as near to Boston as New York Always sincerely yours,
Harvey Cushing
In 1930, Cushing operated on Penfield’s sister for the recur-
rence of a right frontal oligodendroglioma, an event that
added a closer personal bond to their friendship (33–35) (Fig.
10). They kept in touch about neurosurgical teaching and
techniques and about Cushing’s brain tumor registry when he
retired to Yale (21).

THE MNI: “NO TARIFF ON

FIGURE 10. Cushing’s letter about the postoperative recovery of Pen-
field’s sister, November, 1930 (from, Preul MC, Feindel W: “The art is
long and the life short”: The letters of Wilder Penfield and Harvey Cush-
ing. J Neurosurg 95:148–161, 2001 [34]).
OUR EXCHANGE”
Wilder Penfield and William Cone founded the MNI 6 years
after they had moved to Montreal and McGill (Fig. 11). For its
opening on September 27, 1934, Penfield invited Cushing to
give one of the foundation lectures, suggesting that he might
“look into the future or the past of neurology.” He warned
Cushing of the timing and that he would be included in a
selection of “thirteen men whom we consider have contrib-
uted most to the development of neurology and neurosur-
gery” (34, p 157), whose life sketches would be published to

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commemorate the occasion (14, 32). Cushing’s reply from Yale Cushing outdid himself with a broad philosophical and
was characteristic (Fig. 12). historical account titled Psychiatrists, Neurologists and the Neu-
14 June 1934 rosurgeon (14):
Dear Wilder: Permit me at once to convey Yale’s greetings to McGill
Thanks for your letter. I take note of your warning on the occasion of this highly significant ceremony. At
that “no souls are saved after 20 minutes—30 at the the same time, since I have been asked to speak briefly
outside”. about the surgery of the nervous system, I may, unso-
I am a little diffident about having my biography licited, venture to bring to you, the felicitations of the
included with all those people in your volume. Still, so enlarging group of surgeons who restrict themselves to
long as I have retired I suppose it doesn’t matter and this specialty in our two adjoining countries.
you must do as you like. The frontiers which separate us are of concern only to
politicians, cartographers, and customs officers. To the
medical profession—there being no tariff on our ex-
change of doctors and nurses—they are to all intents
and purposes non-existent [a situation that might well
be reexamined today by the American Board of Neuro-
logical Surgery]. We, on our side of the line, continue to
be vastly in Canada’s debt for sending us, among others,
the incomparable Osler.
“It was his textbook,” he continued, “that aroused the in-
terest of Mr. Rockefeller in medicine and led to the establish-
ment of the Foundation bearing his name, which in turn has
made possible the erection of this institute whose Director we
have thrown in for good measure.”
He also referred to the unfulfilled efforts in 1919, after
World War I, of himself and others to establish a National
FIGURE 12. Letter from Cushing to Penfield, June, 1934, about the Institute of Neurology (9). In a letter of August 1934 to Alan
upcoming foundation exercises at the Institute at Montreal (courtesy, Har- Gregg of the Rockefeller Foundation, Cushing had inquired
vey Cushing Archives, Yale University Library). whether the Institute at Montreal could have been a sequel to
this earlier project, because the
Foundation had been one of
the possible sponsors at that
earlier time for “an endow-
ment of about ten million.”
Gregg answered, “So far as I
know, [it] did not have a trace-
able connection with the de-
velopment at Montreal” (24,
25).
The signature of Harvey
Cushing, along with that of
John Fulton, who accompa-
nied him to Montreal, appears
on the program among those
of many distinguished guests
who attended the opening cer-
emonies of the Institute (Fig.
13).
Three decades later, in the
early 1950s, the National Insti-
tute of Neurological Diseases
and Blindness became estab-
lished at Bethesda. A dozen
trainees of the MNI—neurolo-
FIGURE 13. Program of the opening ceremonies of the MNI, September 22, 1934, with the list of guests and gists, neurosurgeons, and neu-
staff: note the signature of Harvey Cushing (encircled) (courtesy, Wilder Penfield Archive). roscientists—formed the core

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FIGURE 14. Address and text of a postcard from Cushing, January 26,
1935, complimenting Penfield for his obituary of Ramón y Cajal (courtesy,
Wilder Penfield Archive).
of the initial staff, and two later became directors of the
Institute (23, 38). Cushing no doubt would have been gratified
by this cyclic exchange. And scores of neurosurgeons of a
younger generation, who were taught the elements of the
Cushing ritual by Penfield and his surgical associates Cone
and Elvidge at the MNI, have returned to the United States;
many have headed university neurosurgical units from Boston
to Seattle and from Chicago to Pasadena (19, 20, 21, 23).
THE OSLER LIBRARY AGAIN
At the end of these formal events, Cushing walked across
the street to the Strathcona Medical Building to view once
again the splendid Osler Library. He was deeply impressed by
its atmosphere: the oak cabinets filled with rare volumes, the
painted coats of arms of the four universities at which Osler
had taught and practiced, the Osler Niche with its fine bronze
profile by Vernon framed by the richly bound editions of
Osler’s favorite authors and with his ashes behind the central
NEUROSURGERY
CUSHING’S CANADIAN CONNECTIONS
FIGURE 15. First draft by Penfield of his tribute at a memorial meeting
for Harvey Cushing, October 1939, at the MNI (from, Penfield W: The
passing of Harvey Cushing. Yale J Biol Med 12:323–326, 1940 [30];
courtesy, Wilder Penfield Archive).
panel. Brooding over this memorable visit on the overnight
train back to New Haven, Cushing decided to leave his books
to Yale University. But before making that decision public, he
convinced Arnold Klebs and John Fulton to do the same. Thus,
the famous Medical Historical Library at Yale was founded
from these three unique collections, inspired by Osler’s mag-
nanimous bequest to McGill (15, 16, 25, 37).
ENVOI
Cushing warmly praised Penfield’s scientific and literary
work. Typical of such messages was a handwritten postcard
about Penfield’s tribute to Ramón y Cajal (29).
Jan 26 [1935]
Dear Wilder—
So much, so well, in so few words—your brief obitu-
ary of Ramón y Cajal. Charmingly done!* I had to write
you this note about it instanter.
Always yours, Greetings to you and your Instituters
and best wishes for 1935.
H.C.
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FEINDEL
FIGURE 16. Harvey Cushing’s name on the frieze in the Hall of Neuro-
logical Fame, MNI (courtesy, MNI, Neuro Archives).
*I only know of one man who might have done it, viz.
C.S.S. [Charles S. Sherrington] or perhaps J.F.F. [John F.
Fulton].
Here is a nostalgic example, almost a symbol, of that pro-
fessional era: the eminent retired neurosurgeon taking time to
dash off a warm personal note, in the best Oslerian fashion, to
his former student and friend, the new director of the Institute
4 months into its infancy; no street address needed, no zip
code, and all this for two Franklin one-cent postage stamps
(Fig. 14).
Harvey Cushing died on October 7, 1939, and for a special
memorial meeting of the Montreal Neurological Society on
November 15, Wilder Penfield hurriedly prepared an epice-
dium on “Harvey Cushing, The Man” (Fig. 15), which read in
part:
In the passing of Harvey Cushing our profession has
lost a surgeon, a neurophysiologist and a scholar of the
greatest distinction. We do well to call a halt in our
clinical proceedings, to devote a meeting of our society
to recognition of this versatile leader of neurosurgery.
In the published version (30), Penfield continued, “Techni-
cian, operator, artist, physiologist, he set up a new standard in
his surgical clinic. He caused a reversal in the flow of graduate
medical students, a flow, for the first time, from East to West
across the Atlantic. His clinic became a universal Mecca to
those who had entered the field of neurosurgery and now it
may be said that neurosurgeons throughout the world belong
to the Cushing School.” Penfield then quotes a letter from
Cushing at the time of the celebration of his 60th birthday in
1929 in regard to the problem of training a neurosurgeon:
We may be setting the standard too high, too compre-
hensive, but it is worth striving for. . . .
The length of time it would take for a proper ground-
ing in neuropathology, psychiatry, neurophysiology,
etc., plus surgery, except for the occasional genius, is
prohibitive. The art is long and the life short. And the
206 | VOLUME 52 | NUMBER 1 | JANUARY 2003
measure of the life is that of a surgeon who begins to see
the end at the stage when he receives birthday volumes
(30).
CONCLUSION
Harvey Cushing’s preeminent role in the development of
neurosurgery as a respectable specialty in North America has
been richly documented in the biographies by Fulton (25) and
Thomson (37) and in recent accounts from neurosurgeons of
the present generation at the three universities—Yale, Johns
Hopkins, and Harvard—at which Cushing left an indelible
legacy of high achievement in scholarship and surgery (2, 17,
27). He has been justifiably named neurosurgery’s “man of the
century” (26).
Cushing’s Canadian connections spanned his entire surgical
career; they would prove to be crucial to Canadian neurosur-
gery. His strong personal and professional relationship with
Sir William Osler and his research on Osler’s biography gave
him an unprecedented understanding of McGill, Toronto, and
Canadian medicine. His surgical ritual influenced his students
Penfield and McKenzie, who went on to establish the two
major Canadian schools for neurosurgical teaching and treat-
ment. Above all, Cushing encouraged Penfield in his clinical
practice and research and in his development of the MNI,
where the name of Harvey Cushing enhances the Hall of
Neurological Fame (Fig. 16).
REFERENCES
1. Archibald EW: Surgical affections and wounds of the head, in Bryant JD,
Beck AH (eds): American Practice of Surgery. New York, William Wood & Co.,
1908, vol 5.
2. Black PMcL: Harvey Cushing at the Peter Bent Brigham Hospital. Neuro-
surgery 45:990–1001, 1999.
3. Botterell EH: Dr. Kenneth George McKenzie: An appreciation. Can Med
Assoc J 91:880–881, 1964.
4. Cushing H: Diary of the Ready Shifters (Journal of a trip to Canada, August,
1896, unpublished, quoted in References 25 and 37).
5. Cushing H: A method of total extirpation of the Gasserian ganglion for
trigeminal neuralgia. Jour A M A 34:1035–1041, 1900.
6. Cushing H: The surgical aspects of major neuralgia of the trigeminal nerve:
A report of twenty cases of operation on the Gasserian ganglion, with
anatomic and physiologic notes on the consequences of its removal. Jour
A M A 44:773–778; 860–865; 920–929; 1002–1008; 1088–1093, 1905 (Presented
at a meeting of the Montreal Medical Society [Medico-Chirurgical Society],
February 5, 1904).
7. Cushing HC: Surgery of the head, in Keen WW (ed): Surgery: Its Principles
and Practice. Philadelphia, W.B. Saunders Co., 1908, vol 3, pp 17–276.
8. Cushing H: Brain tumors and their surgical treatment. Can Lancet 44:507–
509, 1911 (Abstract of an address presented at the Academy of Medicine,
Toronto, February 7, 1911).
9. Cushing H: Concerning the establishment of a National Institute of Neurol-
ogy. Am J Insanity 76:113–129, 1919.
10. Cushing H: The major trigeminal neuralgias and their surgical treatment
based on experiences in 332 Gasserian operations: First paper—The varieties
of facial neuralgia. Am J Med Sci 160:157–184, 1920.
11. Cushing H: Laboratories: Then and Now. Toronto, Privately printed, 1922 (An
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12. Cushing H: The Life of Sir William Osler. Oxford, Clarendon Press, 1925.
www.neurosurgery-online.com

13. Cushing H: Peptic ulcers and the interbrain. Surg Gynecol Obstet 55:1–34,
1932 (The basis of the fourth Balfour Lecture, given at the University of
Toronto, April 8, 1931).
14. Cushing H: Foundation Lecture: Psychiatrists, neurologists and the neuro-
surgeon, in Neurological Biographies and Addresses: Foundation Volume Pub-
lished for the Staff to Commemorate the Opening of the Montreal Neurological
Institute of McGill University, 27th September 1934. London, Oxford University
Press, 1936, pp 17–36 (Also published in Yale J Biol Med 7:191–207, 1935).
15. Cushing H: A Bibliography of the Writings of Harvey Cushing. Springfield,
Charles C Thomas, 1939.
16. Cushing H, Klebs AC, Fulton JF: The Making of a Library: Extracts from Letters,
1934–1941. New Haven, Yale Medical Library and Yale University Press,
1959.
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McGill University Hospitals. Neurosurgery 39:830–839, 1996.
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Foundation of the Montreal Neurological Institute. Boston, Little, Brown and
Co., 1955.
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and his legacy. Neurosurgery 45:977–982, 1999.
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Hospital. Toronto, University of Toronto Press, 1960.
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33:172–173, 1935.
30. Penfield W: The passing of Harvey Cushing. Yale J Biol Med 12:323–326,
1940.
31. Penfield W: No Man Alone: A Neurosurgeon’s Life. Boston, Little, Brown, and
Co., 1977.
32. Penfield W, Elliott H, Gage L: Harvey Cushing. Arch Neurol Psychiatry
34:635–642, 1935.
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role of the “Cushing ritual” and influences from the European experience.
J Neurosurg 75:812–820, 1991.
34. Preul MC, Feindel W: “The art is long and the life short”: The letters of
Wilder Penfield and Harvey Cushing. J Neurosurg 95:148–161, 2001.
35. Rossitch E, Moore MR, Alexander E, Black PMcL: The neurosurgeon’s
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36. Terry N: The Royal Vic: The Story of Montreal’s Royal Victoria Hospital, 1894–
1994. Montreal, McGill–Queen’s University Press, 1994.
37. Thomson EH: Harvey Cushing, Surgeon, Author, Artist. New York, Henry
Schuman, Inc., 1950.
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Acknowledgments
This project was supported by the Wilder Penfield Archive Fund of the Class
of Medicine 1945 of McGill University and the Thomas Willis Research Fund of
the MNI. I thank the neurophotography staff of the MNI for preparing the
figures; Jo-Anne Colby, analyst, Canadian Pacific Railway Archives, Montreal,
for providing a copy of the registry page of the Château Frontenac; the Cushing-
Whitney Medical History Library of Yale University for permission to use the
Cushing letters and illustrations; and Wayne LeBel and Alan Forster at the Osler
Library, McGill University, for Figure 9. Other letters and photographs, as noted
NEUROSURGERY
CUSHING’S CANADIAN CONNECTIONS
in the captions, are from the Wilder Penfield Archive, MNI, McGill University.
Thanks are due also to Dr. Thomas P. Morley, former Chief of Neurosurgery at
the Toronto General Hospital, for helpful discussions about the McKenzie era.
The author is grateful to Ann Watson and Victor Epp for editorial support in
preparation of the manuscript. Some parts of this article were presented at two
annual meetings of the American Association of Neurological Surgeons, To-
ronto, April 1988 (as a talk) and April 2001 (as a poster).
COMMENTS
H arvey Cushing’s influence on neurosurgical training in
countries throughout the world is unparalleled. In this
report by Dr. Feindel, Cushing’s contributions to and connec-
tions with Canadian neurosurgery are depicted accurately.
The establishment of neurosurgical training centers at McGill
University and the University of Toronto would not have
taken root so quickly or so deeply had it not been for Cush-
ing’s personal impact on the lives and careers of Kenneth
McKenzie and Wilder Penfield. In the case of McKenzie, who
received a 1-year fellowship to train under Cushing in 1922
and 1923, much was learned from the master of Peter Bent
Brigham Hospital regarding approaches to neurosurgical
cases. The arduous task of looking after the neurosurgical
service in Boston was clearly the making of McKenzie. Al-
though Penfield never worked directly with Cushing, their
lives intersected on many occasions especially after Penfield
established the Montreal Neurological Institute. Dr. Feindel
has done well to provide figures showing numerous historical
documents that clearly attest to Cushing’s interest in promot-
ing the development of neurosurgery in Canada. Neurosur-
geons north of the 49th parallel are deeply indebted to
Cushing’s historical Canadian connections.
James T. Rutka
Toronto, Ontario, Canada
D r. Feindel, long a distinguished neurosurgeon and noted
historian in the Canadian health care system, has put
together a wonderful historical vignette on Canadian medi-
cine and Harvey Cushing. Just when I think there is nothing
new to add on our father figure, along comes an article such as
this one. Although historical snippets have been published in
books and journals regarding the relationship between
Penfield and Cushing, never has their relationship been so
clearly depicted as in this article. I particularly enjoyed—and
I am sure readers will also—the illustrations that are included
in the article. Some of Cushing’s original drawings have not
been published widely before the appearance of this article.
The immensely trusting, rich relationship that Cushing had
with Penfield is clearly revealed by Dr. Feindel. Just asking
another surgeon to operate on a close relative is an immense
honor, and Cushing, of course, carried it off well. The Cana-
dian story is very well presented and wonderful to read, and
a reprint of this article will be a special bedside reading treat
for future historians!
James T. Goodrich
Bronx, New York
VOLUME 52 | NUMBER 1 | JANUARY 2003 | 207
FEINDEL
D r. Feindel has written, in a charming and free-flowing
style, an interesting documentation of Harvey Cushing’s
Canadian connections. Dr. Feindel gives added relevance to
his subject in quoting from the talk delivered by Cushing at
the opening of the Montreal Neurological Institute on Septem-
ber 27, 1934. Cushing’s statement is, “The frontiers which
separate us are of concern only to politicians, cartographers,
and customs officers. To the medical profession—there being
no tariff on our exchange of doctors and nurses—they are to
all intents and purposes, nonexistent.” In today’s electronic
age and with the increased facility of travel, Cushing’s state-
ment is apt and prescient. The well-chosen selection of illus-
trations by Cushing reveals his wry sense of humor. The rest
of the illustrations provide added vividness to the text.
Dr. Feindel correctly points out that it was as a result of that
1934 visit to the Montreal Neurological Institute that led
Cushing to his decision to leave his large library to Yale.
Because the Medical Historical Library at Yale has achieved
national recognition, I would like to quote from an article I
wrote in 1969: “Originally he had thought that he might make
a short-title list of his holdings and permit his executors to
dispose of the library so that other book lovers might have the
pleasure of making their own collections. However, in 1934,
Floating drydock workshop Shippingport, where the USS Billfish (SSN 676) undergoes renovation at the Electric Boat Company, Groton, Connecticut.
after observing the influence of the Osler Library on students
and faculty at McGill, the idea occurred to him of creating a
similar center of humanistic studies in medicine and science at
Yale” (1). Because I was involved as a cataloguer in my stu-
dent days, when the plan for the Medical Historical Library
was being hatched by Cushing and his protégé John F. Fulton
on this side of the Atlantic as well as by Arnold C. Klebs on the
other side, it is gratifying to see Dr. Feindel’s recognition of the
Canadian connection between the Osler Library at McGill
University and the Medical Historical Library at Yale. Dr.
Feindel’s recognition of Cushing’s literary as well as surgical
talents is summed up in his Conclusion: “Cushing left an
indelible legacy of high achievement in scholarship and
surgery. . . . He has been justifiably named neurosurgery’s
‘man of the century’” (2).
Lycurgus M. Davey
New Haven, Connecticut
1. Davey LM: Harvey Cushing and the humanities in medicine. J Hist Med
Allied Sci 24:119–124, 1969.
2. Laws ER Jr: Neurosurgery’s man of the century: Harvey Cushing—The man
and his legacy. Neurosurgery 45:977–982, 1999.