J Relig Health (2014) 53:1923–1929

DOI 10.1007/s10943-014-9916-1

BIOGRAPHICAL EXPLORATION

Harvey Cushing, M.D., in His World

Curtis W. Hart

Published online: 27 July 2014

 Springer Science+Business Media New York 2014

Abstract Harvey Cushing, M.D. (1869–1939), is the acknowledged father of the disci-
pline of neurosurgery who inspired others to join him in this new field. He was a prolific
researcher in the area of human growth disturbances. And he was among the most literary
of doctors having won the Pulitzer Prize for his two-volume biography of his mentor and
teacher William Osler, M.D. A driven man, he both inspired and intimidated others. This
essay explores Cushing’s character and background along with his relationship to Osler. It
seeks to understand why and how he may be considered a great figure in spite and because
of his demanding and often problematic character. It further seeks to place Cushing in the
context of the transition of American society and American medicine in the latter decades
of the nineteenth and early decades of the twentieth century. Portions of this essay were
originally delivered as part of a Grand Rounds presentation for the Department of Neu-
rosurgery at the New York Presbyterian Hospital Weill Cornell Center.

Keywords Harvey Cushing
William Osler
Flexner report
Neurosurgery
Cushing’s

syndrome
Johns Hopkins Hospital

Who was Harvey Cushing?

Harvey Cushing was a pioneering figure in American medicine and surgery. Known as the
father or originator of the field of neurosurgery, he was also a researcher of note fascinated
with the anomalies of human growth and is included among those who helped found the
field of endocrinology. His career-long investment in studies of the pituitary gland led him
at age sixty to identify the condition that bears his name: Cushing’s syndrome. He and his
teams of surgical colleagues performed over two thousand operations on the human brain.

C. W. Hart (&)
Medicine and Psychiatry, Division of Medical Ethics, Weill Cornell Medical College, 1300 York
Avenue, New York, NY 10065, USA
e-mail: cuh9001@med.cornell.edu

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They were thus able to surpass others who made efforts to remove lesions and tumors from
this most complex of human organs.
Cushing was born in Cleveland, Ohio, to a family of physicians who had migrated from
New England to the Western Reserve earlier in the nineteenth century. He graduated from
local schools in Cleveland, earned his bachelor’s degree from Yale, and then went on to
attend the Harvard Medical School. He studied in Europe in Germany as did many
American physicians and scholars of his era where his fascination with neurosurgery
began. He did his surgical training at the then newly opened Johns Hopkins Hospital in
Baltimore where he studied under the luminaries assembled there, notably William Stewart
Halsted. Cushing was personally mentored by William Osler then considered to be finest
doctor in the world. Osler helped to impart to him values that would shape his professional
identity and character. These values would remain virtually unchanged in Cushing until he
died in 1939. He was part of the era when American medicine arose to become a sovereign
profession even as it became acknowledged and respected on the international scene as
well. Cushing wrote numerous articles for professional audiences and won a Pulitzer Prize
for his two-volume biography of William Osler in the 1920s. That work identifies him as
among the most literary of American doctors. His anatomical drawings of the human brain
and other organs demonstrate that he was graced with visual imagination and talent as well
as literary ones.
Cushing and his cohort of young physicians were fortunate to be born and moving into
their professional lives when the standards of the Flexner Report of 1910 were being
accepted and implemented throughout the United States. In an effort to standardize and
upgrade medical education, Abraham Flexner deemed it necessary that all students
entering what we now know as undergraduate medical education possess a bachelor’s
degree. The curriculum for medical school would be based on two intensive years of basic
science that taught the basis of disease and its treatment followed by another two equally
intensive years of clinical exposure and practice with patients under the mentorship of
senior scientist clinicians. Flexner founded his ideal of this course of study on the Hopkins
model. Gone then were the days when medical education was an uneven, often faulty
process where study for becoming a doctor could be had by following a local physician
around or attending series of lectures that were often made up of grossly inadequate
content. The schools providing this rudimentary education were often nothing more than
glorified diploma mills.
After his stint at Johns Hopkins in its department of surgery, Cushing spent a large
portion of his career at the newly opened Peter Bent Brigham Hospital in Boston. His time
there was interrupted by service as a surgeon on the front in France in World War I after
the United States entered the war on the side of the Allies in 1917. He returned to Boston
after the war to resume his practice and to continue his lifelong avocation of collecting rare
medical books. He died in 1939.

Cushing and Osler

Harvey Cushing had an exceptionally close relationship with William Osler that began
during his time at the then newly opened Johns Hopkins Hospital in Baltimore. It was there
under the mentorship of Osler, the tutelage in surgery of William Halsted, and later during
an extended sojourn to Europe and Germany for study with Theodor Kocher and Victor
Horsley that his life in medicine and surgery took shape. Osler became for Cushing a
mentor and father figure of sorts, a person of greater warmth and approachability than

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Cushing’s own physician father Henry Kirke Cushing. An understanding of Cushing

proceeds in part with an acknowledgement and exploration of the impact of this one great
man, William Osler, upon an aspiring, would be, and soon to become, other great man,
Harvey Cushing. Evidence of this enduring legacy lies in part in Cushing’s compendious,
two-volume biography, The Life of William Osler, that won the Pulitzer Prize. It was
published in 1925, 6 years after Osler’s death in England in 1919 as a result of his being a
victim of the Great Influenza epidemic of the time. Cushing’s own original biography was
written by his colleague, John Fulton, whose celebratory volume appeared in 1946, 7 years
after Cushing’s death in 1939. Both books by Cushing and Fulton promoted idealized
portraits of their subjects. These portraits combined with accrued legends and lore con-
tributed to a larger than life perspective of both individuals. Some have charged that
Cushing’s study of Osler borders on hagiography. And Michael Bliss criticizes Fulton’s
work as viewing Cushing through a romantic lens. These judgments are harsh though
understandable. Many biographies of major figures written by their students and colleagues
reveal similar authorial biases and points of view. The same might be said, for example,
regarding William Herndon’s memoir of his long-time friend and law partner, Abraham
Lincoln, and of the three-volume study The Life of Sigmund Freud written by Ernest Jones
about his teacher and colleague. Both these seminal studies have been criticized in ways
similar to judgments made about Cushing’s and Fulton’s books. These criticisms, however,
do not finally diminish their value as works of scholarship.
Arthur Schlesinger, Jr., once declared that history is never written but rather ‘‘rewrit-
ten’’. By this statement, the then acknowledged dean of the American historical estab-
lishment meant that a fair understanding of any figure of note or significant series of events
demands constant revision as new data and additional historical interpretation become
available. Writing history is thus like doing science in its respect for new data that brings to
light historical eras and figures in ways not seen before. In the case of Osler and Cushing,
any engagement with them requires a balance that avoids hagiography and hero worship on
the one hand and simplistic denigration on the other.
Osler and Cushing did have things in common. Cushing, like Osler, had a virtually
transcendent sense of obligation to his profession and to the teaching of those who would
follow him. He also displayed Oslerian equanmitas (equanimity) with his patients and was
known to become disconsolate if he thought he failed them. Both men were unrepentant
bibliophiles who had their book collections donated to libraries. Both shared a core belief
in the efficacy of science and science-based medicine. Both moved beyond their con-
ventional religious training and acculturation. Osler was a ‘‘son of the manse’’ whose father
was an Anglican clergyman sent out to the provinces of Ontario by his ecclesiastical
superiors. The Cushing family had its own pew in the Old Stone Presbyterian Church in his
native Cleveland and his mother, Bessie, organized regular Bible study for Harvey and his
several siblings. This study with its emphasis on values, righteousness, and exemplary
conduct reinforced the weight of family and tradition upon Harvey and his brother Ned,
both of whom went on to become doctors like their father. Importantly, both William Osler
and Cushing were legendary workaholics. And both lost sons in situations involving
violence. Osler’s only child, Revere, died of shrapnel wounds sustained as a member of the
British army at Ypres in Belgium in 1917 in World War I. By an accident of geography,
Cushing was serving at a field hospital in a nearby sector having volunteered and organized
surgical and medical services for the American Expeditionary Force. He was summoned
and was present when young Osler died. This event and many other similar occasions led
him to remark in his journal of the period that the fallen were ‘‘doubly dead because they

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died so young’’ (Nuland 1994). Harvey Cushing’s son, William, died in what was
apparently a drunk driving accident when he was a freshman at Yale in 1926.
Harvey Cushing did differ from William Osler in important respects. He was exceed-
ingly harsh and sharp-tongued with residents he trained, competitive and highly critical of
surgical rivals, notably his resident Walter Dandy at Johns Hopkins, and at points con-
temptuous of hospital administrators. He was a perfectionist of immense proportions and
extraordinarily self-centered in his professional and family circles. Monomania might well
be an accurate descriptive term for his attitudes and behavior. He browbeat and regularly
criticized his wife Kate whom he otherwise dearly loved. He often neglected her and his
five children for long periods of time. He was a charismatic leader who commanded both
loyalty and respect from his inner circle. Because of the important work he did, those
around him were made to feel important as well. He was not given to suffer fools gladly.
His zeal and ambition were not, as in the case of Osler, cloaked or masked in any way. It
may be that an effort at self definition, distancing, or differentiation from his esteemed
mentor required alternative forms of behavior.

Cushing’s Life and Achievements

Whatever can be said of Harvey Cushing, it is clear that that he was a great man. As Lord
Acton said ‘‘Great men are almost always not good men’’. But if Acton is correct then what
made Harvey Cushing great?
Harvey Williams Cushing was born in Cleveland, Ohio on April 8, 1869, and died in
New Haven, Connecticut on October 7, 1939. His life span bridges the post-Civil War
period through the 1930s. Dynamic change permeated the era of Cushing’s coming of age
and generational maturity. In this period, America emerged as an industrially powerful
nation with a growing population as it entered its life on the world stage. It was an era
when American medicine and surgery became sovereign professions. The Flexner Report’s
impact with its subsequent developments made possible the growth of science-based
medicine and surgery. Medical education became professionalized and the country saw the
birth of medical schools with bona fide scientific and clinical curricula. Harvey Cushing
was a presence and instrumental, in fact a veritable force of nature, in helping bring
modern American medical education, research, and clinical practice into being along with
having it measure up to and in some ways move past its European counterparts.
Harvey Cushing was born into a family of physicians. His father, Henry Kirke Cushing,
practiced in Cleveland as did his father, Harvey’s grandfather, Erastus Cushing, and
Harvey’s brother Ned Cushing. It might be noted that Ned Cushing looked eerily similar to
William Osler. The Cushing clan was by background New England Yankees who migrated
to the Western Reserve in the early decades of the nineteenth century. They became
staunch pillars of this new community on Lake Erie that grew in prominence and power as
the industrial growth of Cleveland and the rest of the Midwest dramatically expanded in
the years following the Civil War. Cushing’s mother, Bessie, ran a domestic ‘‘tight ship’’
whose order and discipline reflected the needs and temperament of Cushing’s father who
provided comfort and amenities for his children. Dr. Kirke Cushing practiced internal
medicine in Cleveland. He is remembered as a benign and reserved man who meted out
punishment and approval in ways characteristic of a flinty New Englander and classical
Victorian pater familias. Harvey’s brother, Ned, returned to Cleveland to practice internal
medicine after completing studies at Harvard Medical School. He was thus unlike his
brother, Harvey, who was destined to claim a larger stage for his interests and ambitions.

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Harvey attended high school in Cleveland followed by Yale where he graduated in 1891.
Cushing’s lifelong dedication to his alma mater as its ‘‘faithful son’’ reflects his rela-
tionships to other paternal figures and institutions.
After Yale, Cushing went on to Harvard Medical School and studied abroad where his
interest in neurosurgery began to emerge and take shape. His surgical training took place at
Johns Hopkins under the tutelage of the esteemed figure of William Halsted. Early on, his
gifts of intellect and imagination began to express themselves in both writing and the
illustrations of his observations in the laboratory and in his surgical pursuits as well. He
married Kate Crowell in 1902 and together they had five children.
He appears to have had boundless energy and a steadfast will to succeed in both
research and clinical pursuits. He returned to Boston in 1912 to become Professor of
Surgery at Harvard Medical School and Chief of Surgery at the newly opened Peter Bent
Brigham Hospital where he stayed until 1932. He concluded his career as Sterling Pro-
fessor of Neurology at Yale and died in 1939 at the age of seventy. The cause of death was
myocardial infarction that may have been due in part to his having been a heavy smoker for
much of his adult life. His body was returned to the ancestral home in Cleveland where he
is buried in Lakewood Cemetery.
His professional accomplishments are many and varied. His book The Pituitary Gland
and Its Disorders was published in 1912. It highlighted his founding interest and contri-
bution to the field of endocrinology and in turn to the delineation of Cushing’s syndrome,
the disease that bears his name. His surgical innovations include but are not limited to
‘‘three fields that … occupied him for much of his operating career: ganglionectomies for
trigeminal neuralgia, intracranial procedures to attack brain tumors, and [of course] special
approaches to the pituitary region’’ (Bliss 2005). He also taught a legion of neurosurgeons
who themselves became leaders in the field.
He was also, as previously noted, instrumental in forging and directing medical services
for the American Expeditionary Force in World War I. His description of that experience is
recorded in his From A Surgeon’s Journal published in 1936. It appears to have been
written in part to enhance and preserve his public persona and reputation as well as to
speak movingly of his searing experience as a doctor at the front. Cushing’s reactions of
dismay and moral horror parallel those of his fellow Midwesterner, Ernest Hemingway,
whose experience of being wounded at the front as an ambulance driver in World War I
became for him a preoccupation and resource for some of his finest writing. Indeed, a
reading of both Cushing’s Journal alongside Hemingway’s In Our Time (1925) and A
Farewell to Arms (1929) reveals how both individuals used the act of writing to bring some
sense of order and necessary emotional catharsis in the face of loss, waste, and mortal
chaos of virtually immeasurable proportions. Both Hemingway’s and Cushing’s narratives
rely similarly on lean, spare prose, and descriptions of concrete events where natural
imagery conveys the larger truth of what both had come to know firsthand. All this is
accomplished without undue embellishment or abstract philosophizing.
Here are passages from Cushing and Hemingway. Both use colloquial speech whose
realism contains and communicates a quest for moral clarity in the face of suffering and
death. First, there is Cushing’s recounting of a visit to a battle zone:
The salient is a waste unbelievably littered with debris of every kind, dead horses,
derelict tanks, fallen and crumpled aeroplanes, cordite cans, shells, mortars, fish-tail
bombs, broken and abandoned limbers, barbed wire, old trenches, water-filled cra-
ters, strips of old road camouflage, gravestones and tumbled cemeteries, sheet-iron

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fragments of old Nissan huts, fallen trees, frames of inverted A-shaped trench sup-
ports, and I can’t remember at moment more-except gooey mud. (Bliss 2005)
Second, there is Cushing’s poignant recollection of the burial of Revere Osler:
A soggy Flanders field beside a little oak grove to the rear of the Dosinghem group—
an overcast, windy, autumnal day—the lone rows of simple wooden crosses—the
new ditches half full of water being dug by the Chinese coolies wearing tin hel-
mets—the boy wrapped in an army blanket and covered by a weather-worn Union
Jack, carried on their shoulders by four slipping stretcher-bearers. A strange scene—
the great grandson of Paul Revere under a British flag, and awaiting him a group of
six or eight American Army medical officers—saddened with the thought of his
father…the Padre recited the usual service—the bugler gave the last ‘Last Post’ and
we went about our duties. Plot 4, Row F. (Bliss 1999)
And, last, there is the following well-known passage in the Hemingway canon. Here
Frederick Henry, the protagonist and Hemingway persona in A Farewell To Arms who has
been wounded both physically and psychically in the horrendous battle of Caporetto in
Italy, reflects upon his traumatic experience at the front and what it has done to him:
I was always embarrassed by the words sacred, glorious, and sacrifice and the
expression in vain. We had heard them sometimes standing in the rain almost out of
earshot, then on proclamations, now for a long time and I had seen nothing sacred,
and the things that were glorious had no glory and the sacrifices were like the
stockyards of Chicago, if nothing was left with the meat except to bury it. There were
many words that you could not stand to hear and finally only the names and places
had dignity. Certain numbers were the same way and certain dates and these were the
names of places were all you could say and have them mean anything. Abstract
words such as glory, honor, courage, or hallow were obscene beside the concrete
names of villages, the numbers of roads, the names of rivers, the numbers of regi-
ments and the dates.
(Hemingway 1929)
A reading of these passages provides a revelation of how both Cushing and Hemingway
struggled to come to grips with what their wartime service had meant for them.
Why did Harvey Cushing succeed with all his warts and flaws? Often it is at least as, if
not more, difficult to discern how and why a person becomes a great, if not a good, man
rather than someone who does not excel in spite of natural talents and abilities. While
family and tradition weighed heavily on Cushing, it is also true that they bestowed upon
him a sense of identity in the way psychoanalyst Erik Erikson describes it as ‘‘a feeling of
continuity and sameness and the ability to act accordingly.’’ (Erikson 1950) Cushing knew
who he was. It would be incorrect to view Harvey Cushing as merely a product of
responses to familial and other forces, influences, and expectations. He transcends any sort
of simple, formulaic analysis. It is more productive, and frankly more interesting, to
speculate upon why he was so successful. There are several factors involved in making this
determination. First, there is the reality of his raw gifts and talents, his basic endowments.
Second, there was the quality and consistency of his education and mentoring. Third, he
had the time and economic resources to nurture his interests. Fourth, he had a spouse who
would put up with him. Fifth, he lived at a time when the basic science and technology
were beginning to be available to make possible his creative investigations and break-
throughs. Sixth, the field of neurosurgery was utterly new and required a champion, a

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leader. To be a leader and founder requires a sense of entitlement, a compelling public (and
in Cushing’s case also literary) persona, a capacity to be implacable in the face of
adversity, the strength to deal with powerful institutions and individuals, and eventually a
willingness to be honored as a sagely eminence grise with a legacy to bequeath to a
profession and to the world at large. Harvey Cushing played all these roles and played
them to the hilt. And, clearly, he loved it.

‘‘It is a Complex Fate Being an American’’

The novelist and man of letters Henry James once wrote ‘‘It is a complex fate being an
American’’ (James 1907). This pithy statement appears in James’ The American Scene
written in 1907. The book is a subtle and descriptive rendering of James’ travels in America to
which he had returned after a 20-year self-imposed exile in England and Europe. It maps out
the geographical, spiritual, and intellectual landscape of the world James knew growing up
and left behind as he discovers it transformed in the same years when Harvey Cushing was
coming to the height of his powers. And it says something about what James felt to be his
complex fate as well. There is no available record about whether Harvey Cushing ever took
the time to read Henry James or consider closely the changes that had taken place in his native
country, the cultural context of his own rise to prominence and the scene of his singular
accomplishments. Cushing was a person of transparent contradictions and complexities:
idealistic and ambitious, loyal and competitive, passionate and ruthless, gifted intellectually
and a natural leader and yet encumbered with interpersonal blind spots.
Harvey Cushing was also very much what Ralph Waldo Emerson described in his own
Journals earlier on in the nineteenth century as
Here’s for the plain old Adam, the simple genuine self against the world.
(Lewis 1955)
Emerson here invokes the biblical Adam as a non-literalistic symbol of American
purpose and potential in the creation of a new world. That was Harvey Cushing. He was the
American individualist par excellence, ready to take on anything in order to create a new
world in medicine and science. Like his Yankee forbears, he was both a puritan and a
patriot bound and determined to succeed and at the same time serve the common good. His
was indeed a complex fate and he was very much an American.

References

Bliss, M. (1999). William Osler: A life in medicine. New York: Oxford University Press.
Bliss, M. (2005). Harvey Cushing: A life in surgery. New York: Oxford University Press.
Cushing, H. (1925). The life of William Osler (2nd ed.). Oxford: The Clarendon Press.
Cushing, H. (1936). From a surgeon’s journal. Boston: Little Brown.
Erikson, E. (1950). Childhood and society. New York: Norton.
Fulton, J. F. (1946). Harvey Cushing: A biography. Springfield: Charles C. Thomas.
Hemingway, E. (1925). In our time. New York: Scribner’s.
Hemingway, E. (1929). A farewell to arms. New York: Scribner’s.
James, H. (1907). The American scene. New York: Penguin.
Lewis, R. W. B. (1955). The American Adam: Innocence, tradition, and tragedy in the nineteenth century.
Chicago: University of Chicago Press.
Nuland, S. B. (1994). How we die. New York: Alfred Knopf.

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