The role of medical illustration in the evolution of transsphenoidal pituitary surgery.

Medical illustration played a crucial, yet often overlooked, role in the evolution of pituitary surgery. From the late 1800s to the present, many preeminent surgeons, in partnership with their surgical illustrator collaborators, developed and then shifted the paradigm of pituitary surgery, from an open procedure with high mortality and morbidity, to an endonasal approach with high success rates that is widely utilized today. This work aims to highlight the role of surgical illustrators as partners to their physician colleagues, creating artistically accessible road maps that shaped the development of the transsphenoidal approach.

The Mayo, Cushing, and Osler Influence on A. L. Rhoton: A Historical Vignette of the Interconnectedness Between Highly Influential Neurosurgery Leaders over 100 Years.

The careers of the Mayo brothers, Harvey Cushing, and Sir William Osler greatly shaped medical and surgical practice in the late 19th century and early 20th century and created a legacy to influence decades of physicians to follow. Additionally, these individuals were instrumental in the founding of neurosurgery as a distinct surgical specialty. Alongside these great men, Dr. Albert L. Rhoton Jr., revolutionized neurosurgical practice through his study of neuroanatomy and development of microsurgical technique in the second half of the 20th century. This review of the interactions and relationships between the Mayo brothers, Cushing, and Osler and their influences on Rhoton highlights the 100-year-long interconnectedness shared between these giants in the history of neurosurgery.

The AANS Harvey Cushing Medal: a demographic and academic analysis of its recipients.

Background: The Harvey Cushing Medal, awarded by the American Association of Neurological Surgeons, is the premier accolade in neurosurgery. The study's purpose was to examine the qualities and accomplishments of previous winners, emphasizing potential selection biases, with the aim to promote social justice and guide young neurosurgeons in their career paths. Results: Predominantly, recipients graduated from top-ranked United States News and World Report institutions and specialized in cerebrovascular and neuro-oncologic/skull base neurosurgery. A significant proportion held roles as department or division chairs and led neurosurgical organizations. All awardees were male, and there was a notable trend of increasing publication counts among more recent recipients. Conclusions: Commonalities among Harvey Cushing Medal winners include graduating from top institutions, holding significant leadership roles, and having an extensive publication history. However, the absence of female and underrepresented minority awardees underscores an urgent need for greater diversity in the selection process.

Meningioma: A Biography-Tumor Forever Tied to the Origins and "Soul of Neurosurgery".

Meningiomas are neoplasms derived from the arachnoid cap cells of the leptomeninges and are the most common intracranial tumor. In the present historical vignette, the evolution of the management and diagnosis of meningioma is described. We begin with studies of skulls from the prehistoric record, such as the Steinheim skull, which demonstrate morphologic changes (e.g., hyperostosis) now known to occur with meningioma growth. We then continue with the earliest formal descriptions of meningiomas, including that by Platter, who published the first report of meningioma, along with early histopathologic descriptions by Cushing, who divined the cytological origins of the tumor and was the first to use the term meningioma. We conclude with a description of current management of meningiomas and potential avenues for further discovery. This article is effectively a lifetime biography of a tumor known and loved by neurosurgeons, the simple and yet complex meningioma.

The Pioneer Neuropharmacologist Alfred Fröhlich (1871-1953) and the Origins of Neuroendocrinology: A Sesquicentennial Remembrance.

The birth of neuroendocrinology as a scientific discipline is traced back to 1900-1901, when Joseph Babinski, Alfred Fröhlich, and Harvey Cushing independently identified adiposogenital dystrophy (Fröhlich syndrome), and related gonadal underdevelopment and obesity to a tumor near the pituitary gland. This discovery prompted decades of research into the brain mechanisms responsible for the control of peripheral metabolism and endocrine functions. On the occasion of the 150th anniversary of Fröhlich's birth, this study traces the origins of his intellectual formation and his association with renowned contemporaries in Austria, England, Italy, and finally Cincinnati, Ohio, where he sought refuge after Austria's annexation by Nazi Germany. Fröhlich interacted with seminal figures in biomedicine, including Lothar von Frankl-Hochwart, Hans Horst Meyer, Ernst Peter Pick, Harvey Cushing, John Newport Langley, and the Nobel laureates Charles Scott Sherrington and Otto Loewi. Alfred Fröhlich, one of the 20th century's most emblematic physicians, left his mark on neurophysiology and neuropharmacology with important works, and published authoritative manuals of drug dispensing and clinical therapy. He confronted the calamities of two World Wars with remarkable resilience like many of his Viennese colleagues who, overcoming the constraints of National Socialism, settled overseas to fulfil their calling as physicians, researchers, and teachers.

A utopian idea: Cushing, Bailey, Penfield, and the National Institute of Neurological Diseases and Blindness.

Toward the end of the First World War, Harvey Cushing conceived of a National Institute of Neurology (NIN) that would integrate neurology, neurosurgery, psychiatry, and allied disciplines within a single institution. It would first be established for the care of American casualties in an existing military hospital in France, and then relocate to the United States. Cushing was unsuccessful in acquiring funding for this project despite appeals to the army and to the Carnegie and Rockefeller foundations. By 1920 the idea had faded from memory. In 1933 Wilder Penfield was successful in obtaining funding from the Rockefeller Foundation for the creation of the Montreal Neurological Institute (MNI). The MNI's faculty held full-time university appointments and they limited their practice to the institute, where their offices and clinics were housed, and to adjoining research laboratories in neuroanatomy, neurochemistry, neurophysiology, and neuropsychology, as Cushing had envisioned. In this paper the argument is made that although Cushing's plan for the NIN was premature, the success of the MNI proved its feasibility. In addition, the MNI's success in integrating clinical care and research within a single institution was a model for the National Institute of Neurological Diseases and Blindness and drove its first clinical research program.

The deep roots of military service in neurological surgery: an academic genealogical analysis of the founding generation.

Throughout human history, advancements in medicine have evolved out of periods of war. The carnage of battlefield injuries provided wartime surgeons an unprecedented opportunity to study anatomy, develop novel techniques, and improve systems of care. As a specialty that was established and evolved during the first half of the 20th century, neurological surgery was heavily influenced by the experiences of its founders during the World Wars I and II. Utilizing the published Neurosurgery Tree, the authors conducted an academic genealogical analysis to systematically define the influence of wartime service on neurosurgery's earliest generations. Through review of the literature and military records, the authors determined that at least 60% of American neurosurgical founders and early leaders served during World Wars I and/or II. Inspired by the call to serve their nation as forces for good, these individuals were heralded as expert clinicians, innovative systems thinkers, and prolific researchers. Importantly, the service of these early leaders helped highlight the viability of neurosurgery as a distinct specialty and provided a framework for early neurosurgical education and expansion. The equipment, techniques, and guidelines that were developed during these wars, such as management of craniocerebral trauma, peripheral nerve repair, and hemostasis, set the foundation for modern neurosurgical practice.

The birth of modern military neurosurgery through the eyes of Harvey Cushing's war memoir From a Surgeon's Journal, 1915-1918.

Dr. Harvey Cushing is considered the father of modern neurological surgery, and his role and efforts in World War I continue to have a lasting effect on today's practice of neurosurgery. During World War I, he embodied the tenets of a neurosurgeon-scientist: he created and implemented novel antiseptic techniques to decrease infection rates after craniotomies, leading him often to be referred to as "originator of brain wound care." His contributions did not come without struggles, however. He faced criticism for numerous military censorship violations, and he developed a severe peripheral neuropathy during the war. However, he continued to stress the importance of patient care and his surgical prowess was evident. In this paper, the authors summarize Cushing's notes published in From a Surgeon's Journal, 1915-1918 and discuss the impact of his experiences on his own practice and the field of neurosurgery.

Dr. Louise Eisenhardt's personal notes: how she and Dr. Cushing collected data and followed patients.

Dr. Louise Eisenhardt was one of the first neuropathologists and was responsible for the development of tumor diagnosis guidelines. This historical vignette reviews her previously unseen handwritten notes in which she describes methods used by her and Dr. Harvey Cushing to obtain patient follow-up data for their Brain Tumor Registry. Her description spans 50 years, using "every possible clue to be jumped upon in [their] clinical records and correspondence." Their follow-up was divided into two periods: early follow-up (1912-1932) and registry (1933-1961). During early follow-up, patients were asked to write to them on the anniversary of their operation. The foundation of the registry necessitated the use of "considerable effort on [their] part to gather up old threads" including renewed contact with patients after 15-20 years. Methods of follow-up included continued verbal and written correspondence with patients and "strong-arm methods," including use of the Fuller Brush man and the exhumation of a body. Drs. Eisenhardt and Cushing believed "every case was important in adding to our collective knowledge of various types of tumors particularly in relationship to life expectancies and suggesting improvement in surgical treatments." Dr. Eisenhardt's meticulous record keeping allows for insights into the first known outcomes-related tumor registry in neurosurgery.

The Original Cushing Society: A Historical Review of the Senior Society's First 6 Meetings.

The Society of Neurological Surgeons (SNS), founded in 1920, is one of the oldest neurosurgical society in the world. The founding members were prominent surgeons that met with the idea of furthering the field of neurosurgery. Initial meetings were forums to observe and discuss new surgeries. During the first 6 meetings of the SNS, surgical cases from the areas of cranial trauma, epilepsy, spinal cord tumors, brain tumors, pituitary tumor, trigeminal neuralgia, and cerebellar tumors were discussed. Publications from the members during that time included articles on the use of intracranial hypertonic saline, trigeminal neuralgia, brachial plexus injuries, management of head injury, spinal cord tumors, cervical spine trauma, and intracranial hemorrhage in the newborn. The members also invited lecturers from other specialties, such as neurology, ophthalmology, radiology, and pathology, typifying the interdisciplinary nature of neurosurgical practice. The meetings served as a forum to build consensus on neurosurgical treatment methods. Cases that ultimately changed the practice of neurosurgery at that time will be profiled. The SNS began as a traveling club of neurosurgical leaders who learned from each other's clinical experience to mold this burgeoning new field. However, the members made an impact on how neurosurgery was practiced nationally.

Harvey Cushing: fundador de la neurocirugía / Harvey Cushing: founder of neurosurgery

Harvey Cushing (1869-1939), considerado el fundador de la neurocirugía como especialidad en los Estados Unidos, fue uno de los grandes médicos del siglo XX. Además de su exitosa práctica clínica fue un pionero en la investigación y avances en diversos campos de la medicina (anestesiología, endocrinología, medicina basada en la evidencia, historia de la medicina y por supuesto neurocirugía). Era además un hombre de familia, padre de cinco hijos, deportista, dibujante y amante de la literatura y escritura

Harvey Cushing (1869-1939), considered the founder of neurosurgery as a specialty in the United States, was one of the great doctors of the 20th century. In addition to his successful clinical practice, he was a pioneer in research and advances in various fields of medicine (anesthesiology, endocrinology, evidence-based medicine, history of medicine, and of course neurosurgery). He was also a family man, father of five children, athlete, cartoonist and lover of literature and writing

Harvey Cushing's international visitors.

Harvey Cushing is considered the father of neurosurgery, not just for his work within the United States, but also for his global influence through international visitors and trainees. Starting in 1920, the neurosurgical clinic at the Peter Bent Brigham Hospital in Boston, led by Cushing, trained surgeons from all over the globe, many of whom returned home to establish neurosurgical departments and become neurosurgical pioneers themselves. The objective of this vignette is to highlight the importance of Cushing's international trainees, describe their contributions, and discuss how each had an impact on the development of the practice of neurosurgery worldwide. The authors demonstrate how Cushing provided the impetus for a movement that revolutionized neurology and neurosurgery worldwide. Even today, international cooperation continues to shape the success of our delicate specialty.

Harvey Cushing's Wanderjahr (1900-1901).

Harvey Cushing's 14-month Wanderjahr had a profound effect on his subsequent personal career, which in turn ushered in the modern age of American neurosurgery. From July 1900 to August 1901, he traveled to European neurosurgical centers in England, France, Switzerland, Italy, and Germany. His excursion happened at a crucial moment in his trajectory; it was built on his existing foundation of Halstedian surgical training and occurred at a time when interest in the special field of neurological surgery was emerging. The research and clinical experiences on his journey-good and bad-undoubtedly informed his fledgling neurosurgical practice. We present a concise account of Harvey Cushing's time in Europe that consolidates accounts from Cushing's travel journals, biographers, and other neurosurgeons. This article highlights tensions in prior works and reveals new insights into the transformative nature of his Wanderjahr. Furthermore, we contextualize his travels and achievements within the broader transformation of American medical education at the turn of the 20th century to elucidate how Europe influenced American medicine. We briefly consider parallel benefits of Harvey Cushing's Wanderjahr and modern domestic or international training opportunities and present potential areas of implementation.

From the Historical Examples of Drs. Osler, Cushing, and Van Wagenen: Lessons on the Importance of Mentorship in Contemporary Neurosurgery.

Although the historical relationships between William Osler, Harvey Williams Cushing, and William Perine Van Wagenen are well known in the neurosurgical world, the nature of the mentor-mentee relationships that existed between these historical giants is not widely appreciated. In this historical vignette, we describe and exemplify such relationships, while at the same time extract important and applicable principles from them. We reviewed relevant primary and secondary sources that documented the interactions between Cushing, Osler, and Van Wagenen. In founding the field of neurological surgery, the brilliant yet volatile Dr. Harvey Cushing received guidance from his mentor, Dr. William Osler. Through our review, it is undeniable that Dr. Osler's personal and professional guidance was vital to young Dr. Cushing's success as the founder of modern neurosurgery. Likewise, Cushing's tutelage of Van Wagenen enabled Van Wagenen to become a leader of a second generation of neurosurgeons, thereby perpetuating the existence of Cushing's high neurosurgical standards. These historical mentor-mentee relationships were built on 4 primary components: accurate recognition of talent, guidance, arrangement of opportunity, and sustenance of mentorship-actions that are commonly implicated in effective mentorship in contemporary studies. Proper mentorship remains indispensable for the success of neurosurgical trainees.

Cushing's dogged struggle against death: the astonishing case of a patient under cardiac arrest surviving craniopharyngioma surgery.

The decisive role Dr. Harvey Cushing (1869-1939) played in medicine goes far beyond the development of neurosurgery. His scientific devotion and commitment to patient care made him an ethical model of strict professionalism. This paper seeks to analyze the decisions Cushing made with the challenging case of HW, an adolescent boy with a craniopharyngioma (CP) involving the third ventricle. Cushing's earlier failure to successfully remove two similar lesions alerted him to the proximity of HW's tumor and the hypothalamus. Consequently, he decided to use the chiasm-splitting technique for the first time, with the aim of dissecting the CP-hypothalamus boundaries under direct view. Unexpectedly, HW suffered cardiac arrest during the surgery, but Cushing did not give up. He continued with the operation while his assistants performed resuscitation maneuvers. Such determined and courageous action allowed Cushing to succeed in an apparently hopeless case. Cushing's unwavering willingness to save patients' lives, even under extreme circumstances, was a fundamental trait defining his identity as a neurosurgeon. Analyzing the way Cushing dealt with HW's case provides valuable lessons for neurosurgeons today, particularly the importance of assuming proactive attitudes and, in certain cases, making painstaking efforts to overcome daunting situations to save a life.

A Thoracic Surgeon Among Neurosurgeons: Edward Archibald's Forgotten Influence on the Professionalization of Neurosurgery.

Edward Archibald, Professor of Surgery at McGill University (1904-1945), Montreal, Canada, was the foremost thoracic surgeon of his generation. Although instrumental in establishing the American Board of Surgery and in standardizing surgical training, he was also influential as a neurosurgeon. Archibald, an early member invited by Harvey Cushing to join the Society of Neurological Surgeons, helped establish neurosurgery as a distinct, specialized discipline. We review Archibald's contributions to the development of neurosurgery in light of his encyclopedic 1908 monograph, "Surgical Affections and Wounds of the Head," which we compare and contrast to the contemporary treatise by Cushing in the same year. Through his writings and correspondence with Wilder Penfield and Cushing, we also describe his role in the creation of the Montreal Neurological Institute. Primary archival sources addressing the professional relationship between Archibald and Cushing and between Archibald and Penfield were consulted. Archibald's personal acquaintance with the principal neurosurgeons of the day, his insight into their personalities, their prominence in the field, and their career paths played a critical role in influencing Penfield to consider relocating to Montreal from Columbia University, despite tempting offers from Boston and Philadelphia. However, it was Archibald's support and mentorship for the creation of an academic center that finally convinced Penfield to move to McGill University. As one of the most influential surgeons of the early 20th century and a founding figure of modern neurosurgery, Archibald is an important part of neurosurgery's legacy.

Norman Dott: three vignettes on the making of a master neurosurgeon.

Purpose: This historical perspective paper attempts to provide a unique picture of Norman Dott through three vignettes from periods of his life and career.Materials and methods: Archive materials relating to Norman Dott in the Lothian Health Service Archive and the University of Edinburgh's Centre for Research Collections, including letters, notes and speeches, were consulted and provide the principle sources supporting this paper. Additional materials including books and journal articles written by or about Dott were accessed while writing this paper.Results and conclusions: Norman Dott CBE FRCSE FRSE FRCSC (1897-1973) is now considered one of the most influential surgeons of his generation. During a 44-year career he was a pioneer of transsphenoidal pituitary surgery, craniopharyngioma surgery, intracranial aneurysm surgery and other neurosurgical topics. The historical vignettes explored in this paper illuminate certain aspects of Dott's life, career and character that had an important impact on his achievements in neurosurgery.

The Sherrington-Cushing connection: A bench to bedside collaboration at the dawn of the twentieth century.

British physiologist Charles Sherrington (1857-1952) and American neurosurgeon Harvey Cushing (1869-1939) were seminal figures in the history of neuroscience. The two came from different worlds, one laboratory-based and the other largely clinical. Their scientific intersection, beginning in July 1901, provides a glimpse into a nascent form of "bench to bedside" collaboration, which carried with it the potential to extend the arm of neurophysiological experimentation from Sherrington's laboratory to Cushing's operatory. I reviewed extensive primary source materials archived at Yale University School of Medicine Library. Sherrington viewed Cushing's bedside work as an opportunity, in humans, to extend his bench-side physiological observations on higher primates, at times almost directing Cushing in the clinic. Cushing would indeed take Sherrington's observations on apes and extend them to his patients, and the work would eventually overturn the prevailing notion that the motor and sensory cortex were intermixed across the Rolandic fissure.

Harvey Cushing, padre de la neurocirugía contemporánea / Harvey Cushing, father of contemporary neurosurgery

La neurocirugía como especialidad se inició en la segunda mitad del siglo XIX y su nombre se debe a la iniciativa del médico Harvey Cushing, quien, después de realizar un periplo por tierras europeas, regresó a Estados Unidos y se dedicó por entero a la cirugía del sistema nervioso. En el presente trabajo se señalan aspectos relacionados con su niñez y adultez, así como su ingreso en el Johns Hopkins Hospital, su participación en la Primera Guerra Mundial y su consolidación como neurocirujano entre los años 1912 y 1932; periodo en el que trabajó en el Peter Bent Brigham Hospital. También se destacan sus aportes a esta rama de la medicina y a otras, su sorprendente producción científica, integrada por 24 libros y 658 artículos, y sus diferentes galardones, entre ellos el Premio Pulitzer de 1926. Finalmente, se le reconoce su papel fundacional de la Society Neurological Surgeons, que luego adoptó el nombre Harvey Cushing Society y hoy es la American Association of Neurological Surgeons. Con estas páginas se persigue rendir tributo a este ilustre galeno, padre de la neurocirugía contemporánea.

Neurosurgery as specialty began in the second half of the XIX century and its name is due to the initiative of the doctor Harvey Cushing who, after carrying out a journey for European lands, returned to the United States and was entirely devoted to the nervous system surgery. Some aspects related to his childhood and adulthood are pointed out in this work, as well as his admission to Johns Hopkins Hospital, his participation in the First World War and his consolidation as neurosurgeon from 1912 to 1932; when he worked at Peter Bent Brigham Hospital. His contributions to this branch of medicine and to other branches, his surprising scientific production, integrated by 24 books and 658 articles, and his different rewards, such as the Pulitzer Prize in 1926 are also remarkable. Finally, his fundational role of the Society Neurological Surgeons is recognized, that adopted the name Harvey Cushing Society and today is the American Association of Neurological Surgeons. The aim of these pages is to pay tribute to this distinguished physician, father of the contemporary neurosurgery.

William Osler and Harvey Williams Cushing: Friendship Around Neurosurgery.

William Osler was a mentor for the younger William Harvey Cushing and they intermingled careers and friendship for the rest of their lives. They shared a common interest in the anatomy and pathology of neurological disorders, and in the history of medicine. Their behavior was, however, sharply different: Osler was the revered physician, full of wisdom and good humor, and Cushing, the prestigious surgeon, in a perennial and successful struggle to improve neurosurgery and himself. Both became medical icons, one beloved, and the other admired, each praised at their death centennial and 150 birth anniversary, respectively.