William Harvey, 2. Harvey and the Royal College versus the "empirics"

Harvey, in solitary fashion, conducted the research that led to the publication in 1628 of his famous treatise De Motu Cordis. Later he joined other anatomists in scientific research and, after becoming a fellow and office holder, assumed a position of prominence in the Royal College of Physicians. There he was an active member, attending meetings, carrying out his duties as an Elect, as Lumleian Lecturer, as censor and frequently as a member of special committees. Harvey the scientist cannot be separated from Harvey the physician. His work in London both as Physician-in-Ordinary to King Charles I and as Physician to St. Bartholomew's Hospital is outlined. His fate however, was, irrevocably tied to the Royalist cause and the Parliamentary Party was instrumental in having him dismissed from the hospital in 1643. After 1650 his reputation was again on the rise. Apothecaries were practising medicine with increasing boldness, and Harvey devoted considerable effort to defending the monopoly of physicians through the offices of the Royal College of Physicians. He fought the "empirics" with every available weapon and in the process introduced a number of needed reforms. In his work as scientist and physician, Harvey epitomized the close links that bound together classically educated physicians, experimental inquiry and anatomical innovation. He made it understood that learned men, not "empirics" were responsible for the great improvements under way in what was to become modern medicine.     

William Harvey, physician and scientist.

William Harvey was born in 1578 and died in 1657. He studied arts at the University of Cambridge and medicine at the University of Padua. He was a Fellow of the College of Physicians of London and physician to St Bartholomew's Hospital and to King James I and King Charles I. His discovery of the circulation of the blood was announced in his Lumleian Lectures to the College of Physicians and later published in his book, De Motu Cordis. His other major work was on embryology, published under the title De Generatione Animalium. Harvey was distinguished in many fields of medicine and medical science and is widely regarded as the founder of modern physiology.     

Exercitatio Anatomica De Motus Cordis et Sanguinis in Animalibus Surgical Revolution

William Harvey (1578–1657), renowned British physician, introduced to the world a unique scientific pradigm pertaining to the circulation of the blood. In 1628, his acclaimed work Exercitatio Anatomica De Motus Cordis et Sanguinis in Animalibus was published in Frankurt, Germany. Because of the discovery of the circulation, the medical world was forever changed afterwards! The incredible implications of Harvey's work on the yet-to-be developed surgical sciences in the centuries ahead make his outstanding contribution shine as a true surgical revolution. Without his knowledge and discovery, the development of surgery, particularly in the cardiac and vascular arena, would likely never have occurred. This work reviews the discovery of circulation within the context of the historical frame of earlier works that allowed the genius of William Harvey to complete his superb contributions to medicine.     

Innovation according to cushing.

Harvey Cushing (1869-1939) is considered one of the great surgical innovators of his generation. His strong determination, self-driven attitude, intense desire to succeed, and clear intellect aided him in his ascent to the top of a new field of medicine, neurosurgery. His innovative force is characterized within the context of his personality and the development of the specialty. Details associated with his innovative spirit, as well as the discipline's history, and Cushing's immense contributions to neurosurgery are discussed. Harvey Cushing, in spite of strong personality drawbacks such as his egotistical attitude and hard-driven character, propelled the field of neurosurgery to levels not conceived before because of his innovative principles.     

Cushing's case XLV: Minnie G

A 23-year-old patient who was examined in 1910 by Harvey Cushing triggered his lifelong interest in the syndrome that bears his name. "Minnie G.," as she became historically known, presented with a "...syndrome of painful obesity, hypertrichosis, and amenorrhea with overdevelopment of secondary sexual characteristics accompanying a low grade of hydrocephalus and increased cerebral tension." This case stimulated Harvey Cushing's inquisitive mind and sparked an interest that 20 years later culminated in his seminal report, "The basophil adenomas of the pituitary gland and their clinical manifestations (pituitary basophilism)." In this classic work, Cushing reported in detail the cases of two patients encountered from his own practice and 10 similar cases collected from the literature. Minnie G. was the first case that Cushing reported. The clinical course of that case is briefly reviewed in this article.     

Dr. Benno Schlesinger: neuroanatomist and neurosurgeon from Vienna, 1900-1983

Benno Schlesinger (1900-1983) was a neurosurgeon, neuroanatomist, and neurologist from Vienna, Austria. He was a great person and a brilliant scientist. Schlesinger's life is a picture-book reflection of Europe's tragedy in the first half of the 20th century. Born an Austrian of Jewish descent, he left his home country and went to the United States where he spent the better part of his life engaging in painstaking research on a wide range of subjects, writing unique research papers on neuroanatomy, and working as a successful neurosurgeon. He made lasting contributions to our understanding of the surgical anatomy of the venous system of the brain and the effects of brain lesions on higher cortical functions. His intimate personal friendship with Harvey Cushing went far beyond their shared enthusiasm for neurosurgery.     

Historical vignette. The neurosurgeon's neurosurgeon: cushing operates on a Penfield

In his autobiography, Dr. Wilder Penfield relates the medical history of his sister, Mrs. Ruth Inglis, who developed a right frontal oligodendroglioma. Penfield performed the initial craniotomy on her, and after her death, reported the case in a paper on frontal lobe function in humans. Although Penfield has provided more than adequate information on certain aspects of his sister's illness, little has been published concerning her subsequent operation performed by Dr. Harvey Cushing at the Peter Bent Brigham Hospital. We feel this case is significant for several reasons. First, it sheds some light on Penfield's personal relationship with Cushing and his sister; it also shows the deep interest that Dr. Cushing took in his patients. Second, this case nicely illustrates how Cushing used his postoperative drawings to make his operative notes more precise. Finally, we see a sample of the work done by Dr. Louise Eisenhardt as pathologist at the Peter Bent Brigham Hospital.     

George J. Heuer: forgotten pioneer neurosurgeon at the Johns Hopkins Hospital

George J. Heuer was a pioneer in neurosurgery at The Johns Hopkins Hospital in the early 20th century; he trained under Harvey Cushing and acted as a mentor to Walter Dandy. In his early career, Heuer focused on research and clinical work in the field of neurosurgery and temporarily led the neurosurgery section at Johns Hopkins. One of his most important contributions to neurosurgery was the modern frontotemporal craniotomy. This elegant craniotomy, which initially was used to approach chiasmal tumors, developed into the modern frontosphenotemporal craniotomy, which neurosurgeons use to approach numerous tumors as well as most aneurysms. Although Dandy is frequently credited with inventing this operation. his article detailing the new approach clearly attributes its origin to Heuer, who was serving in World War I when the new technique was presented. Although he had hoped to lead the neurosurgical section at Johns Hopkins permanently, he returned from military service to find that Dandy had been appointed to this position. Heuer subsequently advanced to a distinguished career in general surgery as the chairman of surgery at two institutions, and was known for his contributions to surgical education. Throughout his academic years, Heuer continued to operate on the nervous system and to perform spinal cord and peripheral nerve surgery. He played an important role along with Cushing and Dandy in the creation of neurosurgery as a specialty, but he is rarely given credit for this accomplishment. The authors describe Heuer's contributions to neurosurgery as well as his distinguished surgical career.     

"No performance in surgery more interesting and satisfactory": Harvey Cushing and his experience with spinal cord tumors at the Johns Hopkins Hospital

Although Harvey Cushing was a neurosurgical pioneer, his work on the spine remains largely unknown. In fact, other than his own publications, Cushing's patients with pathological lesions of the spine who were treated while he was at the Johns Hopkins Hospital, including those with spinal cord tumors, have never been previously described. The authors report on 7 patients with spinal cord tumors that Cushing treated surgically between 1898 and 1911: 2 extradural, 3 intradural extramedullary, and 2 intramedullary tumors. The authors also describe 10 patients in whom Cushing performed an "exploratory laminectomy" expecting to find a tumor, but in whom no oncological pathological entity was found. Cushing's spine surgeries were limited by challenges in making the correct diagnosis, lack of surgical precedent, and difficulty in achieving adequate intraoperative hemostasis. Other than briefly mentioning 2 of the 4 adult patients in his landmark monograph on meningiomas, these cases-both those involving tumors and those in which he performed exploratory laminectomies--have never been published before. Moreover, these cases illustrate the evolution that Harvey Cushing underwent as a spine surgeon.     

William Harvey (2 April 1578)--400 years of physiology]

William Harvey, born on 2 April 1578, was the founder of modern scientific physiology. The importance of his work was that he was the first prominent exponent of the tremendous value of experimental physiology. By postulating the machine model of the circulatory system he also reinforced the idea of Descartes that man is a machine. During the past 400 years this model led to sensational discoveries on the one hand, as well as scientific limitations and cultural and spiritual crises on the other. Serious rethinking about prescientific and prephilosophic premises is urgently needed for the future.     

English roots of medical education in Australasia: Kenneth F. Russell memorial lecture

Some individuals have a heightened perception of history. K. F. Russell was one of these gifted people, and he wrote many books and papers on historical subjects. Two are classics: his history of the Melbourne medical school and his catalogue of the historical books in the library of the Royal Australasian College of Surgeons. Among the books catalogued by Russell is a small work by James Paget entitled Records of Harvey: In Extracts from the Journals of the Royal Hospital of St Bartholomew. This book recalls Paget's career as a teacher and reformer in medical education during the second half of the 19th century, and also his role in drafting a model curriculum for Australia's first university medical school, in Melbourne. Medical education in Melbourne and Adelaide was largely moulded by Paget and other leading London teachers. Cambridge was also influential in Adelaide. Scottish influences were stronger in Dunedin and Sydney. In the two decades before World War I, many graduates from these new medical schools went to Britain for postgraduate experience. They were assisted by British educational institutions inspired by the contemporary ideology of imperialism.     

Innovation According to Cushing

Harvey Cushing (1869–1939) is considered one of the great surgical innovators of his generation. His strong determination, self-driven attitude, intense desire to succeed, and clear intellect aided him in his ascent to the top of a new field of medicine, neurosurgery. His innovative force is characterized within the context of his personality and the development of the specialty. Details associated with his innovative spirit, as well as the discipline's history, and Cushing's immense contributions to neurosurgery are discussed. Harvey Cushing, in spite of strong personality drawbacks such as his egotistical attitude and hard-driven character, propelled the field of neurosurgery to levels not conceived before because of his innovative principles.     

Mildred Codding: an interview with Cushing's medical artist. Interview by Matthew R. Moore, John Shillito Jr., Eugene Rossitch Jr.

Mildred Codding was Dr. Harvey Cushing's medical illustrator and was closely involved with many of his original articles and books. From a recent interview with her we gained many insights into life as a medical artist for the father of modern neurosurgery, both in and outside of the operating room. The artistic drawing techniques of Miss Codding and Dr. Cushing are compared.     

Harvey Cushing’s case series of trigeminal neuralgia at the Johns Hopkins Hospital: a surgeon’s quest to advance the treatment of the ‘suicide disease’

Background  

A review of Dr. Harvey Cushing’s surgical cases at the Johns Hopkins Hospital provided insight into his early work on trigeminal neuralgia (TN). There was perhaps no other affliction that captured his attention in the way that TN did, and he built a remarkable legacy of successful treatment. At the time, surgical interventions carried an operative mortality of 20%.     

No ordinary time, no ordinary men: the relationship between Harvey Cushing and Franklin D. Roosevelt, 1928-1939.

The authors elucidate the strong personal relationship that developed between Dr. Harvey Cushing and Franklin Delano Roosevelt (FDR) from 1928 to 1939, as manifested in their frequent letters to each other. The relationship was initiated by the marriage of their children. Through his correspondence with FDR, Cushing was able to affect several medical issues of the period. The relationship of these two individuals is set within the historical, social, and political contexts of the times.     

Reflections on the contributions of Harvey Cushing to the surgery of peripheral nerves

By the time Harvey Cushing entered medical school, nerve reconstruction techniques had been developed, but peripheral nerve surgery was still in its infancy. As an assistant surgical resident influenced by Dr. William Halsted, Cushing wrote a series of reports on the use of cocaine for nerve blocks. Following his residency training and a hiatus to further his clinical interests and intellectual curiosity, he traveled to Europe and met with a variety of surgeons, physiologists, and scientists, who likely laid the groundwork for Cushing's increased interest in peripheral nerve surgery. Returning to The Johns Hopkins Hospital in 1901, he began documenting these surgeries. Patient records preserved at Yale's Cushing Brain Tumor Registry describe Cushing's repair of ulnar and radial nerves, as well as his exploration of the brachial plexus for nerve repair or reconstruction. The authors reviewed Harvey Cushing's cases and provide 3 case illustrations not previously reported by Cushing involving neurolysis, nerve repair, and neurotization. Additionally, Cushing's experience with facial nerve neurotization is reviewed. The history, physical examination, and operative notes shed light on Cushing's diagnosis, strategy, technique, and hence, his surgery on peripheral nerve injury. These contributions complement others he made to surgery of the peripheral nervous system dealing with nerve pain, entrapment, and tumor.