Kenneth McKenzie, Harvey Cushing, and the early neurosurgical treatment of spasmodic torticollis

In 1923, Dr. Kenneth McKenzie trained at the Peter Bent Brigham Hospital under Dr. Harvey Cushing. At that time, a patient with spasmodic torticollis came to Cushing and was treated with an innovative operation for this disorder with good results. This case sparked an interest in Dr. McKenzie, who published the case 1 year later. In reviewing the surgical histories from the Peter Bent Brigham Hospital, we have found the original records of this well-documented case. The record includes postoperative drawings of the intraoperative field by Dr. Cushing, a sketch by Dr. McKenzie illustrating the postoperative sensory examination, and pre- and postoperative photographs of the patient.     

Origins of Wilder Penfield's surgical technique. The role of the "Cushing ritual" and influences from the European experience

Wilder Penfield left two great legacies: the development of successful surgical treatment of epilepsy and the establishment with his colleagues of the Montreal Neurological Institute as a world-renowned medical center, "dedicated to relief of pain and suffering and to the study of neurology." That Harvey Cushing's surgical ritual (which stemmed from the painstaking operative methods of Halsted) played a paramount role in the origins of Penfield's surgical technique is revealed by a set of notes and drawings by Penfield during repeated visits in the 1920's to Cushing's clinic at the Peter Bent Brigham Hospital. Penfield's intellectual approach to the nervous system was derived from his studies with Sherrington. Holmes, Cajal, and Hortega. His eclectic surgical style emerged from his familiarity with the operating techniques of Halsted, Dandy, Horsely, Sargent, Cushing, Frazier, Whipple, Leriche, and Foerster. Penfield's debt to these teachers is documented in his memoirs and in an unpublished report on European neurosurgery which he sent ot the Rockefeller Foundation in 1928.     

The Harvard Neurosurgical Service at the Children's Hospital Boston and Brigham & Women's Hospital, 1912-2007

The Harvard Neurosurgical Service at Brigham and Women's Hospital and Children's Hospital Boston has a distinguished history, beginning in 1912 when Dr. Harvey Cushing became surgeon-in-chief at the Peter Bent Brigham Hospital. After Cushing left in 1932, the Children's Hospital had a dominant role, with the creation and development of pediatric neurosurgery under Franc D. Ingraham, Donald Matson, John Shillito, and Keasley Welch. In 1987, the service at Brigham and Women's Hospital began to grow with the appointment of Dr. Peter Black as chief. In 2000, it became a department. In 2002, the clinical services at the two institutions were large enough to separate, with Dr. Black continuing as academic chair of both. By 2005, the Brigham and Women's Hospital service had 10 neurosurgeons with brain tumor, cerebrovascular, spine, and intensive care unit divisions; the Children's service had 5 neurosurgeons under Dr. Michael Scott. There were also six full-time scientists in the group. Despite reporting on more than 2500 cases a year, the combined service continued to have a strong academic program. This was helped by a residency with two required research years, an academic day each week, faculty committed to research, strong scientific collaborations, and contributions from many visiting neurosurgeons and research fellows. In its first 94 years, the service has been a strong force in clinical, educational, political, and research efforts in neurosurgery.     

Peter Bent Brigham Hospital

The Peter Bent Brigham Hospital was established in Boston in 1913. The purchase of the site defined what would become one of the largest medical complexes in the world. This hospital was intended to be a university hospital based on the model created by Johns Hopkins University. The pioneering work of Harvey Cushing while at the Peter Bent Brigham Hospital is briefly touched on.     

The development of neurosurgical techniques: The postoperative notes and sketches of Dr. Harvey Cushing

Summary In the early development of American neurosurgical techniques, Harvey Cushing is often considered the founding father. As an accomplished artist and prolific writer his original operative sketches and detailed notes at the Peter Bent Brigham Hospital (1912–1932) are now being explored as early documentation of this pioneering surgeon's development of a field. We present four brain tumor cases with his unpublished sketches and direct quotations to illustrate both the trials and tribulations of those times and Cushing's innate surgical genius.     

Harvey Cushing: neurosurgeon and artist

Harvey Cushing was a man of many talents. He was a skilled, surgeon, scientist, author and bibliophile. In addition, he was an accomplished artist for both medical non-medical subjects. In this paper, we present three surgical drawings of Dr Cushing's that are representative of the nearly one hundred drawings we have thus far found with his operative notes in the Peter Bent Brigham Archives. We will also discuss Cushing's non-medical art, some of the best of which is of the French countryside.     

Local Chemotherapy with Primary Closure of Septic Wounds by Means of Drainage and Irrigation Cannulae

Marius Nygaard Smith-Petersen was born in Grimstad, Norway, of a prominent merchant marine family in 1886 [2]. He came to the States with his mother in 1903 and, initially unable to speak English, completed high school in Milwaukee, Wisconsin, in 1906. He then attended the University of Chicago (1906–07) and graduated from the University of Wisconsin (1910) and the Harvard Medical School (1914) [4]. He completed his surgical internship under Harvey Cushing at the Peter Bent Brigham Hospital, then his postgraduate orthopaedic training under Dr. Elliott Gray Brackett, at the Massachusetts General Hospital and became his assistant in practice 1917. In 1922 Dr. Smith-Petersen entered private practice in Boston, working at the Massachusetts General Hospital. He continued working there with a heavy clinic and operating schedule until shortly before his death from a brief illness in 1953 at the age of 67. Dr. Smith-Petersen traveled widely, was active in many national and international societies, and received many international awards and honorary memberships. As with other Presidents during the war years, he faced challenges organizing the annual meeting for 1944, although the number of members and guests attending had increased (to 1,018) compared to 1943 [3]. During his tenure the first volume of the Instructional Course Lectures was published. He had an extraordinary capacity for work and ability to focus [2], reflected in his creativity scholarly productivity.     

Harvey Cushing's Canadian connections

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 leaders 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 neurosurgical 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 developed into a master surgeon and teacher. On Cushing's second visit to McGill University 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.     

Notes about two paintings in the Francis A. Countway Library of Medicine

Two interesting mural-sized oil paintings hang in the Francis A. Countway Library of Medicine in Boston. One is "The First Operation Under Ether" painted by Robert C. Hinckley in the nineteenth century, and the other is "The First Successful Kidney Transplantation" painted by Joel Babb in 1996. The theme of the former is the first operation with ether performed publicly on October 16, 1846, at the Massachusetts General Hospital. That of the latter is the first successful renal transplantation between identical twins performed at the Peter Bent Brigham Hospital on December 23, 1954. "The First Operation Under Ether" was recreated by the painter, Robert Hinckley, who gathered information by himself about the event, which had occurred over three decades previously in his hometown. He seemed to have exercised some degree of artistic license in recreating the scene. On the other hand, "The First Successful Kidney Transplantation" was planned by the three doctors who were themselves involved in the memorable operation. The painter, Joel Babb, began to recreate the scene after he had been handed some sketches and photos of the event and several photos of the participants. In this case, it seems that authenticity was the main consideration.     

Paul Martin (1891-1968), pioneer of the neurosurgery in Belgium and cofounder member of the review "Neurochirurgie"

As the first chief of an independent neurosurgical unit founded in Belgium in 1948, Paul Martin is to be regarded as the promoter of this specialty in Belgium. After graduation from the ULB. medical school, he was one of the first Belgian doctors to stay for two years (1920-22) in United States in the surgical departments of Halsted and Cushing. He returned to the Peter Bent Brigham Hospital in 1929 for one year as chief of the laboratory of experimental surgery. His career will be impressed by the development of various techniques to localize an intracranial mass such as the ventriculography, encephalography, electroencephalography and later angiography, myelography and iodoventriculography. The introduction of the electrocoagulation was also one of the major advances in surgical technique during his lifetime. In 1955, he was one of the founders of "Neurochirurgie", the official journal of the "Société de neurochirurgie de langue fran?aise".     

The Montreal Neurological Institute

In this centenary year of Wilder Penfield, his contribution to the creation of the Montreal Neurological Institute is reviewed. In the early 1930's, a confluence of favorable circumstances at McGill University and the Royal Victoria Hospital, Montreal, made it possible for Wilder Penfield, with his partner William Cone, to realize his dream of a combined neurological hospital and research institute. Endowed by the Rockefeller Foundation and with initial and ongoing support from community and governments, the Montreal Neurological Institute has continued its exponential growth over the past half-century as a world center for the study and treatment of disorders of the brain and nerves.     

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.     

Facial restoration by transplantation

Hundred years ago, Sir Harold Gillies laid a foundation to the modern plastic surgery trying to reconstruct facial defects of severely disfigured soldiers of World War I. Some years later, Joseph Murray experimented with rejection of skin grafts aimed for treatment of burned patients who sustained their injuries on battlefields of World War II. In 1954, the acquired expertise and intensive research allowed him to perform the first successful kidney transplantation in the world at Peter Bent Brigham Hospital in Boston. For his achievements in organ transplantation he was awarded Nobel Prize in 1990. The face transplantation appears to be a natural evolution of the work of these two extraordinary plastic surgeons. The first case of partial face transplant from 2005 in France revealed the world that facial restoration by transplantation is superior to conventional reconstruction methods. Since 2009, our team has performed 7 cases of face transplantation at Brigham and Women's Hospital, which is to our best knowledge the largest living single center face transplant cohort in the world. In this article, we want to reflect on the experience with face transplantation at our institution from the past years. We aim to briefly review the key points of the know-how which was given to us from the care of these unique patients.     

Dr. Harvey Cushing's attempts to cure migraine based on theories of pathophysiology

A multitude of theories characterized medical thought on migraine in the early 20th century. Newly discovered historical case files revealed Dr. Harvey Cushing's previously unpublished early attempts at surgical cure of migraine. Following institutional review board approval, and through the courtesy of the Alan Mason Chesney Archives, the authors reviewed the microfilm surgical records for The Johns Hopkins Hospital from 1896 to 1912. Patients undergoing surgical intervention by Dr. Harvey Cushing for the treatment of migraine were selected for further review. All 4 patients in the series were women and ranged in age from 29 to 41 years old. The women were admitted and observed in the hospital until a migraine occurred. Surgeries were performed while the women were in the midst of an attack. Cushing used surgical strategies including decompression, temporal artery ligation, and removal of the spine of the second vertebra. In each case, the patients' headaches eventually returned following surgery. Cushing relied on a combination of contemporary theories on migraine including humeral science, vasospastic theory, organic cause, and increased intracranial pressure. His unpublished efforts foreshadowed future surgical efforts at curing migraines.     

Transfacial approaches to the skull base: the early contributions of harvey cushing

In this report, we review Dr. Cushing's early surgical cases at the Johns Hopkins Hospital, revealing details of his early use of craniofacial approaches for malignant pathology of the skull base. Following Institutional Review Board approval, and through the courtesy of the Alan Mason Chesney Archives, we reviewed the Johns Hopkins Hospital surgical files from 1896 to 1912, which included three patients who underwent surgical treatment of lesions involving the skull base through craniofacial approaches: two adults and one child (range 3 to 43 years). The main outcome measures were length of stay and condition recorded at the time of discharge. The indications for surgery included osteochondroma of the sphenoid sinus, sarcoma of the maxillary sinus and middle fossa, and osteoma of the frontal sinus. The mean length of stay was 24.5 days (range 7 to 45 days). Cushing employed craniofacial approaches for malignant pathology nearly 40 years before such techniques became widely used. He practiced the fundamentals of skull base surgery, including preferential removal of bone to achieving adequate exposure for resection. In addition, Cushing clearly understood the importance of proximal vascular control in approaching lesions with complex vascular involvement.     

Clarence Sumner Greene, Sr.: the first African-American neurosurgeon

Largely because of the advances of the Civil Rights movement in the mid-20th century, an increasing number of African-Americans have had the opportunity to become physicians and enter the distinguished field of neurosurgery. Many have made the most of this opportunity, becoming prominent in both academics and private practice. Unfortunately, the details regarding the first African-American neurosurgeon, Clarence Sumner Greene, Sr., have remained in relative obscurity. Born on December 26, 1901 in Washington, D.C., Dr. Greene received his M.D. from the Howard University College of Medicine with distinction in 1936. After 7 years of general surgery residency and 4 years as a professor of surgery at Howard University, he was granted the opportunity by the legendary Wilder G. Penfield to train in neurosurgery at the world-renowned Montreal Neurological Institute from 1947 to 1949. Receiving high praise from Dr. Penfield, Dr. Greene became the first African-American certified by the American Board of Neurological Surgery on October 22, 1953. Subsequently, he was appointed as chair of neurosurgery at Howard University, where he successfully treated intracranial aneurysms, brain tumors, and herniated intervertebral discs until his tragic death in 1957. The diligence and perseverance of Clarence Sumner Greene, Sr., M.D., D.D.S., F.A.C.S. enabled him to overcome incredible odds to become the first African-American neurosurgeon, trained by Dr. Penfield at the Montreal Neurological Institute. A true pioneer, his achievements have opened the door for subsequent African-Americans to enhance the field of neurosurgery.     

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.     

Osler and the "medico-chirurgical neurologists": Horsley,Cushing, and Penfield

Sir Victor Horsley's lecture "On the Technique of Operations on the Central Nervous System," delivered in Toronto in 1906, set the stage for an appraisal of Sir William Osler as a protagonist for the emerging specialty of neurosurgery. During his time at McGill University from 1871 to 1884, Osler performed more than 1000 autopsies. Hispathological reports covered the topics of cerebral aneurysm, apoplectic hemorrhage, vascular infarction, subdural hematoma, meningitis, multiple sclerosis, cerebral abscess, and brain tumor. He wrote about cerebral localization and anatomy and the relationships between the morphological characteristics of the brain and intelligence and criminality. During his continuing career at Philadelphia and Baltimore, Osler published widely on problems in clinical neurology, including monographs on cerebral palsies and chorea as well as chapters on disorders of the nervous system in the first five editions of his popular textbook, The Principles and Practice of Medicine. He became familiar with many of the outstanding figures in medical neurology of his time. Regarding neurosurgery, Osler commended the pioneer operation for a brain tumor in 1884 by Rickman Godlee and the surgery for epilepsy in 1886 by Horsley. In 1907, in discussing the state of brain surgery as reviewed by Horsley, William Macewen, and others, Osler made a plea for "medico-chirurgical neurologists, properly trained in the anatomical, physiological, clinical and surgical aspects of the subject." He played a significant role as a referring physician, mentor, and friend to his young colleague Harvey Cushing (later to become Osler's Boswell), who was breaking new ground in neurosurgery at Johns Hopkins Hospital. Beyond that Osler became an inspiring hero figure for his Oxford student Wilder Penfield, who a few decades later would establish a neurological institute at McGill University where medico-chirurgical neurology would flourish.     

Intra-uterine retention of the detached fetal head

The literature and etiology of intra- uterine retention of the detached fetal head in breech presentation is reviewed. An abstract is given of the only previously reported case.A case in an Indian primipara on the Navajo Reservation is reported.The head was extracted with great difficulty, and then only after perforation, due to disproportion of the pelvis.Convalescence was stormy; but sepsis was combated by sulfanilamide therapy and the eventual recovery was complete.The author desires to express his appreciation to Dr. James G. Townsend, Director of Health, Office of Indian Affairs, and to Dr. W. W. Peter, Medical Director, Navajo Service, for permission to publish this paper. Appreciation is also expressed to Dr. Nathaniel Safran, Junior Physician, Western Navajo Hospital, who assisted in the operation and gave valuable assistance in the care of the patient.