Gone But Never Forgotten: Renaissance of the Harvey Cushing Brain Tumor Registry
Christopher J. Wahl
This brochure was developed for the exhibit of pieces of the Cushing Tumor Registry at the 1996 AANS Annual Meeting that was held in Minneapolis, MN. For information on what has happened with the collection, please click here.
Introduction to the
|“Had it not been for this confounded little book which [Dr. Eisenhardt] was prone to consult at awkward moments, the operative and case mortality percentages for the meningiomas would have been found much lower and the end results much better. For had I been left to myself, the temptation to exclude a case here and there to improve the figures would have been irresistible...” Davey, J. Neurosurg 80: p343.|
Dr. Eisenhardt served as the first editor of the Journal of Neurosurgery from 1944 until 1965. Her studies not only placed her among the scientific elite of her day, but set the foundation for the formal histological and pathological classifications of many neurological tumors: her records form the very soul of the Registry.
For a more complete overview of Dr. Eisenhardt, please refer to Dr. Lycurgus M. Davey’s commemorative article: “Louise Eisenhardt, M.D.: First editor of the Journal of Neurosurgery (1944-1965)” J. Neurosurg 80:342-6, 1994.
Formal Organization of the
Cushing Brain Tumor Registry
A complete misunderstanding provided the impetus for the formal organization of Harvey Cushing’s personal collection of human tumor and brain specimens, microscopic slides, patient records, and photographs. In a letter from S. Burt Wolbach, pathologist at the Peter Bent Brigham Hospital (dated April 8, 1932 — H.C.’s 63rd birthday), he exclaims, “A chance remark dropped by Dr. Elliot Cutler yesterday to the effect that you contemplated destroying your collection of brains quite horrified me.” He suggested alternative fates for the collection.
Cushing replied the following day, “Nothing under the sun would induce me to destroy the brain collection. After all, they don’t belong to me, but to you...The whole series is so carefully recorded that they ought to be of permanent value as a sort of library...to which obscure specimens might be sent and added as time goes on...”
So began the rather convoluted history of Dr. Cushing’s brain collection. There was an immediate movement to establish the collection in the Warren Museum at Harvard Medical School. There were some financial difficulties from the outset, and structural changes would be required in the museum. As difficulties arose, Wolbach and Cutler seemed to lose interest in the project — and the organization, minimally funded, was left to Drs. Cushing, Eisenhardt, and Dr. Percival Bailey, who ran Dr. Cushing’s neuropathological laboratory and cooperated with him on the publication of his monographs.
In all, Dr. Cushing had saved approximately 2000 specimens: tumors resected in the operating room, and when possible, whole brain specimens from patients who had previously been to see him. (The hospital autopsy rate in the 1930s approached 90%, and there is evidence in the hospital charts that some autopsies were even conducted at the patient’s homes!) Additionally, Cushing, Eisenhardt, and Bailey had amassed a photographic archive of nearly 15,000 negatives, all printed on glass plates. Often these images appeared in monographs and journal reports. Photographic material included photomicrographs of microscopic specimens from tumors, operative drawings, and even obscure journal articles relating to specific cases. The keys to the entire archive were Louise Eisenhardt’s log (her “little black book”) and the Brigham Hospital records. In these records, one can easily elucidate the clear reasoning and precise courses of action employed by the neurosurgeon, and his didactic, educational progress notes are exquisite in their clarity and detail.
Cushing brings Yale
September of 1934 finds Dr. Cushing en route home to New Haven from a trip to Montreal to see Osler’s books and celebrated the opening of Wilder Penfield’s Neurological Institute. He anxiously awaited the arrival of Dr. Eisenhardt, who would be bringing his entire Brain Tumor Registry from Boston. On the occasion of his trip, Cushing made the decision to leave his own Historic Library to Yale. He discussed the matter with Mrs. Cushing and sent a handwritten proposal to his colleague and fellow collector, Arnold Klebs: “I wake up in the middle of the night with the thought — why not a Klebs-Fulton-Cushing Collection so that the three could go down to bibliographic posterity hand in hand? Just imagine some young fellow long hence stumbling on our diaries and papers and correspondence about books. I envy him to think what fun he would have for I think in a certain way our three collections share a more personal and intimate provenance than has W.O.’s Library...” Thus, the inertia had been overcome — Yale would be bequeathed three of the finest personal collections of medical historical texts, manuscripts, and incunabulae. Drs. Cushing, Fulton, and Klebs corresponded frequently on the matter after Cushing’s initial suggestion.
The bibliophilia shared by the three men was impressive. Dr. Cushing’s personal interest awakened back in 1900 — while he was abroad studying with the great surgeons and physiologists of his day. The trip transformed into a “medical pilgrimage” of sorts, and he collected materials from that time on. Over the next 40 years, the doctors stole time from their work, studies, and families to collect and browse these manuscripts. They often sent one another texts to review and peruse, and much of their original correspondence still remains within the leaflets and between the pages of the materials. To Cushing, the collections provided some respite from his incessant operations and rounds, and his centered on the incunabula and medical historical texts. Klebs found texts documenting the history of science more to his liking, and Fulton — his was a somewhat eclectic mix of the two. Indeed, one letter written from Klebs to Fulton’s wife, Lucia, suggests that she use whatever influence she may have to keep her husband interested in his experimental work “...before he plunges finally into his most beloved task of book lore.” At any rate, the collections complimented one another quite well, and perhaps because of the rarity of the materials and sharing between the bibliophiles; redundancy was kept to a minimum.
In addition to his Pulitzer Prize winning biography of Sir William Osler, published in 1925, Cushing spent the latter years of his life writing and collecting essays on his experiences as a surgeon, and his opinions on medicine and medical education. Books like From a Surgeon’s Journal, The Medical Career, and Consecratio Medici provide clues to H.C.’s passion for his work.
The Yale Medical School was extremely fortunate to acquire this magnificent collection. Cushing himself hoped that young scholars would have access to these documents to enjoy as he did, and thanks to a handsome grant from Betsy Cushing-Whitney, H.C.’s daughter, these phenomenal materials have been preserved in the Harvey Cushing/John Hay Whitney Historical Library. They are available for the enjoyment of students, faculty, and friends of the medical school.
Legacy to Yale
By June of 1934, the financial and technical problems facing the newly-organized Tumor Registry at Harvard became too much a burden for a retired Cushing to withstand. J.B. Conant, then president of the school, had been excited to have the Registry at Harvard, but could not secure the financial backing H.C. required.
Dr. Cushing had already left Boston for New Haven in 1933 after his retirement from the Brigham. He assumed a position as Sterling Professor of Medicine in Neurology, and routinely lectured to students and staff of the New Haven Hospital. However, Dr. Cushing longed to continue his work with the monographs — having yet to complete his catamount work on his meningioma series. He wrote to Dr. Eisenhardt (still at Harvard) and suggested that she “...take a yardstick and give me an idea of the floor space that the collection of tumors covers...so that we can get some idea of the cubic space the collection occupies...” Dr. Milton Winternitz, head of the pathology department at Yale, had designs on the collection, and assured Cushing he would allocate a suitable space for the entire Registry.
H.C. then urged Louise Eisenhardt to accompany the collection to New Haven, that they may continue their collaboration on the monographs. In a letter of June 27, 1934, Conant reluctantly admitted to Cushing that “his dreams could not be brought to fruition...at Harvard” and should have the collection moved to Yale. Dr. Eisenhardt arrived in New Haven with the specimens in September of the same year. The next problem to face involved making the Brigham records available for use. Owing to an endowment by the Bolton Fund and with grants by the Childs Fund, H.C. was able to have the entire set of records from his surgical series, in addition to several hundred others required for “special purposes”, photographed onto microfilm and brought to New Haven.
The Registry was comfortably arranged in the Brady Museum, and Dr. Eisenhardt, appointed director of the collection, given her own laboratory in Lauder Hall. Cushing and Eisenhardt completed Meningiomas by 1938, and notice had been made in neurosurgical journals that the Registry was available for study or deposit of obscure specimens.
Dr. Cushing spent much of 1938 in poor health. He concentrated much of his efforts writing on the text for his Bio-bibliography of Andreas Vesalius (for which he had been gathering material over 40 years), and no longer had the desire to pursue another monograph. Percival Bailey, H.C.’s past resident, co-author, and laboratory director found himself at the University of Chicago, working with Eric Oldberg. It is a little known fact that Bailey, Cushing, and Oldberg were in accord on the theory that the entire Registry should be moved again, this time to Chicago, where Bailey could continue the research on H.C.’s series and publish monographs on other tumor types not yet addressed.
However, these plans were interrupted in 1939 by the death of Harvey Williams Cushing. Ironically, at that time, Howard M. Hannah of Cleveland (whose only son had succumbed to a neurological tumor), richly endowed the Cushing Brain Tumor Registry at Yale (an event which finally lifted Cushing’s collection to the status he felt it deserved). Louise Eisenhardt and the collection would stay in New Haven, where she served as the editor of the Journal of Neurosurgery and hosted scholars from all over the world.
Dr. Eisenhardt passed away in 1967, leaving curatorship of Harvey Cushing’s aging collection with Dr. Elias Manuelidis. By the early 1970s, few scholars came to study the archive. The over 40-year-old specimens were in a void — too old to be of scientific value, and ironically, too young to be of historical interest. Neuropathology seceded from pathology, and Manuelidis received pressure to find a new space for the archive. Realizing the future historical potential of the collection, he was faced with a genuine quagmire — what to do with an enormous collection of photographs, laboratory materials, and aging gross specimens which reeked of formaldehyde? The answer was clear — the sub-basement of the Edward S. Harkness Medical Student Dormitory.
Perhaps Dr. Manuelidis counted on the fact that an enormous historical collection of brain specimens and photographs, dating to the turn of the century, would be too great a temptation for medical students to avoid. Rumors of the Registry’s existence became part of the lore of Yale Medical School, and trickled through members of each class, year after year. The collection has received many visitors over the past two decades and no doubt been witness to many a bizarre ritual — however, it has remained surprisingly intact. Nearly a century after the first specimens were collected and archived, history has leant the collection the patina it requires to be re-evaluated for its scientific, ideological, and artistic historic value. Plans are currently underway by the Sections of Neurosurgery and Neuropathology at Yale to refurbish and reexamine the remaining materials from the Harvey Cushing Brain Tumor Registry, with the hope that this historic archive may once again be made available for study by neurosurgeons and historians worldwide.
While the immense practical scientific contribution that Harvey Williams Cushing made to the practice of medicine (particularly to neurological surgery) is clear, perhaps his even more profound ideological contributions are more subtle.
One must stop to consider that Cushing began his career when the automobile was a mere novelty, and within thirty years had taken surgery on the brain from a nearly unanimously-fatal act of desperation to a legitimate practice in American medicine. He had been glamorized by the media as the “brain surgeon”; his remarkable charisma, demeanor, and megalomaniacal resolve became associated with the iconography that lay persons still associate with physicians in general, and neurosurgeons in particular. Harvey Cushing left an indelible impression on what it means to be a doctor: that of the scholar, teacher, scientist, and humanitarian.
Aside from Harvey Cushing's obvious innovations in neurological surgery, the Brain Tumor Registry testifies to an equally important ideological development in medicine: the continued tradition of careful, honest observation, clinical correlation, and the development of elegant, simple solutions to clinical problems. H.C. virtually abandoned the scientific laboratory for his clinical studies, and excerpts from his Registry take on the character of lucid correlations — records chronicling his attempts to alter the course of nature through a better understanding of it. Clearly these lessons have permanently impacted the practices of medicine and science.
Specifically, one will recognize similarities between the images correlated for you here from the Brain Tumor Registry, and our modern dependence on Magnetic Resonance Imaging, Functional MRI, Electroencephalograms, Computed Tomographic Scans, ultrasound, and every other sort of modern diagnostic technique not to mention the more common technologies that have been around since before H.C.’s days, like the microscope.
The Harvey Cushing Brain Tumor Registry affords the opportunity to understand the evolution of the empiric method in modern medicine. Owing to its antiquity, the collection of photographs, specimens, slides, and hospital records also give a first-hand glimpse into the world of American medicine in the beginning of the twentieth century. The archive has been buried for many years, but the lessons were never forgotten.
We are looking forward to a complete restoration of the Cushing Brain Tumor Registry. In order to accomplish this task, we have established the Cushing Historical Renovation Fund. This fund will provide for restoring certain of the whole brain specimens, cataloguing the 15,000 photographic negatives and providing space to display as many of the materials as possible. The space to be restored is in John and Lucia Fulton’s home which is owned by the Axion Foundation. The Fulton House Board of Directors want to eventually provide guest accommodations for neuro-science scholars visiting the Cushing/Whitney Historical Library and the Brain Tumor Registry.
Individuals donating at least $200 to the fund will be sent one print of any of the photographs displayed in this exhibit, and an additional print is available for every $100 donated thereafter. Please indicate the print(s) of your choice and make check payable to the Cushing Tumor Registry Restoration Project. The check can be mailed to: Yale University Medical Center, Section of Neurological Surgery, P.O. Box 208039, New Haven, CT 06520-8039.
Christopher J. Wahl (YMS IV)
April 16, 1996
James G. Hirsch, MD Endowed Medical Student Research Fellowship
National Institutes of Health Cancer Research Grant
very special thanks to:
Dennis Spencer, MD, Chairman, Section of Neurological Surgery, YMS
Albert W. Diddle, MD, Major contributor to the CTR Restoration Project
Arthur Ebbert, MD, Professor Emeritus in Medicine
and the following members of the CTR Restoration Committee:
Lycurgus Davey, MD
Robert Gifford, MD
Laura Manuelidis, MD
Andrew Hogan for his help with the selection of photographic materials
Bill Brown and Staff at the Eli Whitney Museum
Terry Dagradi in the Yale Department of Biomedical Communications
Toby Appel and Alina Ozimek in the Cushing/Whitney Historical Library
Martin Gordon, MD
Howard M. Spiro, MD, Director, Yale Program for the Humanities in Medicine