Harvey Cushing: A Life in Surgery (review)

Not afraid to tackle the biography of the big medical guns, Michael Bliss has turned from William Osler to Harvey Cushing. This book is a must for all students of early twentieth-century America, and not simply those interested in the making of modern surgery. Cushing came from a conservative, pious, medical family in Cleveland, Ohio, and retained the values (notably the work ethic) of his upbringing all his life. He went to Yale where his competitive spirit was given full rein on the sports fields; ever after, he thought of life as a competition that needed the players to abide absolutely by the rules. Bliss picks up and employs to good effect Cushing's self-conscious use of the sporting theme to reflect on his life.

Cushing went from Yale to Harvard Medical School and then to the Johns Hopkins Hospital to work under William Halsted. From the first, his safe, painstaking approach to surgery (and everything else) was evident—for instance, in his concern with monitored anesthesia. At Hopkins he fell under the spell of William Osler, who reciprocated the admiration. But although Cushing modeled himself on the great clinician, as Bliss convincingly shows, the two men were quite different: Osler frequently displayed genuine warmth, whereas Cushing usually kept his affections hidden.

At Hopkins, Cushing turned his attention to the nervous system and developed his lifetime preoccupation with the pituitary and its diseases. He was called to the chair at Harvard in 1912. When war came to Europe, Cushing had two stints at the front and seemed, in spite of the horrors, to have enjoyed them as much as any in his life. Back at Harvard, he brought standards to surgery that are still in use. Quietly during these years, and sometimes in spite of himself, he was creating the specialty of neurosurgery. After Osler's death in 1919, Cushing wrote a biography of his hero, published in 1925, which remains a classic. Although he kept many family matters private he had fairly public opinions about women (and their not being enfranchised), Jews, and African-Americans; Cushing lived in a world where everything and everyone (unless exceptionally talented) had its place, largely defined by gender, race, and class. Of his long and publicly happy marriage, Bliss can only pass on the few hints that Harvey and Kate Cushing threw out that not all was heaven at home.

This is an extremely rich biography, not least because of the fantastic array of letters that Bliss has been able to draw on. He also uses the wonderful war diaries as one of the few portals into Cushing's emotions. Employing these materials he has built up a picture of how Cushing changed surgery, not just on the formal stage but also behind the scenes where jealousies and priority disputes raged. Bliss uses Cushing's conservatism to tie the book together, weaving his life into the great cultural upheavals of early twentieth-century America. Cushing's conservatism was the backbone of his high-minded ideals about medical service and his distrust of the Jazz Age. I wanted to know more about his relations with colleagues such as Walter Cannon, but perhaps the silences simply speak to the space between conservatives and liberals in twenties America. Apart from citing secondary sources for particular facts, Bliss employs very few references to the current literature of medical and cultural history. Cushing's biography of Osler and Fulton's biography of Cushing are rather unkindly treated at the outset, although what Bliss owes them becomes rather more apparent at the end.