醫史學 제18권 제2호(통권 제35호) 2009년 12월 Korean J Med Hist 18ː205-222 Dec. 2009 醫史學 제18권 제2호(통권 제35호) 2009년 12월 Korean J Med Hist 18ː89­106 Dec. 2009 ISSN 1225-505X ⒸⒸ大韓醫史學會大韓醫史學會 ISSN 1225-505X Experiment at Bedside : Harvey Cushing’s Neurophysiological Research* Ock-Joo KIM** Table of content 1. Cushing and surgical experimentalism 2. Innovative experimental operation on the pituitary 3. Experiment inseparable from treatment: trigeminal nerve experiment 4. Experiment on the operating table – localization of the sensory cortex 5. Identity, ethos, and human experimentation Often regarded as the founder of neurosurgery in stood at the center of the twentieth-century America, Harvey Cushing developed neurosurgery transformation of American medicine. Born in as a specialty during the early twentieth century.1) Cleveland, Ohio in 1869, Cushing received his A product of the reform of medical education medical education at the Harvard Medical School, during the late nineteenth century in America, he from 1891 to 1896.2) He then began a residency at * This work was supported by the Korea Research Foundation Grant funded by the Korean Government (KRF-2009-371-E00001). ** Department of History of Medicine and Medical Humanities, Seoul National University College of Medicine 1) Cushing has been commemorated as the pioneer of neurosurgery in America. For the life of Harvey Cushing, see E. R. Laws, Jr. Neurosurgery's Man of the Century: Harvey Cushing – the man and his legacy. Neurosurgery 1999;45:977-82; S. I. Savitz. The pivotal role of Harvey Cushing in the birth of modern neurosurgery. the Journal of the American Medical Association (JAMA) 1997;278:1119; R. G. Ojemann. The tradition of Harvey Cushing commemorated by a stamp in the Great American stamp series. The 1987 AANS (American Association of Neurological Surgeons) presidential address [published erratum appears in Journal of Neurosurgery 1988;68:502]. Journal of Neurosurgery 1987;67:631-42; W. F. Meacham. The neurosurgical legacy of Harvey Cushing. Surgery, Gynecology, and Obstetrics 1969;128:1066; Editorial, Harvey Cushing: great pioneer. British Medical Journal 1969;2:3-4; Editorial, Harvey Cushing, a surgical mastermind. Journal of Indiana Medical Association 1969;53:307-8. 2) John F. Fulton. Harvey Cushing: A Biography. Springfield Illinois: Charles C. Thomas, 1946; Elizabeth H. Thomson. Harvey Cushing: Surgeon, Author, Artist. New York: Neal Watson Academic Publications Inc.; 1981. Fulton was Cushing's student and one of the founding members of the Harvey Cushing Society. He reconstructed Cushing's life as much detail as possible, drawing upon voluminous primary sources such as Cushing's and his - 205 - 醫史學 제18권 제2호(통권 제35호) 205-222, 2009년 12월 the Johns Hopkins Hospital under the noted had operated on more than 2,000 brain tumors, surgeon William Stewart Halsted. In 1900, his steadily lowering his surgical mortality rate. He residency completed, Cushing traveled to Europe to was honored as a surgeon, a physiologist, and a spend fourteen months in experimental study with man of letters.4) On his retirement from Harvard Charles Sherrington and Theodor Kocher. After in 1932, he served as a professor of neurology at returning to Johns Hopkins Hospital in 1901, Yale University until he died of myocardial Cushing established a center for experimental infarction in 1939. research in surgery, the Hunterian Laboratory of During the period from 1896 to 1912 when Cushing Experimental Medicine in 1905.3) Cushing had established himself as a neurosurgeon at Johns become interested in neurosurgery during his Hopkins Hospital, he also pursued neurophysiology. residency at Johns Hopkins, and began to develop Along with William Stewart Halsted’s experimental his neurosurgical skills. By 1908, he possessed a studies on surgery, Cushing’s neurophysiological national reputation as a "brain surgeon"; patients work has been praised as a breakthrough in modern came to him steadily from throughout the country. neurosurgery.5) In pursuing physiological questions, In 1912, Harvey Cushing moved from Baltimore Cushing relied not only on laboratory experiments but to Boston, to become Moseley Professor of also on clinical observation and surgical experiments Surgery at the Harvard Medical School and upon his patients. As an elite academic surgeon at Surgeon-in-Chief at the newly- built Peter Bent a teaching hospital, Cushing played a dual role as a Brigham Hospital. At the Brigham Hospital, he scientist and a clinician and freely crossed over the established a resident system, laboratories, an boundary between therapeutic and non-therapeutic operating system, and post-mortem examinations. experiments. Cushing’s case shows that a clear-cut At Harvard, Cushing established neurosurgery as a boundary between therapeutic and non-therapeutic medical specialty, educating medical students and experiments, which was demarcated after the World training surgical residents who came from all over War Ⅱ, did not exist in the early twentieth century the world to work with him. By 1931, Cushing America. This paper seeks to analyze the context of contemporaries' correspondence, papers and speeches. Thomson’s biography of Cushing is less voluminous and more interpretative than Fulton’s. 3) Harvey Cushing, Instruction in operative medicine. With the description of a course given in the Hunterian Laboratory of Experimental Medicine. Johns Hopkins Hospital Bulletin 1906;17:123-34. For a short history of the Hunterian Laboratory, see P. Sampath, D. M. Long, and H. Brem. The Hunterian Neurosurgical Laboratory: the First 100 Years of Neurosurgical Research. Neurosurgery 2000;46:184-94; discussion 94-5. 4) For example, see S. K. Pandya. Harvey Cushing: The man and his literary contributions. Neurology of Indiana 1969;17:164-71; L. M. Davey. Harvey Cushing and the humanities in medicine. Journal of the History of Medicine and Allied Sciences 1969;24:119-24; W. H. Sweet. Harvey Cushing: author, investigator, neurologist, neurosurgeon. Journal of Neurosurgery 1979;50:5-12; E. Rossitch, Jr., and S. Khoshbin. Harvey Cushing as Medical Artist. Surgical Neurology 1989;32:237-40; N. H. Horwitz. Library: Historical Perspective. Harvey Cushing (1869-1939). Neurosurgery 1996;39:1062-7. 5) N. P. Christy. Harvey Cushing as Clinical Investigator and Laboratory Worker. American Journal of Medical Sciences 1981;281:79-96; S. H. Greenblatt. The Crucial Decade: Modern Neurosurgery's Definitive Development in Harvey Cushing's Early Research and Practice, 1900 to 1910. Journal of Neurosurgery 1997;87:964-71. - 206 - Ock-Joo KimːExperiment at Bedside: Harvey Cushing’s Neurophysiological Research Cushing’s experiment upon his patients. I will employ networks through journals and conferences, united by Cushing’s case to examine how the surgical their strong advocacy of experiment. Cushing’s call experimentalism, surgical practice, and professional for the specialization of neurosurgery in 1905 was identity were interconnected in performing surgical based on an ideology of experimentation shared research in early twentieth-century America. among elite medical scientists. Like his teachers, preceptors, and colleagues, 1. Cushing and surgical experimentalism Cushing interpreted history of medicine as a progressive achievement enlightened by experimentation. Although With his education at Yale, Harvard, and Johns they all placed a highly value on experimentation, the Hopkins, and European universities, and with his term “experiment” was used in different ways by various training both at the bedside and in the laboratory, groups. First, basic medical scientists who underwent Cushing helped to create a new profession in the professionalization earlier than clinical scientists argued United State, that of the clinical scientist. In the late that experimentation in the laboratory should be the nineteenth century, inspired by the successes of foundation of the modern medicine. William Henry German scientific medicine, American physicians Welch and Lewellys Barker, for example, believed founded full-time appointments for basic medical that only laboratory-based medical education could sciences in the medical schools of major universitie make good physicians, among whom the highest noble s.6) The opening of the Johns Hopkins Hospital in minds would become experimenters to produce valuable 1889 and the Medical School in 1893 were part of knowledge of human kind.7) Second, while approving a broad reformation in American medical education. of laboratory experimentation as a historical necessity Reformers advocated university-based medical for medical progress, physician William Osler education, with a strong emphasis on laboratory emphasized the importance of clinical observation on teaching and research. The professionalization of the patients and of clinical studies that incorporated basic medical sciences and the establishment of the experimentation upon patients.8) Since disease was the laboratory medical teaching created young doctors very experiment of the Nature, meticulous clinical skilled both in science and in clinical medicine. studies on patients would reveal the hidden secrets Scientifically oriented doctors established their own of the human body. To Osler, the bedside was the 6) Bruce Fye. The Development of American Physiology: Scientific Medicine in the Nineteenth Century. Baltimore and London: The Johns Hopkins Univ. Press; 1987; Kenneth M. Ludmerer. Learning to Heal: The Development of American Medical Education. New York: Basic Books, Inc.; 1985;