A DiligentBy Lee A. Witters, M.D. Effort n April 26, 1638—18 years after the One of the giants of Mayflower’s departure for the New World —the 350-ton Diligent of Ipswich set sail 20th-century medicine— from Gravesend, England. Captained by John Mar- Otin, the ship carried 133 passengers. The Diligent made landfall on August 10 in Boston, then pro- neurosurgeon Harvey ceeded immediately to Hingham, Mass., a South Shore town founded just five years earlier. Among the passengers who disembarked and settled there Cushing—was bound and were Matthew Cushing and Henry Smith. What kind of relationship they had with each determined to pay homage other, if any, is not part of recorded history. But the lives of a direct descendant of each—Dr. Harvey Williams Cushing, the father of neurosurgery and a to a seminal American pioneer in endocrinology, and Dr. Nathan Smith, the founder of Dartmouth Medical School—were physician who lived a century destined to connect 300 years later. Both Nathan Improve, Perfect, Smith and Harvey Cushing were giants of Ameri- &P can medicine in their own time, Smith in the ear- before him—Dartmouth erpetuate ly 19th century and Cushing in the early 20th cen- Dr. Nathan Smith tury. Proof of the confluence of their careers lies in Medical School founder and Early American documents in the Dartmouth archives and in a Medical Education bronze plaque that now adorns a hallway in the Remsen Building at Dartmouth Medical School. Nathan Smith. It’s a saga filled At the unveiling of that plaque on June 17, 1929, Harvey Cushing explained that by the 1700s, Oliver S. Hayward, M.D. with historical coincidence. Constance E. Putnam the Smith and Cushing families had both moved from Hingham to Rehoboth, Mass. Then they part- Witters is the Eugene W. Leonard 1921 Professor of Medicine and of Biochemistry at Dartmouth Medical School, as well as a FOREW ORD BY C. EVERETT KOOP, M.D. professor of biological sciences at Dartmouth College. For more INTRODUCTION BY PHILIP CASH about his academic interests, see dartmed.dartmouth.edu/summer06 /html/faculty_focus.php. Witters is indebted to Barbara Krieger of The covers of the definitive the Rauner Special Collections Library at Dartmouth for assis- biographies of Cushing and Smith tance with historical research for this article and to Constance Put- DARTMOUTH ARCHIVES nam and Drs. David Roberts and Robert Nye for helpful discus- —published in 2005 and 1998, sions. Some spelling and punctuation in the quotations here have Nathan Smith dedicated this DMS building in 1811 by giving the first lecture within its walls. Harvey Cushing gave a talk in the same building in 1929, at respectively—are eerily similar. been modernized and corrected for ease of comprehension. the dedication of a plaque celebrating Smith, whom Cushing admired greatly. The photograph dates from about 1960, and the building was razed in 1963. 52 Dartmouth Medicine—online at dartmed.dartmouth.edu Winter 2007 Winter 2007 online at dartmed.dartmouth.edu—Dartmouth Medicine 53 The ties between the families didn’t stop there. David Cushing’s son Erastus earned his M.D. in 1824 from the Berkshire Medical Institute, whose JOSEPH MEHLING president at the time was one Dr. Josiah Goodhue. It was Goodhue—thanks to a chance 1784 en- counter with Nathan Smith, then 22 years old— DARTMOUTH ARCHIVES who had fostered Smith’s interest in medicine. Erastus Cushing and his family moved in 1835 to Cleveland, Ohio. And there, on April 8, 1869, Harvey Williams Cushing was born to Erastus’s son, Henry Kirke Cushing, and his wife, Betsey—the last of their 10 children. Harvey Cushing’s remarkable life was detailed by medical historian Michael Bliss in a superb 2005 biography titled Harvey Cushing, A Life in Surgery. Cushing entered Yale in 1887 and took the required courses in rhetoric, classics, and mathematics, as well as a few electives—including a course in phys- iological psychology that introduced him to the mysteries of the mammalian brain. But he concen- The plaque honoring Smith is ed ways for a while. The Cushings, in the person of trated on more than just his studies during college. pictured on the facing page in its David Cushing, the first physician in that family, Bliss notes that “when Harvey later reminisced first home—“this room” referred moved to Cheshire, in western Massachusetts, and about not having worked hard at Yale, it was be- to above. Today the plaque hangs the Smiths headed for Chester, Vt., in 1772, when cause he chiefly remembered his extracurricular ac- in the third-floor hallway of the Nathan was 10 years old. tivities.” He was a member of the Yale baseball Medical School’s Remsen Building. team, and among his teammates was Amos Alonzo ust 37 years later, the paths of Smith and Cush- Stagg, later a famous football coach and one of the ing descendants crossed once again. In 1809, a few individuals elected to the College Football Hall young medical student named Ezekiel Dodge of Fame as both a player and a coach. Cushing, too, Ezekiel Cushing wrote Cushing appeared in Nathan Smith’s anatomy was an excellent athlete; one newspaper headline physicians of the time. (In 1922-23, Cushing wrote n 1912, Cushing published a book titled The This circa 1960 photograph shows effusively about his Jclassroom at Dartmouth Medical School, then all read “Cushing’s Great Sprinting for a Long Fly the definitive biography of Osler, The Life of Sir Pituitary Body and Its Disorders: Clinical States the main lecture hall in the building of 12 years old. Ezekiel, though not in Harvey Cush- Starts 10,000 Persons Cheering.” William Osler, which won the Pulitzer Prize for bi- Produced By Disorders Of The Hypophysis Cere- pictured on page 53. The plaque Dartmouth teacher. ing’s direct lineage, sprang from the same Hingham In fact, it was baseball—a Yale-Dartmouth game ography in 1926.) bri, which remains a triumph of American medical Cushing lobbied for so diligently After leaving Hanover, Cushings. Through copious correspondence with —that likely brought Cushing to Hanover, N.H., At Hopkins, Cushing “opened the book of Iliterature. It gives case histories of 48 patients with is on the wall to the far right. his family, Ezekiel was an avid chronicler of DMS’s for the first time. However, as Cushing recounted surgery in a new place,” according to Osler. That pituitary tumors. Among them was Minnie G., a he compared Nathan early years. One of his letters, for example, includes that visit in a 1928 letter to the 11th President of new place was the brain. Cushing’s interest in brain 23-year-old female with a “syndrome of painful obe- For a with links to PDFs of WEB EXTRA Smith’s pedagogical one of the most vivid surviving descriptions of an Dartmouth College, Ernest Martin Hopkins, he surgery stemmed from a procedure he developed in sity, hypertrichosis [excessive body hair], and amen- some of the historical documents men- 1809 “anatomy riot”—an event sparked by public confessed to having “very hazy recollections of 1897 to treat trigeminal neuralgia—a nerve disor- orrhea [absence of menstruation], with overdevel- skills to those he tioned here, plus a complete list of the opposition to the practice of human dissection. Hanover and its buildings, for it is many years since der that causes intense pain in the face. His subse- opment of secondary sexual characteristics accom- sources used, see dartmed.dartmouth. found in Philadelphia, (That and subsequent similar events may have been I have had the pleasure of being there—not so quent concentration on brain surgery firmly estab- panying a low grade of hydrocephalus [enlargement edu/winter07/html/diligent_we.php. a factor in Nathan Smith’s 1813 departure from pleasant either, for if I recall the event correctly, lished him as the “father of neurosurgery”—togeth- of the brain due to an abnormal accumulation of noting that “Dr. Smith Dartmouth for Yale, where he was instrumental in the baseball team of which I was an inconspicuous er with, arguably, Dr. Ernest Sachs of Washington cerebrospinal fluid] and increased cerebral tension.” gives infinitely better founding its medical school.) member got sadly walloped by the sons of Dart- University, who was the father of Dr. Ernest Sachs, Describing her condition as a “polyglandular syn- Ezekiel Cushing also wrote effusively about his mouth. But that was long ago, when I had less rea- Jr., the longtime chief of neurosurgery at Mary drome,” Cushing speculated that it might be “at- lectures on surgery” Dartmouth teacher. After leaving Hanover to con- son for an interest in Nathan Smith.” Hitchcock Memorial Hospital. tributable to disordered pituitary, adrenal, pineal, and “more useful ones tinue his studies at the University of Pennsylvania, By 1902, Cushing had developed an interest in or ovarian influences.” Ezekiel compared Nathan Smith’s pedagogical skills ut the story is getting ahead of itself. After the pituitary gland. An organ the size of a pea at the It was only much later—in 1932—that Cush- on the theory and to those he found in Philadelphia, noting that “Dr. graduating from Yale in 1891, Cushing base of the brain, it secretes hormones that control ing concluded, by analogy to other cases, that Min- practice of physic.” Smith gives infinitely better lectures on surgery earned his M.D. at Harvard in 1895. He numerous bodily functions. Cushing called it the nie G.’s condition had been due to a basophilic pi- than Dr. [Philip Syng] Physick and certainly more spent a year as a surgical intern at Massachusetts “stowaway gland.” He performed his first transsphe- tuitary tumor which caused an overproduction of useful ones on the theory and practice of physic BGeneral Hospital and in 1896 was named a resident noidal removal of a pituitary tumor—through the cortisol by the adrenal gland.