HISTORICAL VIGNETTE J Neurosurg 135:205–213, 2021 Harvey Cushing’s international visitors Eric Suero Molina, PD Dr med, MBA,1 Michael P. Catalino, MD, MSc,2,3 and Edward R. Laws, MD2 1Department of Neurosurgery, University Hospital of Münster, Germany; 2Department of Neurosurgery, Brigham and Women’s Hospital, Boston, Massachusetts; and 3Department of Neurosurgery, University of North Carolina, Chapel Hill, North Carolina Harvey Cushing is considered the father of neurosurgery, not just for his work within the United States, but also for his global influence through international visitors and trainees. Starting in 1920, the neurosurgical clinic at the Peter Bent Brigham Hospital in Boston, led by Cushing, trained surgeons from all over the globe, many of whom returned home to establish neurosurgical departments and become neurosurgical pioneers themselves. The objective of this vignette is to highlight the importance of Cushing’s international trainees, describe their contributions, and discuss how each had an impact on the development of the practice of neurosurgery worldwide. The authors demonstrate how Cushing provided the impetus for a movement that revolutionized neurology and neurosurgery worldwide. Even today, international coop- eration continues to shape the success of our delicate specialty. https://thejns.org/doi/abs/10.3171/2020.5.JNS193386 KEYWORDS Harvey Cushing; training; mentorship; international visitors; history of neurosurgery A doctor must be a traveler. International Influence on Cushing’s Early — Paracelsus (1493–1541) Career: Sir Victor Horsley (1857–1916) Harvey Cushing (1869–1939) dedicated most of his The international thread woven into the fabric of Cush- efforts to teaching during the period when World War I ing’s early career served as a prominent feature coloring (WWI) had just ended, and the first meeting of the So- his role as a neurosurgical educator. The first international ciety of Neurological Surgeons had already occurred. In neurosurgeon to have an important influence on Cushing 1912, Cushing became chief of surgery at the new Peter did so indirectly: Sir Victor Horsley, a pioneering neuro- Bent Brigham Hospital (PBBH) in Boston, Massachusetts. surgeon in the United Kingdom. His global influence, however, was not established until The contributions to neurosurgery made by Horsley 1920, when he began encouraging international visitors are indisputable. He is credited with performing the first to PBBH, who themselves were essential in establishing a operations for spinal neoplasm, epilepsy, and pituitary pa- rapidly expanding global movement in neurosurgical edu- thology, and the first operation for a craniopharyngioma, cation. Many were actually voluntary graduate assistants.1 to name a few.2 Horsley pioneered the concept of stereo- There were at least 32 international visitors in total (Tables tactic techniques and presented the first homunculus of the 1 and 2), but many remain unknown. Most visitors were motor strip of an animal.2 In 1889, Horsley hosted Boston from the United Kingdom or Western Europe, but pio- surgeon John Wheelock Elliot of Massachusetts General neers from Eastern Europe, Canada, Scandinavia, Russia, Hospital (MGH), to whom Horsley demonstrated several and Australia were also included (Fig. 1). Cushing started of his neurosurgical procedures.3 a global initiative in neurosurgery that was uniquely car- It took Elliot about 5 years to perform neurosurgery ried home by each individual trainee. We contend that this himself at MGH. In the summer of 1895, he performed led to rapid global expansions of both neurology and neu- only three neurosurgical operations, and unfortunately, rosurgery by the middle of the 20th century. all 3 patients died. Elliot became discouraged and lost ABBREVIATIONS PBBH = Peter Bent Brigham Hospital; WWI = World War I. SUBMITTED January 16, 2020. ACCEPTED May 11, 2020. INCLUDE WHEN CITING Published online August 21, 2020; DOI: 10.3171/2020.5.JNS193386. ©AANS 2021, except where prohibited by US copyright law J Neurosurg Volume 135 • July 2021 205 Unauthenticated | Downloaded 10/06/21 11:05 PM UTC Suero Molina et al. TABLE 1. Harvey Cushing’s notable international trainees and visitors Time w/ Name Lifetime Position Country Cushing Selected Achievements Sir Charles 1890– Prof of Neurology, Na- England 1920 Contributions to idiopathic intracranial hypertension, otitic hydrocephalus, Symonds 1978 tional Hospital, Queen cluster headache, & encephalitis lethargica Square Description of cause & clinical manifestations of SAH Frédéric 1892– Prof of General Pathol- Belgium 1920– Uncovered central origin of diabetes insipidus w/ Percival Bailey Bremer 1982 ogy, Brussels 1921 Pioneer in sleep research Paul Martin 1891– Prof of Neurosurgery, Belgium 1921– Neurosurgery pioneer in Belgium 1968 Brussels 1922 Advances in depicting intracranial masses w/ ventriculography, encephalogra- phy, electroencephalography, & angiography Cofounded Neurochirurgie journal Sir James 1895– Prof of Surgery, Univer- England 1922 President of Royal College of Surgeons of England (1957–1960) Paterson 1980 sity London Ross Director of Surgery, St. Bartholomew’s Hospital Kenneth G. 1892– Prof of Neurosurgery, Canada 1919, First neurosurgeon in Canada McKenzie 1964 Toronto 1922– First neurosurgeon to treat Ménière syndrome by vestibular nerve division & 1923 posttraumatic intractable epilepsy by hemispherectomy Norman Dott 1897– Prof of Neurosurgery, Scotland 1923– Development of transsphenoidal surgery 1973 University of Edinburgh 1924, Establishment of first neurological surgery unit in Scotland 1929 First surgical treatment of a ruptured aneurysm Advances in surgery of cleft palate Sir Geoffrey 1886– Prof of Neurosurgery, England 1924 First prof of a neurological surgery chair in Britain Jefferson 1961 University of Man- Fellow of the Royal Society (1947) chester Classification of axis fracture named after him First successful embolectomy (brachial artery) in England Jean Morelle 1899– Prof of Neurosurgery, Belgium 1925 Created the first neurosurgery division w/in general surgery in Belgium 1983 Leuven Sir Hugh 1896– Prof of Neurosurgery, England 1926– Founder of modern British neurosurgery along w/ Norman Dott & Geoffrey William Bell 1952 Oxford 1927 Jefferson Cairns Teacher of Hugo Krayenbühl, pioneer of neurosurgery in Switzerland Clovis 1879– Prof of Neurosurgery, France 1927, Pioneer of French neurosurgery Vincent 1957 Paris 1930 First prof of neurosurgery in France Ignaz 1888– Prof of Neurosurgery, Nether- 1927– Pioneer of modern neurosurgery in the Netherlands Oljenick 1981 University of Amster- lands 1929 “Oljenick syndrome”: occipitalization of C1 dam Cofounder of Nederlandse Studieclub voor Neurochirurgie (Dutch Study Club for Neurosurgery) Dumitru 1893– Prof of Neurosurgery, Romania 1927– Founder of Romanian neurosurgery Bagdasar 1946 University of Bucharest 1929 Author of Traité de Neurochirurgie (1948), main training book for neurosurgeons in Romania for >25 yrs Minister of Health for the Romanian government Axel Herbert 1891– Prof of Neurosurgery, Sweden 1929 Founder of Swedish neurosurgery Olivecrona 1980 Royal Serafimer Hospi- Author of Handbuch of Neurochirurgie w/ Wilhelm Tönnis (1954–1974) tal, Karolinska Institute, First recipient of Fedor-Krause Medal from German Society of Neurosurgery Stockholm (1956) Daniel Petit- 1889– Prof of Neurosurgery, France 1930 First president of the Société de Neurochirurgie de Langue Française (1948) Dutaillis 1968 Paris Description of root compression by lumbar disc herniation causing radiculopathy Sir Leonard 1896– Prof of Neurosur- Australia 1929– Founding member of Neurosurgical Society of Australasia Charles Ed- 1978 gery, Royal Adelaide 1930 Honorary neurosurgeon of Royal Adelaide Hospital ward Lindon Hospital Pioneered founding & development of neurosurgery in his region Ferdinand 1902– Prof of Neurosurgery, Nether- 1932 Coeditor of Zentralblatt für Neurochirurgie (1936–1943) Verbeek 1958 University of Groningen lands Cofounder of Nederlandse Studieclub voor Neurochirurgie (Dutch Study Club for Neurosurgery) Eduard A. V. 1899– Prof of Neurosurgery, Denmark 1933 Founder of Danish Neurosurgery Busch 1982 Rigshospitalet, Copen- First prof of neurosurgery in Denmark hagen American Medal of Freedom United Nations Medal of Honor Prof = professor; SAH = subarachnoid hemorrhage. 206 J Neurosurg Volume 135 • July 2021 Unauthenticated | Downloaded 10/06/21 11:05 PM UTC Suero Molina et al. TABLE 2. Other known international trainees and visitors of his enthusiasm.3 However, for 8 weeks during that sum- Harvey Cushing mer Elliot was assisted by a Harvard medical student who Name Place of Work Time w/ Cushing witnessed the last two of these neurosurgical procedures, both the novel approaches and Elliot’s failures.3 That stu- Arthur van Dessel Louvain, Belgium 1925 dent was Harvey Williams Cushing. Cushing himself was Boris M. Fried Russia 1925 later quite critical of Horsley, especially after observing Walter Lehmann Göttingen, Germany 1926 his operations.2 Nevertheless, it appears that Cushing’s Georges Schaltenbrand Hamburg, Germany 1926–1927 first exposure to neurosurgery was borne out of the in- Alan C. Gairdner London, United Kingdom 1928–1929 ternational influence of Victor Horsley on the American surgeon John Elliot. Attracta Halpenny Dublin, Ireland 1929 F. A. R. Stammers Birmingham, England 1929 United Kingdom Gaston de Coppet Bern, Switzerland 1929–1930 Francois Ody Geneva, Switzerland 1930–1931 In addition to Horsley,