Editorial: Cushing and peripheral nerves

Abstract

How fortunate we are to read this splendid article on Harvey Cushing (1869–1939), touching on his early days as America’s father of neurosurgery and his work with peripheral nerves.19 In the late 1800s and early 1900s before World War I (WWI), as pointed out by the authors, intracranial and even spinal surgery was perilous and fraught with poor results. As a result, it was natural for Cushing with his interest in the nervous system to gravitate toward nerve cases. Bliss2 noted that during “[Cushing’s] first years back at Hopkins [after his European tour] he published as much about trigeminal and related [other] nerves as he did on intracranial lesions.” Long10 wrote that in Cushing’s 1st year as a faculty member at The Johns Hopkins Hospital, only 38 neurosurgical procedures were performed, and they were mainly performed for infection, trauma, and tic doloroux. By the time he left Hopkins for Harvard in 1912, 100 neurosurgical cases per year were being performed. By comparison, Walter Dandy, after the elapse of 40 years and in the year before he died at age 60 years in 1946, performed 500 cases. Of course, in Cushing’s early years he was busy in the laboratory as well as reading and writing and becoming the epitome of the surgical scholar. As a result, only a few of the relatively small number of cases he performed were nerve cases. After his training with William Halsted, Cushing visited other outstanding surgeons and basic scientists in Europe, which gave him, along with his Hopkins training, the templates for his subsequent work with peripheral nerves. Much of the influence in the area of nerve may have been of British origin. Bowlby3 had already published a text on nerve and nerve repair in 1889. Bowlby subsequently became a leader in this field serving in Africa and France during WWI where, as in subsequent wars, the incidence of serious nerve injuries could be overwhelming.16 Ballance and Purves-Stewart1 had already published their important text titled The Healing of Nerves in 1901.