By the time Harvey Cushing entered medical school, nerve reconstruction techniques had been developed, but peripheral nerve surgery was still in its infancy. As an assistant surgical resident influenced by Dr. William Halsted, Cushing wrote a series of reports on the use of cocaine for nerve blocks. Following his residency training and a hiatus to further his clinical interests and intellectual curiosity, he traveled to Europe and met with a variety of surgeons, physiologists, and scientists, who likely laid the groundwork for Cushing's increased interest in peripheral nerve surgery. Returning to The Johns Hopkins Hospital in 1901, he began documenting these surgeries. Patient records preserved at Yale's Cushing Brain Tumor Registry describe Cushing's repair of ulnar and radial nerves, as well as his exploration of the brachial plexus for nerve repair or reconstruction. The authors reviewed Harvey Cushing's cases and provide 3 case illustrations not previously reported by Cushing involving neurolysis, nerve repair, and neurotization. Additionally, Cushing's experience with facial nerve neurotization is reviewed. The history, physical examination, and operative notes shed light on Cushing's diagnosis, strategy, technique, and hence, his surgery on peripheral nerve injury. These contributions complement others he made to surgery of the peripheral nervous system dealing with nerve pain, entrapment, and tumor.
Address correspondence to: Aaron A. Cohen-Gadol, M.D., M.Sc., Goodman Campbell Brain and Spine, Department of Neurological Surgery, Indiana University, 1801 North Senate Boulevard, #610, Indianapolis, Indiana 46202. email: email@example.com.
Please include this information when citing this paper: published online January 7, 2011; DOI: 10.3171/2010.11.JNS10804.
CushingH: I. On the avoidance of shock in major amputations by cocainization of large nerve-trunks preliminary to their division. With observations on blood-pressure changes in surgical cases. Ann Surg36:321–3451902
FerraraG: Nuova Selva di Cirugia Divisa in Tre Parti. Nella prima sono gli avvertimenti del manual ed artificioso modo di curare molte e gravi infirmità del corpo humano. Nella seconda sono molti medicamenti esquisiti con le figure de' ferri ò instrumenti necessarii per esercitar l' arte della cirugia. Nella terza parimente si contengono molti rari medicamenti per distillationi con le figure in ultimo de' vasi e fornelli appartenenti all' arte distillatoriaVeniceSebastian Combi1608
PhilipeauxJMVulpianA: Note sur des essais de greffe d'un troncon du nerf lingual entre les deux bouts du nerf hypoglosse, après excision d'un segment de ce dernier neft. Arch Physiol Norm Pathol3:618–6201870
ThomasHMCushingHW: Exhibition of two cases of radicular paralysis of the brachial plexus. One from the pressure of a cervical rib with operation. The other of uncertain origin. Johns Hopkins Hosp Bull14:315–3191903
WallerA: Experiments on the section of the glosso-pharyngeal and hypoglossal nerves of the frog and observations on the alteration produced thereby in the structure of their primitive fibres. Philos Trans R Soc Lond140:423–4291850