William S. Halsted and Harvey W. Cushing: reflections on their complex association

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William Stewart Halsted, the father of modern surgery, and Harvey Williams Cushing, the father of neurosurgery, are remembered for their countless innovations and contributions to the discipline of surgery. Between 1896 and 1912, they worked together at Johns Hopkins Hospital making many of their respective achievements possible. In the later years, their complex relationship, somewhat strained during Cushing's residency, grew into a mutual respect and deep appreciation for one another. In this offering, the authors attempt to elucidate the evolution of this complex relationship.

Abbreviation used in this paper: MGH = Massachusetts General Hospital.

Abstract

William Stewart Halsted, the father of modern surgery, and Harvey Williams Cushing, the father of neurosurgery, are remembered for their countless innovations and contributions to the discipline of surgery. Between 1896 and 1912, they worked together at Johns Hopkins Hospital making many of their respective achievements possible. In the later years, their complex relationship, somewhat strained during Cushing's residency, grew into a mutual respect and deep appreciation for one another. In this offering, the authors attempt to elucidate the evolution of this complex relationship.

William S. Halsted: Historical Background

William Stewart Halsted was born in 1852 in New York City to a strict Presbyterian father who was a successful merchant, having taken over the family business of Halsted, Haines and Company (Fig. 1). As a child, a family member recalled young William being sternly scolded when he was discovered catching frogs in the garden and dissecting them.12 Luckily, his father's words did not prevent him from pursuing surgery later in life. Halsted was schooled at home until 1862. He was then sent to a strict private school in Massachusetts where he attempted to escape in the spring of 1863.11 Between 1863 and 1869, the young Halsted attended Phillips Academy-Andover.8 When he graduated at the age of 16 years, he later recalled that he “was considered too immature for college (undoubtedly true) and was placed at a private day school in New York for one year.” The young Halsted was energetic and bright, although somewhat unruly.

Fig. 1.
Fig. 1.

Painting of William Halsted by Thomas Corner, 1932. Courtesy of The Alan Mason Chesney Medical Archives of The Johns Hopkins Medical Institutions, photo by Aaron Levin.

After successfully taking the entrance examination for college, he wrote that he “entered Yale without conditions in 1870 and graduated in 1874,” and “devoted myself solely to athletics in college.”12 It is true that during his college days Halsted showed little promise of what academic achievements were to come later in his career. He spent most of his time in what was known as the third division of the class, although classmates claimed that he could have easily been in the first division had he studied.11 Halsted belonged to several societies, acted in plays, played baseball, rowed crew, performed gymnastics, and captained the football team to victory in the first official football game. Although he was sociable, he did not drink. He read mostly classic fiction and French in college, although the Yale library has no records of him borrowing any books. However, Halsted stated, “In [my] senior year [I] purchased Gray's Anatomy and Dalton's Physiology and studied them with interest: attended a few clinics at Yale medical school.”12 Halsted graduated from Yale without distinction.

He enrolled in the College of Physicians and Surgeons in New York City. He registered with Dr. Henry Sands, an anatomist and practicing surgeon. He also found himself to be an assistant to Dr. John Dalton, and was well prepared from his reading in college. He immediately excelled there, immersing himself in laboratory experimentation and finding extra opportunities to learn. He sat for and passed the examination to be an internist at Bellevue Hospital before graduating. He then spent his time attending autopsies, assisting in surgical operations, and taking care of patients on the medical wards. Based on the examination for the medical degree, Halsted was among the top 10 in his class, and in an additional competition among those 10, he won the prize at graduation in 1877. Halsted's success continued when he won a competition to be the House physician at New York Hospital the same year.12

After 2 years in Europe during which he intended to round out his medical training, Halsted returned to New York for a period of intense productivity. William H. Welch, an American pathologist who trained in Germany, remembered the period: “Halsted's professional advancement in New York was unprecedentedly rapid. His college positions, his extramural teaching and the mere list of hospitals to which he was appointed visiting surgeon… give some indication of the almost incredible amount of work which he had assumed.” He went on to describe: “the Halsted of those days when he was in his physical prime—a model of muscular strength and vigor, full of enthusiasm and of the joy of life.”12 He was also extremely social, with Welch sharing “delightful memories of the circle of friends, mostly not medical, which used to gather once or twice a week for dinner or a social evening, occasionally a musical, at the cheerful home of the two bachelors, Halsted and Dr. Tom McBride.”12 As a young professor in New York, he was loved by the students he took on in his course. He continued to be social and his quick wit kept many laughing. Halsted was always meticulous with his work. He very early on was devoted to research and truth-finding rather than opinions of others. His experimental work of the time was unique.

One of Halsted's projects involved elucidating the anesthetic effects of cocaine, a new drug at the time that had recently been shown by Karl Koller of Austria to have anesthetic effects when applied topically to the eye and was thought to be a good cure for alcoholism.1 The addictive and harmful effects of cocaine were not yet known. Halsted and his partners (most of whom died of their addiction) unfortunately used themselves as subjects in their experiments to test its use in solution as a nerve block and the drug's safety. They also learned the pleasing effect of sniffing the drug. Halsted got into trouble by taking large doses (as much as 45 mg a day) of the drug with the many physical and mental effects. Halsted was apparently able to pull himself out of this dark period, especially with the help of several friends, and had himself hospitalized in Rhode Island on several occasions.

Dr. William Welch, who had grown close to Halsted in his prime of social, surgical, and academic productivity in New York, recruited Halsted to Johns Hopkins first to assist him and then eventually to become the chief of surgery and establish the first surgical residency program in the US.13 Indeed, when one thinks of the 4 greats of the early days of Johns Hopkins Hospital, Osler, Welch, Halsted, and Kelly are forever epitomized in the famous Sargent painting. Welch vowed to keep Halsted's condition a secret and did all that he could for his friend to help him succeed in his profession. Most did not know of Halsted's addiction, although over time, the truth was known to some.9 Welch, however, wrote after Halsted's death that he was shocked to learn that others had been aware of the secret.

The young Halsted of New York was drastically different from his ways once in Baltimore. Welch wrote, “While brilliancy, boldness, and manual dexterity were attributes I used to hear applied to Halsted… in New York, these were precisely the qualities in which in Baltimore he resented and desired to be substituted by conscientiousness, thoroughness, and safety.”12 Although Halsted was different, his positive reputation preceded him and the secret of his cocaine problem was not generally known. Halsted's success in the second part of his professional career can be partially attributed to his change in personality. However, this drastic personality change made him a confusing mentor for his disciples who eventually went on to establish various schools of surgical specialties, as was the case with Harvey Cushing.

Harvey W. Cushing: Historical Background

Harvey Williams Cushing, as the son of a doctor, grandson of a doctor, and great grandson of a doctor, shared a patrician background with Halstead and was born in Cleveland, Ohio, in 1869. Cushing, in moments of self-eulogy, would remark, “It takes at least three generations to make a good doctor.”10 Despite this long lineage of doctors, it was not always clear what path Cushing would take in life. He was a socially active child, president of his class, participant in school plays, and talented gymnast. Like Halsted, he enrolled in Yale College in 1886.14 He would have liked to have devoted himself to athletics, but Cushing's father forbade him. Cushing and his father remained in close correspondence during the early years at Yale College, and made an agreement that Cushing must remain in the first tier of his class if he wished to continue playing shortstop for the baseball team. Cushing was able to succeed in all aspects of college life. However, like Halsted, the Yale Library does not have any record of Cushing having ever borrowed a book. Cushing excelled at Yale and went on to Harvard Medical School. There, he began to show signs of what greatness was to come. He took on extra work and even began to contribute directly to improving the medical field through the development of such items as ether charts. Cushing knew after medical school that he had a special calling to surgery. He followed medical school with an additional year of training at MGH.

In July of 1895, when Cushing was serving his year as House Pupil for the MGH, he debated his future. His father thought a year abroad in Europe was important at the completion of his medical training, as was customary for young American medical scholars. However, his older brother, Ned, also a physician, wrote Harvey:

Of Halsted and Hopkins…there is no surgeon like him in the land…his aseptic technique is perfect. The scientific manner of his work, keeping at it from the laboratory side simultaneously with his clinical and operative work, is a revelation to a man… if a place is available after you finish your MGH service, take it by all means…a year there would be worth five abroad.15

In November 1895, the Cushing brothers visited Johns Hopkins Hospital where they met Halsted and Osler. Cushing later recalled how he “became enamored of the place. For even a short visit was enough to show an outsider something of the spirit which permeated the early group of workers there.”3,4,5,12 Cushing subsequently wrote Halsted regarding his interest although Halsted's reply was as Cushing's father stated, “noncommittal.”6 Halsted expressed interest but pointed out that there were others at Hopkins that were in line and suggested some time abroad to learn German before coming to Baltimore.2 However, in April 1896, Halsted wrote Cushing once again to say that starting the following year all positions on staff were to be filled by Hopkins graduates and that Cushing should come prior to June of that year to secure a spot on the staff. Halsted also wrote that it would be fine if Cushing came in October, giving him some time for vacation. Cushing promptly cancelled his plans to go abroad to accept this opportunity, unquestionably one of the most significant decisions of his life. Cushing arrived in Baltimore that fall, and so began his working relationship with Halsted. Of the 17 men who achieved resident status under Halsted, Cushing became the fifth.14 Cushing said:

After a year in the wards, I was offered the residency though Bloodgood (fellow resident) stayed on in the resident's rooms for another twelve months while writing his monograph on hernia. There were other candidates for the post, men who had been there longer than I, men better grounded in the fundamentals of surgery, and whom I perhaps excelled in only one thing, in operative technique.4

The Residency: The “Odd” Years

Cushing learned one of his most striking lessons on his 1st day on the wards with Halsted. A contemporary of Cushing's, Elliott Cutler recalled the incident. As a new house officer, Cushing was not allowed into the operating room but a patient from his ward with mammary carcinoma had undergone surgery. The patient was away from the ward for what seemed to Cushing like an unusually long time so he prepared the typical medicines (stimulants) that he had been ordered as a pupil at MGH to give to all postoperative patients, even the ones whose surgeries lasted only minutes. Halsted entered the ward just as Cushing was about to administer the drugs and Cushing announced that he was “carrying out the usual procedure.” Halsted asked Cushing, “Is my patient ill? This is unusual. Let us examine her.” The examination revealed that the patient was fine, with normal pulse and respiration. Halsted then questioned Cushing about the contents of the syringe he had prepared. “Strychnin [sic],” Cushing explained. “It will do the patient good.” When Halsted pushed further, “And, pray, what good will that do?” Cushing did not know. He had been trained at a school “where memory and orders were the rule.” Halsted suggested that Cushing read up on the effects of strychnine and stated that “if your reading convinces you that strychnia is good for the patient, by all means use it.” Cushing did not administer it and as Cutler recalled, “he learned a great lesson—never do anything to a patient without understanding the why and wherefore.”6 Halsted's methods were ones characterized by care and thought before action.

While in Baltimore, Cushing (both as a resident and junior staff surgeon) and Halsted had a complex social and working relationship (Fig. 2). Cushing continued warm social associations with other mentors at the hospital, especially William Osler, who opened up his house as a second home for Cushing.2 Cushing felt differently about Halsted:

I think that in my fifteen years in Baltimore I was never invited to his house more than two or three times. There could have been no greater contrast than the warmth which radiated from the corner of Franklin Street [where the Oslers lived] and the apparent chill at the corner of Preston and Eutaw Place [where the Halsteds lived] where one waited long for an answer to the bell and was usually told by a domestic through a crack that no one was home.5

Fig. 2.
Fig. 2.

Rare photo of Halsted's associates and residents commemorating the 25th Anniversary of Johns Hopkins Hospital, October 7, 1914. Halsted is seen in the middle of the first row (sitting) and Cushing is seen third from the left in the second row (standing). Courtesy of Yale Historical Library.

Even though Cushing did not quite understand his chief, often referred to as the “Professor,” he was amused by his peculiarities. He wrote to his mother:

The Chief and his wife are certainly queer people. A great magnificent cold stone house full of rare old furniture, clocks, pictures, and what not in topsy turvy condition, cold as a stone and most unlivable… They are so peculiar, eccentric, so unlike other people yet so interesting doubtless because of their oddities that one is inclined to shelve his thoughts about them alongside of those of people from fiction—Dickens perhaps.6

He went on in the same letter to state, “The Professor himself is doubtless the best man in his specialty in the country which of course makes being his slave a most valuable experience. I am very fond of him and admire him immensely.”6 While trying to make sense of his oddities, Cushing could not forget Halsted's superior technique in the operating room (Fig. 3). As a matter of fact, Halsted, Finney, and Bloodgood operated on Cushing for appendicitis in 1897.7 Cushing would later remark, “They had all six hands inside of me at once—big hands at that.”8 Even earlier, in 1882, Halsted had performed a cholecystectomy on his own mother.15

Fig. 3.
Fig. 3.

Photograph of Halsted and Cushing operating together. Halsted is seen second from the left bending over the operative field. Cushing is seen third on the right across from Halsted. Courtesy of Yale Historical Library.

Cushing stated it simply when he reflected later in life, “The Professor was to many people an enigma—a fastidious, diffident, sarcastic recluse, yet one who could on occasion when the bars were down be as delightful as anyone I have ever met.”4 Holman10 described Halsted as a Jekyll and Hyde personality. For example, the few times he did attend dinner there with the Halsteds, Cushing remembered the experience “altogether delightful.” Cushing described Halsted as an epicure; everything at the table was the very best, including hand-selected beans for the after-dinner coffee (Turkish).15 He was always dressed in the finest English and French clothing, and when he traveled to Europe—as he did almost every summer— he stayed in the finest, most expensive hotels.4 However, Halsted's irregularities were frustrating to Cushing. At the very least, the new system took Cushing some time to get used to:

It was most disconcerting to me, after the hurly-burly of the MGH, to have my new Chief come, as it were apologetically, some day into Ward G; ask if he might be allowed to examine a particular patient; to have him spend an hour fiddling over a patient with cancer of the breast who had recently been admitted; and then to have him depart saying he was tired and would be able to do nothing more that day. If he were sufficiently interested he might ask that he be permitted to do the operation; and if he came and did operate, so soon as the breast was removed, leaving the huge closure and skin graft to Bloodgood, he would depart with the tissues. These he would study and ruminate over for an interminable time, meanwhile tagging innumerable areas which he wished to have sectioned—a duty which devolved upon the house officer. It was incumbent upon each of us to make all the clinical, bacteriological and pathological studies for every patient in our charge.4

He went on to recognize, “I personally owe to this system what little I know of histological pathology and my early bacteriological studies, some of which got into print, would otherwise have never been made.”4

Cushing grew to appreciate the effectiveness of Halsted's teaching. “Halsted was a man who taught by example rather then precept. He was a safe, fastidious and finished surgeon, by no means a brilliant and showy operator after the style cultivated by many of his contemporaries.”5 If Halsted were interested,

… he would spend an interminable time over a single patient, reviewing the history, taking notes, having sketches made, carrying the problem to the laboratory and perhaps working on it for weeks. Meanwhile, his associates and assistants would run his clinic as best they could. In this way, his school developed—none of his pupils after his own fashion, to be sure—it would have been impossible to imitate him—all of them, nevertheless influenced enormously by his attitude toward surgery and by his operative methods.

Ironically, although Halsted taught by example, it was impossible for his students to emulate his behavior and still be successful. Thus in a way they got the best of both worlds. MacCallum recalled, “He [Cushing] absorbed, of course, all of Dr. Halsted's fundamental principles of surgical practice in the treatment of tissues, haemostasis, the maintenance of asepsis, etc., but he never interested himself in any of the problems that most closely concerned his chief [Halsted].”1,11

All of this was difficult for Cushing to process while working with Halsted because he could not imagine why his chief's behavior was so erratic.7 It was not until many years later that Cushing learned about Halsted's battle with cocaine addiction and the permanent effects on his health. Cushing even stumbled on the use of cocaine as a local anesthetic on his own while searching for safer alternatives to ether anesthesia and was surprised by the lack of enthusiasm from Halsted in his findings. Cushing regretted in later years that he had not known and had been impatient with Halsted in the early years. “This [behavior], I am now quite sure, was due to ill health during my residency and I lament that at the time I did not fully appreciate it. There is a series of notes apparently written in the spring of 1900 from 1201 Eutaw Place—quill pen notes which show something of his irregularities under which I must have fretted considerably.”4 However, Cushing saw very little of Halsted during his residency years:

I saw relatively little of him during my three years as resident, less and less as he perhaps began to feel that I might be entrusted with the bulk of the routine work…I took up local anaesthesia without getting much moral support from the “Professor”. I little realized at the time the reasons for this….13

That process was essential to Halsted's career survival considering his addiction and work ethic: he picked the best men to whom he taught the lessons of a thoughtful, careful, meticulous approach to surgery, and then he entrusted them to take care of the patients. Simply, Halsted was taken by Cushing's ability to get the job done and Cushing had little regard for Halsted's laissez-faire attitude toward his patients as evident in a letter Halsted penned to Cushing in March 1900, “Dr. Cabot writes me that he will be very glad to crush a stone for us when he is here, so that I think we might reserve for him the case you have. I will speak to Dr. Osler about the distended colon case. I should like very much to operate upon him!” In response, Cushing promptly noted: “Stone case was operated upon 10 days ago, got tired of waiting. Colon patient has been waiting two weeks for ultimatum.”14

Cushing's Trip to Europe

Following his residency and unsure of his future with Halsted or at Johns Hopkins, Cushing planned a 14-month journey to Europe. While he was there, he had limited correspondence with Halsted, but he set out to meet some of Europe's greatest surgeons. Interestingly, Halsted also spent time in Europe meeting legendary figures of the day such as Volkmann, Chiari, Zuckerkandl, and Billroth.9–11 In fact, he studied brain anatomy with Meynert.9 Accustomed to Halsted's relatively flawless methods, Cushing was less than impressed with many of the European surgeons he observed. Cushing's first stop was in London, where he was left disillusioned by the techniques of Victor Horsley, pioneer neurosurgeon of the time. He wrote home to his father, “I am a little disappointed in Victor Horsley…The technique of all these men is execrable from our standpoint and they must have many septic wounds.”14 Cushing left London and traveled briefly to several other cities, arriving in Bern, Switzerland, some weeks later, where he met Theodore Kocher. In Kocher, Cushing gained a new surgical mentor, whose surgical technique was as precise as Halsted's, yet his personal warmth toward Cushing was more reminiscent of Osler. Kocher also set Cushing to work in the laboratory, studying the effects of blood pressure on intracranial pressure, reaffirming the phenomenon known as the “Cushing Reflex.” This priority of relevant work in the laboratory that could be practically used in the operating room was also along the style of Halsted and familiar to Cushing.

Kocher and Halsted became friends and correspondents.14 Cushing actually first told Halsted of Theodore Kocher, thinking that the 2 men would be compatible. On his 1899 trip, Halsted became acquainted with him. This relationship, arguably between the best surgeon in Europe and the best in America, was beneficial for them both as they shared many fundamental ideas about surgery. Halsted had Cushing to thank for being the middle man in such a relationship. In 1901, Halsted wrote to Cushing telling him that the trustees of the hospital had approved a new surgery building. In that letter, Halsted said “…It is difficult to discuss the matter satisfactorily by letter. In a very general way it is my intention to tender to you from my service the surgery of the nervous system at the Johns Hopkins Hospital and to give you opportunity to teach and to do special work; a room in the new building.”4 This may be the first note describing the often-questionable interest of Halsted in the development of discipline of neurological surgery due to the poor results from surgery.

Despite the above letter, Halsted was not initially supportive of Cushing to focus his attention on the surgery of nervous system. Due to the poor results of brain surgery, he wanted Cushing to contribute to the development of the field of orthopedic surgery. However, Cushing was not willing to change his mind and Halsted remained pessimistic. Because of Cushing's initial efforts in operating on the brain often ended in fatalities, Halsted once reported to a newspaper that he did not know whether to say “poor Cushing's patients” or “Cushing's poor patients.”15 As he could not persuade Cushing, he may have eventually tried to support Cushing's efforts. In fact, it was Halsted who encouraged Cushing to take up the study of the hypophysis, resulting in Cushing's most important contribution about the surgery of pituitary gland early in his career.9

The Later Years

Willis Gatch, a onetime professor of surgery at the University Medical School at Indianapolis, was a resident at Johns Hopkins recalled the following:

Halsted was afraid of Cushing. Cushing treated him like a door mat, criticized him to his face. If Halsted came to the operating room while Cushing was operating, Cushing would turn his back to him and pay no attention to him. Among other liberties, Cushing concealed cases from Halsted so that he might operate upon them himself. One day Dr. Halsted walked into the operating room to find Cushing operating upon a patient whom he had examined and upon whom he had expected to operate. Somewhat agitated, he left the operating room and headed for the office of the hospital superintendent, but once there, he hesitated, turned, and left the hospital. The next day Cushing was relieved of his duties as resident surgeon, but was advanced to be an associate on the surgical staff, in which capacity he would no longer be in control of cases on the ward. Halsted's intention the day before, fortunately suppressed, was to fire Cushing.10

During the 10 years that followed Cushing's 15-year stay at Hopkins under its preeminent first Surgeon-in-Chief, the two had a healthy correspondence with mutual respect and admiration. As the 2 men grew older and went their own ways—Cushing left to Boston to become the successful Surgeon-in-Chief at Peter Bent Brigham Hospital in 1912—their relationship became closer. Part of an interesting letter from Halsted to Cushing dated May 25, 1914 stated,

“…You have made our clinic famous and I shall try to hold fast my grip on the tail of your kite.”4

Shortly before his death, Halsted acknowledged Cushing and his devotion in a paper he published in 1922:

I embrace this opportunity to express my indebtedness to Harvey Cushing, for thirteen years my brilliant assistant, for his zeal in elaboration these courses and placing them on such a substantial basis that they are now regarded as one of the dominant features of the surgical curriculum for the third-year medical students at the Johns Hopkins University and are being adopted by other medical schools of this country.3

The letters in the later years often had to do with visiting one another. In addition, Mrs. Halsted's aunt became sick in Boston and Cushing corresponded with both Dr. and Mrs. Halsted about her condition. Mrs. Halsted stayed with the Cushings when she came to see her aunt during this time as well. Interestingly, Caroline Hampton Halsted, who came from an aristocratic Southern family, was at one time head surgical nurse at Johns Hopkins.1 Cushing wrote of Mrs. Halsted “she was a strange, unadorned woman dressed in black who affected a masculine garb of the plainest sort…such a contrast to her husband.”4 When Dr. Halsted became sick, Cushing was kept well informed of Halsted's condition and was in contact with Mrs. Halsted to offer any assistance in her husband's care. During the last days of Halsted, Cushing planned to go to Baltimore but did not arrive until after his death. The last time Halsted and Cushing saw each other was at the May 1–3, 1922, meeting of the American Surgical Association in Washington, DC. Following the death of Halsted due to cholangitis, Cushing wrote a tribute to him in Science:

A man of unique personality, shy, something of a recluse, fastidious in his tastes and in his friendships, an aristocrat in his breeding, scholarly in his habits, the victim for many years of indifferent health, he nevertheless was one of the few American surgeons who may be considered to have established a school of surgery, comparable in a sense, to the school of Billroth in Vienna. He had few of the qualities supposed to accompany what the world regards as a successful surgeon. Over-modest about his work, indifferent to matters of priority, unassuming, having little interest in private practice, he spent his medical life avoiding patients–even students, when this was possible–and, when health permitted working in clinic and laboratory at the solution of a succession of problems which aroused his interest. He had that rare form of imagination which sees problems, and the technical ability combined with persistence which enabled him to attack them with promise of a successful issue. Many of his contributions, not only to his craft but to the science of medicine in general, were fundamental in character and of enduring importance.5,13

Also, during the placement of a wreath on Dr. Kocher's tomb, Cushing said:

In my younger days I had the good fortune to come under the influence of two men who were outstanding surgeons of their generation—William S. Halsted and Theodor Kocher. I may couple their names together for they had much in common. They were engaged in similar problems; they were friends and correspondents; they were equally fastidious in their operative craftsmanship and at the same time, by precept and example, exerted a profound influence as investigators on the scientific aspects of their art.1

Cushing remained in contact with Mrs. Halsted and, when she became ill, Cushing remained in daily contact with her doctors. It was perhaps not until after William Halsted's death, that his former resident, Harvey Cushing, was able to put their relationship into words. As he reflected on Halsted in a tribute published in Science, Cushing concluded:

One of [Halsted's] long series of resident-surgeons, who, as others have done, came to know him better after leaving his service, just as many sons learn to know their fathers not until after they have grown up, has in all respect and affection written this inadequate note of appreciation.4

Similarly, during the 10 years that followed Cushing's 15-year stay at Hopkins under its preeminent first Surgeon-in-Chief, the two had a healthy correspondence with mutual respect and admiration.

Conclusions

William Halsted and Harvey Cushing had a complex mentor-protégé relationship. Among all his pupils, Halsted may have been most proud of Cushing. Cushing certainly embraced Halsted's surgical philosophy and was a loyal colleague to him. Although Cushing was generally regarded as amiable by many people, he did not have a close mentor relationship with Halsted. Cushing's obsessive-compulsive personality set him in opposition to Halsted's tentative and passive sensibilities. Osler remained Cushing's most important mentor during his training, although Halsted provided the technical mentorship. However, without learning Halsted's meticulous surgical methods, Cushing might not have been able to conquer neurosurgery. In addition, Halsted's minimal supervision of his residents probably culminated in the greater sense of responsibility in his residents.

On the other hand, Halsted, without the help of such devoted house officers and residents, might not have been able to continue to prosper at his own pace and through his health difficulties, and might not have been able to maintain his position of Surgeon-In-Chief. Although these 2 individuals never jointly collaborated in the writing of any scientific paper, the quiet synergism that characterized their relationship was perhaps the foundation of their countless successes and contributions.

Disclaimer

The authors report no conflict of interest concerning the materials or methods used in this study or the findings specified in this paper.

Please include this information when citing this paper: published online October 31, 2008; DOI: 10.3171/2008.4.17516.

References

Article Information

Address correspondence to: Aaron A. Cohen-Gadol, M.D., M.Sc., Indianapolis Neurosurgical Group and Indiana University Department of Neurosurgery, 1801 North Senate Boulevard, Suite 610, Indianapolis, Indiana 46202. email: acohenmd@gmail.com.

© AANS, except where prohibited by US copyright law.

Headings

Figures

  • View in gallery

    Painting of William Halsted by Thomas Corner, 1932. Courtesy of The Alan Mason Chesney Medical Archives of The Johns Hopkins Medical Institutions, photo by Aaron Levin.

  • View in gallery

    Rare photo of Halsted's associates and residents commemorating the 25th Anniversary of Johns Hopkins Hospital, October 7, 1914. Halsted is seen in the middle of the first row (sitting) and Cushing is seen third from the left in the second row (standing). Courtesy of Yale Historical Library.

  • View in gallery

    Photograph of Halsted and Cushing operating together. Halsted is seen second from the left bending over the operative field. Cushing is seen third on the right across from Halsted. Courtesy of Yale Historical Library.

References

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Cushing HW: Letters New Haven, CTYale University Library Manuscripts and Archives

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Cushing HW: William Stewart Halsted, 1852–1922. Science 56:4614641922

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Rutkow IM: The unpublished letters of William Halsted and Harvey Cushing. Surg Gyn Obst 166:3703821988

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