An eye for detail and a steady hand

Harvey Cushing, M.D., left his name as well as his mark on American medicine—Cushing’s disease, Cushing’s sign, Cushing’s syndrome and Cushing’s scissors. His pioneering innovations in anesthesia and surgical education are still practiced today. But Cushing’s prodigious talents found expression in yet another form: he was also a gifted medical illustrator.

A lecture last fall titled “Harvey Cushing: The Artist,” part of the Fulton-Cushing Lecture Series, explored this lesser-known aspect of the Cushing legacy. “Harvey Cushing was many things to many people: a master neurosurgeon, the father of endocrinology, but he was also a first-rate medical illustrator,” said Robert Udelsman, M.D., M.B.A., chair and the William H. Carmalt Professor of Surgery.

Cushing displayed artistic ability at an early age. A picture of a lion he drew at age 16 reveals the work of a precocious talent, far from the doodles of a typical teenage boy. Cushing’s sharp eye is also evident in sketches of his brother, Ned, and in pictures of the Cuban countryside he drew while on vacation in 1894.

But Cushing didn’t draw pictures just to entertain himself; his drawings served as a detailed record of what he observed. This artistic purpose became increasingly important to him when he enrolled in the Harvard Medical School and later, when he became a house pupil, as interns were then called, at the Massachusetts General Hospital.

Cushing “drew as a method of conveying what he saw on the clinical wards,” Udelsman said. One pen-and-ink drawing found in Cushing’s clinical notebook shows an elderly man with Cheyne-Stokes respiration. Another drawing depicts a man with a massive goiter that resembles a sack of potatoes.

Cushing’s artistic mentor was Max Brödel, known as the father of modern medical illustration. The two met at Johns Hopkins University, where Brödel had established the Department of Art as Applied to Medicine. Brödel taught Cushing his techniques, which included the use of chiaroscuro—contrasts between dark and light to achieve a sense of volume in depicting three-dimensional objects. Cushing, always a quick student, adopted this method and used it effectively to convey such images as a neurosurgeon’s-eye view of the human brain.

As Cushing’s medical career progressed and his skills as an artist grew, he started making illustrations of the medical procedures he planned to use. One Cushing illustration shows a patient with a cleft palate; in the next drawing, one can see Cushing carefully working out his plans to perform the corrective operation.

Cushing was photographed often during his illustrious career; a familiar picture shows him in his dressing room after surgery, head bent over his pad. He’s still wearing surgical gloves as he sketches his operative findings. Today, doctors tape-record their clinical observations, but for Cushing, words and photographs fell short of what could be conveyed by a skilled illustrator—so he made sure he became one.