Life> Kaleidoscope

Brains rescued for posterity

By Randi Hutter Epstein, M.D. (China Daily)
Updated: 2010-09-05 09:59

NEW HAVEN, Connecticut - Two floors below the main level of Yale University's medical school library is a room full of brains. No,not the students. These brains, more than 500 of them, are in glass jars.

The cancerous brains were collected by Dr. Harvey Cushing, who was one of America's first neurosurgeons. They were donated to Yale on his death in 1939 but over time this treasure trove of medical history became a jumble of cracked jars and dusty records shoved in various crannies.

Until now. In June 2010, after a colossal effort to clean and organize the material - 500 of 650 jars have been restored - the brains found their final resting place behind glass cases around the perimeter of the Cushing Center, a room designed solely for them.

These chunks of brains floating in formaldehyde help illustrate the rise of neurosurgery and the evolution of 20th-century American medicine.

The tissue derives from patients during the early days of brain surgery, when doctors had no imaging tools to locate a tumor or proper lighting to illuminate the surgical field; when anesthesia was rudimentary and sometimes not used at all; when antibiotics did not exist to fend off potential infections. Some patients survived the procedure - more often if Dr. Cushing was by their side.

When Dr. Cushing could not remove a tumor,he would remove a piece of the skull so the tumor would grow outward rather than compress the brain. It was not a cure, but it relieved the patient of many symptoms.

Born in Cleveland in 1869, Dr. Cushing was an undergraduate at Yale and finished his career here as a professor of history of medicine. He spent most of his career as chief of neurosurgery, a new specialty, at Peter Bent Brigham Hospital at Harvard University.

When he began operating, a few other doctors were also venturing into the brain, but most patients did not survive the procedure.

"In the first decade of the 20th century,Harvey Cushing became the father of effective neurosurgery," the medical historian Michael Bliss wrote in "Harvey Cushing: A Life in Surgery."

"Cushing became the first surgeon in history who could open what he referred to as 'the closed box' of the skull of living patients with a reasonable certainty that his operations would do more good than harm."

Dr. Dennis Spencer, the chairman of neurosurgery at Yale and the Harvey and Kate Cushing professor of neurosurgery, said Dr. Cushing's major accomplishment was "his meticulous operative technique." "Whatever approach he was going to use to get to a tumor," Dr. Spencer said, "he had this incredibly good judgment in terms of where the tumor was, getting there without harming the brain and then getting out."

Brain surgeons in those days were medical sleuths, relying largely on patients' accounts of their symptoms to figure out where the tumor was. Dr. Cushing popularized an eye exam that took advantage of the specific ways in which different tumors can distort vision - a strategy used into the 1970s, when M.R.I.'s and other imaging tools replaced it. Even today, many tumors in the pituitary gland, which straddles the optic nerves, are initially detected because patients have troubleseeing.

Dr. Cushing discovered that pituitary tumors could lead to vast changes in the body. Cushing's disease and Cushing's syndrome are named for his discoveries.

Indeed, comparatively little progress has been made since Dr. Cushing's time in actually prolonging life in brain-cancer patients."It is fascinating how far we've come in terms of technology but not really in terms of progress for most malignancies," Dr. Spencer said. He added, though, that "in many tumors we are getting closer to the genetic understanding."

Dr. Cushing won a Pulitzer Prize in 1928 for his biography of his mentor, Dr. William Osler.

The $1.4 million restoration of his collection of brains was partly paid for by money from a former patient's family.

The brains and their records were a "complete mess," recalled Dr. Gil Solitaire, a professor of neuropathology at Yale in the 1960s who once shared an office with some of the Cushing paraphernalia. "Some were totally dehydrated, and the jars were cracked."

Dr. Christopher J. Wahl, an assistant professor of orthopedics and sports medicine at the University of Washington in Seattle, wrote his thesis about the brains when he was a Yale medical student, stirring an interest in the restoration.

"The most incredible thing is that it's not just the physical documentation of the founding days of neurosurgery but a social document," Dr. Wahl said. "The bravery of these patients that really had nowhere to turn and this guy who was - cowboy is the wrong word, but an incredible innovator who was doing things at the right time and place."

The New York Times