Intracranial tumours : notes upon a series of two thousand verified cases with surgical-mortality percentges pertaining thereto / by Harvey Cushing.

  • Cushing, Harvey, 1869-1939.
Date:
[1932]
Catalogue details

Licence: In copyright

Credit: Intracranial tumours : notes upon a series of two thousand verified cases with surgical-mortality percentges pertaining thereto / by Harvey Cushing. Source: Wellcome Collection.

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    with which I vainly struggled as others have done before and since.* Of tumours there were few, and in the ensuing twelve years up to 1913, only 194 examples had been verified histologically either at operation or autopsy. Among the cases in this early series there were not more than a dozen enduringly successful tumour extirpations, the larger number of the temporarily favourable operations having been due to the chance ex¬ posure and evacuation of gliomatous cysts. Localising diagnoses were inadequate, cranial roentgenology was in its infancy, and such progress as was made in this interval was largely technical and chiefly concerned principles of palliative decompression and the avoidance of the fistulous and fungating wounds which had previously been so disheartening. My first experience with an intracranial tumour was as follows: A well nourished but undersized and sexually undeveloped girl 16 years of age was admitted to Dr. Osier’s service at the Johns Hopkins Hospital on Decem¬ ber 12, 1901, with the complaint of headaches and failing vision. She had a peculiar waxy appearance of the skin which suggested nephritis, and though the urine of low specific gravity was considerably increased in amount, no renal elements were ever found. The optic nerves were said to show atrophy with superimposed oedema; and constriction of the visual fields, though not plotted, was apparent on rough tests. On February 21, March 8 and March 17, 1902, under the encouragement of my then neurological colleague, the late H. M. Thomas, three exploratory oper¬ ations were performed. They served merely to disclose an internal hydro¬ cephalus. The patient became increasingly stuporous, developed quadripedal rigidities, and finally died on May 1, of inanition with a terminal pneumonia. There was found at autopsy a tumour of the interpeduncular region which was diagnosed by Dr. Welch as a teratoma arising from an anlage of the pituitary body.1 The postmortem disclosure of this wholly unsuspected and apparently inoperable tumour was highly disconcerting and made on me a deep impression. Interest was further aroused by Frohlich’s description in the same year of a pituitary tumour associated with what was called adiposo¬ genital dystrophy rather than the acromegalic changes supposedly pro¬ duced by a tumour in this situation. This coincidence was what incited my long-time interest in pituitary disorders; and as a contrast to the in¬ adequate and fumbling way in which this girl’s case was studied and treated thirty years ago, another story may be told. For on April 15, 1931, what proved to be my 2000th intracranial tumour—also a pituitary lesion—was surgically verified. * The labour in so far as it indirectly concerned brain tumours was not wholly in vain, for out of it came Dandy’s studies of experimental hydrocephalus leading to his notable contribution of ventriculography; also Weed’s and Wegefarth’s studies of the cerebrospinal fluid circulation leading up to Ayer’s cisternal puncture, and to the effect of hypertonic solutions in temporarily reducing states of intra¬ cranial tension particularly when due to acute secondary hydrocephalus as shown by Foley, Putnam and Wislocki. 1 Cf. “Sexual infantilism with optic atrophy in cases of tumour affecting the hypophysis cerebri.” J. Nerv. & Ment. Dis., 1906, xxxiii, 704-716. [Case I].