“Would you like to see the brain collection?” my guide asked, as we finished our tour of the Yale School of Medicine. What scientist could resist?
I was expecting an impersonal chamber crammed with specimens and devices. Perhaps a brightly lit, crowded, antiseptic room, like the research bays we had just been exploring. Or an old-fashioned version, resembling an untidy apothecary’s shop packed with mysterious jars.
But when we entered the Cushing Center in the sub-basement of the Medical Library, it was a dim, hushed space that led through a narrow opening into an expansive area for exploration and quiet reflection. As my guide noted, it looked remarkably like a posh jewelry store, with lovely wooden counters, closed cabinets below, and glass-enclosed displays above.
And such displays! Where I had envisioned an imposing, sterile wall of containers, with disembodied brains floating intact in preservative fluid, there was instead a long sinuous shelf of jars just above eye level, winding around the room. Each brain lay in thick slices at the bottom of its square glass container, the original owner’s name and dates on a handwritten label. Muted light glinting off the jars, and lending a slight glow to the sepia-toned fluid within, gave the impression of a vast collection of amber.
In frames leaning from countertop to wall or resting in a glass-topped enclosure set within the counter were collages of photos and drawings. Surprised, I stepped closer, glimpsed human faces, and found extraordinary science therein.
I had anticipated spectacle: materials displayed in a manner that entertains, yet distances the audience and makes what is viewed seem exotic and alien. Instead, I experienced science in its most human manifestation: specimens arranged to emphasize the reason they were of interest to their original owners, those who had studied them, and those now viewing them.
A typical collage showed photographs of an individual living human being alongside Harvey Cushing’s exquisite drawings of the person’s brain, as dissected during surgery or after death. The photographs were posed to show the whole person as a unique individual—and also, in many cases, revealed the presence of the brain tumor he was then living with, through the shape of the skull or as a lump beneath the skin. The drawings revealed the location and anatomical details of the tumor. The very brain that had animated the person and suffered the tumor reposed in its jar nearby. One could not walk away unmoved.
On the personal level, I was reminded of various individuals I have known whose deaths were caused by brain tumors. The first, decades ago: an admired college mentor. The most recent pair, within the last year: the vivacious wife of one colleague, the young child of another. I remember them as people who enriched others’ lives with their grace and strength of character, and I am grateful for the medical advances that gave them extra time to be part of their families and communities.
As a scientist, I was reminded viscerally that this is exactly what we mean when we say all science exists within a human context. Cushing’s work, memorialized so effectively in this small museum, began at a time when neurosurgery was crude and ineffectual, and hope for those with brain tumors was practically nonexistent. By his career’s end, he had introduced diagnostic and surgical techniques that lowered the surgical mortality rate for his patients to an unheard-of 10 percent, a rate nearly four times better than others achieved.
The human patients on whom Cushing operated were everything to him, simultaneously providing motivation, subject, object, and methods for his research. In endeavoring to find cures for their conditions, he studied their lives and symptoms, operated on and sketched their tumors, and used what he learned from each case to improve his effectiveness. The purely scientific aspect of his work (advancing the surgical treatment of brain tumors) was inextricably linked with its humanistic aspects (understanding the histories and fates of the individual members of his clinical practice). Indeed, it was his methodical linking of the clinical and human sides of medicine that made his contributions of such lasting significance. Cushing himself stressed that “a physician is obligated to consider more than a diseased organ, more than even the whole man—he must view the man in his world.”
Seen in this light, the juxtaposition of images inside the museum’s frames carries dual meanings. First, the combined images document the course of medical history, forming what the biographer Aaron Cohen-Gadol calls “the diary of neurological surgery in its infancy.” The very format of these still photographs, hand-drawn sketches, and carefully stained glass slides reminds us that Cushing worked in an era before radiological methods for brain imaging and, initially, an era when even still photography was rather cumbersome. Indeed, his own artistic talent and training were crucial for accurately recording the outcomes of his surgeries. The contents of the images capture the conditions of patients when they came to see Cushing, the treatment, and the aftermath. Collectively, they show how neurology and neurosurgery were practiced in Cushing’s day and how these fields evolved year by year throughout his career.
Second, the combined images directly influenced the course of medical history. Cushing deliberately correlated, through the information in the photographs, anatomical sketches, and medical records, the external indicators of otherwise hidden medical problems within the skull. This led to improvements not only in how neurosurgeons operated but also in how readily other doctors could recognize early external indications of brain tumors and send patients for prompt treatment. As Cushing’s biographers note, “Each patient is of historical significance now because our discipline of neurological surgery evolved through his or her care.” Moreover, because he trained a generation of neurosurgeons in these methods, Cushing helped ensure the continuing development of the field; a number of these junior colleagues, in turn, were instrumental in the creation of the museum that now makes the images publicly visible.