THE CRUCIAL DECADE - MODERN NEUROSURGERYS DEFINITIVE DEVELOPMENT IN CUSHING,HARVEY EARLY RESEARCH AND PRACTICE, 1900 TO 1910

When Harvey Gushing announced his full-time commitment to neurological surgery in 1904, it was a discouraging and discouraged enterprise. Ot her surgeons' mortality rates for patients with brain tumors were 30 t o 50%. By 1910 Cushing had operated on 180 tumors; he had a thriving p ractice, with a patient mortality rate of less than 13%. The three ess ential ingredients of his success were: 1) a new surgical conceptualiz ation of intracranial pressure (ICP); 2) technical innovations for con trolling ICP; and 3) establishment of a large referral base. In the ye ars 1901 through 1905, the implications of his research on the ''Cushi ng reflex'' were quickly translated into surgical techniques for contr olling TCP. In the period between 1906 and 1910, Cushing built up his referral practice by publishing widely, and especially by lecturing to medical audiences throughout the United States and Canada. His scient ific work on ICP was essential to his clinical success, but without hi s professional and social ability to build a thriving practice, there would have been insufficient material for him to use to improve his ap proaches.