Harvey Cushing's Treatment of Skull Base Infections at the Johns Hopkins Hospital, 1896–1912

Introduction: Harvey Cushing began his career in a time period when strict surgical protocols were evolving, which allowed new avenues of surgical procedures, enabling him to apply the concept of sterility to develop safe and effective methods in neurosurgery. This is the first report of Harvey Cushing's management and treatment of skull base infections while he was at Johns Hopkins.

Methods: Through the courtesy of the Alan Mason Chesney Archives, the Johns Hopkins surgical records from 1896 to 1912 were reviewed.

Results: Twelve patients underwent operative intervention for infections of the skull base. The mean age was 28.5 years (range, 5 to 63 years). Seven patients (58%) were female. Infections involving the skull base were acquired from the following initial diagnoses: empyema antrum (3), cerebral abscess from infected skull fragments (1), cerebral lobe abscess from spread of a tooth abscess (1), frontal sinusitis (2), mastoid defect (2), necrosis (2), and a compound depressed fracture (1). The mean length of stay was 15.8 days (range, 4 to 34 days). Postoperatively, nine patients were discharged in “well” or “good” condition, two patients died, and one patient remained the same.

Conclusion: Cushing used meticulous irrigation technique in treating skull base infections, stemming from his laboratory research regarding appropriate irrigation fluid in physiological experiments. In this series, Cushing used postoperative drainage in only four patients, demonstrating his understanding that unnecessary drainage could potentially lead to infection or other problems. His careful evaluation of patients, application of laboratory findings, and adherence to sterility helped Cushing create a foundation in successfully treating skull base infections.