7. Cushing, Harvey, 1929-1932

File — Box: 1

Scope and Contents

From the Collection: This collection contains professional, personal, and subject correspondence; financial and property papers; course material; discussions, book and article reviews, and miscellaneous writings; and extensive case records with indexes, documenting the life, interests, and neurosurgical career of Francis Clark Grant. Although the correspondence is incomplete (primarily 1923 to 1933), the discussions and reviews extend to 1949, and the case records span Grant's entire career, 1921-1957.

Professional, personal, subject, and business correspondence issued and received (Series "K","M","E", and "I 1" in Grant's original filing scheme) is contained in Series 1. Although the professional correspondence (Series 1.1) spans only the years 1923-1932, the principal correspondents constitute a virtual who's who in the development of neurosurgery: Bernard Alpers, Percival Bailey, Harvey Cushing, Walter Dandy, Temple Fay, Charles H. Frazier, Walter Freeman, Gilbert Horrax, Kenneth G. McKenzie, William Mixter, Wilder Penfield, I.S. Ravdin, Ernest Sachs, George Schaltenbrand, and Byron Stookey. Folders for individuals are interfiled with an alphabet of miscellaneous folders, some of which also include significant names, e.g., William Spiller and Max Peet. The letters provide a great deal of insight into the activities, personalities, medical developments, and thinking in the early years of the new specialty of Neurosurgery. Three folders of Charles H. Frazier correspondence extend until 1932, four years before Frazier's death, and include also a file of departmental financial accounts.

Personal correspondence (Series 1.2), arranged in an alphabet of miscellaneous folders followed by a few specific names, includes Grant's colleagues, friends, students, relatives, and legal and financial advisors, and contains considerable information on his social activities and hobbies, especially his Maine home and boating interests. The folder of T. H. Weisenberg includes typescripts of Grant's summary/reviews of articles for the Archives of Neurology and Psychiatry, 1924-1931, for which Weisenberg was editor in chief.

Series 1.3-1.5 contains a small amount of subject material relating to Grant's personal interests. Included are correspondence on schools, which contains useful family information; on the International Grenfell Association; a file on the 1928 Associated Harvard Clubs meeting in Philadelphia, for which Grant chaired the Schools of Medicine and Public Health Committee; and some material on "Prohibition and Narcotics" which provides a glimpse of the physician's role in prescribing and obtaining alcohol during prohibition.

Series 2, a small collection of financial and property papers, relates to family members (for example, E. W. Clark and Co.) and family estates; to medical consultations; to the Frances Clark Scholarship Fund; to plans for a suite of offices to be shared by Drs. Frazier, Spiller, and Grant.

Also included are some representative records of Grant's properties, assets and accounts, and a colorful letter describing a sailing trip (n.d., possibly from Grant's son William, whose wife could be the "Betty" in the letter.) Some correspondence re: Philip B. Fisher includes Grant's interesting personal response to a conflict within the Philadelphia office of Scudder, Stevens and Clark. A file on miscellaneous dealers reflects Grant's interests in antiques, art, books, and history, especially relating to sailing ships and navigation of the North Atlantic coast.

Grant's experiences during World War II in training Army and Navy medical officers in medicine, general surgery, and neurosurgery, are recorded in Series 3. Included, for example, are course schedules, planning and follow up correspondence, source material, the neurosurgical course curriculum and Grant's analysis of it, student critiques of the course, and Grant's evaluations of individual students.j Sidney R. Govons, M.D., (1912- ) was a Charles Harrison Frazier fellow at the Hospital of the University of Pennsylvania, 1940-1943; his name appears as a staff physician in some of Grant's case records during that period. Articles and related correspondence, especially concerning Govons' work on experimental head injury, are retained in Series 4. Some correspondence (Folder 5) describes Govons' Army experience as a neurosurgeon without assignment, which he attributes partly to the Army's use of general surgeons trained in Grant's two month course.

Grant was a prolific writer and valued contributor to neurosurgical meetings and publications. Series 5 contains a varied representation of his discussions, book reviews, and miscellaneous neurosurgical writings, 1932-1949. The (forty) discussions are incomplete; Grant was actively involved, for example, in almost every meeting of the Philadelphia Neurological Society, both presenting and discussing, through the 1920s, 30s, and 40s. Much of the material is published (as these are) in the Society Transactions sections of the Archives of Neurology and Psychiatry.

Dr. Grant's detailed case records, with card index, 19211957 (Series 6), constitute the bulk of this collection. Spanning his entire career, the files contain histories, operative notes, correspondence, autopsies, charts, test results, some X rays and photographs, and follow up, often for years or until the patient's death. Physicians everywhere consulted Grant and referred patients, and Grant saw patients in many area hospitals regularly, although the majority of his cases were seen at the Hospital of the University of Pennsylvania and its graduate affiliates: Postgraduate, Medico Chirurgical, and Polyclinic Hospitals. The files are arranged by year, then according to a comprehensive alpha numeric classification scheme, then by the patient's name. The scheme is very different from the one used by Frazier, thorough and accommodating to both basic and changing interests of Grant's practice: areas of the body or nervous system, procedures, diagnoses, and combinations thereof. Letters represent broad categories, each with a numerical breakdown. Unfortunately the complete code has not been found. V

An attempt has been made to reconstruct much of the code (Appendix 1) by isolating the common element(s), in sometimes complex histories, that would constitute a logical, definitive arrangement. In most categories a pattern emerges clearly; however, some uncertainties remain, especially in category "C", where the breakdown of pituitary tumor cases seems unrelated to operative technique, tumor type, location, symptom pattern, or therapy, and in "G" and all code letters beyond "H", where there are very few records. Occasional odd cases in otherwise clear categories seem to be errors by the coder.

Grant divides his cases roughly into the following broad categories: cerebrum, cerebellum, pituitary sellar area, facial nerves, neck and shoulder area, peripheral nerves, gastrointestinal tract, spine and spinal cord, trauma, plastic repair (?), autopsy, and miscellaneous/problems. Special areas of interest include tumors of all areas of the brain and spinal cord; brain and spinal abscess; head injury; herniated disc; operative technique for the pituitary; major trigeminal neuralgia; cordotomy, sympathectomy, alcohol injection, and other techniques for relief of pain; lobotomy; nerve surgery and repair; ventriculography and encephalography.

A few of the specific code categories are further subdivided, notably A 9 [disorders with mental and/or behavioral complications]. These include the classes from which, beginning in 1938, candidates for lobotomy were chosen, chiefly, A 9-C [cortical atrophy/agenesis mental deficiency with depressive/agitative psychoneurosis] and

A 9-l [manic depressive psychosis]. Accordingly, from 1938 on, all A 9 categories were lumped together except the lobotomies. These were classed as A 9-c (1938-1940) and A 9-l (1941-1957), in later years including primarily newer related techniques, such as frontal lobe injection, thalamotomy, and chemopallidectomy.

Each letter category seems to have one division (number) for consultations only (largely correspondence, not case records.) It is worth noting that each of these divisions might contain any or all of the other subjects within the category, and might be searched in addition to the subject. For example, lobotomy cases may be found in category A 12 (consultations) as well as A 9; herniated disc cases in

H 10 as well as H 1. ^

A time study of the codes might provide interesting clues to Grant's career as well as the development of neurosurgery. For example, categories E 1 to E 7 appear primarily in the early years, rarely after 1928. These relate largely to the thyroid and neck glands, possibly reflecting a major interest of Dr. Frazier in his early years as John Rhea Barton Professor of Surgery at the University of Pennsylvania. The subject of lobotomy first appears in 1938, three years after its advent in Spain. In 1942 herniated disc operations appear, along with spinal tumors, in category H 1, by 1943 exploding the category from one (small) to six folders.

The card indexes to the case files (Series 6.2) seem complete, covering the years 1921 to 1955, and separately, 1956 and 1957. Arranged alphabetically by patient's name, each card contains a synopsis of the case, including the classification number, for quick review or to locate a patient's file. One filing inconsistency was noted: nuns

were filed variously, some by family surname, others under "Sister", then by first name.

An incomplete (N Z only) card index to Grant's photograph collections (Series 6.3.1), described by Robert Groff as "outstanding", provides a name and possible subject approach to the photographs contained in the patient files. An index to slides (6.3.2) is more complete (A Z), and has been retained in case the slides should some day be found.

Grant's photograph and slide collections were apparently incorporated into a single numbered listing, in subject series (unrelated to the case classification scheme.) Notations on alphabet guide cards, as well as subject cards interfiled in the indexes, provide clues to the scheme.

(A partial approximation, derived from the card notations, is attached as Appendix 2.) A number of photos illustrating techniques appear in the index under "Technique" as well as subject; some give the patient's name, and others might possibly be found by locating the case file folder (by subject code and date), and searching for the numbered photograph.

To date (August 1991) the only photographs in the Grant collection are those included with the case records; neither slides, photo files, negatives, nor the numerical subject listing have been located. ^ Processing note

Although the Grant papers had been boxed hurriedly and out of order, the papers fall into natural series. Grant's original alpha numeric filing arrangement for his professional and personal material was identifiable, and was retained as appropriate within the series. (Original code numbers are indicated following headings in the finding aid.) Folders of miscellaneous correspondence have been rearranged from chronological to alphabetical order, so that all of an individual's correspondence falls together.

Duplicates and a small file of personal correspondence ("L"), relating to minor medical problems, have been removed, along with routine correspondence and files re: such personal interests as travels, cars, charities, sports, books, fraternities, theatre, and numerous clubs and organizations in which Grant participated. Also removed were extensive files (4.5 linear feet) relating to Grant's banking and investment interests; maintenance, repair, and rental of his properties in Philadelphia (2026 Spruce Street, 9012 Crefeld Street, 2031 Locust Street) and on Mount Desert Island, Me., as well as his various boats; and insurance and leases.

Off prints of eighteen of Grant's articles and five book chapters (1935-1940) have been removed and placed with the uncataloged reprints of Fellows of the College of Physicians of Philadelphia. An additional cataloged collection of nineteen reprints, 1922-1929, is housed in the Library of the College, and several other bibliographic references may be found in the card catalog.