A Diligent Effort

52 Dartmouth Medicine—online at dartmed.dartmouth.edu online at dartmed.dartmouth.edu—Dartmouth Medicine 53Winter 2007Winter 2007

Witters is the Eugene W. Leonard 1921 Professor of Medicineand of Biochemistry at Dartmouth Medical School, as well as aprofessor of biological sciences at Dartmouth College. For moreabout his academic interests, see dartmed.dartmouth.edu/summer06/html/faculty_focus.php. Witters is indebted to Barbara Krieger ofthe Rauner Special Collections Library at Dartmouth for assis-tance with historical research for this article and to Constance Put-nam and Drs. David Roberts and Robert Nye for helpful discus-sions. Some spelling and punctuation in the quotations here havebeen modernized and corrected for ease of comprehension.

One of the giants of

20th-century medicine—

neurosurgeon Harvey

Cushing—was bound and

determined to pay homage

to a seminal American

physician who lived a century

before him—Dartmouth

Medical School founder

Nathan Smith. It’s a saga filled

with historical coincidence.

n April 26, 1638—18 years after theMayflower’s departure for the NewWorld—the 350-ton Diligent of Ipswich set sail

fromGravesend, England. Captained by JohnMar-tin, the ship carried 133 passengers. The Diligentmade landfall on August 10 in Boston, then pro-ceeded immediately to Hingham, Mass., a SouthShore town founded just five years earlier. Amongthe passengers who disembarked and settled therewere Matthew Cushing and Henry Smith.What kind of relationship they had with each

other, if any, is not part of recorded history. But thelives of a direct descendant of each—Dr. HarveyWilliams Cushing, the father of neurosurgery and apioneer in endocrinology, and Dr. Nathan Smith,the founder of Dartmouth Medical School—weredestined to connect 300 years later. Both NathanSmith and Harvey Cushing were giants of Ameri-can medicine in their own time, Smith in the ear-ly 19th century and Cushing in the early 20th cen-tury. Proof of the confluence of their careers lies indocuments in the Dartmouth archives and in abronze plaque that now adorns a hallway in theRemsen Building at Dartmouth Medical School.At the unveiling of that plaque on June 17,

1929, Harvey Cushing explained that by the 1700s,the Smith and Cushing families had both movedfromHingham to Rehoboth, Mass. Then they part-

Nathan Smith dedicated this DMS building in 1811 by giving the first lecture within its walls. Harvey Cushing gave a talk in the same building in 1929, atthe dedication of a plaque celebrating Smith, whom Cushing admired greatly. The photograph dates from about 1960, and the building was razed in 1963.

DARTMOUTHARCHIVES

By Lee A. Witters, M.D.

Improve, Perfect,& Perpetuate

F O R E W O R D B Y C . E V E R E T T K O O P, M . D .

I N T R O D U C T I O N B Y P H I L I P C A S H

Oliver S. Hayward, M.D.

Constance E. Putnam

Dr. Nathan Smith

and Early American

Medical Education

O

The covers of the definitivebiographies of Cushing and Smith—published in 2005 and 1998,respectively—are eerily similar.

online at dartmed.dartmouth.edu—Dartmouth Medicine 55Winter 2007

physicians of the time. (In 1922-23, Cushing wrotethe definitive biography of Osler, The Life of SirWilliam Osler, which won the Pulitzer Prize for bi-ography in 1926.)At Hopkins, Cushing “opened the book of

surgery in a new place,” according to Osler. Thatnew place was the brain. Cushing’s interest in brainsurgery stemmed from a procedure he developed in1897 to treat trigeminal neuralgia—a nerve disor-der that causes intense pain in the face. His subse-quent concentration on brain surgery firmly estab-lished him as the “father of neurosurgery”—togeth-er with, arguably, Dr. Ernest Sachs of WashingtonUniversity, who was the father of Dr. Ernest Sachs,Jr., the longtime chief of neurosurgery at MaryHitchcock Memorial Hospital.By 1902, Cushing had developed an interest in

the pituitary gland. An organ the size of a pea at thebase of the brain, it secretes hormones that controlnumerous bodily functions. Cushing called it the“stowaway gland.” He performed his first transsphe-noidal removal of a pituitary tumor—through thesphenoid sinus, behind the nose—in 1909. Thatpatient had acromegaly, an overproduction ofgrowth hormone by the pituitary. In 1910, he im-proved on the technique by using a sublabial ap-proach—entering through the upper lip instead.

n 1912, Cushing published a book titled ThePituitary Body and Its Disorders: Clinical StatesProduced By Disorders Of The Hypophysis Cere-

bri, which remains a triumph of American medicalliterature. It gives case histories of 48 patients withpituitary tumors. Among them was Minnie G., a23-year-old female with a “syndrome of painful obe-sity, hypertrichosis [excessive body hair], and amen-orrhea [absence of menstruation], with overdevel-opment of secondary sexual characteristics accom-panying a low grade of hydrocephalus [enlargementof the brain due to an abnormal accumulation ofcerebrospinal fluid] and increased cerebral tension.”Describing her condition as a “polyglandular syn-drome,” Cushing speculated that it might be “at-tributable to disordered pituitary, adrenal, pineal,or ovarian influences.”It was only much later—in 1932—that Cush-

ing concluded, by analogy to other cases, that Min-nie G.’s condition had been due to a basophilic pi-tuitary tumor which caused an overproduction ofcortisol by the adrenal gland. That was the first de-scription of a condition that is now commonlycalled “Cushing’s disease.” Yet ironically, HarveyCushing never operated on the pituitary gland of apatient with the disease that bears his name. (Seepages 58 and 59 for more about Cushing’s disease.)

54 Dartmouth Medicine—online at dartmed.dartmouth.edu Winter 2007

The ties between the families didn’t stop there.David Cushing’s son Erastus earned his M.D. in1824 from the Berkshire Medical Institute, whosepresident at the time was one Dr. Josiah Goodhue.It was Goodhue—thanks to a chance 1784 en-counter with Nathan Smith, then 22 years old—who had fostered Smith’s interest in medicine.Erastus Cushing and his family moved in 1835

to Cleveland, Ohio. And there, on April 8, 1869,HarveyWilliams Cushing was born to Erastus’s son,Henry Kirke Cushing, and his wife, Betsey—thelast of their 10 children.Harvey Cushing’s remarkable life was detailed

by medical historianMichael Bliss in a superb 2005biography titled Harvey Cushing, A Life in Surgery.Cushing entered Yale in 1887 and took the requiredcourses in rhetoric, classics, and mathematics, aswell as a few electives—including a course in phys-iological psychology that introduced him to themysteries of the mammalian brain. But he concen-trated on more than just his studies during college.Bliss notes that “when Harvey later reminiscedabout not having worked hard at Yale, it was be-cause he chiefly remembered his extracurricular ac-tivities.” He was a member of the Yale baseballteam, and among his teammates was Amos AlonzoStagg, later a famous football coach and one of thefew individuals elected to the College Football Hallof Fame as both a player and a coach. Cushing, too,was an excellent athlete; one newspaper headlineread “Cushing’s Great Sprinting for a Long FlyStarts 10,000 Persons Cheering.”In fact, it was baseball—a Yale-Dartmouth game

—that likely brought Cushing to Hanover, N.H.,for the first time. However, as Cushing recountedthat visit in a 1928 letter to the 11th President ofDartmouth College, Ernest Martin Hopkins, heconfessed to having “very hazy recollections ofHanover and its buildings, for it is many years sinceI have had the pleasure of being there—not sopleasant either, for if I recall the event correctly,the baseball team of which I was an inconspicuousmember got sadly walloped by the sons of Dart-mouth. But that was long ago, when I had less rea-son for an interest in Nathan Smith.”

ut the story is getting ahead of itself. Aftergraduating from Yale in 1891, Cushingearned his M.D. at Harvard in 1895. He

spent a year as a surgical intern at MassachusettsGeneral Hospital and in 1896 was named a residentunder Dr. William Halsted, the chief of surgery atJohns Hopkins, and was subsequently put in chargeof the surgical wards there. Cushing’s time at Hop-kins led to close relationships with both Halstedand Dr. William Osler—two of the most famous

ed ways for a while. The Cushings, in the person ofDavid Cushing, the first physician in that family,moved to Cheshire, in western Massachusetts, andthe Smiths headed for Chester, Vt., in 1772, whenNathan was 10 years old.

ust 37 years later, the paths of Smith and Cush-ing descendants crossed once again. In 1809, ayoung medical student named Ezekiel DodgeCushing appeared in Nathan Smith’s anatomy

classroom at Dartmouth Medical School, then allof 12 years old. Ezekiel, though not in Harvey Cush-ing’s direct lineage, sprang from the same HinghamCushings. Through copious correspondence withhis family, Ezekiel was an avid chronicler of DMS’searly years. One of his letters, for example, includesone of the most vivid surviving descriptions of an1809 “anatomy riot”—an event sparked by publicopposition to the practice of human dissection.(That and subsequent similar events may have beena factor in Nathan Smith’s 1813 departure fromDartmouth for Yale, where he was instrumental infounding its medical school.)Ezekiel Cushing also wrote effusively about his

Dartmouth teacher. After leaving Hanover to con-tinue his studies at the University of Pennsylvania,Ezekiel compared Nathan Smith’s pedagogical skillsto those he found in Philadelphia, noting that “Dr.Smith gives infinitely better lectures on surgerythan Dr. [Philip Syng] Physick and certainly moreuseful ones on the theory and practice of physicthan Dr. [Benjamin] Rush.” That’s high praise in-deed, for Rush, notable as a signer of the Declara-tion of Independence, was a prominent professor ofmedical theory and clinical practice, while Physickis considered the “father of American surgery.”

Ezekiel Cushing wroteeffusively about hisDartmouth teacher.After leaving Hanover,he compared NathanSmith’s pedagogicalskills to those hefound in Philadelphia,noting that “Dr. Smithgives infinitely betterlectures on surgery”and “more useful oneson the theory andpractice of physic.”

The plaque honoring Smith ispictured on the facing page in itsfirst home—“this room” referredto above. Today the plaque hangsin the third-floor hallway of theMedical School’s Remsen Building.

This circa 1960 photograph showsthe main lecture hall in the buildingpictured on page 53. The plaqueCushing lobbied for so diligentlyis on the wall to the far right.

For a with links to PDFs ofsome of the historical documents men-tioned here, plus a complete list of thesources used, see dartmed.dartmouth.edu/winter07/html/diligent_we.php.

WEB EXTRA

DARTMOUTHARCHIVES

JOSEPH

MEH

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online at dartmed.dartmouth.edu—Dartmouth Medicine 57Winter 2007

Dartmouth and told an amusing story about an ear-ly Dartmouth president, John Wheelock, who at-tended one of Smith’s lectures. Wheelock was “soimpressed [by the lecture] that at the ensuingevening prayers in the old chapel he gave thanks asfollows: ‘O Lord, we thank Thee for the OxygenGas; we thank Thee for the Hydrogen Gas; and forall gases. We thank Thee for the Cerebrum; wethank Thee for the Cerebellum; and for theMedul-la Oblongata.’”Yet Cushing was also critical of the process of

medical education. He explained that Smith’schance meeting with Josiah Goodhue was instru-mental to the former’s career in medicine. “And,”Cushing continued, “I am not at all sure that wenowadays go about our selection of candidates forthe profession in the right way, by insisting on anunduly long preparation in the premedical sciencesbefore those aspiring to be doctors are ever broughtin contact with patients. It is possibly a good wayof selecting those who are likely to become medicalscientists, but in the process many who have thenatural gifts for medical practice are apt to becomesidetracked.” Cushing would surely be dismayed bythe fact that similar thoughts are heard from pre-sent-day premeds, as they struggle through coursesin calculus, organic chemistry, and physics.

pon his return to Boston, Cushing wroteHopkins to thank him for the chance tospeak in Hanover. He took the opportu-

nity to express his thoughts about DartmouthMed-ical School, which had 14 years previously stoppedgranting the M.D. That action had been taken inthe wake of the 1910 Flexner Report, whichcharged medical schools with providing more for-mal clinical education. Because of its remote loca-tion, DMS could not provide students with suffi-cient clinical experience, so in 1914 it had becomea two-year, basic science medical school.“I think you have a perfectly unique opportuni-

ty to do a great service to the State of New Hamp-shire,” wrote Cushing, “if you could build up aschool which would supply the country, let us saybetween Concord and Montreal, with its familypractitioners and country doctors. . . . You alreadyhave a most excellent nucleus, and when I saw thatclinical teaching was going on hand in hand withscience teaching, I was simply delighted. I wouldmuch rather be in a school of that sort than to holdmy post at Harvard. So would Nathan Smith if youcould call him back.”In the same letter, Cushing returned his hono-

rarium and suggested that a tablet honoring Smithbe placed “to come under the eye of the undergrad-

56 Dartmouth Medicine—online at dartmed.dartmouth.edu Winter 2007

nior class in what might be called the realm of vo-cations.” The course included public lectures by in-dividuals of, as Vernon put it, “high eminence inAmerica in their various callings [who] most gra-ciously [came] to Dartmouth to make worthy disci-ples and to repel unworthy ones.”

ushing was, not surprisingly, the exemplarof medicine. A few weeks before his trip toHanover, he inquired in a letter to Ver-

non: “Can you tell me . . . for what purpose RoomNo. 6, the northeast corner of the first story of Dart-mouth Hall, where Nathan Smith first started med-ical teaching at Dartmouth, is at present utilizedand whether there is any marker on the room orbuilding to indicate the historical association? Ifnot, I would like to have my honorarium for thelecture utilized for the purpose.”It was President Hopkins who responded to the

question. He wrote back to inform Cushing thatthe old Dartmouth Hall had burned down in 1904,so there would be “no essential truth to any mark-er.” But Hopkins did express interest in the idea ofa “tablet” commemorating Smith and proposedplacing it in the building that had housed theMed-ical School since 1811; Smith himself had overseenconstruction of the building, which was the firststructure in the U.S. built for the purpose of med-ical education.On November 20, 1928, Cushing spoke in 103

Dartmouth Hall on “The Ideals, Opportunities, andDifficulties in a Medical Career.” An edited ver-sion of his remarks was published in 1929 in amonograph titled The Medical Career, which waswidely distributed to Dartmouth premedical andmedical students and to DMS alumni.Cushing began his talk by expressing the hope

“that what I may have to say will produce fromamong you some good physicians and repel someincapable ones. There is, in reality, little to be said,other than that medicine has become so many-sided that anyone with a good head, a good heart,or skillful hands who is possessed of a spirit of ser-vice, who is not afraid of hard work, and who willbe satisfied with a modest income, will find ampleopportunity for happiness and for the exercise ofhis talents.” He went on to highlight the many ca-reers possible within medicine—physician or sur-geon, investigator or health official—in remarksthat are as relevant to students of today as they wereto those of 1928.Although Cushing said he “did not set out to

make this address center about Nathan Smith,”much of the speech is indeed about the “indelibleimprint of his personality on this, your belovedDartmouth.” He lauded Smith’s contributions to

The same year that he described the case ofMinnie G.—1912—Cushing moved from Balti-more to Boston, joining the staff of Peter BentBrigham Hospital and becoming the Moseley Pro-fessor of Surgery at Harvard. He remained there un-til 1933, when he retired and moved to Yale. Hewas named the Sterling Professor of Neurosurgeryat Yale but never performed surgery, taught a course,or did any research in New Haven.

evertheless, Cushing’s move there was sig-nificant in view of his interest in NathanSmith, given Smith’s role in the founding

of the medical school at Yale. Early evidence ofCushing’s admiration for Smith can be found in a1924 address to the Congress on Medical Educa-tion, titled “The Clinical Teacher and the MedicalCurriculum.” In it, Cushing railed against the stan-dard medical curriculum and championed the ap-prenticeship model that was central to Smith’s vi-sion of medical education. “There is much that apresent-day medical student might envy in the op-portunities offered to a young man of a century ago,apprenticed to such a person, let us say, as NathanSmith,” Cushing stated. “In our present-day schools. . . the Nathan Smiths, if there are any, scarcelyknow even the names of their many pupils, whomperforce they meet in a classroom so crowded thatthe elbow-to-elbow method of teaching and learn-ing is no longer possible.”Four years after that talk, Cushing was invited to

visit Dartmouth—the place that had given Smithhis start in medical education. During the 1928-29academic year, Dartmouth’s Department of Biogra-phy (yes, there truly was such a department) offereda course called Representative American Careers.Its aim, according to Ambrose White Vernon, thedepartment’s chair, was “to orient students of the se-

At his 1928 lecture oncareers in medicine,although Cushing saidthat he “did not set outto make this addresscenter about NathanSmith,” much of thespeech is indeed aboutthe “indelible imprintof his personality onthis, your belovedDartmouth.”

Above is a letter from Cushing toPresident Hopkins, acceptingDartmouth’s offer of an honorarydegree. Cushing had spoken atDartmouth in November 1928.

Pictured here at Dartmouth’s 1929Commencement are President Hop-kins on the far right and, from thefar left, three of that year’s hon-orary-degree recipients—HarveyCushing; Harry Thayer, a Dartmouthalumnus and the retired presidentof AT&T; and Franklin DelanoRoosevelt, then the governor ofNew York (this photo is one of onlya few pictures taken after FDR’s1921 bout with polio to showhim standing without assistance).

BOTH:DARTMOUTHARCHIVES

BOTH:DARTMOUTHARCHIVES

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U

online at dartmed.dartmouth.edu—Dartmouth Medicine 59Winter 200758 Dartmouth Medicine—online at dartmed.dartmouth.edu Winter 2007

uate student [rather] than merely under the eye ofthose going into medicine, for after all he is one ofyour great figures and should be made much of.”Cushing even suggested the tablet’s wording: “InRoomNo. 6 in the Northeast corner of the first sto-ry of the old Dartmouth Hall, Nathan Smith as Pro-fessor of Anatomy, Surgery, Chemistry, and theTheory and Practice of Physic began the teachingof Medicine here November 20, 1797, therebyfounding the fourth medical school to be estab-lished in this country.” (Cushing erred regardingthe date, however. The first DMS classes, in 1797,were taught in a private home in Hanover. It wasnot until 1799 that the Board of Trustees allowedSmith to use Room 6 in Dartmouth Hall.)

opkins responded with an endorsementof Cushing’s ideas as to both the medicalschool’s future and the placing of a tablet.

“I thank you for the expression of your opinion youhave given in regard to the Medical School,” Hop-kins wrote. “It is completely in accordance with myown convictions, and it likewise conforms to myown aspirations for the School. . . . There is no rea-son in the world why we should not put up a tabletin the northern corridor of Dartmouth Hall withthe word of tribute thereupon in appreciation ofNathan Smith which you have suggested.”A tablet honoring Smith was indeed put up only

seven months later, though not in the locationCushing suggested. But over 40 years would passbefore Dartmouth again offered the M.D. degree.Hopkins expressed his support for revitalizing DMS,including in a letter to the American Medical As-sociation’s Council on Medical Education, but theDartmouth Trustees questioned the use of generalfunds to support an institution “never contemplat-ed in the original charter of the College.” Hopkins’sexecutive assistant, Robert Strong, wrote a letterto Cushing in January 1929 that attests to Hop-kins’s frustration with the limitations of a two-yearschool. Strong wrote that Dr. John Bowler, thenDMS’s dean, planned to give a copy of Cushing’sMedical Career to every DMS graduate, “as we havenot been able to do very much for these men in theway of tying them up with the College, [so] wethought of this as an excellent way of bringinghome to them, and particularly to the men whoonly had a premedical course at Dartmouth, some-thing of the worthwhileness of the school, its finetradition, and the hopes for its future.”On April 3, 1929, Hopkins himself wrote to

Cushing to inform him that the Trustees of Dart-mouth College wished to award him an honoraryDoctor of Letters at Commencement that June.

Cushing wanted theplaque “to comeunder the eye of theundergraduate student[rather] than merelyunder the eye of thosegoing into medicine,for after all [NathanSmith] is one of yourgreat figures and shouldbe made much of.”

Above is a patient with a pituitarytumor (though a different kind thandescribed in the adjacent box) whowas treated by Cushing himself in1919. His notes describe her as a“21-year-old woman [with] coarsehands, large head, and a large,protuberant lower jaw.” He usedthe transsphenoidal approach hepioneered to remove her tumor.

encountered Harvey Cushing as neither adoctor nor a medical educator but as theeponym of a disease. My battle with the

condition that bears his name probably beganfive to eight years before I knew I had it—or atleast that’s how long my doctors hypothesizethat the 1.1-centimeter tumor in my pituitarygland had been growing.In 2004, my primary-care doctor in Massa-

chusetts noticed that I had suspiciously highblood pressure, which did not drop even after Ichanged my diet and began taking antihyper-tensive medication. I had a magnetic resonanceangiogram and blood tests, but the results wereinconclusive. So I began to dig on my own—injournals and online—into what might be caus-ing my symptoms. I finally concluded that Cush-ing’s disease was a plausible explanation. I hadheard of it in animals, because I had recently in-terned in a veterinary research lab, where I wasworking on the optimization of a cortisol test fordiagnostic purposes. I could not believe how ac-curately all of the disease’s common symptomsmirrored changes I’d been noticing in my bodyand my general well-being.

I had previously attributed these changes tomy lifestyle or to genetics, never suspecting thatthey could be indicative of a serious medicalcondition. I’d noticed that I was gaining weightin my face and belly, for example, but blamed iton poor eating and partying my senior year incollege. I might not have appeared particularlyoverweight, but for someone who is 5'5" andnormally weighs 110 pounds to gain an oddlydistributed 25 pounds within a matter of monthswas troublesome. More troublesome still was thefact that I didn’t lose any weight even after I be-gan a summer job that had me eating well andworking out daily. The excess dark hair on myarms and face I thought must be due to my Ital-ian heritage. The anxiety, irritability, and spon-taneous emotional rollercoaster rides must, Itold myself, be because I’m an overachiever whoconstantly worries about making the grade.But even I was unable to come up with an

explanation for my loss of scalp hair, sud-denly diminished capacity for physical ac-tivity, easy bruising, and frequent colds andstrep throats.In September of 2004, when I began

graduate studies in molecular and cellularbiology at DMS, I set out to find an endocri-nologist. Dr. LeeWitters, a professor of med-icine and of biochemistry (and the authorof the adjacent feature about Harvey Cush-ing), put me in touch with Dr. John Turco,an endocrinologist and the director of theDartmouth College Health Service. Wast-ing no time, Dr. Turco confirmed that I hada pituitary tumor, and I was officially diag-nosed as having Cushing’s disease.That November, I had two transsphe-

noidal surgeries—a technique pioneered byCushing. Dr. Benoit Gosselin, a Dartmouthotolaryngologist, skillfully navigated mynasal passages, and Dr. Nathan Simmons, aneurosurgeon, removed my tumor. Or so wethought. But my cortisol levels did not nor-malize, so I had the same operation a weeklater in hopes of removing any residual hy-persecretory cells. (Coincidentally, I’d wit-nessed this procedure at a medical forumfive years before, though to remove anoth-er type of pituitary tumor—one that causesacromegaly, also known as gigantism.)My recovery from the operations went

well, but my cortisol levels still did not nor-malize. The doctors put me on ketoconazole,a drug that is used as an antifungal as well asto control cortisol levels. This was not along-term solution but would suffice to man-age some of my symptoms until we could in-vestigate other options.

n April of 2005, I was referred for gam-ma-knife therapy, also known as stereo-tactic radiosurgery, at the University of

Virginia. This procedure focuses multiplebeams of radiation on a tumor, delivering anintense dose of radiation safely to a precisearea. It’s a one-day outpatient procedure, butresults are usually not seen until a year to ayear and a half later. Patience was the keynow. In the meantime, despite being onmedication, I continued to experience manysymptoms. My leg muscles had atrophiednoticeably, and a bone scan revealed osteo-porosis in my hip and spine—another long-term effect of the disease. To treat my thin-

ning bones, I was started on daily shots ofrecombinant human parathyroid hormone.

ertainly this was not the smoothtransition to graduate school that Ihad hoped for, but my natural in-

terest in science and medicine helped mecope with and understand my disease. I duginto the literature about treatments andstudies conducted at the molecular level. Inour second year of doctoral study, we are re-quired to pass a qualifying exam that in-cludes writing a grant-like proposal on a sub-ject of our choice. Happily, I was able to in-corporate an investigation of pituitary tu-mors into my proposal, making the projectvaluable personally as well as academically.Each day was a frustrating struggle yet awonderful learning experience.A year and a half after the gamma knife

treatment, my cortisol still hadn’t droppedto the level we hoped for. Since it is theadrenal glands that are stimulated by the pi-tuitary tumor to produce excess cortisol,their removal was the treatment of last re-sort. In July of 2006, Dr. William Laycock,a laparoscopic surgeon at Dartmouth, per-formed a successful bilateral adrenalectomy.For the rest of my life, I’ll have to take med-ication to replace two key hormones pro-duced by the adrenal glands—aldosterone,which regulates the body’s balance of saltand water, and cortisol, which fends off in-fections and aids in coping with stress.I must remain ever vigilant of my health

and adjust my medication when the needarises. Failure to do so could result in anadrenal crisis, which, because of my low cor-tisol levels, could send me into a coma,seizure, or shock or could even result indeath. I wear a medical alert bracelet andhave a medical alert sticker on my car, andI also carry emergency cortisol shots in caseI should have an adrenal crisis or be unableto take my medication orally.It has been over a year since my adrena-

lectomy, and it is amazing, finally, to feel al-most normal again. I can climb stairs with-out stopping, my clothes fit again, I am ableto focus and concentrate, I can brush myhair without it falling out all over theplace, and I can bump my leg and not de-velop a giant bruise. My bone density hasshown marked improvement as well.

It breaks my heart when I hear of peoplewith Cushing’s disease who get depressed,even suicidal, due to the physical changesand hormonal imbalances caused by thedisease. I attribute much of my recovery,though it is still ongoing, to my amazingteam of doctors at DHMC, with whom Ihave wonderful interactions; to my effortsto be proactive in understanding the diseaseand its treatment; and to the strong supportI’ve gotten from family and friends, both athome and at Dartmouth.I cannot fathom what it must have been

like to cope with such a puzzling disease inthe years before Harvey Cushing elucidatedits origin and advanced its treatment.

Giving a human faceto Cushing’s diseaseBy Kristine Pattin

Pattin is in her fourth year of graduate studies in molecular andcellular biology at Dartmouth Medical School.

�

That’s Pattin above,before her surgery (notethe roundness of herface), and below, today.Her tumor is depicted inthe preop MRI at left.

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come to earth today; could he be reincarnat-ed here and stand at his own desk strongly, asI stand here feebly and haltingly addressingyou, what would he say to us? . . . ‘What is thenumber of your graduates today and wheredo they go?’ And you would say, ‘We haveno graduates.’ And I think Nathan Smithwould be very much hurt and surprised, andI think he would go where I am sure he wouldfind very receptive ears; he would go to thepresident of the College and say, ‘Mr. Hop-kins, can’t you in mymemory, or can’t you forthe worthwhiledness of the act, revivify yourmedical school and have a full four years’course in your school, if for no other purposethan to do what President Wheelock agreedought to be done—to supply New Hamp-shire with its doctors?’”

After Cushing’s address, Mildred Crosby,granddaughter of Dr. Dixi Crosby (a mem-ber of the DMS faculty from 1838 to 1870and the founder of Hanover’s first hospital),unveiled the tablet.

The following day, Cushing was present-ed with his honorary Doctor of Letters at the159th Dartmouth Commencement. He waslauded by Hopkins as a “great physician andexpert technician, keen in diagnosis of hu-man ills and of proved wisdom in friendlycounsel for those seeking physical or socialhealth; richly endowed with the God-givenattributes of a sympathetic heart and an un-derstanding mind.” Among the other hon-orary-degree recipients that year were HarryBates Thayer, an 1879 graduate of Dart-mouth College and the retired president ofAT&T, and Franklin Delano Roosevelt, thenthe governor of New York State.

hen the 1811 Medical Schoolbuilding was razed in 1963, dueto structural unsoundness, the

tablet was moved to a hallway on the thirdfloor of DMS’s then brand-new RemsenBuilding. Ironically, had it been installed inthe location suggested by Cushing, it mighthave been destroyed in a 1935 fire that de-molished the “new” Dartmouth Hall.

Harvey Cushing’s final brush with Na-than Smith’s legacy came upon his move toYale in 1933, just after he attended the pres-idential inauguration of his newfound friend,Franklin Roosevelt. But who knows—theweb of connections between the descendantsof Henry Smith and Matthew Cushing mayyet play out in still another chapter.

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A Diligent Effort

continued from pages 58-59Cushing received the letter on his 60thbirthday, April 8, and—in the only hand-written letter to Hopkins in all his corre-spondence for 1928-29—thanks him for thebirthday present. “I am told that 60 has its fe-licities,” Cushing wrote to Hopkins. “To betaken into the fellowship of Dartmouth, nowthat Anno Domini has to this extent over-taken me, I regard as an evidence of the truthof this saying.”

On Monday, June 17—the day beforeCommencement—students, faculty, andMedical School alumni gathered in the lec-ture hall of the 1811 DMS building to dedi-cate a tablet honoring Smith. Both the tim-ing and the location were fitting, for 1929marked the 100th anniversary of Smith’sdeath, and Smith had delivered the very firstlecture ever given in the building, probablyin that very room. The bronze tablet, featur-ing a bas-relief portrait of Smith, had beendesigned by Dr. Colin Campbell Stewart, aprofessor of physiology at DMS who was leg-endary among students for his artistic skill atthe blackboard.

ushing gave the main address at thededication. Though neither of hissuggestions—as to wording or loca-

tion—had been followed, and it is unclearwhether his 1928 honorarium went towardthe tablet’s cost, Cushing’s comments aboutSmith were gracious and reverent: “For aschool, for a nation indeed, for a state, for achurch, to have some individual that theycan in a way use before the world as a sym-bol of what they would like to have otherpeople think them to be is the greatest goodfortune. . . . And so I think, when a schoollike your own has some person who has beena person of outstanding distinction—tomakeuse of that person for similar purposes as ameans of tying together the sympathies andthe interests historically and otherwise of agroup of people, which graduates represent,is something that always should be soughtfor. And here we have the gift of this extra-ordinary man, who stands out as among thegreatest of the doctors who have taught andpracticed and worked in our country.”

Cushing continued in his remarks to lob-by forcefully for the revitalization of theMedical School. “Were Nathan Smith to

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LorenShortly after his wifeRenetta’s death, Loren begansearching for the perfect wayto honor her memory. It wasat this time that, in what hecalls “a wonderful case ofserendipity,” he received acharitable gift annuitybrochure in the mail fromDHMC’s Office of GiftPlanning. “It seemed like aperfect opportunity tomemorialize her,” notes theDartmouth College alumnus.

By establishing a charitablegift annuity, Loren created aloving memorial to Renetta

that will ultimately benefit research at DHMC. He will also receive agenerous income tax deduction and a fixed, guaranteed income for life.“Because of my advanced age,” the octogenarian observes, “this is myopportunity for giving with vision.”

CHARITABLE GIFT ANNUITY FEATURES

• guaranteed fixed income for life• partially tax-free income• charitable tax deduction• cash or appreciated assets may be gifted• income for one or two lives

Contact us today to learn more about Charitable Gift Annuities and other types of planned gifts.

Toll Free 1-866-272-1955Office of Gift Planning

E-Mail: Gift.Planning@Hitchcock.org Web site: www.dhmc.org/dept/dev/cga

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SAMPLE RATES

Age Rate

65 5.9%70 6.5%75 7.1%80 8.0%85 9.5%89+ 11.0%

DartmouthMedical School

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